Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Doing To Your Brain!

there's a very famous experiment in which rats were engineered to have no dopamine and the scientists discovered that if they put food in the rat's mouth the rat would eat but if you put the food even a body length away the rat will starve to death which tells us that dopamine is fundamental to get the things that we need for our basic survival now every time we're doing something that's pleasurable from sugar to video games work pornography social media that will affect dopamine and the more dopamine that's released the more likely that drug or behavior

is to be addictive but also the genetic risk of addiction is about 50 to 60% so if you have a biological parent or grandparent with addiction you are more likely to develop that addiction we have to keep it in balance in order to stay healthy Dr Anna lmy is Professor of Psychiatry at Stanford chief of the Stanford addiction clinic and a world leading expert on the subject of doping she will tell you how this one powerful chemical is controlling your life and what to do about it one of the most important findings in Neuroscience in

the past 75 years is that the same parts of the brain that process pleasure also process pain and the balance wants to remain level the problem is that we automatically seek out pleasure and avoid pain and we're exposed to all kinds of Pleasures that we have in the modern world and our brains are reeling in response to try to compensate now I need more of my drug and more potent forms to get the same effect which then leads to addiction and that's what happened to me when I got addicted to romance novels take me into

that phase of your life I was out of control and I needed to restore a level balance and take the advice I give my patients and what is that advice the Diary of a CEO is independently fact checked for any studies or science mentioned in this episode please check the show notes this has always blown my mind a little bit 53% of you that listen to the show regularly haven't yet subscribed to the show so could I ask you for a favor before we start if you like the show and you like what we do

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say this to you so I'm just going to say it how it comes out my mouth and I apologize if this is messy but if there was ever an episode this year that you should listen to it is this one I've since this episode was recorded about a month ago all I've been thinking about is how on Earth I get you to watch this and I don't say this often the last time I said this was the first time Mo gordak came on this podcast this is the second time I've said this in almost four

years of recording this podcast on YouTube and the reason for that is so many of the things that I know you're struggling with in your life that stand in the way of the person you want to become that relationship you have with your phone the procrastination the cycles of behavior that make you feel embarrassed and full of shame that you've just never been able to crack all of them all of them I genuinely believe for many of you are going to be understood today if you listen to this episode it has changed my life and

it has changed much of the lives of my team if if I'm wrong here you have the right to message me and tell me that I was wrong please listen to this episode really really I mean that from the bottom of my heart and just to make sure you do throughout this episode there's going to be these popups if you collect eight of these codes that are going to pop up on the screen and put them in the document link below you'll unlock something very special some additional content please listen to this episode Dr Anna

lmy you wrote one of the most iconic well-known books about dopamine which propelled the subject matter of dopamine into the public Consciousness but I guess the most important question I should ask you is why does dopamine matter ah good question good good place to start I mean dopamine matters because it fundamental to our survival right so it's the chemical that we make in our brain that tells us this is something we should approach explore investigate so it's it's really almost the survival chemical so what is dopamine if you had to explain it to a 10-year-old

how would you go about explaining it so dopamine is a chemical that we make in our brain um it has many different functions but one of its most important functions is that it helps us experience pleasure reward and motivation um it may be even more important for the motivation to do things than it is for the pleasure itself so for example there's a very famous experiment in which rats were engineered to have no dopamine in the brain's reward pathway and the scientists discovered that if they put food in the rat's mouth the rat would eat

the food would seem to get some pleasure from the food if you can deter that from watching a rat eat which I think they felt like they could uh but if you put the food even a body length away the rat will starve to death the idea being that without dopamine we're not motivated to seek out the things that we need for our basic survival that's crazy so you get a rat you put the food an inch from its mouth and it will starve to death because it doesn't have dopamine the dopamine required to just

reach out and eat yeah essentially maybe it's not an inch maybe it's a little more than an inch but the idea being that dopamine is necessary to be motivated to do the work to get the thing that we need and having an understanding of dopamine how might that improve my life having a basic understanding of how dopamine Works how we process Pleasure and Pain and also what happens with dopamine as we go from adaptive recreational use to Mal adaptive addictive use is something that is really useful especially for those of us living in the modern

world where now we're exposed to so many reinforcing substances and behaviors that we've all become vulnerable to the problem of addiction and what are the biggest misconceptions of on the subject of dopamine because it's kind of thrown around in society I see it in my group chats people saying I need more dopamine or whatever or you know that person just craves dopamine what what are the biggest misconceptions you've come across the main miscon conception is that somehow we can get addicted to dopamine we're not getting addicted to dopamine itself dopamine is neither good nor bad

it's a signal to tell us whether or not something that we're doing is potentially useful for our survival and also it's related to what we predicted about how rewarding or pleasurable something would be and so it's really um you know I sort of sometimes I joke it's like the um reward theory of relativity DOP mean is in the sense that Pleasure and Pain really are truly relative to one another and so dopamine gives us information about where we are in that relativity scale between Pleasure and Pain and when you say relative you mean I mean

it's it's quite fitting for anyone that can't see we have a a set of scales on the table and scales are relative to each other because if you pour in one end the other end goes up and if you pour in the other end the other end goes up and this end goes down and when you say relative that's what you're describing right yes that's what that's what I'm describing yes okay and what activities that I do every day have an impact on my dopamine well probably almost everything you know in some ways um I

mean every time we are doing something that's pleasurable reinforcing rewarding that will affect dope mean it's it's really the primary signal that lets us know that this thing is potentially important for our survival as I mentioned um but you know even um aversive stimuli can trigger dopamine what's oh something that's painful or not pleasurable dopamine gets involved in in that um equation anything that's novel or new is something that triggers our dopamine in in our reward pathway dopamine is fundamental for movement so not just pleasure and reward but also movement so for example Parkinson's disease

which is a disease related to stiffness and Tremor is caused by a depletion of dopamine in a part of the brain called the substantia and as dopamine gets depleted in that part of the brain people lose the ability to move their bodies and it's probably no coincidence that the same neurotransmitter that is so important for pleasure reward motivation is also really important for movement because most organisms have to to locomote toward the object of their desire we want that thing we have to exert effort right we have to put in the work to go get

it but in the world today we really don't have to do that right we can swipe right we can swipe left and all of a sudden it magically appears at the touch of a finger and that's very confusing for our brains because that's not how we evolved we really evolved for for having to do quite a bit of upfront work for a tiny little bit of reward I just want to before we move on talk about this point you said because I think it's quite foundational to everything we're going to talk about about dopamine being

relative to pain and I have this set of scales in front of me and here I have some chemicals that are likely to produce dopamine in my brain I believe right so alcohol I have some rum I have some whiskey I have some vodka and can you explain to me using this rum whiskey and vodka how dopamine is relative to pain and what going on in my brain sure okay I'll slide this over to you oh okay so one of the most exciting findings in Neuroscience in the past 75 years is that Pleasure and Pain

are collocated in the brain so the same parts of the brain that process pleasure also process pain and in a very simple reductionist kind of way they work like opposite sides of a balance so imagine that deep in your brain's reward pathway which is is another exciting Discovery right that there's this dedicated reward pathway of the brain that consists broadly speaking of the prefrontal CeX which is this large gray matter area right behind our foreheads that's so important for future planning for delayed gratification for appreciating future consequences you might think of it as like the

brakes on the car if we're going to analogize to to a to an engine and then deep you know in the brain we've got what we call the limic areas or the emotion brain and there you have the nucleus accumbens and the vental tegmental area that are rich in dopamine releasing neurons right and they act like the accelerator on the car so when you've got a healthy functioning brain you've got enough accelerator but not too much right so enough dop Meine being released but not too much and youve got a healthy prefrontal cortex putting the

brakes on that dopamine release when people um become addicted there's either a problem with the brakes the prefrontal cortex or the accelerator the nucleus accumbens and vental tegmental area or both right what we're finding is that there's actually a disconnect so there are large neuronal circuits and Pathways between those deep lyic structures and the prefrontal cortex that literally get severed or disconnected when people become addicted as we think about Pleasure and Pain being collocated in the same parts of the brain working like opposite sides of the balance in order to understand what happens in the

addicted brain is to appreciate that there are fundamental rules governing this balance and one of the most important rules is is that the balance wants to remain level it does not want to be tilted very long to the side of either pleasure or pain and in fact what our brain does is first tilt an equal and opposite amount to whatever the initial stimulus is so I'm going to try to illustrate that here so let's say our initial stimulus is alcohol now alcohol Works through its own chemical pathway it works on our endogenous opioid system the

opioids that we make we have receptors for opioids in our brains it works on our endogenous Gaba system which is our calming neurotransmitter and at the end of the day it releases dopamine in the reward pathway so any potentially addictive substance will release dopamine in the reward pathway the more that's released and the faster that's released in a given individual the more likely that substance is to be addictive now another important concept here is what we call drug of choice which is to say what releases a lot of dopamine in your brain may not release

a lot of dopamine in my brain and vice versa right which is this idea that people have predictions to different kinds of drugs and by the way people can get addicted to behaviors too I should emphasize that when you say drug of choice you mean the brain has a particular sensitivity to that drug in terms of dopamine yes okay the more dopamine that's released the faster that it's released the more likely that drug is to be addictive for a given individual so you're holding some whiskey there I'm holding some whiskey there could be a brain

that is very sensitive to Whiskey and there could be a different brain that you could pull all the whiskey and you like and the dopamine response is sort of limited exactly okay and for many of my patients who become addicted to alcohol they will tell you that from the first moment they had alcohol they knew they were either in trouble or had met their best friend or some combination it was a very potent experience for them all right so let's let's go ahead and put this on the pleasure side of the balance dopamine is being

released but no sooner has that happened then my brain will work very hard to restore a level balance and by the way a level balance is what neuroscientists call homeostasis okay and one of the overarching physiologic drives for all living organisms is to return to homeostasis homeostasis is that parameter of what's often called called affordances or states of being that are adaptive and healthy for the organism for example like we have a certain homeostasis of body temperature and if we go much too much beyond that either too high or too low we will disintegrate and

die right so homeostasis is that that states of being that are compatible with existence and and potentially advantageous too sort of Baseline level that's right yeah Baseline level and by the way we're always releasing dopamine at a kind of tonic Baseline level in our brains I sometimes think of it as the heartbeat of the brain so what's happened here for people that can't see is you've poured a little bit of whiskey into one end of the scale the pleasure side of the scale and the other side of the scale has risen because now there's whiskey

um in the the pleasure side which I guess is released dopamine exactly so now now we' released dopamine in the reward pathway okay because the pain side went up does that mean there's now less pain in the brain well I think you know again this is a metaphor it's an oversimplification the idea here is just when we press on the pleasure side we're releasing dopamine in the reward pathway and experiencing pleasure okay okay but no sooner has that happened then our brain will try to compensate or adapt to increased dopamine firing by down regulating dopamine

transmission for example by involuting post synaptic dopamine receptors that mean okay okay so our brain is a bunch of wires you know um that conduct these electrical signals and and these long spindly cells are called neurons and the thing about neurons is that they don't actually touch end to end there's a little Gap or space between them and that Gap is called the synapse and that Gap or synapse is bridged by what we call neurotransmitters and dopamine is one of those neurotransmitters okay and when the pre synaptic neuron pulses and releases dopamine it crosses the

synapse and binds to a receptor on the post synaptic neuron which either continues or aborts that electrical signal does that make sense yes okay so one of the ways that our brain can decrease the effects of dopamine decrease dopamine transmission is by involuting or taking inside the neuron the post synaptic receptor that way when dopamine is released it has nowhere to bind oh okay so it's like removing the docking station exactly very good it's removing the docking station so essentially getting back to our scale we've we've you know ingested alcohol we've increased dopamine firing in

the reward pathway but remember our pleasure pain balance wants to return to the level position level with the ground homeostasis so it's going to decrease dopamine transmission by for example involuting those post synaptic dopamine receptors but one thing about the brain in its process of trying to get back to homeostasis and again I like to think of this neuro adaptation process as these Gremlins hopping on the pain side of the balance to bring it level again you don't have Gremlins here you have these little rocks but let's go ahead and put a rock on the

pain side of the balance and the these rocks are are friends right their job is to level the balance because remember we got to go back to homeostasis I'm going to put a rock on and you're going to see oh my gosh it overshot right it now I've got it pressed down on the the pain side of the balance but that's exactly what happens in our brains in this process of neuro adaptation those Gremlins hopping on the pain side of the balance don't get off as soon as the balance is level they stay on until

we're tilted and equal an opposite amount so is that what a hangover is or a cown as they would say when people take drugs they say I have a come down exactly that's exactly what it is that's the hangover the come down the Blue Monday or on a much smaller scale just that moment of craving right that moment of wanting to have one more shot right why does it overshoot why can't it just perfectly hit homeostasis such a great question because then we'd feel fine yeah why did Mother Nature do that to us so cruel

right yeah okay I'm going to tell you an evolutionary just so story what we mean by that is we don't really know why you know this mechanism exists but from an evolutionary perspective if you're living in a world of scarcity and everpresent danger this is the perfect mechanism to make sure that we're never satisfied with what we have that we're always wanting more it's made us the ultimate Seekers okay because immediately after getting something I'm now feeling a lack of pleasure and I'm at a deficit you know on the pain side of the scale which

means that I'm going to go seeking out more dopamine and in a world where everything is quite scarce that could mean going on another 4-Hour hunt the next day to go killer gazelle or something perfect you got yeah you got it interesting yeah okay so that's going to motivate me because this get so Jesus people that have hangovers don't seem very motivated right so now that's a so why is that right it's because alcohol is a product of human engineering that releases so much dopamine all at once in the reward pathway that our brains are

reeling to compensate right we we really weren't evolved for this much pleasure with this much easy access as you said yourself we were really evolved for to have to do quite a lot of work upfront and to be hungry and to be lonely and to be tired and then get a little bit of reward that would then bring us back up to homostasis so really we were evolved to be pressing on the pain side of the balance in our effort to find pleasure and then when we find it that little bit of food or clothing

or shelter or a mate would bring us back to the level position does that makes sense yeah so you're you're telling me essentially that we're all wired to be addicted because if this is how our brain works in a world it's designed to seek out more dopamine but the problem we have now is we have all the synthetic dopamine effectively like this so synthetic chemicals and synthetic things and you know an Internet that is wiring us to give us so much dopamine so easily that that means that our brains are effectively like mismatched to the

world that we live in and therefore wired to be addicted yeah I think you actually said that I found a quote you said in an interview where you said we all wired to be addicted and if you're not addicted yet it's right around the corner right coming to a website near you yes I I guess I would I would qualify that a little bit by saying we're wired for survival in a world of scarcity that's not the world live in now we live in a world of overwhelming overabundance and so there is a mismatch between

this ancient wiring that has us relentlessly pursuing pleasure in order to survive and a world that's so infused with pleasure and so many rewarding stimuli that now we're overwhelming our reward system and our brains are reeling in response to try to compensate so what happens to this scale then in such a world where I can get a big hit of dopamine all the time using some of these synthetic things or the internet or pornography or whatever else what's going on with this scale over and over again okay great so let me get there let me

first say though that remember after we do something that's highly pleasurable our brain compensates with neuro adaptation tilting an equal and opposite amount to the side of pain and then restoring our balance back to the level position right or what we call homeostasis so this doesn't last forever right it's to pleasure then it's to pain then it's back to the level position but if we continue to consume our drug of choice over days to weeks to months to years and we add in a whole bunch of other drugs and now we're consuming you know pornography

and smoking pot and eating um donuts and you know you name it all at the same time then essentially what happens is those Gremlins on the pain side of the balance end up camped out there for anyone that see she put all of the Rocks into the pain side to represent All Of The Addictive behaviors that this individual has now taken on right and now we've entered addicted brain by which I mean that we've changed our honic or Joy set point to the side of pain now we need more and more of our drug in

more potent forms not to get high and feel good but just to level the balance feel normal and this is not going to be enough to level the balance I would have to like keep filling this much more than this container can hold and that would be in Pursuit really of just trying to level that balance so that we can feel normal and when we're not using we're walking around with a balance tilted toward the side of pain experiencing the universal symptoms of withdrawal from any addictive substance or behavior which are anxiety irritability insomnia depression

and crav so if I managed to get enough vodka whiskey rum and pour it into the pleasure side of the scale now that all the rocks are in the pain side of the scale I managed to outweigh it it would it would what would then happen more rocks more rocks would be added yes more so momentarily yeah I would maybe be in a little bit of pleasure yes but then my brain would remove those docking stations again remove more of them and more rocks would go in and I'd slam down on the pain side again

which means I need more alcohol to try and get up to pleasure SL okay so really you want to you want to like dopamine fast you need you need to just balance this and this is so difficult because of the world we live in it's almost it's it's it's funny enough because this little scales experiment um analogy here has given me a huge amount of empathy for people that are addicts oh gosh I'm so glad you said that because I think that is the key to empathy for the disease of addiction as well as for

people with the disease having empathy for themselves is recognizing that on some level it it's it's out of their control right because when we are tilted to the side of pain the overwhelming drive to restore a level balance or restore homeostasis as quickly as possible overwhelms any other rational thought about the consequences of my drug use right it's just like get back to the level position because if I do that I'll at least feel temporarily better one of the things this analogy also highlights for me is that people who are addicted aren't trying to self

harm right and this is kind of the prevailing narrative that if you're like why would you do that to yourself right whereas when I look at this analogy I go actually what they're trying to do is to deal with pain and we're all trying to find ways to deal with our pain and but in this analogy what ultimately happens and I guess is what's happening with addicts is the way they're choosing to deal with their pain is becoming self-destructive and that's creating more pain right and it's this vicious downward cycle yes and I think that

sort of reframing of what's going on there is really critical because again it begets more empathy absolutely I agree with you and and I think you know we this this metaphor it makes an assumption that we all start with a pleasure pain balance that's level with the ground but actually that's probably not true right some people at Baseline may actually be more depressed or more anxious or may have had life experiences that sets them up for a kind of chronic stress reaction and we know that people with co-occurring psychiatric disorders for example are at increased

risk of developing addiction probably because they're reaching for that substance to self medicate their psychiatric problem the the issue with that is that it's not medicinal right it's not healing although in the short term substances can help with those kinds of feelings feelings of psychological and physical pain over time because of the way the brain adapts as we've discussed substances and other addictive behaviors just make psychiatric problems worse right as we drive ourselves further into the the kind of uh you know the pain side of the balance so is this why trauma often leads to

addictive behaviors because the trauma has caused a a pain a stress and we're searching for ways to medicate that pain or stress yeah to numb ourselves to not be present in our reality and have to deal with what's going on there is dopamine what role is dopamine playing in it's all the same dopamine originally was to help us find those things that we need to survive food clothing shelter a mate we call those Natural Rewards but today that same reward pathway that relies on dopamine has been hijacked by all of these artificial rewards that our

brain confuses as necessary for survival which is why people with severe addiction will be willing to lose you know not consciously but unconsciously their loved ones their homes their jobs everything they have in pursuit of their drug of choice it's because their brain has been hijacked and they now confuse the drug as necessary for survival the other thing about drugs is that they're incredibly potent they release a lot of dopamine all at once which again is confusing for our brain Natural Rewards require upfront effort where we do a lot of work and then we get

a little bit of dopamine and that's what our brains evolved for I mean I can that makes sense in my own life when I'm most stressed or most challenged by something professionally is when I I immediately notice that my diet goes out the window I start eating things that are bad I actually stop going to the gym as much um and it's it be can form a bit of a downward spiral can't it I guess as we've kind of seen from the dopamine scale um can I can I get back to that your question though

about trauma and stress so um there's a very series there's a very interesting series of experiments in rodents mice and rats where they first of all rodents very easily get addicted to cocaine they will press a lever for cocaine until exhaustion or death but if that cocaine is then taken away that behavior will extinguish which means that the mice will eventually just stop pressing the lever right because they're not getting any cocaine totally makes sense and then they'll go off and do something else in the cage but if they're then exposed to a very painful

foot shock right so a very extreme physical pain which you could equate to a serious life stressor the first thing the rat will do is run over to the lever and start pressing for cocaine which tells us that once our brain has discovered a drug that releases a lot of dopamine in our reward pathway even after we stop using that drug if we are exposed to an extreme stressor our brain will tell us immediately go and do that thing that gives us a lot of dopamine because you are under stress and I need to be

relieved of stress does that make sense makes perfect sense yeah so if you especially so if you discover your drug of choice when you're younger and it's food or it's pornography or if it's I don't know anything that really made you feel good for a moment a moment of pleasure that will always become in the case of these rodent experiments the thing you run back to when life gets hard right and we see that again and again in people in sustained recovery from addtion that when they are under stress that is a trigger potentially for

them to relapse so they have to be really thoughtful in their lives for number one trying to avoid stressful situations and and by the way stress can come in many different forms there's a great acronym in in alcoholic synonymous called halt hungry angry lonely tired those kinds of stressors everyday stressors which we all experience hungry angry lonely tired can trigger us to want to use so people in recovery have to be really thoughtful about not getting too hungry not getting too angry not getting too lonely and not getting too tired at the end of this

conversation I want to go through all of the sort of practical solutions that someone struggling with an addiction to social media pornography food whatever it might be um Can Implement to try and shift that cycle that they might be going through especially when they're halting hungry angry lonely or tired how often have you worked with addicts have you spent much time working with addicts directly oh my gosh yeah so that's the bulk of my career is working uh with people with all different kinds of addictions me an example of the most obscure the most I

had a patient who was addicted to water I know hard hard to imagine you have to though understand her narrative so she had a very severe alcohol addiction she got into recovery from that addiction and gave up alcohol but she discovered that by drinking copious amounts of water she could become hyponic meaning that she could lower the sodium levels in her bloodstream which would then lead her to become delirious and so in her desire to just be checked out she would do that she would she would drink a large amounts of water she's doing okay

no sadly she's not um she she ended up taking her own life so that was very sad gosh in that situation was there was there a root cause of that behavior pattern further Upstream some kind of trauma or experience that had set this sort of cascade cascading set of issues off yeah you know I'm just speaking broadly um for for some patients with severe addiction trauma is a huge Factor um especially severe Early Childhood trauma but there are also many folks we see who have kind of great parents and have had happy childhoods and have

great social networks and and work that they enjoy and yet they still become addicted and that's because we again we are wired to consume as much as possible of whatever releases dopamine in our brains to have survived Evolution to this date and yet we're living in this world where we have access to so many drug aied substances and behaviors that we've all become vulnerable to this problem and the reason I highlight this is because one of the things that I think has happened in the field of addiction medicine that maybe isn't the best is that

often times patients themselves as well as their providers are digging really deep to find the trauma or the reason that someone has become addicted and I think that that's important to do in some cases but in in other other cases it can lead to kind of manufacturing trauma where there really isn't any furthermore I would say that when a person is in the throws of their addiction they're not going to be able to really do the complex emotional processing of their trauma while they're still using their drug of choice that they really need to get

out of that Vortex of addiction and get into some degree of recovery before you would even want to go tackle some of those early traumatic experiences how many people do you think are struggling with some form of addiction well if you think of addiction as a spectrum disorder right there's mild moderate and severe um and there's I would even say a kind of a pre- addiction state where we're all sort of dabbling in compulsive overc consumption I would say the vast majority of us like 90 probably 95% have some degree of compulsive over consumption and

you know if and when it tips over into what we would call addiction there's not a brain scan or a blood test to assess that it's not like you know switching a light a light switch and it's like oh yeah now you have addiction um it's not like that it's you know it's a gradual often a gradual and Insidious thing and we don't in fact have a biological measurement of addiction we Bas it on what we call phenomenology which is patterns of behavior that re repeat themselves across time and broadly speaking the definition of addiction

is the continued compulsive use of a substance or a behavior despite harm to self and or others and so you know that harm can be very subtle um or not right and it can be a judgment call interesting because we do throw the word Addiction around a lot in society but but really the most important part of that is to understand if it's harming yourself or someone else the behavior pattern yes that's right and to also recognize that we're not very good judges of that when we're chasing dopamine okay so we sometimes justify behaviors we

have as being not harmful and it's fine and it's not impacting me at all and what do you mean exactly and we don't we're not very good at seeing true cause and effect honestly when it comes to these behaviors which is why often times people won't really see the harm until they've stopped using for a period of time in your book dopamine Nation you talk about an addiction that you had yes and it was really surprising to me because I would never have thought that being obsessed with erotic novels could be classified as an addiction

what happened what was the behavior take me into that that phase of your life so I was in my early 40s um my kids were no longer little um I got a lot of my self-worth and identity from being a mom and my kids were sort of entering adolescence they were doing fine but they didn't need me as much um so I had kind of a grief reaction you know in response to that was trying to figure out you know how to navigate this next phase of my life I'd always been a reader and in

particular a reader of novels um in my own way that was how as a child I self soothed was to escape into uh the Fantasy Life of novels um but I never had what what I would call a problem with it and then one day I heard another mother at school said that she was reading this great book it was called Twilight it was about these vampires and she was going on and on about it and I read it and I I can't tell you what it was but it was just like the the the

key in my particular it was completely transporting it just released a lot of dope mean is all I can imagine in my brains reward pathway and so I read the whole series and then I read the series again and I read it again and of course by the third or fourth time it wasn't as you know reinforcing and I thought to myself I wonder if there are any more vampire romance novels and then for me the real Tipping Point was I got an e-reader I got a Kindle because what happened was I I even before

I got the Kindle I started reading you know novels that I would say I would be slightly embarrassed to admit that I was reading like kind of bodice Ripper novels as time went on I I needed more and more like graphic kinds of descriptions in order to find it pleasurable and and by the way that's classic for the addiction narrative right where you start out with a little bit and it goes a long way and then over time you build up tolerance that's neuro adaptation the Gremlins pressing down on the pain side of balance now

I need more of my drug in more potent forms to get the same effect gradually over time I started um reading you know more and more sort of graphic erotic sexualized versions of this novel and I would I was embarrassed so I would hide that I was reading them and that gets into the whole double life of addiction where now we're lying about our use we're we're using our drug over here but pretending like we're not so my kids or my husband would walk in the room and I would be you know hiding behind another

book one book behind another book so it looked like I was reading something you know I don't know more sophisticated and then the Tipping Point for me came really when I got a Kindle or an e-reader and then my reading was totally Anonymous I could read these books anywhere any time no one knew what I was reading and as soon as I finished one um I could read another one and I almost overnight became a chain reader like literally when I was n doing something else that I had to do I was reading romance novels

one after another after another um which meant I was you know less present for my kids less present for my husband I would often stay up till 2: 3 4 in the morning on a week night reading romance novels have to get up two hours later go to work exhausted not able to be present for my patience not enjoying my work gradually getting more depressed more irritable more anxious more insomnia we went on on a a family vacation with an family friends of ours everybody together at this beach house all the kids playing I was

like hiding in a room reading romance novels so and this is exactly what happens with addiction is that our Focus Narrows and the things that we used to enjoy are no longer pleasurable only this one thing has salience for us we plan our whole whole day around getting it using it hiding our use um and that's what happened to me it's so interesting because I was as you were talking about that I was thinking about all the behaviors that I have that are maybe isolating me or you know I just even things like spending a

lot of time on the internet just watching video after video after video on YouTube or um those kinds of things or just like spending tons of time in my WhatsApp group chat talking like roasting my friends about nothing right how do you know if like this is it's cuz on end of the spectrum I could say okay well that's harming my relationship with people in the real world but it's helping making me feel good and it's you know maybe helping me in another department because I'm learning more about vampires or you know like so like

you know because there's there might be net harm somewhere else but then an upside over here which and then I start rationalizing this Behavior like how' you just distinguish between these behaviors and know what's bad and what's good you know what it's really hard um these digital devices are powerful tools but also very potent drugs there's no doubt that digital media lights up the same reward pathway as drugs and alcohol these devices and platforms were designed to be addictive that is to keep us scrolling and tapping long beyond what we plan for or what we

want or even what's pleasurable I think we can all relate to using this medium to a point where we don't even like it anymore and yet have difficulty getting ourselves off of it that really speaks to the inherently reinforcing and cognitively adherent nature of this medium it is a drug and so you know if and when and how we're crossing into addictive use I think we need to be very Vig about whether that's happened in our lives and one of the ways to do that is actually to try cutting out that particular digital medium that

website or that behavior for a period of time long enough to experience withdrawal potentially reset reward Pathways and then re-evaluate because when we're in the behavior as you yourself noted it's very easy to rationalize oh I need to do this for work oh I need need to do this to stay in touch with my friends oh I'm learning so much from this right and all of that may have been true initially but may not be that true anymore and what I often point to is the subtler signs of addiction which are things like depression anxiety

in attention insomnia restlessness these can be early signals for our consumption entering into that addiction range but us not realizing it because again we don't see cause and effect which is why doing an experiment like I did with my romance novels you know following in the footsteps of my patients and taking the advice I give them and I gave my romance novels up for 30 days right just to see like okay I think this is a problematic Behavior can I give it up how will I feel and the very first day that I the very

first 24 hours hours that I did not read any romance novel any novel at all I was astounded at my level of anxiety restlessness and utter insomnia I had completely unlearned the art of putting myself to sleep without this digital narrative and that lasted a good 10 to 14 days completely mapping on with the amount of time it takes typically to get out of acute withdrawal that is to say for those neuro adapt PA Gremlins to hop off the pain side of the balance and for homeostasis to to begin to be re restored um but

by the time I got to weeks three and four I felt not just better than I had in the first two weeks but actually better than I had felt in a really long time I enjoyed my kids more I was more present for them I enjoyed my husband more my work seemed salian again I had started to think oh maybe I should do something else you know maybe maybe I you know this work I've been doing it a long long time I don't it's not that interesting anymore all of a sudden it was interesting again

right so you see the relativity of that honic pathway and how when we're doing that behavior or substance that's so reinforcing that everything else loses its salience we can really misidentify what is causing our irritability anxiety insomnia until we stop that substance for long enough to see its impact on our lives how is it making you feel because I think a lot of a lot of people can't understand how you could get addicted to a book I'm sure some people understand that but but for me it's not something I've ever become addicted to so how

how did it feel was it like exciting is it arousing is it somewhere in between I mean I think that romance novels are essentially socially sanctioned pornography for women okay and the medium is narrative and if you're a person for whom narrative is a powerful drug as it is for me a story a narrative a fiction um very potent since I was a child then you know it was a natural that that that would be the thing that I would get addicted to and basically just like we've hacked and bioengineered everything to make it more

potent I mean people there's a formula for writing romance novels like if you take a physical copy if you go to a store and you pick up a romance novel and you literally physically open it to 2third of the way through you will get to the climactic scene pun intended right it's it's like it's engineered I mean I got to a point where I wouldn't even read it read after I wouldn't finish the book I would go on to the next book just to get to the climax part and then you'd move yeah and I

wouldn't even read the danum ma or like what happens to the characters I didn't care you didn't care about no and also I didn't I got to point where I didn't care about the quality of the writing or the depth of the car it didn't matter it was it was the drug it was that moment I was looking for and you know there are a lot of free books on Amazon some some of which are high quality and some of which are not but like you know any good drug dealer knows free samples that's the

way you hook people I would search for these free samples and that's part of it too like the searching for the drug so the Working The Upfront work you do for the drug is part of the drug right it's all that you know the machinations and the hiding and the this and the that that gets to be part of like all of the rituals surrounding it as you were talking as well I thought about work and work addiction yes because you earlier used the term excessive consumption and when I think about work even my work

I Think Jesus I excessively consume work I start so many bloody businesses and invest in so many things and if you look to that behavior objectively if you're like an alien looking down at me you'd go this guy's got a problem do you know what I mean you think you think that's funny joking you know I feel for you and it's funny cuz in society we then those people are reinforced we clap that's right we clap we got this guy's not sleeping he's working 18 hours a day clap clap clap give him a trophy an

award name a thing after him or her or right you know um and it's just really interesting that that that addiction of work and you tell me if it is it can be an addiction it's certainly in the scale of one end being sort of consumption excessive consumption in the other hand being addiction it's on there somewhere people can get addicted to work and part of the reason is that we've drug aied work right when when I say drug aied what do I mean we've made it more potent and this is true for all all

these drugs we've made them more potent more novel more Bountiful meaning there's more of it and more accessible so if we if we break that down with work how is work more potent well certain types of work are more reinforcing not all types of work so for example Works work White Collar work is often now associated with stock options and bonuses right um there's often like a social media aspect to it or maybe even a Fame aspect or as you point out those are our cultural Heroes right so you get all this you know agulation

for being a workaholic and that also because we're such social creatures right and human connection stimulates dope mean that that also makes work more of a potent drug personal brand right so you're LinkedIn oh my God this person got a promotion we all clap we the likes the comments you're amazing the agulation the a as you said the awards the trophies and then you've got um the fact the fact of novelty so once we've exposed our brains enough times to a certain drug as I said we develop tolerance right and then we need more potent

forms or novel forms one of the ways we overcome tolerance is by taking our drug and then changing it slightly like adding a little new molecule on this chemical right or on the Internet you know when we're searching videos we want something similar to what we liked before but just a little bit different and that's what the algorithm does automatically right it offers oh you should check this out oh how about this oh check that out right and that engages our treasure seeking function we're looking for that that novel thing but that's not too novel

right it has to be in our category of things we like and I think for work we have that too like there are so many ways now that people can engage in their work and it's not all bad that it's novel but you know certain types of work it makes it very enticing then you have quantity right I mean work never ends there's like no natural stopping point for work you know you do a line of cocaine you run out of money you run out of cocaine you're done right but that's not true for work

everywhere anytime and then that gets to accessibility one of the biggest risk factors for addiction to any drug or behavior is simple access we know that if you grow up in a neighborhood where drugs are sold on a street corner you're more likely to try them more likely to get addicted if you live in a world where you have access to work 24/7 you're more likely to expose your brain to more work and more likely to get addicted to work again especially if it's got all those other reinforcing qualities this is probably in part why

people quit their jobs you mean if they just get overwhelmed or it's it's partially why people can never quit but I think it's important to make a distinction between work that's reinforcing in those ways and then work that's completely not reinforcing yeah alienating mind-numbing work in which the the actual task is separated from the meaning of a task I mean they quit their jobs either in search of more dopamine so if I'm working in a job where I don't know maybe it once gave me dopamine and now it's become monotonous and the same right I

I need to quit to go find but there's novelty for you that's right yeah and that's true people many people change jobs every two to three years I I recently read that the the average life of a business now is like 15 years whereas you know 50 years ago it was 50 years and there's all this turnover all this churn chasing novelty also you know I I do want to emphasize that people who are in work that's not like intrinsically rewarding but is the opposite kind of soul sucking that's also a risk factor for addiction

because people just wait till the end of the day till they can go home and then use a drug to numb themselves from the stress of work so it's it's plausible that people who are in lower pleasure jobs are more likely to be overweight or addicted or dependent on alcohol yeah or simply opt out of the workforce as many young men are doing now in the United States and what we know from data that's been collected is many of them are playing video games right they've just completely opted out of the workforce I guess this

in part explains why there's a drinking culture that's associated with people who are potentially lower class um because they're doing um potentially less pleasurable work and they're therefore they if we think about the scale that they would then end up in the pub after work you know maybe that's partially true but even people doing like doctors and lawyers they're are oh okay yeah equal rates of alcoholism among those groups I think what's happening there though is that the nature of the work is just so stressful whether it's white collar or blue collar that there's this

kind of work hard play hard right I'm going to work all day and at the end of the day I'm going to reward myself so now you've got a pleasure pain balance that's going pleasure pain pleasure pain and and remember the biological definition of stress is any deviation from neutrality so that every time our brain has to work to restore a level balance we're actually triggering our stress response triggering our own adrenaline it's stressful to have to restore the balance from those extremes of Pleasure and Pain I read in um your book you were talking

about how different behaviors and sort of chemicals and substances have different impacts and I was on page 50 of dopamin nation in a study of mice sex increases the release of dopamine by 100% And amphetamines which is like drugs right hardcore drugs increases it by 1,000% by this accounting one hit of a meth pipe is equal to 10 orgasms yes it's interesting to think about that the different behaviors we have and how they'll have a bigger impact on our dopamine is there like any in an in in typical order of things that are like extremely

dopamine inducing and things that aren't what's it like the top and bottom of the list but in your view you know I really think that it depends on the person and we've got to look at drug of choice right I mean potent drugs like methamphetamine like opioids like alcohol like nicotine like cannabis um are are going to be very reinforcing for many people but not for all people and most people do have their one drug that they sort of prefer above all others so although generally speaking intoxicants release a lot of dopamine in the reward

pathway um I think every person is going to be different and also we we don't really have good ways of measuring absolute values of dopamine in human beings right we can do that in rats but we can't really do that in humans it's it's relative values I've got this um picture here which shows what looks like brain scans in uh normal person but then in someone who's addicted to different substances I'll put this on the screen and I'll link it below in the description for anyone that needs it and wants to see it but it

effectively shows the impact that like cocaine has on the brain meth um alcohol and heroin what is what is going on here so the red in this image represents dopamine transmission okay so how much dope mean is being released from the pr synaptic neuron Crossing that synapse binding to receptors on the Sy aptic neuron how much dopamine is kind of swirling around in the reward pathway part of the brain and what this image shows is that on the left hand side in healthy control subjects who do not have addiction there's plenty of red right so

there's plenty of dopamine Transmission in the reward pathway specifically here in the nucleus accumbens but if you look at the right hand column you'll see that in these individuals who have been using cocaine meth amphetamine alcohol and heroin in addictive ways there's almost no red which means there's decreased or below normal levels of dopamine transmission they are in a chronic dopamine deficit State this is evidence of the brain trying to compensate for too much dopamine being triggered by down regulating its own dopamine production and transmission not just to Baseline but below Baseline and importantly these

individuals who are addicted to these substances these brain scans were done two weeks after they stopped using oh wow yeah which tells us that this dop dopamine deficit State persists for some period of Time how long well it depends on the person but we know at least from this experiment that the first two weeks are this persistent dopamine deficit state which is consistent with acute withdrawal right people feel when they first stop their drug of choice they feel terrible right they experience all of the symptoms of physical withdrawal that correspond with that particular drug they

were using usually the opposite of what the drug did plus the universal symptoms of withdrawal from any addictive substance or behavior anxiety irritability insomnia depression and craving now if they can get through the first 10 to 14 days what we see clinically is those acute withdrawal symptoms slowly start to get better and we think that that is mapping on to regenerating dopamine Transmission in the reward pathway and if they can make it to a month that's usually the point for for on average in based on clinical experience when people really can start to get out

of that constant state of craving for their drug of choice and begin to see some light at the end of the tunnel for what their lives might look like if they can maintain abstinence from their drug and we can't just inject or drink dopamine I mean I guess that would be like drinking alcohol we can't just artificially mess with the the balances to try and restore the dopamine levels in an addict can we can't just add a little bit of dopamine yeah it's it's a great question because we have some natural experiments that suggest what

what might happen if we do that so as I mentioned before people with Parkinson's have depletion of DOP mean in the substan That's What Causes That that motor disease the treatment for it is to give L Doopa which is a dopamine precursor if I were to give you a spoonful of dopamine it would do absolutely nothing because it doesn't cross into the bra the brain it doesn't cross the blood brain barrier but I could give you lopa which is a precursor chemical that would cross your blood brain barrier and get turned into dopamine and then

diffusely bind dopamine receptors in your brain in the reward pathway but also in the movement Pathways when we give patients with Parkinson's dopamine in this form that can temporarily improve their movements but in about one in four Parkinson's patients they will develop a denovo addictive disorder shopping addiction sex addiction other types of addiction because we have the same problem we are stimulating the reward pathway with dopamine that is ingested exogenously from the outside and our brain reads that as oh boy got to compensate by downregulating dopamine transmission to below Baseline which then puts us in

that addiction Vortex does that make sense it does so we have to I mean it tells me that we have to live lives in a certain sense of we have to live our lives in a certain sort of homeostasis and it's so easy not to in the world we live in it's like it's like impossible to live in a perfect homeostasis balance in the world we live in right even more than having to try to live within this sort of narrow range of homeostasis in the world we live in today we probably have to intentionally

do things that are painful do things that are hard pleasure pain balance like we learn that when we press on the pleasure side of the balance like with alcohol or pornography or romance novels or cannabis or whatever it is right no sooner does that happen than our brain adapts by those neuro adaptation Gremlins hopping on the pain side of the balance to bring it level again but they like it on the balance so they don't get off right when it's level they stay on until we're tilted an equal an opposite amount to the side of

pain that's the come down the hangover Etc but it turns out the opposite is also true if we intentionally press on the pain side of the balance for example with exercise or an ice cold water bath or intermittent fasting those Gremlins will hop on the pleasure side of the balance and we will get our dopamine indirectly by paying for it up front and there are studies in humans showing that when humans expose themselves to exercise for example dopamine levels gradually rise over the latter half of the exercise and then when the exercise stops dopamine levels

will remain elevated for hours after afterwards before going back down to the Baseline level position without ever going into that dopamine deficit state so it's a great way to get our dopamine in directly because it's much less vulnerable to that compulsive craving phenomenon of overuse so you're not going to get an exercise come down you can butc and people can get addicted to exercise right but typically it's it's very unusual because The Upfront cost to to do the work and endure the pain of exercise in the first place mitigates our vulnerability to an exercise addiction

and in general H okay CU it's so hard to do that it's going to be it's not like pulling a lever on a slot machine or clicking on a porn website is difficult yes okay so fighting for the dopamine is insulates us against the chance of an addiction having to really fight hard for it okay yeah and this kind of explains I guess in part why I pulled out some stats ahead of our conversation today that from 1996 to 2008 participation in ultramarathons has increased by 1,676 the ice bath Market is expected to rise from

350 million in 2024 to to nearly half a billion by 2030 the number of people taking part in obstacle course races like tough mut or hrock etc etc has increased by almost 7x from 2010 to 2017 it seems like in society there's this counter movement towards people seeking out hard dopamine chasing pain yeah those are amazing I didn't know that those are amazing numbers um you know in general there's a part of me that wants to say well that's a good thing um but there there's another part of me that's wary also because we're so

good at drug aying everything that we do that there's a way in which these types of behaviors can also be drug aied right made more potent with all of the technology the way that we count ourselves the leaderboards the social comparisons all of that takes this thing which is really in its natural state kind of impervious to addiction like you just typically wouldn't get addicted to these types of painful physical activities you would do what you needed to do for survival but we've managed to make them addictive in all these different ways I still think

it's a better way to get your dopamine like I really encourage exercise we always talk about movement as medicine and in general our our life is so convenient so easy so passive so sedentary that I'm telling patients all the time you know get up off the couch move your body walk around the block I think that's the bigger obstacle right now is just getting people to move but I do think we need to be wary of not going too far in the direction of like the ultra Ultra Ultra whatever it is so what is a

better way to live if we're trying to optimize happiness and to keep our dopamine in balance and not have the crashes Etc and come downs and hangover what is a optimal way to live our lives do we have to look back at our caveman ancestors and live like them I think that part of the problem is that we've organized Our Lives now around rewards almost everything that we do is predicated on the Feelgood moment we'll have at the end of it and because of that that we are missing out on the process we're projecting our

psyche forward into the future toward the reward and not able to really be here in the moment okay this is going to be sound weird I'm going to give you a weird example so driving over here today I found I was nervous for this interview and in a way looking forward to it but in a way wanting it to be over right and and in seeing that in myself I thought that's so sad like that's that's so sad that we live our lives that way myself included always this weird blend of wanting whatever we're doing

to be over so that in a way we can just go hide and do whatever that self- steem thing is that we do where we're safe and we're like you know stimulating ourselves in some way and then I thought well what if I knew that I was going to die right after this going come off really weird now but what if I knew that I was actually going to die right after our conversation today that totally changes my perspective doesn't it because this time you and I have that's all I got it's over for me

when this so this this conversation is it I really better be right here right now and really taking joy in whatever you and I can find together and and I think the more we can do that the better what's happening there you're removing the thought of the outcome the rewards the potential you know failure or whatever and you're focusing on just being present and in doing so what is happening it's a great question and I've actually given this quite a lot of thought because I remember when I was in college and I you know met

some like Zen people and they were like be here now be here now and I thought well whenever I'm here now I'm miserable like I I I don't like me and I don't like being in the world I I don't want to be here now I want to be somewhere else so I didn't really understand what they were getting at it really took me you know till I had lived quite a lot of life and had some you know some significant experiences and given it some thought that I realized oh be here now means be

here now and be uncomfortable and be okay with being uncomfortable and being okay with not being able to control my pleasure or my pain or my comfort level but just being open to whatever comes and I think that's a really a key shift that I'm not trying to control my experience in the moment and that it's okay to be unhappy or Restless or uncomfortable and not trying to run away from that but just really turn and face it and embrace the discomfort which I also think is quite Universal I don't think I'm I'm alone in

that and then the key piece about not not anticipating the reward is helps me be in the moment right because I'm not just waiting for the good thing to come after I'm saying to myself imagine there's nothing good coming after nothing at all right there's just there aren't rewards this is it and then also being able to say and it's okay if in the moment like it's not great like I I can Embrace that you know I can be unhappy or Restless or anxious or whatever it is and then when I do that you know

I feel like there's a funny funny thing that happens and all the sudden I I'm not as anxious right and I am present and it there is some Joy there interesting so when you allow yourself to deal with being uncomfortable in the moment it turns out you it removes the thing that was making you uncomfortable in the moment which is like the avoidance or the worry or overthinking whatever else yeah I I think we have this and it's fed by modern culture this kind of expectancy that really we should be happy all the time and

if you know if we've arranged things appropriately for our lives and if we've done our work and you know aimed true then we should just be like life is great and I don't believe that anymore I think that you know I mean like Buddha said life is suffering but I really think that fundamentally like it's uncomfortable to be alive and that it's a kind of a constant state of restlessness and discomfort if we're being really honest and and tuning in when I really let myself see that and feel that all of a sudden I'm I'm

freed from from some of that what has caused your anxiety throughout your life in the moment you you referenced earlier that some things have happened that have led you to understand this better and understand yourself better what is what am I missing from this jsaw puzzle yeah well you're you're good you could have been a psychiatrist oh really yeah it's always time this doesn't work out there's still time right it's not too late you get a new profession yay um I think you know for me the the big Turning Point um was that we lost

our we lost a child and um in the immediate aftermath of our child's death I was just determined to like sort of undo the experience and um you know get enough Psychotherapy and enough whatever whatever it took to sort of not feel that pain and it wasn't until I really just said oh like I'm going to feel this pain for the rest of my life it's never going away that suddenly I felt some relief from that pain and that was a real window for me so interesting that the it's acceptance yeah and and you know

and and I think you know one of the reasons I love treating patients with addiction is because I really relate to that hitting bottom moment you know that moment when it's like you just have the feeling that like everything I try to do to manage this Behavior or to make my life better only makes it worse I felt like I had a very similar experience um and that it was only when I kind of realized oh I yeah I I can't run from this I cannot run this pain uh that I I begin to have

some the beginnings of relief from that experience I can't outrun this pain it's all natural sort of disposition to try and outrun pain isn't it that's the irony right we're really wired to outrun the pain we are like we reflexively seek out pleasure and avoid pain and yet that's the very thing thing that doesn't get us to where we want to go but we do now live in a world where it's very easy to outrun the pain yes this is a lion that's chasing me this could be a bad email and then I open up

a tab and start Doom scrolling or open up a tab and start watching video playing video games or pornography or whatever yeah that's exactly right there are so many ways that we can now distract ourselves from you know our own suffering or our own awareness and where do you find yourself now with dealing with that grief and the pain as we sit here yeah I mean I I feel like in many ways it's been a real gift in my life you know it's really informed my life in in ways that um I mean I I've

learned things from that experience that I think it would have been almost impossible for me to learn otherwise you deal with a lot of people that are in a state of suffering I imagine that's a weight because I um even hearing the story of the lady that passed away after that water addiction it was like a it was like a weight on my shoulders just to hear it so if your profession puts you right at the heart of this type of suffering how do you manage that to to hold that weight a couple things um

first of all a lot of people get better and when people with addiction get better it's so much better that it's incredibly rewarding to see and they're amazing people Absolut like the most tenacious talented people you'll ever meet and when they get better it impacts so many other people right their friends their family the people they work with so it's very rewarding work and and not at all burdensome of course you know for patients who don't don't get better or patients who die it's a terrible feeling and there is a sense of um responsibility and

and guilt even when I feel like there was nothing that I could have done otherwise um you know I carry those losses with me so it's hard is there any particular cases that have stayed with you the most I mean every patient I've had who's died while under my care those are incredibly painful um and I will never you know those are sort of a those people will be with me as a part of me for all of my life young and old yeah young and old yeah it's especially tragic to you to lose young

people and it always feels like their second gu ing like oh if only I had done that or if only we had intervened here but I just think that's the nature of death we we can't get away from the feelings of guilt around it no matter who we are and no matter the circumstances how young can addiction and the consequences of addiction ruin someone's life like how young can someone be when their life is ruined from from the work you've done and the the patients you've worked with and what are those addictions typically that seem

to be most um susceptible to those that are young well I mean you know some some kids start with drugs and alcohol you know five six seven eight five six yeah I mean it's you know some some some kids use with their parents or their caregivers they're exposed very early if we seriously conceptualize digital media as a drug I mean then we've got you know even younger cohorts starting with that and we do know that kids can get addicted to digital media and as a result um die from that I mean there was just this

tragic case of a young man who essentially got addicted to a chat box I think he was 14 not my patient it was written up um in the New York Times in the Wall Street Journal and he fell in love with this chat box started to isolate wasn't spending time with his family or friends and then eventually took his own life purportedly so he could join this imaginary person what's the youngest patient you've ever seen the youngest I've seen is probably around 15 14 15 and they had an addiction yeah usually cannabis alcohol nicotine can

you get addicted to cannabis oh yeah oh my gosh cannabis is very addictive really oh yeah yeah harmful very harmful the target organ that it damages the most is the brain um it's harmful in many ways I mean it number one it demotivates people often and so they can have the feeling that they're getting stuff done or that they're creative when in fact they're not doing anything um it most people smoke it and so it can be damaging to the lungs and and other other organs um a lot of people say that well cannabis isn't

addictive because I don't have this standard withdrawal phenomenon when I stop like I don't have the shakes or anything like that but keep in mind the universal symptoms of addiction are psychological symptoms anxiety irritability depression insomnia craving and people have that in Spades when they try to stop using cannabis plus we often see something called the hyperemesis syndrome so cannabis can help with nausea and vomiting it can help decrease the feeling of wanting to vomit but again as the brain continues to be exposed to it there's this process of neuro adaptation it stops working and

it can even turn on them and do the opposite So eventually people can actually have a cyclical vomiting syndrome as a result of cannabis so they'll show up in the emergency room and say I can't stop I can't stop vomiting and the reason is because of the Cannabis that they maybe initially started uh to stop feelings of nausea on page 40 of dopamine Nation you say we've lost the ability to tolerate even minor forms of discomfort yeah and as I was reading through this section of your book I was thinking it sounds like we've gone

a little bit soft in society um we've reset our pleasure pain threshold to the side of pain that even the slightest thing feels like trauma to us even things that objectively speaking a generation or two ago would not have been considered traumatic are now trauma we live in a bit of a trauma Society uh one that doesn't appear to be very resilient and the only measure of that that I have is if I think about the work that my grandfather had to do versus the work that you know people maybe in my generation do in

complain about and seem to be like objectively suffering over and stressed about it seems like there's been a shift in our threshold our tolerance levels can this be explained through dopamine what's going on here and do you believe that's true have we gone a bit soft I would say succinctly yes I do believe we have gone a bit soft but I don't think it's a moral problem or a character problem I actually think it's a physiological problem based on the fact that we're insulated from Pain and we're exposed to all kinds of Pleasures so I

really think that we have individually and collectively reset our reward Pathways to the side of pain meaning that the Gremlins have now accumulated on the pain side we've tipped ourselves to the side of pain because we've had so much pleasure because we've had so much pleasure yes thanks for having me clarify so that you now we need more and more pleasure to feel any pleasure at all and the slightest little pain and we're you know experiencing excruciating pain you add to that the fact that we have a culture that tells us we should never be

in pain and that if we are something's wrong with our life or something's wrong with our wife or something's wrong with our job and so now you've got you know a whole generation of folks who feels like they're experiencing more pain because they're literally don't do not have the mental calluses to tolerate pain and now they're being told and if you have any pain at all you must have you know something wrong with your brain go see a doctor go take a pill and I think this is really uh this is not a direction we

want to keep going in we have a mental health culture where we assume most things are mental health illness um in page 186 of your book you say I've become convinced that the way we tell our personal stories is a marker and predictor of mental health now if you live in a society where everything has a label and it's a it's a disease or an illness or you know I I don't feel good today so I've got this disorder and therefore I need this medication I guess there's two questions is my assessment of this situation

correct and be is this a bad place to be in a society where we think everything every feeling we have every you know we think everything that makes us different is a deficiency let me let me start let me let me answer this by talking a little bit about the role of language and narrative because I think this is very fascinating and you know as a psychiatrist and a therapist that is my bread and butter right is is narrative how people tell their stories by by giving language to our experience we gain awareness of our

conceptual models of the world okay okay and what I have learned over time is that the way people tell their stories is a window into their model of the world and that there are healthy narratives and not so healthy narratives and in general in my clinical experience when people come into the room and they tell their life story in such a way that they're always the victim of other people and Circumstance in the world those are people who are number one not doing well and number two not going to do well going forward unless they

change that narrative to acknowledge what they've contributed to the problem and the reason for that is because the way that we narrate Our Lives is not just a way to understand our past it actually is our road map for the future so if I see myself as a victim and that's my narrative I will literally create victimhood for myself going forward I will literally change my sensed experience so that whatever happens I'll make sure I end up as a victim when people with severe addiction get into recovery one of the most palpable changes that I

see is the way that they narrate their lives they go from in addiction talking about their lives as if it's always everybody else's fault to in recovery talking about their lives in a way that says oh you know what I could have done better here or you know what that's something that I keep doing that really messes with my life that I want to change and I'm going to figure out how to change that why is it so hard to take responsibility in such a way great question we just hate to do it because when

we do it we feel shame and shame is an incredible painful emotion it's like a gut punch of an emotion that is associated with fear of Abandonment fear of being shunn by our tribe we'd much rather paper that shame over with anger and resentment toward others it's it's interesting because there'll be a different groups of people listening to this now there'll be the high responsibility group that just love and revel and taking responsibility because they think taking responsibility means that they are strong it means that I'm so strong I can take the blame and withstand

it and it's funny cuz the more I've learned to take responsibility for things in certain areas of my life The more I've become proud of myself and the more I think I'm strong and I'm like oh look at me I can take responsibility for anything and it doesn't and then if you go down this spectrum you'll eventually get to the end of the spectrum where you've got people who even as they heard you say that will feel cognitive dis they'll feel a sense like a little it'll irritate them it'll piss them off and they will

be the whatab about gang they'll be saying yes but what about Dave he did this to me and you know they'll immed like the immediate reaction would be they they're pissed off they've probably gone now they've gone so we're not even talking to them anymore but if you but it's fine we can talk about them they're no longer here but that group of people my question really is how do you speak to that group of people and convince them that actually taking personal responsibility is a good thing for them and if they're focused on what

their core values or their North Star is in their life then personal responsibility is the path there not blame not victimhood you know like how do you turn those people around great question and I have to say what I know about this I learned from Al Alcoholics Anonymous and what they do because they do something that's really incredible first of all it's necessary to validate somebody's victimhood so this is to say you have been wrong if if they really have been wronged to validate that or you experience this trauma or you were born into this

crappy situation and you were just a kid and you had no choice about that and to really acknowledge that but then the fourth step of the 12 steps of Alcoholic Anonymous talks about looking at each of those situations and after writing down like this person wronged me and exactly what they did so you know taking time to focus on the resentment right then only after that to say okay but is there anything that I did that contributed to that problem is there anything at all that I could have done differently and for a little kid

you know born into a horrific situation you there's not much right that that a kid could have you know we don't we don't expect a child to take responsibility but the adult who was that child who continues to perpetuate some of th the harms they experienced on other people now we're talking now you can begin to take responsibility for your actions in the world so I think starting with validating you know the trauma or the victimhood or the way in which we were wronged processing it so giving it airtime right but not stopping there which

is by the way which is by the way often you know in therapy certain types of therapy that's often where we stop we don't then take it that very important next up and say but you know let's go and look at that again and like is there anything at all that you're contributing to this problem maybe it's just that you continue to ruminate about it right that like you're ruminating on your resentments is in a way your happy place and maybe that's what you need to stop doing so that form of sort of psychotherapy that

stops there can help keep us sick and make us sick it it it's interesting because someone that's in that therapy room who has ruminated themselves all the way down to having a low self-esteem being depressed or whatever um it appears to me that people who are at that sort of ground floor State find it hardest to take responsibility for some reason just that's an observation in my life that the the people that I have met that are the worst or that struggle the most with taking responsibility are those that have a very low self-esteem so

it's almost this double-edged like Catch 22 and then I I've also P pondered whether you know someone that never takes responsibility is more likely to have bad things happen to them make mistakes which are then going to further hurt their self-esteem which are going to make it even harder to take responsibility so I guess the question is is there this Rel is there a relationship between my current self-esteem and my ability or inability to take responsibility for a situation yeah great great question it brings to mind a a patient of mine who um who said

to me that um you know that and he had very very low self-esteem and he said essentially Dr ly I'm the piece of crap around which the universe revolves meaning that he had his own brand of narcissism in which he wasn't the most successful person he was the most successful at being the least successful person and that became his identity right that was sort of how he saw himself and also how he saw the world and it became very entrenched and it was a kind of a narcissism because he created then situations in order to

perpetuate like I'm the worst of the worst so I think the ways in which we get these sort of entrenched ideas about ourselves and the world can really hold us back from seeing clearly Who We Are Who other people are and what what the possibilities are does our personal narrative need to be positive I mean what do I guess what do you mean by positive like ra I'm great almost like have a have a positive ending because I was thinking about the personal narrative I've created in my life and my personal narrative is like kid

born in Africa came to the UK little bit of racial abuse here and there felt different shame insecurity parents weren't around this made me independent the shame made me motivated and then I did this this this and it went well that's like my personal narrative um but if my personal narrative was moved to Plymouth from Botswana in Africa a little bit of Shame little bit of pain parents weren't around my parents didn't love me people don't love me right right if my personal narrative ended there would it be you know would it be detrimental to

me ever becoming successful happy healthy I'm just wondering if because we all have a personal narrative we have like a story if we're up on stage and someone passes a mic to us and says tell us your story we'll narrate this version of events um skewed towards victimhood to heroism to you know yeah I mean as I said before how we narrate Our Lives is important right it's it's not trivial and there are healthier narratives and there are not healthy narratives and and I would argue that the you know the victim narrative where you know

perpetuates victimhood you could make the same argument that the the hero's journey narrative perpetuates hero good having said that if we get too stuck in any fixed Identity or any narrative I think that can become its own trap right and then we wall ourselves off feeling like we have to show up in a certain way or be a certain person and I wonder if you have that experience like you know you have this hero's journey and now you got to be this hero and I mean I could imagine that that would be burdensome at times

yeah I think it causes a lot of like dissonance internally what I mean like dis so when I say dissonance I mean discomfort internally because people meet a version of you that doesn't reflect the version of you that you know so like that the experience you have when you go like I go to the gym or something yes and I say this to my team all the time anyone that knows me personally his head me say this 50 times I will say the phrase I just don't understand what these people are talking about like I

just don't get it and I said to my team the other day in the office I went it's almost like I think they're lying to me and I said I was in this I was in this meeting group when you say you don't understand you mean when they when they praise you or okay yeah yeah it's so yeah unbelievable what they're saying to me that it um that it feels like you're I've not even watched the trumman show I just know what it means but it feels like this is these people are just all lying

to you yeah and I I was I think I was talking to Jack and the team the other day about going to Thailand and being so far away from home and people coming up to you like thousands of people we doing this meet and greet thing and saying these things to you and you and I said to the team I was like I think it's like it's part of my brain that's like these people are lying to me and also um yeah you can see how it can be a slippery slope to slide in to

their Narrative of you right and you've got to do quite a lot to just like stay at home what I mean by stay at home I don't mean like physical location I mean like staying grounded in like who you actually are right um and this goes for people that obviously you know have a a public platform or don't it's very easy for one person on the internet to say something to you and then you to start to accept that as your narrative it's easy for your parents to tell you that you should be a doctor

and then you go to university and you study to be a doctor and you become a doctor and then you start thinking you're a doctor and how that can sway you away from the full array of things that make you who you are the music you know the the whatever Hobbies you had yeah narratives are comfortable sometimes they make us feel heard and understood they make us fit yeah but they also are a double-edged sword because they can take us away from like who we actually are yes yeah so when I think about you know

your experience of feeling like people must be lying to you I mean sometimes we call this something like the impostor syndrome where you never thought of it like that you know it yeah projected personal that is is you know true in a way but also doesn't capture the fullness of who you are or maybe is so extreme in terms of um looking good that it's inevitable that you'll feel some dissonance with that kind of heroic figure and I think the way to think about that and also you know um not become like cynically suspicious of

people who who who praise you when they meet you is just to recognize that you have become a kind of Cipher or a vehicle for their projections so they've listened to you they've had a very positive experience or maybe they learned something and it meant a lot in their lives and you were the vehicle for that and so you're a symbol for them and they're projecting positive feelings onto you and because you're now integrated in their mental tapestry as kind of a you know a totemic figure or a token something important Sy interesting cuz part

of what you just as you were talking I was thinking you know what's interesting I don't even I'm not even the smart one in this I'm interviewing these smart people no and the smart people are changing their lives and then someone comes up to me in Thailand and says well you're wrong about that so you're obviously really smart and you also have you know a really high emotion quotient right which is its own kind of underappreciated smarts where you read people really well and you have intuitive reasoning and I mean I don't know you but

you also seem very humble and real and so all of these things that people have a craving for you know authenticity someone they can relate to um someone familiar I mean keep in mind too that more and more people live alone and have maybe fewer close contacts so a person like you with a regular show that they tune into to regularly you become you're in their living room yeah you're not just some distant celebrity like you are your voice is there your face is there they feel they know you because they've seen you in all

these different situations and I think that's really natural and normal and not a bad thing so you just have to realize when you go out into the world you know you You' become a symbol for people they're projecting onto you you don't have to necessarily identify with that but it's okay to let them have you know their experience through you if that makes any sense it makes a lot of sense okay yeah no it makes a lot of sense I felt the same imposter syndrome as you said everything there I was like that's um very

kind of you to say but it's it's just very I think part of the dissonance comes from the fact that I sit here in a room with you and there's only the person in this whole room we're in this big Studio here in Los Angeles is Jack yeah and so there's part of your brain the like prehistoric brain that thinks the three people that are aware of what happened in this room are me you and Jack that's it yeah and then you you go to you go to Kuwait right amazing and a comes up to

you in the gym and goes that conversation that you had about addiction right and that that's the dissonance like you went there yeah but it's I don't know the preo brain might might not be able to fully comprehend the idea of cameras and numbers you know people are listening at the moment oh no they feel that they're there and they and and again you you know the guests are totally secondary because they're watching because they're identifying with you and the questions that you ask as you yourself said are questions that you anticipate they would want

to ask right you said that so you are also channeling them when it comes to food I trust my gut and I trust Zoe a business I'm an investor in and today's sponsor of this podcast all the nutritionists I've spoken to have highlighted just how misleading information is out there when it comes to food take healthy Halos the claims you see on packaging that say things like low sugar and nothing artificial are often a sign of foods to avoid have you ever noticed a health claim on fresh fruit you probably get my point understandably there's

loads of distrust out there who should you turn to for accurate information I use Zoe which is backed by one of the world's largest microbiome databases and most scientifically Advanced atome gut health tests Zoe gives you proven science whenever you need it as a Zoe member you'll get an at-home test kit and personalized nutrition program to help you make smarter food choices that support your gut to sign up visit zoe.com and use my code stepen 10 for 10% off your membership that's zoe.com code Steven 10 trust your gut trust Zoe on this point of how

we help someone in our lives who's suffering with some of the things we've talked about today what is a bad way to try and help someone because we're in our in our love for them sometimes we do things which even in my own experience of people that are struggling in my life I think actually I think in my pursuit of helping them I've actually hurt them in some way yes well you know there's this whole uh sort of area of the addiction field called codependency and codependency refers to the ways in which a loved one

of the addicted person can actually enable or make their addiction worse without realizing it and without intending to and the way that essentially happens is that we can well number one addiction can is very often a family systems problem so the person who gets addicted their addiction affects everybody in the family and in order to cope and compens say families can end up in these very strange maladaptive places but they often have difficulty seeing how to get out of those situations or how their behavior is harming their addicted loved one because in a sense they

themselves get addicted to the addicted person and then use that addicted person to regulate the way that they feel so for example I treat a lot of families where like the adult child is deep in their addiction the parents know that the money they're giving the child is mostly going to drugs and yet cannot bring themselves to stop giving the money and often they're manipulated by the child the child saying well the adult child saying something like well if you don't give me money for drugs I'm going to go get it off the streets and

it's going to be laced with fentel then I'll I'm going to die and it's going to be on your hands so this kind of like emotional hostage taking but even when it's not that blatant what can happen is just this very fascinating very twisted and meshed relationship between the addicted person and the codependent person where again having the person engage in their Addiction in a way is a predictable scenario for the codependent person so even though they may say on the face of it they want this person to stop their Addiction on another another level

they really don't they get to be the Martyr they get to be the Savior or they even just get to predict what that person is doing based on their use I've had experiences in my life and this is why I really wanted to ask this question where I thought I was helping someone yeah and then the minute I withdrew the help and basically completely gave up the person got better yes but for six seven eight years this person struggled and the minute I stopped helping they got better I was like so I I I said

to my partner before when I was talking about this I was like it's possible to prop someone up in their like compulsive behavior and not realize you're doing it in fact there's three examples which me and my friends are aware of and one of my friends talks openly about this where I was propping him up yeah I was letting him stay at my house I was providing for him while he was in his struggles the minute I had a difficult conversation with him when he was I think I was 25 years old and he was

30 and I said you got to go you got to go you got to get out of my house he went back moved in with his parents in his childhood room he built up his whole life again he's out of the compulsive behaviors he's very successful very rich living abroad now I was like God if I hadn't have pushed him out my like basement he probably would still be there I thought I was doing him a favor and there's another really poent example to me quite recently where someone who I've known for many many many

years um minute I said to them listen and this sounds really harsh right because I tried paying for their therapy tried paying for everything for this person and eventually I got to the point where I said honestly I tried don't talk to me about this anymore yeah stop talking to me about it just don't message me about it don't talk to me about it anymore they got better yep yeah it's really F so so there um Kai Erikson wrote this book on deviants where he studied Puritan societies and found that no matter what group of

humans you looked at there was always there were always going to be people who were on the margins of the society he he use the word deviant his point being that groups of humans we just have these roles and we have these hierarchies and there's always somebody on top and always somebody below and when when we're occupying a certain Niche or when we stop occupying it we make room for somebody else so when you stop being the hero and the Savior that person had room to stop being the sick victim interesting yeah and my last

question on this then is how do you approach that conversation with that person because so often it's approached through frustration or shame or blame um what's the best way to approach someone who's struggling with a behavior to express that your concerned and to I don't know offer your help if that's a good thing I think we can always try to find our empathy for them without necessarily um doing things that would perpetuate or enable that behavior and we need to recognize that for many people with severe addiction the the the only thing that will get

them into recovery is real life consequences real life negative consequences and that our trying to protect them from that is not protecting them at all we've got to let them hit the rock bottom I mean this is a hard one because you have a lot of families now dealing with children who are severely addicted to opioids for whom you know being out on the streets might really result in their death so this is not for every situation but I can tell you in my clinical experience after 25 plus years the majority of people with severe

addiction who get into recovery get into recovery as the result of a real life negative consequences lost their job lost their partner ended up in jail what whatever it was until there are those significant consequences for some people they just won't be able to have the motivation to make a change guys back to a quote I had a long time ago some 10 years ago that said change happens when the pain of staying the same becomes greater than than the pain of making a change there you go that's a good one I want to talk

about digital drugs one of the subjects that's been recurring theme on this podcast inspired initially I think it was mentioned in an episode we had but then it was um such a huge amount of the feedback we got in the comment section that I thought we need to talk about this more because clearly there's a lot of people suffering we also then used a tool um which looks at what people are Googling in searching a lot and one of the most popular searches around the subject matter of addiction is pornography addiction yeah it's actually it

was number number one and four in the The Search tool that we used and the phrases people are using are how to stop pornograph addiction how to help someone with pornography addiction how to rewire my brain which are sort of all sort of correlated themes so pornography addiction something you see a lot oh my gosh I have to create a little bit of a space actually before I ask this question because I did a porn debate on the show and I got a very long voice note from a good friend of mine who said just

watch the porn debate there was two women there and a guy and me stevenh um but I just wish someone had mentioned that women get addicted to addicted to porn too yeah and then on the episode one of the top three comments on the episode is I'm a woman um it wasn't mentioned but I also have a pornography addiction and you've also kind of echoed that with the erotic like novels that you you mentioned romantic novels so pornography addiction do you see that often and I guess critically how does one go about overcoming that and

how do you know it's a pornography addiction I guess it goes back to the point of harm but yeah yes yeah so um I do think that pornography addiction is one of the biggest addictions and the most silent and the most shameful addictions that we have now in the modern world um we will not infrequently have a patient come in to the clinic who claims to have other problems and it's not until visit three or four that they finally fess up I'm really here for a pornography addiction there's so much shame around it it's so

incredibly shameful for people to admit that they are spending their time looking at these images often associated with compulsive masturbation some people their addiction manifests by actually pursuing Partners so dating apps are highly addictive and and meetups all of this is related to sex an orgasm which releases dopamine in the reward pathway but it's not just the moment of orgasm it's all of the rituals and the buildup and the searching um that's related to it women can get addicted to pornography as well as men although I would say that men outnumber women um probably you

know in my clinical experience um I don't know 10 to one women however are much more vulnerable to love addiction which is also real right uh the pathological compulsive falling in love with Partners um and then getting into these relationships that are really dramatic and not healthy and then falling out of love and then pursuing doing another love partner so the these addictions are real um they are very harmful for people who get addicted ultimately they're not even about sex they're about human attachment and the desire for human attachment and also just as a way

to self- soothe and Escape our own everyday suffering and I'm particularly concerned about girls and boys who now have access to all kinds of sexual images that would not have been possible for them to get access to a generation or two ago and now you know a child with five with an iPad can accidentally end up um on a site that has very graphic uh sexual images and videos so what's the harm of pornography watching pornography well there's a lot lot of potential harms one of the harms especially if combined with you know compulsive masturbation

is that just simply addictive which means that the more people do it the more they want to do it then they have the come down where they don't feel good and then pretty soon it becomes like a a compulsive repetitive Loop where they're spending large amounts of their day uh engaging in this activity and that that in itself is highly debilitating but other harms um I think that are significant are it really does change a person's conceptualization of what sex is is and what sex is for and I don't want to get into the whole

thing of like you know sex is exercise or sex is recreational fun compared with sex you know as something that's maybe more sacred because I I I I'm not here to judge any of that except to say that if a main pathway for a young person to learn about sex is through watching pornography that's going to give them a very distorted view of what you know real sex uh is like not to mention what relationships are like right and how sex um becomes a part of um an intimate relationship I've heard a few people say

that pornography lowers our motivation to go out there in the world and to pursue getting a job and getting a career and going to the gym etc etc and through the lens of what we've talked about today where dopamine was this motivating force for those rats to just reach out and eat the food if you remove the dopamine from the rat's and it wouldn't even eat food in front of it and it will starve to death when we think about men you said roughly in your practice about 90% of the people that come in with

a pornography addiction of men this all kind of overlaps to create this picture that in the modern world when we think about why more men are lonely why they're more often in their basements playing video games now or watching pornography than ever before why they're having less sex and having sex later um why they're struggling to form Rel relationships um why less men are potentially in college at the moment um maybe some of the answers are in the fact of just like how men are wired because if they've thinking this through if men are more

likely to have a disposition to these kinds of behaviors then these kinds of behaviors are more likely to impact and demotivate and destabilize men is that all like rough broadly accurate I absolutely agree which is why I've talked about the smartphone as a masturbation machine essentially these devices have become the way that we meet our physical emotional sexual intellectual needs and taken to the extreme that would mean that we're no longer relying on other people to meet those needs we're meeting the needs ourselves with with this technology and with the devices and I don't think

that's a future that anybody wants taken to the extreme right because we are social creatures we need to connect with each other human connection is vital to a thriving life and survival in general so yes I have a lot of concerns that that pornography is now replacing intimacy with people in real life or disrupting our expectations of intimacy with people in real life when you say expectations do you mean like hard work we have to do to create and find intimacy that too and also just expectations around sex a lot of folks that I work

with with sex addiction as they try to give up pornography compulsive masturbation or whatever they Define as their uh sexual adct sexually addictive behaviors what they find is that they almost go in the opposite direction and they kind of have zero interest in sex or they just don't have interest in sex with their real life partner or they can't enjoy sex with their real life partner you know which all kind of makes sense right when you hijack the reward pathway with this incredibly potent version of sex you come back down to earth with your actual

partner who's got his or her own needs and you know aging bodies or whatever it is um it's hard to experience pleasure in that realm in an attempt to offer people out there now that are struggling with some kind of form of compulsive Behavior or addiction a pathway to turn this around what is step one in your book I talk I've read all these incredible ideas is around the wisdom we can learn from addicts I learned about dopamine fasting and I also learned about radical honesty in the role that that plays what is the process

so someone listening to this right now they're struggling with one of these addictions they've got a pornography addiction they're addicted to gaming maybe it's food maybe it's erotic novels maybe they're on they Twilight the reading Twilight at the moment what what do you say to that person at the step one is step one is really just acknowledging the behavior that it's problematic and that it might require some changing in our lives um um the next step is being honest with ourselves and maybe another person about why we do the behavior what we get out of

it what's positive uh step three would be honestly making a list of all of the problems with the behavior how is it interfering with my goals and as we talked about my values what do other people say to me about how it's problematic is one of the problems potentially that it's just not working anymore the way that it used to right I'm developing tolerance I need more to get the same effect it's doing the opposite of what I want it to do and after we've done all that really done a really honest self assessment about

the behavior I recommend a 30-day dopamine fast now we're not really fasting from dopamine right because we're not really ingesting dop me what we're doing a fast from is whatever that substance or behavior is that is causing these kinds of problems potentially maybe we aren't even really sure but we think it might be give it up for 30 days why 30 days well we know that two weeks is not enough right we know that from this Imaging study right that people are still in that dopamine deficit state two weeks after stopping but 30 days based

on clinical experience not just mine but that of many other people who do this work that no for most people no matter the drug and no matter sort of the severity and chronicity once they get to about 30 days they begin to feel better they begin to come out of of that tunnel of constant craving they begin to be able to imagine a life in which they would um you know not necessarily have to rely on this substance or on this Behavior what I always tell folks when they're preparing for the dopamine fast is just

remember you will feel worse before you feel better but that is withdrawal mediated suffering once you get through those first 14 days you'll begin to feel better and potentially by 30 days you'll feel much better than you have in a really long time now this is not to say that 30 days of fasting is going to cure your addiction not at all um but it's the beginning it's the beginning of being able to see causality getting some insight it's an experiment right our lives are one big experiment what better way to understand the variables in

our lives than to change one thing one variable and see what happens do we then need to you talk about this concept of self-binding yes self-binding right what role not PL what this self-binding is a way of acknowledging that if we rely on Willpower alone we will not be successful especially living in this drug aied world and what we need to do is anticipate desire before we're in the throws of Desire by creating both literal and metacognitive or thought you know gunan experiment like barriers between ourselves and our drug of choice so these barriers can

be actual physical barriers like putting our device into a kitchen safe and locking it up over the night or leaving it outside of our bedroom or getting the potato chips the alcohol the Cannabis out of the house deleting our contact drug dealers information and telling our drug dealer don't call me and I won't call you um because these are all cues these are all cues that's right and the cues can be physical things so someone I see can cues cues can also be basically an emotion you talked about halt hungry angry tired I eat well

during the day like now as I leave here there'll be a salad I reckon in the in the Green Room over there for me and the only time where I'm susceptible to not eating well is if it's late and so when you said the hungry angry lonely tide thing that is probably the state that I'm in sometimes when I get home certainly hungry certainly tired probably a little bit lonely as well but certainly those two things and that seems to be when I'm most susceptible to making a regrettable decision as it relates to my dopamine

I've also wondered if if dopamine is responsible for what people almost call like the sugar Cravings that we have so what I've observed is in previous years of my life when when I was eating lots of sugar I would then go into about like a two week cycle of like binging the sugar and right now I'm in like a really great cycle of with my food where I have no cravings for the sugar I'm I'm in a staying in a hotel here in La there's a mini bar in the room with Oreos and gummy all

these chocolates and all these things and I haven't touched them because for some reason in this like couple of weeks of my life or whatever I just don't have the Cravings anymore but I kind of suspect that if I start eating them yes then the next four weeks will be a car crash yes why does this happen yeah it's so fascinating and and I think this is sort of a universal experience so first of all sugar is addictive it lights up the same reward pathway as drugs and alcohol clear dopamine release in the nucleus bins

part of the reward pathway in response to sugar and when we quit sugar we have a come down right we go into withdrawal and it's manifested in all the different ways that we've talked about and it lasts for about two weeks and one of the most Salient symptoms is intense craving for sugar and it's so amazing how intense it is but if we can get through that period and get out of that Vortex of addictive craving the craving gradually gets better and then eventually goes away which is by the way very paradoxical because whatever our

drug is when we first stop it we have intense cravings and we have the feeling that the Cravings will only get worse with time even though we logically may have experienced otherwise by giving it up before we have the feeling this is going to last forever it never does right with time the craving goes away and once we are in that Arena where we're not constantly craving we might have something that triggers the craving right but like stress but generally we're not dealing with a craving if we were then to reexpose our brains to a

little bit of sugar immediately back in the vortex of craving and there's an experiment I love that illustrates this it's an experiment in rats where rats were injected with cocaine the same amount of cocaine every day for seven days and over the course of those seven days the rats went from kind of hiding in the shadows of the cage to progressively running a little bit more and a little bit more and by day seven they were in a running frenzy right as measured by these beams of light that they were crossing then there was no

more cocaine injected after seven days and no cocaine or any addictive substance administered to the rats for a year which is a rat lifetime a really long time that would make you think oh you know that there's no more cocaine in the system no none of that and then the rats were injected with a single dose of cocaine and immediately they were plunged back into that running frenzy that you saw on day seven really important information because it tells us that there's some kind of permanent latent echo in our brains once we've been exposed to

and especially if we become addicted to a particular substance such that even with sustained abstinence on the order of years and decades if we are reexposed to that drug we can immediately be plunged into the depths of our addiction there's no ramp up period that happens and of course we see this all the time you know people with alcohol addiction who are then exposed to alcohol and right back to their Max use or even exposed to something like opioids and alcohol also works on our endogenous opioid system so there's some homology or similarity between alcohol

and opioids and then immediately being plunged into opioid addiction which then leads them back to their alcohol whole addiction it made me think about children it made me think about children because if I'm a 5-year-old and I'm binging on sugar yeah this sets me up for a life where I'm going to be I mean based on the analogy I just the experiment I just had based on the experiment I just heard there it sets me up for a life where I'm going to so easily slip right back into that addiction for sugar um and also

I know that the brain isn't fully developed when we're children so maybe the effect is even more um lasting significant is any of that true yeah it's all true which is why a big focus of the addiction medicine field is prevention and trying to make sure that we protect kids brains from the harms of these addictive substances and behaviors like what from sugar to digital media video games pornography social media or any other drug you know nicotine so many kids are vaping now you know taking 50 plus Puffs a day on their nicotine Vape cannabis

alcohol what's going on in the brain if we if a kid is exposed to those things so essentially at age five we have more neurons and neuronal connections than we have in the rest of our adult lives about 50% more neuronal connections than we'll have it as adults which is what makes us such good Learners when we're kids kids can just absorb anything because they're sort of like these Tod potent sponges with all these neurons and all these neuronal connections but we age through adolescence to about age 25 we cut back or what's called prune

the neural circuits that we don't use and we myelinate or make more efficient the neural circuits that we use most often such that by age 25 we are left with the neurological scaffolding that will serve us for the rest of our adult lives that means that if we're engaging in addictive maladaptive coping at a young age we're elaborating a neural circuitry based on that maladaptive coping which is going to set us up for addiction in adulthood I always like to emphasize though that because the Child and Adolescent brain is so plastic or Tod potent or

so changeable that's also a very hopeful message it means that even a young person exposed at a young age to an addictive substance if we can get in there early enough while their brain is still plastic enough we can rewire them whereas when I treat people in their 70s and ' 80s who have been you know smoking pot their whole lives or drinking alcohol mainly it was manageable now all of a sudden they retire they're in their 60s all this time the pot's a lot more potent they can develop these full-blown addictive disorders late in

life and it's very hard to treat them because they've lost a lot of that plasticity that would allow them to regenerate new neural Pathways once they abstain what is the most important thing that we didn't talk about that we should have as it relates to dopamine oh my God we talked about so much I I don't even know it seems like it was a lot of stuff I guess based on the questions you're exposed to from the general public is there anything that we missed that someone at home right now is going to be screaming

at the screen um talk about yeah well I mean I guess I would emphasize that when I talk about the dopamine fasting it's an early intervention it's not an intervention that I would recommend for someone who had repeatedly tried to quit on their own and been unable to you know clearly that would be an exercise and futility that person should go and get professional help maybe they need to go to a residential treatment center I also wouldn't recommend dopamine fasting or just quitting your drug of choice if you're at risk for a lifethreatening withdrawal so

we can have life-threatening withdrawal from alcohol and benzo isipin like clopin Xanax adaman again in those cases go see a professional get help with a medical detoxification before you try to you know sustain absence for a period of time so you know I would blanket the whole thing with like the caveat go see your addiction you go see the addiction medicine specialist near you thank you so much you're wel it's been so unbelievably um thought-provoking for for me in so many ways I thought I knew what dopamine was I thought I had covered all the

ground there was to cover on these subjects of sort of compulsive behaviors but I was so unbelievably wrong and it wasn't until I got into your book and started reading through your work that I was like oh my God most people have a clue about dopamine and the role it plays on us and this scale analogy is particularly memorable because that helps me to Think Through um many of the behaviors that I have in my life that I've either struggled with or become quite stubborn in various ways but also has turned a couple of lights

on to some of the things I said about like my sugar um eating sugar and um even like going to the gym and why like my motivation can seem to fluctuate with the gym sometimes it's so unbelievably important because this little neurotransmitter seems to control so much of our lives um and we never taught anything about it so we become these kind of puppets and the puppet master is this this brain which is firing off all of these neurotransmitters that are determining who we are who we become and also who we don't become um thank

you so so so much I I know you were nervous coming here today but I have to tell you you are very brilliant you're exceptionally brilliant in so many ways you you that's why I said you should start a podcast because you're really Built For This medium thank you you have a a certain warmth and empathy to you while while also being incredibly smart and accessible in the way that you communicate so please carry on because I I don't think although you overcame that the difficulty of those nerves I think there's so many hundreds of

thousands and millions of people listening now that are so thankful that you did oh like really thankful that you did and if youve just nudged their life a little bit in a better Direction that's that's worthwhile so thank you um we have a closing tradition on this podcast where the last guest leaves a question for the next guest without knowing who they're going to be leaving it for what is the most recent piece of information that changed your life I think the most recent piece of information that was very impactful for me was the realization

that we are probably going to be cybernetically enhanced in the future and interfacing with technology in a way that's completely seamless and that this is inevitable we're going to become cyborgs or at least we're going to be surrounded by the technology in a way that's invisible um and it's going it's going to be just completely integrated into our lives whether we'll it'll actually be under the skin I think it will be um but I can see in that so much potential good and promise and and so much that's really terrifying especially when I think about

the way it's going to change us as humans and my big fear about it is that we will become more and more isolated and that we'll end up sort of in these little cubicles of our own making scattered alone all across you know planet Earth I I hope it doesn't lead to that but that's that's my word it's interesting when we become connected to the internet and we truly interface with the internet we really don't need to use our physical being anymore because we can experience all the joy and adventure and travel digitally and that's

I mean it just messes with the incentive structures like we've talked about with dopamine yeah changes our ability to to get up and go and to do things I mean that's a lovely hopeful ending for us thank you so much yeah thanks for the opportunity to you know teach people about this information I hope it's helpful for people super helpful and I'm going to link both of these books below I've got the dopamine Nation book which was the original I believe yes um and then following That You released dopamine Nation workbook which is a practical

guide to find balance in an age of indulgence I highly recommend everybody reads these I'm going to go and reread them on my journey home back to London tonight so I really really appreciate you read these books and honestly everyone needs to go read these books I'm sure they will so thank you than you so much thank you so much do you know that 80% of New Year's resolutions fail by February it's because we focus too much on the end goal and we forget the small daily actions that actually move us forward those actions that

are easy to do are also easy not to do in life it's easy to save a dollar so it's also easy not to making one small Improvement each day one tiny step in the right direction has a big difference over time and that is the 1% mindset which is why we created the 1% diary a 90day journal designed to help you stay consistent and focus on the small wins and make real progress over time it also gives you access to the 1% Community a space where you can stay accountable motivated inspired along with many others

on the same Journey we launched the 1% diary in November and it sold out so now we're doing a second drop join the wait list at the diary.com and you'll be the first to know as soon as it's back in stock I'll put the link below [Music] ah [Music] [Music]