Audio Player
Starting at:
Addiction, Trauma, Porn, Dopamine Detox | Anna Lembke
November 6, 2023
•
2:29:55
•
undefined
Audio:
Download MP3
ℹ️ Timestamps visible: Timestamps may be inaccurate if the MP3 has dynamically injected ads. Hide timestamps.
Transcript
Enhanced with Timestamps
360 sentences
22,911 words
Method: api-polled
Transcription time: 145m 2s
The Economist covers math, physics, philosophy, and AI in a manner that shows how different countries perceive developments and how they impact markets. They recently published a piece on China's new neutrino detector. They cover extending life via mitochondrial transplants, creating an entirely new field of medicine. But it's also not just science they analyze.
Culture, they analyze finance, economics, business, international affairs across every region. I'm particularly liking their new insider feature. It was just launched this month. It gives you, it gives me, a front row access to The Economist's internal editorial debates.
Where senior editors argue through the news with world leaders and policy makers in twice weekly long format shows. Basically an extremely high quality podcast. Whether it's scientific innovation or shifting global politics, The Economist provides comprehensive coverage beyond headlines. As a toe listener, you get a special discount. Head over to economist.com slash TOE to subscribe. That's economist.com slash TOE for your discount.
Think Verizon, the best 5G network is expensive? Think again. Bring in your AT&T or T-Mobile bill to a Verizon store today and we'll give you a better deal. Now what to do with your unwanted bills? Ever seen an origami version of the Miami Bull?
Jokes aside, Verizon has the most ways to save on phones and plans where you can get a single line with everything you need. So bring in your bill to your local Miami Verizon store today and we'll give you a better deal.
The reason that you're depressed or anxious or inattentive or unable to sleep or just not interested in your life could be because of this
you're using or this high-potency behavior like pornography and masturbation or online gambling or video game. And if you could just cut that out for a period of time, that would allow those neuroadaptation gremlins to hop off the pain set of the balance and for homeostasis to be restored.
Anna Lemke is an award-winning professor at Stanford University, who's written extensively on behavioral sciences, addiction, and psychiatry. She demonstrates how the most minor of activities can lead to ruinous habit formation. And in this podcast, we talk specifically about action steps you can take if you find yourself addicted to pornography, to social media, to masturbation, to drugs, to your phone, to coffee, to virtually anything because addiction uses the same dopaminergic reward pathways
and so luckily the treatments themselves can be generalized. Questions explored are how do you know you're addicted? Is that different than just being reliant on something like sex or shopping or eating? Is it different than a predilection? We also covered trauma and how that relates to cravings and what you can do about it of course. Professor Lemke is warm, inviting, and a decidedly open person. Such candidness is rarely seen in any human
Let alone a guest on a podcast. I highly recommend picking up her book dopamine nation link is in the description as it'll give you insight into yourself to temper a mild to moderate addiction or dependency recognize when you're on such a road and also show you how to help others who are close to you that are going through something like this directly inspired by the book in the discord right now you can go and there's a new channel that's been created called dopamine detox where in November for
30 days i'm personally going to abstain from something which i'll announce there and other people will similarly dopamine detox you can choose whatever you like you can announce it and you'll have other people to hold you accountable and a place to go when you feel pulled to what you're supposed to be as chewing so think of something that you would like to rid yourself of for the next 30 days and we can do so together as a toe community making the process much less painful maybe even enjoyable
I forgot to mention my name is Kurt Jaimungal. For those of you who are new to this channel, it's Theories of Everything, where ordinarily it's highly abstract, sometimes philosophical. How do you reconcile general relativity with quantum field theory, for instance? Or what is modal epistemology and what does that have to do with the morality of artificial intelligence, independent of whether such AI systems can be conscious? Whereas this episode is a decidedly more practical one, much like the episode with Lillian Dindo. Anyhow, enjoy this podcast with Anna Lemke.
Professor, I'm so happy to have you on. Thank you. And I've been going through your book, dopamine, dopamine nation right here. Me and my wife actually have been going through it. She has some comments. She's like, Oh, babe, she writes so well. Please let her know that. Ah, that's nice. Thank you. I spoke with you. I don't know if you recall how we met, but we met with Carl Friston at this event online on zoom. Yeah, of course.
Yeah, that was wonderful. You did a great job moderating a diverse panel. Thank you. Thank you. So my first question to you is, can you please tell the audience your experience with addiction? Sure. So addiction runs in my family, specifically alcohol use disorder.
But I thought that those genes had skipped me, so to speak, because my early exposure to alcohol was that it wasn't reinforcing at all for me. It just made me sleepy and gave me a headache. So I thought, oh, I guess I don't have whatever that is that people have that makes them vulnerable to addiction. And that was also true for other substances that I had tried.
And I just generally felt like I was just too anxious a person to ever want to be sort of out of control, which is how I sort of viewed addiction before I knew anything about it. Little did I know that really addiction is in many ways the manifestation of an intense desire to be in control. Anyway, interestingly, in my early 40s, I happened upon the whole genre of romance novels.
And I have always been a reader and reading has been my great escape from early childhood. And for whatever reason, it was actually the Twilight Saga. For those of you who are not familiar, it's a teenage vampire romance series. So in middle age, I somehow read it because some of my middle age friends told me it was really good and it really transported me. So it just took me outside of myself in a way a book hadn't done for a long time. So again, fiction has always done that for me to some degree.
but I kind of got really into the whole romance novel genre and started reading every romance novel that I could find. It started with the vampires and the werewolves and the necromancers, soothsayers, and then it branched out to romance novels more broadly. But interestingly, it wasn't until I got a Kindle that I really became a compulsive reader. What happened as soon as I finished reading one, I could buy another one, I could get them very cheaply on Amazon.
I started reading a lot more. I started staying up later and later at night. The other thing was that it was anonymous so that I could read these things that I would generally be embarrassed if somebody found the book lying around. But on my Kindle, nobody knew. And so the combination of those two things, the easy access to what turned out to be an infinite universe of romance novels and the immediate delivery and the anonymity
Those things conspired to turn me essentially into a romance novel addict, so to speak. And again, I don't want to trivialize life-threatening addiction by comparing my experience without some caveats to the problem of life-threatening addiction, which I see and treat in the clinic. But I will say that there were a remarkable number of similarities to what was happening to me in my compulsive reading habit.
over a couple of years and the same kinds of patterns that I was seeing my patients. So to make a longer story short, I essentially realized one day that I had a problem and I sort of on myself did the kinds of interventions I asked my patients to do. Namely, I abstained from all romance novels for 30 days and found that I felt a lot better at the end of that time period.
I had gotten progressively more depressed and anxious as people with addiction will do. And when I stopped, I felt better. Then I thought, okay, I can go back to reading in moderation. Then I had what we call the absence violation. So a binge episode where I read all weekend long doing anything else and then decided, oh, I actually can't moderate this behavior. It's really out of control and compulsive. So then I gave up romance novels, uh, essentially forever from, from that point on.
So it's not advisable to test, do I still have this addiction? Let me dip my toe back in. Do not do that if you have an addiction. No, I wouldn't say that. I would say in fact that the majority of our patients who are willing to engage in the abstinence trial, the dopamine fast for 30 days want to go back to using their drug of choice, but they want to use differently. They want to use less. They want to use in a way that's not as fraught and harmful.
And some of them are able to do that with enormous effort and a lot of barriers. Most of them are not able to do that. And so but eventually have to test it out a number of times before coming to that conclusion. Can you clarify what you mean when you say drug of choice? Because I assume that it's not just something physical. It could be an action and also clarify what you mean by addiction, please.
Sure. So addiction is the continued compulsive use of a substance or behavior despite harm to self and or others. When we diagnose addiction clinically, we base it on phenomenology, which is to say very recognizable and repeatable patterns of behaviors that occur across ethnic groups, cultures, time periods that meet this criteria and usually composed of the three C's control compulsion consequences,
That is to say out of control use, compulsive use and continued use despite consequences, as well as often tolerance, which is needing more of the drug over time to get the same effect or finding that your drug has stopped working or doing for you what it used to do. And then withdrawal, which is finding that when we try to cut back or quit, that we have a pretty recognizable withdrawal pattern, which makes it difficult. So that's what addiction is.
Drug of choice is a really important concept that's understudied in the field of addiction, but it speaks to the enormous inter-individual variability between humans in terms of what is reinforcing for their unique brains. Alcohol, for example, and other drugs, traditional drugs tend not to be particularly reinforcing for me.
So I just assumed that I don't have this vulnerability to addiction, but it turned out I just hadn't yet met my drug of choice, which turns out to be in this area of love, attachment, combined with narrative stories and reading. And that turns out to be my drug of choice, what I'm vulnerable to if other factors conspire to make it very, very accessible, very anonymous.
So drug of choice is really important and it also speaks to really important aspect of the time that we live in now in that
not only do we have more potent forms and more accessibility to traditional drugs like nicotine, alcohol, cannabis, opioids, stimulants, but we also have a whole universe of drugs that didn't exist before. We have online pornography, we have video games, we have online shopping, we have social media, we have Twitter, we have all these digital drugs essentially.
Which many of which are about human attachment which have now exploded the vulnerability To the problem of addiction because now if you haven't found your drug of choice yet It's coming soon to a website near you. Hmm. How does one disentangle a dopamine seeking behavior from a coping mechanism? Addiction is maladaptive coping so it can start out as
Adaptive coping, in general, people usually rely on high dopamine rewards.
They bind to certain receptors receptors in our brain or stimulate certain neural circuits in our brain that then as a downstream effect trigger the release of dopamine in our dedicated reward pathway. So I just use it as a shorthand talk about high dopamine substances, but the substances themselves don't have dopamine in them. If I were to eat a spoonful of dopamine, it would do absolutely nothing because it wouldn't even cross my blood brain barrier. So typically people, you know,
Start out using a substance or a behavior for one of two reasons, either to have fun or to solve a problem. And when it's in the to solve a problem category, then it's essentially a coping mechanism, right? And the reason that people return to using a second, third or gazillionth time, whatever it may be,
Is because it works, right? It does what I was looking for. It makes me, it takes the edge off my anxiety. It helps me go to sleep. It elevates my mood. It helps me pay attention, whatever it is. It alleviates my boredom. It makes me feel less lonely. You name it. Um, but the problem is, you know, that with repeated exposure to the same or similar reinforcing substances, the brain adapts.
It starts to down regulate dopamine transmission as well as other neurotransmitters that are there to make us feel good in order to respond to injury or respond to need. And then eventually we can end up in this kind of chronic dopamine deficit state, which is characterized by anxiety, irritability, insomnia, depression, craving. So the very thing that we were trying to solve turns out to be the thing that we then exacerbate with continued use. And that's when we've entered addicted brain.
When we're harming self and or others, and yet we continue to use that substance, even though it's essentially causing harm or continue to do that behavior, even though it's causing harm. Is there a reason why we don't hear about serotonin detoxing? We hear about dopamine detoxing. And yeah, also in your book, I sense that you're dispelling the dopamine is purely a feel good hormone. It's more something released in anticipation of a reward. And it's not as if it's
Yeah, so let me let me just parse that a little bit.
So different substances and behaviors work through their own unique chemical cascades. Traditional drugs of abuse are essentially addictive or reinforcing because they mimic a chemical we already make, right? So we already make our own endogenous opioids. The reason people get addicted to opioids that occur in nature is because they do what our brains already do, but usually in a much more potent way.
LSD mimics the serotonin that our brains already makes. Typically, we get that wonderful oneness or expansive feeling or that feeling of connection to others with opioids. We get either a euphorin effect or we get a pain relieving effect or anxiolytic effect. Alcohol works through our GABA and opioid systems.
And so nicotine works on our nicotinic acetylcholine receptors, cannabis works on our endocannabinoid system. Love and attachment probably works through both the opioid and serotonin systems, right? So you've got, you know, gambling probably works through serotonin and norepinephrine, which is our stimulation system. So these are very complex chemical cascades.
But the final common pathway for all reinforcing drugs and behaviors turns out to be the release of dopamine in this dedicated reward circuit consisting broadly of the nucleus accumbens, the ventral tegmental area, which are rich in dopamine releasing neurons and connect to the prefrontal cortex, which is our control center of the brain right behind our foreheads. So
Talking about dopamine is just a simplified way of talking about the ultimate result of all of these reinforcing behaviors. So one way to think about dopamine is that it's the neurotransmitter that says to us, whatever it is you're doing right now that caused me to be released in your brain, this is something that you need to pay a lot of attention to because it's important to your survival, right?
Uh-huh. Dopamine is the neurotransmitter that says pay attention to what's going on. It's important. It could be crucial to your survival and you probably will want to do it again and again and again. Now, what is the role of dopamine and is it really involved in pleasure? And the answer is that with initial exposure, it absolutely is involved with pleasure.
Because we know that different intoxicants and reinforcing substances and behaviors release a lot of dopamine all at once in the reward pathway. And so that dopamine is what makes us feel good and want to do that thing again. However, dopamine is also really important to anticipation of pleasure because
When we anticipate doing that thing that released a lot of dopamine, we also get a little hit of dopamine followed by a little mini dopamine deficit state, which then creates the craving to want us to go get the real deal so that we can get more of that dopamine. Furthermore, as people repeatedly expose their brain to reinforcing substances and behaviors, the brain adapts to those high levels of dopamine, especially if they're exceedingly high, which is what intoxicants will do. And remember,
Our brain, this reward circuitry, evolved in a world of scarcity and ever-present danger where generally there weren't a lot of rewards around. We had to really work hard to get them. We had to go hungry and walk tens of kilometers and
You know being without shelter and look for people and then after working really hard You know find a little bit of a reward to give us a little hit of dopamine that basically just put us back to our homeostatic base What we have now is we have at the touch of our fingertips these Explosively potent dopamine releasers that give us an explosion of dopamine all at once and our brains are reeling to compensate
and compensate by going into this dopamine deficit state so that over time our drug of choice doesn't release much dopamine at all anymore. Instead what it does is contributes to this compensatory dopamine deficit state as part of the opponent process mechanism. So when we talk about dopamine and whether or not it's about pleasure or whether about reward or whether about anticipation reward, you have to take into account
Where in the cycle of exposure to that particular stimulus, the organism is the first time the organism is exposed. If it's important for survival or the organism sees it that way, it will lead to a huge release of dopamine and that is pleasurable. Otherwise we wouldn't know to approach it again. Right? So this idea that people say, Oh, it doesn't have anything to do with pleasure. It's just about, you know, the differential between the baseline and anticipates like, no,
Okay, great, great. Now here, I know that the people who are listening won't be able to see this, but this is a page from your book, and I'd like you to describe the image and then explain what it's trying to illustrate.
Right, so this is a metaphor that I use in the book to try to help people understand what happens in the brain as we become addicted. What is the result of repeatedly exposing our brains to highly reinforcing dopamine-releasing substances and behaviors? And I use the metaphor of a balance or like a seesaw in a kid's playground representing how we process pleasure and pain.
To me, it's very exciting that much of the neuroscience in the last 75 years suggests that pleasure and pain are co-located in the brain. The same parts of the brain that process pleasure also process pain. And you could say they work like opposite sides of a balance. That's obviously highly reductionistic and oversimplified, but as a general metaphor to explain homeostasis and allostasis, I think it works well. So going with that metaphor, when I read a romance novel,
Because that's a drug of choice for me, along with chocolate and YouTube videos and other things. I get a release of dopamine in my brain's reward pathway. That's why you didn't watch the YouTube video I sent you. Exactly. That's going to trigger you. Really, I was in clinic all day and didn't have time. But yeah, that would be another good reason for me not to watch it.
Anyway, that releases dopamine in my brain's reward pathway and my balance tilts to the side of pleasure. But there are certain rules governing this balance. And the first and most important rule is that the balance wants to remain level, or what neuroscientists call homeostasis. We're always releasing dopamine at a baseline tonic level. Our brains want to go back to that. The question is, how do our brains do that? And the way our brains do that is
First, by tilting an equal and opposite amount to whatever the initial stimulus is. And I like to imagine that as these neuro adaptation gremlins. They hop on the pain side of the balance to bring me level again, but they like it on the balance. So they stay on until that balance is tilted an equal and opposite amount to the side of pain. That's the come down the blue Monday, the hangover, that moment of wanting to watch one more YouTube video or chapter in my romance novel have one or two or maybe 10 more pieces of chocolate.
Now if i resist that urge which requires resistance because remember the balance wants return to the level position so when i'm those gremlins are on the pain side of balance if i have a box of chocolate they're very hard not to eat another one but if i wait enough time maybe it's seconds maybe it's minutes maybe it's hours maybe it's days gremlins hop off and homeostasis is restored.
Here's the second rule of the balance if i continue to expose my brain repeatedly to these high dopamine releasing rewards that initial deviation to pleasure gets weaker and shorter but that after response to pain gets stronger and longer in other words the gremlins multiply and they get bigger and stronger and pretty soon i have enough gremlins on the pain side of my balance
To fill this whole room and they're camped out there and that is alo stasis that's where we change our hedonic or joy set point now i need more of my drug in more potent potent forms not to feel good but just to level the balance and feel normal.
I'm walking around with a balance that's tilted to the side of pain, and I'm experiencing the universal symptoms of withdrawal from any addictive substance or behavior, which are anxiety, irritability, insomnia, dysphoria, and craving. And the reason this is so tricky in clinical care
is because patients will say well my cannabis is the only thing that alleviates my anxiety or alcohol is the only thing that helps my depression and if you could just fix my depression or fix my anxiety i wouldn't get addicted what they are i wouldn't use the substance in an addictive way but what they don't see is what was initially a solution
to their problem of depression and anxiety has actually become the cause of their depression and anxiety. Sorry. Go ahead. No, please interrupt me. You just performed a restorative linguistic switch here. You flipped there the to an A. So for instance, they said this was the solution. This is the only thing that helps me. In other words of the then you said what was initially a solution. So you changed it to it's not just one. It was it could have been many. Right. And so they have a narrow view.
That's right. Coming to overvalue this particular substance or behavior, kind of narrowing of their focus or interests, everything else kind of loses its color, nothing is interesting anymore, or things that used to be pleasurable and are just going to become less pleasurable. This is what happens in addiction. It becomes just this one thing can alleviate my anxiety, or this is the only thing that I'm interested in. For example, in my own life,
As I got started to spend more and more time reading romance novels, staying up later and later every night, reading romance novels at family functions, reading romance novels at work in between patients. The subtle change that occurred that I didn't link to the reading romance novels, but which was indeed linked, was that I started to enjoy my work less, started to enjoy my family less. I started to get more depressed. I started to get more anxious.
And I started to feel more and more, I just want to be reading romance novels all the time. It's a great escape. It's the only place I want to be, the only thing I like doing. Other hobbies fell to the wayside. So this kind of sort of narrowing of focus, this sort of blinders on, this overvaluing this one activity, this having the sense that only this thing is going to give me joy and pleasure and not seeing that in fact it is this activity
with this, you know, which was initially reinforcing, which is now contributing to my dopamine deficit state or my changed hedonic set point. And the reason that we know this is because we have neuroimaging studies in humans that show, you know, once people stop using their drug dopamine, well, when they're when they're using their drug,
dopamine levels are actually below the levels of healthy control subjects. So you would think, Oh my God, they're ingesting all these drugs. They should have sky high dopamine. No, the opposite is true. They have, they have sub normal levels. It would be because their brain has downregulated postsynaptic dopamine receptors, downregulated dopamine production, all as a way to compensate for this artificial, uh, you know, a bathing of their brain in, in these dope in dopamine, due to these exogenous exogenous sources.
So I interrupted you when you were saying that they said this is the only solution and then this is something that initially was a solution, but has now become a problem dot dot dot. Right. So patients will come in and say, this is, you know, a doctor, I need help with my depression or my anxiety or my inattention, whatever it is. And I'll say to them, well, I think there's a distinct possibility because of this process of neuro adaptation and, and allostasis.
that the reason that you're depressed or anxious or inattentive or unable to sleep or just not interested in your life could be because of this high potency substance that you're using or this high potency behavior like pornography and masturbation or online gambling or video games. And if you could just cut that out for a period of time, that would allow those neuro adaptation gremlins to hop off the pain side of the balance and for homeostasis to be restored.
I want to emphasize we're not asking people to go live in a cave and not have any sensory experiences. What we're asking them to do is identify the problematic substance or behavior in their lives. It's not one that I judge to be problematic. It's one that they've judged to be problematic or a family member has judged to be problematic. And I say, well, let's eliminate that for 30 days.
Give time for those neuro adaptation gremlins to hop off the pain side of the balance and for homeostasis to be restored. Recognize that when you first give it up, because you've been accumulating those gremlins on the pain side of the balance, you're going to feel worse before you feel better. You're going to slam down to the side of pain, but that's withdrawal mediated. And if you can just get through the first 10 to 14 days, those gremlins will get the memo that they should hop off homeostasis or baseline levels of dopamine firing will be restored. And I bet you will feel better without her having to do any other intervention.
And they're understandably skeptical because what they say is, I've tried every antidepressant, I've tried every psychotherapy, but I can tell you that the only thing that relieves my anxiety, depression, insomnia and attention is this substance or this behavior. And that's when I validate and I say, I hear you that in that moment it feels better, but all you're really doing is temporarily restoring a level balance from that pain position
and causing those gremlins to multiply further. What you really need to do is give up that substance altogether, let those gremlins hop off and restore homeostasis that way, rather than being at war with the gremlins. And what we find is that about 80% of folks who are willing to do that feel enormously improved after 30 days of abstinence without our having done any other intervention. And this is supported by
An experiment that was done a long time ago now, probably 20 years ago by Brown and Chuckett, where they took a cohort of adult males who had alcohol use disorder, alcoholism, who also met criteria for major depressive disorder. They put them in a hospital where they had no access to alcohol for one month.
They did not give them any treatment for depression at all, not no psychotherapy, no meds, nothing. At the end of that time period, 80% of those individuals no longer met criteria for major depressive episode. So simply by stopping drinking, their symptoms of depression resolved. And we see that again and again and again in clinical care. Another phrase you mentioned that's cool is that you said, Hey, I'm not asking you to go live in a cave for 30 days. Now,
Would living in a cave for 30 days be salutary or deleterious? Now, the reason I would think it would be deleterious, and you could tell me if I'm incorrect, is that it's solving something that's quote unquote extreme, like an addiction with something else that's extreme. And so then when they come back into the real world, well, they may have solved their problem in a cave, but then they deal with all the triggers of the real world. So some people when they when they're going through some
Let's say mental health issues. They feel like what I need to do, I need to go to Brazil and take ayahuasca. I need to do something extreme. I need to go live in the woods for seven days alone. Is it replacing something that's let me rephrase that. Is it replacing something intense with something else that's intense or not? Maybe it's OK. You could you could do that. In fact, that's better. Go live in a cave for 30 days.
You know, I think there are many paths to the top of the mountain. You know, it could be that for some individuals being in something like a cave for 30 days might actually be helpful. I think I was using that more metaphorically though, to talk a little bit about, you know, how the term dopamine fasting is often used here in Silicon Valley that you have
And I think that that's not what we're recommending to our patients because our patients are coming to us
You know, with mental health issues, addiction and other mental health issues, we would never recommend that folks in that fragile and vulnerable state go into a cave. What we might recommend is that they go to a 30-day residential rehabilitation facility where they don't have access to alcohol, but where they're surrounded by people with whom they can make positive therapeutic connections, where they might get prescribed some medications, where they're in group and individual therapy.
But nonetheless, the sort of Silicon Valley dopamine fast, the point there is I think a broader one, which is to say we live in a society today, which is very, very noisy. We are constantly overstimulated, constantly being asked to react to enormous quantities of flooding really of information. And as a result, our brains
are stressed, you know, we are we are kind of in this constant state of hyper arousal. And because of that, the point is, I think we could all benefit from in different ways, kind of quieting our lives for a period of time, or doing a fast from something that we consume more than we would like. And this is the approach that we take. It's not that it's not really realistic, frankly, for most people to even go away to like a retreat or something like that. Most people just have to keep going with their lives.
What they can do is identify one or two substances or behaviors that they use in an out of control, compulsive, and harmful way that they would like to manage better in their lives and focus on giving that up for 30 days and then seeing what the impact is. It's really an experiment.
Life is one big experiment. Why not experiment with these everyday behaviors and habits? One of the ways to figure out how a system works is to change a variable in that system and record what happens. And so that's essentially what we're asking people do the experiment, eliminate alcohol, as long as you're not at risk for life threatening withdrawal, right? Eliminate cannabis, eliminate pornography and compulsive masturbation, eliminate video games, eliminate romance novels, see what happens.
It can be very instructive for me. It certainly was. I experienced actual withdrawal where I had intense insomnia in the first 10 to 14 days. That's what we would expect people in those first 10 to 14 days, whether they're giving up sugar or giving up romance novels, they it's hard, but by weeks three and four, what I experienced and what most of our patients experience is the craving eventually subsides.
mood gets better, anxiety lessens, there's a sort of quiet, quieting and centering that happens. There's an ability to be more present because we're not constantly looking forward to some future reward, right? Because if you think about it, if you organize your whole day around getting past right now, you and I talking to each other so that I can get to, you know, whatever my Netflix binge or my romance novel or my whatever, you know,
Then it's harder to be fully present in the moment. But if we give up the kinds of rewards that we're all using to shape our day, we can be fully more present and people talk about that a lot. I'm able to be more present for my spouse, more present for my children, more present for other tasks that I have to do. So this is the kind of thing that we we ask. It sounds like the first two weeks will be the most difficult for sure. What should people expect? You mentioned insomnia.
And what should people do in order to get it over some of the common side effects or detrimental effects or whatever we want to call them. So if one is an AA, I imagine that they can call someone you have a partner. Now this many people who are listening, they have people in their lives, but they're alone in this regard. What are they to do?
Well, I do think it is very important to stay connected to other people. Ideally, you would maybe do the exercise together with somebody else. So you're encouraging each other, helping each other remain accountable. This can be in the context of a mutual health group like Alcoholics Anonymous or Cannabis Anonymous or Sexaholics Anonymous or just with a loving partner or a family member or friend.
Who knows what you're going through maybe shares that problem and you can do it together. If you're doing it on your own you can have a trusted individual. Let people know you know that you're doing it so that they can help support you in other ways even if they are not themselves engaging in
in the dopamine fast activity. Um, I think learning how to just sit with the uncomfortable emotions without reaching for our maladaptive, uh, you know, high dopamine reward, um, and observing how that craving can come and go and, and, and that we can endure it. This is sometimes called surfing urge surfing that it can sweep over us like a way, but it doesn't last forever. That can be empowering.
For people creating alternate activities now one danger with alternate activities sometimes we replace one reward with another right so instead of reading romance novel i'm gonna have a cookie.
But the problem with that is cookies are also highly potent and I might end up getting addicted to cookies or compulsively eating cookies or just gaining weight, which is not something I would necessarily want to do. So sometimes we recommend actually something called hormesis. Hormesis is Greek for to set in motion. It's about how we can use painful stimuli to actually upregulate dopamine and other neurotransmitters. So this would be things like exercising or
You mentioned in one of your talks that there's a misconception about the present moment that we think of it as a blissful state, but rather it's characterized by a painful tedium. Can you outline that and help people help set expectations correctly to
guide them through this boredom that they'll experience when they no longer have this addiction or when it's interrupting their thoughts and they have to not follow it. Yeah, so yeah, let me qualify that that quote a little bit. I will say that being present in the moment can be wonderful. But I know that, you know, in my youth, I would often, you know, hear people like Ram Dass say be here now and things like that. And I always tried to do that and found that
That was intensely uncomfortable for me because being in my own thoughts and in my own body, I didn't want to be there. That wasn't a particularly delightful place. I have a lot of anxious ruminations and things I worry about and guilt I feel and regrets and on and on. I always thought, well,
You know, I must not be doing the being in the moment correctly, because if I were, uh, wouldn't I experience some kind of levitating bliss? Cause that seems to be what people are promising. It really took until midlife for me to realize, Oh, be here now means being in my mind and in my body, even if it's not a particularly comfortable place. And even if I find myself, you know, circling the drain on repetitive ruminative thoughts,
If I stay there long enough and breathe or do whatever other meditation exercises to help with grounding and centering, eventually those kinds of thoughts lose their potency or instead help inform decision making and moving forward. That voice of our own consciousness telling us
Things we need to do and listening to it and saying, oh, I should probably do that. If my mind is telling me enough times I should do that, I should say sorry or write a letter, things like that, instead of constantly trying to distract ourselves from ourselves.
Razor blades are like diving boards. The longer the board, the more the wobble, the more the wobble, the more nicks, cuts, scrapes. A bad shave isn't a blade problem, it's an extension problem. Henson is a family-owned aerospace parts manufacturer that's made parts for the International Space Station and the Mars Rover.
Now they're bringing that precision engineering to your shaving experience. By using aerospace-grade CNC machines, Henson makes razors that extend less than the thickness of a human hair. The razor also has built-in channels that evacuates hair and cream, which make clogging virtually impossible. Henson Shaving wants to produce the best razors, not the best razor business, so that means no plastics, no subscriptions, no proprietary blades, and no planned obsolescence.
It's also extremely affordable. The Henson razor works with the standard dual edge blades that give you that old school shave with the benefits of this new school tech. It's time to say no to subscriptions and yes to a razor that'll last you a lifetime. Visit hensonshaving.com slash everything.
If you use that code, you'll get two years worth of blades for free. Just make sure to add them to the cart. Plus 100 free blades when you head to H E N S O N S H A V I N G dot com slash everything and use the code everything. Speaking of the unconscious and listening to it, it's psychoanalysis. They have an emphasis on the psyche comprising different
Personalities some that are nested some that are intersecting or structures intra-psychic structures. How do these have? Bearing on the struggles people will face in addiction and also I want to transition to trauma so you can also talk about that as well Okay, so are you talking about like the id the ego the superego? Yeah, and Jung is quite Elaborate it's much more than that. He is more broke there are more complexes and personas and archetypes and a collective
Yeah, I mean, you have sort of departs, yeah, right, departs from Freud in that, you know, Freud believes that I mean, Freud's great contribution was that we have this unconscious, right, where we can have these experiences outside of conscious awareness that
very powerful drivers and that part of the healing process is to become more aware of those unconscious thoughts and feelings and drives. So that still echoes today in the work that we do. Oftentimes today that presents itself as sort of mindfulness practices. What is mindfulness? It's the ability to observe our thoughts and feelings without judgment. And that would have been something that
Freud would very much have championed this idea of, his method for doing it was through psychoanalysis, this sort of uninhibited, sort of unfiltered speech to another rather distant human as a way to get in touch with psychoanalysis, with our unconscious. That's of course Freud's famous
psychoanalytic therapy or talk therapy. Jung was a student of Freud, a colleague slash student, but he departed from Freud in that Jung came to believe that there was really what he called the collective unconscious. So that it wasn't that the unconscious just lives within our own mind. It's that really we have a societal or cultural
Or maybe even metaphysical conscious that's connecting us all together. And that's where these archetypes live, this idea that they're these sort of universal archetypes that will be the same across cultures and across time periods, because they're also uniquely human and emerging from this collective human consciousness.
So I mean, I can't say I've really spent a lot of time like mapping that onto the addictive process per se. I mean, I could certainly, you know, sort of think about it now, but it's not something that I've spent a lot of time doing. In some ways, you know,
In some ways, I would say my work is nudging people a little bit away from too much introspective time. Because I think what can happen, especially when we're dealing with compulsive behaviors and addictive behaviors, is that people would prefer to spend a lot of time introspecting as to why they do a behavior instead of
Taking the steps necessary to change the behavior and in my experience, at least when it comes to addiction, that kind of deep introspection while we're still using our drug of choice is not very fruitful. It doesn't really get us anywhere. In fact, actions need to come before feelings.
So I don't have to understand why I use, I don't have to investigate my trauma. What I need to do is I need to stop using, reset my reward pathways and then once I've done that and I get my frontal lobe back online talking to my limbic brain or my emotion brain, so I'm not just acting out of my lizard reflexes.
Then we can begin the work of introspection and looking at, okay, what are some unconscious drives? What are some early, you know, trauma that might have contributed to my turning to substances or needing substances? Then that work is much more fruitful. Yeah, I had a friend who would constantly brood. Well, we all have issues, but he had some issues which he
would think about over and over and over. I would catch him just sitting in a chair just unhappy. I would tell him, sometimes it's as simple as if you don't want to eat chocolate, you remove the chocolate from your home. Like you can focus on the actions. And then he would counter with saying, yeah, but then you're not getting at the root cause. I want to get at the root. I want to get at the root. You fix the root. Don't give me a Western approach. I want to do the Eastern approach of getting straight to the core.
Tell me what you think about that general approach and also is that even a correct characterization of the East and the West? You can go there if you like. Yeah, I'm not sure it's the correct characterization of East and West because I would say that in Western psychiatry and psychology and mental health,
I'm that that is also been the process kind of deeply retrospective that is to say looking in the past and introspective that is to say looking inward has been the dominant approach for the last hundred years and i think it's important to look at it historically and contextually you know when freud and many other psychiatrists and psychoanalysts and people thinking about this these kinds of things a hundred years ago
They were emerging from, you know, kind of Victorian era stiff upper lip where people didn't talk about their feelings. It was highly stigmatized to have mental illness. There were all kinds of somatization. That is physical manifestations of mental health problems. Um, you know, the, the grand hysterics of the sal patria. This was how people got emotional needs met. They presented with physical problems because people didn't really
have a language or a category for brain diseases that relate to emotion. And so, of course, you know, the huge contribution of Freud and others was to say, no, no, that's not going to work. We need to really unpack that stuff and look at it and find out what it's related to and what may have contributed to it and how it's contributing to our suffering today. So that was the great unpacking of all of those kinds of repressed feelings.
But unfortunately, I think now in the 21st century, we've taken that too far, such that now people are spending enormous amounts of time. In some cases, I would argue too much time introspecting and retrospecting and trying to look deeply inward to find, you know, the cause of their suffering. Would you say they romanticize their suffering? Yeah. Or maybe maybe I would say overvaluing it is probably what I would say.
giving it too much weight or even going back and reworking quite benign episodes to make them more significant or more traumatic than they really are because we're looking for a causal explanation of our suffering.
Instead of just saying that, wow, all of that could be a contributing factor, but here's what's also a contributing factor, like your immediate environment, the people that you're with, how you're spending your time, the fact that you're not exercising, that you're not eating right, that you're not getting enough sleep, that you're smoking pot every day, that, you know, you're playing video games 24 seven, that you're reading romance novels, you know, whatever you want to do to call it. And that, you know, really maybe that's having a much bigger impact on your mental health.
than what happened to you when you were eight years old. Furthermore, I think that we have evolved these tropes, especially in Western culture, that really, if we're not happy 24-7, there must be something wrong with us, or wrong with our lives, or wrong with our relationships. When in fact, life just is hard. And even the most mentally well person with the most fortunate
Circumstance is going to experience a great deal of suffering because being human is a delicate proposition. So I think some of recalibrating around expectations and then also really re-emphasizing behavioral activation and action before spending too much time kind of cogitating on what might be sort of an emotional cause.
How important is bedside manner between a therapist and a patient or a doctor and a patient? And what lessons can one learn from that relationship that one can apply to one's own self-talk if one doesn't have a therapist? Okay, yeah, interesting question. Well, I mean, I really believe that the primary healing mechanism in psychotherapy or in any doctor-patient relationship is in fact the relationship.
And that if we are fully present in a healing way for our patients that can have a tremendous impact on their well-being and is much more important in the long run than any pill we could prescribe or
the particular type of psychotherapy that we're using. And I'm always reminding my medical students and my residents of this, that it is our healing presence and the gift of listening and being fully present and responsive that is in fact the most important part of our encounters with our patients. Martin Buber, you know, talks about the I and thou moment. He was a philosopher and a theologian.
I love that. His work is largely unintelligible to me anyway, but the basic concept of I am now is a very nice concept. It's that two human beings can make an incredibly powerful life-changing connection even in a fleeting moment of time by really being fully present for each other.
So it is really important. In terms of the other part of your question, which I think was, what was it again? How can you apply the lessons of bedside manner to oneself if you're lacking in a therapist for whatever reason, you're too uncomfortable or you can't afford it? Yeah, well, it's a great question. I'm not sure it is possible to just do this in isolation. I mean, certainly our self-talk and the way that we
We can be far more empathic with ourselves. We can be less judgmental. We can sort of interject a kind therapist and imagine what that person would say to us instead of what we're saying to ourselves. So I think that can be helpful. But I do think that there's only so much that we can do on our own. Again, what is healing about seeing another human being and sharing your inner thoughts is that you're sharing them with another human being that that and we are such
Social beings, you really need to need to be in relationship with each other. And, you know, I think self help is great. And we can, you know, make a lot of progress by sort of collecting data on what we're doing really being thoughtful about it, making some small changes, seeing what happens documenting that. But I do think that in general, you know, doing things in isolation will only get us so far. I imagine that the negative effects in the spectrum of
say being too judgmental, too tough on oneself and then leniency that it's a horseshoe in the sense that you can be too forgiving of yourself where you allow yourself to be unindustrious and feckless and get away with too much. The proper balance is in the middle, a balance point. Do you find that it's more of the overly blaming and accusatory type or that it's more of a molly coddling and indulgent type? Yeah, another interesting question.
I think when people are in crisis, it's both of those extremes simultaneously. So there's a lot of self-blame, enormous amount of shame, really paralyzing shame, self-hatred. Self-hatred is a very common modern phenomenon. It's amazing how much people living in the modern world seem to hate themselves. Imposter syndrome, FOMO, all of that.
And yet, at the same time, people seem to be much more likely when they're in a psychological crisis to lie to themselves, to blame other people, to not really genuinely have difficulty seeing how they've contributed to a problem,
how they've really missed opportunities or failed to be grateful when they could have and should have been grateful. So both of those things are happening simultaneously when people are regressed and in crisis. And it's, you know, probably, you know, this would historically have been filed under primitive defense mechanisms, right? So all of those kinds of regressed, primitive maladaptive things that we do as we
Realize we're you know feel threatened as an organism and feel that we have to like defend ourselves against a hostile universe Did you find that when you're writing this book dopamine nation or any of your books? Is it therapeutic? Um It's not therapeutic in the sense that I'm solving problems that I didn't know the answer to
It is therapeutic in the sense that it's the only solitary creative work that I do. My professional life is immersed in service to patients and to students and mentees and everything I do is people intensive and collaborative. I'm with people all the time. I have to be fully present with those individuals.
The writing of the books is like a day a week I give to myself
where I don't talk to anybody after sending my kids off to school. At least that's, you know, when I'm really writing, I'm not doing that work now because I don't have time. But when I do do that work, and so it's really a gift to myself. It's kind of, you know, letting myself play hooky and be play in the playground. And so it's very satisfying in that regard. David Foster Wallace said that good writing is ego death. Ah,
Do you resonate with that? Yeah, I do in the sense that when you're writing, you get too caught up in how people will respond to it or whether it's any good. You don't get very far. You have to really be coming from a very different place. For me, it comes from a place of like
What are attachment styles and trauma? Yeah.
Well, I'm not an expert in attachment styles. There are lots of good books out there on this, but obviously our earliest human attachments with our caregivers goes a long way to shaping how we go through the world. And people have analyzed the different attachment styles that are out there, secure attachment, insecure attachment. Again, I'm not a real expert in all those categories, but the idea is that
Whatever environment we grow up in, if we're going to survive, we have to figure out how to survive in that environment. What can be an effective coping strategy in a dysfunctional environment doesn't necessarily serve us well
once we leave that environment. So I think that's kind of, you know, one conceptualization of trauma that if you're raised in a very dysfunctional environment, you're naturally going to develop a coping styles that will help you survive that environment, but in the long run, what will not necessarily serve you well in your life. And so then there's an incredible reworking that has to happen. So what is intergenerational trauma? And then what role does that have to play in addiction or addictive personalities?
Intergenerational trauma has to do with the ways in which these maladaptive coping strategies or family system styles that evolve in a given family will get passed on to grandchildren and great-grandchildren because
We don't just pass on our jeans we also pass on everything to do with how we navigate the world plus there's a whole new area. Write the means the means if you want to call it that plus there's a whole area of epigenetics that looks at how in fact.
those behaviors can actually become part of our DNA and get literally passed on in our genes. And that's a very interesting work and makes sense to me that, you know, through our repetitive behaviors, you're going to express some proteins and not others. And the expression of those proteins will then affect, you know, future generations. When we spoke last time, we talked off air
about the power of stories and the power of a higher power. So and we wanted to talk about that this time. So please, what are stories? How are they relevant here? And how is a higher power relevant to any of this?
We're all storytelling machines. We have large parts of our prefrontal cortex that are dedicated toward narrative. And narrative is essential to humans as a way to organize past experience. But our autobiographical narratives are also roadmaps for our own future. So they become not just a way to organize the past, but also a way to know how to make decisions going forward.
And one of the things that I think happens in good psychotherapy is that the therapist and the patient together explore autobiographical narratives and try to figure out
In my opinion, you know, one that hues as closely as possible to reality or what really happened, because I think when we're telling true stories, we have access to better information to make decisions going forward. But when we're telling stories that really aren't true about ourselves, which, by the way, we're very prone to do true as in factual, sorry, true as in factual, true as in factual. Yeah. Yeah. Well, we're not telling true, truthful and factual stories.
Then we don't have access to good information to make choices going forward. So stories are really, really important. They're sort of our, you talk about memes. I mean, we pass these things down through generations through the stories we tell, you know, and stories are also a fundamental way to experience live time. That was Foucault, but also to understand cause and effect. I know no better way in the human realm to understand true cause and effect than through storytelling.
So and in terms of higher power I mean this this is a really fascinating area to me but it essentially has to do with like locus of control and what I've seen again and again in recovery from severe addiction
is that especially people with the severest forms of addiction that eventually the only thing that really gets them into recovery is to give that locus of control over to a power greater than themselves. That doesn't need to be a deity necessarily. It could be the mystery of the universe or it could be my AA fellowship or it could be the power of love.
Basically it's the acknowledgement, at least with severe addiction, that when I'm in charge and only relying on myself and my own decision making, things go awry. So I need to acknowledge with humility that I'm not actually in control of what's going on here and that the harder I try to work to
you know, contain or manage or control my life the worse things actually get. So there's this amazing pivot that occurs when people give up that sense of control to a higher power and let instead life unfold and try to commune with that higher power either through meditation or prayer or going to meetings or fellowship or what have you, that people then begin to be able to access
a wisdom and a strength that otherwise they don't have access to and then begin to make much better decisions in their lives. So is this higher power just anything that's outside of you that has more control over you than you do of yourself? Because if that's the case, I could imagine that everyone believes in a higher power. Well, if you're a Marxist, you believe it's the corporations. If you're a capitalist, maybe it's the government.
If you're someone who doesn't like your job, maybe it's your boss, that person has so much more power than me. And I imagine that that's not terribly helpful in the way that when people say believe in a higher power or recognize that there's a higher power and that will help you through your addiction. I imagine that that's not what's meant. So please delineate what's meant by higher power. Yeah, great, great, great point.
So to clarify further, the higher power is something higher than any human agency. So not just higher than my human agency, but higher than any human being could possibly. So there's no other human being or human element that could solve this problem, right? So it's something meta, something outside of human agency and human understanding.
It's much, much higher than than that. Yeah, I don't know if there are studies on this, but is it more powerful if it's considered to be divine, a divine higher power? Or is it more powerful if it's a secular higher power, like it must be the objective universe that has no emotion? Yeah, I, you know, unfortunately, I feel like our language in this space is so limited, because I don't think it needs to be necessarily a divine human power. And yet,
I'm not sure calling it a secular human power really fully captures it. I think, I believe very strongly that it doesn't even really need necessarily to be defined. And this is in some ways the genius of AA. It's a higher power according to your understanding. So, I mean, I don't think you need to define it. For some people it's very important to define it. It's important for them to know, is this God?
If so, whose God is it? You know, what religion is this going to be associated with? But for many people, that's not important at all and proves not to be the critical element. It's really more a profound stance of humility and willingness and acknowledging that I don't know who's in control, but I know it's not me and I know it's not you. Humility is a great word.
because it's also related to being humiliated. And it sounds to me like in one of your other talks when referencing telling the truth, something I was thinking, I don't know if this is the case. I'm going to tell you what my thoughts are. I want to hear what your thoughts are is that there are truths so we can just begin to never lie and tell the truth. But then there are also lies that we have told in the past. And do we come forward with those? Well, that's much more tricky because there's a mountain of them.
So one option is you confess all those lies to this higher power. But you have to believe in quote unquote in this higher power. Otherwise, it's not humiliating to confess. And there's something about walking through the fire that is where the redemptive qualities are, that if there's no consequence to it, then your confession was for not. It was as if you just told a cup and maybe the cup to some people is divine. And in that case, that's fine. But that's rare.
Yeah, I think you're right. I mean, when we think about a higher power, however we define it, there has to be a sense of shock and awe and maybe even a little bit of terror before that the word power
With higher power has any meaning, right? Actually Kierkegaard wrote about this concept of Kierkegaard's the the corner of the phrase the leap of faith and he wrote about this concept of infinite resignation that before you can even have this leap of faith there has to be this kind of infinite resignation of recognizing
In a way, the profound humility of our own efforts to really get to that place that a higher power can transport us. And while we're on the topic of speaking the truth or telling the truth, can you outline why that's important? And not just neurobiologically, like not just okay, the prefrontal cortex is strengthened, but somehow psychologically as well.
Yeah, so this idea of like radical honesty comes from my work with patients over the years finding that those who are able to get into recovery from the severest addictions and stay in recovery are the ones that have learned that they can't lie about anything. So not only can they not lie about
Uh, you know, their use, they can't lie about why they're late for a meeting, what they had for breakfast, where they're going to be Saturday night. It's those trivial lies that they have to be the most careful about because that will lead them back into, uh, the bigger lies about using. And to me, that's fascinating. I mean, what is it about, uh, this kind of embracing this concept of radical honesty and never lying that helps people with addiction? I think it works on a bunch of different levels.
One of the levels that it works on is just their own insight and awareness of what they're actually doing. So part of what happens when we lie, and the average adult tells one to two lies per day, is that we're not just lying to other people, we're largely also lying to ourselves. And to talk about Freud's unconscious, we're allowing certain themes and things that we do and say and think to remain in those dark recesses of our minds. Whereas if we're articulating something, there's something very, very powerful
turning our inner life into words that we share with another human. It really makes it real in a way that it's not otherwise and it hugely enhances our awareness of it. So that's one of the big things. The other thing is that telling the truth profoundly enhances intimacy.
We're definitely afraid of people knowing our faults and weaknesses, our deep desires, our shameful desires, whatever it is.
We're afraid that if we tell people they'll, you know, run away from us. But in fact, the opposite happens. You know, if we really share our shame, um, people come to us, you know, they want to be closer to us. It enhances trust. So it's a wonderful way of augmenting intimacy. And very often that kind of deep intimacy or connection to other human beings is the best antidote to addiction.
I just saw a patient today with a, uh, he has a sex addiction and he was experiencing intense cravings. He and his wife had a bunch of things to do around the house and he was kind of dreading doing those things. And you know, he's struggling in his addiction and out of the blue came this craving to act out that basically he was planning that after she went to bed, he would look at pornography, which is, you know, part of his definition of relapse. Uh huh.
And then it occurred to him, well, you know what? I'm just going to let her know what's going on for me. And he said, I just want to let you know I'm having a lot of cravings right now wanting to act out and I'm formulating a plan. And she responded by saying, thank you for sharing that with me. Do you want to talk about it? Is there anything that I can do to help? That's sweet.
Well, even better, even better after they talked about it, you know, and she went to bed, he had no cravings. So his cravings went away. And really, what's so key there is that really what what was the craving in search of it was in search of some intimate human connection at a point when he was feeling low. So instead of escaping to his
So if I was to recapitulate, please let me know if this is correct or incorrect.
When you lie, you feel as if you're manipulating and you're getting away with something like you've achieved something, something positive. Otherwise, you wouldn't have lied. But what's actually happening is that you poison yourself. You've corrupted your heart and your heart is a large aspect of you. And further, and you maybe you don't know this, but my background is in math and film. Yeah, yeah. There's a screenwriting adage that says the more specific the pain, the more applicable it is or the more relatable it is.
And further, the more general you try to be, the less relatable it is paradoxically. In other words, you think that you're going to repulse someone by revealing your innermost, specific, painful, personal thoughts. But what actually happens is that you endear people to you. And then further, what you've articulated is that you also get endeared to other people. So I don't know if I interpreted what you said correctly in my own inference or my own translation, but tell me what you think.
Yeah, that's I mean, I guess I might use slightly different phrasing, but I mean, I think you're, you know, similar themes, I think, you know, what I touched on is just how telling the truth makes us more aware and gives us more insight into what we're actually doing. Yeah, because when we don't tell the truth, we are not aware of these behaviors, they remain in our unconscious. And then we continue to lie to ourselves.
So that's one of the primary ways that this radical truth-telling can be helpful is that it increases our knowledge base, right? It increases our perception. It increases the information that we're taking in about the world, which then enhances our models, right? So if we're going to use an active inference language, we improve our perception, we improve our models, and then we have better models going forward to interpret the world.
Does free will have any relevance here? Like it's important to believe in free will or it's actually better if you do not if you say no this is not in my control? I don't know. I don't know the answer to that. That's a great question. I do think often about free will and I haven't even concluded myself what I've decided about it one way or another. But the other thing is that
The other thing is that, let me just say I would like to believe in free will. I think that's a better universe where we have some free will. And I do think that that degree of randomness that's built into the universe is that opportunity for free will. But the other thing is just that telling the truth also enhances intimacy. It allows us to draw near to other people, which then serves as an antidote to addictive behaviors.
What is this hard-earned wisdom that people have when they go through an addiction and then they come out of it or trauma and then come out of it or maybe my language of quote-unquote coming out of it is not something that's helpful but please translate into however it should be?
I think any type of profound suffering that we come through the other side hopefully makes us stronger and wiser. That is an idea that's been around forever. There's this
There's this idea from Japan, I'm not going to remember the name of it, but this idea that if you break a bowl and then you put it back together and you glaze it, it's stronger than it was in its original form. So I think that's true. That's been sort of a truism in all cultures in some shape or form. It's not always true. Sometimes a broken bowl can't be put back together and that's a shame.
But when it can, then the idea is that we're stronger for it. Yeah. And does it also make you more resilient? I think so. Yeah, absolutely. Yeah. And are there some interventions that are better for eliciting this wisdom slash resilience? So for instance, a pharmacological one is not as good or a talk therapy one in combination with medication is the best.
I don't know if there are studies on this. It depends on the disorder and it depends on the person and it depends on the circumstance. Sometimes for some people, medication is the best answer. For others, it's different. Psychosocial intervention sometimes is a combination of the two. It depends on what disorder you're treating. I would hate to generalize across the board for every single disorder.
I do think in general we're too quick to prescribe medications in many instances and that we over medicate and there's a big problem with polypharmacy. Our health care system is designed
For patients of yours that can lucid dream,
Have you found it to be helpful? Like you say, okay, if you're in your dream, ask this question to this character. You know, I don't really know much about that. I've certainly heard about it, but I can't say I know really even what that is. Okay. We've talked about individual action plenty on this podcast and we've talked about patient to individual action. So what about family to individual?
So if you're part of a family and you want to help an individual or a friend group and you want to help an individual and then also what about society? Yeah, so I mean in terms of are you asked specifically if you have a friend or family member was struggling with addiction? Yeah, there are two questions in there. So what do you do if you have a friend or family member that's suffering in this way? How do you treat them? How do you view them in your head as well in order to
I think that the medical model here is very useful, the disease model of addiction, which basically argues that there are predisposing innate genetic factors for developing addiction and then plus we live in an addictogenic world where we're surrounded by highly reinforcing drugs and behaviors at the touch of our fingertips, making us all more vulnerable to this problem.
And that once we expose our brains repeatedly over time to this highly reinforcing substance or behavior, we essentially change our brains. You know, as I've talked about, we can go into this dopamine deficit state and then we do lose some degree of our own personal agency. We're slaves to this hijacked brain or where our brain mistakes this rewarding substance or behavior as something necessary for survival.
We start to commit all of our available resources to getting the drug, hiding the drug, withdrawing from the drug and doing it all over again. And the reason that I think that's a good model is because it's supported by the evidence, but it's also a model that helps elicit compassion and the realization that
Our loved one is not choosing the drug over us, but rather our loved one has lost the ability to choose. They really are caught in the vortex of addiction. Because otherwise what happens is that there's a lot of shame and blame.
and people feeling that their loved one cares more about the drug than they do about them. I just saw a couple this afternoon in their 70s and he can't stop drinking and she says he won't stop drinking but he literally on some level can stop drinking.
So it's painful to see that. It doesn't mean that the family member can't feel anger because that's appropriate. But again, recognizing that it is a brain disease and this person has lost their personal agency to the disease. So when it comes to then interacting with family members, I think it's
It's good to choose a time in which we're not dysregulated and they're not intoxicated or withdrawing and then bring up the topic and just express it as something that you're bringing up because you care about them and you want what's best for them and it's painful to watch them do X, Y or Z or that they may not realize that X, Y or Z substance or behavior
is causing these kinds of problems. So to act as a kind of calm and compassionate mirror to reflect back to them the impact of their substance use or their addictive behaviors on their lives and on our lives because people don't see that or they don't let themselves be aware of it.
Now what about, okay, we're going to get to society in just a moment. What about now flipping it from individual to family or individual to friends? So you're that individual or the person who's listening is that individual who feels as if they're addicted to something and they know it and
They know that they harm the people around them, but at the same time, they want some sympathy from the people around them. Like, look, please help me. You need to understand where I'm coming from. So what do they do other than send them this podcast? What do they do? What do they tell the friends and the family members?
What is a person with addiction do? Yeah. Well, I mean, I think there can be words and actions. And usually if there aren't actions tied to the words, people aren't going to put much weight into the words. So if a person with addiction really wants to get better, then they can say that to others. I really want to change. Here are the steps I'm going to take to try to change. And here's what you can do to support me.
But you can't just say, oh, I have addiction and so it's a disease and I have no agency. So you should feel badly for me and let me do what I want. That's not what we're talking about. We're talking about a disease. It's both a disease process and one for which that individual can and needs to take responsibility for reaching out for help. So maybe they can't stop on their own, but they can choose to turn to others and
and open themselves up to getting help. And if they're unwilling to do that as well, then I think the loved one has the right to say, well, I love you, but I can't live with you anymore, right? I mean, I feel for you and all that, but if you're not going to take these steps to make some changes, then there are going to be real life consequences, including I may leave or I may stop supporting you or you may have to leave or whatever it is.
One of the things that I have learned after two decades of treating people with addiction is that many people with severe addiction will not find the motivation to change unless there are real life consequences for them. They lose their housing, they lose a spouse, they lose their rights to be with their children, they lose their job, they get a DUI. So consequences, you know, and family members can empathically and in a frame of loving a family member,
Yeah, so in other words, they're saying the words, I love you, but I have to kick you out. Though what they mean is I love you. And it because I love you, I have to kick you out. There you go. It's not even a button. Right. That's right. That we have this view of love is
Simply tenderness and clemency. That's right. Yeah, yeah, good. So the reason I had asked about the society question is I wanted to go over to the audience questions. And that's a nice segue. Someone from the audience had asked, why treat the individual in a sick society? Shouldn't you treat the society? What is it like our society is sick? It's an abnormal society. I'm sure you've heard these claims.
Yeah, I mean, it's essentially the claim I'm making in dopamine nation, right? The big idea there is that the location of the disease process is not in our individual brains, it's in the world that we live in now, in which we are surrounded by highly reinforcing substances and behaviors at the tip of our fingers, and we're told that we should pursue consumption. That's kind of our raison d'etre.
I absolutely agree with that, that in order for us to be healthy, we have to change the modern ecosystem. And the way that we need to change is we need to limit access to highly reinforcing drugs and behaviors, and we have to develop a new kind of social etiquette around eschewing or avoiding, you know, intoxicants except in extreme moderation.
and actually doing things that are challenging or difficult or even painful as a way to kind of reset her reward pathways. And we have to do it with a sense of meaning and purpose derived not just from the fact that we will individually feel better if we do that, but also we will save our planet. I mean, our consumptive behaviors are not only self-destructive, they're also just highly destructive to the environment and to the planet that we live on.
the way that, you know, we're absolutely depleting our forest fuel sources, fisheries, you name it, because we eat too much and we smoke too much and we drink too much and we buy too many cars and all of it. Have you read Pure White and Deadly by John Yudkin? So it's a book from the 70s, I believe, and he makes the case that the problem in our society or one of the largest problems is over consumption of refined sugars.
which I think you can generalize to empty carbs. Right. And so in the self development world, there's something called keystone habits and working out as one of them. So if you do this, the rest of your life benefits and your other positive habits will come more easily. Is it the case? Have you seen that it's the case where if someone is over consuming on carbs, then it affects the rest of their life and in negative ways with respect to what you treat them for clinically?
Oh, sure. So we see actually quite a lot of food addiction in our, in our clinic, independent of obesity, which is sort of interesting. Some people who binge on foods, and I would say basically, we all have disordered eating in the modern age, like our food supply is so plentiful and so drugified with the addition of fat, salt, sugar, and other flavorants that we're all prone to overeat, and then trying to find
I was talking to my
Right. You have repetitive things where you've lost desire for certain foods unless they're just the food you want in that moment. But many people are struggling in other ways where they can't stop eating these highly processed, highly caloric foods for the first time in human history. There are more people on the planet with obesity than who are underweight or malnourished.
For the first time in human history, people are getting surgeries to reroute their intestines so that they can manage their overconsumption. So we've clearly reached a tipping point with our food supply. And we see more and more people who are outright addicted to food, even separate from being obese, people who compulsively overconsume food until they're essentially passed out just the way that people drink alcohol in that manner. So, you know, food's a real addiction.
So yeah, it shows up in all kinds of ways, just the way that other addictions can make people depressed and anxious and inattentive and unable to sleep and not able to be present and narrowing of focus and all those things. We see that with food addiction too. The next question which comes from the audience is what should I do to parent my young child? And also is there a difference between young boys and young girls in this regard?
Yeah, so I do think there are differences between boys and girls in the sense that the kinds of, let's say, intoxicants or drugs that girls will gravitate to, like social media, are just slightly different than boys on average. These are gross generalizations. Boys, it's more likely to be pornography and video games as well as substances. Although interestingly, over time, we've seen more and more girls use things like alcohol.
such that now there are as many women in the United States struggling with alcohol use disorder, alcohol addiction as men, which is very different from past generations where the ratio was more like two to one and then hundreds of years ago was more like five to one men to women. So women are, you know, drug use is much more socially normalized now among women. And so more and more women are developing drug addictions. But, you know, speaking of parenting young children,
I just think all of the things that we know already, the kind of common sense things,
have healthy attachments, to spend time together as families, but in particular with devices. I think kids under the age of 11 or 12 should really not have their own devices that give them unfettered access to the internet. Yeah, so I do think that we can't underestimate the power of these digital drugs. Digital content is highly reinforcing and quantity and frequency matter. So to sort of say, well, my kid
I think that we can't do that as parents. That would be essentially like giving our kids a pack of cigarettes and saying, go at it. I think we have to recognize the addictive potential, which doesn't mean no video games, but it does mean really, you know, or social media or whatever, even pornography.
Because kids are using it, so I think to have open honest discussions and really think about limiting use. I talk with families a lot about having behavioral contracts, making sure kids do their homework and their family chores. Behavioral contract. Yeah, so kind of where you have
People have to do certain things to earn the time on video games and social media or time on their devices and then have that time be limited where they have to give interesting for adults. Could that be implemented to yourself or in combination with a partner? Yeah, absolutely. Absolutely. And then I really recommend that families do like a digital Sabbath where they take one day a week or even just a half day a week where everybody leaves their devices at home, all the devices.
And they do something together with no devices. I think it's super important for parents to model what they want their kids to do. I have a lot of parents who are on their devices constantly and then complain that their kids are on their devices constantly. It's like, well, if you don't change your behavior, they're not going to change theirs. Our actions as parents are much, much louder than words. So if our kids see us constantly on our devices, they're going to think, oh, that's how
That's how you do it. So I think really important to have like times when we're not on devices, like dinner times or other family occasions. Professor, I find whenever I leave my phone at home, I love it. Like I'm with my wife and I'm much more present, but invariably right before I'm about to leave the house, even though I have all the evidence of all the other times where I've enjoyed myself, I say,
Yeah, but there's going to be an emergency where I'll need to call someone. So let me I'll come up with some excuse to bring it.
Yeah, I know people feel really naked without their phones. It's true. But the truth of the matter is if there really were an emergency, what would your phone allow you to do to manage that? Someone's going to call 911 or they're going to help out. If you're not physically there, what can you do anyway? You know, I never really carry a smartphone around except when I'm traveling and I need to do Uber or something like that. And I tell you, I think my quality of life is really enhanced by that.
Professor, I'll confess something right now. You have me at a time where because of your book, your book has made me get off of coffee. And right now I'm six days off of coffee. So I'm loopy and it's your fault. I'm inarticulate. Oh, and by the way, you mentioned that it's much better to do a detox, a quote unquote dopamine detox, a 30 day one with other people. And so inspired by you,
When this launches right now in the discord for this channel, which is like a chat room, will be a dedicated channel in the chat room for a 30 day detox where you, if you want to give up something, I'll give up something. We'll all state what it is if you want to make it public and then we can keep each other accountable for the next 30 days. This should release in early November, late October. Yeah, that's great. I love it. Yeah, that's great that you're doing that. I'm wondering, are you willing to share how much coffee you were drinking?
Two and a half cups. Okay. And what made you decide what made you decide to give it up? Well, I tend to I drink coffee four times a week. Okay. And I take three days off because I want to make sure that I'm not adapted to it and still gives the alert effects that I want. But then I thought, you know, many people say coffee increases anxiety and I have anxiety and also increases sleeplessness. And I have insomnia, like horrible insomnia, horrible, horrible insomnia.
I'm sorry. Oh, my gosh. I'm sorry. Yeah, that's hard. So I thought, why not eliminate caffeine? Sorry, coffee. Why not eliminate coffee? Go back to drinking black tea. OK. So retain the caffeine, but it's much less in black tea, especially if you just have one. OK. Is it harder than is it harder than you thought it would be? Today's the worst day. I feel so horrible, but it's great because I have you to speak to. Oh, there you go. OK, good, good.
Well, good for you for trying it because it doesn't even sound like it was particularly problematic except that you're wondering and that's a good thing to wonder about whether you could improve anxiety and insomnia by eliminating it for longer and I think that's a worthy experiment because
For some people, caffeine really can increase anxiety and insomnia. So I think it is a really interesting and good experiment. So good for you. And make sure that you stay the full 30 days because if you just do it for two weeks, you'll get all the hard part without the benefit. You really have to do it long enough to get your brain to get some message.
This coffee is really not coming. So I guess I'm going to make some changes here. So I'll be curious to know how it goes. Specifically, what motivated me was your distinction between mild and moderate addictions. And I don't think I have an addiction to coffee, but I think it was approaching a mild addiction. So it goes mild, moderate to what? Severe. Severe. Severe. Okay. Yeah. Yeah. And I'm not even sure you would make the cutoff for a coffee addiction. I think for you, you're even just maybe a little, you know,
Many people wanted to know about how is it that they can self assess if they're on the route to a mild addiction, if not mild to moderate. And I know that psychiatrists and health professionals will always say, go seek a health professional, go seek your family doctor. But in the absence of that, is there some rudimentary
set of five questions someone can ask. Oh, sure. I mean, I would say open up the Diagnostic and Statistical Manual of Mental Disorders. There are 11 criteria. You can go through those criteria. If you meet two or more of those criteria, then you would meet criteria for a mild use disorder. So that's what I would do.
In an effort to keep this podcast a complete resource, I'm going to list out the 11 questions from the DSM-5 about addiction. Count how many times you say yes. Number one, do you sometimes have difficulty controlling how much you use your drug or how long you use it? Also, recall that you can substitute the word behavior for drug.
Number two have you made any unsuccessful attempts to cut down your usage number three do you sometimes spend a significant amount of time using or recovering from your usage of drugs or engaging that behavior number four has your drug had any negative effects at home at school at work.
Number five has it negatively impacted your social life number six do you continue to use despite negative consequences number seven have you put off things or neglected to do things because of your drug use or your behaviors number eight.
Do you have strong cravings? Has your tolerance increased? Are you able to use more than you did before? Have you experienced withdrawal symptoms the next day? Has it led to any dangerous situations? The criteria is that if you've answered yes to two or three of these, you have a mild substance abuse. If you've answered yes to four or five of them, you have a moderate substance abuse.
Another question that comes from the audience is, is it better to be addicted to something that's a positive habit like working out?
So when I use the word addiction, I'm really talking about psychopathology. That means you've crossed the line from it being adaptive or it being a hobby or it being a habit into it being a mental illness, which means it has to be compulsive. It has to be out of control and it has to cause harm to self and others.
Um, you know, short of that, I don't really call it an addiction. So, but, but it is true that some people can get addicted to even behaviors that we typically think of as healthy, like exercising or in my case, reading or maybe playing chess or, um, you know, other, other things that, that we think of as well. That can't be an addiction because you're playing chess and smart people play chess or whatever it is.
But the truth is that we're all wired slightly differently, we all have a different drug of choice. And so it is possible, although it's much harder, and not as common, but it is possible to get addicted to exercise. So how do we how does that look when people are addicted to exercise? That means they're compulsively engaging in exercise, despite repetitive injuries, seeing a doctor who says you've got to stop doing that.
Despite family members saying it's really adversely impacting our family life, that you have to spend X hours every day doing your sport. Yeah, so my mother-in-law, anytime I'll give her any supplement like melatonin, she'll say, is that addictive? Am I going to get addicted? What she means is, am I going to have a tendency to that? Am I going to
Now rely on that. So what is the word that she should be using? It's not addiction. It is what? Well, I actually think the way she's using it is exactly correct and good for her for asking it because there are a lot of pills that get passed out by doctors and otherwise that actually are dangerous and addictive and people taking them don't know I can't tell you how many people
We see who were started on benzodiazepine like Xanax or Valium or Ativan or Klonopin, who then cannot get off and come and say, my doctor never told me this was addictive. So what do we mean by saying something is addictive? We mean that the average person with enough exposure to that substance or behavior will find it difficult to stop even when they want to. And with intoxicants, that's generally true.
Right. So like opioids prescribed for pain by a doctor are still addictive because the average person with enough time on an opioid will have trouble getting off of that opioid. And yeah, it might be just be dependence, physical dependence, but in the olden days, physical dependence and addiction were synonymous. Now we kind of separate those two allowing for
For example, doctors prescribing things to patients that are dependence forming but I think you could debate whether or not there really is a difference between those things, especially from a neurobiological perspective.
So good for your mother-in-law for asking you that and not just indiscriminately taking pills that somebody gives to her. Somebody, her son-in-law. And let me say, and then that gets back to this original question about like, you know, healthy activity like exercise. So generally exercise is not addictive.
But can you get addicted to it? You sure can, right? Also, because we've drugified exercise, we have these machines that make it easier to do more repetitive motions more intensely. We have all these ways to count it. We now have leaderboards and social media that's gamifying it. So you know, we've taken something that before it was nearly impossible to get addicted to it. And now it's a lot easier. This one said,
I would like her opinion on methadone. I had battled opiate addiction many years and constantly relapsed. The moment I started methadone, all my cravings went away and I finally got a decent night's sleep and he's at a clinic, he said. I do understand the stigma of methadone, but it truly saved my life. I've been on this program since 2008 and haven't been better. Good job, got my child back and so on. All positive things have happened for me. I hate that I have to take it each morning, but
The benefit in my life has far outweighed the bad. Just curious her thoughts. Yeah, you know, I ultimately think that we need to be practical about these things and methadone maintenance for severe opioid use disorder is evidence based treatment. It's one of the best and most evidence based treatments that we have for any addictive disorder.
Sounds like it's really working for you. I would urge you to stay on it and consider it the equivalent of insulin for diabetes that essentially this is a medicine that you will probably need for the rest of your life as long as it continues to work well for you. In my book, Dopamine Nation, I do talk about opioid agonist treatments like methadone and buprenorphine and I explain from a neurochemical point of view why they work and why they're important. Okay, the last question now.
And then you and I have got to get some rest. Relax. Yes. So we've talked about phone addiction. What you can do is you can just have an abstinence day and put your phone away maybe one day a week or so. OK. What are the three strategies that are most effective for dealing with addictive behaviors of porn, alcohol and other drugs such as smoking? And also are strategies different than tactics? Hmm.
Well, I would say this is what I cover in my book that's encompassed by the dopamine acronym. The interventions, whether it's a drug use, alcohol use disorder, or a behavioral addiction like sex, compulsive masturbation, gambling, shopping, video games are pretty much the same.
First, you want to collect the data, what you're doing, how much and how often. That's D for data. This is the dopamine acronym. O is for objectives. Why are you doing it? What are you hoping to get out of it? Are you really getting out of it? What you're hoping to get out of it? Or is there a gap between those things? P stands for problems associated with use. Write down all the things that are not working about using that substance. The A is for abstinence. Do four weeks of not using it. You'll feel worse before you feel better. You'll collect data on yourself. You'll be able to tell.
What the true impact of that behavior is on your life. Really hard to know why you're in your consumption, but if you take a break from it, you'll get more perspective, get better and accurate information. The M stands for mindfulness. This is what we talked about. Learning to just surf the urge or sit with that emotion, watch it come and go, tolerate uncomfortable emotions without reaching for our drug of choice.
The I stands for insight that's practicing radical honesty and the ways in which we become more aware of our behaviors and actions by telling the truth about them to ourselves and others. The N stands for next steps if we make it through the 30 days and we feel better and we can decide do I want to make continue abstinence from this substance or behavior from this particular video game or from pornography and masturbation or from online shopping sites or from cannabis
Or do I want to go back to using but use less, use differently? If you decide to go back to using, make a really detailed plan for what that is going to look like, how much and how often. So this is the question that comes up. Well, what do we do after the dopamine fast? I'm not going to be able to, you know, I'm still going to live in the world. I don't want to abstain forever.
So then, okay, well, what is your use going to look like? What are your red flags? How are you going to hold yourself accountable? And then the E for dopamine stands for experiment. And that's where we go back into the world and give it a try again for another 30 days.
Okay, my goal was moderation. You know, in my case, I tried to go back to reading romance novels and binged all weekend long and showed up at work bleary eyed and said that's not going to work for me. So then committed to a long term abstinence. But for other people, they may they may be successful moderating or they may be successful for a while and then slip it back into more compulsive overuse, or they may be successful, but decide it's not worth it because it's exhausting. It's even abstinence is easier. So these are just it's just one
Big experiment. The links to all books referenced and all articles referenced and everything will be in the description. The current book is dopamine nation. The previous book is drug dealer MD. It's about the overprescribing epidemic. Yeah. Are you working on anything new?
Actually, I'm working on a dopamine nation workbook. So this is an interactive workbook that people can make their way through to do that kind of dopamine acronym that we talked about, you know, data objectives, problems.
There were some extra questions for Anna conducted on a separate day, which you're about to see. So professor,
How important is forgiveness and apologizing both for you to yourself, for you to others, and maybe even family and friends to you if you're the addicted one, you in quotations.
Yeah, well, I mean, I think of what does an apology consist? An apology starts with acknowledging that in some ways we've done wrong or we've harmed somebody else through our actions or words. So I think that's very important to acknowledge that when we've harmed others and it's somewhat instinctive, I think, for humans to want to
both see themselves in the best light and also be their own worst enemy. It's sort of a polarizing reflex, meaning that we can be very hard on ourselves at the same time that we can be far too easy on ourselves and generally want to rationalize behavior that's harmful toward others without recognizing our own contribution. And I think it's really important
After we've done that, the next step is to let people know that we are aware that we've harmed them and that we feel
Contrition or sadness, regret for that behavior combined with the desire to want to make amends. And what does that mean? Amends is a forward looking. So, you know, apologizing and regret that's looking toward the past. And amends is looking toward the future and saying, well, I'm not going to do this behavior again.
So for example, in my own life with one of my kids, I started reading her journal.
Which I rationalized to myself was appropriate because she had a health condition and I was concerned she wasn't sharing with me the things I needed to know in order to help her with her health. But really, that was a transgression of her privacy. It was a wrong thing. I knew it was a wrong thing when I was doing it, but I rationalized it nonetheless. And it took me a long time to get around to telling her that I had done that.
And part of my reluctance was that I knew once I told her and apologize that I wouldn't be able to keep doing it. Right. So that's the whole amends part. The apology really has to come with the intention of changing the behavior or at least trying to change behavior.
And so eventually I did apologize and she was incredibly gracious about it and said, that's terrible that you did that. And it did impact her trust of me. Um, but she was also even in that moment, able to forgive me, which speaks to her very wonderful nature as well as the good foundation of our relationship. That even though I had significantly breached our, you know, that, that trust,
I could apologize, make amends and we can rebuild. And I really think that's the foundation of apology. It's respecting ourselves and the other person and the relationship enough to want to continue to make it better. And that's the way that we make relationships better because we're always going to make mistakes. We're all very flawed. Is it important for you to be forgiven? So you're apologizing, but sometimes the person won't say, well, I forgive you. Maybe they'll say,
Yeah, right. Well, that's of course the great fear behind admitting that we've done wrong and apologizing.
is that the person won't accept our apology or that they'll be so horrified by what we've done that they won't want to have anything to do with us going forward. That is the great fear. But I really do think that nine times out of ten, we think that the person is going to run screaming from us when in fact
the opposite happens. They're in fact drawn closer because honesty is a great gift. Again, if an apology comes with desire to change the behavior, that's an acknowledgement of wanting to invest in that person and in the relationship. So I think generally apologizing, you know, a good faith apology is a way to strengthen relationships. It doesn't typically lead to a worsening of that relationship.
Now, for an addict, is it important for them to conceptualize themselves as an addict? Or should I not even say what I just said, which is as an addict, like am I contributing to some stereotype by saying so or a stigma?
Yeah, it's such a great question because the language around addiction is really evolving and there's a whole group, especially inside medicine, that feels like we should try to destigmatize the language of addiction. For example, not use the term addict.
use the term something what we call patient centered language, a person with addiction, a person with the disease of addiction, a person with an alcohol use disorder, rather than saying that's an alcoholic or that's an addict. And there are other
On the flip side, a lot of people in the community of people with addiction who are trying to get into recovery refer to themselves as addicts, alcoholics. In a funny kind of way,
It's somewhat invalidating to say, well, we shouldn't use that language when the very people struggling with these disorders will identify themselves in that way. I mean, who are we in the medical community to say what language should be used by the very people who embody those disorders? So I don't know. I'm personally somewhat conflicted about it.
And so getting to your, the underlying point of your question took me a while to get there, but I eventually, you know, that what, what is the nature of the role of identity in addiction and recovery? And, um, you know, identity is really important and, and, and sort of coming to know yourself and also redefine yourself in the world is an important part of recovery.
and acknowledging and identifying that you do in fact have an addictive disorder and that you may need to turn to others for help with that is an important part in that identity transition for people. So the people who you mentioned that refer to themselves as addicts, do they do so because of just the history that's just what they've learned or do they find it helpful?
Because it implies that their addiction is more powerful than them and it's useful for them to conceptualize it like that because then they know I need to seek help.
You know, it's probably not possible to generalize. You know, some people who refer to themselves as addicts, it might be helpful to do that. Others might use that as a kind of embodiment of the justification of why they can just keep using and never be able to stop. So it's you know, it's it's probably cuts both ways. Yeah, that's an interesting point. Tony Robbins mentioned something like that. Tony Robbins, a motivational speaker. He said, look, if you
don't smoke if someone offers you a cigarette you don't say i'm not into smoking you say i'm not a smoker like you actually have that as part of your identity that you're not a smoker he said it's important he said the way that you frame your identity can help you get over
or move toward what you want. Yeah, right. Yeah, you're absolutely right. And it does, again, speak to the ways in which adopting certain identities can be helpful or harmful. You know, in the Alcoholics Anonymous and 12-Step Community, they feel that self-identifying as an addict, including calling yourself, for example, a smoker or calling yourself an alcoholic or an addict,
Is fundamental to the process of recovery because you are acknowledging that unlike normal people are nice you can't use that substance in moderation you can't use it recreationally the way that other people might once you start using you will continue to use it will lead to all kinds of significant problems and your life will become unmanageable.
So in that, you know, contrary to Tony Robbins, which I'm not I'm not saying he's not wrong. I'm just saying I think for different personalities and different temperaments, you know, sort of adopting agency through certain identities.
I understand. You smiled when I said Tony Robbins. So you're familiar with Tony Robbins? Yeah, of course. Yeah.
Can you please tell me more because I wasn't aware that many academic psychologists know about him or his practices and I've always wondered what are their views on it? Well, I don't feel I know enough to honestly go into it, you know, in a public. I mean, I've heard of him. I know many, many people have benefited from his work and have quit smoking as a result. I think that's fabulous. Great, great.
Professor, what are the rat park experiments and what do they tell us about addiction or society's impact on addiction? Yeah, so the rat park experiments were a series of experiments conducted under the leadership of Bruce Alexander many decades ago now, where he essentially challenged the prevailing paradigm in studying addiction in the laboratory, which was to put a rat in a very small cage with a lever
which if pressed would deliver intravenous cocaine or what have you to the rat and then measure the rats behavior in response to that. And what researchers had found was that given access to a lever for cocaine in a small cage with nothing else to do, that rat will essentially press the lever till exhaustion or death. So that became a kind of working animal model for studying addiction.
Bruce Alexander came along and said
If you put pretty much any human being in a room with nothing to do but press a lever for cocaine, that's what they're going to do. That's not adequately simulating what really happens in life. And his hypothesis was that if you put a rat in a very, very large cage with a lever that they can press for cocaine, but a lot of other things that they might do, sawdust, piles of sawdust they can explore,
Running wheels maze other rats right now it's very likely that they're not gonna. Necessarily press that lever or press it quite as often and so that was the rap heart experiment he and his colleagues built a giant.
maze, they put these rats in and according to their results, rats were less inclined to press a lever for cocaine when they had other things to do. And since that time, the whole rat park experiment has really become somewhat iconic
And really a metaphor more than anything else for the need for a healthy environment and healthy alternative sources of dopamine if we want to intervene in the serious public health problem of addiction that battling addiction whether you're dealing with rats or human beings is not simply going to be a matter.
of, for example, limiting access to drugs or, you know, treating drug addiction. It's got to be looking at more, more holistically at the environment and identifying what makes for a healthy community, what makes for a healthy environment, and then promoting those things as well. And the human sort of the human experiments
that maybe were inspired directly by Rat Park, but maybe not, I don't know, were things like the studies in Iceland where they opened up a bunch of youth gymnasiums. They created a youth curfew so teenagers couldn't go out past a certain time of day. They promoted all kinds of
social goods and social networking and they saw a reduction in teen drug and alcohol use in their communities. So again, it's just this sort of idea that the holistic social environment really matters. One of the claims that I've made is that the problem with the world that we live in today is
not just that we have a rat park, but we have actually a rat amusement park. So we've taken even healthy kinds of activities and we've drugified them. We've made them more reinforcing. We've made them more accessible, more potent, more novel.
So it's such that now we can get addicted to and or binge on just about anything such that this idea of rat park you know has to take into the account the fact that science technology and are just our own propensity for extremism and everything that we do has turned what was previously healthy stuff
into potentially addictive stuff like social media, right, has taken human connection and human relationships and distilled it down into its most addictive essentials, whether it's
you know, through dating apps or Instagram or Discord on a video game or what have you. So I think that's really important to acknowledge. Also footnote to that, which I find fascinating is that running wheels, you know, a rat on a running wheel. Scientists used to think that a running wheel was a neutral or inner measurement of physical activity in rats, but then they began to notice that certain rats
would preferentially run on the running wheel to using cocaine, but not in moderation. They would actually run on that running wheel till complete exhaustion. In other words, it looks like some rats get addicted to running wheels to the point where they run themselves to death.
So I just think that's an interesting and fascinating metaphor to for human life today, where even things like exercise have been made more technological, more addictive with all the machines that we have, and addition of social media and leaderboards and rankings, and all of these ways that we can see what other people are doing and how far they went. And so it's just it's just interesting.
I imagine you would say that the addiction to exercise would be one of the more positive addictions though, or is that not the case? Well, when I use the word addiction, I'm talking about psychopathology defined as the continued compulsive use of a substance or behavior despite harm to self or others. I certainly have made and will continue to make the strong argument in favor of exercise as a healthy way to get dopamine indirectly by paying for it upfront.
But anything that gets dopamine, even if it's a healthy way to get dopamine, if overdone, can lead to addiction. So when I talk about exercise addiction, I'm not talking about healthy adaptive amounts of exercise. I'm talking about people who are exercising to the point where they're getting injured. It's interfering with their family life, with their job. They've really genuinely become compulsive about it. And oftentimes exercise addiction, although rare,
Is occurring with more frequency again as we've kind of professionalized and and and technologized if i could say that making up a word all of these exercise pursuits.
That's super interesting because there's someone named David Goggins who is not a motivational speaker, let me think, what is he?
He's a motivational guy. I wouldn't say motivational speaker, but some guy who many people find helpful because he's this epitome of someone who can push through extreme suffering for some goal. So he'll run even if his
leg start to bleed and he'll just keep going on this race over and over because he said, I'm going to run two marathons today. And so I'm going to do that no matter what. And I used to look at that as well and be like, wow, that's something to be emulated or something to have as a value, even if you don't achieve it. But now I'm wondering, is that just a sign of addiction itself? Because he repeats this in every other activity that he does. So he started yoga and then he just does yoga for three hours or four hours. Right.
Well, I think that, you know, many people find inspiration in people who in other people who do things that are really difficult. And I think that is admirable, you know, people who challenge themselves who take on painful or difficult activities, you know, that that that is inspiring. And those people
can function as heroes, but without commenting on any individual person, because I'm not familiar with Goggins, but not with his specific activities, I do think we need to draw into it. A very advanced athlete
Who pushes themselves very far that might be healthy for that person was for a person who never gets up off the couch for them to do that would be harmful so sorry where you're starting again again i want to exercise is one of the most potent antidepressants anxiolytics even anti addiction.
Professor, given that you could have gone into any field of medicine, maybe any field in general, why did you choose addiction as a subfield? And if you didn't start an addiction, then why did you choose that?
I'm always interested in, look, there's a plethora that you chose in front. Yeah. But you walked through one or two doors out of 300. Right. So why? Well, I mean, this is kind of cliched, but addiction found me not the other way around. I did choose psychiatry because I was interested more in quality of life than quantity of life. And I wanted to have enduring relationships through time with my patients, which
Psychiatry, thank goodness, still affords us in modern medicine. But I was actively avoiding patients with addiction early in my psychiatric career, primarily because I had learned very little in medical school or residency in how to treat them. And I also, like most of my colleagues, conceptualized addiction as a social problem, a willpower problem,
not something within the purview of medicine, not something for doctors to treat. And this was 25 years ago or so. But what happened was I discovered that if you have a patient with bipolar disorder who's also addicted to alcohol or drugs, you can prescribe all the mood stabilizers in the world and you can be the best psychotherapist and you can talk about every conversation they ever had with their mother. And if you don't also address the addictive behaviors, they are not going to get better.
And that was really my realization, I realized that I was actually not functioning as a very good psychiatrist, because I was ignoring the addictive problems that my patients actively had. And they weren't bringing it up because I wasn't asking because it's a stigmatizing behavior associated with a lot of shame. Right, right, right. People aren't going to disclose it unless you as a skilled practitioner, give them the opportunity to do that. So that was essentially the shift.
Have you found that writing about your addiction or writing about trauma? So I know those are maybe separate questions, but maybe there's something common underlying. Have you found that that's helpful? And under what circumstances, like what questions should someone be asking themselves when they write? So when you say right, do you mean sort of like keeping your own journal or writing? What do you mean writing for an audience? No, I just mean for yourself. It doesn't have to be a journal. It could just be two years after the event. If it's a traumatizing event.
Or maybe while you're attempting to help yourself out of an addiction to just write about it because I heard that writing as a whole is salvific when it comes to psychological conditions like getting over psychological conditions that is but I don't know what sort of writing is salvific because there are various forms.
Right. So I mean, again, I would say there's a lot of inter individual variability, you know, what might work for one person wouldn't necessarily work for another. But in general, we organize our thoughts and feelings through language, we understand our experiences through language. And so by putting our experiences and our thoughts and emotions into coherent language, especially if we're then using that to communicate with another human being,
We ourselves can become aware of cause and effect in a way that's hard if we're not using language to organize the sort of cacophony that's happening in our own minds. I will say though that I think for people with severe addiction trying to get in recovery,
Isolation is such a big part of the disease and I would think that writing in isolation would in general not be as effective as writing or communicating in a way that is shared.
This is, of course, why 12 Steps and other mutual help groups are so useful. They, in fact, provide a structure to organize experience. And so people are creating a narrative within that useful structure, rather than just kind of, you know, some sort of stream of consciousness, which I'm not sure is necessarily all that helpful. Speaking of writing, when your book, Dopamine Nation, became a bestseller,
And it was winning still is winning awards at the time when the flurry of events were occurring. What was going through your mind? How are you feeling? You know, for me, the process of writing a book is very rewarding in the sense that almost all the work that I do is collaborative and is service oriented and is interacting with others. So for me, the book writing was
a creative thing that I could do in quiet moments by myself. The process itself I found enjoyable and I really didn't give much thought to what would happen after it was published. Of course, whenever you write a book, you want people to read it. You have the audience in mind, you're thinking of people reading it, you're wondering,
what their reaction will be but i have to say for me that was not when i for the books that i've written the sort of primary motive it was really very process oriented and so um you know with dopamine nation and also my my book my prior book drug dealer mg it was a surprise uh that people a lot of people read the book and and seemed to
to find it useful. I think the whole thing is just sort of humbling like, wow, I'm really lucky that I had the opportunity to express these ideas and that in expressing these ideas, people are receiving these ideas and finding them helpful and expressing gratitude. I feel very fortunate that I've
I mean, really the thing that's closest to my heart in my professional life is taking care of patients. And to this day, I still love taking care of patients. It's the most gratifying thing that I do. People are fascinating, you know,
people's heroism in the face of very difficult odds is inspiring. And even to this day, I have a lot of joy in seeing patients and taking care of patients. And in teaching too, because in a way that's sort of an extension of that same sort of thing. You know, sort of having young people who are interested in doing this work and helping them, you know, realize their their dream. That's also very rewarding.
Was there a patient who reshaped your understanding of addiction most? And obviously you can speak in generalities here. It was never going to be one person. I think it was just the river of human lives that I've experienced from my office here over 25 years that's had a huge impact on me and the way that I see the world. And every single one, I would say, shaped me in some way.
Earlier when we spoke about a higher power, you mentioned that it needs to transcend you as a person and to the physicist or to the materialists, the law of nature or the laws of nature would do that. But then they would be hard pressed to find some solace in it if it's just the reductive laws of quantum field theory, for instance. So what else is there to this notion of a higher power that is necessary for it to be nutritious?
Well, I wouldn't presume to tell anybody else what their higher power is. I think the key piece of this shift, this kind of spiritual shift and the importance of spirituality for many people in recovery is really the acknowledgement of the locus of control, not being within them, but being in a, and not being actually in another person either, but being
I think for some people, just that is enough. This shift of locus of control. For other people, there's a much stronger need to more specifically define what is the source of control? How personal is it in my life? How much is my life part of a plan that this external force
has imagined for me, I think people are very different in in their need for that. But almost always that shift, I will not say I will say that's not for everybody. There are some people for whom kind of believing that they are in control and that their control to overcome their addiction is the key piece for them. So it's it's again, it's it's not a universal
There are many paths to the top of this mountain, but for many people that I've seen, because really it's this wanting to exert their control on the world and people around them that gets them into their addiction, it's the letting go that allows them to find recovery. Did you happen to find a common characteristic between people who feel like they need
or actually find it salutary to retain the control and to emphasize that I have control over this addiction versus those who find it more nourishing to let go. Like is there something that unifies those people? Yeah, I have given some thought to this and I think there's no research that I know of looking at this and
I don't know, I'm not sure what I think about this because I don't see that many people who get into recovery by taking more control. Typically what I see is that it's the failure of taking that control and this kind of letting go and admitting that they're out of control.
That is really the key turning point for many people. However, they define that which doesn't need to be in a religious or theistic or even spiritual frame. But typically, that's what I see. But I could see that, for example, somebody who really felt that their life was very much out of control and someone who had a certain degree of learned helplessness that for that person,
A topic that's important nowadays, maybe in all of human history, is free will, the argument of whether we have it or not. And I understand that there's some evidence that suggests that the belief in free will leads to an improved life satisfaction.
But it sounds like here there may be a divide, like you're not supposed to. No, no, I don't think there's a divide. I think you can, you know, surrender to a higher power and also believe that you have agency and responsibility. It's just what is it that we have agency over, you know, and is it possible to have both agency? Is it possible to have agency in a world in which there's also this concept of power greater than ourselves that has, you know, is determining
what happens next to some extent in our lives. I think those things are totally compatible and can coexist. What would you like to be remembered for? Oh, gosh, I haven't even given this any thought. I don't know, I guess I wouldn't be remembered as a good mother, a good wife, a good doctor and a good teacher. OK, thank you. You're welcome. OK, now me and you got to get some sleep.
Yes. Thank you so much, Kurt. I'm so glad you got questions from the audience. That's great. So we can answer what people are really interested in. Take good care, Kurt. Get some sleep. I will. You're going to sleep well tonight, I think. Yeah, I think so as well. OK, take care. Take care. Bye bye. Bye bye.
Once more, in case you missed it, in an effort to keep this podcast a complete resource, I'm going to list out the 11 questions from the DSM-5 about addiction. Count how many times you say yes. Number one, do you sometimes have difficulty controlling how much you use your drug or how long you use it? Also recall that you can substitute the word behavior for drug.
Number two have you made any unsuccessful attempts to cut down your usage number three do you sometimes spend a significant amount of time using or recovering from your usage of drugs or engaging that behavior number four has your drug had any negative effects at home at school at work.
Number five has it negatively impacted your social life number six do you continue to use despite negative consequences number seven have you put off things or neglected to do things because of your drug use or your behaviors number eight.
Do you have strong cravings? Has your tolerance increased? Are you able to use more than you did before? Have you experienced withdrawal symptoms the next day? Has it led to any dangerous situations? The criteria is that if you've answered yes to two or three of these, you have a mild substance abuse. If you've answered yes to four or five of them, you have a moderate substance abuse.
Six or more is severe. Keep in mind, no single test is completely accurate and you should always consult your physician when making a decision about your health. We've been having issues monetizing the channel with sponsorship, so if you'd like to contribute to the continuation of theories of everything, then you can donate through PayPal, Patreon, or through cryptocurrency. Your support goes a long way in ensuring the longevity and quality of this channel. Thank you. Links are in the description.
The podcast is now concluded. Thank you for watching. If you haven't subscribed or clicked that like button, now would be a great time to do so as each subscribe and like helps YouTube push this content to more people. You should also know that there's a remarkably active Discord and subreddit for theories of everything where people explicate toes, disagree respectfully about theories and build as a community our own toes.
Links to both are in the description. Also, I recently found out that external links count plenty toward the algorithm, which means that when you share on Twitter, on Facebook, on Reddit, etc., it shows YouTube that people are talking about this outside of YouTube, which in turn greatly aids the distribution on YouTube as well.
Last but not least, you should know that this podcast is on iTunes, it's on Spotify, it's on every one of the audio platforms. Just type in theories of everything and you'll find it. Often I gain from re-watching lectures and podcasts and I read that in the comments, hey, toll listeners also gain from replaying. So how about instead re-listening on those platforms? iTunes, Spotify, Google Podcasts, whichever podcast catcher you use.
If you'd like to support more conversations like this, then do consider visiting Patreon.com slash Kurt Jaimungal and donating with whatever you like. Again, it's support from the sponsors and you that allow me to work on Toe full time. You get early access to ad free audio episodes there as well. For instance, this episode was released a few days earlier. Every dollar helps far more than you think. Either way, your viewership is generosity enough.
Raise a spoon to Grandma, who always took all the hungry cousins to McDonald's for McNuggets and the Play Play Slide. Have something sweet in her honor. Come to McDonald's and treat yourself to the Grandma McFlurry today. Ba da ba ba ba. And participate in McDonald's for a limited time.
▶ View Full JSON Data (Word-Level Timestamps)
{
"source": "transcribe.metaboat.io",
"workspace_id": "AXs1igz",
"job_seq": 7100,
"audio_duration_seconds": 8702.19,
"completed_at": "2025-12-01T00:38:01Z",
"segments": [
{
"end_time": 20.896,
"index": 0,
"start_time": 0.009,
"text": " The Economist covers math, physics, philosophy, and AI in a manner that shows how different countries perceive developments and how they impact markets. They recently published a piece on China's new neutrino detector. They cover extending life via mitochondrial transplants, creating an entirely new field of medicine. But it's also not just science they analyze."
},
{
"end_time": 36.067,
"index": 1,
"start_time": 20.896,
"text": " Culture, they analyze finance, economics, business, international affairs across every region. I'm particularly liking their new insider feature. It was just launched this month. It gives you, it gives me, a front row access to The Economist's internal editorial debates."
},
{
"end_time": 64.514,
"index": 2,
"start_time": 36.34,
"text": " Where senior editors argue through the news with world leaders and policy makers in twice weekly long format shows. Basically an extremely high quality podcast. Whether it's scientific innovation or shifting global politics, The Economist provides comprehensive coverage beyond headlines. As a toe listener, you get a special discount. Head over to economist.com slash TOE to subscribe. That's economist.com slash TOE for your discount."
},
{
"end_time": 78.114,
"index": 3,
"start_time": 66.203,
"text": " Think Verizon, the best 5G network is expensive? Think again. Bring in your AT&T or T-Mobile bill to a Verizon store today and we'll give you a better deal. Now what to do with your unwanted bills? Ever seen an origami version of the Miami Bull?"
},
{
"end_time": 96.22,
"index": 4,
"start_time": 78.626,
"text": " Jokes aside, Verizon has the most ways to save on phones and plans where you can get a single line with everything you need. So bring in your bill to your local Miami Verizon store today and we'll give you a better deal."
},
{
"end_time": 119.889,
"index": 5,
"start_time": 96.51,
"text": " The reason that you're depressed or anxious or inattentive or unable to sleep or just not interested in your life could be because of this"
},
{
"end_time": 138.746,
"index": 6,
"start_time": 122.073,
"text": " you're using or this high-potency behavior like pornography and masturbation or online gambling or video game. And if you could just cut that out for a period of time, that would allow those neuroadaptation gremlins to hop off the pain set of the balance and for homeostasis to be restored."
},
{
"end_time": 167.619,
"index": 7,
"start_time": 139.599,
"text": " Anna Lemke is an award-winning professor at Stanford University, who's written extensively on behavioral sciences, addiction, and psychiatry. She demonstrates how the most minor of activities can lead to ruinous habit formation. And in this podcast, we talk specifically about action steps you can take if you find yourself addicted to pornography, to social media, to masturbation, to drugs, to your phone, to coffee, to virtually anything because addiction uses the same dopaminergic reward pathways"
},
{
"end_time": 190.896,
"index": 8,
"start_time": 167.619,
"text": " and so luckily the treatments themselves can be generalized. Questions explored are how do you know you're addicted? Is that different than just being reliant on something like sex or shopping or eating? Is it different than a predilection? We also covered trauma and how that relates to cravings and what you can do about it of course. Professor Lemke is warm, inviting, and a decidedly open person. Such candidness is rarely seen in any human"
},
{
"end_time": 216.578,
"index": 9,
"start_time": 190.896,
"text": " Let alone a guest on a podcast. I highly recommend picking up her book dopamine nation link is in the description as it'll give you insight into yourself to temper a mild to moderate addiction or dependency recognize when you're on such a road and also show you how to help others who are close to you that are going through something like this directly inspired by the book in the discord right now you can go and there's a new channel that's been created called dopamine detox where in November for"
},
{
"end_time": 241.323,
"index": 10,
"start_time": 216.578,
"text": " 30 days i'm personally going to abstain from something which i'll announce there and other people will similarly dopamine detox you can choose whatever you like you can announce it and you'll have other people to hold you accountable and a place to go when you feel pulled to what you're supposed to be as chewing so think of something that you would like to rid yourself of for the next 30 days and we can do so together as a toe community making the process much less painful maybe even enjoyable"
},
{
"end_time": 269.36,
"index": 11,
"start_time": 241.561,
"text": " I forgot to mention my name is Kurt Jaimungal. For those of you who are new to this channel, it's Theories of Everything, where ordinarily it's highly abstract, sometimes philosophical. How do you reconcile general relativity with quantum field theory, for instance? Or what is modal epistemology and what does that have to do with the morality of artificial intelligence, independent of whether such AI systems can be conscious? Whereas this episode is a decidedly more practical one, much like the episode with Lillian Dindo. Anyhow, enjoy this podcast with Anna Lemke."
},
{
"end_time": 296.664,
"index": 12,
"start_time": 271.937,
"text": " Professor, I'm so happy to have you on. Thank you. And I've been going through your book, dopamine, dopamine nation right here. Me and my wife actually have been going through it. She has some comments. She's like, Oh, babe, she writes so well. Please let her know that. Ah, that's nice. Thank you. I spoke with you. I don't know if you recall how we met, but we met with Carl Friston at this event online on zoom. Yeah, of course."
},
{
"end_time": 316.152,
"index": 13,
"start_time": 296.8,
"text": " Yeah, that was wonderful. You did a great job moderating a diverse panel. Thank you. Thank you. So my first question to you is, can you please tell the audience your experience with addiction? Sure. So addiction runs in my family, specifically alcohol use disorder."
},
{
"end_time": 341.203,
"index": 14,
"start_time": 316.442,
"text": " But I thought that those genes had skipped me, so to speak, because my early exposure to alcohol was that it wasn't reinforcing at all for me. It just made me sleepy and gave me a headache. So I thought, oh, I guess I don't have whatever that is that people have that makes them vulnerable to addiction. And that was also true for other substances that I had tried."
},
{
"end_time": 370.708,
"index": 15,
"start_time": 341.834,
"text": " And I just generally felt like I was just too anxious a person to ever want to be sort of out of control, which is how I sort of viewed addiction before I knew anything about it. Little did I know that really addiction is in many ways the manifestation of an intense desire to be in control. Anyway, interestingly, in my early 40s, I happened upon the whole genre of romance novels."
},
{
"end_time": 399.275,
"index": 16,
"start_time": 371.032,
"text": " And I have always been a reader and reading has been my great escape from early childhood. And for whatever reason, it was actually the Twilight Saga. For those of you who are not familiar, it's a teenage vampire romance series. So in middle age, I somehow read it because some of my middle age friends told me it was really good and it really transported me. So it just took me outside of myself in a way a book hadn't done for a long time. So again, fiction has always done that for me to some degree."
},
{
"end_time": 426.63,
"index": 17,
"start_time": 400.179,
"text": " but I kind of got really into the whole romance novel genre and started reading every romance novel that I could find. It started with the vampires and the werewolves and the necromancers, soothsayers, and then it branched out to romance novels more broadly. But interestingly, it wasn't until I got a Kindle that I really became a compulsive reader. What happened as soon as I finished reading one, I could buy another one, I could get them very cheaply on Amazon."
},
{
"end_time": 453.029,
"index": 18,
"start_time": 426.971,
"text": " I started reading a lot more. I started staying up later and later at night. The other thing was that it was anonymous so that I could read these things that I would generally be embarrassed if somebody found the book lying around. But on my Kindle, nobody knew. And so the combination of those two things, the easy access to what turned out to be an infinite universe of romance novels and the immediate delivery and the anonymity"
},
{
"end_time": 482.159,
"index": 19,
"start_time": 453.387,
"text": " Those things conspired to turn me essentially into a romance novel addict, so to speak. And again, I don't want to trivialize life-threatening addiction by comparing my experience without some caveats to the problem of life-threatening addiction, which I see and treat in the clinic. But I will say that there were a remarkable number of similarities to what was happening to me in my compulsive reading habit."
},
{
"end_time": 510.111,
"index": 20,
"start_time": 482.483,
"text": " over a couple of years and the same kinds of patterns that I was seeing my patients. So to make a longer story short, I essentially realized one day that I had a problem and I sort of on myself did the kinds of interventions I asked my patients to do. Namely, I abstained from all romance novels for 30 days and found that I felt a lot better at the end of that time period."
},
{
"end_time": 538.575,
"index": 21,
"start_time": 510.384,
"text": " I had gotten progressively more depressed and anxious as people with addiction will do. And when I stopped, I felt better. Then I thought, okay, I can go back to reading in moderation. Then I had what we call the absence violation. So a binge episode where I read all weekend long doing anything else and then decided, oh, I actually can't moderate this behavior. It's really out of control and compulsive. So then I gave up romance novels, uh, essentially forever from, from that point on."
},
{
"end_time": 569.172,
"index": 22,
"start_time": 539.309,
"text": " So it's not advisable to test, do I still have this addiction? Let me dip my toe back in. Do not do that if you have an addiction. No, I wouldn't say that. I would say in fact that the majority of our patients who are willing to engage in the abstinence trial, the dopamine fast for 30 days want to go back to using their drug of choice, but they want to use differently. They want to use less. They want to use in a way that's not as fraught and harmful."
},
{
"end_time": 594.428,
"index": 23,
"start_time": 569.872,
"text": " And some of them are able to do that with enormous effort and a lot of barriers. Most of them are not able to do that. And so but eventually have to test it out a number of times before coming to that conclusion. Can you clarify what you mean when you say drug of choice? Because I assume that it's not just something physical. It could be an action and also clarify what you mean by addiction, please."
},
{
"end_time": 622.722,
"index": 24,
"start_time": 595.009,
"text": " Sure. So addiction is the continued compulsive use of a substance or behavior despite harm to self and or others. When we diagnose addiction clinically, we base it on phenomenology, which is to say very recognizable and repeatable patterns of behaviors that occur across ethnic groups, cultures, time periods that meet this criteria and usually composed of the three C's control compulsion consequences,"
},
{
"end_time": 652.039,
"index": 25,
"start_time": 623.148,
"text": " That is to say out of control use, compulsive use and continued use despite consequences, as well as often tolerance, which is needing more of the drug over time to get the same effect or finding that your drug has stopped working or doing for you what it used to do. And then withdrawal, which is finding that when we try to cut back or quit, that we have a pretty recognizable withdrawal pattern, which makes it difficult. So that's what addiction is."
},
{
"end_time": 675.572,
"index": 26,
"start_time": 653.387,
"text": " Drug of choice is a really important concept that's understudied in the field of addiction, but it speaks to the enormous inter-individual variability between humans in terms of what is reinforcing for their unique brains. Alcohol, for example, and other drugs, traditional drugs tend not to be particularly reinforcing for me."
},
{
"end_time": 701.681,
"index": 27,
"start_time": 675.947,
"text": " So I just assumed that I don't have this vulnerability to addiction, but it turned out I just hadn't yet met my drug of choice, which turns out to be in this area of love, attachment, combined with narrative stories and reading. And that turns out to be my drug of choice, what I'm vulnerable to if other factors conspire to make it very, very accessible, very anonymous."
},
{
"end_time": 718.353,
"index": 28,
"start_time": 702.125,
"text": " So drug of choice is really important and it also speaks to really important aspect of the time that we live in now in that"
},
{
"end_time": 744.821,
"index": 29,
"start_time": 719.189,
"text": " not only do we have more potent forms and more accessibility to traditional drugs like nicotine, alcohol, cannabis, opioids, stimulants, but we also have a whole universe of drugs that didn't exist before. We have online pornography, we have video games, we have online shopping, we have social media, we have Twitter, we have all these digital drugs essentially."
},
{
"end_time": 772.619,
"index": 30,
"start_time": 744.821,
"text": " Which many of which are about human attachment which have now exploded the vulnerability To the problem of addiction because now if you haven't found your drug of choice yet It's coming soon to a website near you. Hmm. How does one disentangle a dopamine seeking behavior from a coping mechanism? Addiction is maladaptive coping so it can start out as"
},
{
"end_time": 788.609,
"index": 31,
"start_time": 773.473,
"text": " Adaptive coping, in general, people usually rely on high dopamine rewards."
},
{
"end_time": 818.285,
"index": 32,
"start_time": 789.002,
"text": " They bind to certain receptors receptors in our brain or stimulate certain neural circuits in our brain that then as a downstream effect trigger the release of dopamine in our dedicated reward pathway. So I just use it as a shorthand talk about high dopamine substances, but the substances themselves don't have dopamine in them. If I were to eat a spoonful of dopamine, it would do absolutely nothing because it wouldn't even cross my blood brain barrier. So typically people, you know,"
},
{
"end_time": 839.326,
"index": 33,
"start_time": 818.916,
"text": " Start out using a substance or a behavior for one of two reasons, either to have fun or to solve a problem. And when it's in the to solve a problem category, then it's essentially a coping mechanism, right? And the reason that people return to using a second, third or gazillionth time, whatever it may be,"
},
{
"end_time": 863.916,
"index": 34,
"start_time": 839.599,
"text": " Is because it works, right? It does what I was looking for. It makes me, it takes the edge off my anxiety. It helps me go to sleep. It elevates my mood. It helps me pay attention, whatever it is. It alleviates my boredom. It makes me feel less lonely. You name it. Um, but the problem is, you know, that with repeated exposure to the same or similar reinforcing substances, the brain adapts."
},
{
"end_time": 892.688,
"index": 35,
"start_time": 864.428,
"text": " It starts to down regulate dopamine transmission as well as other neurotransmitters that are there to make us feel good in order to respond to injury or respond to need. And then eventually we can end up in this kind of chronic dopamine deficit state, which is characterized by anxiety, irritability, insomnia, depression, craving. So the very thing that we were trying to solve turns out to be the thing that we then exacerbate with continued use. And that's when we've entered addicted brain."
},
{
"end_time": 920.606,
"index": 36,
"start_time": 892.995,
"text": " When we're harming self and or others, and yet we continue to use that substance, even though it's essentially causing harm or continue to do that behavior, even though it's causing harm. Is there a reason why we don't hear about serotonin detoxing? We hear about dopamine detoxing. And yeah, also in your book, I sense that you're dispelling the dopamine is purely a feel good hormone. It's more something released in anticipation of a reward. And it's not as if it's"
},
{
"end_time": 948.285,
"index": 37,
"start_time": 920.845,
"text": " Yeah, so let me let me just parse that a little bit."
},
{
"end_time": 976.271,
"index": 38,
"start_time": 948.592,
"text": " So different substances and behaviors work through their own unique chemical cascades. Traditional drugs of abuse are essentially addictive or reinforcing because they mimic a chemical we already make, right? So we already make our own endogenous opioids. The reason people get addicted to opioids that occur in nature is because they do what our brains already do, but usually in a much more potent way."
},
{
"end_time": 998.422,
"index": 39,
"start_time": 976.715,
"text": " LSD mimics the serotonin that our brains already makes. Typically, we get that wonderful oneness or expansive feeling or that feeling of connection to others with opioids. We get either a euphorin effect or we get a pain relieving effect or anxiolytic effect. Alcohol works through our GABA and opioid systems."
},
{
"end_time": 1021.442,
"index": 40,
"start_time": 998.865,
"text": " And so nicotine works on our nicotinic acetylcholine receptors, cannabis works on our endocannabinoid system. Love and attachment probably works through both the opioid and serotonin systems, right? So you've got, you know, gambling probably works through serotonin and norepinephrine, which is our stimulation system. So these are very complex chemical cascades."
},
{
"end_time": 1045.964,
"index": 41,
"start_time": 1021.749,
"text": " But the final common pathway for all reinforcing drugs and behaviors turns out to be the release of dopamine in this dedicated reward circuit consisting broadly of the nucleus accumbens, the ventral tegmental area, which are rich in dopamine releasing neurons and connect to the prefrontal cortex, which is our control center of the brain right behind our foreheads. So"
},
{
"end_time": 1076.22,
"index": 42,
"start_time": 1046.527,
"text": " Talking about dopamine is just a simplified way of talking about the ultimate result of all of these reinforcing behaviors. So one way to think about dopamine is that it's the neurotransmitter that says to us, whatever it is you're doing right now that caused me to be released in your brain, this is something that you need to pay a lot of attention to because it's important to your survival, right?"
},
{
"end_time": 1103.012,
"index": 43,
"start_time": 1076.681,
"text": " Uh-huh. Dopamine is the neurotransmitter that says pay attention to what's going on. It's important. It could be crucial to your survival and you probably will want to do it again and again and again. Now, what is the role of dopamine and is it really involved in pleasure? And the answer is that with initial exposure, it absolutely is involved with pleasure."
},
{
"end_time": 1127.09,
"index": 44,
"start_time": 1103.66,
"text": " Because we know that different intoxicants and reinforcing substances and behaviors release a lot of dopamine all at once in the reward pathway. And so that dopamine is what makes us feel good and want to do that thing again. However, dopamine is also really important to anticipation of pleasure because"
},
{
"end_time": 1155.93,
"index": 45,
"start_time": 1127.534,
"text": " When we anticipate doing that thing that released a lot of dopamine, we also get a little hit of dopamine followed by a little mini dopamine deficit state, which then creates the craving to want us to go get the real deal so that we can get more of that dopamine. Furthermore, as people repeatedly expose their brain to reinforcing substances and behaviors, the brain adapts to those high levels of dopamine, especially if they're exceedingly high, which is what intoxicants will do. And remember,"
},
{
"end_time": 1167.517,
"index": 46,
"start_time": 1156.169,
"text": " Our brain, this reward circuitry, evolved in a world of scarcity and ever-present danger where generally there weren't a lot of rewards around. We had to really work hard to get them. We had to go hungry and walk tens of kilometers and"
},
{
"end_time": 1191.852,
"index": 47,
"start_time": 1167.978,
"text": " You know being without shelter and look for people and then after working really hard You know find a little bit of a reward to give us a little hit of dopamine that basically just put us back to our homeostatic base What we have now is we have at the touch of our fingertips these Explosively potent dopamine releasers that give us an explosion of dopamine all at once and our brains are reeling to compensate"
},
{
"end_time": 1218.439,
"index": 48,
"start_time": 1192.125,
"text": " and compensate by going into this dopamine deficit state so that over time our drug of choice doesn't release much dopamine at all anymore. Instead what it does is contributes to this compensatory dopamine deficit state as part of the opponent process mechanism. So when we talk about dopamine and whether or not it's about pleasure or whether about reward or whether about anticipation reward, you have to take into account"
},
{
"end_time": 1247.466,
"index": 49,
"start_time": 1219.394,
"text": " Where in the cycle of exposure to that particular stimulus, the organism is the first time the organism is exposed. If it's important for survival or the organism sees it that way, it will lead to a huge release of dopamine and that is pleasurable. Otherwise we wouldn't know to approach it again. Right? So this idea that people say, Oh, it doesn't have anything to do with pleasure. It's just about, you know, the differential between the baseline and anticipates like, no,"
},
{
"end_time": 1268.541,
"index": 50,
"start_time": 1247.91,
"text": " Okay, great, great. Now here, I know that the people who are listening won't be able to see this, but this is a page from your book, and I'd like you to describe the image and then explain what it's trying to illustrate."
},
{
"end_time": 1291.118,
"index": 51,
"start_time": 1269.65,
"text": " Right, so this is a metaphor that I use in the book to try to help people understand what happens in the brain as we become addicted. What is the result of repeatedly exposing our brains to highly reinforcing dopamine-releasing substances and behaviors? And I use the metaphor of a balance or like a seesaw in a kid's playground representing how we process pleasure and pain."
},
{
"end_time": 1318.08,
"index": 52,
"start_time": 1291.254,
"text": " To me, it's very exciting that much of the neuroscience in the last 75 years suggests that pleasure and pain are co-located in the brain. The same parts of the brain that process pleasure also process pain. And you could say they work like opposite sides of a balance. That's obviously highly reductionistic and oversimplified, but as a general metaphor to explain homeostasis and allostasis, I think it works well. So going with that metaphor, when I read a romance novel,"
},
{
"end_time": 1336.681,
"index": 53,
"start_time": 1318.37,
"text": " Because that's a drug of choice for me, along with chocolate and YouTube videos and other things. I get a release of dopamine in my brain's reward pathway. That's why you didn't watch the YouTube video I sent you. Exactly. That's going to trigger you. Really, I was in clinic all day and didn't have time. But yeah, that would be another good reason for me not to watch it."
},
{
"end_time": 1365.06,
"index": 54,
"start_time": 1337.346,
"text": " Anyway, that releases dopamine in my brain's reward pathway and my balance tilts to the side of pleasure. But there are certain rules governing this balance. And the first and most important rule is that the balance wants to remain level, or what neuroscientists call homeostasis. We're always releasing dopamine at a baseline tonic level. Our brains want to go back to that. The question is, how do our brains do that? And the way our brains do that is"
},
{
"end_time": 1392.176,
"index": 55,
"start_time": 1365.657,
"text": " First, by tilting an equal and opposite amount to whatever the initial stimulus is. And I like to imagine that as these neuro adaptation gremlins. They hop on the pain side of the balance to bring me level again, but they like it on the balance. So they stay on until that balance is tilted an equal and opposite amount to the side of pain. That's the come down the blue Monday, the hangover, that moment of wanting to watch one more YouTube video or chapter in my romance novel have one or two or maybe 10 more pieces of chocolate."
},
{
"end_time": 1415.538,
"index": 56,
"start_time": 1392.961,
"text": " Now if i resist that urge which requires resistance because remember the balance wants return to the level position so when i'm those gremlins are on the pain side of balance if i have a box of chocolate they're very hard not to eat another one but if i wait enough time maybe it's seconds maybe it's minutes maybe it's hours maybe it's days gremlins hop off and homeostasis is restored."
},
{
"end_time": 1437.295,
"index": 57,
"start_time": 1416.135,
"text": " Here's the second rule of the balance if i continue to expose my brain repeatedly to these high dopamine releasing rewards that initial deviation to pleasure gets weaker and shorter but that after response to pain gets stronger and longer in other words the gremlins multiply and they get bigger and stronger and pretty soon i have enough gremlins on the pain side of my balance"
},
{
"end_time": 1455.128,
"index": 58,
"start_time": 1437.722,
"text": " To fill this whole room and they're camped out there and that is alo stasis that's where we change our hedonic or joy set point now i need more of my drug in more potent potent forms not to feel good but just to level the balance and feel normal."
},
{
"end_time": 1473.609,
"index": 59,
"start_time": 1455.691,
"text": " I'm walking around with a balance that's tilted to the side of pain, and I'm experiencing the universal symptoms of withdrawal from any addictive substance or behavior, which are anxiety, irritability, insomnia, dysphoria, and craving. And the reason this is so tricky in clinical care"
},
{
"end_time": 1493.387,
"index": 60,
"start_time": 1473.609,
"text": " is because patients will say well my cannabis is the only thing that alleviates my anxiety or alcohol is the only thing that helps my depression and if you could just fix my depression or fix my anxiety i wouldn't get addicted what they are i wouldn't use the substance in an addictive way but what they don't see is what was initially a solution"
},
{
"end_time": 1521.988,
"index": 61,
"start_time": 1493.712,
"text": " to their problem of depression and anxiety has actually become the cause of their depression and anxiety. Sorry. Go ahead. No, please interrupt me. You just performed a restorative linguistic switch here. You flipped there the to an A. So for instance, they said this was the solution. This is the only thing that helps me. In other words of the then you said what was initially a solution. So you changed it to it's not just one. It was it could have been many. Right. And so they have a narrow view."
},
{
"end_time": 1552.756,
"index": 62,
"start_time": 1522.995,
"text": " That's right. Coming to overvalue this particular substance or behavior, kind of narrowing of their focus or interests, everything else kind of loses its color, nothing is interesting anymore, or things that used to be pleasurable and are just going to become less pleasurable. This is what happens in addiction. It becomes just this one thing can alleviate my anxiety, or this is the only thing that I'm interested in. For example, in my own life,"
},
{
"end_time": 1582.022,
"index": 63,
"start_time": 1553.166,
"text": " As I got started to spend more and more time reading romance novels, staying up later and later every night, reading romance novels at family functions, reading romance novels at work in between patients. The subtle change that occurred that I didn't link to the reading romance novels, but which was indeed linked, was that I started to enjoy my work less, started to enjoy my family less. I started to get more depressed. I started to get more anxious."
},
{
"end_time": 1607.398,
"index": 64,
"start_time": 1582.398,
"text": " And I started to feel more and more, I just want to be reading romance novels all the time. It's a great escape. It's the only place I want to be, the only thing I like doing. Other hobbies fell to the wayside. So this kind of sort of narrowing of focus, this sort of blinders on, this overvaluing this one activity, this having the sense that only this thing is going to give me joy and pleasure and not seeing that in fact it is this activity"
},
{
"end_time": 1628.336,
"index": 65,
"start_time": 1607.91,
"text": " with this, you know, which was initially reinforcing, which is now contributing to my dopamine deficit state or my changed hedonic set point. And the reason that we know this is because we have neuroimaging studies in humans that show, you know, once people stop using their drug dopamine, well, when they're when they're using their drug,"
},
{
"end_time": 1658.456,
"index": 66,
"start_time": 1628.831,
"text": " dopamine levels are actually below the levels of healthy control subjects. So you would think, Oh my God, they're ingesting all these drugs. They should have sky high dopamine. No, the opposite is true. They have, they have sub normal levels. It would be because their brain has downregulated postsynaptic dopamine receptors, downregulated dopamine production, all as a way to compensate for this artificial, uh, you know, a bathing of their brain in, in these dope in dopamine, due to these exogenous exogenous sources."
},
{
"end_time": 1688.063,
"index": 67,
"start_time": 1659.497,
"text": " So I interrupted you when you were saying that they said this is the only solution and then this is something that initially was a solution, but has now become a problem dot dot dot. Right. So patients will come in and say, this is, you know, a doctor, I need help with my depression or my anxiety or my inattention, whatever it is. And I'll say to them, well, I think there's a distinct possibility because of this process of neuro adaptation and, and allostasis."
},
{
"end_time": 1716.135,
"index": 68,
"start_time": 1688.66,
"text": " that the reason that you're depressed or anxious or inattentive or unable to sleep or just not interested in your life could be because of this high potency substance that you're using or this high potency behavior like pornography and masturbation or online gambling or video games. And if you could just cut that out for a period of time, that would allow those neuro adaptation gremlins to hop off the pain side of the balance and for homeostasis to be restored."
},
{
"end_time": 1738.78,
"index": 69,
"start_time": 1716.578,
"text": " I want to emphasize we're not asking people to go live in a cave and not have any sensory experiences. What we're asking them to do is identify the problematic substance or behavior in their lives. It's not one that I judge to be problematic. It's one that they've judged to be problematic or a family member has judged to be problematic. And I say, well, let's eliminate that for 30 days."
},
{
"end_time": 1769.019,
"index": 70,
"start_time": 1739.326,
"text": " Give time for those neuro adaptation gremlins to hop off the pain side of the balance and for homeostasis to be restored. Recognize that when you first give it up, because you've been accumulating those gremlins on the pain side of the balance, you're going to feel worse before you feel better. You're going to slam down to the side of pain, but that's withdrawal mediated. And if you can just get through the first 10 to 14 days, those gremlins will get the memo that they should hop off homeostasis or baseline levels of dopamine firing will be restored. And I bet you will feel better without her having to do any other intervention."
},
{
"end_time": 1796.834,
"index": 71,
"start_time": 1769.872,
"text": " And they're understandably skeptical because what they say is, I've tried every antidepressant, I've tried every psychotherapy, but I can tell you that the only thing that relieves my anxiety, depression, insomnia and attention is this substance or this behavior. And that's when I validate and I say, I hear you that in that moment it feels better, but all you're really doing is temporarily restoring a level balance from that pain position"
},
{
"end_time": 1823.968,
"index": 72,
"start_time": 1797.278,
"text": " and causing those gremlins to multiply further. What you really need to do is give up that substance altogether, let those gremlins hop off and restore homeostasis that way, rather than being at war with the gremlins. And what we find is that about 80% of folks who are willing to do that feel enormously improved after 30 days of abstinence without our having done any other intervention. And this is supported by"
},
{
"end_time": 1844.138,
"index": 73,
"start_time": 1824.94,
"text": " An experiment that was done a long time ago now, probably 20 years ago by Brown and Chuckett, where they took a cohort of adult males who had alcohol use disorder, alcoholism, who also met criteria for major depressive disorder. They put them in a hospital where they had no access to alcohol for one month."
},
{
"end_time": 1874.48,
"index": 74,
"start_time": 1844.616,
"text": " They did not give them any treatment for depression at all, not no psychotherapy, no meds, nothing. At the end of that time period, 80% of those individuals no longer met criteria for major depressive episode. So simply by stopping drinking, their symptoms of depression resolved. And we see that again and again and again in clinical care. Another phrase you mentioned that's cool is that you said, Hey, I'm not asking you to go live in a cave for 30 days. Now,"
},
{
"end_time": 1905.759,
"index": 75,
"start_time": 1876.084,
"text": " Would living in a cave for 30 days be salutary or deleterious? Now, the reason I would think it would be deleterious, and you could tell me if I'm incorrect, is that it's solving something that's quote unquote extreme, like an addiction with something else that's extreme. And so then when they come back into the real world, well, they may have solved their problem in a cave, but then they deal with all the triggers of the real world. So some people when they when they're going through some"
},
{
"end_time": 1928.677,
"index": 76,
"start_time": 1906.049,
"text": " Let's say mental health issues. They feel like what I need to do, I need to go to Brazil and take ayahuasca. I need to do something extreme. I need to go live in the woods for seven days alone. Is it replacing something that's let me rephrase that. Is it replacing something intense with something else that's intense or not? Maybe it's OK. You could you could do that. In fact, that's better. Go live in a cave for 30 days."
},
{
"end_time": 1953.78,
"index": 77,
"start_time": 1929.138,
"text": " You know, I think there are many paths to the top of the mountain. You know, it could be that for some individuals being in something like a cave for 30 days might actually be helpful. I think I was using that more metaphorically though, to talk a little bit about, you know, how the term dopamine fasting is often used here in Silicon Valley that you have"
},
{
"end_time": 1983.473,
"index": 78,
"start_time": 1954.36,
"text": " And I think that that's not what we're recommending to our patients because our patients are coming to us"
},
{
"end_time": 2010.52,
"index": 79,
"start_time": 1984.224,
"text": " You know, with mental health issues, addiction and other mental health issues, we would never recommend that folks in that fragile and vulnerable state go into a cave. What we might recommend is that they go to a 30-day residential rehabilitation facility where they don't have access to alcohol, but where they're surrounded by people with whom they can make positive therapeutic connections, where they might get prescribed some medications, where they're in group and individual therapy."
},
{
"end_time": 2038.439,
"index": 80,
"start_time": 2011.971,
"text": " But nonetheless, the sort of Silicon Valley dopamine fast, the point there is I think a broader one, which is to say we live in a society today, which is very, very noisy. We are constantly overstimulated, constantly being asked to react to enormous quantities of flooding really of information. And as a result, our brains"
},
{
"end_time": 2068.797,
"index": 81,
"start_time": 2038.933,
"text": " are stressed, you know, we are we are kind of in this constant state of hyper arousal. And because of that, the point is, I think we could all benefit from in different ways, kind of quieting our lives for a period of time, or doing a fast from something that we consume more than we would like. And this is the approach that we take. It's not that it's not really realistic, frankly, for most people to even go away to like a retreat or something like that. Most people just have to keep going with their lives."
},
{
"end_time": 2089.087,
"index": 82,
"start_time": 2069.104,
"text": " What they can do is identify one or two substances or behaviors that they use in an out of control, compulsive, and harmful way that they would like to manage better in their lives and focus on giving that up for 30 days and then seeing what the impact is. It's really an experiment."
},
{
"end_time": 2117.705,
"index": 83,
"start_time": 2089.77,
"text": " Life is one big experiment. Why not experiment with these everyday behaviors and habits? One of the ways to figure out how a system works is to change a variable in that system and record what happens. And so that's essentially what we're asking people do the experiment, eliminate alcohol, as long as you're not at risk for life threatening withdrawal, right? Eliminate cannabis, eliminate pornography and compulsive masturbation, eliminate video games, eliminate romance novels, see what happens."
},
{
"end_time": 2144.821,
"index": 84,
"start_time": 2118.524,
"text": " It can be very instructive for me. It certainly was. I experienced actual withdrawal where I had intense insomnia in the first 10 to 14 days. That's what we would expect people in those first 10 to 14 days, whether they're giving up sugar or giving up romance novels, they it's hard, but by weeks three and four, what I experienced and what most of our patients experience is the craving eventually subsides."
},
{
"end_time": 2172.722,
"index": 85,
"start_time": 2145.23,
"text": " mood gets better, anxiety lessens, there's a sort of quiet, quieting and centering that happens. There's an ability to be more present because we're not constantly looking forward to some future reward, right? Because if you think about it, if you organize your whole day around getting past right now, you and I talking to each other so that I can get to, you know, whatever my Netflix binge or my romance novel or my whatever, you know,"
},
{
"end_time": 2201.442,
"index": 86,
"start_time": 2172.722,
"text": " Then it's harder to be fully present in the moment. But if we give up the kinds of rewards that we're all using to shape our day, we can be fully more present and people talk about that a lot. I'm able to be more present for my spouse, more present for my children, more present for other tasks that I have to do. So this is the kind of thing that we we ask. It sounds like the first two weeks will be the most difficult for sure. What should people expect? You mentioned insomnia."
},
{
"end_time": 2222.705,
"index": 87,
"start_time": 2202.039,
"text": " And what should people do in order to get it over some of the common side effects or detrimental effects or whatever we want to call them. So if one is an AA, I imagine that they can call someone you have a partner. Now this many people who are listening, they have people in their lives, but they're alone in this regard. What are they to do?"
},
{
"end_time": 2249.65,
"index": 88,
"start_time": 2224.172,
"text": " Well, I do think it is very important to stay connected to other people. Ideally, you would maybe do the exercise together with somebody else. So you're encouraging each other, helping each other remain accountable. This can be in the context of a mutual health group like Alcoholics Anonymous or Cannabis Anonymous or Sexaholics Anonymous or just with a loving partner or a family member or friend."
},
{
"end_time": 2265.896,
"index": 89,
"start_time": 2250.043,
"text": " Who knows what you're going through maybe shares that problem and you can do it together. If you're doing it on your own you can have a trusted individual. Let people know you know that you're doing it so that they can help support you in other ways even if they are not themselves engaging in"
},
{
"end_time": 2296.186,
"index": 90,
"start_time": 2266.561,
"text": " in the dopamine fast activity. Um, I think learning how to just sit with the uncomfortable emotions without reaching for our maladaptive, uh, you know, high dopamine reward, um, and observing how that craving can come and go and, and, and that we can endure it. This is sometimes called surfing urge surfing that it can sweep over us like a way, but it doesn't last forever. That can be empowering."
},
{
"end_time": 2307.756,
"index": 91,
"start_time": 2296.186,
"text": " For people creating alternate activities now one danger with alternate activities sometimes we replace one reward with another right so instead of reading romance novel i'm gonna have a cookie."
},
{
"end_time": 2334.957,
"index": 92,
"start_time": 2308.166,
"text": " But the problem with that is cookies are also highly potent and I might end up getting addicted to cookies or compulsively eating cookies or just gaining weight, which is not something I would necessarily want to do. So sometimes we recommend actually something called hormesis. Hormesis is Greek for to set in motion. It's about how we can use painful stimuli to actually upregulate dopamine and other neurotransmitters. So this would be things like exercising or"
},
{
"end_time": 2363.677,
"index": 93,
"start_time": 2335.179,
"text": " You mentioned in one of your talks that there's a misconception about the present moment that we think of it as a blissful state, but rather it's characterized by a painful tedium. Can you outline that and help people help set expectations correctly to"
},
{
"end_time": 2392.056,
"index": 94,
"start_time": 2364.36,
"text": " guide them through this boredom that they'll experience when they no longer have this addiction or when it's interrupting their thoughts and they have to not follow it. Yeah, so yeah, let me qualify that that quote a little bit. I will say that being present in the moment can be wonderful. But I know that, you know, in my youth, I would often, you know, hear people like Ram Dass say be here now and things like that. And I always tried to do that and found that"
},
{
"end_time": 2413.012,
"index": 95,
"start_time": 2392.79,
"text": " That was intensely uncomfortable for me because being in my own thoughts and in my own body, I didn't want to be there. That wasn't a particularly delightful place. I have a lot of anxious ruminations and things I worry about and guilt I feel and regrets and on and on. I always thought, well,"
},
{
"end_time": 2442.602,
"index": 96,
"start_time": 2413.865,
"text": " You know, I must not be doing the being in the moment correctly, because if I were, uh, wouldn't I experience some kind of levitating bliss? Cause that seems to be what people are promising. It really took until midlife for me to realize, Oh, be here now means being in my mind and in my body, even if it's not a particularly comfortable place. And even if I find myself, you know, circling the drain on repetitive ruminative thoughts,"
},
{
"end_time": 2468.763,
"index": 97,
"start_time": 2443.148,
"text": " If I stay there long enough and breathe or do whatever other meditation exercises to help with grounding and centering, eventually those kinds of thoughts lose their potency or instead help inform decision making and moving forward. That voice of our own consciousness telling us"
},
{
"end_time": 2483.08,
"index": 98,
"start_time": 2469.326,
"text": " Things we need to do and listening to it and saying, oh, I should probably do that. If my mind is telling me enough times I should do that, I should say sorry or write a letter, things like that, instead of constantly trying to distract ourselves from ourselves."
},
{
"end_time": 2501.698,
"index": 99,
"start_time": 2483.916,
"text": " Razor blades are like diving boards. The longer the board, the more the wobble, the more the wobble, the more nicks, cuts, scrapes. A bad shave isn't a blade problem, it's an extension problem. Henson is a family-owned aerospace parts manufacturer that's made parts for the International Space Station and the Mars Rover."
},
{
"end_time": 2530.179,
"index": 100,
"start_time": 2501.698,
"text": " Now they're bringing that precision engineering to your shaving experience. By using aerospace-grade CNC machines, Henson makes razors that extend less than the thickness of a human hair. The razor also has built-in channels that evacuates hair and cream, which make clogging virtually impossible. Henson Shaving wants to produce the best razors, not the best razor business, so that means no plastics, no subscriptions, no proprietary blades, and no planned obsolescence."
},
{
"end_time": 2546.544,
"index": 101,
"start_time": 2530.179,
"text": " It's also extremely affordable. The Henson razor works with the standard dual edge blades that give you that old school shave with the benefits of this new school tech. It's time to say no to subscriptions and yes to a razor that'll last you a lifetime. Visit hensonshaving.com slash everything."
},
{
"end_time": 2574.343,
"index": 102,
"start_time": 2546.544,
"text": " If you use that code, you'll get two years worth of blades for free. Just make sure to add them to the cart. Plus 100 free blades when you head to H E N S O N S H A V I N G dot com slash everything and use the code everything. Speaking of the unconscious and listening to it, it's psychoanalysis. They have an emphasis on the psyche comprising different"
},
{
"end_time": 2604.189,
"index": 103,
"start_time": 2574.684,
"text": " Personalities some that are nested some that are intersecting or structures intra-psychic structures. How do these have? Bearing on the struggles people will face in addiction and also I want to transition to trauma so you can also talk about that as well Okay, so are you talking about like the id the ego the superego? Yeah, and Jung is quite Elaborate it's much more than that. He is more broke there are more complexes and personas and archetypes and a collective"
},
{
"end_time": 2620.794,
"index": 104,
"start_time": 2604.241,
"text": " Yeah, I mean, you have sort of departs, yeah, right, departs from Freud in that, you know, Freud believes that I mean, Freud's great contribution was that we have this unconscious, right, where we can have these experiences outside of conscious awareness that"
},
{
"end_time": 2648.763,
"index": 105,
"start_time": 2621.425,
"text": " very powerful drivers and that part of the healing process is to become more aware of those unconscious thoughts and feelings and drives. So that still echoes today in the work that we do. Oftentimes today that presents itself as sort of mindfulness practices. What is mindfulness? It's the ability to observe our thoughts and feelings without judgment. And that would have been something that"
},
{
"end_time": 2672.619,
"index": 106,
"start_time": 2649.155,
"text": " Freud would very much have championed this idea of, his method for doing it was through psychoanalysis, this sort of uninhibited, sort of unfiltered speech to another rather distant human as a way to get in touch with psychoanalysis, with our unconscious. That's of course Freud's famous"
},
{
"end_time": 2693.319,
"index": 107,
"start_time": 2673.012,
"text": " psychoanalytic therapy or talk therapy. Jung was a student of Freud, a colleague slash student, but he departed from Freud in that Jung came to believe that there was really what he called the collective unconscious. So that it wasn't that the unconscious just lives within our own mind. It's that really we have a societal or cultural"
},
{
"end_time": 2714.445,
"index": 108,
"start_time": 2693.814,
"text": " Or maybe even metaphysical conscious that's connecting us all together. And that's where these archetypes live, this idea that they're these sort of universal archetypes that will be the same across cultures and across time periods, because they're also uniquely human and emerging from this collective human consciousness."
},
{
"end_time": 2733.234,
"index": 109,
"start_time": 2714.445,
"text": " So I mean, I can't say I've really spent a lot of time like mapping that onto the addictive process per se. I mean, I could certainly, you know, sort of think about it now, but it's not something that I've spent a lot of time doing. In some ways, you know,"
},
{
"end_time": 2763.78,
"index": 110,
"start_time": 2734.906,
"text": " In some ways, I would say my work is nudging people a little bit away from too much introspective time. Because I think what can happen, especially when we're dealing with compulsive behaviors and addictive behaviors, is that people would prefer to spend a lot of time introspecting as to why they do a behavior instead of"
},
{
"end_time": 2784.155,
"index": 111,
"start_time": 2764.77,
"text": " Taking the steps necessary to change the behavior and in my experience, at least when it comes to addiction, that kind of deep introspection while we're still using our drug of choice is not very fruitful. It doesn't really get us anywhere. In fact, actions need to come before feelings."
},
{
"end_time": 2808.302,
"index": 112,
"start_time": 2784.667,
"text": " So I don't have to understand why I use, I don't have to investigate my trauma. What I need to do is I need to stop using, reset my reward pathways and then once I've done that and I get my frontal lobe back online talking to my limbic brain or my emotion brain, so I'm not just acting out of my lizard reflexes."
},
{
"end_time": 2834.838,
"index": 113,
"start_time": 2808.302,
"text": " Then we can begin the work of introspection and looking at, okay, what are some unconscious drives? What are some early, you know, trauma that might have contributed to my turning to substances or needing substances? Then that work is much more fruitful. Yeah, I had a friend who would constantly brood. Well, we all have issues, but he had some issues which he"
},
{
"end_time": 2861.732,
"index": 114,
"start_time": 2835.708,
"text": " would think about over and over and over. I would catch him just sitting in a chair just unhappy. I would tell him, sometimes it's as simple as if you don't want to eat chocolate, you remove the chocolate from your home. Like you can focus on the actions. And then he would counter with saying, yeah, but then you're not getting at the root cause. I want to get at the root. I want to get at the root. You fix the root. Don't give me a Western approach. I want to do the Eastern approach of getting straight to the core."
},
{
"end_time": 2878.951,
"index": 115,
"start_time": 2862.073,
"text": " Tell me what you think about that general approach and also is that even a correct characterization of the East and the West? You can go there if you like. Yeah, I'm not sure it's the correct characterization of East and West because I would say that in Western psychiatry and psychology and mental health,"
},
{
"end_time": 2903.916,
"index": 116,
"start_time": 2879.241,
"text": " I'm that that is also been the process kind of deeply retrospective that is to say looking in the past and introspective that is to say looking inward has been the dominant approach for the last hundred years and i think it's important to look at it historically and contextually you know when freud and many other psychiatrists and psychoanalysts and people thinking about this these kinds of things a hundred years ago"
},
{
"end_time": 2933.609,
"index": 117,
"start_time": 2904.48,
"text": " They were emerging from, you know, kind of Victorian era stiff upper lip where people didn't talk about their feelings. It was highly stigmatized to have mental illness. There were all kinds of somatization. That is physical manifestations of mental health problems. Um, you know, the, the grand hysterics of the sal patria. This was how people got emotional needs met. They presented with physical problems because people didn't really"
},
{
"end_time": 2964.275,
"index": 118,
"start_time": 2934.309,
"text": " have a language or a category for brain diseases that relate to emotion. And so, of course, you know, the huge contribution of Freud and others was to say, no, no, that's not going to work. We need to really unpack that stuff and look at it and find out what it's related to and what may have contributed to it and how it's contributing to our suffering today. So that was the great unpacking of all of those kinds of repressed feelings."
},
{
"end_time": 2991.749,
"index": 119,
"start_time": 2964.804,
"text": " But unfortunately, I think now in the 21st century, we've taken that too far, such that now people are spending enormous amounts of time. In some cases, I would argue too much time introspecting and retrospecting and trying to look deeply inward to find, you know, the cause of their suffering. Would you say they romanticize their suffering? Yeah. Or maybe maybe I would say overvaluing it is probably what I would say."
},
{
"end_time": 3008.473,
"index": 120,
"start_time": 2992.363,
"text": " giving it too much weight or even going back and reworking quite benign episodes to make them more significant or more traumatic than they really are because we're looking for a causal explanation of our suffering."
},
{
"end_time": 3038.473,
"index": 121,
"start_time": 3008.797,
"text": " Instead of just saying that, wow, all of that could be a contributing factor, but here's what's also a contributing factor, like your immediate environment, the people that you're with, how you're spending your time, the fact that you're not exercising, that you're not eating right, that you're not getting enough sleep, that you're smoking pot every day, that, you know, you're playing video games 24 seven, that you're reading romance novels, you know, whatever you want to do to call it. And that, you know, really maybe that's having a much bigger impact on your mental health."
},
{
"end_time": 3068.473,
"index": 122,
"start_time": 3039.002,
"text": " than what happened to you when you were eight years old. Furthermore, I think that we have evolved these tropes, especially in Western culture, that really, if we're not happy 24-7, there must be something wrong with us, or wrong with our lives, or wrong with our relationships. When in fact, life just is hard. And even the most mentally well person with the most fortunate"
},
{
"end_time": 3096.067,
"index": 123,
"start_time": 3068.848,
"text": " Circumstance is going to experience a great deal of suffering because being human is a delicate proposition. So I think some of recalibrating around expectations and then also really re-emphasizing behavioral activation and action before spending too much time kind of cogitating on what might be sort of an emotional cause."
},
{
"end_time": 3124.821,
"index": 124,
"start_time": 3096.476,
"text": " How important is bedside manner between a therapist and a patient or a doctor and a patient? And what lessons can one learn from that relationship that one can apply to one's own self-talk if one doesn't have a therapist? Okay, yeah, interesting question. Well, I mean, I really believe that the primary healing mechanism in psychotherapy or in any doctor-patient relationship is in fact the relationship."
},
{
"end_time": 3137.961,
"index": 125,
"start_time": 3125.503,
"text": " And that if we are fully present in a healing way for our patients that can have a tremendous impact on their well-being and is much more important in the long run than any pill we could prescribe or"
},
{
"end_time": 3164.718,
"index": 126,
"start_time": 3138.268,
"text": " the particular type of psychotherapy that we're using. And I'm always reminding my medical students and my residents of this, that it is our healing presence and the gift of listening and being fully present and responsive that is in fact the most important part of our encounters with our patients. Martin Buber, you know, talks about the I and thou moment. He was a philosopher and a theologian."
},
{
"end_time": 3184.326,
"index": 127,
"start_time": 3164.718,
"text": " I love that. His work is largely unintelligible to me anyway, but the basic concept of I am now is a very nice concept. It's that two human beings can make an incredibly powerful life-changing connection even in a fleeting moment of time by really being fully present for each other."
},
{
"end_time": 3214.445,
"index": 128,
"start_time": 3185.077,
"text": " So it is really important. In terms of the other part of your question, which I think was, what was it again? How can you apply the lessons of bedside manner to oneself if you're lacking in a therapist for whatever reason, you're too uncomfortable or you can't afford it? Yeah, well, it's a great question. I'm not sure it is possible to just do this in isolation. I mean, certainly our self-talk and the way that we"
},
{
"end_time": 3243.524,
"index": 129,
"start_time": 3214.94,
"text": " We can be far more empathic with ourselves. We can be less judgmental. We can sort of interject a kind therapist and imagine what that person would say to us instead of what we're saying to ourselves. So I think that can be helpful. But I do think that there's only so much that we can do on our own. Again, what is healing about seeing another human being and sharing your inner thoughts is that you're sharing them with another human being that that and we are such"
},
{
"end_time": 3273.183,
"index": 130,
"start_time": 3243.933,
"text": " Social beings, you really need to need to be in relationship with each other. And, you know, I think self help is great. And we can, you know, make a lot of progress by sort of collecting data on what we're doing really being thoughtful about it, making some small changes, seeing what happens documenting that. But I do think that in general, you know, doing things in isolation will only get us so far. I imagine that the negative effects in the spectrum of"
},
{
"end_time": 3302.176,
"index": 131,
"start_time": 3273.729,
"text": " say being too judgmental, too tough on oneself and then leniency that it's a horseshoe in the sense that you can be too forgiving of yourself where you allow yourself to be unindustrious and feckless and get away with too much. The proper balance is in the middle, a balance point. Do you find that it's more of the overly blaming and accusatory type or that it's more of a molly coddling and indulgent type? Yeah, another interesting question."
},
{
"end_time": 3328.2,
"index": 132,
"start_time": 3302.654,
"text": " I think when people are in crisis, it's both of those extremes simultaneously. So there's a lot of self-blame, enormous amount of shame, really paralyzing shame, self-hatred. Self-hatred is a very common modern phenomenon. It's amazing how much people living in the modern world seem to hate themselves. Imposter syndrome, FOMO, all of that."
},
{
"end_time": 3348.712,
"index": 133,
"start_time": 3328.831,
"text": " And yet, at the same time, people seem to be much more likely when they're in a psychological crisis to lie to themselves, to blame other people, to not really genuinely have difficulty seeing how they've contributed to a problem,"
},
{
"end_time": 3372.892,
"index": 134,
"start_time": 3349.121,
"text": " how they've really missed opportunities or failed to be grateful when they could have and should have been grateful. So both of those things are happening simultaneously when people are regressed and in crisis. And it's, you know, probably, you know, this would historically have been filed under primitive defense mechanisms, right? So all of those kinds of regressed, primitive maladaptive things that we do as we"
},
{
"end_time": 3396.459,
"index": 135,
"start_time": 3373.2,
"text": " Realize we're you know feel threatened as an organism and feel that we have to like defend ourselves against a hostile universe Did you find that when you're writing this book dopamine nation or any of your books? Is it therapeutic? Um It's not therapeutic in the sense that I'm solving problems that I didn't know the answer to"
},
{
"end_time": 3423.285,
"index": 136,
"start_time": 3397.398,
"text": " It is therapeutic in the sense that it's the only solitary creative work that I do. My professional life is immersed in service to patients and to students and mentees and everything I do is people intensive and collaborative. I'm with people all the time. I have to be fully present with those individuals."
},
{
"end_time": 3445.06,
"index": 137,
"start_time": 3423.729,
"text": " The writing of the books is like a day a week I give to myself"
},
{
"end_time": 3473.08,
"index": 138,
"start_time": 3445.23,
"text": " where I don't talk to anybody after sending my kids off to school. At least that's, you know, when I'm really writing, I'm not doing that work now because I don't have time. But when I do do that work, and so it's really a gift to myself. It's kind of, you know, letting myself play hooky and be play in the playground. And so it's very satisfying in that regard. David Foster Wallace said that good writing is ego death. Ah,"
},
{
"end_time": 3497.961,
"index": 139,
"start_time": 3473.336,
"text": " Do you resonate with that? Yeah, I do in the sense that when you're writing, you get too caught up in how people will respond to it or whether it's any good. You don't get very far. You have to really be coming from a very different place. For me, it comes from a place of like"
},
{
"end_time": 3526.374,
"index": 140,
"start_time": 3498.985,
"text": " What are attachment styles and trauma? Yeah."
},
{
"end_time": 3554.292,
"index": 141,
"start_time": 3527.295,
"text": " Well, I'm not an expert in attachment styles. There are lots of good books out there on this, but obviously our earliest human attachments with our caregivers goes a long way to shaping how we go through the world. And people have analyzed the different attachment styles that are out there, secure attachment, insecure attachment. Again, I'm not a real expert in all those categories, but the idea is that"
},
{
"end_time": 3571.92,
"index": 142,
"start_time": 3555.043,
"text": " Whatever environment we grow up in, if we're going to survive, we have to figure out how to survive in that environment. What can be an effective coping strategy in a dysfunctional environment doesn't necessarily serve us well"
},
{
"end_time": 3601.032,
"index": 143,
"start_time": 3572.125,
"text": " once we leave that environment. So I think that's kind of, you know, one conceptualization of trauma that if you're raised in a very dysfunctional environment, you're naturally going to develop a coping styles that will help you survive that environment, but in the long run, what will not necessarily serve you well in your life. And so then there's an incredible reworking that has to happen. So what is intergenerational trauma? And then what role does that have to play in addiction or addictive personalities?"
},
{
"end_time": 3624.701,
"index": 144,
"start_time": 3601.34,
"text": " Intergenerational trauma has to do with the ways in which these maladaptive coping strategies or family system styles that evolve in a given family will get passed on to grandchildren and great-grandchildren because"
},
{
"end_time": 3644.411,
"index": 145,
"start_time": 3624.701,
"text": " We don't just pass on our jeans we also pass on everything to do with how we navigate the world plus there's a whole new area. Write the means the means if you want to call it that plus there's a whole area of epigenetics that looks at how in fact."
},
{
"end_time": 3672.346,
"index": 146,
"start_time": 3644.77,
"text": " those behaviors can actually become part of our DNA and get literally passed on in our genes. And that's a very interesting work and makes sense to me that, you know, through our repetitive behaviors, you're going to express some proteins and not others. And the expression of those proteins will then affect, you know, future generations. When we spoke last time, we talked off air"
},
{
"end_time": 3686.476,
"index": 147,
"start_time": 3672.602,
"text": " about the power of stories and the power of a higher power. So and we wanted to talk about that this time. So please, what are stories? How are they relevant here? And how is a higher power relevant to any of this?"
},
{
"end_time": 3713.49,
"index": 148,
"start_time": 3688.234,
"text": " We're all storytelling machines. We have large parts of our prefrontal cortex that are dedicated toward narrative. And narrative is essential to humans as a way to organize past experience. But our autobiographical narratives are also roadmaps for our own future. So they become not just a way to organize the past, but also a way to know how to make decisions going forward."
},
{
"end_time": 3726.732,
"index": 149,
"start_time": 3713.49,
"text": " And one of the things that I think happens in good psychotherapy is that the therapist and the patient together explore autobiographical narratives and try to figure out"
},
{
"end_time": 3753.063,
"index": 150,
"start_time": 3726.937,
"text": " In my opinion, you know, one that hues as closely as possible to reality or what really happened, because I think when we're telling true stories, we have access to better information to make decisions going forward. But when we're telling stories that really aren't true about ourselves, which, by the way, we're very prone to do true as in factual, sorry, true as in factual, true as in factual. Yeah. Yeah. Well, we're not telling true, truthful and factual stories."
},
{
"end_time": 3782.978,
"index": 151,
"start_time": 3753.899,
"text": " Then we don't have access to good information to make choices going forward. So stories are really, really important. They're sort of our, you talk about memes. I mean, we pass these things down through generations through the stories we tell, you know, and stories are also a fundamental way to experience live time. That was Foucault, but also to understand cause and effect. I know no better way in the human realm to understand true cause and effect than through storytelling."
},
{
"end_time": 3800.913,
"index": 152,
"start_time": 3783.916,
"text": " So and in terms of higher power I mean this this is a really fascinating area to me but it essentially has to do with like locus of control and what I've seen again and again in recovery from severe addiction"
},
{
"end_time": 3830.998,
"index": 153,
"start_time": 3801.459,
"text": " is that especially people with the severest forms of addiction that eventually the only thing that really gets them into recovery is to give that locus of control over to a power greater than themselves. That doesn't need to be a deity necessarily. It could be the mystery of the universe or it could be my AA fellowship or it could be the power of love."
},
{
"end_time": 3853.797,
"index": 154,
"start_time": 3831.749,
"text": " Basically it's the acknowledgement, at least with severe addiction, that when I'm in charge and only relying on myself and my own decision making, things go awry. So I need to acknowledge with humility that I'm not actually in control of what's going on here and that the harder I try to work to"
},
{
"end_time": 3882.022,
"index": 155,
"start_time": 3854.138,
"text": " you know, contain or manage or control my life the worse things actually get. So there's this amazing pivot that occurs when people give up that sense of control to a higher power and let instead life unfold and try to commune with that higher power either through meditation or prayer or going to meetings or fellowship or what have you, that people then begin to be able to access"
},
{
"end_time": 3906.049,
"index": 156,
"start_time": 3882.432,
"text": " a wisdom and a strength that otherwise they don't have access to and then begin to make much better decisions in their lives. So is this higher power just anything that's outside of you that has more control over you than you do of yourself? Because if that's the case, I could imagine that everyone believes in a higher power. Well, if you're a Marxist, you believe it's the corporations. If you're a capitalist, maybe it's the government."
},
{
"end_time": 3929.172,
"index": 157,
"start_time": 3906.391,
"text": " If you're someone who doesn't like your job, maybe it's your boss, that person has so much more power than me. And I imagine that that's not terribly helpful in the way that when people say believe in a higher power or recognize that there's a higher power and that will help you through your addiction. I imagine that that's not what's meant. So please delineate what's meant by higher power. Yeah, great, great, great point."
},
{
"end_time": 3956.937,
"index": 158,
"start_time": 3929.377,
"text": " So to clarify further, the higher power is something higher than any human agency. So not just higher than my human agency, but higher than any human being could possibly. So there's no other human being or human element that could solve this problem, right? So it's something meta, something outside of human agency and human understanding."
},
{
"end_time": 3986.954,
"index": 159,
"start_time": 3957.892,
"text": " It's much, much higher than than that. Yeah, I don't know if there are studies on this, but is it more powerful if it's considered to be divine, a divine higher power? Or is it more powerful if it's a secular higher power, like it must be the objective universe that has no emotion? Yeah, I, you know, unfortunately, I feel like our language in this space is so limited, because I don't think it needs to be necessarily a divine human power. And yet,"
},
{
"end_time": 4015.503,
"index": 160,
"start_time": 3987.534,
"text": " I'm not sure calling it a secular human power really fully captures it. I think, I believe very strongly that it doesn't even really need necessarily to be defined. And this is in some ways the genius of AA. It's a higher power according to your understanding. So, I mean, I don't think you need to define it. For some people it's very important to define it. It's important for them to know, is this God?"
},
{
"end_time": 4045.196,
"index": 161,
"start_time": 4015.93,
"text": " If so, whose God is it? You know, what religion is this going to be associated with? But for many people, that's not important at all and proves not to be the critical element. It's really more a profound stance of humility and willingness and acknowledging that I don't know who's in control, but I know it's not me and I know it's not you. Humility is a great word."
},
{
"end_time": 4070.606,
"index": 162,
"start_time": 4045.555,
"text": " because it's also related to being humiliated. And it sounds to me like in one of your other talks when referencing telling the truth, something I was thinking, I don't know if this is the case. I'm going to tell you what my thoughts are. I want to hear what your thoughts are is that there are truths so we can just begin to never lie and tell the truth. But then there are also lies that we have told in the past. And do we come forward with those? Well, that's much more tricky because there's a mountain of them."
},
{
"end_time": 4100.145,
"index": 163,
"start_time": 4071.203,
"text": " So one option is you confess all those lies to this higher power. But you have to believe in quote unquote in this higher power. Otherwise, it's not humiliating to confess. And there's something about walking through the fire that is where the redemptive qualities are, that if there's no consequence to it, then your confession was for not. It was as if you just told a cup and maybe the cup to some people is divine. And in that case, that's fine. But that's rare."
},
{
"end_time": 4120.828,
"index": 164,
"start_time": 4101.254,
"text": " Yeah, I think you're right. I mean, when we think about a higher power, however we define it, there has to be a sense of shock and awe and maybe even a little bit of terror before that the word power"
},
{
"end_time": 4143.404,
"index": 165,
"start_time": 4121.459,
"text": " With higher power has any meaning, right? Actually Kierkegaard wrote about this concept of Kierkegaard's the the corner of the phrase the leap of faith and he wrote about this concept of infinite resignation that before you can even have this leap of faith there has to be this kind of infinite resignation of recognizing"
},
{
"end_time": 4170.759,
"index": 166,
"start_time": 4144.855,
"text": " In a way, the profound humility of our own efforts to really get to that place that a higher power can transport us. And while we're on the topic of speaking the truth or telling the truth, can you outline why that's important? And not just neurobiologically, like not just okay, the prefrontal cortex is strengthened, but somehow psychologically as well."
},
{
"end_time": 4192.432,
"index": 167,
"start_time": 4172.449,
"text": " Yeah, so this idea of like radical honesty comes from my work with patients over the years finding that those who are able to get into recovery from the severest addictions and stay in recovery are the ones that have learned that they can't lie about anything. So not only can they not lie about"
},
{
"end_time": 4220.913,
"index": 168,
"start_time": 4192.756,
"text": " Uh, you know, their use, they can't lie about why they're late for a meeting, what they had for breakfast, where they're going to be Saturday night. It's those trivial lies that they have to be the most careful about because that will lead them back into, uh, the bigger lies about using. And to me, that's fascinating. I mean, what is it about, uh, this kind of embracing this concept of radical honesty and never lying that helps people with addiction? I think it works on a bunch of different levels."
},
{
"end_time": 4252.09,
"index": 169,
"start_time": 4222.193,
"text": " One of the levels that it works on is just their own insight and awareness of what they're actually doing. So part of what happens when we lie, and the average adult tells one to two lies per day, is that we're not just lying to other people, we're largely also lying to ourselves. And to talk about Freud's unconscious, we're allowing certain themes and things that we do and say and think to remain in those dark recesses of our minds. Whereas if we're articulating something, there's something very, very powerful"
},
{
"end_time": 4275.077,
"index": 170,
"start_time": 4252.517,
"text": " turning our inner life into words that we share with another human. It really makes it real in a way that it's not otherwise and it hugely enhances our awareness of it. So that's one of the big things. The other thing is that telling the truth profoundly enhances intimacy."
},
{
"end_time": 4285.623,
"index": 171,
"start_time": 4275.742,
"text": " We're definitely afraid of people knowing our faults and weaknesses, our deep desires, our shameful desires, whatever it is."
},
{
"end_time": 4311.869,
"index": 172,
"start_time": 4286.544,
"text": " We're afraid that if we tell people they'll, you know, run away from us. But in fact, the opposite happens. You know, if we really share our shame, um, people come to us, you know, they want to be closer to us. It enhances trust. So it's a wonderful way of augmenting intimacy. And very often that kind of deep intimacy or connection to other human beings is the best antidote to addiction."
},
{
"end_time": 4339.206,
"index": 173,
"start_time": 4312.381,
"text": " I just saw a patient today with a, uh, he has a sex addiction and he was experiencing intense cravings. He and his wife had a bunch of things to do around the house and he was kind of dreading doing those things. And you know, he's struggling in his addiction and out of the blue came this craving to act out that basically he was planning that after she went to bed, he would look at pornography, which is, you know, part of his definition of relapse. Uh huh."
},
{
"end_time": 4357.978,
"index": 174,
"start_time": 4339.838,
"text": " And then it occurred to him, well, you know what? I'm just going to let her know what's going on for me. And he said, I just want to let you know I'm having a lot of cravings right now wanting to act out and I'm formulating a plan. And she responded by saying, thank you for sharing that with me. Do you want to talk about it? Is there anything that I can do to help? That's sweet."
},
{
"end_time": 4382.039,
"index": 175,
"start_time": 4358.592,
"text": " Well, even better, even better after they talked about it, you know, and she went to bed, he had no cravings. So his cravings went away. And really, what's so key there is that really what what was the craving in search of it was in search of some intimate human connection at a point when he was feeling low. So instead of escaping to his"
},
{
"end_time": 4409.65,
"index": 176,
"start_time": 4382.346,
"text": " So if I was to recapitulate, please let me know if this is correct or incorrect."
},
{
"end_time": 4436.732,
"index": 177,
"start_time": 4410.333,
"text": " When you lie, you feel as if you're manipulating and you're getting away with something like you've achieved something, something positive. Otherwise, you wouldn't have lied. But what's actually happening is that you poison yourself. You've corrupted your heart and your heart is a large aspect of you. And further, and you maybe you don't know this, but my background is in math and film. Yeah, yeah. There's a screenwriting adage that says the more specific the pain, the more applicable it is or the more relatable it is."
},
{
"end_time": 4466.596,
"index": 178,
"start_time": 4437.244,
"text": " And further, the more general you try to be, the less relatable it is paradoxically. In other words, you think that you're going to repulse someone by revealing your innermost, specific, painful, personal thoughts. But what actually happens is that you endear people to you. And then further, what you've articulated is that you also get endeared to other people. So I don't know if I interpreted what you said correctly in my own inference or my own translation, but tell me what you think."
},
{
"end_time": 4495.367,
"index": 179,
"start_time": 4467.961,
"text": " Yeah, that's I mean, I guess I might use slightly different phrasing, but I mean, I think you're, you know, similar themes, I think, you know, what I touched on is just how telling the truth makes us more aware and gives us more insight into what we're actually doing. Yeah, because when we don't tell the truth, we are not aware of these behaviors, they remain in our unconscious. And then we continue to lie to ourselves."
},
{
"end_time": 4524.923,
"index": 180,
"start_time": 4495.964,
"text": " So that's one of the primary ways that this radical truth-telling can be helpful is that it increases our knowledge base, right? It increases our perception. It increases the information that we're taking in about the world, which then enhances our models, right? So if we're going to use an active inference language, we improve our perception, we improve our models, and then we have better models going forward to interpret the world."
},
{
"end_time": 4548.251,
"index": 181,
"start_time": 4525.247,
"text": " Does free will have any relevance here? Like it's important to believe in free will or it's actually better if you do not if you say no this is not in my control? I don't know. I don't know the answer to that. That's a great question. I do think often about free will and I haven't even concluded myself what I've decided about it one way or another. But the other thing is that"
},
{
"end_time": 4574.155,
"index": 182,
"start_time": 4548.677,
"text": " The other thing is that, let me just say I would like to believe in free will. I think that's a better universe where we have some free will. And I do think that that degree of randomness that's built into the universe is that opportunity for free will. But the other thing is just that telling the truth also enhances intimacy. It allows us to draw near to other people, which then serves as an antidote to addictive behaviors."
},
{
"end_time": 4596.493,
"index": 183,
"start_time": 4574.718,
"text": " What is this hard-earned wisdom that people have when they go through an addiction and then they come out of it or trauma and then come out of it or maybe my language of quote-unquote coming out of it is not something that's helpful but please translate into however it should be?"
},
{
"end_time": 4611.067,
"index": 184,
"start_time": 4597.619,
"text": " I think any type of profound suffering that we come through the other side hopefully makes us stronger and wiser. That is an idea that's been around forever. There's this"
},
{
"end_time": 4638.217,
"index": 185,
"start_time": 4611.613,
"text": " There's this idea from Japan, I'm not going to remember the name of it, but this idea that if you break a bowl and then you put it back together and you glaze it, it's stronger than it was in its original form. So I think that's true. That's been sort of a truism in all cultures in some shape or form. It's not always true. Sometimes a broken bowl can't be put back together and that's a shame."
},
{
"end_time": 4663.66,
"index": 186,
"start_time": 4638.746,
"text": " But when it can, then the idea is that we're stronger for it. Yeah. And does it also make you more resilient? I think so. Yeah, absolutely. Yeah. And are there some interventions that are better for eliciting this wisdom slash resilience? So for instance, a pharmacological one is not as good or a talk therapy one in combination with medication is the best."
},
{
"end_time": 4691.561,
"index": 187,
"start_time": 4664.07,
"text": " I don't know if there are studies on this. It depends on the disorder and it depends on the person and it depends on the circumstance. Sometimes for some people, medication is the best answer. For others, it's different. Psychosocial intervention sometimes is a combination of the two. It depends on what disorder you're treating. I would hate to generalize across the board for every single disorder."
},
{
"end_time": 4710.589,
"index": 188,
"start_time": 4692.773,
"text": " I do think in general we're too quick to prescribe medications in many instances and that we over medicate and there's a big problem with polypharmacy. Our health care system is designed"
},
{
"end_time": 4740.043,
"index": 189,
"start_time": 4710.589,
"text": " For patients of yours that can lucid dream,"
},
{
"end_time": 4767.568,
"index": 190,
"start_time": 4740.759,
"text": " Have you found it to be helpful? Like you say, okay, if you're in your dream, ask this question to this character. You know, I don't really know much about that. I've certainly heard about it, but I can't say I know really even what that is. Okay. We've talked about individual action plenty on this podcast and we've talked about patient to individual action. So what about family to individual?"
},
{
"end_time": 4793.643,
"index": 191,
"start_time": 4768.012,
"text": " So if you're part of a family and you want to help an individual or a friend group and you want to help an individual and then also what about society? Yeah, so I mean in terms of are you asked specifically if you have a friend or family member was struggling with addiction? Yeah, there are two questions in there. So what do you do if you have a friend or family member that's suffering in this way? How do you treat them? How do you view them in your head as well in order to"
},
{
"end_time": 4820.623,
"index": 192,
"start_time": 4794.155,
"text": " I think that the medical model here is very useful, the disease model of addiction, which basically argues that there are predisposing innate genetic factors for developing addiction and then plus we live in an addictogenic world where we're surrounded by highly reinforcing drugs and behaviors at the touch of our fingertips, making us all more vulnerable to this problem."
},
{
"end_time": 4845.93,
"index": 193,
"start_time": 4821.357,
"text": " And that once we expose our brains repeatedly over time to this highly reinforcing substance or behavior, we essentially change our brains. You know, as I've talked about, we can go into this dopamine deficit state and then we do lose some degree of our own personal agency. We're slaves to this hijacked brain or where our brain mistakes this rewarding substance or behavior as something necessary for survival."
},
{
"end_time": 4865.52,
"index": 194,
"start_time": 4846.186,
"text": " We start to commit all of our available resources to getting the drug, hiding the drug, withdrawing from the drug and doing it all over again. And the reason that I think that's a good model is because it's supported by the evidence, but it's also a model that helps elicit compassion and the realization that"
},
{
"end_time": 4881.63,
"index": 195,
"start_time": 4866.067,
"text": " Our loved one is not choosing the drug over us, but rather our loved one has lost the ability to choose. They really are caught in the vortex of addiction. Because otherwise what happens is that there's a lot of shame and blame."
},
{
"end_time": 4897.927,
"index": 196,
"start_time": 4881.63,
"text": " and people feeling that their loved one cares more about the drug than they do about them. I just saw a couple this afternoon in their 70s and he can't stop drinking and she says he won't stop drinking but he literally on some level can stop drinking."
},
{
"end_time": 4923.114,
"index": 197,
"start_time": 4898.643,
"text": " So it's painful to see that. It doesn't mean that the family member can't feel anger because that's appropriate. But again, recognizing that it is a brain disease and this person has lost their personal agency to the disease. So when it comes to then interacting with family members, I think it's"
},
{
"end_time": 4946.357,
"index": 198,
"start_time": 4923.353,
"text": " It's good to choose a time in which we're not dysregulated and they're not intoxicated or withdrawing and then bring up the topic and just express it as something that you're bringing up because you care about them and you want what's best for them and it's painful to watch them do X, Y or Z or that they may not realize that X, Y or Z substance or behavior"
},
{
"end_time": 4965.555,
"index": 199,
"start_time": 4946.681,
"text": " is causing these kinds of problems. So to act as a kind of calm and compassionate mirror to reflect back to them the impact of their substance use or their addictive behaviors on their lives and on our lives because people don't see that or they don't let themselves be aware of it."
},
{
"end_time": 4981.578,
"index": 200,
"start_time": 4966.783,
"text": " Now what about, okay, we're going to get to society in just a moment. What about now flipping it from individual to family or individual to friends? So you're that individual or the person who's listening is that individual who feels as if they're addicted to something and they know it and"
},
{
"end_time": 4997.432,
"index": 201,
"start_time": 4981.834,
"text": " They know that they harm the people around them, but at the same time, they want some sympathy from the people around them. Like, look, please help me. You need to understand where I'm coming from. So what do they do other than send them this podcast? What do they do? What do they tell the friends and the family members?"
},
{
"end_time": 5023.609,
"index": 202,
"start_time": 4999.07,
"text": " What is a person with addiction do? Yeah. Well, I mean, I think there can be words and actions. And usually if there aren't actions tied to the words, people aren't going to put much weight into the words. So if a person with addiction really wants to get better, then they can say that to others. I really want to change. Here are the steps I'm going to take to try to change. And here's what you can do to support me."
},
{
"end_time": 5049.343,
"index": 203,
"start_time": 5024.838,
"text": " But you can't just say, oh, I have addiction and so it's a disease and I have no agency. So you should feel badly for me and let me do what I want. That's not what we're talking about. We're talking about a disease. It's both a disease process and one for which that individual can and needs to take responsibility for reaching out for help. So maybe they can't stop on their own, but they can choose to turn to others and"
},
{
"end_time": 5076.51,
"index": 204,
"start_time": 5050.282,
"text": " and open themselves up to getting help. And if they're unwilling to do that as well, then I think the loved one has the right to say, well, I love you, but I can't live with you anymore, right? I mean, I feel for you and all that, but if you're not going to take these steps to make some changes, then there are going to be real life consequences, including I may leave or I may stop supporting you or you may have to leave or whatever it is."
},
{
"end_time": 5106.323,
"index": 205,
"start_time": 5077.21,
"text": " One of the things that I have learned after two decades of treating people with addiction is that many people with severe addiction will not find the motivation to change unless there are real life consequences for them. They lose their housing, they lose a spouse, they lose their rights to be with their children, they lose their job, they get a DUI. So consequences, you know, and family members can empathically and in a frame of loving a family member,"
},
{
"end_time": 5131.92,
"index": 206,
"start_time": 5106.834,
"text": " Yeah, so in other words, they're saying the words, I love you, but I have to kick you out. Though what they mean is I love you. And it because I love you, I have to kick you out. There you go. It's not even a button. Right. That's right. That we have this view of love is"
},
{
"end_time": 5154.957,
"index": 207,
"start_time": 5132.329,
"text": " Simply tenderness and clemency. That's right. Yeah, yeah, good. So the reason I had asked about the society question is I wanted to go over to the audience questions. And that's a nice segue. Someone from the audience had asked, why treat the individual in a sick society? Shouldn't you treat the society? What is it like our society is sick? It's an abnormal society. I'm sure you've heard these claims."
},
{
"end_time": 5183.968,
"index": 208,
"start_time": 5155.35,
"text": " Yeah, I mean, it's essentially the claim I'm making in dopamine nation, right? The big idea there is that the location of the disease process is not in our individual brains, it's in the world that we live in now, in which we are surrounded by highly reinforcing substances and behaviors at the tip of our fingers, and we're told that we should pursue consumption. That's kind of our raison d'etre."
},
{
"end_time": 5206.527,
"index": 209,
"start_time": 5184.445,
"text": " I absolutely agree with that, that in order for us to be healthy, we have to change the modern ecosystem. And the way that we need to change is we need to limit access to highly reinforcing drugs and behaviors, and we have to develop a new kind of social etiquette around eschewing or avoiding, you know, intoxicants except in extreme moderation."
},
{
"end_time": 5234.258,
"index": 210,
"start_time": 5207.022,
"text": " and actually doing things that are challenging or difficult or even painful as a way to kind of reset her reward pathways. And we have to do it with a sense of meaning and purpose derived not just from the fact that we will individually feel better if we do that, but also we will save our planet. I mean, our consumptive behaviors are not only self-destructive, they're also just highly destructive to the environment and to the planet that we live on."
},
{
"end_time": 5264.684,
"index": 211,
"start_time": 5234.872,
"text": " the way that, you know, we're absolutely depleting our forest fuel sources, fisheries, you name it, because we eat too much and we smoke too much and we drink too much and we buy too many cars and all of it. Have you read Pure White and Deadly by John Yudkin? So it's a book from the 70s, I believe, and he makes the case that the problem in our society or one of the largest problems is over consumption of refined sugars."
},
{
"end_time": 5293.063,
"index": 212,
"start_time": 5265.094,
"text": " which I think you can generalize to empty carbs. Right. And so in the self development world, there's something called keystone habits and working out as one of them. So if you do this, the rest of your life benefits and your other positive habits will come more easily. Is it the case? Have you seen that it's the case where if someone is over consuming on carbs, then it affects the rest of their life and in negative ways with respect to what you treat them for clinically?"
},
{
"end_time": 5322.688,
"index": 213,
"start_time": 5294.002,
"text": " Oh, sure. So we see actually quite a lot of food addiction in our, in our clinic, independent of obesity, which is sort of interesting. Some people who binge on foods, and I would say basically, we all have disordered eating in the modern age, like our food supply is so plentiful and so drugified with the addition of fat, salt, sugar, and other flavorants that we're all prone to overeat, and then trying to find"
},
{
"end_time": 5336.425,
"index": 214,
"start_time": 5323.148,
"text": " I was talking to my"
},
{
"end_time": 5362.125,
"index": 215,
"start_time": 5336.937,
"text": " Right. You have repetitive things where you've lost desire for certain foods unless they're just the food you want in that moment. But many people are struggling in other ways where they can't stop eating these highly processed, highly caloric foods for the first time in human history. There are more people on the planet with obesity than who are underweight or malnourished."
},
{
"end_time": 5389.548,
"index": 216,
"start_time": 5362.125,
"text": " For the first time in human history, people are getting surgeries to reroute their intestines so that they can manage their overconsumption. So we've clearly reached a tipping point with our food supply. And we see more and more people who are outright addicted to food, even separate from being obese, people who compulsively overconsume food until they're essentially passed out just the way that people drink alcohol in that manner. So, you know, food's a real addiction."
},
{
"end_time": 5412.944,
"index": 217,
"start_time": 5390.145,
"text": " So yeah, it shows up in all kinds of ways, just the way that other addictions can make people depressed and anxious and inattentive and unable to sleep and not able to be present and narrowing of focus and all those things. We see that with food addiction too. The next question which comes from the audience is what should I do to parent my young child? And also is there a difference between young boys and young girls in this regard?"
},
{
"end_time": 5441.988,
"index": 218,
"start_time": 5414.411,
"text": " Yeah, so I do think there are differences between boys and girls in the sense that the kinds of, let's say, intoxicants or drugs that girls will gravitate to, like social media, are just slightly different than boys on average. These are gross generalizations. Boys, it's more likely to be pornography and video games as well as substances. Although interestingly, over time, we've seen more and more girls use things like alcohol."
},
{
"end_time": 5468.933,
"index": 219,
"start_time": 5442.671,
"text": " such that now there are as many women in the United States struggling with alcohol use disorder, alcohol addiction as men, which is very different from past generations where the ratio was more like two to one and then hundreds of years ago was more like five to one men to women. So women are, you know, drug use is much more socially normalized now among women. And so more and more women are developing drug addictions. But, you know, speaking of parenting young children,"
},
{
"end_time": 5474.701,
"index": 220,
"start_time": 5470.316,
"text": " I just think all of the things that we know already, the kind of common sense things,"
},
{
"end_time": 5501.869,
"index": 221,
"start_time": 5474.991,
"text": " have healthy attachments, to spend time together as families, but in particular with devices. I think kids under the age of 11 or 12 should really not have their own devices that give them unfettered access to the internet. Yeah, so I do think that we can't underestimate the power of these digital drugs. Digital content is highly reinforcing and quantity and frequency matter. So to sort of say, well, my kid"
},
{
"end_time": 5521.817,
"index": 222,
"start_time": 5501.869,
"text": " I think that we can't do that as parents. That would be essentially like giving our kids a pack of cigarettes and saying, go at it. I think we have to recognize the addictive potential, which doesn't mean no video games, but it does mean really, you know, or social media or whatever, even pornography."
},
{
"end_time": 5541.169,
"index": 223,
"start_time": 5522.381,
"text": " Because kids are using it, so I think to have open honest discussions and really think about limiting use. I talk with families a lot about having behavioral contracts, making sure kids do their homework and their family chores. Behavioral contract. Yeah, so kind of where you have"
},
{
"end_time": 5569.121,
"index": 224,
"start_time": 5541.442,
"text": " People have to do certain things to earn the time on video games and social media or time on their devices and then have that time be limited where they have to give interesting for adults. Could that be implemented to yourself or in combination with a partner? Yeah, absolutely. Absolutely. And then I really recommend that families do like a digital Sabbath where they take one day a week or even just a half day a week where everybody leaves their devices at home, all the devices."
},
{
"end_time": 5592.858,
"index": 225,
"start_time": 5569.514,
"text": " And they do something together with no devices. I think it's super important for parents to model what they want their kids to do. I have a lot of parents who are on their devices constantly and then complain that their kids are on their devices constantly. It's like, well, if you don't change your behavior, they're not going to change theirs. Our actions as parents are much, much louder than words. So if our kids see us constantly on our devices, they're going to think, oh, that's how"
},
{
"end_time": 5618.353,
"index": 226,
"start_time": 5593.473,
"text": " That's how you do it. So I think really important to have like times when we're not on devices, like dinner times or other family occasions. Professor, I find whenever I leave my phone at home, I love it. Like I'm with my wife and I'm much more present, but invariably right before I'm about to leave the house, even though I have all the evidence of all the other times where I've enjoyed myself, I say,"
},
{
"end_time": 5623.78,
"index": 227,
"start_time": 5618.78,
"text": " Yeah, but there's going to be an emergency where I'll need to call someone. So let me I'll come up with some excuse to bring it."
},
{
"end_time": 5652.739,
"index": 228,
"start_time": 5624.36,
"text": " Yeah, I know people feel really naked without their phones. It's true. But the truth of the matter is if there really were an emergency, what would your phone allow you to do to manage that? Someone's going to call 911 or they're going to help out. If you're not physically there, what can you do anyway? You know, I never really carry a smartphone around except when I'm traveling and I need to do Uber or something like that. And I tell you, I think my quality of life is really enhanced by that."
},
{
"end_time": 5680.179,
"index": 229,
"start_time": 5653.49,
"text": " Professor, I'll confess something right now. You have me at a time where because of your book, your book has made me get off of coffee. And right now I'm six days off of coffee. So I'm loopy and it's your fault. I'm inarticulate. Oh, and by the way, you mentioned that it's much better to do a detox, a quote unquote dopamine detox, a 30 day one with other people. And so inspired by you,"
},
{
"end_time": 5708.029,
"index": 230,
"start_time": 5680.708,
"text": " When this launches right now in the discord for this channel, which is like a chat room, will be a dedicated channel in the chat room for a 30 day detox where you, if you want to give up something, I'll give up something. We'll all state what it is if you want to make it public and then we can keep each other accountable for the next 30 days. This should release in early November, late October. Yeah, that's great. I love it. Yeah, that's great that you're doing that. I'm wondering, are you willing to share how much coffee you were drinking?"
},
{
"end_time": 5738.422,
"index": 231,
"start_time": 5708.507,
"text": " Two and a half cups. Okay. And what made you decide what made you decide to give it up? Well, I tend to I drink coffee four times a week. Okay. And I take three days off because I want to make sure that I'm not adapted to it and still gives the alert effects that I want. But then I thought, you know, many people say coffee increases anxiety and I have anxiety and also increases sleeplessness. And I have insomnia, like horrible insomnia, horrible, horrible insomnia."
},
{
"end_time": 5766.459,
"index": 232,
"start_time": 5738.422,
"text": " I'm sorry. Oh, my gosh. I'm sorry. Yeah, that's hard. So I thought, why not eliminate caffeine? Sorry, coffee. Why not eliminate coffee? Go back to drinking black tea. OK. So retain the caffeine, but it's much less in black tea, especially if you just have one. OK. Is it harder than is it harder than you thought it would be? Today's the worst day. I feel so horrible, but it's great because I have you to speak to. Oh, there you go. OK, good, good."
},
{
"end_time": 5783.37,
"index": 233,
"start_time": 5767.039,
"text": " Well, good for you for trying it because it doesn't even sound like it was particularly problematic except that you're wondering and that's a good thing to wonder about whether you could improve anxiety and insomnia by eliminating it for longer and I think that's a worthy experiment because"
},
{
"end_time": 5806.169,
"index": 234,
"start_time": 5783.951,
"text": " For some people, caffeine really can increase anxiety and insomnia. So I think it is a really interesting and good experiment. So good for you. And make sure that you stay the full 30 days because if you just do it for two weeks, you'll get all the hard part without the benefit. You really have to do it long enough to get your brain to get some message."
},
{
"end_time": 5834.667,
"index": 235,
"start_time": 5806.493,
"text": " This coffee is really not coming. So I guess I'm going to make some changes here. So I'll be curious to know how it goes. Specifically, what motivated me was your distinction between mild and moderate addictions. And I don't think I have an addiction to coffee, but I think it was approaching a mild addiction. So it goes mild, moderate to what? Severe. Severe. Severe. Okay. Yeah. Yeah. And I'm not even sure you would make the cutoff for a coffee addiction. I think for you, you're even just maybe a little, you know,"
},
{
"end_time": 5864.855,
"index": 236,
"start_time": 5835.094,
"text": " Many people wanted to know about how is it that they can self assess if they're on the route to a mild addiction, if not mild to moderate. And I know that psychiatrists and health professionals will always say, go seek a health professional, go seek your family doctor. But in the absence of that, is there some rudimentary"
},
{
"end_time": 5888.729,
"index": 237,
"start_time": 5865.384,
"text": " set of five questions someone can ask. Oh, sure. I mean, I would say open up the Diagnostic and Statistical Manual of Mental Disorders. There are 11 criteria. You can go through those criteria. If you meet two or more of those criteria, then you would meet criteria for a mild use disorder. So that's what I would do."
},
{
"end_time": 5907.466,
"index": 238,
"start_time": 5889.428,
"text": " In an effort to keep this podcast a complete resource, I'm going to list out the 11 questions from the DSM-5 about addiction. Count how many times you say yes. Number one, do you sometimes have difficulty controlling how much you use your drug or how long you use it? Also, recall that you can substitute the word behavior for drug."
},
{
"end_time": 5924.872,
"index": 239,
"start_time": 5907.466,
"text": " Number two have you made any unsuccessful attempts to cut down your usage number three do you sometimes spend a significant amount of time using or recovering from your usage of drugs or engaging that behavior number four has your drug had any negative effects at home at school at work."
},
{
"end_time": 5939.957,
"index": 240,
"start_time": 5924.872,
"text": " Number five has it negatively impacted your social life number six do you continue to use despite negative consequences number seven have you put off things or neglected to do things because of your drug use or your behaviors number eight."
},
{
"end_time": 5965.845,
"index": 241,
"start_time": 5940.265,
"text": " Do you have strong cravings? Has your tolerance increased? Are you able to use more than you did before? Have you experienced withdrawal symptoms the next day? Has it led to any dangerous situations? The criteria is that if you've answered yes to two or three of these, you have a mild substance abuse. If you've answered yes to four or five of them, you have a moderate substance abuse."
},
{
"end_time": 5979.718,
"index": 242,
"start_time": 5965.845,
"text": " Another question that comes from the audience is, is it better to be addicted to something that's a positive habit like working out?"
},
{
"end_time": 6002.056,
"index": 243,
"start_time": 5981.493,
"text": " So when I use the word addiction, I'm really talking about psychopathology. That means you've crossed the line from it being adaptive or it being a hobby or it being a habit into it being a mental illness, which means it has to be compulsive. It has to be out of control and it has to cause harm to self and others."
},
{
"end_time": 6028.37,
"index": 244,
"start_time": 6002.551,
"text": " Um, you know, short of that, I don't really call it an addiction. So, but, but it is true that some people can get addicted to even behaviors that we typically think of as healthy, like exercising or in my case, reading or maybe playing chess or, um, you know, other, other things that, that we think of as well. That can't be an addiction because you're playing chess and smart people play chess or whatever it is."
},
{
"end_time": 6055.776,
"index": 245,
"start_time": 6029.036,
"text": " But the truth is that we're all wired slightly differently, we all have a different drug of choice. And so it is possible, although it's much harder, and not as common, but it is possible to get addicted to exercise. So how do we how does that look when people are addicted to exercise? That means they're compulsively engaging in exercise, despite repetitive injuries, seeing a doctor who says you've got to stop doing that."
},
{
"end_time": 6079.77,
"index": 246,
"start_time": 6056.22,
"text": " Despite family members saying it's really adversely impacting our family life, that you have to spend X hours every day doing your sport. Yeah, so my mother-in-law, anytime I'll give her any supplement like melatonin, she'll say, is that addictive? Am I going to get addicted? What she means is, am I going to have a tendency to that? Am I going to"
},
{
"end_time": 6103.2,
"index": 247,
"start_time": 6081.357,
"text": " Now rely on that. So what is the word that she should be using? It's not addiction. It is what? Well, I actually think the way she's using it is exactly correct and good for her for asking it because there are a lot of pills that get passed out by doctors and otherwise that actually are dangerous and addictive and people taking them don't know I can't tell you how many people"
},
{
"end_time": 6131.032,
"index": 248,
"start_time": 6103.677,
"text": " We see who were started on benzodiazepine like Xanax or Valium or Ativan or Klonopin, who then cannot get off and come and say, my doctor never told me this was addictive. So what do we mean by saying something is addictive? We mean that the average person with enough exposure to that substance or behavior will find it difficult to stop even when they want to. And with intoxicants, that's generally true."
},
{
"end_time": 6151.51,
"index": 249,
"start_time": 6131.749,
"text": " Right. So like opioids prescribed for pain by a doctor are still addictive because the average person with enough time on an opioid will have trouble getting off of that opioid. And yeah, it might be just be dependence, physical dependence, but in the olden days, physical dependence and addiction were synonymous. Now we kind of separate those two allowing for"
},
{
"end_time": 6165.316,
"index": 250,
"start_time": 6152.039,
"text": " For example, doctors prescribing things to patients that are dependence forming but I think you could debate whether or not there really is a difference between those things, especially from a neurobiological perspective."
},
{
"end_time": 6185.52,
"index": 251,
"start_time": 6165.862,
"text": " So good for your mother-in-law for asking you that and not just indiscriminately taking pills that somebody gives to her. Somebody, her son-in-law. And let me say, and then that gets back to this original question about like, you know, healthy activity like exercise. So generally exercise is not addictive."
},
{
"end_time": 6212.705,
"index": 252,
"start_time": 6185.93,
"text": " But can you get addicted to it? You sure can, right? Also, because we've drugified exercise, we have these machines that make it easier to do more repetitive motions more intensely. We have all these ways to count it. We now have leaderboards and social media that's gamifying it. So you know, we've taken something that before it was nearly impossible to get addicted to it. And now it's a lot easier. This one said,"
},
{
"end_time": 6241.544,
"index": 253,
"start_time": 6213.353,
"text": " I would like her opinion on methadone. I had battled opiate addiction many years and constantly relapsed. The moment I started methadone, all my cravings went away and I finally got a decent night's sleep and he's at a clinic, he said. I do understand the stigma of methadone, but it truly saved my life. I've been on this program since 2008 and haven't been better. Good job, got my child back and so on. All positive things have happened for me. I hate that I have to take it each morning, but"
},
{
"end_time": 6262.671,
"index": 254,
"start_time": 6241.732,
"text": " The benefit in my life has far outweighed the bad. Just curious her thoughts. Yeah, you know, I ultimately think that we need to be practical about these things and methadone maintenance for severe opioid use disorder is evidence based treatment. It's one of the best and most evidence based treatments that we have for any addictive disorder."
},
{
"end_time": 6291.442,
"index": 255,
"start_time": 6262.773,
"text": " Sounds like it's really working for you. I would urge you to stay on it and consider it the equivalent of insulin for diabetes that essentially this is a medicine that you will probably need for the rest of your life as long as it continues to work well for you. In my book, Dopamine Nation, I do talk about opioid agonist treatments like methadone and buprenorphine and I explain from a neurochemical point of view why they work and why they're important. Okay, the last question now."
},
{
"end_time": 6315.35,
"index": 256,
"start_time": 6291.544,
"text": " And then you and I have got to get some rest. Relax. Yes. So we've talked about phone addiction. What you can do is you can just have an abstinence day and put your phone away maybe one day a week or so. OK. What are the three strategies that are most effective for dealing with addictive behaviors of porn, alcohol and other drugs such as smoking? And also are strategies different than tactics? Hmm."
},
{
"end_time": 6330.657,
"index": 257,
"start_time": 6315.998,
"text": " Well, I would say this is what I cover in my book that's encompassed by the dopamine acronym. The interventions, whether it's a drug use, alcohol use disorder, or a behavioral addiction like sex, compulsive masturbation, gambling, shopping, video games are pretty much the same."
},
{
"end_time": 6360.503,
"index": 258,
"start_time": 6331.271,
"text": " First, you want to collect the data, what you're doing, how much and how often. That's D for data. This is the dopamine acronym. O is for objectives. Why are you doing it? What are you hoping to get out of it? Are you really getting out of it? What you're hoping to get out of it? Or is there a gap between those things? P stands for problems associated with use. Write down all the things that are not working about using that substance. The A is for abstinence. Do four weeks of not using it. You'll feel worse before you feel better. You'll collect data on yourself. You'll be able to tell."
},
{
"end_time": 6384.582,
"index": 259,
"start_time": 6361.203,
"text": " What the true impact of that behavior is on your life. Really hard to know why you're in your consumption, but if you take a break from it, you'll get more perspective, get better and accurate information. The M stands for mindfulness. This is what we talked about. Learning to just surf the urge or sit with that emotion, watch it come and go, tolerate uncomfortable emotions without reaching for our drug of choice."
},
{
"end_time": 6412.551,
"index": 260,
"start_time": 6385.077,
"text": " The I stands for insight that's practicing radical honesty and the ways in which we become more aware of our behaviors and actions by telling the truth about them to ourselves and others. The N stands for next steps if we make it through the 30 days and we feel better and we can decide do I want to make continue abstinence from this substance or behavior from this particular video game or from pornography and masturbation or from online shopping sites or from cannabis"
},
{
"end_time": 6431.613,
"index": 261,
"start_time": 6412.995,
"text": " Or do I want to go back to using but use less, use differently? If you decide to go back to using, make a really detailed plan for what that is going to look like, how much and how often. So this is the question that comes up. Well, what do we do after the dopamine fast? I'm not going to be able to, you know, I'm still going to live in the world. I don't want to abstain forever."
},
{
"end_time": 6445.026,
"index": 262,
"start_time": 6431.954,
"text": " So then, okay, well, what is your use going to look like? What are your red flags? How are you going to hold yourself accountable? And then the E for dopamine stands for experiment. And that's where we go back into the world and give it a try again for another 30 days."
},
{
"end_time": 6474.462,
"index": 263,
"start_time": 6445.435,
"text": " Okay, my goal was moderation. You know, in my case, I tried to go back to reading romance novels and binged all weekend long and showed up at work bleary eyed and said that's not going to work for me. So then committed to a long term abstinence. But for other people, they may they may be successful moderating or they may be successful for a while and then slip it back into more compulsive overuse, or they may be successful, but decide it's not worth it because it's exhausting. It's even abstinence is easier. So these are just it's just one"
},
{
"end_time": 6492.125,
"index": 264,
"start_time": 6474.462,
"text": " Big experiment. The links to all books referenced and all articles referenced and everything will be in the description. The current book is dopamine nation. The previous book is drug dealer MD. It's about the overprescribing epidemic. Yeah. Are you working on anything new?"
},
{
"end_time": 6506.493,
"index": 265,
"start_time": 6492.637,
"text": " Actually, I'm working on a dopamine nation workbook. So this is an interactive workbook that people can make their way through to do that kind of dopamine acronym that we talked about, you know, data objectives, problems."
},
{
"end_time": 6535.435,
"index": 266,
"start_time": 6506.664,
"text": " There were some extra questions for Anna conducted on a separate day, which you're about to see. So professor,"
},
{
"end_time": 6548.2,
"index": 267,
"start_time": 6536.169,
"text": " How important is forgiveness and apologizing both for you to yourself, for you to others, and maybe even family and friends to you if you're the addicted one, you in quotations."
},
{
"end_time": 6580.333,
"index": 268,
"start_time": 6550.52,
"text": " Yeah, well, I mean, I think of what does an apology consist? An apology starts with acknowledging that in some ways we've done wrong or we've harmed somebody else through our actions or words. So I think that's very important to acknowledge that when we've harmed others and it's somewhat instinctive, I think, for humans to want to"
},
{
"end_time": 6609.684,
"index": 269,
"start_time": 6581.032,
"text": " both see themselves in the best light and also be their own worst enemy. It's sort of a polarizing reflex, meaning that we can be very hard on ourselves at the same time that we can be far too easy on ourselves and generally want to rationalize behavior that's harmful toward others without recognizing our own contribution. And I think it's really important"
},
{
"end_time": 6631.459,
"index": 270,
"start_time": 6610.128,
"text": " After we've done that, the next step is to let people know that we are aware that we've harmed them and that we feel"
},
{
"end_time": 6653.848,
"index": 271,
"start_time": 6632.039,
"text": " Contrition or sadness, regret for that behavior combined with the desire to want to make amends. And what does that mean? Amends is a forward looking. So, you know, apologizing and regret that's looking toward the past. And amends is looking toward the future and saying, well, I'm not going to do this behavior again."
},
{
"end_time": 6662.944,
"index": 272,
"start_time": 6654.633,
"text": " So for example, in my own life with one of my kids, I started reading her journal."
},
{
"end_time": 6688.422,
"index": 273,
"start_time": 6663.404,
"text": " Which I rationalized to myself was appropriate because she had a health condition and I was concerned she wasn't sharing with me the things I needed to know in order to help her with her health. But really, that was a transgression of her privacy. It was a wrong thing. I knew it was a wrong thing when I was doing it, but I rationalized it nonetheless. And it took me a long time to get around to telling her that I had done that."
},
{
"end_time": 6703.404,
"index": 274,
"start_time": 6688.746,
"text": " And part of my reluctance was that I knew once I told her and apologize that I wouldn't be able to keep doing it. Right. So that's the whole amends part. The apology really has to come with the intention of changing the behavior or at least trying to change behavior."
},
{
"end_time": 6733.131,
"index": 275,
"start_time": 6703.882,
"text": " And so eventually I did apologize and she was incredibly gracious about it and said, that's terrible that you did that. And it did impact her trust of me. Um, but she was also even in that moment, able to forgive me, which speaks to her very wonderful nature as well as the good foundation of our relationship. That even though I had significantly breached our, you know, that, that trust,"
},
{
"end_time": 6763.626,
"index": 276,
"start_time": 6733.763,
"text": " I could apologize, make amends and we can rebuild. And I really think that's the foundation of apology. It's respecting ourselves and the other person and the relationship enough to want to continue to make it better. And that's the way that we make relationships better because we're always going to make mistakes. We're all very flawed. Is it important for you to be forgiven? So you're apologizing, but sometimes the person won't say, well, I forgive you. Maybe they'll say,"
},
{
"end_time": 6777.875,
"index": 277,
"start_time": 6764.002,
"text": " Yeah, right. Well, that's of course the great fear behind admitting that we've done wrong and apologizing."
},
{
"end_time": 6795.606,
"index": 278,
"start_time": 6778.046,
"text": " is that the person won't accept our apology or that they'll be so horrified by what we've done that they won't want to have anything to do with us going forward. That is the great fear. But I really do think that nine times out of ten, we think that the person is going to run screaming from us when in fact"
},
{
"end_time": 6824.821,
"index": 279,
"start_time": 6795.606,
"text": " the opposite happens. They're in fact drawn closer because honesty is a great gift. Again, if an apology comes with desire to change the behavior, that's an acknowledgement of wanting to invest in that person and in the relationship. So I think generally apologizing, you know, a good faith apology is a way to strengthen relationships. It doesn't typically lead to a worsening of that relationship."
},
{
"end_time": 6837.534,
"index": 280,
"start_time": 6825.179,
"text": " Now, for an addict, is it important for them to conceptualize themselves as an addict? Or should I not even say what I just said, which is as an addict, like am I contributing to some stereotype by saying so or a stigma?"
},
{
"end_time": 6855.333,
"index": 281,
"start_time": 6838.029,
"text": " Yeah, it's such a great question because the language around addiction is really evolving and there's a whole group, especially inside medicine, that feels like we should try to destigmatize the language of addiction. For example, not use the term addict."
},
{
"end_time": 6870.265,
"index": 282,
"start_time": 6855.811,
"text": " use the term something what we call patient centered language, a person with addiction, a person with the disease of addiction, a person with an alcohol use disorder, rather than saying that's an alcoholic or that's an addict. And there are other"
},
{
"end_time": 6895.52,
"index": 283,
"start_time": 6870.811,
"text": " On the flip side, a lot of people in the community of people with addiction who are trying to get into recovery refer to themselves as addicts, alcoholics. In a funny kind of way,"
},
{
"end_time": 6920.879,
"index": 284,
"start_time": 6896.22,
"text": " It's somewhat invalidating to say, well, we shouldn't use that language when the very people struggling with these disorders will identify themselves in that way. I mean, who are we in the medical community to say what language should be used by the very people who embody those disorders? So I don't know. I'm personally somewhat conflicted about it."
},
{
"end_time": 6945.538,
"index": 285,
"start_time": 6921.766,
"text": " And so getting to your, the underlying point of your question took me a while to get there, but I eventually, you know, that what, what is the nature of the role of identity in addiction and recovery? And, um, you know, identity is really important and, and, and sort of coming to know yourself and also redefine yourself in the world is an important part of recovery."
},
{
"end_time": 6969.616,
"index": 286,
"start_time": 6946.101,
"text": " and acknowledging and identifying that you do in fact have an addictive disorder and that you may need to turn to others for help with that is an important part in that identity transition for people. So the people who you mentioned that refer to themselves as addicts, do they do so because of just the history that's just what they've learned or do they find it helpful?"
},
{
"end_time": 6978.166,
"index": 287,
"start_time": 6970.145,
"text": " Because it implies that their addiction is more powerful than them and it's useful for them to conceptualize it like that because then they know I need to seek help."
},
{
"end_time": 7009.189,
"index": 288,
"start_time": 6979.684,
"text": " You know, it's probably not possible to generalize. You know, some people who refer to themselves as addicts, it might be helpful to do that. Others might use that as a kind of embodiment of the justification of why they can just keep using and never be able to stop. So it's you know, it's it's probably cuts both ways. Yeah, that's an interesting point. Tony Robbins mentioned something like that. Tony Robbins, a motivational speaker. He said, look, if you"
},
{
"end_time": 7025.145,
"index": 289,
"start_time": 7009.616,
"text": " don't smoke if someone offers you a cigarette you don't say i'm not into smoking you say i'm not a smoker like you actually have that as part of your identity that you're not a smoker he said it's important he said the way that you frame your identity can help you get over"
},
{
"end_time": 7051.032,
"index": 290,
"start_time": 7025.589,
"text": " or move toward what you want. Yeah, right. Yeah, you're absolutely right. And it does, again, speak to the ways in which adopting certain identities can be helpful or harmful. You know, in the Alcoholics Anonymous and 12-Step Community, they feel that self-identifying as an addict, including calling yourself, for example, a smoker or calling yourself an alcoholic or an addict,"
},
{
"end_time": 7074.309,
"index": 291,
"start_time": 7051.032,
"text": " Is fundamental to the process of recovery because you are acknowledging that unlike normal people are nice you can't use that substance in moderation you can't use it recreationally the way that other people might once you start using you will continue to use it will lead to all kinds of significant problems and your life will become unmanageable."
},
{
"end_time": 7091.63,
"index": 292,
"start_time": 7074.77,
"text": " So in that, you know, contrary to Tony Robbins, which I'm not I'm not saying he's not wrong. I'm just saying I think for different personalities and different temperaments, you know, sort of adopting agency through certain identities."
},
{
"end_time": 7123.012,
"index": 293,
"start_time": 7093.217,
"text": " I understand. You smiled when I said Tony Robbins. So you're familiar with Tony Robbins? Yeah, of course. Yeah."
},
{
"end_time": 7152.278,
"index": 294,
"start_time": 7123.439,
"text": " Can you please tell me more because I wasn't aware that many academic psychologists know about him or his practices and I've always wondered what are their views on it? Well, I don't feel I know enough to honestly go into it, you know, in a public. I mean, I've heard of him. I know many, many people have benefited from his work and have quit smoking as a result. I think that's fabulous. Great, great."
},
{
"end_time": 7181.783,
"index": 295,
"start_time": 7152.551,
"text": " Professor, what are the rat park experiments and what do they tell us about addiction or society's impact on addiction? Yeah, so the rat park experiments were a series of experiments conducted under the leadership of Bruce Alexander many decades ago now, where he essentially challenged the prevailing paradigm in studying addiction in the laboratory, which was to put a rat in a very small cage with a lever"
},
{
"end_time": 7209.411,
"index": 296,
"start_time": 7182.227,
"text": " which if pressed would deliver intravenous cocaine or what have you to the rat and then measure the rats behavior in response to that. And what researchers had found was that given access to a lever for cocaine in a small cage with nothing else to do, that rat will essentially press the lever till exhaustion or death. So that became a kind of working animal model for studying addiction."
},
{
"end_time": 7212.449,
"index": 297,
"start_time": 7209.923,
"text": " Bruce Alexander came along and said"
},
{
"end_time": 7240.606,
"index": 298,
"start_time": 7213.08,
"text": " If you put pretty much any human being in a room with nothing to do but press a lever for cocaine, that's what they're going to do. That's not adequately simulating what really happens in life. And his hypothesis was that if you put a rat in a very, very large cage with a lever that they can press for cocaine, but a lot of other things that they might do, sawdust, piles of sawdust they can explore,"
},
{
"end_time": 7256.852,
"index": 299,
"start_time": 7240.606,
"text": " Running wheels maze other rats right now it's very likely that they're not gonna. Necessarily press that lever or press it quite as often and so that was the rap heart experiment he and his colleagues built a giant."
},
{
"end_time": 7275.469,
"index": 300,
"start_time": 7257.244,
"text": " maze, they put these rats in and according to their results, rats were less inclined to press a lever for cocaine when they had other things to do. And since that time, the whole rat park experiment has really become somewhat iconic"
},
{
"end_time": 7298.063,
"index": 301,
"start_time": 7275.469,
"text": " And really a metaphor more than anything else for the need for a healthy environment and healthy alternative sources of dopamine if we want to intervene in the serious public health problem of addiction that battling addiction whether you're dealing with rats or human beings is not simply going to be a matter."
},
{
"end_time": 7323.012,
"index": 302,
"start_time": 7298.473,
"text": " of, for example, limiting access to drugs or, you know, treating drug addiction. It's got to be looking at more, more holistically at the environment and identifying what makes for a healthy community, what makes for a healthy environment, and then promoting those things as well. And the human sort of the human experiments"
},
{
"end_time": 7343.899,
"index": 303,
"start_time": 7323.643,
"text": " that maybe were inspired directly by Rat Park, but maybe not, I don't know, were things like the studies in Iceland where they opened up a bunch of youth gymnasiums. They created a youth curfew so teenagers couldn't go out past a certain time of day. They promoted all kinds of"
},
{
"end_time": 7367.568,
"index": 304,
"start_time": 7344.804,
"text": " social goods and social networking and they saw a reduction in teen drug and alcohol use in their communities. So again, it's just this sort of idea that the holistic social environment really matters. One of the claims that I've made is that the problem with the world that we live in today is"
},
{
"end_time": 7384.189,
"index": 305,
"start_time": 7368.148,
"text": " not just that we have a rat park, but we have actually a rat amusement park. So we've taken even healthy kinds of activities and we've drugified them. We've made them more reinforcing. We've made them more accessible, more potent, more novel."
},
{
"end_time": 7407.056,
"index": 306,
"start_time": 7384.701,
"text": " So it's such that now we can get addicted to and or binge on just about anything such that this idea of rat park you know has to take into the account the fact that science technology and are just our own propensity for extremism and everything that we do has turned what was previously healthy stuff"
},
{
"end_time": 7418.08,
"index": 307,
"start_time": 7407.602,
"text": " into potentially addictive stuff like social media, right, has taken human connection and human relationships and distilled it down into its most addictive essentials, whether it's"
},
{
"end_time": 7446.647,
"index": 308,
"start_time": 7418.746,
"text": " you know, through dating apps or Instagram or Discord on a video game or what have you. So I think that's really important to acknowledge. Also footnote to that, which I find fascinating is that running wheels, you know, a rat on a running wheel. Scientists used to think that a running wheel was a neutral or inner measurement of physical activity in rats, but then they began to notice that certain rats"
},
{
"end_time": 7466.015,
"index": 309,
"start_time": 7446.971,
"text": " would preferentially run on the running wheel to using cocaine, but not in moderation. They would actually run on that running wheel till complete exhaustion. In other words, it looks like some rats get addicted to running wheels to the point where they run themselves to death."
},
{
"end_time": 7493.37,
"index": 310,
"start_time": 7466.442,
"text": " So I just think that's an interesting and fascinating metaphor to for human life today, where even things like exercise have been made more technological, more addictive with all the machines that we have, and addition of social media and leaderboards and rankings, and all of these ways that we can see what other people are doing and how far they went. And so it's just it's just interesting."
},
{
"end_time": 7519.889,
"index": 311,
"start_time": 7493.695,
"text": " I imagine you would say that the addiction to exercise would be one of the more positive addictions though, or is that not the case? Well, when I use the word addiction, I'm talking about psychopathology defined as the continued compulsive use of a substance or behavior despite harm to self or others. I certainly have made and will continue to make the strong argument in favor of exercise as a healthy way to get dopamine indirectly by paying for it upfront."
},
{
"end_time": 7547.039,
"index": 312,
"start_time": 7519.889,
"text": " But anything that gets dopamine, even if it's a healthy way to get dopamine, if overdone, can lead to addiction. So when I talk about exercise addiction, I'm not talking about healthy adaptive amounts of exercise. I'm talking about people who are exercising to the point where they're getting injured. It's interfering with their family life, with their job. They've really genuinely become compulsive about it. And oftentimes exercise addiction, although rare,"
},
{
"end_time": 7559.087,
"index": 313,
"start_time": 7547.039,
"text": " Is occurring with more frequency again as we've kind of professionalized and and and technologized if i could say that making up a word all of these exercise pursuits."
},
{
"end_time": 7581.493,
"index": 314,
"start_time": 7559.343,
"text": " That's super interesting because there's someone named David Goggins who is not a motivational speaker, let me think, what is he?"
},
{
"end_time": 7598.217,
"index": 315,
"start_time": 7581.903,
"text": " He's a motivational guy. I wouldn't say motivational speaker, but some guy who many people find helpful because he's this epitome of someone who can push through extreme suffering for some goal. So he'll run even if his"
},
{
"end_time": 7627.398,
"index": 316,
"start_time": 7598.524,
"text": " leg start to bleed and he'll just keep going on this race over and over because he said, I'm going to run two marathons today. And so I'm going to do that no matter what. And I used to look at that as well and be like, wow, that's something to be emulated or something to have as a value, even if you don't achieve it. But now I'm wondering, is that just a sign of addiction itself? Because he repeats this in every other activity that he does. So he started yoga and then he just does yoga for three hours or four hours. Right."
},
{
"end_time": 7649.224,
"index": 317,
"start_time": 7628.473,
"text": " Well, I think that, you know, many people find inspiration in people who in other people who do things that are really difficult. And I think that is admirable, you know, people who challenge themselves who take on painful or difficult activities, you know, that that that is inspiring. And those people"
},
{
"end_time": 7670.998,
"index": 318,
"start_time": 7649.599,
"text": " can function as heroes, but without commenting on any individual person, because I'm not familiar with Goggins, but not with his specific activities, I do think we need to draw into it. A very advanced athlete"
},
{
"end_time": 7689.582,
"index": 319,
"start_time": 7670.998,
"text": " Who pushes themselves very far that might be healthy for that person was for a person who never gets up off the couch for them to do that would be harmful so sorry where you're starting again again i want to exercise is one of the most potent antidepressants anxiolytics even anti addiction."
},
{
"end_time": 7716.135,
"index": 320,
"start_time": 7690.333,
"text": " Professor, given that you could have gone into any field of medicine, maybe any field in general, why did you choose addiction as a subfield? And if you didn't start an addiction, then why did you choose that?"
},
{
"end_time": 7741.954,
"index": 321,
"start_time": 7716.732,
"text": " I'm always interested in, look, there's a plethora that you chose in front. Yeah. But you walked through one or two doors out of 300. Right. So why? Well, I mean, this is kind of cliched, but addiction found me not the other way around. I did choose psychiatry because I was interested more in quality of life than quantity of life. And I wanted to have enduring relationships through time with my patients, which"
},
{
"end_time": 7765.828,
"index": 322,
"start_time": 7742.466,
"text": " Psychiatry, thank goodness, still affords us in modern medicine. But I was actively avoiding patients with addiction early in my psychiatric career, primarily because I had learned very little in medical school or residency in how to treat them. And I also, like most of my colleagues, conceptualized addiction as a social problem, a willpower problem,"
},
{
"end_time": 7795.708,
"index": 323,
"start_time": 7766.374,
"text": " not something within the purview of medicine, not something for doctors to treat. And this was 25 years ago or so. But what happened was I discovered that if you have a patient with bipolar disorder who's also addicted to alcohol or drugs, you can prescribe all the mood stabilizers in the world and you can be the best psychotherapist and you can talk about every conversation they ever had with their mother. And if you don't also address the addictive behaviors, they are not going to get better."
},
{
"end_time": 7825.077,
"index": 324,
"start_time": 7795.828,
"text": " And that was really my realization, I realized that I was actually not functioning as a very good psychiatrist, because I was ignoring the addictive problems that my patients actively had. And they weren't bringing it up because I wasn't asking because it's a stigmatizing behavior associated with a lot of shame. Right, right, right. People aren't going to disclose it unless you as a skilled practitioner, give them the opportunity to do that. So that was essentially the shift."
},
{
"end_time": 7855.128,
"index": 325,
"start_time": 7825.93,
"text": " Have you found that writing about your addiction or writing about trauma? So I know those are maybe separate questions, but maybe there's something common underlying. Have you found that that's helpful? And under what circumstances, like what questions should someone be asking themselves when they write? So when you say right, do you mean sort of like keeping your own journal or writing? What do you mean writing for an audience? No, I just mean for yourself. It doesn't have to be a journal. It could just be two years after the event. If it's a traumatizing event."
},
{
"end_time": 7875.299,
"index": 326,
"start_time": 7855.657,
"text": " Or maybe while you're attempting to help yourself out of an addiction to just write about it because I heard that writing as a whole is salvific when it comes to psychological conditions like getting over psychological conditions that is but I don't know what sort of writing is salvific because there are various forms."
},
{
"end_time": 7901.988,
"index": 327,
"start_time": 7876.049,
"text": " Right. So I mean, again, I would say there's a lot of inter individual variability, you know, what might work for one person wouldn't necessarily work for another. But in general, we organize our thoughts and feelings through language, we understand our experiences through language. And so by putting our experiences and our thoughts and emotions into coherent language, especially if we're then using that to communicate with another human being,"
},
{
"end_time": 7921.988,
"index": 328,
"start_time": 7902.551,
"text": " We ourselves can become aware of cause and effect in a way that's hard if we're not using language to organize the sort of cacophony that's happening in our own minds. I will say though that I think for people with severe addiction trying to get in recovery,"
},
{
"end_time": 7937.995,
"index": 329,
"start_time": 7923.78,
"text": " Isolation is such a big part of the disease and I would think that writing in isolation would in general not be as effective as writing or communicating in a way that is shared."
},
{
"end_time": 7967.176,
"index": 330,
"start_time": 7938.695,
"text": " This is, of course, why 12 Steps and other mutual help groups are so useful. They, in fact, provide a structure to organize experience. And so people are creating a narrative within that useful structure, rather than just kind of, you know, some sort of stream of consciousness, which I'm not sure is necessarily all that helpful. Speaking of writing, when your book, Dopamine Nation, became a bestseller,"
},
{
"end_time": 7994.445,
"index": 331,
"start_time": 7968.729,
"text": " And it was winning still is winning awards at the time when the flurry of events were occurring. What was going through your mind? How are you feeling? You know, for me, the process of writing a book is very rewarding in the sense that almost all the work that I do is collaborative and is service oriented and is interacting with others. So for me, the book writing was"
},
{
"end_time": 8019.019,
"index": 332,
"start_time": 7995.196,
"text": " a creative thing that I could do in quiet moments by myself. The process itself I found enjoyable and I really didn't give much thought to what would happen after it was published. Of course, whenever you write a book, you want people to read it. You have the audience in mind, you're thinking of people reading it, you're wondering,"
},
{
"end_time": 8043.712,
"index": 333,
"start_time": 8019.292,
"text": " what their reaction will be but i have to say for me that was not when i for the books that i've written the sort of primary motive it was really very process oriented and so um you know with dopamine nation and also my my book my prior book drug dealer mg it was a surprise uh that people a lot of people read the book and and seemed to"
},
{
"end_time": 8072.585,
"index": 334,
"start_time": 8044.019,
"text": " to find it useful. I think the whole thing is just sort of humbling like, wow, I'm really lucky that I had the opportunity to express these ideas and that in expressing these ideas, people are receiving these ideas and finding them helpful and expressing gratitude. I feel very fortunate that I've"
},
{
"end_time": 8102.875,
"index": 335,
"start_time": 8072.944,
"text": " I mean, really the thing that's closest to my heart in my professional life is taking care of patients. And to this day, I still love taking care of patients. It's the most gratifying thing that I do. People are fascinating, you know,"
},
{
"end_time": 8130.077,
"index": 336,
"start_time": 8103.063,
"text": " people's heroism in the face of very difficult odds is inspiring. And even to this day, I have a lot of joy in seeing patients and taking care of patients. And in teaching too, because in a way that's sort of an extension of that same sort of thing. You know, sort of having young people who are interested in doing this work and helping them, you know, realize their their dream. That's also very rewarding."
},
{
"end_time": 8158.899,
"index": 337,
"start_time": 8130.828,
"text": " Was there a patient who reshaped your understanding of addiction most? And obviously you can speak in generalities here. It was never going to be one person. I think it was just the river of human lives that I've experienced from my office here over 25 years that's had a huge impact on me and the way that I see the world. And every single one, I would say, shaped me in some way."
},
{
"end_time": 8186.22,
"index": 338,
"start_time": 8159.94,
"text": " Earlier when we spoke about a higher power, you mentioned that it needs to transcend you as a person and to the physicist or to the materialists, the law of nature or the laws of nature would do that. But then they would be hard pressed to find some solace in it if it's just the reductive laws of quantum field theory, for instance. So what else is there to this notion of a higher power that is necessary for it to be nutritious?"
},
{
"end_time": 8214.787,
"index": 339,
"start_time": 8188.183,
"text": " Well, I wouldn't presume to tell anybody else what their higher power is. I think the key piece of this shift, this kind of spiritual shift and the importance of spirituality for many people in recovery is really the acknowledgement of the locus of control, not being within them, but being in a, and not being actually in another person either, but being"
},
{
"end_time": 8244.275,
"index": 340,
"start_time": 8215.077,
"text": " I think for some people, just that is enough. This shift of locus of control. For other people, there's a much stronger need to more specifically define what is the source of control? How personal is it in my life? How much is my life part of a plan that this external force"
},
{
"end_time": 8271.903,
"index": 341,
"start_time": 8244.684,
"text": " has imagined for me, I think people are very different in in their need for that. But almost always that shift, I will not say I will say that's not for everybody. There are some people for whom kind of believing that they are in control and that their control to overcome their addiction is the key piece for them. So it's it's again, it's it's not a universal"
},
{
"end_time": 8300.503,
"index": 342,
"start_time": 8272.551,
"text": " There are many paths to the top of this mountain, but for many people that I've seen, because really it's this wanting to exert their control on the world and people around them that gets them into their addiction, it's the letting go that allows them to find recovery. Did you happen to find a common characteristic between people who feel like they need"
},
{
"end_time": 8320.998,
"index": 343,
"start_time": 8301.032,
"text": " or actually find it salutary to retain the control and to emphasize that I have control over this addiction versus those who find it more nourishing to let go. Like is there something that unifies those people? Yeah, I have given some thought to this and I think there's no research that I know of looking at this and"
},
{
"end_time": 8346.886,
"index": 344,
"start_time": 8321.561,
"text": " I don't know, I'm not sure what I think about this because I don't see that many people who get into recovery by taking more control. Typically what I see is that it's the failure of taking that control and this kind of letting go and admitting that they're out of control."
},
{
"end_time": 8373.763,
"index": 345,
"start_time": 8347.5,
"text": " That is really the key turning point for many people. However, they define that which doesn't need to be in a religious or theistic or even spiritual frame. But typically, that's what I see. But I could see that, for example, somebody who really felt that their life was very much out of control and someone who had a certain degree of learned helplessness that for that person,"
},
{
"end_time": 8397.125,
"index": 346,
"start_time": 8374.582,
"text": " A topic that's important nowadays, maybe in all of human history, is free will, the argument of whether we have it or not. And I understand that there's some evidence that suggests that the belief in free will leads to an improved life satisfaction."
},
{
"end_time": 8426.664,
"index": 347,
"start_time": 8398.063,
"text": " But it sounds like here there may be a divide, like you're not supposed to. No, no, I don't think there's a divide. I think you can, you know, surrender to a higher power and also believe that you have agency and responsibility. It's just what is it that we have agency over, you know, and is it possible to have both agency? Is it possible to have agency in a world in which there's also this concept of power greater than ourselves that has, you know, is determining"
},
{
"end_time": 8456.374,
"index": 348,
"start_time": 8426.903,
"text": " what happens next to some extent in our lives. I think those things are totally compatible and can coexist. What would you like to be remembered for? Oh, gosh, I haven't even given this any thought. I don't know, I guess I wouldn't be remembered as a good mother, a good wife, a good doctor and a good teacher. OK, thank you. You're welcome. OK, now me and you got to get some sleep."
},
{
"end_time": 8475.657,
"index": 349,
"start_time": 8456.544,
"text": " Yes. Thank you so much, Kurt. I'm so glad you got questions from the audience. That's great. So we can answer what people are really interested in. Take good care, Kurt. Get some sleep. I will. You're going to sleep well tonight, I think. Yeah, I think so as well. OK, take care. Take care. Bye bye. Bye bye."
},
{
"end_time": 8496.254,
"index": 350,
"start_time": 8476.288,
"text": " Once more, in case you missed it, in an effort to keep this podcast a complete resource, I'm going to list out the 11 questions from the DSM-5 about addiction. Count how many times you say yes. Number one, do you sometimes have difficulty controlling how much you use your drug or how long you use it? Also recall that you can substitute the word behavior for drug."
},
{
"end_time": 8513.66,
"index": 351,
"start_time": 8496.254,
"text": " Number two have you made any unsuccessful attempts to cut down your usage number three do you sometimes spend a significant amount of time using or recovering from your usage of drugs or engaging that behavior number four has your drug had any negative effects at home at school at work."
},
{
"end_time": 8528.746,
"index": 352,
"start_time": 8513.66,
"text": " Number five has it negatively impacted your social life number six do you continue to use despite negative consequences number seven have you put off things or neglected to do things because of your drug use or your behaviors number eight."
},
{
"end_time": 8554.616,
"index": 353,
"start_time": 8529.07,
"text": " Do you have strong cravings? Has your tolerance increased? Are you able to use more than you did before? Have you experienced withdrawal symptoms the next day? Has it led to any dangerous situations? The criteria is that if you've answered yes to two or three of these, you have a mild substance abuse. If you've answered yes to four or five of them, you have a moderate substance abuse."
},
{
"end_time": 8578.166,
"index": 354,
"start_time": 8554.616,
"text": " Six or more is severe. Keep in mind, no single test is completely accurate and you should always consult your physician when making a decision about your health. We've been having issues monetizing the channel with sponsorship, so if you'd like to contribute to the continuation of theories of everything, then you can donate through PayPal, Patreon, or through cryptocurrency. Your support goes a long way in ensuring the longevity and quality of this channel. Thank you. Links are in the description."
},
{
"end_time": 8602.637,
"index": 355,
"start_time": 8578.166,
"text": " The podcast is now concluded. Thank you for watching. If you haven't subscribed or clicked that like button, now would be a great time to do so as each subscribe and like helps YouTube push this content to more people. You should also know that there's a remarkably active Discord and subreddit for theories of everything where people explicate toes, disagree respectfully about theories and build as a community our own toes."
},
{
"end_time": 8620.657,
"index": 356,
"start_time": 8602.637,
"text": " Links to both are in the description. Also, I recently found out that external links count plenty toward the algorithm, which means that when you share on Twitter, on Facebook, on Reddit, etc., it shows YouTube that people are talking about this outside of YouTube, which in turn greatly aids the distribution on YouTube as well."
},
{
"end_time": 8645.811,
"index": 357,
"start_time": 8620.657,
"text": " Last but not least, you should know that this podcast is on iTunes, it's on Spotify, it's on every one of the audio platforms. Just type in theories of everything and you'll find it. Often I gain from re-watching lectures and podcasts and I read that in the comments, hey, toll listeners also gain from replaying. So how about instead re-listening on those platforms? iTunes, Spotify, Google Podcasts, whichever podcast catcher you use."
},
{
"end_time": 8670.708,
"index": 358,
"start_time": 8645.811,
"text": " If you'd like to support more conversations like this, then do consider visiting Patreon.com slash Kurt Jaimungal and donating with whatever you like. Again, it's support from the sponsors and you that allow me to work on Toe full time. You get early access to ad free audio episodes there as well. For instance, this episode was released a few days earlier. Every dollar helps far more than you think. Either way, your viewership is generosity enough."
},
{
"end_time": 8702.193,
"index": 359,
"start_time": 8687.329,
"text": " Raise a spoon to Grandma, who always took all the hungry cousins to McDonald's for McNuggets and the Play Play Slide. Have something sweet in her honor. Come to McDonald's and treat yourself to the Grandma McFlurry today. Ba da ba ba ba. And participate in McDonald's for a limited time."
}
]
}No transcript available.