Skip to content
Huberman LabHuberman Lab

Dr. Keith Humphreys on Huberman Lab: Why red wine harms more

Humphreys explains why alcohol cancer risk outweighs heart claims; addiction heritability, cannabis potency shifts, and behavior restructuring for recovery.

Dr. Keith HumphreysguestAndrew Hubermanhost
Jan 12, 20263h 27mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 3:22

    Keith Humphreys

    1. KH

      someone says, "I want to quit smoking," a, a good clinician will say, "Why, why would you want to do that?" Just say, "So tell me, w- why would you wanna-- what, what do you wanna get out of this? 'Cause it's work. I mean, I'm happy to work with you, but, you know, what, what is it? What are your, what are your motives?" And, and sort of helping them build up, you know, in their own mind, 'cause again, this is about them, not you, what do you get? And that's what the therapist does. The other thing that's really important is that, like any other-- any time you're making a behavior change, hang out with other people who are trying to make the same change. You want to start jogging? Join a jogging group. You want to stop drinking, I would, you know, suggest go, go check into an A- AA meeting or one of the other fellowships we have. Having other people on the same journey is good for us. It sh- I mean, everything shows that no matter what you're doing, I'm losing weight, I'm exercising, I'm more whatever, I'm quitting smoking, because it gives you two things: it gives you support, but it also gives you some accountability. Say, "Hey, you were going jogging, and, uh, on Tuesday you weren't there. What's up? Are, are you gonna be part of this group or not?" And that is, uh, helpful for people. [upbeat music]

    2. AH

      Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr Keith Humphreys. Dr Keith Humphreys is a professor of psychiatry and behavioral sciences at Stanford School of Medicine, and he is one of the world's foremost experts on addictive substances and behaviors and how to overcome addictions of all kinds. He is also an expert on how science, commercial marketing, lobbying, and the legal system interact to create what are called addiction for profit businesses. The alcohol, food, and opioid industries come to mind as just a few examples of these, and he's an expert on how all of that shapes things like legal policy. Today, we discuss all the major addictions to give you the most up-to-date information on alcohol, cannabis, opioids, gambling, and much more. Dr Humphreys gives us the unbiased facts, and more importantly, he explains how to think about the health risks of any substance or behavior in a logical way. For instance, while it may be true that a certain amount of alcohol could afford you some heart health benefits, we hear this, then we hear it's not true, it goes back and forth, he explains that any heart benefits that exist from alcohol are greatly offset by the increased cancer and other risks of alcohol. And with respect to cannabis, he explains who may be okay to use it, but who should absolutely not. We also discuss the most effective ways to get over any addiction. That includes alcohol, pornography, stimulants, and much more. As you'll soon see, Dr Keith Humphreys is no ordinary scientist or psychologist or addiction expert. He has the big picture on addiction and what it means to try and navigate life nowadays in an ocean of addiction-for-profit marketing and confusing health information. I assure you that today he doesn't tell you what to think or what to do about various substances and addictive behaviors, but rather how to think about them, and in doing so, how to avoid and overcome essentially any addiction. It's a powerful conversation that I'm certain will help millions of people make better decisions. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, today's episode does include sponsors. And now for my discussion with Dr Keith Humphreys.

  2. 3:22 – 9:14

    Addiction; Genetic Risk

    1. AH

      Dr Keith Humphreys, welcome.

    2. KH

      Good to meet you, Andrew.

    3. AH

      Addiction is a big topic, but I think for a lot of people, it gets slotted into one small drawer. Uh, but if we were to compare it to, say, mental illness, many, many things: depression, manic bipolar, OCD, and on and on. How do you parse this thing that we call addiction in thinking about how best to possibly treat addiction, especially when it comes to trying to treat addiction en masse at the level of policy, which we'll also talk about today? So, uh, put simply, how do you frame addiction, uh, and how should people think about it?

    4. KH

      Yeah, it's hard because it's a word, unlike, say s- you know, uh, maybe it's a little like schizophrenia, where people say like, "Oh, you know, he's a schizophrenic person," and what they actually mean is, you know, he's a person with different moods and that sort of thing. Addiction is even more like that. It's in common parlance. People say, you know, "I'm addicted to, you know, you know, uh, y- a TV show," or, "I'm addicted to my, my phone," or that sort of thing. But, you know, w- it's not just stuff you do a lot, uh, you know, which we sometimes c- you know, colloquially call addiction. It's the persistence of doing something that is harmful. So, like, the classic animal study, you know, is, you know, James's old study with rats done in the '50s, showing that you could give a, a rat, uh, uh, the opportunity to give itself brain stimulation, which they enjoy, and that they would continue to do that even as they were starving to death next to a, a pile of food pellets or, or run out of water while they were next to water. That is what it was. It's not the doing the things over and over or even being compulsive about things, it's doing them to the point of destruction, when you would normally, you know, any other behavior, you would think, well, you would just stop doing that, but people don't, and that's the sine qua non of addiction.

    5. AH

      I've tried to, uh, create a definition for addiction, which is that it's a progressive narrowing of the things that bring one pleasure, that it doesn't happen all at once. Like, someone doesn't take heroin once and then stop doing everything else. It's a-- tends to be progressive. I suppose it could be overnight. But, um, is that true? I'm happy to revise the definition.

    6. KH

      Yeah, no, that, that is true. So you see, um, the other types of rewards, particularly natural rewards, start to fall away from the person's life. So I'll sacrifice, you know, my relationship with my, my parents or my, my spouse or my friends. I will stop going to work when I, you know, which, uh, would normally, you know, generate the things I needed to, to eat, or I'll, I'll give up my housing for the sake of this substance. And then you become not only more physically dependent on it, but essentially you're psychologically dependent on it 'cause it's the one thing left that is still rewarding. Everything else has been stripped away, and that makes it easier to understand why people would still hang on to it in that situation when it feels like it's, "Look, it's the only time I feel good, is that, that moment when I take that hit."

    7. AH

      ... These days, there are a lot of industries that are, um, addiction for money-

    8. KH

      Yeah

    9. AH

      - basically, industries, and we're gonna talk about all of them. [chuckles]

    10. KH

      Yeah.

    11. AH

      Nicotine, alcohol, cannabis, social media, all of these. Um, but for the time being, eh, do you think that there is truly something to the, quote-unquote, "genetic bias" for becoming an addict? And is it very substance or behavior specific? Um, let's start with maybe alcohol-

    12. KH

      Yeah

    13. AH

      - for example.

    14. KH

      Yeah, that's a great question. So let, let me start by just, um, getting rid of one myth, where we say people are born addicted. You'll sometimes read, you, you know, uh, if, if Mom was addicted to fentanyl, then the baby is born addicted. That is not possible because, you know, a, a fetus has no association between their behavior and the exposure to the drug. So they can be physically dependent, meaning they'll go through withdrawal upon birth, but they're not, they're not addicted. But you can have risk from birth in your genes, and those, those shared est- uh, the estimation of, you know, how much of that is shared, it's actually quite a bit. You know, we look at studies where kids were adopted out of families with parents who, you know, were addicted to alcohol, much higher likelihood of developing an alcohol problem, even if they were raised by teetotalers, for ex- for example. How big is that? You know, it varies across, you know, studies, it varies across, uh, substances, but it's large. It might be, like, you know, .3, .4, .5, uh, for, for most of them. And, you know, you, you can imagine that the same genes, some might be specific, and some might be more general. So here's an example of a specific one. Um, if you are born into a group like Han Chinese are, and you lack the enzyme or don't have much of a particular enzyme that is used to metabolize alcohol, it is just a less enjoyable experience to drink. You know, you know, you can't break it down to acetaldehyde and acetic acid and all that sort of thing. And so that one is v- eh, but that would lower your risk for anything else, but at least specific for alcohol. But other genes for things like impulsivity, um, that, that would put you at risk for, you know, across substances. Being sensation-seeking, um, you're gonna try more drugs. That means it's more likely that, you know, you're going to get, uh, exposed to one. Another thing we see happening, which is really fascinating and poorly understood, I've, I, of course, know, doing what I do, lots of people are in recovery, and I've, uh, known people and had people in my studies who have been, say, clean and sober in their, you know, sense for 20 years, and then all of a sudden, they develop, like, a very strong sexual compulsion, or they gain 30 pounds 'cause they're just eating and eating and eating. And it's like, you know, the, the underlying diathesis, whatever it is, has found a new phenotypic expression, uh, 'cause it was never actually resolved. What was resolved was the particular set of behaviors that went with the addictions they had when they got into recovery.

  3. 9:14 – 18:03

    Alcohol Use Disorder & Alcoholism; Genetic Predisposition & Addiction Risk

    1. AH

      When it comes to alcohol, I've heard it said that there's a subset of people with, um, I guess nowadays, they call it alcohol use disorder. Can we just call it alcoholism today?

    2. KH

      Sure.

    3. AH

      Okay, sometimes people will lash back at me if I call s- uh, refer to someone as an alcoholic, but I have enough friends who are alcoholics, that joke is only on them, by the way, uh, who are recovered, so I can make the joke. Um, 'cause they're impressive recovery, uh, stories, and they all just say, "Just call it what it is, which is alcoholism." There's just so much splitting of names now. Are you- eh, I don't wanna put you in a position of saying something that's gonna offend anyone, whereas I, I-

    4. KH

      No, this is worth-

    5. AH

      - I can do that

    6. KH

      ... It's worth getting into. So use disorder is a much broader-spectrum thing. So, you know, when, when you, if you diagnose someone with alcohol use disorder, it can be mild, moderate, or severe, and the people at the mild end, everyone at AA would laugh at. You know, th- this is a person who occasionally drinks too much, has some harms, but basically, life is still put together. They would, you know, and people in AA would be like: "You, you gotta be kidding me, that's, that's your problem?" It's only when you get up to the severe end where we, we see the things, where it looks like addiction. So they aren't, they aren't actually the same thing, addiction and use disorder. Use disorder-

    7. AH

      Mm

    8. KH

      ... is broader. And it was, it was there to sort of, um, move alcohol like other health behaviors that you might start addressing, particularly in, like, primary care. So, you know, just like we would like, you know, doctors to intervene when someone is 15 pounds overweight and has moderate, uh, high blood pressure, so that they don't, you know, later, you know, develop a more serious problem, that was the idea. Well, let's have, you know, a lower severity problem that a doctor might, while the person still has a fair amount of control, advise you, "Hey, you know, if you could just cut back a bit now, you could avoid a lot of suffering later." That's where that came from, but I'm, I'm comfortable talking about addiction. It's a good word.

    9. AH

      Mm-hmm.

    10. KH

      It's scientifically meaningful.

    11. AH

      Mm-hmm.

    12. KH

      And it's something the public understands.

    13. AH

      Yeah, and if you go to an AA meeting, uh, eh, they go around the room saying, "I'm so-and-so, and I'm an alcoholic." They don't say, "I'm so-and-so, and I have alcohol use disorder."

    14. KH

      Oh, that's right.

    15. AH

      Um, so-

    16. KH

      Absolutely, yeah, yeah.

    17. AH

      So many people who have, uh, who are in recovery, um, define at some level of their identity, [chuckles] not their total identity-

    18. KH

      Right

    19. AH

      ... as an alcoholic. It's actually an important part of the 12-step recovery process, which we'll talk about. In any case, not to split hairs here, but, uh, I'm grateful that you're willing to embrace that nomenclature, and thanks for clarifying that, why it was split. Um, because sometimes these clinical, uh, and naming things are split, eh, because of, quote-unquote, "sensitivities." We don't want to offend, et cetera, and we don't want to offend. Okay, so alcohol, um, I've heard it said that there's a subset of people, somewhere around 8 to 10%, for whom they, they drink alcohol, and they experience it very differently. They experience it more as a, for lack of a better term, kind of a dopaminergic, a, you know, energising experience for, um, and this could relate to tolerance, but that they have a very different experience, subjectively, of alcohol than most everybody else, who can build up tolerance. Anyone can build up tolerance, um, and then it takes longer to get into the sedative effects, the depressive effects of alcohol. But-... I've heard it said that this eight to 10% are particularly susceptible to becoming alcoholics because they drink, and they feel spectacularly good, and they can keep drinking in a way that many other people either pass out, black out, crash their car, end up in jail, or dead. And so in some sense, this eight to 10% may be at greater risk-

    20. KH

      Yes

    21. AH

      ... than everyone else.

    22. KH

      Yeah, so, uh, Mark Schuckit, who's a s- superb psychiatrist, was based in, in Southern California for most of his career, did some wonderful studies of male, uh, children of, uh, alcoholic fathers. And one of the things he showed is that when given alcohol, their body sway is less at an alm- at a level you can't even perceive, but he could measure that, you know, with [crosstalk]

    23. AH

      Body sway?

    24. KH

      Yeah, like how much they moved, like how, how hard the alcohol hit them.

    25. AH

      Mm-hmm.

    26. KH

      And they had, uh, fewer hangovers the next day.

    27. AH

      Mm-hmm.

    28. KH

      And then you might think, "Well, that's great. It doesn't hit you that hard, but, you know, you can drink a lot," and like, no, that's the problem because someone else would get the signal of like, "Whoa, I, I, you know, I'm, I'm feeling kinda dizzy here. I must have had too much to drink," or the next morning, they get up and go, "Oh, God, I'm never doing that again." They don't get that signal. It's, you know, less, less punishing, more rewarding, and you see that across drugs. Uh, and this is almost surely genetic, um, how much people like different drugs, you know, varies enormously. I, I, I, I'll be personal about this, so I, uh, you know, uh, had an injury. Uh, I broke my ulna, and, you know, I, I had to take, uh, Vicodin for the pain afterwards. I find taking opioids so unpleasant. I feel bound up, you know, miserable, groggy, that I just took one and said, "Pain is better than this." I have worked with people, clinically, who say, "The first time I had an opioid, it was like a hole in my chest that had been there my whole life filled up for the very first time." That has everything to do with genes. There's no wa- it's not due to... There's no learning history there, right? But there's something, you know, I'm just wired differently for that particular drug than people who get in trouble, uh, with it is, and these don't necessarily go in groups, so someone can, you know, hate opioids, but, you know, love cannabis or love alcohol. Um, and that, of course, is going to change their, their risk. How could it not?

    29. AH

      This is such an important point, and I didn't realize that it extended to things outside of alcohol, uh, because oftentimes, when a discussion starts to surface about addiction and whether or not zero is better than any, whether or not things can be done in moderation, I think this is actually a big, um, unspoken point of friction. Because some people really can drink five or six drinks-

    30. KH

      Oh, yeah

  4. 18:03 – 20:37

    Sponsors: David & BetterHelp

    1. KH

      it's really irrelevant.

    2. AH

      ... I'd like to take a quick break and acknowledge one of our sponsors, David. David makes a protein bar unlike any other. It has 28 grams of protein, only 150 calories, and zero grams of sugar. That's right, 28 grams of protein, and 75% of its calories come from protein. That's 50% higher than the next closest protein bar. These bars from David also taste amazing. Right now, my favorite flavor is the new cinnamon roll flavor, but I also like the chocolate chip cookie dough flavor, and I also like the salted peanut butter flavor. Basically, I like all the flavors. They're all delicious. Also, big news, David bars are now back in stock. They were sold out for several months because they are that popular, but they are now back in stock. By eating a David bar, I'm able to get 28 grams of protein in the calories of a snack, which makes it very easy for me to meet my protein goals of one gram of protein per pound of body weight per day, and to do so without eating excess calories. I generally eat a David bar most afternoons, and I always keep them with me when I'm away from home or traveling, because they're incredibly convenient to get enough protein. As I mentioned, they're incredibly delicious, and given that 28 grams of protein, they're pretty filling for just 150 calories, so they're great between meals as well. If you'd like to try David, you can go to davidprotein.com/huberman. Again, that's davidprotein.com/huberman. Today's episode is also brought to us by BetterHelp. BetterHelp offers professional therapy with a licensed therapist carried out entirely online. I've been doing therapy for many years now, and I can tell you that it's a lot like physical workouts. There are days when I want to do it, and there are days when I don't want to do it, but every time I finish a therapy session, I come away feeling much better and knowing that the time was very well spent. Typically, when I finish a therapy session, I come away with at least one valuable insight or perspective on something that I'm working through, whether that's with work, relationships, or my personal life, or just simply my relationship to myself. There's just so much benefit that comes through effective therapy, and with BetterHelp, they make it very easy to find an expert therapist who can provide you with the benefits that come from effective therapy. With over 30,000 therapists, BetterHelp is one of the world's largest online therapy platforms, having served over five million people globally. And it works, with an average rating of 4.9 out of five for a live session, based on over 1.7 million client reviews. Also, because BetterHelp is done entirely online, it's extremely time efficient. There's no driving to a therapist's office, looking for parking, et cetera. If you'd like to try BetterHelp, you can go to betterhelp.com/huberman to get 10% off your first month. Again, that's betterhelp.com/huberman.

  5. 20:37 – 23:36

    Women & Alcohol Use; Young Adults; Cannabis Use

    1. AH

      Women are drinking more or less now?

    2. KH

      Women, unfortunately, um, you know, in the r- late '90s, early aughts, the alcohol industry figured out that, uh, women had more money, and but they weren't drinking the way men were. So they, uh, engaged in a long-term campaign to try to increase women's drinking. So things like, you know, mommy, mommy wine juice, and those wine- wine, uh, mommy wine chats online and all that, that was really engineered by them. Even some of the ones that look organic online were engineered by the industry, and it worked. Women's drinking went up a lot, um, and the damage per drink is more for women for most things than it is for men, for partly due to body size, but also partly probably due to some hor- hormonal things. And so it's been, you know, a exploitation, as I see it, you know, o- of women, and I notice a lot of young women now, like undergraduates I talk to, re-evaluating that. Like, looking at their mom's experience and saying, "You know, I don't think I wanna do that," and I, I, and I'm, I'm really encouraged by that. I- not, not that I want to control, you know, the decisions w- women make, but I don't want them making them just because the industry slickly marketed to them, um, because the industry's sole interest is always gonna be to generate profit, and you do that with addiction. Because, you know, something like, what, 10% of our country drinks about half the alcohol? So you h- yeah, you're shocked. Yeah-

    3. AH

      10% of the country drinks half the alcohol?

    4. KH

      ... drinks half the alcohol. Right, United States. So if you're running the industry, you want that group to be as big as possible. You do not make money off people who have a, you know, half a bottle of wine on special occasions. You make your money on the people who drink, drink the equivalent of multiple bottles of wine every single day. So you have a... Fundamentally, these industries, the more addiction there is, the, the better off they do financially.

    5. AH

      Wow, there's a lot there. The statistics say that drinking is at an all-time low in the United States right now, at least the-

    6. KH

      Some statist- yeah, yeah.

    7. AH

      Some statistics.

    8. KH

      So something seems to have changed, and th-

    9. AH

      Mm-hmm

    10. KH

      ... and this may have something to do with this new generation.

    11. AH

      Mm-hmm.

    12. KH

      I mean, there, there's less risk behavior in lots of things on, you know, over the last 10 years, so, uh, you know, less, uh, you know, cutting class, less, uh, less chance of, uh, uh, dropping out of high school, uh, fewer unwanted pregnancies, all that stuff. So there is- th- that generation will probably be a drier generation than their parents were.

    13. AH

      Is cannabis use higher in that group? Everyone likes to just default to, "Well, cannabis is up, so alcohol is down," implying that you have to do something, that people have to be using some sort of mind-altering substance.

    14. KH

      Yeah. With the legalization of cannabis, um, we certainly have seen a lot more use and a lot stronger products, but youth use really has only changed pretty slightly.

    15. AH

      Mm-hmm.

    16. KH

      So the growth has really been among adults, including adults who probably stopped at some point and have now gone back in later life to, uh, using cannabis.

  6. 23:36 – 31:47

    Health Benefit to Alcohol?, Red Wine, Cancer Risk; Social Pressure

    1. AH

      We'll get back to cannabis, but I wanna, um, parse the alcohol stats a bit more, also as it relates to, uh, to women. Maybe we can just either put to rest or not this argument that some amount of alcohol, typically it's red wine, is couched this way, is more beneficial for you than not drinking at all. My read of the data, and we covered this in a long episode on alcohol a few years ago, was that zero is better than any, and that two per week, two drinks per week, and that's getting very specific about ounces for, you know, spirits versus a... Two dr- f- per week-... it's sort of the upper limit for adult non-alcoholics that, um, don't want to incur any additional health risk. Um, the cancer risk, very clear. The, uh, disruption to sleep, which probably cascades into other things, inflammation, et cetera. But is zero better than any? Is two safe for non-alcoholic adults? Because every week it seems, I see a new article that says, "Zero is better than any. No, wait, it turns out there's some benefit from two drinks per week [chuckles] ." And I'm getting, frankly, I'm not tired of it, but it's almost getting funny-

    2. KH

      Yeah

    3. AH

      ... the extent to which the, uh, it's traditional media, not to poke on them, but they just keep flip-flopping. And then the questions that always come up are, well, did the alcohol industry sort of encourage this study? Because if we're honest, there's a lot of advertising of alcohol in traditional media outlets.

    4. KH

      Oh, absolutely. So, uh, statement against interest, because I like red wine, I would love to believe it is healthy. [chuckles] It's not. Uh, and the whole thing about red wine per se, by the way, was it never made any sense. W- like, why would there be a benefit to red wine that wasn't, you know, in other alcoholic beverages, right? And it came from a 60 Minute story, I think it was in the '90s, it was about why do French people, why do, why do Mediterraneans live so long? It's the red wine. Red wine sales exploded! You know, you know, this is so great.

    5. AH

      Resveratrol was an argument.

    6. KH

      Yes, that's right.

    7. AH

      Yeah.

    8. KH

      You know, there's such trace amounts that are just, like, ludicrous, you know, in a grape skin. Um, and so that was just spread, and it was just so great for the industry. It's better for you than not drinking. Um, and you know, that's just not true. Uh, you know, it's, it's, um, when you look at peop- they would look at studies and say, "Well, look, you know, the, the n- the non-drinking group have higher mortality than the low-drinking group." And the, the, the famous, they call it the J-shaped curve, you know, like that. The problem is, non-drinkers include people who are, like, in Alcoholics Anonymous. That's why they don't drink. They had a, you know, a wretched experience with alcohol. And so, um, you know, they had, they've had different kinds of damage to their bodies, maybe their health is, isn't as good, they're not gonna live as long. But it's not that they would be better off if they went back to drinking. They would- things would, would go to hell, basically, for them. And, uh, that just got, you know, marketed and, and, and spread, and it, and it's not true. There might be some cardiac benefit, okay? But you know, we don't, we don't get to, you know, live our lives as single organs. We have a whole body. You have to weigh that, if that is true, and it is wobbly, but if that's true, it's smaller than the cancer risk. So your net is you're not gonna get any mortality gain from, uh, or mortality reduction from drinking alcohol. If you have two drinks a week, and by a drink, I mean, like, a 12-ounce beer, uh, a, a one-ounce shot, or a, uh, a glass of wine, a four-ounce glass of wine, you, you have slightly higher risk, but it is very, very, very small. And, you know, it's not the kind of thing, if I w- you know, if, if I were giving health advice to the country, that would not be on my top 10 things to be, you know, really frightened about. I think it's, it's very small. It's just not good for you. That's what science has overturned, the industry message, that this is, will extend your life and you'll be more healthy if you drink than if you don't. There's n- there's no way we can establish that as being true.

    9. AH

      You said it very clearly, but I'm going to, um, just repeat it, because I think it's super important for people to take note of, that the cardiac benefit is less than the cancer risk, and I think that's a very important way to view these stats. The episode that we did about alcohol, um, had a lot of different responses. Uh, there's obviously a s- selection bias in the responses, but many people gave up drinking, who I later learned wanted to quit drinking. They didn't like it. The downstream effects of the disruption to sleep from alcohol and so on, probably part of the effect. Um, it was very interesting as it relates to women because, um, many people, including some members of my family, really like their post-work glass of wine or want a drink to just kind of mark an end to the day and, and relax. Um, my observation was that many women who stopped drinking, either because of that discussion about alcohol or others that they had heard, did so when they learned that women have a particular risk to cancer as it relates to alcohol. Meaning if the breast cancer risk and other hormone, um-

    10. KH

      Ovarian cancer

    11. AH

      ... and ovarian, hormone-related cancers and so forth, not always hormone-related. But the moment it mo- that the "it's probably best to avoid alcohol entirely" conversation moved into women's specific health, it had a, a very potent impact, uh, which is interesting in its own right.

    12. KH

      Mm-hmm.

    13. AH

      Um, and it speaks to what's perhaps required to override some of the marketing because, let's be fair, it's nice to relax with friends, and if people think relaxing with friends is easier to do over a glass of wine or two, then that's a great, not just marketing scheme, it's also somewhat true for them until there's counter-evidence. And so what I'm really getting at here is, you know, how is it that people should frame what they know to be risky versus the other benefits of alcohol that clearly exist? Like, helps people relax, um, it's social, they stress less-

    14. KH

      Mm-hmm

    15. AH

      ... and so on and so forth.

    16. KH

      You know, as I mentioned, I'm someone who drinks wine, and I know that it is, you know, on, on average, you know, it's not healthy. Um, why do I do that? It's like, well, because it creates other things, particularly with ex- exactly that situation. That, you know, uh, getting together with friends is enjoyable, uh, enriching. Good food is enriching. Good food and a, and a, and a good wine tastes good, uh, and I value those things. And there are many other decisions we make like that, where we endure some risk because, uh, we care about something else. You know, it's, it's dangerous to, you know, for, for someone my age to, you know, hike up a mountainside, probably. Um, but, uh, if, if the view is spectacular, I can, I say, "Oh, I'm gonna accept that risk, and maybe I'm more prone to twist my ankle or something, but this is just really beautiful." That, that's okay. I think, I think what the p-... place we got in alcohol that was bad, was needing an explanation to stop. So how often have you ever said to someone at a party, or seen someone say at a party, "Why are you drinking?" I've never heard that, but I've certainly heard a million times, "Why aren't you drinking?"

    17. AH

      If you don't drink at parties, or you refuse an offer of alcohol, people think there's something wrong with you.

    18. KH

      Yeah, and you have, so you have to have an explanation. Like, I, "Well, I, I got a, a exam tomorrow morning," or, uh, "I've got a cold," or, or, or something. It's like, you shouldn't need an explanation. Um, but people do feel, feel that social pressure, and so that's one way health information can work. Why didn't the person just quit beforehand? 'Cause they may not have had an explanation that worked in their, uh, their circle, and now you can say, "Well, you know, I'm s- I see the, those data on, uh, you know, ovarian cancer, and, uh, you know, I just I, I decided to quit drinking." Um, and, you know, that is... You know, health is a reason people still accept, I think, as a, a, a legitimate for changing behavior. You can make that, you know, 'cause, you know, cancer is scary. And that may be why, uh, people quit. Um, you know, same thing happened when, you know, first surgeon general smoking, uh, thing came out. Everybody smoked. You had to, to, to sort of fit in at work, you had to smoke. And when that came out, there were a lot of people who just quit immediately. They clearly were capable of quitting, wanted to quit, but they needed some ex- to tell everybody, "Why are you not smoking anymore? Why can't, why don't you carry cigarettes anymore? I can't bum one

  7. 31:47 – 37:41

    Alcohol in Social Gatherings, Social Anxiety, Vulnerability, Work & Dates

    1. KH

      off you anymore." It's like, "That, that's why."

    2. AH

      Why do you think people who drink, uh, feel uncomfortable about people not drinking around them? When people would ask me, uh, if I wanted to drink, and I'd say, "No," and they'd say, "Why?"

    3. KH

      Yeah.

    4. AH

      They often say that. I would say, uh, the truth, which is, "I'll say anything that's on my mind without drinking."

    5. KH

      Mm-hmm.

    6. AH

      "You don't want me to drink, 'cause then I'll tell you everything that's on my mind."

    7. KH

      Oh, [chuckles] that's good.

    8. AH

      You know, it's true. I, I mean, like, I, I will tell people what I'm thinking. Uh, I don't need to, like, loosen up.

    9. KH

      Mm-hmm.

    10. AH

      I'm pretty relaxed in social settings. I don't have much social anxiety, but I realize some people might have-

    11. KH

      Yeah

    12. AH

      ... trouble with social anxiety.

    13. KH

      Yeah. You know, I, I, I spent a little time in Japan when I was a young man, and there's this, you know, culture of getting, going out after work, like the salarymen going to work, and, and someone getting really, really drunk, and everyone's drinking, and you're vulnerable with each other. And you, and then, you know, that, that I will, I will... It's like a trust exercise-

    14. AH

      Mm

    15. KH

      ... like that falling backwards thing, except it is that we're all drunk. And if someone weren't doing it, it's like, "Why, why are you not undergoing any... What, you're, so we're all gonna be vulnerable-

    16. AH

      Mm

    17. KH

      ... and you're not?" You know, like, "Are you gonna exploit us in some way? Or I'm gonna say, you know, I think I hate the boss, and then you're gonna repeat that at work, 'cause, you know, you're, you're, you're [chuckles] the one person sober enough to remember I said that?" I think that is a real thing, that-

    18. AH

      Mm

    19. KH

      ... that people have anxiety about. Or I can imagine, you say, what, what if, uh, you know, a, uh, a man and woman are on a date, and the guy keeps giving drinks to the woman and doesn't drink himself? Like, you know, what is the natural thing to think, "Are you trying to get me drunk? Are you gonna take advantage of me, because you, you know, you're gonna be with it, and I'm not, 'cause I'm gonna be drunk?" So, so those kinds of fears may be i- in the soup. Um, but I d- I don't think, you know, so like say maybe that's, you know, rational at some level, but I don't think that should drive our sort of routine social interaction with our friends. It should just be a non-issue, you know-

    20. AH

      Mm

    21. KH

      ... of what do you want, and if he goes, "I want sparkling water," I just give you a glass of sparkling water and don't say, "Why haven't you, why aren't you drinking this intoxicating beverage?" You know, you shouldn't need to explain it to me.

    22. AH

      The trust piece is super interesting, so is the vulnerability piece. Um, a couple thoughts about this, and they're just editorial thoughts, so, uh, forgive me. But one is, for years, I thought how crazy it was, I would go to these meetings with doctors and scientists who ostensibly were working on issues related to health, and everyone would just get trashed at the bar.

    23. KH

      [chuckles]

    24. AH

      And I wasn't into that. Um, and I wasn't judgmental. I actually kind of liked it, 'cause by the third day of the meeting, I'm cranking, and they're all just... I can tell they're all just bleary, and they-

    25. KH

      [laughs]

    26. AH

      ... and they're also aging much faster than I am. They, they, they would get what, you know, the tenured look, as we would call it-

    27. KH

      Uh-huh

    28. AH

      ... or as I would call it. Like, you see them in five years, I'm like, "What happened to you? You aged 15 years." And, and I- these people tended to drink a lot, both at meetings and outside meetings. Alcohol was paid for often by the meeting fees. This gets a little... I'm not trying to, you know, point a finger here. And then a lot of the stuff that happened at meetings that turned out cost people jobs was always alcohol-related.

    29. KH

      Yeah.

    30. AH

      In the instance of the, the man and woman on a date drinking, or a group of, uh, people at work drinking together, in Japan, it sounded like it was men getting drunk with other men.

  8. 37:41 – 44:38

    Old vs New Cannabis & THC Levels; Smoked vs Edible Forms

    1. AH

      is, like, the, the purpose here. Let's talk about cannabis a bit, uh, because eventually I'd like to weave back to how industries impact use and abuse. Um, cannabis, when I was growing up, was illegal. You'd go to jail for it.

    2. KH

      Mm-hmm.

    3. AH

      People still smoked pot. It happened. Um, the idea was that it was much less potent. We can talk about that. But now it's a whole industry.

    4. KH

      Yes.

    5. AH

      And the edible industry has contributed to this greatly because it bypasses the, um, the s- blowing of smoke, um, the, the smell, um, and a number of other things. So what are your thoughts about cannabis as something that can be used, quote, unquote, "recreationally, medicinally," and its potential for abuse? And then let's talk about how those things have been amplified or reduced by the fact that it's essentially legal or decriminalized. So what are your thoughts on cannabis?

    6. KH

      Yeah, so I, whenever I talk about it, I, I make a distinction between sort of old and new cannabis. So, you know, if you go back to the '80s and '90s, uh, when, as you mentioned, it was illegal everywhere, the THC content, that's the principal intoxicant, would be, you know, three, four, five percent, something like that-

    7. AH

      Mm-hmm

    8. KH

      ... on average. And now, you know, studies of legal sales show the average product is about twenty percent. That's dramatically stronger. The other point is how people use it is different, perhaps related to that high potency. Uh, Jonathan Calkins, uh, pulled together a lot of really interesting data that got a lot of play, and it showed that f- about forty, I think it's forty-two percent of people who use cannabis use it every day or almost every day. That is also different. So back, if you go back in the past, you know, the more modal user might have been once or twice a week. So you put those things together, some- so you take somebody, you know, and they... Well, what was like a, an '80s pot smoker? "Well, on weekends, you know, I'd smoke a joint at, you know, five percent." But now, if it's means every day I'm consuming twenty percent, you quickly realize, like, their brain exposure is dramatically higher, about sixty-five times higher, uh, between the modes of those two, two, uh, experiences. And what, you know, what, so what does sixty-five times mean? Well, t- it coincidentally is also the potency difference between a coca leaf and cocaine. That is s- that is sixty-five times, too. So it's a big difference-

    9. AH

      Mm-hmm

    10. KH

      ... and as you know, you know, you know, dose makes the poison. So, so it is a, just a really different drug than what was back there, and this is very hard to get across to parents because their view is, like, "Ah, I s- I smoked weed, you know, it's, it is, you know, who cares if my, you know, fifteen-year-old is using it?" It's like, but that's kind of saying, "You drank low-alcohol beer, and you're not, you're, you're, you're not concerned that your fifteen-year-old is guzzling vodka." That's, that's kind of the difference, and it's just a bigger deal than it used to be. Even when you take away the fact that you have an industry really pushing it, just the drug is stronger, more addictive. Does it have any, uh, medical applications? Almost surely. You know, the cannabinoid receptor system, evolutionarily, is, you know, one of the oldest in the, the, uh, in the history of Homo sapiens. It is both in the brain, but it's also in the body. There are clearly gonna be some applications for pain. Um, you know, w- you know, there's-- many people would say they spontaneously get relief. It's hard to tell always what that means, uh, because sometimes that's just relief from withdrawal. But, but, you know, probably some, some type of medical applications for pain will come out of this plant. We do have some out of the CBD, which is the, uh, non-intoxicating part, uh, as a medication that is used, uh, in seizure disorders in kids, you know, so there'll, there'll be some other things like that, for sure. Um, and, you know, you know, the, it's easier to study this than it has ever been before. Um, you know, the, um, about twenty twenty, Congress changed the way, uh, research works, so it's a lot, a lot simpler to, to, uh, do it. So we'll, we'll, we'll figure those things out. Um, but it is just a, a more, a more dangerous drug than it was, you know, when I was a young person.

    11. AH

      I had a guest on the podcast, uh, who's a cannabis researcher a- runs an animal lab. Um, and we invited him on because I had released a solo episode about cannabis, where I touched on some of the risk for psychosis-

    12. KH

      Yeah

    13. AH

      ... in, uh, young men, um, and made some points about, frankly, concerns about cannabis because of the high THC content. Uh, he was not happy with the things I said. He made that clear on social media, so, um... By the way, this isn't the way to get invited on the podcast, but we invited him on- [chuckles] ... and, uh, I, I think we had a very fruitful discussion-

    14. KH

      Okay

    15. AH

      ... where he clarified a few things for me, and one of the things that he claims, uh, is that-... despite the higher THC content, that there's a distinct difference between smoked versus edible cannabis, whereby people who smoke cannabis, even the high THC cannabis, um, are very good at gauging the kind of w- level of high so that they don't go into paranoid modes. They don't surpass the, the plane of high that would make them feel paranoid or, um, put them into a psychotic episode. But that people who take edibles, because it's harder to gauge where you're at, if you can just swallow an edible or even nibble on an edible, [chuckles] um, often surpass the level at which they would be comfortable, meaning at which there's a psychotic episode or there's paranoia. So he was making this kind of, um, soft argument for the fact that the elevated T- THC levels in cannabis are not such a problem because people are essentially taking less to offset the, the difference.

    16. KH

      Yeah, I think there's no evidence for that at all. In fa- and, and, uh, people are surprisingly bad, even experienced pot smokers, at judging in lab studies of, like, how strong different cannabis is. I don't agree with that part, but I do agree we should think about the edibles differently because of the onset is different through the gut. You know, so when you smoke anything, you know, you get that, that goes very efficiently, you know, to the brain. But when you eat something, you know, it takes a while, you know-

    17. AH

      Mm

    18. KH

      ... to have its effect. And so particularly when these products came out and a lot of people were n- uh, new to them, they would, uh, you know, bite down on, you know, one piece of the, whatever, the bar, the cookie, or whatever. "Five minutes later, I feel the same," take another bite, "Still feel the same," s- and then just eat the whole thing, and then it would all hit them like, like a train. And, you know, that, that does happen. The other thing that is true is that a lot of these, uh, products are not well made, or they're not up to, like, the standards of, like, you would have a cookie. You would, you would never open up a bag of, uh, chocolate chip cookies in the United States and find all the chocolate chips at one end and just dough in the rest, but that does happen i- with, uh, cannabis products in legal markets. And so if you just bite on the wrong part, you're getting the, you know, the whole enchilada, so to speak, um, it, that... Because it's not evenly blended through, and there are some people who've gotten to, gotten into trouble, uh,

  9. 44:38 – 52:29

    Cannabis & Psychosis Risk; Cardiac Health; Youth Cannabis Use & Transition to Adulthood

    1. KH

      on that as well.

    2. AH

      Interesting. What about the psychosis risk?

    3. KH

      Yeah, so I was very skeptical of this literature for years. Not, not to say that the science was bad, but just, like, it seemed to me there'd be lots of ways to explain it. Um, and I'm a lot less skeptical now, candidly, because, you know, in the, in the, in the old studies, they would be... Those were men who had used cannabis in, in teen years, and then they would have higher rates of, of, uh, psychotic disorders in adulthood. These were studies based on, like, Swedish, uh, registries, 'cause everybody has to register for the, uh, the, uh, military, you know. Um, and, um, they would track people, and it, it's a quite amazing data. So they, it is a whole national data, that's good, but there's lots of reasons that could come about. You know, could be a common factor between those two things. Um, you know, but, um, the evidence has gotten stronger, [chuckles] a- as the drug has gotten stronger, and again, we've gotta, gotta realize people are using it, um, much more intensely. So if this effect is there, it's much more plausible that it would be from a much stronger drug used, you know, every day, could generate higher rates of psychosis. It's hard to test this 'cause it's a rare, thankfully, condition, but I think there is, you know, probably something there, I'm sad to say. I wish it, I wish there weren't, but there probably is something there. Um, I would not use cannabis if I had any first-degree relatives with any, you know, schizophrenia, schizo personality, anything in the psychi- bipolar disorder. I would not personally, uh, recommend that, uh, for anybody. I think that's probably, uh, probably quite risky.

    4. AH

      What about the cardiac risk and other health risks? I've heard recently that there's a direct risk of cannabis, even if it's not smoked or vaped, uh, on cardiac health.

    5. KH

      I'm not sure of that, of non-smoked cannabis in the heart. I mean, I'm, look, I haven't looked at that literature, so I don't, I don't know the answer to that. Um, I realize there's some... One point, uh, I should touch on that you also raised earlier about, uh, first drinking, which is everything is different when the brain is plastic, and our brains are most highly plastic, um, you know, when we're young. And so a lot of these effects, the worst things are gonna be because people start when they're in teen or, you know, late, late single, single digit. That's where addictions overwhelmingly start, and that is where, if there is a, a, a psychotic risk, it's almost surely then, during that period of brain development, before people get their first psychotic break, which tends to be around 18, 19, uh, 20, 21. Uh, I'd worry about it less for anything, you know, initiating a substance when you're 50 is far less likely to end you up with an addiction or some other terrible thing than, uh, when you're young.

    6. AH

      I'm sure everyone knows at least one person or, or has heard of one person who's, uh, very productive in their life, healthy family, job, et cetera, um, high energy, who uses cannabis. Um, in my observation, they are the rare exception. Um, and there are a lot of examples of people who use cannabis who, um, don't really go anywhere in life. They, they don't go through the normal developmental progression of finding a job that can sustain them, right? Of organizing their life, their relationship life, their professional life, and, uh, clearly, there are other aspects to life, but those are key ones, [chuckles] uh, right? And, um, what are the data on high THC or just frequency of cannabis use as it relates to life progression, failure to launch, we call it now-

    7. KH

      Yeah

    8. AH

      ... for, typically, it's guys that, young men that fail to launch, um-... Yeah, and I wanna be clear, uh, not for political reasons, but I wanna be clear. When I say fail to launch, I don't mean that every kid has to go to college and, you know, be a, you know, a varsity athlete or any of this, but just moving out of one's home eventually, getting a regular job, keeping the job, hopefully having healthy relationships of various kinds, and being self-sustaining. That's what I'm talking about.

    9. SP

      Yeah, absolutely true. I mean, uh, for example, I w- I, uh, did Ezra Klein's show. He's obviously a very successful guy, and he mentioned that he sometimes uses cannabis edibles. I mean-

    10. AH

      He has that look. No, I'm just kidding. [laughing]

    11. SP

      Yeah, yeah.

    12. AH

      Sorry, Ezra, just teasing.

    13. SP

      Yeah, yeah.

    14. AH

      Yeah.

    15. SP

      I mean, so, you know, there's-- and, you know, you could-- there are very, very, very successful people who use cannabis, for sure. Overall, though, I mean, uh, I'll, I'll steal a phrase from Jonathan Calkins: it's like, you know, we have performance enhancement drugs. It's kind of a performance-degrading drug. So it's not, it's not fentanyl. You know, your, your, your odds of your death being directly tra- traced to it are extraordinarily low. But it does, with regular use, undermine certain things that you need to succeed in the modern world, like short-term memory and concentration and being able to keep track of details, and for some people, also, it, it undermines their sort of motivation to do much of anything. I mean, the couch lock is a real thing. Um, you know, I, I know families in Palo Alto, where I'm from, a very achievey place, who had straight A, uh, you know, a straight A son, you know, doing everything, starring on a sports team, whatever, who, you know, six months later, was just smoking cannabis all day and had no interest in the team he used to star on and the math he used to be great on, and, like, that's, that's pretty frightening. And all those things are not conducive to succeeding in, in, again, in a modern world. If maybe back in an agrarian society, it didn't matter 'cause we, you know, everything was on muscle power, right? Um, but, you know, to succeed in, in this society, you have to be able to do those things, and, and you, you are in competition. You know, if you want a job, you know, computer coding, you're, you're in competition not just with the smartest kids in your neighborhood, you're in competition with the smartest kids who are in Mumbai, you know, and, and in Tokyo, and if you can't focus or you're just slower and you can't remember things, um, or you have trouble, like, making sure you, uh, keep track of time, um, that is gonna put you at a disadvantage, uh, and, and, uh, you can end up at this, that stereotype of, you know, living in mom's basement. That, unfortunately, is true of a, a chunk of people who are heavy users of cannabis.

    16. AH

      Yeah, I worry a lot about examples of so-and-so is very high-achieving, and they use cannabis. Um, I had a friend growing up who desperately wanted to be a professional golf player, and he would cite all these professional golf players who were heavy drinkers. He ended up just being good at the heavy drinking [chuckles] part.

    17. SP

      Yeah.

    18. AH

      Um, sadly. Um, I think he turned his life around at some point, but these examples of people who can use very addictive substances and are open about that and are very high-achieving, I think there's a, there's a real detriment to that messaging. Now, of course, you don't want people to cloak their reality, but it's, it's complicated.

    19. SP

      Yeah, and, and it also has policy risks, too. I mean, you know, when, when you make up the rules, uh, you know, and, you know, your laws and regulations to, to think, "Well, you know, I'm, I'm accomplished. I, I'm able to use this, so that must mean it's pretty safe," it's like that just doesn't follow, uh, logically. The fact that you occasionally, you know, take a snort of cocaine or whatever and, and you're still a state senator, uh, that doesn't prove that that would be safe for everyone. And, you know, we, the, we know people have different levels of risk, they have different social capital, they have different incentives in their lives, and, um, you, you can't overgeneralize from a sort of a lucky life or a costed life. Sometimes you can do more of that than you can when, you know, there's not many, uh, you know, uh, nets sort of between the person and the,

  10. 52:29 – 54:13

    Sponsor: AG1

    1. SP

      you know, and the ground. By now, I'm sure that many of you have heard me say that I've been taking AG1 for more than a decade, and indeed, that's true. The reason I started taking AG1 way back in 2012, and the reason why I still continue to take it every single day, is because AG1 is, to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the market. What that means is that it contains not just vitamins and minerals, but also probiotics, prebiotics, and adaptogens to cover any gaps that you might have in your diet, while also providing support for a demanding life. Given the probiotics and prebiotics in AG1, it also helps support a healthy gut microbiome. The gut microbiome consists of trillions of little microorganisms that line your digestive tract and impact things such as your immune status, your metabolic health, your hormone health, and much more. Taking AG1 consistently helps my digestion, keeps my immune system strong, and it ensures that my mood and mental focus are always at their best. AG1 is now available in three new flavors: berry, citrus, and tropical. And while I've always loved the AG1 original flavor, especially with a bit of lemon juice added, I'm really enjoying the new berry flavor in particular. It tastes great, but then again, I do love all the flavors. If you'd like to try AG1 and try these new flavors, you can go to drinkag1.com/huberman to claim a special offer. Right now, AG1 is giving away six free sample packs of AGZ, which is AG1's new sleep formula, which, by the way, is fantastic. It's the only sleep supplement I take. It eliminates the need for all these pills, and my sleep has never been better. The special offer gives you six free samples of that AGZ, as well as three AG1 travel packs and a bottle of vitamin D3K2 with your first subscription. Just go to drinkag1.com/huberman

  11. 54:13 – 1:05:28

    Industries of Addiction, Regulation; Gambling, Slot Machines, Novelty; Casinos

    1. SP

      to get started. I heard a wonderful talk that, uh, you participated in, um, [lip smack] with, uh, one of the members of the Kennedy family. It wasn't Robert-

    2. AH

      Patrick?

    3. SP

      ... Patrick Kennedy-

    4. AH

      Yeah

    5. SP

      ... excuse me, who's been very open about his own recovery.

    6. AH

      Yeah.

    7. SP

      So many gems in that talk. We'll put a link to it, and we'll touch on some of those things again, but just, it's such an important conversation. Um, and, you know-

    8. AH

      ... it came up in that discussion that many industries are industries of addiction: alcohol, cannabis, gambling. Nowadays, I was thinking about what you guys were talking about, and nowadays, it's very difficult to look at any industry and not see it that way at some level.

    9. KH

      They talk about it themselves that way.

    10. AH

      Mm-hmm.

    11. KH

      You know, they, they'll, if you get together with app developers, they'll say, "How do we make this more addictive?" You know, so it's, it's-- and it, and it is good for business. There is no customer like an addicted customer, so of course, that's gonna be appealing if you're trying to sell something.

    12. AH

      I guess the question is, healthy addictions or adaptive addictions are things that fall outside the progressive narrowing of the things that bring you pleasure. Because a kid getting, quote, unquote, "addicted to a learning app," uh, that carries over into a number of things, one hopes, um-

    13. KH

      Oh, yeah, yeah

    14. AH

      ... in school and, uh, or even social media. I've learned a lot from YouTube videos. He- heck, I even watched that YouTube video of you and Patrick, uh, [chuckles] you know, uh-

    15. KH

      Yeah

    16. AH

      ... uh, on YouTube. So there's this double-edged blade piece, uh, but when it comes to alcohol and cannabis, what you told us earlier, like, getting women to drink more by making it seem like an important part of being a woman in the United States- [chuckles]

    17. KH

      Mm-hmm

    18. AH

      ... to drink.

    19. KH

      Yeah.

    20. AH

      That sounds diabolical.

    21. KH

      Yeah.

    22. AH

      Convincing people that cannabis is gonna make them more creative, and it's not as bad as alcohol, that, to me, is very diabolical, and I, and I worry about this, "Well, it's not as bad as alcohol" argument because, I mean, shooting yourself in the head is way worse than stabbing yourself in the head.

    23. KH

      Well, alcohol also kills, you know, about 150,000 Americans a year, so if that's our bar, we should have hand grenades in the drug store. They're, you know, they'd kill tens of thousands, but not 150,000. You know, we should legalize drunk driving 'cause, you know, that only kills 10,000 people. I mean, that's just a crazy thing to set as the, "Well, [chuckles] as long as it kills less than 150,000 people a year, it sounds great to me." No, that doesn't make any sense. I mean, I, I am, uh, be clear, like, economically, I am a capitalist. I'm glad we have companies. I love living in Silicon Valley. I love all the things people create there, and, um, and I think that is im- an important part for society to work, to have a private sector. Um, and at the same time, you have to regulate addictive, uh, goods, temptation goods, very intelligently and tightly because you can't count on the sort of rational consumer to protect themselves like you can when you're dealing with cabbage or lettuce, which nobody ever overdoses on. But we do see people burning down their lives over all these drugs, and for that reason, you know, to pro- to protect those people but also to protect the rest of us from the consequences of that, that's why, you know, you need things like advertising restrictions. That's why taxes, to which people are-- people, e- even heavy users respond to price. Um, you know, that's a really important tool to regulate them. I would do, I would do much more with cannabis particularly. You know, just some of the promotion is so naked, and a lot of it is in places where kids are exposed, particularly. And this has just been a long-term fight. You know, we had it with the tobacco industry. Almost any nasty thing you could say about the tobacco industry turned out to be true. [chuckles] I mean, you know, they did work to make it more addictive. They worked to defeat, uh, any type of health regulation. They were marketing to kids, all that stuff, so that, those are the economic incentives, and so you, you sh- you should not be naive, um, if you work in this space, about what the financial incentives are if you're making an addictive product. More addiction is good for your bottom line. So us on the r- on the other side have to say, "All right, we're gonna put in laws and regulations so that that is harder to achieve." Never gonna get rid of all of it, but you can make it a lot, lot harder. Gambling is a great example. I mean, I'm just amazed that we have just given up on any restrictions on gambling now. I mean, when I was a kid, Pete Rose was not allowed to go into the Hall of Fame 'cause he had once placed a bet or... on his own team. He wasn't even doing anything corrupt, but he was- he bet on his own team would win. He was kept out of the Hall of Fame. Now, you can't watch a sporting event without having gambling ads shoved in your face. Like, that's an example of something that should just not be the case. That is terrible for anyone who's trying to quit gambling. It's terrible. A lot of young men particularly, but not just young men, are just ruining themselves economically over, over sports gambling, and we, we did, we don't need this. We, we can, we can do without it.

    24. AH

      [lips smack] Gambling thing's a real concern. Uh, we had a guest on this podcast who's a self-admitted, uh, gambling addict, and, um, a friend of mine who treats gambling addicts said, uh, "It's among the worst of the addictions because they live with the reality it's true, that the next time really could change it all."

    25. KH

      Mm-hmm.

    26. AH

      And he said, "Eventually, they get addicted to the shame of losing." They just get so f- uh, winning becomes a thing of the distant past. I mean, this sounds crazy to, to-

    27. KH

      It-

    28. AH

      ... the rest of us, but-

    29. KH

      It's fascinating

    30. AH

      ... um, it's fascinating, and it, um, and disturbing. Um, and gambling addicts will say that every addiction is gambling.

  12. 1:05:28 – 1:08:50

    Decriminalization vs Legalization; Cannabis, Gateway Drug?

    1. KH

      and that'll be the end of it, so. [chuckles]

    2. AH

      So industries that drive this stuff, okay, alcohol, um, cannabis. It's gonna be very interesting to see what happens with cannabis now and going forward. Is it the case that in states where it's le- legalized or decriminalized, that the state collects its taxes on it?

    3. KH

      Yeah, it depend- depends. Those are different regimes, and, and this is a really important point to get into when you think about policy. So decriminalization is about the user, and that's to say, "Look, we're not gonna punish you for using pot," okay? And that is a pretty popular... It's always, act- it's been a popular policy for a long time, and doesn't s- seem to really affect use that much. You know, maybe a little bit, but not a lot. Legalization is making the production, processing, marketing, and sale illegal, bringing in a corporation-

    4. AH

      Mm

    5. KH

      ... and that is fundamentally different, um, you know, because the corporation is going to have very smart people who are, you know, good at selling, and they will increase, you know, consumption of the product. Um, it, at this point, I, you know, I, I don't know the exact state count, but it's mo- most people in the United States, population-wise, have access at this point to recreational, uh, cannabis, and virtually every state, I believe, has something. If it's not recreational, it's medical, or there were these, uh, due to hemp, there was sort of a way, mistake they made in regulation, there's a way to process hemp, that you can make these, like, Delta-8s and Delta-9s. So even in states that are prohibited, there's quite a bit of, like, you know, hemp-laced beverages, which are quite strong.

    6. AH

      Is cannabis a g-... gateway drug? We were told that when we were in school.

    7. KH

      Yeah, so all drugs are gateway drugs. The, the, the w- the lie in that was that, you know, cannabis had some unique role, um, you know, that was gonna lead you to use heroin use. But the truth is, anything, like, you know, if you, if you're a teenager and you start smoking, or you start drinking, or you start, uh, you know, using cannabis or, or, you know, stealing prescription, uh, opioids from your parents or whatever, that will increase your likelihood of progressing to other substances, you know, for multiple reasons. You know, one, you might like it. Say, "Okay, well, I g- I guess I'm kind of interested. Let me, let me try some others." Two, your social networks may change, so you're around other people who do this, and so they're- you're comfortable with them, they're comfortable with you, and they're also more likely to have something else you, you might wanna try. And then the third thing is there could be some brain sensitization, you know, going on, uh, that, you know, makes, you know, uh, drugs more rewarding. And there is some interesting work with, like, identical twins in different states, which s- seem to suggest that you could be starting some unfolding process when you expose, expose a young, young brain to it. So all those processes is how gateways work. The lie was that it was just cannabis, and this actually fits with the general lie, I would say, is that alcohol is a drug, and we pretend that it isn't. So you, you know, you, you mentioned, like, people getting drunk at science conferences or health conferences. I have seen conferences, political events, where people spend all day demonizing drug users and talking about, you know, the threat of drugs and how evil drugs are and how we have to, you know, destroy all drugs, and then they all go to the bar and get drunk as if they are not drug users. Not wanting to admit that alcohol is a drug is, A, very useful for the industry, but it was also just useful politically because, you know, you could say, "Well, the big threat to kids is cannabis," when, you know, it's much, much more likely

  13. 1:08:50 – 1:18:58

    Psylocibin or LSD, Addiction Treatment; Microdosing, Clinical Trial Challenges

    1. KH

      a kid was gonna get in trouble with alcohol than with cannabis.

    2. AH

      These days, there's a lot of discussion about psychedelics. Broad category of drugs-

    3. KH

      Yeah

    4. AH

      ... LSD, psilocybin. MDMA is an empathogen, not a psychedelic, but somehow it's been lumped into it, uh, and methyl. Uh, well, it's a, uh, methylenedioxymethamphetamine. MDMA, ecstasy, folks, it's methamphetamine with some modifications. So it's not a psychedelic, it's an empathogen, um, but it gets lumped with that. Ketamine gets lumped with it, dissociative anesthetics, not a psychedelic. So if we're gonna have a conversation about psychedelics, I wanna be re- really clear. Um, maybe we just put psilocybin-

    5. KH

      Mm-hmm

    6. AH

      ... and LSD on the table, and then talk about the empathogens and ketamine and all the rest separately, because so often these get lumped in, and it re- leads to a lot of confusion. I know several people who feel they've benefited tremendously from doing clinical work, meaning with a guide in safe setting, et cetera, on high-dose psilocybin, maybe only two or three times total, and that's it.

    7. KH

      Mm-hmm.

    8. AH

      For treatment of depression, sometimes for alcohol issues and other issues. I'm not talking about microdosing. They do a high dose, so two, two to five grams.

    9. KH

      Mm-hmm.

    10. AH

      A lot of addicts who use other things are interested in or currently using or considering using psilocybin, LSD less so, uh, as a means to get over their addiction. I'd like your thoughts about that and your thoughts about these compounds specifically.

    11. KH

      Yeah, I mean, they're exciting, uh, in, in part because we haven't really made much progress in pharmacotherapy in the last twenty years, you know, for lots of things, for depression, for, for addiction, you know? So the thought that these might work, and I think they're, other than the GLP-1s, you know, one of the, you know, probably say the second... I'd, I'd say my second bet on that. I'd put my first one in GLP-1 agonist. Um, there is an awful lot of hype, um, but real things can be hyped. Um, you know, so the fact that there are a lot of extravagant claims being made, and also again, talking about industry, you know, there are people who are, you know, hoping to make a, a huge sum of money on these, on these medications. Um, but there's also something there. Um, you know, you l- you could look at different pilot studies, um, you know, small trials. They are encouraging, um, and uh, I'm glad that, um, you know, it's a lot easier now to do these types of studies. You know, we just had my friend, Dr. Todd Korthuis, down to Stanford, you know, p- he's from Oregon. You know, Oregon is doing these things, probably similar experience to what the, uh, you know, your, your friend had, where you get, you know, you have a prep- you have preparation, you know, with a, with a trained person, you get the medication, and then you do the integration session afterwards, and there are... And people would say it's, you know, it was transformative for them. Um, there are also people who have very bad experiences on them, too, though, it has to, it has to be said, and that's why we don't just say, "All right, let's just use this as our frontline med."

    12. AH

      You mean during the psychedelic experience and afterwards?

    13. KH

      Or afterwards, like flashbacks. You know, you're driving along, and then you have a flashback, you know, and, you know, that, that is both upsetting and de- depending what you're doing at the time, you know, could, could carry some risk to it. Um, we don't know that well, how well these, or, or exactly how these drugs work, you know, the sort of serotonergic, uh, kinds of, kinds of drugs. The one thing we do know good, though, keeping on the topic of addiction, is thankfully, um, you know, there's no evidence that people get addicted to psilocybin or, uh, to LSD. If they have abuse potential, it's extremely, extremely slight. So I've, I've always worried about them far less, uh, as a class of, of drugs than I do things like stimulants, which I know, and, you know, and alcohol.

    14. AH

      My read of the literature, and this might have been updated since, uh, is that there is zero evidence that microdosing psilocybin has any benefit.

    15. KH

      Yeah, uh, I, I think that's just silly.

    16. AH

      Mm-hmm.

    17. KH

      Uh, yeah.

    18. AH

      Um, there is solid evidence that in a clinical setting, as you pointed out, and thank you for pointing it out, we're talking about at least two or three talk sessions without-... psilocybin, then a psilocybin journey that's typically two guides for safety purposes. Now, that's kind of how it's being explored.

    19. KH

      Mm.

    20. AH

      So they're, um, to avoid exploitation-

    21. KH

      Right, and there has been some of that

    22. AH

      ... conditions, 'cause there has been some exploitation-

    23. KH

      Yeah

    24. AH

      ... mainly in the MDMA, uh, trials. But, um, and then follow-up, that it's been somewhere between 60 and 70% of people who go into that sort of thing with major depression that hasn't been resolved by other approaches, um, get either significant relief or, uh, full remission after two full versions of what I just described at fairly high dosages. When I think about the negative impacts, I- certainly there's the, quote, unquote, "bad trip," um, phenomenon. What I've observed quite a lot, and, uh, I hear from a lot of people in this psychedelic space, is that post-MDMA, for trauma, post-psilocybin for major depression and addiction issues, there's the, not euphoria, but the feeling that something s- significant has changed in the weeks and months afterwards, and then some period of time later, a significant dr- sudden drop in mood-

    25. KH

      Mm

    26. AH

      ... and that frightens them, and that they're able to recover from, but that it's a real thing, a real trough. And this, by the way, is separate from the very well-known trough that comes t- two days after MDMA use. We could talk about that, but, um, there, you get high, and then there's a low [chuckles] -

    27. KH

      Yeah

    28. AH

      ... you know, very well explained.

    29. KH

      As, as, as with stimulants.

    30. AH

      As with stimulants.

  14. 1:18:58 – 1:20:32

    Sponsor: Helix Sleep

    1. KH

      depressed, and it helped them, that would be a good medicine to have, right?

    2. AH

      ... I'd like to take a quick break and acknowledge our sponsor, Helix Sleep. Helix Sleep makes mattresses and pillows that are customized to your unique sleep needs. Now, I've spoken many times before on this and on other podcasts about the fact that getting a great night's sleep is the foundation of mental health, physical health, and performance. When we aren't getting great sleep on a consistent basis, everything suffers, and when we are sleeping well and enough, our mental health, physical health, and performance in all endeavors improve markedly. Now, the mattress you sleep on makes a huge difference in the quality of sleep that you get each night. How soft it is or how firm it is all play into your comfort and need to be tailored to your unique sleep needs. If you go to the Helix website, you can take a brief two-minute quiz, and it will ask you questions such as, "Do you sleep on your back, your side, or your stomach?" Maybe you know, maybe you don't. "Do you tend to run hot or cold during the night?" Things of that sort. You answer those questions, and Helix will match you to the ideal mattress for you. For me, that turned out to be the Dusk, D-U-S-K, mattress. I've been sleeping on a Dusk mattress for more than four years now, and it's been far and away the best sleep that I've ever had. If you'd like to try Helix, you can go to helixsleep.com/huberman, take that two-minute sleep quiz, and Helix will match you to a mattress that's customized for you. Right now, Helix is giving up to twenty-seven percent off their entire site. Helix has also teamed up with TrueMed, which allows you to use your HSA, FSA dollars to shop Helix's award-winning mattresses. Again, that's helixsleep.com/huberman

  15. 1:20:32 – 1:28:10

    Brain Plasticity & Age; Ketamine, Depression, Transcranial Magnetic Stimulation (TMS)

    1. AH

      to get up to twenty-seven percent off. SSRIs, selective serotonin reuptake inhibitors, and all the other antidepressants have gotten kind of a bad rap in recent years. Uh, there's the idea that all the school shooters were on SSRIs. Um, whether or not that can be [chuckles] separated from the data on how many kids are on SSRIs, you'll tell us. Um, talk therapy, SSRIs, and other prescription antidepressants, psilocybin, and any psychedelic for the treatment of depression, and on and on, all funnel into brain plasticity.

    2. KH

      Mm-hmm.

    3. AH

      If I sit in your office and I tell you what's bothering me, and you give me insights, and over time, I work with that, that's- and I get better, it's the consequence of brain plasticity. The- so I think of all of these things, whether or not pharmacologic or talk therapy or a combination-

    4. KH

      Or, or TMS.

    5. AH

      Or TMS, transcranial magnetic stimulation.

    6. KH

      Mm.

    7. AH

      Thank you. Yeah, it's, it's all about rewiring brain circuits, and so it's not about the psychedelic experience. Where I get frustrated is when people say, "Oh, you know, these things open plasticity." I think to myself, "Oh, my God, as somebody who studied plasticity, David Hubel and Torsten Wiesel, who essentially got the Nobel Prize for it, were my scientific great-grandparents. Like, they would be ro-- I think Torsten's still alive, but David would be rolling over in his grave [chuckles] or, you know, like-

    8. KH

      Yeah.

    9. AH

      No! Like, you don't wanna open plasticity because it can go in any direction. You want directed plasticity. And so while talk therapy is slower, while, um, TMS might be slower, I mean, y- plasticity needs to be funneled. It just can't be, "Let's just open plasticity," and I think people are very intrigued by the idea of just opening plasticity as if that's gonna solve the issue.

    10. KH

      Plasticity, which we have naturally the most when, when we're young, is absolutely a two-edged sword. So you know, if you try to learn, you know, French at my age, it's just really, really hard, you know, to, to pick up that new habit, whereas if you, you know, grow up speaking it, or you as, as, or, or you try to learn as a second language in a teenager, you've- you're gonna have much more capacity to get it and, and retain it. That's true. It's also true that if you start smoking cigarettes in my age, you probably will not get addicted, and if you start smoking cigarettes when you're 13, you almost certainly will.

    11. AH

      Is that true?

    12. KH

      Yes, same thing, plasticity. Almost all addictions start when people are young. You know, and you can-- and you can think of addiction as a learned, you know, it, it is a, it is a... You know, it's maladaptive learning, but it is learning, you know, that you, you know, you acquire those things, and you stay all the way through. It's why, you know, sometimes older people, I can remember getting mad, like, shows they like got canceled, and people were watching them. I remember the show 'cause my parents watched it, Dr. Quinn, Medicine Woman.

    13. AH

      Oh, yeah.

    14. KH

      Well, why? 'Cause old people watched it, and advertisers don't wanna pay for old people. The advertisers want, want young people-

    15. AH

      Want lifetime users.

    16. KH

      That's right-

    17. AH

      [laughs]

    18. KH

      ... and to instill those habits-

    19. AH

      Oh, my gosh

    20. KH

      ... when people are young-

    21. AH

      Okay

    22. KH

      ... is how you get them to do it for 50 years.

    23. AH

      Mm-hmm.

    24. KH

      You can't really persuade many people my age to start eating Cheerios or Frosted Flakes or whatever, but you, you start it when people are young, and that just underscores the point you're making of, like, plasticity isn't good or bad. It's, it's this capacity the brain has, and it can be used in, in very different ways.

    25. AH

      Maybe it explains why for, despite some minimal effort, I can't get addicted to TikTok. It's just, it's, it's aversive to me, thank goodness.

    26. KH

      But maybe if you'd started when you were 13, it didn't exist then, but, you know, if it did, you might have. You might have found it far more, far more engaging, uh, and, and picked up that habit.

    27. AH

      Chances are, I mean, based on what I observe [chuckles] uh, and knowing myself. You mentioned ketamine. Ketamine's an interesting one, A, not a psychedelic, dissociative anesthetic, has some proven benefit for depression, although maybe transient-

    28. KH

      Mm, yeah

    29. AH

      ... but a high abuse potential, and here in Los Angeles, not six months goes by without hearing about some famous person dying of ketamine, which means that a lot more non-famous people are dying of ketamine, and we're not hearing about it.

    30. KH

      That's a good point, yeah, and I, I don't know if you can, if you can post articles, but we did a review, me, Todd, Todd Corti and some other colleagues, of the potential therapeutic effect of, of these whole drugs. And, and the thing about ketamine that struck me, yes, it is FDA approved for treatment-resistant depression, so it is approved. There's a lot of negative trials for depression. I mean, it didn't, like, vault over the, you know, efficacy thing. It cleared it. There are some positive trials, and I, I can say I know a couple people who I judge when I trust said it was very, very valuable to them in a deep depression. But, um, I didn't view it as quite the knockout I thought it was gonna be before I read all these studies, and then you, you do have that problem. It is addictive. It also... And so we have a, a lot of people getting addicted, and then also the bladder d- you know, damage you get from it. You know, you get young people with, you know, sort of, you know, 60-year-old bladders from ketamine, and, like, that is... I mean, most urologists have seen this now.

  16. 1:28:10 – 1:36:10

    SSRIs, Mass Shootings, Suicide, Side Effects; Drug Approval; Ibogaine & PTSD

    1. AH

      something to, uh, where people would want to explore, but, um, as long as we're on SSRIs, um, do SSRIs make people shoot other people or themselves?

    2. KH

      No, no, I don't believe that the mass shooting thing... I, um, I mean, it, it doesn't fit the data where mass shootings are. I mean, there was just a mass shooting in Australia. Just think, that is so rare that you see these in developed countries other than the United States. That was their first mass shooting in thirty years. There's plenty of people take SSRIs in Australia. Why weren't there mass shootings? Europe, d- many people take SSRIs. They don't have the level of mass shootings. So at that, I don't think that is the explanatory variable. I mean, I think the explanatory variable is that it's extremely easy to get high-powered weaponry in our country, and it's harder pretty much in the rest of the developed world.

    3. AH

      Not pushing back for sake of pushing back, but I, I've seen data, I don't know how solid the data are, uh, that something like seventy-plus percent of the prescription drugs for depression are consumed by the United States, so that the, the relative, uh, percentages of a population, maybe that's a better way to frame it, taking SSRIs is much, much higher in the United States than it is, say, in, um, Northern Europe-

    4. KH

      Yeah, yeah

    5. AH

      ... or in Australia. So yes, they take SSRIs, but at, at a much lower frequency.

    6. KH

      Yeah, but you would, you would not go thir- if, if there were significant risk, you wouldn't go thirty years without a mass shooting in a country. Australia, what does it have? Twenty-five, thirty million people in it. I mean, you know, e- even at a lower rate, there would be... The, the disparity is so huge-

    7. AH

      Mm-hmm

    8. KH

      ... in where mass shootings occur, that that's just not gonna be the, you know, the likely explanatory variable.

    9. AH

      What about suicides?

    10. KH

      There is some worry about adolescents on SSRIs. This has been a really hard-fought, you know, debated issue for years, and, and it's tough because depression, of course, raises suicide risk, right? So you- by definition, if someone's getting an SSRI, they already have some, some risk present. I think there's some legitimate worry with teenagers. I would say it's non-zero, but to be honest, it's not completely in my wheelhouse, so I'm just gonna leave it at that. Uh, there are people who've, who've worked on this, uh, um, much more, uh, deeply than I can. Still, though, I would say there are many teenagers on these medications who benefit from them also. There's no doubt about that.

    11. AH

      Yeah, and folks who are interested in this, I'm, I'm working on a, on an episode with a guest about some of these long-term effects of SSRIs that some people seem to experience. There, there is a cohort of people out there, um, this is one of the great things about the Internet, who have rallied together and saying: "Hey, you know, we have the same constellation of symptoms. Uh, we don't have any bias against the medical industry, but we were prescribed SSR, SSRIs in, uh, in our teen years and early twenties, and there's a constellation of, of, um, mainly sexual side effects and, and mood-related side effects that don't seem to resolve even after coming off." We also see this with finasteride, which was used to treat baldness-

    12. KH

      Yeah, yeah

    13. AH

      ... and our colleague, uh, Mike Eisenberg, um, came on here and, and said: "Look, the data aren't really there, but I hear from a lot of young guys who were given these, you know, anti-hair loss drugs, and they come off the drugs, and they're still experiencing debilitating sexual side effects." And so th- it is true that the medical profession sometimes takes ten, twenty years to catch up to what many people-... are experiencing.

    14. KH

      That is true. Yeah.

    15. AH

      So I'm, I'm not trying to make a, a-

    16. KH

      Mm-hmm

    17. AH

      ... an anti-SSRI statement here, but I think there, there is, there are people walking around out there that are convinced one way or the other that SSRIs messed them up pretty bad, and they have loud voices, and so I think that's where the concern comes from.

    18. KH

      Yeah. I, I, I honestly don't know the, you know, uh, what, what the evidence is in that particular case. I will say just something very general about medications, how we approve them. They're approved on short-term trials. I mean, if you look at, like, the typical trial for opioids and pain, you know, it's like nine weeks or 12 weeks.

    19. AH

      Mm-hmm. Mm-hmm.

    20. KH

      And there's lots of medications, you know, and opioids are a good example, that, that doesn't necessarily mean that taking them for a year gives you the same effects because you be- you know, for example, you become tolerant to them, or you might become addicted to them and all that. And that is a general just challenge of how we regulate these medications. There are post-marketing studies, you know, that, that are done, but, um, particularly if something is a, uh, complicated and rare, uh, from a widely used medication, it, it's, it's hard to figure that out. I mean, doctors will make reports. They get, you know, aggregated up, but, um, that's hard, that's hard to figure out.

    21. AH

      Before moving on from the discussion about psychedelics, our late and indeed great colleague, Nolan Williams, sadly, he passed, um, a few months ago. Um, we may talk about that later, maybe not. I'll-- either way, I'll put a link to his, uh, information because he's a, a, a critical figure in this general space around the treatment of, of depression, um, because of his work on TMS, the SAINT protocol, as it's referred to, uh, as well as ibogaine, which is a very unusual psychedelic. Uh, but he was running trials on veterans mainly taking ibogaine out of country, illegal in the United States, so he had to do it out of country. Um, [lips smack] it's a 22-hour-long psychedelic experience. Uh, you have to be heart rate monitored. Nobody does this recreationally, and nobody should do it recreationally. Sometimes it was followed up with DMT, sometimes no, but from my last discussion about Nolan before, um, [lips smack] he passed, it seemed like the data were very encouraging, s- such that people who had... veterans who had PTSD and/or addiction issues would do ibogaine once under this intense supervision, sometimes followed by DMT, and would experience a total remission of everything bad, [chuckles] frankly. They're back to life, and it was pretty striking, uh, at least the way it was being described, uh, so much so that I was anticipating that ibogaine would be the first FDA-approved psychedelic, in part because it's not the kind of thing you can just do hanging around with your friends, and you wouldn't want to. It, it involves a lot of, uh, scary experiences in there that one works through. What are your thoughts about the ibogaine work and ibogaine as a potential first through the legal door of, of psychedelics?

    22. KH

      Yeah, so, um, Nolan and I were office neighbors, and I really liked him. He was a huge loss. I think he was one of the great psychiatrists of his generation. Just enormous respect for him as a person and as, as a scientist, and, uh, I, I, I miss him every day when I walk by his office. Um, uh, I think what he did with ibogaine is really fascinating, in part because he did-- the important thing, he imaged, uh, people, uh, neuroimaged them before and afterwards, and he was able to see a lot of these changes. And why does that matter? Because, you know, um, you, people, uh, you know, there, there's certain experiences people might have, describe very enthusiastically and think they're really different, but they aren't, in fact, different. But he actually documents that it's different. So, you know, I think that's, was really groundbreaking, and it's sad he's not gonna get to continue that work. The, the thing you say is, this is an open-label trial with no control group, so that's what, that's what we have so far. So the, n- now the thing is to do a proper trial, you know, and, and see. You know, there is a lot also sort of ceremony around this. You know, it's sort of like, as a, a colleague might describe as, "It's like the final mission for the soldiers." They go down to either New Mexico, they do this. There's a lot of camaraderie. There's a lot of other good stuff packed around it.

    23. AH

      Mm-hmm.

    24. KH

      And so, like, is that part of the therapeutic experience, or is it entirely a, you know, a, a chemical experience? That's the thing you would find out in a, a trial. You know, you would have sort of, you know, you do, do all that other stuff, but you wouldn't have the ibogaine at the end. And, you know, absolutely worth, worth, uh, studying and, uh, you know, it, uh, it, newer hands will have to pick this up, but I really hope people will.

    25. AH

      Yeah, I, I'm very curious as to where that work is gonna go now that... 'cause it really was Nolan spearheading that work, but there are people who are working hard to keep it m- you

  17. 1:36:10 – 1:44:04

    Caffeine Addiction?; Stimulants & Rehab; Prescription Stimulants & ADHD

    1. AH

      know, going forward. [lips smack] Stimulants. Um, I'm a heavy caffeine user.

    2. KH

      Okay.

    3. AH

      My caffeine tolerance is insanely high.

    4. KH

      Uh-huh.

    5. AH

      I mean, people have, uh, teased me online, "There's no way that's true, 800 milligrams a day of caffeine?" [lips smack] Child's play. Meaning, when I was a kid, I've got a photograph of me drinking yerba mate. My father's Argentine. Out the gourd, which is p- rarely, um, [lips smack] uh, stimulatory, although nice, even flat ride, you know.

    6. KH

      Mm-hmm.

    7. AH

      You can tell I like stimulants, by the way, I talk about them. When I was three or four years old, 800 milligrams of caffeine, no big deal. You know, a gram of caffeine a day, that's kind of like where I'm nearing my, my limit. I can drink caffeine all day long. I stop around 2:00 PM, so I can sleep well. Not a problem. I think 90% of the world uses caffeine, adult world uses caffeine. Is caffeine... I'm asking this for my own reasons, is caffeine addictive? Is it dangerously addictive? It makes me more productive. Um, I love life on caffeine. I can handle life without caffeine if I have a flu or cold.

    8. KH

      Mm.

    9. AH

      Otherwise, I'm not interested in finding out what life without caffeine is like.

    10. KH

      I'm probably the worst person to answer this 'cause I, I love coffee, and as, as, as I like to say, I don't have a problem with coffee. If I had to choose between coffee and my children, I can make that decision-

    11. AH

      Sure

    12. KH

      ... but I would really miss them.

    13. AH

      [laughing] Got me with that one.

    14. KH

      I knew that was an okay joke to say 'cause my sons laughed when I told it to them. But, um, the, the, um... Yeah, it's a stimulant, so it's rewarding, and, and it is potentially addictive, but, you know, so how- what would you see if someone were addicted? You, you... Someone come in and says, "I'm drinking so much, I'm retching. I'm having, you know, shooting stomach pains. I can't sleep." Say, "Are you gonna stop?" And if, you know, I, I, I've actually never met anyone, but perhaps there are some people who say, "No, I can't seem to stop using it." It's like, okay, that would be addictive, but I've never met a true, what I consider, a coffee, coffee addict, uh, person, 'cause it's not that intense of a stimulant. And the, you know, the, the thing, you know, you can GI symptoms, things like that, that would be the main thing, or, or jitteriness and sleeplessness, but almost everybody who experiences those seems to quit.

    15. AH

      Mm-hmm.

    16. KH

      Um, so, or, or at least everyone I, I've met seems to quit. More generally on stimulants, I have to say, this is the biggest disappointment of my career, uh, what the, in the addiction field. I started my career in the late '80s, and going into, um, uh, in the Lower East Side of Detroit, which was very rough, uh, crack cocaine was everywhere, and the treatment offering to people who were addicted to crack cocaine then, in the late '80s, is not very different from what it is today, uh, you know-

    17. AH

      Which is?

    18. KH

      ... almost forty years later. No pharmacotherapy at all. Um, nothing, no evidence of anything that, that works in pharmacotherapy. Um, a lot of, uh, uh, psychotherapies that don't really seem to work very well. Um, you know, and, you know, groups and stuff like that, you know, which have sort of like very at, at most, modest effects. I'm talking about therapy groups. Um, that's not a lot of development, and a lot of people have tried. I mean, they've tried all kinds of, you know, medications for, for stimulants and just not been able to succeed. The only thing that seems to work is contingency management, which are these things where you, uh... Steve Higgins, I think, was the first person to do this, where he showed against the idea that people have no control in addiction, which is, in fact, rare. They have impaired control but not no control. He started experimenting with people who were addicted to cocaine, saying: "Well, you're coming into treatment. How about tomorrow, uh, we'll do a urinalysis when you come in, and, um, you know, and if it's a negative urinalysis, the first day, we'll give you two bucks, and the day after, we'll give you four bucks, and the day after, we give you eight bucks, day after, we give you sixteen b- bucks." And he found out people stopped. You know, they, they, they wanted those rewards, and that's, that's managing a contingency. You can use that to change stimulant, uh, users' behavior. Also, for other things, you know, like, uh, uh, you know, well, if you, you know, if you come in, there's some kind of reward, or you, um, if you fill out a job application, there's some kind of reward. That is the only thing that really looks good for stimulant use disorder, and it's fine as a behavioral technology, and I'm glad to say it's been expanded a lot. Um, you can, you can do it, um, under, you know, it's covered by insurance now in most places. But it's just disappointing to me that if you, if you transf- you know, took Keith twenty twenty-five back to late '80s and, like, talked to those same people I was meeting coming to treatment, they'd say, "Wow, what, what new things happened for people like me over the next f- you know, in the forty years, man from the future?" I'd say, "I'm sorry, basically nothing," and that is really disappointing.

    19. AH

      What about all the prescription stimulants, Adderall, Vyvanse? I feel very lucky that those didn't exist-

    20. KH

      Mm-hmm

    21. AH

      ... when I was in high school and college and graduate school, probably in part because I like caffeine enough that-

    22. KH

      Yeah

    23. AH

      ... I worry that I might have liked them. I've never taken any of the things I just mentioned.

    24. KH

      Yeah.

    25. AH

      Back then, we had Ephedra and Ephedrine pills-

    26. KH

      Sure

    27. AH

      ... and things like that that were sold over the counter, and that, that always felt too stimulatory. Um, nowadays, I would say ha- yes, at least half of my friends with male children, those children are on amphetamines for the treatment of ADHD.

    28. KH

      Uh-huh.

    29. AH

      And they start them young, and then they call me 'cause I have a network, not because I can treat, but not a clinician, but then they call me because they're worried about the, um, [lips smack] growth-stunting effects.

    30. KH

      Mm-hmm.

  18. 1:44:04 – 1:47:24

    Nicotine, Mistaking Withdrawal for Benefit

    1. KH

      So, um, it, you know, that, that could well be true.

    2. AH

      So when you look out on the landscape of, like, energy drinks, and nicotine has made a, a big comeback-

    3. KH

      Yeah

    4. AH

      ... big comeback. Um, interesting stimulant because it's both a stimulant, but it also relaxes you to some extent.

    5. KH

      Yeah.

    6. AH

      I tried it for a bit, the gums. Despite my, uh, caffeine tolerance, I very, um, sensitive to drugs, so I can do, like, two milligrams of nicotine gum, and it, and I noticed it gave me spasms in my throat when I wasn't taking it. Um, and I was told that's because the m- the muscarinic-

    7. KH

      Yeah

    8. AH

      ... acetylcholine stimulation, so you start, your throat starts spasming, then you feel like you need it. It's actually a physical sensation.

    9. KH

      Wow!

    10. AH

      Then the oral health folks tell me that it's bad for gum disease, and the skin folks, this, this always gets, uh, typically women, but here in LA, men and women, um, it definitely ages skin faster because of the vasoconstriction-

    11. KH

      Yeah

    12. AH

      ... in, in the skin. So it makes you look older, even though you're not smoking it, the oral nicotine. But here, I just have to pepper with what I've heard. Uh, we have a Nobel Prize-winning colleague, I'll just name him, it's Richard Axel at Columbia, who told me long ago and many times, nicotine is protective against Parkinson's and Alzheimer's, which is why he chews a, or did chew tons of Nicorette, uh, per day. Um, so what's the deal? Nicotine seems like it has some benefits. It might make you look older, it might maybe you need to take better care of your teeth. It's a stimulant, but highly habit-forming and addictive. So what's your view on nicotine as an industry and as a substance?

    13. KH

      Yeah, I mean, it's a poison. If you, if you consumed all the nicotine in a carton of cigarettes, [chuckles] it would kill you. I mean, you know, that, uh, that's re- remarkable, uh, uh, that it, that is so popular because of that, it is exactly the reason you say. It's both, "I feel sharper," and then, um, I, uh, yet I feel, I feel relaxed at the same time. Um, I, I, I think a lot of people who use it are mistaking, uh, the treatment of withdrawal for a drug benefit.

    14. AH

      Can you elaborate on that?

    15. KH

      Yeah, sure. So, like, if you, let's say you smoke. When you sleep, obviously you're not smoking, and the nicotine blood level goes down, and you wake up, feel jittery and jangly and all that, and you have your first cigarette, it feels great because you're put- you're, you're... It- but that doesn't mean, wow, cigarettes are really good for you. Look, you smoke, and you feel really good. What, what you're doing is just the withdrawal that makes you agitated and angry and annoying go, goes away, and you, you attribute that, well, you know, it's the use of the nicotine. But, you know, it could just be [chuckles] you are dependent on this drug, and what you're asking to do is persist through the, you know, the days where you will feel cognitively sludgy and maybe a little bit keyed up and all that. But then, you know, once you go through the withdrawal, you won't need it to get to that point. I think there's a lot of people, like, that happens with cannabis a lot, too. I mean, a lot of people say, "I can't sleep without it." So like, yeah, well, one, one sign of cannabis withdrawal is sleeplessness. So are you sure that you've got, like, a sleep disorder that you're treating and not that you basically just are trapped in a cycle of-

    16. AH

      Mm

    17. KH

      ... withdrawal and medicating withdrawal? Happens with opioids, too, is another example. People think, "My pain's coming back," and it's like, "My injury." It's like, mm, well, could be, but it could also be you're dependent on opioids.

    18. AH

      What's your advice to those people, to ride it out?

    19. KH

      There are treatments that can make, you know, withdrawal easier from different types of drugs. But yeah, I mean, if you can get past that point, you, you could be free of using it at all, and wouldn't that be nice to do?

  19. 1:47:24 – 1:48:44

    Sponsor: LMNT

    1. KH

      It's definitely worth running the experiment.

    2. AH

      I'd like to take a quick break and acknowledge one of our sponsors, LMNT. LMNT is an electrolyte drink that has everything you need and nothing you don't. That means the electrolytes, sodium, magnesium, and potassium, all in the correct ratios, but no sugar. Proper hydration is critical for brain and body function. Even a slight degree of dehydration can diminish your cognitive and physical performance. It's also important that you get adequate electrolytes. The electrolytes, sodium, magnesium, and potassium, are vital for the functioning of all cells in your body, especially your neurons or your nerve cells. Drinking LMNT makes it very easy to ensure that you're getting adequate hydration and adequate electrolytes. My days tend to start really fast, meaning I have to jump right into work or right into exercise. So to make sure that I'm hydrated and I have sufficient electrolytes, when I first wake up in the morning, I drink 16 to 32 ounces of water with an LMNT packet dissolved in it. I also drink LMNT dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and losing water and electrolytes. LMNT has a bunch of great-tasting flavors. In fact, I love them all. I love the watermelon, the raspberry, the citrus, and I really love the lemonade flavor. So if you'd like to try LMNT, you can go to drinklmnt.com/huberman to claim a free LMNT sample pack with any purchase. Again, that's drinklmnt.com/huberman

  20. 1:48:44 – 1:55:23

    Tool: How to Talk to Someone with Addiction

    1. AH

      to claim a free sample pack. I'm certain a lot of people, including me, are interested in how to avoid getting addicted to things and how to get over addiction to different things. And I'm very curious as to whether or not the field of addiction treatment has started to parse early, middle stage, and kind of late-stage addiction, or whether or not it's all just considered addiction. Like, for instance, a number of people now are suspecting that they might be addicted to social media or their phone or texting or something, uh, something electronic. They are suspecting that they might be, uh, too dependent on food.

    2. KH

      Mm-hmm.

    3. AH

      Uh, they might be addicted to X, Y, and Z, and I think that represents the great success of you and your colleagues and people like Anna Lembke and people being pub- public advocates about what addiction is and isn't.

    4. KH

      Mm-hmm.

    5. AH

      But to me, it seems like independent of the substance or the behavior, if somebody is early in the-... experience of feeling like they're weighed down by something, and it's hurting them in some subtle way, very different than somebody who's, like, raising a hand, hopefully, um, or thinking, hopefully not, about taking their own life because they're so hopelessly addicted to alcohol or drugs, they've lost everything. So as a clinician, what's your approach if somebody says, "Hey, I, I think I might have a problem with X?"

    6. KH

      First off, you would say, um, "Wow, I'm so glad you told me. Um, th- th- this is something that tens of millions of people experience, and many of them stay silent about it, and therefore, people feel, and you may feel, that you are strange or this is shameful, or, uh, you know, or, um, an odd experience, when it is really an extremely common experience." And so you're, and you're saying that so the person doesn't feel embarrassed, and they feel comfortable, you know, talking about it. Um, the other thing is you convey optimism. You know, there are probably, you know, surveys give something like twenty-four million Americans are in recovery. Uh, we just don't notice them because someone in recovery looks like anybody else. We notice them when they're actively addicted, but not when they're in recovery, 'cause they, they sort of return, and they just look like, "Oh, that's just a schoolteacher, that's an accountant, that's a police officer," whatever, but that there's a lot of reason for rational hope. And, uh, in the particular case you're talking about, when someone's just starting to worry, in its early stage, the odds that they will, um, recover are dramatically higher. So, you know, you-- it's, it's much, much easier to sort of pull out before you've burned your life down around you. So, you know, it's real... It's tough when people come in, and you say, "All right, well, do you have family support?" "Well, my family doesn't talk to me anymore." "Okay, uh, do you have at least a safe place to live?" "No, I lost my... I'm, I'm s- you know, sleeping on a couch right now." Um, you know, "Well, at, at work, are you..." "No, I lost my job." You know, th- that's tough, uh, for the person to rebuild everything, but if you still have those resources, there's still people who love you in your life, you still have a meaningful role where you're contributing, and you also have some accountability, that's gonna help you make that behavior change, whatever it is. I would say that about any behavior change, not just one, uh, connected to substances. And then what do we do when we, we, we work with people? Well, we, we always think about motivation. Um, it's hard. This may seem strange, but if someone says, "I wanna quit smoking," a, a good clinician will say, "Why, why would you wanna do that?" Um, you think like, "Well, that's dumb," you know. Aren't you supposed to say, "Yeah, good, great, good!" It's like, well, if you don't wanna do it, it doesn't matter what I think, right? You know, and also, there's quite a few people, if you push on it, they actually become less likely to do it, if you sort of nag them. So you say, "So tell me, w- why would you wanna... W- what do you wanna get out of this? 'Cause it's work. I mean, I'm happy to work with you, but, you know, what, what is it? What are your, what are your motives?" And that's, you know, reflecting on that, like, "Well, here's the thing. I, like, all my clothes stink, and I hate the way it..." So you would, you would, you would enjoy, and help them elaborate. "So you would, like, get up, and your clothes would feel, smell really good, and you'd feel good about yourself?" Goes, "Yeah, yeah, yeah." It's like... "You know, and I, and I'm spending a lot of money." "So how much are you spending?" You know, um, you know, whatever, it's two thousand bucks a year. "So if you had two thousand bucks 'cause you hadn't smoked in a year, what would you buy for yourself? What would be something you'd really enjoy? Tell me about it." And, and sort of helping them build up, you know, in their own mind, 'cause again, this is about them, not you. What do you get? 'Cause this is gonna be tough, and maybe I wanna do it today, but in three days, I'm gonna be in withdrawal, and I'm gonna feel like I wanna go back, and I need to think about, wait a minute, you know, when I-- if a year without smoking, I get, you know, that two thousand dollar trip to Cancun I've always wanted to take. Um, so I... You know, that, that helps, that helps motivate them. And then you talk, and then you, you just do a, some, like, sort of behavioral analysis of where do you use, how much do you use, what do you use? Are there cues to use? Often, for many people, there are, you know, um, or, and, and also to non-use. Are there places where you would never use? "Oh, I'd never use, you know, I never at my mom's house." "Huh, okay, that's good to know. Maybe you could visit your mom more often." Or, you know, uh, you know, uh, uh, "I never smoke on a, a holy day, whatever my religion is." "Oh, okay, so the, let's talk about that. How do you get through that day? What are the techniques you use there that we could try on, try on other days?" Um, and also, "What are the things that get you in trouble?" You know, like, uh, "I'm trying to quit drinking." "Well, what... If I went into your house and opened up the cabinet, what would it be?" "Well, it'd be, like, you know, twenty different types." "So, so could that go somewhere else? Could you give that away so that it's behaviorally harder for you to, uh, you know, get this? You'd have to go down the street and go to a liquor store," that kind of thing. Uh, help people on stuff like that, and then, you know, there's often practical skills in learning that, like, how do I manage a social interaction without alcohol, for example? Or what do I do for fun? You maybe, you know, think like that. Or, or how do I hang out with my friend who loves to drink and explain to him what, why I can't drink anymore? Um, those kinds of things as well, and that's what the therapist does. The other thing that's really important is that, like any other... Any time you're making a behavior change, this is maybe seem like incredibly simple, almost dumb advice, but hang out with other people who are trying to make the same change. You wanna start jogging? Join a jogging group. You know, you want to, uh, you wanna stop drinking? I would, you know, suggest go, go check into an A, AA meeting or one of the other fellowships we have, LifeRing Recovery or, or SMART Recovery. Having other people on the same journey is good for us. It sh- I mean, everything shows that no matter what you're doing, I'm losing weight, I'm exercising, I'm more whatever, I'm quitting smoking, because it gives you two things: it gives you support, um, but it also gives you some accountability. It's like, "Hey, you were going jogging, and on, uh, Tuesday, you weren't there. What's up? Are, are you gonna be part of this group or not?" And that is, uh, helpful for people, the, the combination of the two,

  21. 1:55:23 – 2:00:58

    Perception of Addicts, Character Defect, Pain

    1. KH

      so all those things we encourage people to do.

    2. AH

      That's wonderful to hear, um, some concrete [chuckles] questions that one would ask because I think people have heard of, you know, just quit. I think a lot of people who aren't familiar with addiction as a chemical, brain circuit, hormonal, full body, full brain issue, but mostly a brain circuit issue-

    3. KH

      It almost makes you... Sorry, it almost makes you laugh, just think like, it's like someone's gonna say, "My God, why didn't [chuckles] I think of that before? Thanks, Doctor," and stamp on the cigarette and walk out.

    4. AH

      I know.

    5. KH

      But yeah.

    6. AH

      It's wild, right? I mean, this u- uh, addiction used to be looked at as a character defect.

    7. KH

      Mm-hmm.

    8. AH

      And, um-... I, certainly addicts have character defects, but I would argue at no greater rate than, uh, non-addicts.

    9. KH

      Everybody, everybody has character defects.

    10. AH

      Everybody has character defects, er, exactly. Um, and part of the reason I think it was viewed as a character defect is that, A, addictions vary, and susceptibility to them varies. So if it's been easy for me to quit drinking alcohol, and I wasn't aware of what addiction is, I might look at somebody who's having a hard time quitting drinking and just think, "Well, just quit. I did it."

    11. KH

      Yeah.

    12. AH

      "You can't"-

    13. KH

      Yes.

    14. AH

      ... this kind of thing, and, and, um, and just swap whatever substance or behavior for alcohol there. Um, and then I think the other reason is that oftentimes, sadly, um, addicts hurt people around them in their addiction.

    15. KH

      Yeah.

    16. AH

      This is, you know, they lose money that wasn't theirs. They, um, they harm themselves or others in very, in psychologically or physically, and, and, um, I mean, I know drug addicts that it had to come down to their kid getting into their drugs and almost dying before, uh, they finally quit, and even at that time, they were concerned that they might not be able to quit, even though they adore their children-

    17. KH

      Yeah

    18. AH

      ... and wife.

    19. KH

      Yeah.

    20. AH

      Fortunately, that person is still sober some years later, but it's like, y- you can imagine, I, from the outside, it l- you can come up with some pretty good character defect arguments [chuckles] -

    21. KH

      Yeah

    22. AH

      ... when, you know, when you observe that kind of thing. But when these people get sober, it's spectacular how the real person seems to emerge, um, which points to the fact that the addiction masks something about who they truly are, not the other way around.

    23. KH

      No, I agree with that, and I think you're right that a lot of the explanations from addiction come from people who are hurt and angry, you know, with, with, uh, good reason. You know, they had an-

    24. AH

      Mm

    25. KH

      ... they had an addicted parent, and that was hard u- for them, or their, their, their marriage is disintegrating, and so they're mad, and they're gonna... so they're gonna have a certain amount of venom in how they explain this, you know, sort of understandably. And in addiction, you know, people do do things they would not otherwise do. I mean, like you're saying, you know, um, lying about lots of things that there's no, y- they, they normally wouldn't lie about, like, "I promise I'll show up to the baseball game and watch you, watch you play your game," or, um, you know, "Yeah, I'm gonna save up some money, and we're gonna get that, uh, you know, the, the plumbing fixed," but I'm actually spending it on drugs, those types of things, and, you know, that, uh, hurts people. The, the, I, I've, I've... and I, and it's very important to acknowledge that because sometimes the language about the message that sometimes government, public health people have given about addiction is a disease, sounds scolding to people who've been harmed by addicted people. Like, like I'm saying, "You, you know, you're, I... We don't feel sorry for you. We feel sorry for this person. They're ill," and, you know, it's almost like, "How dare you be angry at, at, at your mother? She was ill. It wasn't her fault." It's like, i- it still hurts, you know? It doesn't, you know... If, if someone who has dementia, uh, you know, goes on a, um, an angry rant and says a lot of nasty things, it still hurts. It's still scary. The fact that it's a disease is, doesn't change your experience, you know, as a person. And, uh, so I'm always, I'm always, uh, trying in public messaging to acknowledge that the pain is enormous. It's really tough to live with an addicted person. It's hard.

    26. AH

      It's a complicated problem, uh, from a public health and, uh, psych- just psychologically. I mean, we're in the wake right now of the, uh, Robert Reiner and his, and his wife being-

    27. KH

      Yeah

    28. AH

      ... killed by stabbing, which is, seems additionally violent and horrible, by their son, it seems, he's been charged anyway, um, who was an addict, and the photos of him that are going up, uh, make him look quite angry and deranged-

    29. KH

      Mm-hmm

    30. AH

      ... frankly. It's gonna be interesting to see how that shapes people's views of addicts and addiction, and the fact that he was, um, supported by his parents for a long time in that addiction. They even made a movie together-

  22. 2:00:58 – 2:09:53

    Overcoming Addiction, Immediate Rewards, AA; Addict & Co-Dependency?

    1. KH

      so there'll be, you know, grief and sadness about that.

    2. AH

      Asking why would you want to quit-

    3. KH

      Yeah

    4. AH

      ... [chuckles] is a very interesting question.

    5. KH

      Seems strange, doesn't it?

    6. AH

      Yeah, and I wanna talk for a moment, uh, about the carrots and the sticks.

    7. KH

      Mm-hmm.

    8. AH

      Um, the sticks are kind of obvious in most cases. "Well, if I wasn't smoking, I wouldn't have to pay for cigarettes, I wouldn't smell bad, I wouldn't, I wouldn't cough so much." Um, uh, the carrots are often a little more cryptic and probably harder for people to think about, for the addict to think about, um, if they're very far into their addiction. Um, recently, there, observed some spectacularly enormous, [chuckles] frankly, weight loss achievements of some famous people, uh, country music singer Jelly Roll, forgive, uh, me, that's his name. [chuckles] Um, I didn't name him that. He, that was his name. He was a giant man. He was, like, close to four- in excess of, like, 400 pounds or something, lost over 300 pounds, and he's a transformed human being. The way he talks about what he's doing, he's, he's running 5Ks and half marathons. I mean, he's a completely different person, and, um, but for somebody who's still stuck in the very large body, they can't-... imagine those carrots, because they've never really lived in them. And so how do you make a, a carrot motivation, a positive motivation, feel real for a patient, um, in a way that it can really pull them forward, as opposed to just all the stuff that they're not gonna feel? Because you have to be pretty close to losing it all for the, the sticks to really matter.

    9. KH

      Yeah. Yeah, so all people, to some extent, you know, discount future rewards to some-- you know, like, so we buy the $5 latte instead of putting it in our retirement, even though if we did that every day, we would have a million dollars, you know, when we were 65, right? And in addiction, they do it even more. So pe- when, in, in, in addition, if you a- ask people about what, you know, what about something, would you, would you take, you know, uh, $5 today or $20 tomorrow? They're more likely to say $5 right now, it, almost as if tomorrow doesn't exist. So this really is a problem, and you can't really say to people, "You know, if you, if you get in recovery, after, like, five years, you're probably gonna-- I bet you'll meet a nice person, and you'll, you'll get married and settle down, and you, and then you'll go back to school and get a job." It's like, that's all, like, you know, fantasy camp kinds of stuff, right? So you have to... It's okay to have those long-term goals. Sometimes those are very motivating, but, uh, you wanna focus on things that are immediate because that's the world they're living in, a world of immediacy. That, you know, you know, for example, you will have more money every day. You know, you will not... If you're using an il- illegal drug, your, your, your risk of arrest will drop to zero immediately once you stop engaging in these transactions. Um, you will feel physically better, um, you know, very, very quickly, uh, than, than you feel right now. And, you know, social reinforcement really matters, too. This is one of the geniuses of the people who developed the 12-step fellowships, the fact that you get literal status by how many days you have not u- or years you have not used the substance, and you get, you know, respect, and, and we, you know, we care about those things for very good reasons. They've been central to the survival of the species. I've, I've always thought it was clever of the, of AA to have the, um, one day at a time concept. Um, you know, which just maybe seems, like, hokey, like a slogan, but you can't suddenly quit drinking for the rest of your life. It's not here yet, right? And that's just seems inconceivable. But can you not drink today? Not drink today and go to a meeting and get some reward for that? Yeah, you can probably do that, and so just do that every day, and then you will have thirty years eventually. But you, you don't have to wait for all those rewards, 'cause it's very, very, very few people can do that, and of the ones who really can, they're probably not very prone to addiction. People who are think that far ahead all the time, uh, and have extremely high self-control, so they'd be less likely.

    10. AH

      And what about the addictions where people either believe or it's actually true that it helps them be more functional in other areas of their life? Less social anxiety with two or three drinks. Um-

    11. KH

      Yeah

    12. AH

      ... you know, taking a prescription stimulant and you can get your work done. Uh, maybe they are true ADHD, but, you know, not revealing anything, you know, that isn't already known. I mean, stimulants raise levels of alertness, alertness is a prerequisite for focus, and you're out the gate, whether it's caffeine or, or people who are taking... And I think even on our dear Stanford campus, I would bet that there are students who are not prescribed Adderall, Vyvanse, and other stimulants that take them-

    13. KH

      Surely

    14. AH

      ... in order to get-

    15. KH

      Yeah

    16. AH

      ... work done. It's a very competitive place, and they're driven, and, um, no one wants to feel tired when you got work to do.

    17. KH

      So this is also part of when you, when you look at motivation. So what-- some people think what you do is, you say, "Drugs are bad. Look at all these things it's ruining. You, you know, it does this. It's hurting you this way, that way, this way." In effect, you're kind of telling the person they're an idiot, right? If you, if you actually do that. So you get them to articulate, "Well, clearly, you like some things about it. What are they?"

    18. AH

      Mm-hmm.

    19. KH

      And put them on the table. "Well, you know, it's just like my friendship group has always drunk, and I would just love those hunting trips. We all get, you know, shit-faced together, and it's real fun." "Okay, so that'd be one thing you're getting. What, what else? Tell me." And you're, you're take- you're not framing this as a struggle between you as the punishing force that's gonna deny that this person has enjoyed something about this or gets something out of it socially. And you say, "So this is why-- so this is what we need to decide. These are the costs, and these are the benefits. It's your life, not mine. You know, do you wanna go for this or not?" And you let... And you, you acknowledge the grief of those things. Like, you know, "Man, I'm used to be so much closer to my college buddies, and now I had to skip our annual trip for the first time 'cause I was afraid I would relapse." Like, wow, that's, that is a real cost. I mean, that has to be grieved. Um, you know, and there, there are many things like that. I, I, I know people with relationships where, um, one person nagged the other to quit drinking, and then, when the person got sober, left them because they changed a lot in ways that they didn't like, and they fa- it turned out there were certain aspects of person, you know, their drinking problem, that worked for that other person, whether it was, "Well, I had more control over the checkbook 'cause you were, you were always drunk, and I got to make my spending decisions by myself," or, um, you know, "I didn't have to... I, I, I find now that we're talking more, I, I realize I don't like a lot of things you say, you know, than before," and that, that, that is all, that's all real. I mean, those, those, those kinds of things happen. Drugs always work in some crude sense. You know, they, they, I mean, necessarily beneficial, but they have some function, right?

    20. AH

      Mm-hmm.

    21. KH

      And you gotta figure that out 'cause that will change if the drug use changes.

    22. AH

      Yeah, the, the partner example is interesting, uh, because there's this whole notion of co-dependents teaming up with or partnering up with addicts. This is why things like Co-Dependents Anonymous and, um, and-

    23. KH

      Yeah, I think that's a bit overstated, honestly, but-

    24. AH

      You think so?

    25. KH

      Yeah, yeah, yeah. One of the really interesting studies was done by, uh, Ruth Konkin, who was my colleague for a while, and it was ab- uh, women who were married to alcoholic men and, um, did, you know, all the things that fit the co-dependent thing. But then the, when the men got sober, and they went back and studied them a year later, the women looked exactly like women of men who had never been alcoholic.

    26. AH

      Hmm.

    27. KH

      So a lot of the things that are attributed to the personality of the co-dependent person is actually a reaction to addiction.

    28. AH

      Mm-hmm.

    29. KH

      You know, they're hyper-responsible. They have to be because, uh, the mortgage won't get paid. Um, you know, they're, they're placating. Well, they have to be 'cause they've got this volatile person, potentially dangerous person. That's where a lot of that comes from, and I think, I think it was a bit unfair-- I mean, obviously, the people have bad taste in partners. There's no, no doubt about that. But maybe a bit unfair to, um, not appreciate a lot of things families do are, are more reactive than something that was preexistent and fit with an addiction.

    30. AH

      ... That's a really important point, because I think, um, most people think the addict-codependent pairing is almost like a prerequisite. Um, and it actually reminds me of this whole literature, which I think is an important literature, uh, that became popular about, you know, avoidant attachment versus anxious attachment, and this idea that-

  23. 2:09:53 – 2:16:21

    Longterm Drug Use, Dopamine, Cues & Relapse; Social Media

    1. KH

      we don't match, not 'cause I picked the wrong person, but that person changed."

    2. AH

      Yeah. In keeping with that, and the original question, which was different stages of addiction perhaps requiring different approaches, there's this idea, perhaps, um, trying to remove my neuroscientist lens here, but I, I believe, I'll just be open about this, I believe that at some point, if you use certain substances long enough, the brain is changed significantly enough that the opportunity for recovery is different depending on whether or not you go to a meeting, which certainly works for, let's just say-

    3. KH

      Mm

    4. AH

      ... all of the addictions-

    5. KH

      Mm-hmm

    6. AH

      ... early on, probably most of them in the middle. But I know a few ex-heroin addicts. They're different.

    7. KH

      Mm-hmm.

    8. AH

      They're still different even though they're sober. I knew them before. Now, it's not a perfect experiment, 'cause there was time, et cetera, but we know that certain drugs actually kill neurons.

    9. KH

      Oh, yeah.

    10. AH

      Certain drugs, certain drugs rewire the reward circuitry, and the person is different. It's not to say that they shouldn't quit.

    11. KH

      Mm.

    12. AH

      Uh, they should. Um, but it's harder to imagine sitting down with someone who's been using heroin or methamphetamines for a number of years and say, "All right, let's think about w- how you're losing. Let's see what you could win in this circumstance." I mean, I, I hope that's the case.

    13. KH

      Mm-hmm.

    14. AH

      But it seems like they're rewired. They're a different beast.

    15. KH

      Yeah, well, that is fundamental to the understanding of the disorder. That is a change in the brain, and there's, you know, you can call it disease, you can call it disorder. I often think of it as, um, deeply maladaptive learning. You know, I'm like, I'm like that rat who really, really believes the most important next thing for me to do is to consume this powder, uh, and when I'm ignoring all the things that I'm, I'm evolved to do instead. Um, so, so, um, it is de- definitely true. You see these changes, and you can observe them in the brain, and it, and it, and it's amazing, you can even predict things that the person can't even report on. So we did some work, uh, myself, Claudia Padula, Brian Knutson, Kelly McNiven, up at the, uh, VA in Menlo Park, of, uh, people who were in a residential program addicted to methamphetamine, all of them off methamphetamine while they were in the residential thing, and, uh, then, uh, giving them, uh, imaging them, uh, and showing them cues of meth-associated things, like the pipe, or the powder, and all that, and asking them, "How much do you like that? What do you feel towards that?" Well, independent of that, there's also, uh, nucleus accumbens activation that you can see, and that predicted who relapsed. Not what they said, but what there was going on in their brain. They didn't even necessarily know it.

    16. AH

      We should say nucleus accumbens is a critical node within the dopamine reward circuitry of the brain that underlies the path to addiction and m- many other things that initially feel good. [chuckles]

    17. KH

      Yeah.

    18. AH

      Um-

    19. KH

      Yeah, that's right.

    20. AH

      So, so the brain was report- it could... Nucleus accumbens, let's just put in dopamine activation-

    21. KH

      Yeah, right, right

    22. AH

      ... as a proxy.

    23. KH

      Right.

    24. AH

      So levels of dopamine activation, so to speak, we're being neurosciency, uh, here, uh, technically precise. Levels of dopamine activation predicted whether or not the person would relapse better than their own self-report of the subjective feeling-

    25. KH

      Yes

    26. AH

      ... of whether or not they would relapse.

    27. KH

      I crave this.

    28. AH

      Got it.

    29. KH

      I like this. I want this. And it helps explain why, um, you know, a- a- addicted people sometimes get a unfair rap, uh, in terms of, well, they, you know, they lie, you know, about what their desires are. "I really, really wanna stop using." Well, you know, I would assume if they're in a residential program for 28 days, they, they do in fact, want to stop using, but they don't have complete insight to what's going on on the inside of their brain, l- like anyone else's. So that, that pers- those two people would both say, "I really, really wanna do this," and one goes out and relapses, and the other doesn't. It doesn't necessarily mean the, the one who relapsed lied. It may just be, "I didn't realize how deeply my brain has been changed," and it's pretty hard for me, given, you know, the neighborhood I live in, to walk around and see no one using drugs, uh, ever, uh, to see no, uh, allusions to drugs in TVs or movies, to see no pipes, to see no powders. Um, and, and that... And, and I'm gonna relapse, because I have rewired, uh, my, my reward system.

    30. AH

      So in 12-step, when they talk about your addict brain or one's addict brain, "That's my addict brain." That's your, that's your addict brain talking. That's not you. I think this study that you referred to, I think, pinpointed the addict brain is, at least in part, nucleus accumbens dopamine reward circuitry activation.

  24. 2:16:21 – 2:26:11

    Brain Stimulation, TMS; Homelessness, Substance Use & Rehab

    1. KH

      no nutritive value at all, um, but is clearly seductive.

    2. AH

      I'm out of the lab these days, but if I were to go back into the lab, I'd want to team up with clinicians like you and some of our engineering, bioengineering friends and develop something, which would be similar to what Nolan and company developed for depression, right? Brain stimulation, not just willy-nilly, but of sp- particular brain areas and circuits to try and undo major depression. Wouldn't it be wonderful if there was a brain stimulation device that could tweak the reward circuitry in the presence of a cue-

    3. KH

      Yep

    4. AH

      ... that predicted methamphetamine for the amphetamine addict, or alcohol for whatever, process behavioral addictions, and wouldn't eliminate the ability to experience reward, but would eliminate the s- the essentially the bad addiction or, or tamp it down, tamp down the rewarding properties of the bad a- addiction.

    5. KH

      Mm-hmm.

    6. AH

      And a- at the same time, do an experiment, a parallel experiment, where you ramp up the reward circuitry in, uh, in the presence of a, uh, something that cued for positive behavior. Because I don't think you can just tamp down reward circuitry. This is, uh, one of the challenges I have with the, um... You know, okay, obviously, abstinence is gonna be critical, but for somebody that has a nucleus accumbens, and we all do, [chuckles] uh, it's gonna wanna latch on to something, and I've seen so many addicts pivot to the next thing. Sometimes it's a healthy thing.

    7. KH

      Mm-hmm.

    8. AH

      Many ultra runners are addicts.

    9. KH

      I've met people like that, too. Yeah.

    10. AH

      You can't go to a, a 12-step meeting, and this is somewhat cultural and, uh, also, but you can't go to a 12-step meeting and not see people with lots and lots of tattoos. If they have issues with, um, and I'm not demonizing tattoos, but, uh, if they have issues with drugs or alcohol, um, typically smoking will pop up in its place. They need something. We need something, and ideally, it would be, you know, school, and family, and connection, and community, and, uh, public service. Great, if we c- you know, but a device that could help, um, tune the, the specificity of reward, I don't think is outside the realm of, of possible. I'm thinking like a Stanford guy now, we all- we like to engineer everything.

    11. KH

      Yeah, yeah.

    12. AH

      But, but why not? It's being done for OCD, it's being done for depression, it's being done for PTSD, [chuckles] it's being done for, for so many things. I mean, after all, it's plasticity that we're after.

    13. KH

      Yeah, I mean, and you're, you're right, that, that, the, um, one of the challenges is, you know, addiction is-- it's not like it's introduced something new into the body, it's working on the very system we use to negotiate life. It is the thing we use for, you know, learning, you know, acquisition of knowledge, acquisition of skills. So it's, um, it's not like if, if we just didn't have that, we would be better off. We wouldn't be better off. We, we couldn't survive without it. The only neurosurgery patient is at West Virginia University, you know, who had a very uncontrollable addiction and got-- I'm not exactly sure of the nature of the implant, if it's a stim- stimulating implant. Uh, that's happened once. It was covered. People want to read about it, Lenny Bernstein, a friend of mine at Washington Post, interviewed that, that patient and the team. But I think that is likely that we will see, uh, something like that. I suspect we will see more rTMS, right, uh, you know, transcranial magnetic stimulation, because it's not so invasive, not so expensive, and not so risky. We're, we're about to start, led by Greg Salem, he's a really good psychiatrist, a multi-site study with, uh, uh, rTMS to the dorsolateral prefrontal cortex for, um, people who are, uh, cannabis use disorder, uh, addicted to cannabis. Um, there are lots of people working on these, uh, protocols for, for alcohol, for cocaine. Doesn't always work. Uh, you know, r- rTMS is ki- almost saying like rTMS is almost like saying, "We put them on pills,"-

    14. AH

      Right

    15. KH

      ... because there's, you know, w- what brain region-

    16. AH

      Sure

    17. KH

      ... at what intensity, all that kind of stuff. But, um, that is a way, you know, to intervene far more directly, you know, to the brain than talk therapy, for example.

    18. AH

      Mm-hmm.

    19. KH

      Um, so, um, you know, I think, I think that is certainly possible. Uh, im- and implants made possible-- This particular case was someone who was very, very, very... Had tried everything on Earth and still couldn't stop. And interestingly, even with the, the, uh, implant, still needs medications, goes to lots of 12-step meetings. It's, it, it didn't just made it, make it disappear. Can say, though, uh, uh, we haven't talked about GLP-1 agonist, if we w- want to get into that, that is maybe something that would-... have the lasting effect on changing what one wanted.

    20. AH

      I definitely want to talk about GLP-1s. I think be- just before we pivot there-

    21. KH

      Okay.

    22. AH

      Um, when I think about the, quote, unquote, "homeless problem"-

    23. KH

      Yes

    24. AH

      ... living in California, you can't but see this. Um, I think of it as at least, you tell me where my numbers are off, fifty percent an addiction problem, either first or also.

    25. KH

      Mm-hmm.

    26. AH

      Um-

    27. KH

      In this economy-

    28. AH

      So-

    29. KH

      Yeah.

    30. AH

      Yeah, I mean, those folks aren't going to go to 12-step meetings.

  25. 2:26:11 – 2:29:08

    Addiction Treatment Policy, Rehab & Insurance

    1. KH

      and then make better decisions for themselves.

    2. AH

      I know you've been involved in legislature, it, and it's always nice when a guest, I can say you did that under a Republican administration and a Democrat-

    3. KH

      Yeah

    4. AH

      ... a Democratic administration, so, uh, we don't have to get into partisan politics here. Uh, two administrations, [chuckles] uh, opposite sides of the aisle, your goal there was to get better legislature as it relates to addiction and treatment of addiction.

    5. KH

      Correct.

    6. AH

      Yeah.

    7. KH

      Yeah, yeah.

    8. AH

      So where are we at? What do we need?

    9. KH

      Since, like, 2008, up to present moment, has been-... the best addiction treatment policy we've had as a country, and that was because 2008 is when parity legislation came in. This means, like, Blue Cross, Aetna, and all those, when they cover stuff, they have to cover mental health and addiction, too, at, at, at a comparable level. And th- those laws have expanded to cover more and more people on the private side. Then on the public side, the expansion, particularly of Medicaid, has become the, the backbone of a substance use treatment system. Like in places where I'm from, West Virginia, I happen to know it's the biggest spender, you know, of the addiction treatment system. That is good. That has made treatment in, um, better quality, easier to access, and because Medicaid is a mainstream healthcare player, it helps integrate addiction care better into the rest of the healthcare system.

    10. AH

      So excuse me for interrupting, but practically speaking, so somebody's got a son or a daughter who's got an opioid issue or an alcohol issue-

    11. KH

      Yeah

    12. AH

      ... and they want help. Um, if they have insurance, they can go to a treatment center, and it will mostly or completely be covered by insurance?

    13. KH

      It depends on the plan. I wouldn't promise anyone in particular, but here's what used to be legal. It used to be a plan could say, "Your co-payment for an outpatient visit is five bucks, unless it's mental health or substance use. In that case, it's twenty-five bucks." Or, "You're allowed to have up to th- you know, six months of hospitalization a year, unless it's mental health and substance use, then you're allowed to have fourteen days." Those kinds of things, which made very skimpy benefits, are now illegal in almost all plans.

    14. AH

      Interesting.

    15. KH

      So the odds as, as a mom or dad, when you open up the plan today, that your, your, whatever you got through your work or, or wherever, will give your kids something that they need, is just way, way higher than it's ever been before, and that was due to advocacy and, and changing the law and changing the regulations. 'Cause obviously, covering care costs money. Insurers don't like to, you know, cover care. They, you know, they have to, but they also don't want to, and so, you know, keeping the pressure on, they have to follow the law. So in, in that sense, we're in a, in a better place on the private side. The challenge on the public side will be the, uh, contraction of Medicaid. So, you know, the, the budget bill that was passed this last year takes about a trillion dollars, roughly, out of Medicaid over the coming years, and, you know, s- a number of people on Medicaid have substance use problems. So how they will get substance use care and, and other care that they need is not entirely clear. So I'm quite, uh, I'm worried about the impact of

  26. 2:29:08 – 2:38:08

    Tool: 12-Step Programs, AA, Accessibility & Benefits

    1. KH

      that, especially on low-income Americans who are dealing with addiction.

Episode duration: 3:27:00

Install uListen for AI-powered chat & search across the full episode — Get Full Transcript

Transcript of episode t6RCTP4fc9Q

Get more out of YouTube videos.

High quality summaries for YouTube videos. Accurate transcripts to search & find moments. Powered by ChatGPT & Claude AI.

Add to Chrome