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Understanding & Treating Addiction | Dr. Anna Lembke

In this episode I interview Dr. Anna Lembke, MD, Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University School of Medicine. Dr. Lembke is a psychiatrist and expert in treating addictions of all kinds: drugs, alcohol, food, sex, video games, gambling, medication etc. She is also an expert in the opioid crisis and the author of Dopamine Nation: Finding Balance in the Age of Indulgence. We discuss the biology and psychology of why people become addicted to certain substances and behaviors and the key role that our “dopamine balance” plays in creating addiction. We also explore the science and practice of how to conquer addictions, why people relapse and how to avoid relapsing. Dr. Lembke shares her expertise on topics closely related to addiction such as community, shame and lying, and she explains why telling the truth—even about the most basic things in daily life—adjusts dopamine levels in our brains. This episode is an important one for anyone struggling with addictions of any kind, for their friends and families and for health care professionals. It is also for anyone who has defeated addiction and is determined to stay clean. Last but not least, it helps explain why all humans do what we do and how we can all maintain a healthy sense of pleasure seeking in life. For an up-to-date list of our current sponsors, please visit our website: https://www.hubermanlab.com/sponsors. Previous sponsors mentioned in this podcast episode may no longer be affiliated with us. Social & Website Instagram: https://www.instagram.com/hubermanlab Threads: https://www.threads.net/@hubermanlab Twitter: https://twitter.com/hubermanlab Facebook: https://www.facebook.com/hubermanlab TikTok: https://www.tiktok.com/@hubermanlab Website: https://www.hubermanlab.com Newsletter: https://www.hubermanlab.com/newsletter Apple Podcasts: https://apple.co/3thCToZ Spotify: https://spoti.fi/3PYzuFs Dr. Anna Lembke Website: https://www.annalembke.com Stanford Profile: https://profiles.stanford.edu/anna-lembke Dopamine Nation (new book): https://amzlink.to/az09noicps3RR Timestamps 00:00:00 Dr. Anna Lembke, Addiction Expert 00:02:25 Disclaimer & Sponsors: ROKA, InsideTracker, Headspace 00:07:00 Dopamine, Happiness & Impulsivity 00:15:56 What Is Pleasure? 00:18:20 Addiction, Boredom & Passion for Life 00:24:00 Pain-Pleasure Balance Controls Addiction 00:29:10 Dopamine Deficits, Anhedonia 00:30:47 Are All Addictions the Same? 00:35:38 Boredom & Anxiety Lead to Creativity 00:40:35 Finding Your Passion Starts with Boredom & Action Steps 00:50:05 How to Break an Addiction 00:55:25 Relapse, Craving & Triggers 01:07:40 Can People Get Addicted To “Sobriety”? 01:11:45 Are We All Wired for Addiction? 01:15:57 Bizarre Addiction 01:18:14 Recovered Addicts Are Heroes 01:20:10 Lying, Truth Telling, Guilt & Shame 01:30:40 Clinical Applications of: Ibogaine, Ayahuasca, Psilocybin & MDMA 01:40:20 Social Media Addiction 01:51:25 Narcissism 01:53:30 Goal Seeking, Success & Surprise 01:58:10 Reciprocity 02:01:15 Closing Comments, Resources Disclaimer: https://www.hubermanlab.com/disclaimer

Andrew HubermanhostAnna Lembkeguest
Aug 16, 20212h 2mWatch on YouTube ↗

CHAPTERS

  1. 0:00 – 9:00

    Intro, Guest Background, and Dopamine Obsession

    Andrew Huberman introduces the episode, outlines his aim to deliver zero-cost science tools, thanks sponsors, and presents guest Dr. Anna Lembke, a Stanford psychiatrist specializing in addiction. They set the stage by acknowledging public fascination with dopamine and its reputation as the “pleasure” molecule, then ask what dopamine really is and what people misunderstand about it.

  2. 9:00 – 16:30

    Dopamine Basics: Neurotransmission, Reward, and Movement

    Lembke explains dopamine as a neurotransmitter that transmits signals between neurons and is central both to reward and movement. She introduces tonic (baseline) dopamine levels versus phasic deviations above and below that baseline, emphasizing that it’s the deviation that we feel as pleasure or pain, not absolute levels.

  3. 16:30 – 26:30

    Temperament, Impulsivity, and Vulnerability to Addiction

    The discussion turns to how temperament and traits like impulsivity, anxiety, and baseline excitement might shape addiction risk. Lembke distinguishes impulsivity (acting without delay between urge and action) from startle or anxiety and notes that some traits we pathologize as mental illness might be adaptive in other environments.

  4. 26:30 – 43:00

    What Is Pleasure? Escaping Pain and the Boredom of Modern Life

    Lembke complicates the notion of pleasure by explaining that many people initially use drugs or behaviors not to chase euphoria but to escape suffering. She argues that in the modern world, where basic needs are easily met and leisure time is high, many people feel bored and unanchored, particularly those who need more friction and intensity, making them prone to addiction.

  5. 43:00 – 55:00

    Pleasure–Pain Balance and the Mechanics of Addiction

    Here Lembke introduces her central model: pleasure and pain share brain circuitry and function like a balance that seeks homeostasis. Addictive substances and behaviors cause large dopamine surges that tip the balance toward pleasure, followed by compensatory dips toward pain. Repeated use drives the system into a chronic dopamine-deficit state, where nothing feels good except the drug.

  6. 55:00 – 1:05:00

    Addiction as Progressive Narrowing vs. Expansion of Sources of Pleasure

    Huberman offers his formulation that addiction is a progressive narrowing of the things that bring you pleasure, while “enlightenment” (loosely defined) might be a progressive expansion. Lembke relates this to recovery, where the goal is a flexible, resilient pleasure–pain balance that can tilt and re-center rather than a flat, unchanging baseline.

  7. 1:05:00 – 1:17:00

    Friction, Passion, and Doing the Work Right in Front of You

    They unpack the cultural obsession with “finding your passion” versus Lembke’s clinical observation that many addicted or unhappy young people are waiting for the perfect calling while drowning in high-dopamine distractions. She argues for focusing on the immediate work that needs doing—however small—as a path to meaning, stability, and eventually genuine passion.

  8. 1:17:00 – 1:38:00

    One Day at a Time: The Unit of the Day and Habit-Building

    Connecting recovery slogans to neuroscience, they emphasize the 24-hour day as the natural unit for human planning and self-regulation. Rather than obsessing over 10-year visions, people in recovery, high performers, and even special operators succeed by focusing on doing today well and letting those days compound over time.

  9. 1:38:00 – 1:51:00

    The 30‑Day Dopamine Reset: Phases and Expectations

    Lembke details her core clinical intervention: a 30-day abstinence from the problematic drug or behavior to reset dopamine pathways. She breaks down the typical time course—two very difficult weeks, then incremental improvement—while acknowledging that some people need higher levels of care and that not all brains fully recover baseline resilience.

  10. 1:51:00 – 2:10:00

    Relapse, Craving Triggers, and the Itch Metaphor

    They explore why relapse often happens not just after crises but also when life is going well. Lembke describes craving as a trigger-induced mini dopamine spike followed by a mini-deficit, and uses the metaphor of an unbearable itch that one eventually scratches, even in sleep, to convey the involuntary nature of relapse in severe addiction.

  11. 2:10:00 – 2:21:00

    Addiction to Recovery Itself and the Role of Community

    Huberman asks whether people can become addicted to recovery communities like 12‑step groups. Lembke openly embraces this idea, arguing that if one must be addicted to something, being “addicted” to a pro-social, truth-telling, service-oriented community is far better than drugs. She ties this to oxytocin–dopamine circuitry and discusses social bonding as a healthy source of intense reward.

  12. 2:21:00 – 2:43:00

    Truth-Telling, Shame, and Rebuilding the Self

    The conversation pivots to the central role of radical honesty in recovery. Lembke notes that people in 12‑step programs insist on eliminating even small, unrelated lies. She links this to neuroscience showing that truthful behavior may strengthen prefrontal control over limbic and reward circuits, helping restore the very systems addiction erodes.

  13. 2:43:00 – 3:02:00

    Psychedelics, Quick Fixes, and Cautious Optimism

    They address burgeoning interest in psychedelic-assisted treatments (psilocybin, MDMA, ibogaine) for addiction and trauma. Lembke grants that carefully controlled clinical trials show promising short-term results but remains skeptical that condensed “transformational” experiences can solve a chronic, relapsing condition, and warns about misinterpretation and risky self-experimentation in the general public.

  14. 3:02:00 – 3:26:00

    Social Media as a Drug and Strategies for Control

    Drawing on her role in the documentary “The Social Dilemma,” Lembke insists that social media must be viewed as a deliberately engineered drug. Together they discuss how platforms exploit dopamine through endless scrolls, likes, and social comparison, the infantilizing effect of phones, and practical strategies like phone-free spaces, time-boxing use, and building offline tribes.

  15. 3:26:00 – 3:54:00

    Narcissism, Achievement Culture, and Process over Outcomes

    They close by examining how social media and meritocratic cultures amplify narcissistic preoccupation and performance pressure. Lembke contrasts today’s medical students, driven to “do everything,” with her own simpler aim of becoming a good doctor. She and Huberman converge on the idea that orienting toward daily process, service, and authenticity—rather than chasing recognition—is both more sustainable and more likely to produce meaningful “success.”

  16. 3:54:00

    Conclusion and Resources

    Huberman wraps up by reiterating the value of Lembke’s insights and strongly recommending her book “Dopamine Nation.” He reminds listeners how to support the podcast, engage via comments and Patreon, and thanks them for their interest in science.

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