Dr. Anna Lembke on Huberman Lab: How to Beat Addiction

1. 0:00 – 0:15

   Anna Lembke

   1. AHAndrew Huberman0:00

      (soft rock music) Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance. And now for my discussion with Dr. Anna Lembke.

2. 0:15 – 1:54

   Dopamine, Reward & Movement

   1. AHAndrew Huberman0:15

      I and many listeners of this podcast are obsessed with dopamine. What is dopamine, and what are maybe some things about dopamine that most people don't know and probably that I don't know either?

   2. ALAnna Lembke0:30

      So dopamine is a neurotransmitter, and neurotransmitters are those molecules that bridge the gap between two neurons. So they essentially allow one neuron, the presynaptic neuron, to communicate with the postsynaptic neuron. Um, dopamine is intimately, uh, associated with the experience of reward, but also with movement, which I think is really interesting because movement and reward are linked, right? If you think about, you know, um, early humans, it, you had to move in order to go seek out the water or the, the meat or whatever it was. So, um, dopamine is this really, um, powerful, important molecule in the brain that helps us, um, experience pleasure. It's not the only neurotransmitter involved in pleasure, but it's a really, really important one. And if, if you wanna think about something that most people don't know about dopamine, which, which I think is really interesting, is that we, we are always releasing dopamine at a kind of tonic baseline rate, and it's really the deviation from that baseline rather than, like, hits of dopamine in a vacuum that make a difference. So when we experience pleasure, our dopamine release goes above baseline, and likewise, dopamine can go below that tonic baseline and then we experience a kind of pain.

3. 1:54 – 5:24

   Baseline Dopamine; Genetics, Temperament & Addiction

   1. ALAnna Lembke1:54

   2. AHAndrew Huberman1:54

      Interesting. So is it fair to say that one's baseline levels of dopamine, how frequently we're, are releasing dopamine in the absence of some, uh, I don't know, drug, or food, or experience, just sitting, being, uh, is that associated with how happy somebody is, their kind of baseline of happiness or level of depression?

   3. ALAnna Lembke2:16

      There is evidence that shows that people who are depressed may indeed have lower tonic levels of dopamine. So that's a really reasonable thought, and there's, uh, some evidence to suggest that that may be true. The other thing that we know is that if we, um, expose ourselves chronically to substances or behaviors that repeatedly release large a- amounts of dopamine in our brain's reward pathway that we can change our tonic baseline and actually lower it over time as our brain tries to compensate for all of that dopamine, which is more really than we were designed to, to experience.

   4. AHAndrew Huberman3:00

      Interesting. And is, would, is it, um, the case that our baseline levels of dopamine are set by our genetics, by our heredity?

   5. ALAnna Lembke3:08

      Well, I think, you know, if you think about sort of y- you know, the early stages of development in infancy, certainly that is true. You're kind of, you know, born with probably whatever is your baseline level. But obviously, your experiences can have a huge impact on where your, your dopamine level ultimately settles out.

   6. AHAndrew Huberman3:29

      Do you think that's, uh, set in terms of, um, our parents and obviously nature, uh, and nurture interact, but, uh, is that, is dopamine at the core of our temperament?

   7. ALAnna Lembke3:41

      I don't really think we know the answer to that. But I will say that people are definitely born with different temperaments, and those temperaments do affect their ability to experience joy. Um, and, and you know, we've known that for a long time, and we describe that in many different ways. One of the ways that we describe that in the modern era is to use psychiatric nomenclature, like, "This person has a dysthymic temperament," or, you know, "This person has chronic major depressive disorder." Um, in terms of looking specifically at who's vulnerable to addiction, um, that's an interesting sort of mixed bag, because when you look at, uh, the research on risk factors for addictions or what kind of temperament, uh, of a person makes them more vulnerable to addiction, you see, um, some interesting findings. First, you see that people who are more impulsive, who have a thought to do something and just do it impulsively-

   8. AHAndrew Huberman4:37

      Mm-hmm.

   9. ALAnna Lembke4:38

      ... are people who are more vulnerable to addiction. What we now conceptualize in our current ecosystem as mental illness are actually traits that in another ecosystem might be very advantageous. They're just not advantageous right now because of the world that we live in. And, and I think, you know, impulsivity is potentially one of those, right? 'Cause we live in this world that's such a sensory-rich environment, right, that we're c- being bombarded with all of these opportunities, these sensory opportunities, and we have to constantly check ourselves. And so, so, so impulsivity is something that right now, um, can be a difficult trait, but isn't in and of itself a bad thing.

4. 5:24 – 7:18

   Addiction, Modern Life & Boredom

   1. ALAnna Lembke5:24

   2. AHAndrew Huberman5:24

      In a previous conversation we had, you said something that really rung in my mind, which is that many people who become addicted to things have this feeling that normal life isn't interesting enough.

   3. ALAnna Lembke5:35

      Mm-hmm.

   4. AHAndrew Huberman5:36

      Maybe you could just tell us a little bit about your experience with this asso- association, if it really exists, between, uh, people's sense of the normalcy or maybe even how boring life can be and their tendency to become addicts of some sort.

   5. ALAnna Lembke5:50

      I think that life for humans has always been hard. But I think that now, it's harder in unprecedented ways, and I think that the way that life is, is really hard now is that it actually is really boring. All of our survival needs are met. We don't even have to leave our homes to meet every single physical need, you know, as long as you have a certain level of financial well-being, whi- which, which frankly, um, you know, we talk so much about, you know, the, the income gap, and certainly there is this enormous gap between rich and poor. But that gap is smaller than it's ever been in, like, the history of humans. We don't really have anything that we have to do, so we're all forced to make stuff up, you know, whether it's being a scientist, or being a doctor, or being an Olympic athlete, or, you know, climbing Mount Everest, and people really vary in their need for friction. And some people need a lot more than others, and if they don't have it, they're really, really unhappy. And I do think that a lot of the people that I see with addiction and other forms of mental illness are people who need more friction. Like, they're unhappy not necessarily because there's something wrong with their brain, but because their brain is not suited to this world.

5. 7:18 – 12:39

   Pleasure-Pain Balance, Dopamine, Addiction

   1. AHAndrew Huberman7:18

      Let's talk about the pleasure/pain balance and addiction, and I've heard you use this, uh, see-saw or balance scale-

   2. ALAnna Lembke7:25

      Right.

   3. AHAndrew Huberman7:25

      ... um, a- analogy before, and I think it's a wonderful one.

   4. ALAnna Lembke7:29

      Yeah. So to me, one of the most significant findings in neuroscience in the last 75 years is that pleasure and pain are co-located, which means the same parts of the brain that process pleasure also process pain, and they work like a balance. So when we feel pleasure, our balance tips one way. When we feel pain, it tips in the opposite direction. And one of the overriding rules governing this balance is that it wants to stay level, so it doesn't wanna remain tipped very long to pleasure or to pain, and with any deviation from neutrality, the brain will work very hard to restore a level balance, or what scientists call homeostasis. And the way the brain does that is with any stimulus to one side, there will be a tip in equal and opposite amount to the other side.

   5. AHAndrew Huberman8:15

      It's like the principal laws of physics.

   6. ALAnna Lembke8:17

      Yes. Right.

   7. AHAndrew Huberman8:18

      Yeah.

   8. ALAnna Lembke8:18

      Right? So, like, I like to watch YouTube videos. When I watch YouTube videos of American Idol, you know, it tips to the side of pleasure, and then when I stop watching it, um, I have a comedown, right, which is a tip to the equal and opposite amount, um, on the other side, and that's that moment of wanting to watch one more YouTube video, right? It's not something that consciously happens or that we're aware of unless we really begin to pay attention. And of course, one way to combat that is to do it more, right, and more and more and more. So I think, I think that is really what I want people to tune into and, and get an awareness around, because once you tune into it, you can see it a lot, and if you, you know, keep the model of the balance in mind, I think it ha- it gives people kind of a way to imagine what they're experiencing on a neurobiological level and understand it, and in that understanding, get some mastery over it, which is really what this is all about. Because ultimately, we do need to disengage, right? We can't live in that space all the time, right? We have other things we need to do, and there are also serious consequences that come with trying to repeat and continue that experience or that feeling.

   9. AHAndrew Huberman9:33

      Yeah. So if I understand this correctly, uh, when we find something that we enjoy that feels pleasureful, uh, social media, food-

   10. ALAnna Lembke9:42

       Right.

   11. AHAndrew Huberman9:43

       ... sex, gambling, whatever happens to be there's a, some dopamine release when we engage-

   12. ALAnna Lembke9:48

       Right.

   13. AHAndrew Huberman9:48

       ... in that behavior.

   14. ALAnna Lembke9:48

       Mm-hmm.

   15. AHAndrew Huberman9:49

       And then what you're telling me is that very quickly-

   16. ALAnna Lembke9:52

       Yes.

   17. AHAndrew Huberman9:53

       ... and beneath my conscious awareness-

   18. ALAnna Lembke9:55

       Mm-hmm.

   19. AHAndrew Huberman9:55

       ... there's a tilting back of the scale where pleasure is reduced by way of increasing pain.

   20. ALAnna Lembke10:02

       Right.

   21. AHAndrew Huberman10:03

       And I've heard you say before that the pain mechanism has some competitive advantages over the pleasure mechanism such that it doesn't just bring the scale back to level.

   22. ALAnna Lembke10:15

       Mm-hmm.

   23. AHAndrew Huberman10:15

       It actually brings pain higher-

   24. ALAnna Lembke10:18

       Mm-hmm.

   25. AHAndrew Huberman10:18

       ... than pleasure.

   26. ALAnna Lembke10:19

       Mm-hmm. What happens right after I do something that is really pleasurable and releases a lot of dopamine is, again, my brain is gonna immediately compensate by downregulating my own dopamine receptors, my own dopamine transmission to compensate for that, okay, and that's that comedown or the hangover, that aftereffect, that moment of wanting to do it more. Now, if I just wait for that feeling to pass, then my dopamine will re-regulate itself, and I'll go back to whatever my chronic baseline is. But if I don't wait, and here's really the key, if I keep indulging again and again and again, ultimately, I have, I have so much on the pain side, right, that I've essentially reset my brain to what we call, like, an anhedonic or lacking-in-joy type of state, which is a dopamine deficit state. So that's really the, the, the way in which pain can become the main driver is because I've indulged so much in these high-reward behaviors or substances that my brain has had to compensate by way downregulating my own dopamine such that even when I'm not doing that drug, I'm in a dopamine deficit state, which is akin to a clinical depression. I have anxiety, irritability, insomnia, dysphoria, and a lot of mental preoccupation with using again or getting the drug. So in general, what we want is some kind of flexibility in that balance and the ability to re- easily reassert homeostasis. We don't wanna break our balance, which is possible if we overindulge for enough period of time and end up with a balance tipped to the side of pain, this dopamine deficit state we've been talking about. We wanna, we want a flexible, resilient balance, right, which can be sensitive to things going on in the environment, which can experience pleasure and approach, which can experience pain and recoil, right? This is all adaptive and healthy and necessary and good.We would never want a balance that doesn't tilt.

   27. AHAndrew Huberman12:13

       Right.

   28. ALAnna Lembke12:13

       That would be a disaster-

   29. AHAndrew Huberman12:14

       Right.

   30. ALAnna Lembke12:14

       ... where we wouldn't be human, um, and we wouldn't want that. It'd be really, really boring. On the other hand, what people in recovery from addiction talk about is, to some extent, having to learn to live with things being a little boring a lot of the time, right? So trying to avoid some of this intensity and thrill-seeking and escapism that really is at the core of addictive tendencies.

6. 12:39 – 14:26

   Resetting Dopamine, Substance or Behavior Recovery, Tool: 30-Day Abstinence

   1. AHAndrew Huberman12:39

      So along those lines, I've heard you say that in order to reset the dopamine system, essentially in order to break an addictive pattern, 30 days of zero interaction with that substance, that person, et cetera.

   2. ALAnna Lembke12:55

      Right.

   3. AHAndrew Huberman12:55

      Is that correct?

   4. ALAnna Lembke12:56

      Yeah. And, and 30 days is, in my clinical experience, the average amount of t- of time it takes for the brain to reset reward pathways for dopamine transmission to regenerate itself. By depriving ourselves of this high-dopamine, high-reward substance or behavior, we allow our brains to regenerate its own dopamine t- for the balance to re- equilibrate, and then we're in a place where we can sort of enjoy other things.

   5. AHAndrew Huberman13:20

      So I'd like to, um, dissect out that 30 days a little more-

   6. ALAnna Lembke13:24

      Mm-hmm.

   7. AHAndrew Huberman13:24

      ... finely. So days one through ten, I would imagine, will be very uncomfortable.

   8. ALAnna Lembke13:29

      Yes.

   9. AHAndrew Huberman13:30

      Anxiety.

   10. ALAnna Lembke13:31

       Mm-hmm.

   11. AHAndrew Huberman13:31

       Trouble sleeping.

   12. ALAnna Lembke13:31

       Yep.

   13. AHAndrew Huberman13:32

       Um, physical agitation-

   14. ALAnna Lembke13:34

       Yes.

   15. AHAndrew Huberman13:34

       ... and to the point where-

   16. ALAnna Lembke13:35

       Mm-hmm.

   17. AHAndrew Huberman13:36

       ... uh, you know, um, maybe impulsive, angry. Should one expect all of that? Should the-

   18. ALAnna Lembke13:41

       Yeah. So what I say to patients, and it's a really important piece of this intervention, is that you will feel worse before you feel better. I'm j-

   19. AHAndrew Huberman13:49

       For how long?

   20. ALAnna Lembke13:50

       Yeah. So-

   21. AHAndrew Huberman13:50

       This is probably the first question they ask, right?

   22. ALAnna Lembke13:52

       Yes. And I, and I say, "Usually, in my clinical experience, you'll feel worse for two weeks, but if you can make it through those first two weeks, the sun will start to come out in week three." And by week four, most people are feeling a whole lot better than they were before they stopped using their substance. So it's a hard thing. Like, you have to sign up for it.

   23. AHAndrew Huberman14:12

       Then days 21 through 30, dopamine is starting to be released in response to the taste of a really good cup of coffee, for instance.

   24. ALAnna Lembke14:20

       Yes, exactly.

   25. AHAndrew Huberman14:21

       Whereas before, it was only to insert, you know, addictive behavior.

7. 14:26 – 18:39

   Relapse, Addiction, Reflexive Behavior, Empathy

   1. AHAndrew Huberman14:26

   2. ALAnna Lembke14:26

      Right.

   3. AHAndrew Huberman14:26

      One thing I've seen over and over again, (sighs) sadly often in the same individuals, is they get sober from whatever, they're doing great, and then all of a sudden you get this call. "So-and-so is back in jail. So-and-so's wife is gonna leave him because he drank two bottles of, of wine and took a Xanax at 7:00 AM, crashed his truck into a pole, has got two beautiful kids." Like, how did this happen again? To the point where by the fourth and fifth time, people are just done. And so what I'd like to talk about in this context is what sorts of things help other people that we know that are addicted? What really helps? And are there certain people for whom it's hopeless?

   4. ALAnna Lembke15:16

      Yeah. So there, there are people who will die of their disease of addiction, you know, and I think conceptualizing it as a disease is a helpful frame. There are other frames that we could use, but I do think given the brain physiologic changes that occur with sustained heavy drug use and what we know happens to the brain, it, it, it is really reasonable to think of it as a brain disease. And, and for me, uh, the real window of, let's say, being able to access my compassion around people who are repeat relapsers even when their life is so much better, when they're in recov-

   5. AHAndrew Huberman15:56

      Oh, yeah. Yeah.

   6. ALAnna Lembke15:56

      Yeah, it's like, it's like a no-brainer, right? Um, is, is to conceptualize this balance and the dopamine deficit state and a balance tilt- tilted to the side of pain and to imagine that for some people, after a month or six months or maybe even six years, their balance is still tipped to the side of pain. That on some level, that balance has lost its resilience and its ability to restore homeostasis.

   7. AHAndrew Huberman16:22

      It's almost like the hinge on that balance-

   8. ALAnna Lembke16:24

      Yes.

   9. AHAndrew Huberman16:24

      ... is messed up.

   10. ALAnna Lembke16:25

       Exactly. Imagine that you had an itch somewhere on your body, okay? I mean, we've all had that. Like, you know, whatever the source. You know, if you really focus, you could go for a pretty good amount of time not scratching it. But the moment you stopped focusing on not scratching it, you would scratch it, and maybe you'd do it while you were asleep, right? That s- And that is what happens to people with severe addiction. That balance is essentially broken. Homeostasis does not get restored despite sustained abstinence. They're living with that constant specter of that pull. It never goes away. So let me say there are lots of people with addiction for whom that does go away, and it goes away at four weeks for many of them. But in severe cases, that's always there, and it's lingering, and it's the moment when they're not focusing on not using, it's like a reflex. They fall back into it. It's not purposeful. It's not because they wanna get high. It's not because they value using drugs more than they do their family. None of that. It's that really they, they, they cannot not do it when given the opportunity and that moment when they're not thinking about it. Does that make sense?

   11. AHAndrew Huberman17:40

       That's a great description, and actually in that description, I can feel a bit of empathy because the way you describe scratching an itch in your sleep-

   12. ALAnna Lembke17:49

       Yeah.

   13. AHAndrew Huberman17:50

       You know, I've, I've done that with mosquito bites in summer.

   14. ALAnna Lembke17:52

       Right.

   15. AHAndrew Huberman17:52

       You're scratching, and like-

   16. ALAnna Lembke17:53

       Right.

   17. AHAndrew Huberman17:53

       ... and you wake up scratching that-

   18. ALAnna Lembke17:54

       Right.

   19. AHAndrew Huberman17:55

       ... that, that mo- mosquito bite. And I also have to admit that I've experienced not feeling like I wanna pick up my phone because it's so rewarding but just finding myself doing it.

   20. ALAnna Lembke18:07

       Yes. Of course. Yes.

   21. AHAndrew Huberman18:08

       Like, "I'm not gonna use this thing. I'm not gonna use this thing."

   22. ALAnna Lembke18:10

       Right.

   23. AHAndrew Huberman18:11

       And then, and then just finding myself doing it.

   24. ALAnna Lembke18:12

       Yes.

   25. AHAndrew Huberman18:12

       Like, "What am I doing here?"

   26. ALAnna Lembke18:13

       Right. Right.

   27. AHAndrew Huberman18:14

       Sort of the, "How did I get back here again?"

   28. ALAnna Lembke18:16

       Yes. Right.

   29. AHAndrew Huberman18:16

       And I, I know enough about brain function to understand that we have circuits that-... generate deliberate behavior, and we have circuits that generate reflexive behavior. And one of the goals of the nervous system is to make the deliberate stuff reflexive so you don't have to make the decision because decision-making is a very costly thing to do.

   30. ALAnna Lembke18:36

       E- e- exactly.
8. 18:39 – 21:37

   Triggers, Relapse, Dopamine

   1. ALAnna Lembke18:39

   2. AHAndrew Huberman18:39

      Why is it then that people will relapse not just after getting fired from a job or their spouse leaving them, but when things are going really well?

   3. ALAnna Lembke18:47

      Yeah.

   4. AHAndrew Huberman18:47

      Is it this s- unconscious mechanism? 'Cause I've seen this before, is, uh, they have a great win. I have a friend who's a really impressive creative, um, I don't wanna reveal any more than that, but, uh, and relapsed upon getting another really terrific opportunity to create for the entire world. And I was like, "How can that happen?"

   5. ALAnna Lembke19:08

      Mm-hmm.

   6. AHAndrew Huberman19:08

      But now I'm beginning to wonder was it the dopamine associated with that win...

   7. ALAnna Lembke19:12

      Mm-hmm. Mm-hmm.

   8. AHAndrew Huberman19:13

      ... that opened the spigot on his dopamine system?

   9. ALAnna Lembke19:15

      Mm-hmm. Mm-hmm. Yeah.

   10. AHAndrew Huberman19:16

       Because, um, it happened in a phase of, of a really great stretch of life.

   11. ALAnna Lembke19:21

       Yeah. Triggers are things that make us want to go back to using our drug and the key thing about triggers, whatever they are, is they also release a little bit of dopamine, right? So just thinking about, um, whatever the trigger is that we associate with drug use or just thinking about drug use can already release this anticipatory dopamine, this mi- little mini spike. But here's the part that I think is really fascinating, that mini spike is followed by a mini deficit state. So it goes up and then it doesn't go back down to baseline, it goes below baseline tonic levels, and that's craving, right? So that anticipation is immediately followed by wanting the drug and it's that dopamine deficit state that drives the motivation to go and get the drug. So many people talk about dopamine as not really about pleasure, but about wanting and about motivation. And so it is that deficit state that then drives the locomotion to get it.

   12. AHAndrew Huberman20:20

       And earlier your description of dopamine being involved in the desire for more, giving the sense of reward but also movement.

   13. ALAnna Lembke20:27

       Right.

   14. AHAndrew Huberman20:27

       I have to assume that those things are braided together...

   15. ALAnna Lembke20:29

       Yes. Yes.

   16. AHAndrew Huberman20:29

       ... in our nervous system for the specific intention of when you feel something...

   17. ALAnna Lembke20:33

       Yes.

   18. AHAndrew Huberman20:33

       ... good, then you feel the pain...

   19. ALAnna Lembke20:35

       Yes.

   20. AHAndrew Huberman20:36

       ... where maybe you don't notice it...

   21. ALAnna Lembke20:37

       Yes.

   22. AHAndrew Huberman20:37

       ... and then the next thing you know, you're pursuing more of the thing that can deliver pleasure.

   23. ALAnna Lembke20:40

       Yes. And I love the way you used the word braided together. That's beautiful. There are people for whom bad life experiences, loss, you know, in any form, stress, in many different forms, that's a trigger. But there are absolutely people for whom the trigger is things going well and the things going well can be like the reward of the things going well, but very often what it is, is the removal of the hypervigilant state that's required to keep their use in check. So it's this sense of, "I wanna celebrate." You know? Or, "I wanna... This reward happened, I wanna put more reward on there." And it's really, really fascinating because when people come to that realization th- about themselves, that they're most vulnerable when things are going well, um, that's really a valuable insight because then they can put some, you know, things in place or barriers in place, or go to more meetings or whatever it is that they do, you know, to protect themselves.

9. 21:37 – 23:58

   Shame, Truth Telling & Recovery

   1. ALAnna Lembke21:37

   2. AHAndrew Huberman21:37

      I wanted to, um, just touch on something that you mentioned which is, uh, the shame.

   3. ALAnna Lembke21:42

      Yeah.

   4. AHAndrew Huberman21:42

      I heard you say, um, in an interview with somebody else recently that truth-telling and secrets are sort of at the core of recovery. And, um, yeah, tell us more about that.

   5. ALAnna Lembke21:57

      Yeah. So one of the things that I found really fascinating about working with people in recovery was how telling the truth, even about the merest detail of their lives, was central to their recovery. It's not even just not lying about using drugs. I, I have to not lie about anything. I can't lie about why I was late to work this morning, which we all do, "Oh, I hit traffic." No, I didn't hit traffic, I wanted to spend two more minutes reading the paper and drinking my coffee, right? So people with addiction will get into, you know, the lying habit where they're lying about random stuff 'cause they're sort of in the habit of lying, and how recovery is really about telling the truth. And there's really interesting neuroscience behind it that suggests that when we tell the truth, we actually potentially strengthen our prefrontal cort- cortical circuits and their connections to our limbic brain and our reward brain. And of course these are circuits that get disconnected when we're in our addiction, right? Our balance in our reward pathway or limbic brain, our emotion brain is doing one thing and our cortical circuits are completely disengaged from that, ignoring what's happening, which is easy to do because it's reflexive. We don't need to think about that balance for the balance to be happening but we have to reengage those circuits, anticipate future consequences, think through the drink, you know, not just how am I gonna feel now if I use but how am I gonna feel tomorrow or six months from now? And that telling the truth is in fact a way to do that, to make these connections stronger and there are... I talk about some studies in my book that, that kind of indirectly show that. So I find that really fascinating, plus th- the just like being open and honest with people really does create very intimate connections, and those intimate connections create dopamine. You think people are gonna run away from you if you tell them about all, like, your weird neuroses, but really they don't. What they're like is, "Oh, thank God, I- I'm not the only one." Right?

   6. AHAndrew Huberman23:50

      I love that there's neuroscience being done on truth-telling...

   7. ALAnna Lembke23:53

      Yeah.

   8. AHAndrew Huberman23:53

      ... and the value of truth-telling.

   9. ALAnna Lembke23:54

      Yeah.

   10. AHAndrew Huberman23:55

       I th- I think, I hope they'll continue to do more work.

   11. ALAnna Lembke23:57

       Yeah.

   12. AHAndrew Huberman23:57

       Um,

10. 23:58 – 29:01

    Addiction, Psychedelic-Assisted Therapy, Psilocybin, MDMA

    1. AHAndrew Huberman23:58

       I wanna ask you about using drugs to treat drug addiction.

    2. ALAnna Lembke24:02

       Mm-hmm.

    3. AHAndrew Huberman24:03

       This is a vast area, right? Different chemistries for different drugs and different purposes, but the, the rationale as I understand it, is take people who are in a pattern of addiction, launch them into a experience that's also chemical and extreme, often of the extreme serotonin...And or extreme dopamine type. So, MDMA-

    4. ALAnna Lembke24:27

       Right.

    5. AHAndrew Huberman24:27

       ... ecstasy, for instance-

    6. ALAnna Lembke24:28

       Mm-hmm.

    7. AHAndrew Huberman24:28

       Tons of serotonin dump.

    8. ALAnna Lembke24:29

       Mm-hmm.

    9. AHAndrew Huberman24:29

       Tons of dopamine dump. How neurotoxic? If neurotoxic, debatable, et cetera, et cetera. Not a topic for now. But a lot. And then somehow, that extreme experience wrapped inside of a, uh, a supported network in there, whether or not there's just someone there or whether or not they're actively working through something with the patient, is supposed to eject the person into a life where drug use isn't, uh, as much of interest. This violates everything that we've talked about in terms of dopamine biology.

    10. ALAnna Lembke25:02

        Yeah.

    11. AHAndrew Huberman25:03

        It would, if this arrangement is the way I described it, cause more addiction. It is anything but a dopamine fast. It's a dopamine feast.

    12. ALAnna Lembke25:12

        Mm-hmm. Mm-hmm.

    13. AHAndrew Huberman25:13

        So, we hear about successful transitions through this, at least anecdotally, and may-

    14. ALAnna Lembke25:19

        Mm-hmm.

    15. AHAndrew Huberman25:19

        ... um, maybe some clinics are like, "What is going on?"

    16. ALAnna Lembke25:24

        (laughs)

    17. AHAndrew Huberman25:24

        (laughs) What is going on? Doesn't make any sense to me.

    18. ALAnna Lembke25:27

        Yeah. So, I think it's good that you're skeptical. Um, I think we all should be skeptical. Having said that, um, there are clinical studies showing, um, you know, and these are small studies and they're short duration, small number of subjects, but, you know, taking people, for example, who are, uh, addicted to alcohol and then having them have this g- let's say psychedelic experience in a very controlled setting-

    19. AHAndrew Huberman25:54

        So either... Typically, it's a high dose psilocybin or, or three dose, as I saw it for the MAPP study of, of MDMA of ecstasy.

    20. ALAnna Lembke26:02

        Right.

    21. AHAndrew Huberman26:02

        Those are sort of the-

    22. ALAnna Lembke26:02

        Yes.

    23. AHAndrew Huberman26:02

        ... seem to be the kind of-

    24. ALAnna Lembke26:03

        Like, the typical, right.

    25. AHAndrew Huberman26:04

        ... the kind of bread and butter of this kind of work.

    26. ALAnna Lembke26:06

        Right, right.

    27. AHAndrew Huberman26:06

        Yeah.

    28. ALAnna Lembke26:06

        But the thing to really keep in mind is that this is completely interwoven with regular psychotherapy, and that these are highly selected individuals, right?

    29. AHAndrew Huberman26:17

        Right, and clinical trials.

    30. ALAnna Lembke26:18

        Right, right.
11. 29:01 – 31:50

    Social Media & Addiction, Tool: Intentionality

    1. ALAnna Lembke29:01

    2. AHAndrew Huberman29:01

       There are a couple other things I just wanna touch on, um, but they all relate to social media.

    3. ALAnna Lembke29:07

       Okay.

    4. AHAndrew Huberman29:08

       I have to imagine that we need to regulate, not necessarily eliminate this behavior. How addicting is it and what is healthy social media behavior?

    5. ALAnna Lembke29:20

       The first message I would wanna get across about social media is that it really is a drug, and it's engineered to be a drug. Which doesn't mean that we can't use it, um, but we need to be very thoughtful about the way u- we, we use it. And so that means with intention and in advance, planning our use, right? And trying to use it in, as a, as a, as a really awesome tool to potentially connect with other people, and not to be used by it, um, or get lost in it. We do need to figure out, you know, how to make this, this tool something that's, you know, gonna be good for us and, and not ultimately harmful. As more and more of us are spending more and more time on social media, we're divesting our libidinous energies, et cetera, from real life interactions. So I think our collective challenge, and it should be our mission, is to make sure that we are preserving and maintaining offline ways to connect with each other. So this is the key. You have to, with intention, prior to being in that situation, think of literal physical and metacognitive barriers that you can put between yourself and your phone or whatever your, your drug is, to create these intentional spaces where you're not constantly interrupting yourself, essentially, and distracting yourself. Because I really do think we're losing the ability to have a sustained thought, right? I mean, we, we get so far and then, then you get to that point in the thought where it's a little bit hard to know what's coming next, and it's very easy to check your phone or check your email or look something up on, you know, the internet. And then you never get that opportunity to finish that thought, which is really the source of creative energy and an original thought, right? You're not just reacting to-

    6. AHAndrew Huberman31:18

       Right.

    7. ALAnna Lembke31:18

       ... what's coming at you.

    8. AHAndrew Huberman31:18

       And something that could contribute to the world. I know a number of people are gonna have questions and wanna get in contact with you. You are not on social media.

    9. ALAnna Lembke31:26

       That's correct. Yes, and-

    10. AHAndrew Huberman31:27

        You are true to your-

    11. ALAnna Lembke31:28

        Yes.

    12. AHAndrew Huberman31:28

        You are true to your ideology.

    13. ALAnna Lembke31:30

        Yeah. Yeah.

    14. AHAndrew Huberman31:30

        That is, that's great. Thank you so much for sharing this information, and, um, I know I learned a ton and I know everyone else is gonna learn a lot more about addiction and the good side of dopamine, so.

    15. ALAnna Lembke31:41

        That's right. Thank you for having me. (upbeat music) It's been really, really great to talk with you.

Episode duration: 31:50