Dr. Anna Lembke

“The body is a powerful instrument, and we often forget about it.”

Listeners get ready for a powerful, impactful, thought-provoking show with Dr. Anna Lambke, the author of the sensational best-selling book Dopamine Nation: Finding Balance in the Age of Indulgence. I love how this conversation flowed so easily and comfortably through a variety of topics, especially starting out by talking about athletes and how the nature of addiction can permeate even what seems to be the healthy, fit part of the population, and especially how we’re all now vulnerable to all manner of dopamine seeking/dopamine triggering temptations. This is because, as you’ll hear in this show, the world has transformed from a place of scarcity to “a place of overwhelming abundance.” From drugs to food to news to gambling, shopping, gaming, texting, sexting, Facebooking, Instagramming, YouTubing, and even tweeting, there has been a massive increase in the numbers, variety, and potency of highly rewarding stimuli—a staggering increase that Dr. Lembke finds extremely concerning and seriously harmful. She even refers to smartphones as, “Modern-day hypodermic needle[s], delivering digital dopamine 24/7 for a wired generation.” 

During this episode, I call attention to a quote from Dr. Lembke that could be the secret to leading a rich, meaningful, and fulfilling life. She’ll detail the idea in the show, but here you go to consider for now: The routine things you do in daily life can take on epic proportions, but it doesn’t mean you have to get to the top of the mountain. This idea reminded me a lot of a famous Martin Luther King quote, one that you’ll hear me share during this episode: “If a man is called to be a street sweeper, he should sweep streets even as Michelangelo painted, or Beethoven composed music, or Shakespeare wrote poetry. He should sweep streets so well that all the hosts of heaven and earth will pause to say, ‘Here lived a great street sweeper who did his job well.’” 

You’ll hear about Dr. Lembke’s experience with patients that had extreme and shocking addictions and also realize that all of us, every day, are also in this highly vulnerable situation, thanks to the inexorable progress of society and technology to the point where everything is easy and we can get instant gratification all day long. You’ll also learn about the importance of achieving a neurochemical balance in your brain and how to stay out of that downward spiral into addiction from excessive dopamine seeking behavior. I highly encourage you to pick up her book Dopamine Nation—there are just so many great tips in there for whatever level you’re striving to improve as a person, and I love her recommendation for embarking on a detox process lasting at least 30 days and how that can be the secret to rebalancing your brain, and I think you will too. 

Dr. Anna Lembke is a professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and the author of the best-selling book Dopamine Nation: Finding Balance in the Age of Indulgence.


The smartphone is today’s hypodermic needle delivering digital dopamine. [01:20]

Should we allow ourselves to get excited about things? Are the highs and lows good for you? [05:20]

Dopamine is triggered when we enumerate things rather than looking at the process. [09:24]

After you win the gold, what is next? The consumption of sports even as a spectator is very much vulnerable to this problem of addiction. [11:37]

The point is that we all have the same mental circuitry that gets us to instinctively approach pleasure and avoid pain. [15:00]

How to we navigate that balance of existing in competitive, modern culture? [17:36]

What’s amazing about our phone screens is that the screen itself is reinforcing. [23:27]

It is hard to imagine the world we grew up in with no phones and internet when we look at what today’s youth are living with. [27:09]

The routine things that you do in daily life can take on epic proportions, but it doesn’t mean you have to get to the top of the mountain. [29:56]

We need to convey the message to young people to not try to find the grandiose thing you need to do but, instead look at your life as it is and whatever hand you’ve been dealt, make a positive difference every day.  [32:24]

We need to recognize that our vulnerability to primitive signals, is part of the solution. [36:10]

We need to do intermittent fasting with our devices in order to narrow the window in which we are engaged. [39:46]

We are constantly commandeered to keep connected. It starts with awareness. In this addictogenic world, how do unhook ourselves from video games, for example? [41:10]

With repeated exposure to the reinforcing drug or behavior, the response gets weaker and shorter. To reset from the addiction, it seems that 30 days is the magic number. [46:03]

The progression to addiction is exactly the same whether you’re dealing with a drug that you ingest or you’re dealing with a behavior like gambling or video games. [48:04]

Are there genetic vulnerabilities with addictions? [49:50]

How is radical honesty involved in this story? [52:14]



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Brad (01:20): 
Listeners get ready for a powerful, impactful thought provoking show with Dr. Anna Lembke. She is the author of the sensational bestselling book, Dopamine Nation: Finding Balance in the Age of Indulgence. And I loved how this conversation just flowed very breezidly and comfortably through a variety of topics, especially starting out, talking about athletes and how the nature of addiction can, uh, permeate even what’s seemingly to be the healthy fit population. But especially how, um, you know, we’re all now in this game, we’re all vulnerable to all manner of, dopamine seeking temptations, dopamine-triggering temptations of modern life. Here’s a quote from Dr. Lembke to tee this up. “Because we’ve transformed the world from a place of scarcity. That means the survival of the fittest, right? Our ancestral life, where we had to go and hunt and gather and fight for our lives essentially today, instead of a place of scarcity, it’s a place of overwhelming abundance, drugs, food,, news, gambling, shopping, gaming, texting, sexting, Facebooking, Instagramming, YouTubing, tweeting. The increased numbers, variety and potency of highly rewarding stimuli today is staggering.

Brad (02:46):
The smartphone is the modern day hypodermic needle delivering digital dopamine 24 7 for a wired generation. Dr. Lembke is a professor of psychiatry at Stanford University Medical School and chief of the Stanford addiction medicine, dual diagnosis clinic in the book. She talks, uh, quite a bit about her patients that had these, uh, extreme and shocking addictions and how they process through that. But rather than seeing myself as separate from someone who might be considered a more extreme addict, I realize that all of us every day are in this highly vulnerable situation, thanks to the inexorable progress of society and technology to where everything is easy, and we can get instant gratification all day long. So you’re gonna learn about the importance of achieving this neurochemical balance in the brain, inducing, appropriate amounts of pain, discomfort challenge, and that could be, uh, working hard physically or cognitively, and that will help the brain rebalance and keep you out of that

Brad (03:58):
trap of downward spiral into addiction from excessive dopamine seeking pleasure, seeking instant gratification behavior. You’re really gonna enjoy this conversation. I highly encourage you to pick up the book. There’s so many great tips in there at whatever level you’re striving to improve as a person, especially this recommendation that, a detox process lasting at least 30 days can be the secret to rebalancing and getting out of even those, um, what you might consider minor or annoying little proclivities that we have for, uh, thrill seeking behavior that are out balance and result in a net adverse overall experience. So let’s hear it from Dr. Ana, here we go.

Anna (04:46):
Dr. Anna, I’m so happy to catch up with you. We have important things to talk about. I have an opening line for you. Ready?

Anna (04:55):

Brad (04:56):
I was gonna say that I was incredibly excited to talk to you, but I, I don’t wanna get too excited. I don’t wanna get those, those neurochemicals out of balance. Okay. There we go. But I am very excited. And your book, Dopamine Nation subtitled Finding Balance in the Age of Indulgence, pretty much, uh, identifies a major problem of society today.

Anna (05:20):
Yes, it does. And I appreciate your wanting to start off without getting too out of balance, which does raise, you know, an interesting philosophical question about, should we let ourselves get excited about things? Should we, should we be throwing these great big birthday parties, you know, for our kids, or is that also part of the problem? So I like that you started out there.

Brad (05:44):
Well, what do you think? I I’ve reflected on times in my life where, you know, the highs and lows were more extreme. I used to be an athlete, so I raced on the professional triathlon circuit for nine years and everything was saw about the next big race. And, oh my gosh, it’s so mellow dramatic. If I have a bad race, my, my life is terrible. Then if I win I’m on the cover of the magazine Whoopie doo, Hey, there it is in the background 30 years later, it’s still on my wall. Whoopie do do. But you know, you move into different phases of life. I think maturity is great. And one of the things about best things about getting older is a little more perspective where, you know, what we do is not the end of the world and that the sun will rise another day.

Anna (06:29):
Well, so I find this really fascinating and to my surprise, one of the big audiences for my book, Dopamine Nation has actually been athletes, especially elite athletes. So I’m really, you know, and as you know, in my book, one of the things I do recommend is actually intentionally inviting pain into our lives as an indirect source of dopamine, which I, um, which I claim based on the, you know, neuroscience is less vulnerable to this problem of addiction because we’re less likely to get tolerant to it. But having said that, clearly people can get addicted to various forms of pain. People can get addicted to exercise and just striving in general. So I’m very curious as you look back on your triathlon career and the kind of striving cycle that you were in, I mean, do you regret that time or do you feel like it was, I mean, would you do it differently looking back? What do you think?

Brad (07:25):
Definitely the, the main difference would be, um, to, to have a kind or gentler approach, which is what I promote now about fitness. Cause I think we were socialized inaccurately to think that no pain, no gain is the essence of being a competitor. And so I think you learn through struggle, failure, disappointment, these valuable lessons where you keep a, a little more of a level head. And I think that the physical exertion should be balanced better, but you’re probably asking about, you know, my mindset and all that. And I think, um, you know the focus on the process or the emphasis on the process, which comes out of your work wonderfully, and I wrote down some great quotes about this. I think that’s where the magic is, is where, yeah, you’re waking up every day. You have a passion, you have excitement, you’re striving, you’re striving, but the, the result is sort of a consequence rather than the obsession. And I think that’s where we get into trouble is when we’re obsessed with, I guess, pleasure seeking that’s where we head down the path of addiction and disappointment and things of that nature.

Anna (08:32):
Well, thank you for sharing that. So one of the big problems that I I see in the world today is that we’ve drugifiy even healthy and adaptive behaviors. And one of the ways in which sports has surely become drug fight is not just through like the various types of equipment that allow us to push ourselves to unprecedented extremes, but also really important through the rankings and the social media and the ways in which now it becomes about the time or the ranking and the competitive pool is just so much greater. I mean, in some, in ways that I find really interesting, the Olympics has sort of lost some of its salience because it was the one place before that you had people from all over the world kind of coming together and competing against each other, but now that’s happening all the time, right?

Anna (09:24):
Millions of people over the world, through social media ranking themselves and even high schoolers, you know, even elementary school-age athletes kind of being ranked on a national level and that contributing. So it’s, that’s what I mean, it’s like the bad part is the chasing the dopamine part. And what, what is dopamine sensitive to? It’s sensitive to things like enumeration when we give something a number. So like the digital likes or the rankings on video games or for that matter the times and the ranking on sports and the quantification of our behavior, I think is it’s a big piece of how we’ve sort of drugified these things that make it harder to focus on process.

Brad (10:06):
That’s pretty much the essence of the problem I see with sports all the way down to youth. And I went through that journey with my kids and, you know, it was, it was nauseating to have this over pressurized, parental driven, competitive experience. Obsession with winning and ranking. Yes. And so I guess in contrast, a healthy, a healthy approach would be bringing in these other neurochemicals, like serotonin oxytocin, they, um, satisfaction, fulfillment, long term bonding with others. Is that what we’re shooting for?

Anna (10:47):
Yeah. And I think, especially with athletes, you know, really deemphasizing the identity piece as like, I’m this, you know, star baseball player or I’m, you know, I’m the person who’s gonna get recruited to X, Y or Z division school. And really allowing young people to develop a grounding of their identity in things that are transcendent, you know, not the things that are tied to these kind of material, competitive pieces. Of course, we all love sports and the excellence of sports and the human body and achievement. So it’s not that we’re throwing it out the window, but if that’s all that the person has, and there’s no sort of girding of that or scaffold beneath that, then you’re really, you know, setting people up for a very serious fall.

Brad (11:37):
Yeah. And I think, uh, we’ve been kind of brainwashed to misunderstand this as the adoring public obsessing with our teams winning and filling the stadiums. But it, it really is, um, an ill-advised even for the, the elite athletes of the world and we’ve seen, oh my gosh, talk about hitting close to home. The tragic story of the Stanford goalkeeper and, and, and other athletes that are, you know, that can’t they succumb to the pressure, or we’re talking about the suicide cases in collegiate athletes. Right. And then even at the elite levels, when they go and win everything, then they go crash their Roll Royce at three in the morning. And, uh, yeah, it’s, they can’t even adjust to, to real life, even as they have all the accolades and all the success,

Anna (12:27):
Right. Or even, you know, with less dramatic kind of, you know, tragic endings, you’ve just got like, you know, that gold medal winner who’s sacrificed so much of their life. And then they’re like, but what do I, what now? You know,

Brad (12:39):
The Weight of Gold, the documentary featuring Michael Phelps and talking about a lot of ’em right. Is there, there’s no place to go from, right. The pinnacle of there will never be another dopamine rush to match winning the gold.

Anna (12:53):
Yeah. Yeah. Yeah. So, I mean, I mean, and, and you know, the other thing about sports is that, you know, it’s not just the athlete who then finds themselves caught in the dopamine vortex, but it’s the gaping maw of spectators who are basically their so source of Dopamine hits. And maybe it involves them gambling on athletes in addition, but it doesn’t even have to be that, but the kind of consumption of sports as a spectator is very much vulnerable to this problem of addiction.

Brad (13:24):
Oh boy. And addiction is really your central focus of the book. I really appreciate how you, how you presented everything, including, um, bringing your personal story in. And I, it, it occurred to me as I’m reading kind of the extreme cases of addiction that we’re all familiar with and, oh, uh, that the, the homeless encampment down by the river, those people are all addicts and I’m driving by thinking that I’m immune from all this stuff. But I think we all need to sit back and reflect and realize that, um, at some level, uh, the addiction is, is profound in society, especially with, um, oh, here’s your quote. The smart phone is the modern day hypodermic needle delivering digital dopamine 24 7 for a wired generation. So boy, it’s the, the desire to be, to be free from that is, is a daily and constant challenge for everyone.

Anna (14:20):
Boy, that’s for sure. And, you know, I think it’s important to acknowledge that addiction is a spectrum disorder and of course, you know, people with severe life threatening addictions that is different than what I talk about in, you know, the book as my kind of romance, novel reading addiction.

Brad (14:36):
Oh, right. I should have, uh, identified she. Yeah, no, no. That you like to read a lot of romance, novels people. Um, if you’re watching on YouTube, you could probably see my addiction in the background, which is, um, the dark chocolate rack here. and, um, I’m reflecting as I’m running out. And I realize shoot, I’m running out and may, maybe I should leave the rack empty for a few days just to prove that, you know, yeah. I, I can, uh, I can be resilient here. Okay. Excuse me.

Anna (15:00):
No, no, it’s, it’s great. And I think, you know, the point that I’m trying to make in the book is that, you know, wherever we fall on that spectrum of compulsive over consumption to extremely threatening addiction, the point is that we all have the same mental circuitry that gets us to instinctively approach pleasure and avoid pain. And that, that, you know, ancient wiring is great for a world of scarcity because it makes us constant strivers, never satisfied with what we have always wanting more, but it’s incredibly pernicious in a world of overwhelming over abundance, which is the world we live in now, in which, you know, even previously healthy and adaptive behaviors like sports, like we’ve been talking about have now become drugified and turned into, you know, the, the prospect of essentially chasing dopamine separate from the original meaning or purpose of that activity,

Brad (15:53):
Right. The, the original originally and adaptive behavior. And I I’m remembering, Baron Pierre de Coubertin,, the founder of the modern Olympics. He said, the important thing is not to win, but to take part, the Olympic oath goes on and on. It’s like, are you kidding? We have tracked that thing because NBC just paid 877 million for the rights. Right. And so we wanna see especially the red, white, and blue athletes win, but the whole thing’s become marginalized commercialized, same with, I think the fitness industry, diet health, the areas that I traffic in is everything’s been, um, you know, branded and, and put a price tag on.

Anna (16:30):
Right. And that’s a really important point that not only do things become potentially more addictive when we enumerate them or quantify them, because dopamine is very sensitive to numbers. But also when we monetize things, you know, in our capitalist system, anything that becomes monetized, then, you know, we’re our sort of striving mechanism, you know, kicks in and then this can become, you know, which is why sort of workaholism is, is a real problem today.

Brad (16:57):
So we don’t wanna, we don’t want to tip toe over that, uh, edge. And, and then, um, you know, how do we negotiate or navigate this, this route, if we want to achieve tenure in a, in a university system? We have to be counting things. And, the business experts that, uh, that try to reign me in want, wanna see my spreadsheets. I’m like, oh yeah, spreadsheets, I that’s on my to-do list. I promise. Right. So we don’t wanna trend too far in the other direction where we’re the easy breezy surfer dude. Although I think those people have a lot of secrets that, that the rest of us, uh, deserve to be yeah. To be unlocked.

Brad (17:36):
How do we navigate that balance of existing in competitive, modern culture?

Anna (17:42):
Well, I mean, I think, you know, it is a balance, right? It’s a dynamic interaction between ourselves and the environment. And I think the key is really to not, you know, go too far in one direction or the other. But to try to really strive to find, you know, this balance between a pain and pleasure between consumption and abstinence, depending also on our own unique physiologic makeup, cuz people are gonna come, come out at different places on that.

Brad (18:13):
It occurs to me that, uh, in years, decades, generations passed, we probably did that really well. We, we did a hard day’s work at the factory. We came home, we sat down that maybe it was a home cooked meal, they had to put even a little more effort in, and then you sat by the, the radio and listened to the show as you’re entertainment. It seems now we have this tremendous ability to hijack as, as Dr. Robert Lustig says in, in the title of his book, The Hacking of the American Mind. We can, we can hijack this, these long routes and now click a button and Door Dash comes rather than having to chop any vegetables. And that, that seems to be, that was my most benign example I could think of. But of course we also have, um, my, my former podcast guest, John Gray talks about the, the evil combination of video games in porn for the young today’s modern male, because they can hijack their two most profound inner biological drives, uh, just by sitting in front of a screen.

Anna (19:12):
Right? Yes, exactly. And I think the key for people to understand who might be, you know, listening and think, well, well, who cares? I mean, that’s fine. I mean, you know, like great that I can push a button and get a pizza delivered and watch a video game. But I think what people don’t realize is what the hidden biological costs are. Um, and then those, those biological costs have, you know, very tangible repercussions in our lives. And what, by that, I mean that, you know, our brain is fundamentally wired to preserve homeostasis or kind of a level balance of dopamine firing. And by bombarding our brain reward circuitry with this fire hose of dopamine, from the moment we wake up to the moment we go to to bed again, what, what, what the brain has to do to adapt to that is essentially downregulate our own dopamine production and transmission that puts us into a dopamine deficit state.

Anna (20:11):
That is we get to a point where our dopamine firing is actually below baseline. And that is very akin to a clinical depression. So, you know, the universal symptoms of withdrawal, which is what we’re experiencing in that dopamine deficit state are anxiety, irritability, insomnia, dysphoria, and craving. So the bottom line is that paradoxically, this relentless pursuit of pleasure and obtaining of pleasure in a world that’s made, um, these, these reinforcers so accessible is that we ultimately end up more miserable, you know, more unhappy, less, less able to actually experience any pleasure at all. And I think that that’s kind of the message that I’m trying to convey. You know, in do mean that, that there are really physiologic costs to this and there incremental may accumulate over time and, you know, they can get us to a very dark place.

Brad (21:04):
So, if we wanted to, um, kind of try to regain balance, we have this thing, it’s not your term. I think you, you, you, you call it the opponent process reaction, right. It’s scientific term. Okay. So, this is where you mentioned briefly before, if we go out there and do that silly stuff, like jump into my chest freezer or do a, a challenging hike or, uh, sit down and try to type a paper, uh, we put ourselves into discomfort of either physical or I guess a cognitive challenge could count too, perhaps. Yeah. And we get this opponent process reaction.

Anna (21:45):
Yeah. So I think what I use in the book as an extended metaphor of a balance, like a beam on a central fulcrum, which is like a teeter totter and a kid’s playground, which represents how our brains process pleasure and pain. Because process because pleasure and pain are co-located in the brain in the same parts of the brain. That process pleasure also process pain. And they work like opposite sides of balance. So when we do something that’s pleasurable or reinforcing our balance tilts to the side of pleasure, but one of the overarching rules governing this balance again, is that it wants to restore a level position or what neuroscientists call homeostasis. And it does that by adapting to that stimulant or that, that intoxicant by downregulating our own dopamine production and transmission. And I imagine that as these neuro adaptation gremlins hopping on the pain side of the balance to bring it level again, but they like it on the balance.

Anna (22:35):
So they stay on until it’s tilted and equal and opposite amount to the side of pain. That’s the come down, the opponent process mechanism, the after effect. And then ultimately they get off maybe after a few seconds or minutes or hours or days. And then we are at the level balance again. But if we continue to bombard our reward pathway with highly reinforcing drugs and behaviors, we accumulate more and more gremlins on the side of the balance. And ultimately they’re camped out there. And we’re now walking around with a balance tilted the side of pain, we’re in a chronic dopamine deficit state. Now we need to use our drug not to get high, just to feel normal. And when we’re not using it, we’re, we’re experiencing these universal symptoms of withdrawal. So with enough abstinence from our drug and enough brain plasticity, you know, we, those gremlins will eventually hop off and homeostasis is restored, which is why I recommend dopamine fasting.

Anna (23:27):
But the other thing that I recommend is actually intentionally pressing on the pain side of the balance because the gremlins are agnostic to whatever the initial stimulus is. If we press first on the pleasure side, by using an intoxicant, they will jump on the pain side. But if we press on the pain side, for example, by exercising, doing an ice cold water bath, doing something cognitively challenging, emotionally challenging, something that requires our strong focus and attention, anything that’s difficult, then those gremlins will hop on the pleasure side of the balance and will actually trigger our bodies’ own homeostatic healing mechanisms will start to upregulate, serotonin neuroepinephrine, dopamine. And that’s really a much better way to, you know, get our dopamine as long as we don’t overdo it. As we talked about in the beginning, pressing too hard, uh, and too fast on the pain side of the balance actually turns, uh, that into an intoxicant mm-hmm . So, so that’s really the idea, you know, how to find balances that if we’re gonna press on the pleasure side, we need to do it not very often to leave enough time in between for those gremlins to hop off and for homeostasis to be restored. And that ultimately a better way to get our dopamine is actually gentle presses on the pain side of the balance, so that we reset our head Don, or pleasure that point to the side of pleasure,

Brad (24:53):
Right. Appropriate, uh, appropriate introduction of pain challenge, discomfort, struggle. Yes. Right.

Anna (25:01):
Yes, exactly.

Brad (25:01):
And when you say, drug this and drug that I I’m assuming the, uh, reaching for the smartphone could be in the same category as, as actually taking a drug, when it comes to that addiction.

Anna (25:14):
Yes, absolutely. So what’s amazing about screens, including obviously our smartphone screen is that the screens itself are reinforcing. So it’s not just that there are, there are a portal to highly reinforcing behaviors and actual substances that we can get delivered, but the medium itself is reinforcing, you know, the screen, the flashing light is sort of like a primitive fire. I think the, you know, the, the kind of tapping on the phone sort of keys into our sort of, you know, micro movements that we probably evolved over millions of years, whether it’s grinding weed or picking berries, you know, we have this sensation of actually accomplishing something with this little device, but in fact, you know, we may not be accomplishing anything at all with the time and energy spent, but we have the feeling of doing something important.

Brad (26:00):
Wow. Those, those primitive comparisons, we never thought about that, or they say smoking a lot of the habit is the, the manual act of bringing something, you know, using your hands. So I guess the, the phone counts in there too.

Anna (26:14):
Yeah. Especially since most of us live such disembodied lives now where we’re really spending all of our time and energy in our heads. And very little time in our bodies, people are generally not very well acquainted with their bodies, you know, with the exception of athletes, of course. But even some athletes, you know, tune out signals, right. Don’t listen to their bodies in the way that they should. Um, so I think, you know, this disembodied nature is part of what makes these digital drugs so appealing. I mean, if you think about like video game avatars, these are very physical avatars. People are jumping and running and doing cartwheels while the actual person is really just sitting for hours and hours, you know, in their, in their chair. So there’s a clear need to be embodied. And yet we’re, we are sort of denying that need. And I think it’s leading to quite a lot of psychopathology.

Brad (27:09):
‘m particularly, I guess, sensitive to these things because I’m in that age group, I don’t know about you listeners or, or Dr. Anna, but I’ve had this reference point of half of my life or whatever it was before even the internet fired up. And certainly the mobile devices have only been around for, you know the last generation. And I have all these, uh, reflections and memories of going to the bookstore on a Saturday afternoon and, and, you know, reading for an hour from this book and an hour from that book and bringing a stack home. And now, um, you know, I’m embarrassed to say, like I’m too busy to sit down and, and read very much. I, I hit audible pretty hard, but most of that audible cause we’re putting at 1.75 to 2.0 speed, instead of 1.0 speed, how can I stand to be at 1.0 speed when I can push this button and read more books. So it’s, it’s kind of tough to juxtapose all that, all that time in the natural world, my childhood, of course, we can all reference the childhoods we’re running around outside and then came in for dinner. And so, you know, it’s, it’s a heavy heart when I’m thinking about these problems and looking at the life that my kids face, who are both in their twenties now and have been brought up with the technology world.

Anna (28:22):
Yeah. I mean, I think we, we really underestimate, underestimate the merits of just slowing things down. We really have this illusion, that speed is of the essence and that the more that we do in any given unit in time, the more we’ll get and the more we’ll get what we’re the happier we’ll be. And yet, of course, we’ve all experienced that we get to where we wanted to get, and it was not what we thought it would be. And there’s this kind of deflation and disappointment and physiologically truly a kind of dopamine free fall. So, um, I think this, this, this it’s so important that we sort of, and in fact, the intentional, the intentional slowing down in the moment of what we were doing and trying to do it more slowly, which is so paradoxical. And so countercultural can actually help us be more present in the moment and tap into process, which as we were talking about in the beginning is so important, like to, how can we get to that place where we’re in our bodies in the moment engaged in process and not constantly feeling like we’re missing out or that if only we were further along, or if only I had already arrived at this place, that I’m, that I’m going to,

Brad (29:37):
That, that comment reminds me of your, your, your epic life changing quote. I’ve been thinking about it every day since I heard it, I think on another show a couple months ago. And it was, it was, um, if you can guess it I’ll give you $2, but it was, I think it really represents the secret to life. Are you ready?

Anna (29:56):

Brad (29:57):
You said the routine things that you do in daily life can take on epic proportions, but it doesn’t mean you have to get to the top of the mountain. It reminds me also of Martin Luther. King’s famous quote about the street sweeper. Maybe people are familiar with that. He says one is one is to be a street sweeper resolved to be the greatest street sweeper that the world has ever known where everyone who passes by say, there, there goes the, the greatest cleanest street ever, that kind of thing. Yeah.

Brad (30:25):

Brad (30:25):
Right. And, um, that, uh, that resonates so beautifully with me because like I referenced back in my, my athletic times, it’s like, um, now literally the sum total of that entire decade on earth, uh, is in a manila folder in the back of my file cabinet where it has the result of every race. Yeah. But I, you know, I lived and breathed every single one of those pieces of paper that slotted into a file folder in the back of my file cabinet. Yeah. And so at the time, like it, it is okay for things to take on epic proportions, but the result is now in the folder. It’s inconsequential to anything it’s all about. It’s all about the journey. And I think the sooner we figure that out, especially you young listeners out there, if, if you’re feeling that pressure from the outside world, I’m always trying to be the, you know, the counter motivational parent where I say, Hey, don’t worry. You know, there’s enough US senators. There’s two from each state that equals a hundred. You don’t have to, uh, you know, answer to anyone, but your own, you know, your own calling really.

Anna (31:27):
Yes. You know, thank you for this message is so important for people young and old, uh, myself included. You know, I think the, the, we all want to feel that our lives matter. We, we all want to feel that, right? We want to feel that there’s a reason that we’re here, that we’re making some kind of positive difference that our life has value. And yet so much of the way that we strive to get to that place, that feeling that our lives matter or the conviction that it’s true, um, is so orthogonal to the things that will actually, you know, give us that feeling. And you and I have, you know, through hindsight, the ability to know that like we have achieved the thing, right. And we looked at it and it was hollow and it didn’t have it. Didn’t, didn’t shine and sparkle, the way that we thought it would.

Anna (32:24):
And we put it on our shelves and it’s getting dull and now we might even throw it away. So how is it that we can convey to young people, you know, what, what this essence is. And I really think, you know, it’s encouraging young people to, yes, don’t try to find the grandiose thing that you need to do, but instead look at your life as it is, and the opportunities, even in your life, whatever hand you’ve been dealt to make a positive difference every day in a small way that may never get recognized by anybody else, but that has meaning for you. Right. And it might be something like you see a piece of litter on the ground and you stop to pick it up and put it in the garbage with a whole lot of other people pass that and didn’t do that.

Anna (33:15):
So, so, and then just like, and letting yourself just realize that that that’s enough that these small positive acts of good, we we’re really, we’re, we’re, we’re given these moral quandaries all the time. We don’t see them, but if we were to really open up to them and see them and notice how many opportunities we have in a day to make a moral choice, and if we choose right, how powerful that is and how that is really that’s meaning making and that’s life changing, but not in a way that’s ever gonna get any awards or, you know, compliments even, I think that’s so important. And these are the transcendent qualities, the kind of universal truths.

Brad (34:03):
Yeah. I mean, it’s possible. I don’t know. Let me ask the expert here is, is our whole life about neurochemistry? I mean, if we’re getting these feel good sensations as we go through our day, by picking up the trash that no one else did, rather than looking at our spreadsheets and seeing that there’s a missing zero from what we want on our our business revenues, is that all, is that all there? Is, is there, is there nothing, uh, more than just make keeping yourself in that, happiness, contentment satisfaction, rich, meaningful life?

Anna (34:46):
No, I mean, I think, uh, you know, in fact the opposite, I mean, I think what we have to realize is that our brain is limited in its capacity to see true cause and effect. And even, even in limited in terms of sensory processing and that our brain is really evolved for a very different world than we live in now. Right. I mean, our brain has really evolved for basic survival. So since we don’t have to really worry about basic survival anymore. What are we gonna do? We’ve gotta rethink, you know, this process and we’ve gotta actually start to ignore some of our chemical signals, and act counter to some of those signals, um, in, for, you know, in service of higher meaning and purpose, which is actually outside of our brain. I think we probably spend too much time and effort trying to pull meaning from inside of ourselves or from our like brain chemistry,

Brad (35:47):
Our primitive brains.

Anna (35:48):
Right. And instead, what we have to do is really transcend the body and the brain a and recognize that the serious limitations of, of these brain signals,

Brad (36:00):
Right. We’re, we’re smart enough to realize that, but then we, we drift back into primitive brain when we, when we shouldn’t, we should, we should flip flop it. I love that.

Anna (36:10):
Right. And, and, and I think recognizing our vulnerability to these kind of primitive signals is part of the solution, because what we have to realize is that once we’re in a situation where we trigger one of these automatic circuits, it’s very hard to resist, like the pleasure pain balance. Once, once you’re offered your drug of choice, , you know, the craving and desire will be so overwhelming there, there’s a very rare individual who could actually refuse in that moment. Um, so what we need to do is build kind of a world within a world so that we are anticipating these triggers and insulating ourselves from the constant temptations, by surrounding ourselves with other people who think the way that we do and want to transcend some of these primitive processes by limiting our access to drugs by maybe limiting our digital products or what’s on our digital products.

Anna (37:05):
You know, not having certain things in our home. So I think we have to, you know, a little bit like, you know, Ody had the sailors time to the mast, when he heard the siren song, because he knew once he heard the siren song, he would, you know, steer the ship into the rocky shores and they would all perish. So, um, you know, the sailors he’d said, put bees wax in your ears. And he said, time me to the mast and that way, you know, when they got heard the siren song and felt the draw, they had already anticipated that in a way that allowed them to, uh, get through that, that channel with that, and still resist. I think that’s the key.

Brad (37:42):
Whew. Yeah, it occurs to me that the more systems and habits that you build into place, um, I referenced my wonderful morning exercise routine all the time, because it’s been life changing for me, even as a lifelong athlete and a fitness freak, who’s been deeply immersed in this stuff since I was a little kid, I still didn’t have a go to you know, exact way that I started my day in a physical fitness effort until, and it’s now five years, I have a streak going. So perhaps I’m addicted to something this positive. And that could turn into a question, but because I do that for the first 40 minutes of every single day, that means I’m not on my phone. Right. Otherwise of course I, you know, vulnerable, tempted, all those other things that we all are. So if you’re, if you’re building these, these models, then whew, you know, by the time it’s, uh, 2:00 PM, I might, uh, indulge in a, a, a sweeping of the Instagram feed and maybe I’ll even enjoy it because I haven’t had it pollute my life to the extent that I have all those negative feelings.

Anna (38:53):
Right. So exactly. So your morning routine is a great example of self finding, you know, as well as a little bit pressing on the pain side to get dopamine indirectly. But you figured out that it is these, you know, we, we, we emphasize so much like thoughts and emotions, and those are obviously important, but behavior is really important and behavior can often be the starting place to change thoughts and emotions. So you get up and you immediately do a behavior. You do a physical exercise routine, which serves a bunch of different functions. Number one, it, it probably, you know, it’s a form of hormesis to upregulate your own dopamine transmission, and it’ll remain elevated for our, for hours afterwards, as we know exercise can do. But furthermore, it, it creates a kind of a, a time function where it delays your first access to your digital device, which is important.

Anna (39:46):
It’s kinda like intermittent fasting, right? We have to do intermittent fasting with our devices as well. Mm. Um, in, in order to narrow the window in which we’re engaged with the devices, which will then limit our consumption. So these are exactly the types of practices. I always say to my patients, I said, you know, you know, we can talk about the emotions behind this, and we talk and talk about your thoughts, ness and all that’s important, but what are your practices? What are you actually going to do on any given day that’s gonna help you be able to get to the end of the day and say, yeah, that was a pretty good day,

Brad (40:20):
Right? So I guess it, one of the starting points is that awareness, rather than the mindless consumption of digital information, or plopping down on the couch, grabbing the remote control and perhaps in, um, you know, creating an addiction to streaming entertainment because, um, boy, you watch a great show and I’m famous for when it comes to my bedtime, I will jump up and, and go find that thing before the thing, the next episode starts, I only have nine seconds cuz I know if that would kick into the next episode, it’s gonna be, it’s gonna be tempting to watch, especially if it”s Larry David, you know. I mean, you can’t, you can’t stop it. So yeah. Uh, that, that awareness is, is key. And I think, um, we probably have to have those defenses up throughout the entire day because that we’re just getting slammed.

Anna (41:10):
Yes. That’s, that’s the great insight, right. That we are getting constantly invited to indulge

Brad (41:16):
Invited. How polite of you to say that. Yeah.

Anna (41:19):
Right, right. Commandeered is maybe more accurate. Um, and so we have to anticipate that and we have to put these barriers in place. We have to enlist others to help us and, and do it together with them. It’s much easier to limit ourselves when we’re doing it together with other people. Um, but yeah, you’re absolutely right. I mean, it’s a very complicated addictogenic world and we have to anticipate that. And I think it starts with, you know, the awareness, but also the behaviors. Right. We have to put the physical barriers in ways. Like you physically jump up and get out of the bed. Right. You don’t, you’re not thinking a thought to yourself, you move away from the next episode button so that you’re, you can’t physically press it. I think we need much more of that kind of these physical barriers and the kind of physical practices, because again, it’s, the body is a powerful instrument and we often forget about it.

Brad (42:15):
Is that word addictogenic, did you make that up? Is that a real word?

Anna (42:19):
I don’t know. it, it could be that I made it up. I have no idea. I love it.

Brad (42:23):
I love it. addictogenic world. So yeah. Um, the term you used in the book about setting these boundaries, categorical self finding, can you describe that further as we strive to escape from the, the age of indulgence?

Anna (42:39):
Yeah. So this is where we, within a given category, let’s say video games. We recognize that there are certain video games that once we start playing, we just can’t stop. So then after a period of abstinence from video games to reset reward pathways, which is what I, what I do with my patients who come in with video game addiction, as we’re talking specifically about how to reintegrate video game is back into their lives. And the specificity is really important here. It’s not a sort of vague, well, I’m gonna go back to using, but I’m gonna use less. It’s like, no, when are you gonna use, what are you gonna use? And the, what are you gonna use is the categorical self binding, like which video games do you feel like you need to avoid altogether and which, which are the ones you feel like you can play in, in some moderation.

Anna (43:21):
And that extends out to other things. So for example, for, for me, I mean, I talk about my, you know, my romance reading. I’m gonna been a reader all my life, but I kind of got addicted to this certain genre. And so in general, I avoid that genre of novel. And I, I read a lot of mysteries and I read a lot of non-fiction and other things, but I, I try not to read romance novels. Of course. Now when I go and I do read a romance novel, it’s it doesn’t do anything for me. So that’s the irony too, that you can eventually, what happens in the cycle of addiction is the drug just stops working for us. Like we have this kind of euphoric recall of what it was like, but then when we try to recreate that feeling, we don’t get, we don’t get that anymore. And that’s again, because of this neuro adaptation, which is probably on some level permanent, um, you know, although you can reset reward pathways, those gremlins once created never entirely go away. And their call was kind of waiting in the wings to hop back on, uh, which is certainly, you know, what my patients also describe with alcohol and cannabis and other more typical drugs.

Brad (44:22):
Yeah. I suppose that’s highly adaptive cuz you think about the extreme thrill seeker who, who needs a higher high. And so they jump off the building with the parachute and now that’s not good enough. So they have to jump off the, uh, you know, the airplane and land on the building and so forth. Right. That’s kinda, that could get you

Anna (44:41):
In trouble. Yeah. And that’s called tolerance needing more and more of our drug or more potent forms over time to get the same effect or finding that our drug stops working for us at a given dose or even turns on us. Yeah. And, tolerance is, um, sometimes if we abstain for a period of time, we can recapture tolerance. But sometimes for people to tolerance is actually, you know, permanent and they can’t kind of re, especially as we age to recapture, you know, that, that joy, which is, you know, hard, but it is what it is.

Brad (45:12):
Yeah. I think it’s all right. Yeah,

Brad (45:15):
That’s right. Not a lot of it’s really redeeming when you think about it, if you get, if you get too far deep into anything and I’m familiar with the extreme exercise, you know, pursuit of the endorphin like chemicals that come into play after, especially a strenuous workout, then you’re you find yourself pushing yourself harder and harder and then throw in the numbers that you mentioned earlier. So if you become competitive and wanna beat your time and feel, you know, a greater hormonal bathing and, uh, feel good hormones after, um, pretty soon you, you, you, you crash. And then, uh, as you describe the, the, the baseline level of dopamine and other things are, are below normal, and then you, then you experience depression, anxiety. Is that what we’re talking about?

Anna (46:03):
Yeah. So ultimately with repeated exposure to that reinforcing drug or behavior, what happens is that initial response gets weaker and shorter. That’s tolerance. But that after response to the pain side gets longer and stronger, we essentially go into this chronic dopamine deficit state. And that feels exactly like depression, anxiety, um, you know, insomnia. So in fact, what, when we get to that place, what we need to do to reestablish a healthy hedonic level of dopamine is actually abstain from that drug for long enough to sort of trick the brain into, uh, kind of resetting those baseline dopamine levels.

Brad (46:43):
Right. I remember you saying not two weeks people, you need 30 days and it’s 30 days the magic number.

Anna (46:50):
No, I’ve been doing this for about two decades and it’s amazing how consistently 30 days is the magic number. Two weeks is almost universally when people are still in withdrawal. It’s really only in weeks three and four, that they start to come out of it. So if people don’t abstain people will say, well, I abstain and it didn’t make any difference. I’m like, well, how long did you abstain? It was a week or it was two weeks and say, yeah, that’s, that’s not long enough. You need to really go longer. And in fact, although 30 days is the average time, you know, for the brain to begin to reap the rewards of the dopamine fast abstaining for longer than that is really what it takes to really fully heal the brain, you know, and really get it. So for people, for example, with like alcohol addiction, mm-hmm, like they start, they usually, they feel a lot better at 30 days, but if they could go three months or six months, those gains are just increased even beyond that.

Brad (47:41):
And would this be applicable to anything that one could consider adverse addiction?

Anna (47:53):
What do you mean by that?

Brad (47:55):
I mean, does, is it applied to a mobile device use, substance abuse, overeating, whatever the, whatever the category is overexercising.

Anna (48:04):
Yeah. So, you know what we call we, we call addiction to a behavior, a process addiction, or a behavioral addiction as opposed to a substance use disorder. But what I find so fascinating is that the, the natural history of the progression to addiction is exactly the same whether you’re dealing with a drug that you ingest or you’re dealing with a behavior like gambling, pornography, video games, social media. People usually start out for one of two reasons to have fun or to solve a problem. If it works for them, then they’ll go back to that substance repeatedly. And if they get progressed to regular daily use, they’ll eventually build up tolerance or they need more and more of the drug to get the same effect. They’ll start to increase their quantity, put more and more effort and energy and time and money into getting that drug, using the drug.

Anna (48:53):
And eventually if they’re, you know, prone to addiction to that drug, then they’ll start to sacrifice all kinds of resources. And they’ll start to experience all kinds of problems. And yet even those problems are not enough to deter them from the pursuit of their drug, and really that’s kind of the heart of, of addiction. It’s the continued use, despite consequences. Now, many of us will go part of the way down that path and then go wait a minute. You know, this isn’t working out and we’ll be able to recalibrate. And that means that we probably don’t have vulnerability to addiction to that particular substance or behavior, but people with that vulnerability to addiction, they can get to that point and they can either not see the consequences, or even if they see the consequences, they can’t stop, right. They, they can continue with this relentless pursuit. And that’s really, um, you know, the hallmark of addiction that like the best loss of agency, even in the face of severe consequences

Brad (49:50):
And are there genetic vulnerabilities? And if they are, do they go across the board, we know so much about the contention that alcoholism has a genetic component, a strong genetic component, I suppose. Um, is that person also vulnerable to the mobile device? More so than someone else? That kind of thing?

Anna (50:10):
Yeah. So it gets to this concept of drug of choice, you know, what tilts your balance? The side of pleasure may not tilt mine and vice versa. And then there are certainly people who seem to be vulnerable to addiction to just about anything , uh, and that’s probably partially inherited. But it’s also true that once you’ve been addicted to something had a severe addiction, you kind of prime the brain for addiction, and then you’re vulnerable to cross addiction. There’s, there’s lots of hope. People with severe, severe addictions to lots of different substances and behaviors get into really robust and wonderful recovery. So it’s, it’s not, it’s not that we have to despair, but it is true that, you know, an addiction probably permanently changes the brain, making us more vulnerable to future addictions.

Brad (50:49):
Well, I guess the high dopamine seeking attribute is in so many ways positive. It was evolutionary driving, survival driving, and now we just have to temper it with some increased awareness of all the vulnerabilities we have in the shortcut life.

Anna (51:07):
Yeah. So that’s really the key. I mean, you know, I think many forms of mental illness are sort of traits that are endemic in the population that in a given ecosystem are either advantageous or disadvantageous. But because the ecosystem changes enough, our genetics are wise enough to keep those genes around and in case something catastrophic changes the environment. Right? So if you think about people who are, are severely addicted, basically what they are is tenacious drivers, who aren’t gonna give up when everybody else does. And again, in a, in an apocalyptic world, let’s say, um, you know, where, where we’re having to, um, go back to sort of subsistence or survival. I bet people with genetic vulnerability for addiction are gonna be the people who are gonna be the most valuable members of the tribe, you know, because they don’t give up.

Brad (51:57):
Right. Uh, Bruce Willis did. Okay. In Diehard. In fact, he came back, Diehard five times or something. He just , he just wouldn’t give up. How is, how is radical honesty involved in this story?

Anna (52:14):
Well, radical honesty is something that I learned about from my patients. What I discovered is that patients in the most robust and sustained recovery from severe addictions were people who had concluded that they couldn’t lie about anything. So not just lie, not lie about their drug use, but also not lie about small things in everyday life. And it turns out that the average human tells one to two lies per day. So we’re all natural liars. We do it reflexively. We’re usually lying to cover up small transgressions or trying to make ourselves look better, smarter, faster, more wonderful than we are. But it, you know, what what’s happening when we, when we commit to not lying even about small things, is that we’re probably activating the prefrontal cortex, which is the storytelling telling part of our brain, which is really fundamental to creating our autobiographical live narratives, which become not just a way to organize the past, but also provide a roadmap for the future.

Anna (53:10):
What I find in my practice is that people who tell true stories about themselves are the people who are gonna most likely be able to have access to the information they need going forward to make good decisions. Whereas people who are telling narratives that are not, you know, adhering to the truth are people who are deep in their addiction and are not gonna make progress. Mm. And as people move from addiction into recovery, the narratives change, it’s really fascinating. And they go from these narratives that are often self deluding into these narratives that are much more realistic, you know, along the lines of, well, yes, this happened to me. But on the other hand, this is, this is what I contributed to the problem.

Brad (53:49):
So that must be fascinating to sit there and watch the, watch the arc of the character.

Anna (53:53):
It is.

Brad (53:54):
if it’s a patient and yeah, I guess you gotta bite your tongue, initially, because it has to be on their own time. I don’t know.

Anna (54:00):
Yes. Yeah. Well, what’s really interesting is that when people are using their drug in their addiction, they really can’t see true cause and effect, not just around their addiction, but in general in the world. And they can present very personality disordered, but when they stop using and they get into recovery and they reset reward pathways, oftentimes those kind of personality looking traits disappear. And then they’re able to really, you know, engage their frontal lobe and sort of, you know, process information say, oh, wait a minute. You know, this relates to this, relates to this. And so you get a more coherent narrative, you get a more logical narrative, you get a more truthful narrative that really does, is able to see, you know, true cause and effect because that’s what our brains are. We’re always telling stories in an effort to understand true cause and effect so that we can make better decisions going forward. But when we’re in an addiction, we, we can’t tell truthful stories cuz we can’t see true cause and effect. Cause we’re really focused on just getting more dopamine. It becomes a physiologic overriding, um, kind of a mechanism that just shuts down all of our other systems.

Brad (55:08):
And you’re saying this extends beyond the issue at hand. So the person who’s drinking too much and you, you intervene and, and call them on it. Not only are they gonna be in denial about that, but they’re also gonna be, um, kind of clouded in how their career might be harmed by their drinking and so forth.

Anna (55:29):
Oh yeah. Or even just in terms of the way they conceptualize the future. There’s a wonderful experiment where healthy controls were asked to, to finish this statement, like in the future, I see myself and for healthy control subjects, usually they ended up narrating something that had to do with, you know, a decade, hence people who were in deep in their addiction, they answered the question, uh, in the future. I see myself and they would talk about like a week from now, right? Because the addicted brain is a, a brain that’s mired in immediate short term rewards. We don’t, we’re not even able to project ourselves into the future. And so, so it’s really, it’s really physiologic.

Brad (56:06):
Whew. What a, what a, what a lot to think about and, and strive to increase our awareness. I thank you so much for these great insights and the great book, dopamine nation. I also wanna know, uh, how, how do you do it, Dr. Anna? You you’re seeing patients you’re in clinical practice teaching at Stanford. You’re writing these sensational bestselling books and you’re striving to, you know, not get sucked into the, the numbers game and, and the dopa minetogenic lifestyle.

Anna (56:35):
Well, you know, it on the surface of it, when you say it like that, it sounds like a lot, but, you know, actually, I, I, I spend a lot of time, kind of managing my mental health by slowing my life down, taking the time. Wow. For exercise and quiet reflection, time with family and friends, really focusing on process, um, taking, trying to take it a day at a time, trying to be truthful, and, and do small acts, uh, uh, through a day and not kind of future, uh, let’s say catastrophize one way or another. I mean, I struggle just like everybody else, but I have learned to narrow it down to the window of just trying to have a series of, of good days as I understand them.

Brad (57:22):
Right. And I would speculate, uh, you’re probably, it probably hasn’t held you back from tangible material success and accomplishment to keep those efforts in place and take the time for a hike rather than another hour at the screen, or what have you.

Anna (57:39):
Yeah. In fact, I would say, if you look at the trajectory of my life, it was only when I began doing that, you know, sort of seeking to live a life that prioritize the deeper meanings that oddly some of these professional accomplishment sort of started. It was as if, you know, it was only when I stopped striving for those things, that those things came.

Brad (58:03):
Imagine that, people, what a great example. Yeah. Thank you so much. How do we connect with you further?

Anna (58:09):
Well, I’m not on social media, but

Brad (58:11):
I imagine that too. Okay. You gotta go get the book then. Yeah. And have an actual, an in depth experience there. You love.

Anna (58:18):
There you go. There you go.

Brad (58:19):
Okay. Go look for Dopamine Nation. That’s a sign reading for all listeners. Thank you so much, Dr. Anna Lembke. Great show.

Anna (58:26):
You’re welcome. Thanks for having me.

Brad (58:31):
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