EVERY SPOKEN WORD
155 min read · 31,059 words- 0:00 – 2:25
Dr. Anna Lembke, Addiction Expert
- AHAndrew Huberman
(instrumental music) 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. Today, I have the pleasure of introducing Dr. Anna Lembke. Dr. Lembke is a psychiatrist and the Chief of the Addiction Medicine Dual Diagnosis Clinic at Stanford University School of Medicine. She's a psychiatrist who treats patients struggling with addiction. She has successfully treated patients dealing with drug addiction, alcohol addiction, and behavioral addictions, such as gambling and sex addiction, as well as other types of addiction. In fact, during our discussion, I learned that there are a huge range of behaviors and substances to which people can become addicted to, and that there is a common biological underpinning of all those addictions. I also learned that there's a common path to the treatment and recovery from essentially all addictions. Dr. Lembke explained that to me and explained how to think about and conceptualize our own addictions, as well as the addictions of other people who are struggling to get treatment, move through treatment, and stay sober from their addictions. In addition to treating patients, Dr. Lembke is an author and was featured in the 2020 Netflix documentary, The Social Dilemma. I'm excited to tell you that she has a new book coming out called Dopamine Nation: Finding Balance in the Age of Indulgence. The book comes out August 24th and is an absolutely fascinating read into addiction and ways to treat various types of addiction. I've read the book cover to cover, and all I'll tell you is that at the very first chapter and throughout, you are going to be absolutely blown away. The stories about her patients are extremely engaging. It brings forward the real struggle of addiction and the incredible, I think it's fair to say, heroic battles that people fight in order to get through addictions of various kinds. And all of that is woven through with story, with science in ways that make it very accessible to anyone, whether or not you have a science background or not. I can't recommend it highly enough. So again, the book is Dopamine Nation: Finding Balance in the Age of Indulgence. It comes out August 24th of this year, 2021, and you can pre-order that book by going to Amazon. We will provide a link to that in the show caption.
- 2:25 – 7:00
Disclaimer & Sponsors: ROKA, InsideTracker, Headspace
- AHAndrew Huberman
Before we begin, I just want to mention 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, I'd like to thank the sponsors of today's podcast. Our first sponsor is ROKA. ROKA makes sunglasses and eyeglasses that are of the absolute utmost quality. Founded by two all-American swimmers from Stanford, everything about the sunglasses and eyeglasses that ROKA makes was designed with performance in mind. First of all, they're very lightweight. You don't even really notice that they're on your face. Second of all, even if you get sweaty, they don't slip off. In fact, they were designed to be worn at work or around the house, but also if you're running or biking, so you can move seamlessly between different activities without having to change your sunglasses or eyeglasses. In addition, the lenses are designed with the science of the visual system in mind. I've spent my career working on the science of the visual system, and I can tell you that it's not trivial to build a lens that allows you to see with perfect clarity whether or not you're in bright sunshine and then move into shadows, but the ROKA glasses allow you to do that. You always see things with absolute clarity. Another terrific thing about ROKA eyeglasses and sunglasses is the aesthetic. A lot of so-called performance sunglasses and eyeglasses, they're not really built with the best aesthetic, and they kind of make people look like cyborgs. With ROKA, they have a lot of different styles to choose from, but all those styles are of the sort that you could wear out to dinner or to work or when engaging in physical activity. If you'd like to try ROKA glasses, you can go to ROKA, that's R-O-K-A, .com and enter the code HUBERMAN at checkout, and if you do that, you'll get 20% off your first order. Today's podcast is also brought to us by InsideTracker. InsideTracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and reach your health goals. I'm a big believer in getting regular blood work done, and I've been doing that for a number of years for the simple reason that most, if not all of the factors that impact your immediate and long-term health can only be analyzed in detail with a quality blood test. And now with the advent of modern DNA tests, you can get further insight into what's going on beneath the hood, so to speak. The problem with a lot of blood and DNA tests, however, is you get numbers back, you get the levels back of various things, and you find out if certain things are too high or too low or right on target, but there are no directives about how to move those numbers in the direction that you would want them to go. With InsideTracker, they have a dashboard that makes all of that very easy, and that dashboard takes your numbers and can help direct you towards particular lifestyle factors, nutrition factors, exercise, supplementation, et cetera, that can help you bring those numbers into the ranges that are right for you. If you'd like to try InsideTracker, you can go to insidetracker.com/huberman, and if you do that, you'll get 25% off any of InsideTracker's plans. Just use the code HUBERMAN at checkout. Today's episode is also brought to us by Headspace. Headspace is a meditation app that's backed by 25 published peer-reviewed studies and has over 600,000 five-star reviews. I've been meditating for a very long time. I'm 45 years old now, almost 46, and I started meditating when I was about 15 years old. The problem, however, is keeping up a meditation practice. I've experienced this myself. I've had periods of time where I'm meditating regularly and then periods of time where I just kind of fall off the rails and I'm just not doing it at all. There's now tons of evidence, evidence from neuroscience, evidence from psychology, evidence from areas of biology focused on stress and the immune system, that a meditation practice, when done regularly, is extremely beneficial for mental and physical health and things like focus and creativity.However, you have to do the meditation practice and so if you're not doing it regularly, that's a serious problem. And if you are doing it regularly, great. With Headspace, I find that I can stick to a meditation practice very easily. In fact, that's why I started using it and that's why I continue to use it. I try and get a meditation practice in every day, but sometimes that requires that it be a brief meditation practice. With Headspace they have a huge range of different meditations of different durations, and so that's really helpful in building and maintaining these powerful meditation practices. If you want to try Headspace, you can go to headspace.com/specialoffer, and if you do that you'll get a free one-month trial with Headspace's full library of meditations. This is the best deal offered by Headspace. Basically, you get access to everything they've got completely free for a one-month trial. So if you'd like to try that, go to headspace.com/specialoffer. And now for my discussion with Dr. Anna
- 7:00 – 15:56
Dopamine, Happiness & Impulsivity
- AHAndrew Huberman
Lembke. All right. Great to have you here.
- ALAnna Lembke
Thank you for having me. I'm excited to be here.
- AHAndrew Huberman
Yeah, I have a lot of questions for you. I- I and many listeners of this podcast are obsessed with dopamine and what is dopamine, how does it work? We all hear that dopamine is this molecule associated with pleasure. I think the, uh, the term dopamine hits, like I'm getting a dopamine hit from this, from Instagram or from likes or from praise or from whatever, is now, um, commonly heard. What is dopamine and what are maybe some things about dopamine that most people don't know and probably that I don't know either?
- ALAnna Lembke
So dopamine is a neurotransmitter and neurotransmitters are those molecules that bridge the gap between two neurons. So they essentially allow one neuron, the presynaptic neuron, to communicate with the postsynaptic neuron. Um, dopamine is intimately, uh, associated with the experience of reward, but also with movement, which I think is really interesting because movement and reward are linked, right? If you think about, you know, um, early humans, it, you had to move in order to go seek out the water or the- the meat or whatever it was. Um, and even in the most primitive organisms, dopamine is released when food is sensed in the environment. For example, C. elegans, a b- a very, um, primitive worm. So, um, dopamine is this really, um, powerful, important molecule in the brain that helps us, um, experience pleasure. It's not the only neurotransmitter involved in pleasure, but it's a really, really important one. And if- if you want to think about something that most people don't know about dopamine, which- which I think is really interesting, is that we- we are always releasing dopamine at a kind of tonic baseline rate and it's really the deviation from that baseline rather than, like, hits of dopamine in a vacuum that make a difference. So when we experience pleasure, our dopamine release goes above baseline, and likewise, dopamine can go below that tonic baseline and then we experience a kind of pain.
- AHAndrew Huberman
Interesting. So is it fair to say that one's baseline levels of dopamine, how frequently we're- are releasing dopamine in the absence of some, uh, I don't know, drug or food or experience, just sitting, being, uh, is that associated with how happy somebody is, their kind of baseline of happiness or level of depression?
- ALAnna Lembke
There is evidence that shows that people who are depressed may indeed have lower tonic levels of dopamine. So that's a really reasonable thought and there is, uh, some evidence to suggest that that may be true. The other thing that we know, and this is, you know, uh, really kind of what- what the book is about, is that if we, um, expose ourselves chronically to substances or behaviors that repeatedly release large a- amounts of dopamine in our brain's reward pathway, that we can change our tonic baseline and actually lower it over time as our brain tries to compensate for all of that dopamine, which is more really than we were designed to- to experience.
- AHAndrew Huberman
Interesting. And is- would- is it, um, the case that our baseline levels of dopamine are set by our genetics, by our heredity?
- ALAnna Lembke
Well, I think, you know, if you think about sort of, y- you know, the early stages of development in infancy, certainly th- that is true. You're kind of, you know, born with probably whatever is your baseline level. But obviously your experiences can have a huge impact on where your- your dopamine level ultimately settles out.
- AHAndrew Huberman
Mm-hmm. So, um, if somebody's disposition is one of, um, constant excitement and anticipation or easily excited, uh, y- these are th- I think about the kind of people where you say, "Hey do you want to check out this new place for tacos?" And they're like, "Yeah, that'd be great." And other people are, um, a little more cynical-
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
... harder to budge, like my bulldog Costello.
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
Um, very- very stable low levels of dopamine with big inflections in his case. Um, w- is that, do you think that's, uh, set in terms of, um, our parents and obviously nature, uh, and nurture interact, but, uh, is that, is dopamine at the core of our temperament?
- ALAnna Lembke
I don't really think we know the answer to that. But I will say that people are definitely born with different temperaments and those temperaments do affect their ability to experience joy. Um, and- and, you know, we've known that for a long time and we describe that in many different ways. One of the ways that we describe that in the modern era is to use psychiatric nomenclature, like this person has a dysthymic temperament.... or, you know, this person has chronic major depressive disorder. Um, in terms of looking specifically at who's vulnerable to addiction, um, that's an interesting sort of mixed bag, because when you look at, uh, the research on risk factors for addictions or what kind of temperament, uh, of a person makes them more vulnerable to addiction, you see, um, some interesting findings. First, you see that people who are more impulsive are more vulnerable to addiction. So what is impulsivity? That means having difficulty, um, putting space between the thought or desire to do something and actually doing it. And people who have difficulty putting a space there, or who have a thought to do something and just do it impulsively-
- AHAndrew Huberman
Mm-hmm.
- ALAnna Lembke
... are people who are more vulnerable to addiction.
- AHAndrew Huberman
Interesting. Could I, uh, I, in terms of impulsivity, is this something that relates literally to, um, the startle reflex? Like I, for instance, as a, uh, lab director, I'm familiar with walking around my lab and, um, when I decide, deciding I'm gonna talk to my people, of course, when they knock on my door, it's always like, "Wait, why am I being bothered right now?"
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
Even though I love to talk to them, but I walk around my lab from time to time, and some people I notice, I'll say, um, "Do you have a moment?" And they'll slowly turn around and say, "Yeah," or "No," in some cases.
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
Um, and other people will jump the moment I say their name.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
They actually have a, uh, a kind of a heightened, um, startle reflex.
- ALAnna Lembke
Right.
- AHAndrew Huberman
Is that related to impulsivity, or is what you're referring to, um, an attempt to, uh, withhold behavior that's very deliberate, u- under very deliberate conditions?
- ALAnna Lembke
Yeah, so I don't think that that startle reflex is, is necessarily related to impulsivity. That, that can be related to anxiety, so people who are high anxiety people will tend to have more of a startle reflex. Impulsivity is a little bit different. And by the way, impulsivity is not always bad, right? Um, impulsivity is, is that thing where there's not a lot of self-editing or worrying about future consequences. You know, you have the idea to do something and you do it. And of course, we can imagine many scenarios where that's absolutely wonderful. Um, you know, there can be a sort of a, let's say, intimate, um, interactions between people where you wouldn't really want to be super inhibited about it, right? You would want to be disinhibited and, and impulsive. Um, there, I can also, like, imagine, like, sort of, um, fight or flight scenarios, like battle scenarios, right, where, where it would really be good to be impulsive and just go, "Rah!" You know? Just go-
- AHAndrew Huberman
Where hesitation can cost you your life.
- ALAnna Lembke
Right. Yes.
- AHAndrew Huberman
Yeah.
- ALAnna Lembke
That's right. That's right. But, you know, a- and I think this, uh, brings up a really, something that I've c- come to believe a- after 25 years of practicing psychiatry, is that what we now conceptualize in our current ecosystem as mental illness are actually traits that in another ecosystem might be very advantageous. They're just not advantageous right now because of the world that we live in, and, and I think, you know, impulsivity is potentially one of those, right? 'Cause we live in this world that's sort of like you have to, um, constantly be thinking sort of rationally about the consequences of X, Y or Z, and it's such a sensory rich environment, right, that we're c- being bombarded with all these opportunities, these sensory opportunities, and we have to constantly check ourselves. And so, so, so impulsivity is something that right now, um, can be a difficult trait, but isn't in and of itself a bad thing.
- 15:56 – 18:20
What Is Pleasure?
- AHAndrew Huberman
what is pleasure and how does it work at the biological level and, um, if, if it feels right, at the psychological level? I think we... And, um, if you don't mind, uh, painting a picture of sort of the, the range of things that you have observed in your clinic or in life that people can become addicted to. But just to start off really simply, what is this thing that we call pleasure?
- ALAnna Lembke
Well, I think it's, it's actually really hard to define pleasure in any kind of succinct way, because certainly there is the seeking out of, um, uh, a, a high or a euphoria or, or I think s- you know, the kind of experience that most anybody would associate with the word pleasure. But, but also, um, the seeking out, uh, of those same substances and behaviors is often a way to escape pain. So for example, when I, when I talk to people with addiction, um, sometimes their initial foray into using a drug is to get pleasure, but very often it's a way to escape their suffering, whatever their suffering may be. And certainly as people become addicted, even those who initially were seeking out pleasure are ultimately just trying to avoid the pain of withdrawal or the pain of the consequences of their drug use. So I, I think it's, you know, uh, very hard to actually, you know, define it as this unitary thing, and it's certainly not just getting a high. There are so many ways in which people sort of want to escape, which is not the same thing as sort of this hedonic-
- AHAndrew Huberman
Mm-hmm.
- ALAnna Lembke
... you know, wanting to feel pleasure.
- AHAndrew Huberman
So someone could decide that they want to go out and dance or get up and dance because of the pleasure of dancing. I can imagine that. Um, but, uh, and maybe it's very difficult for them to stay s- seated when a particular song comes on o- for instance, but, um, seeking what we would call pleasure in order to eliminate pain, th- that evokes a different picture in my mind. That evokes a picture of somebody that, um, feels lost or depressed or underwhelmed, um-... I definitely want to get into the precise and general description of addiction and what that is,
- 18:20 – 24:00
Addiction, Boredom & Passion for Life
- AHAndrew Huberman
but in a previous conversation we had, you said something that really rung in my mind, which is that many people who become addicted to things, uh, let's call them addicts...
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
... um, have this feeling that normal life isn't interesting enough.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
That they are seeking a super normal experience, and that the day to day routine, um, balance, which is actually in the title of your book, uh, Dopamine Nation: Finding Balance in the Age of Indulgence, that the word balance itself can sometimes be a bit of a, a, uh, an aversive term...
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
... for people.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
And, um, I, I'm struck by this idea, and the reason I want to explore it is because so much of what I see online is about generating a lack of balance.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
About being tilted forward at all times, really leaning into life hard, experiencing life, you know, living a full life. Uh, even the commencement sh- speech given by Steve Jobs on this campus was really about finding passion, digging, you know, there's so much in the narrative now.
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
Um, so maybe you could just tell us a little bit about your experience with this asso- association, if it really exists, between, uh, people's sense of the normalcy or maybe even how boring life can be and their tendency to become addicts of some sort.
- ALAnna Lembke
Yeah. Well, I mean, I, I think that life for humans has always been hard, but I think that now it's harder in unprecedented ways. And I think that the way that life is, is really hard now is that it actually is really boring. Um, and the reason that it's boring is because all of our survival needs are met, right? I mean, we don't even have to leave our homes to meet every single physical need, you know, as long as you're of a certain level of financial well-being, which, which frankly, um, you know, we, they, we talk so much about, you know, the, the income gap, and certainly there is this enormous gap between rich and poor. But that gap is smaller than it's ever been in like the history of humans. Um, even the poorest of the poor have more, um, excess income to spend on leisure goods than they ever have before in human history. Um, if you look at leisure time, for example, so people without a high school education have 42% more leisure time than people with a, um, a college degree. Um, so, so w- my, my point here is that life is hard now in this really weird way, in that we don't really have anything that we have to do. So we're all forced to make stuff up, you know, whether it's being a scientist or being a doctor or being an Olympic athlete or, you know, climbing Mount Everest, and people really vary in their need for friction. And some people need a lot more than others, and if they don't have it, they're really, really unhappy. And I do think that a lot of the people that I see with addiction and other forms of mental illness are people who need more friction. Like they're unhappy not necessarily because there's something wrong with their brain, but because their brain is not suited to this world.
- AHAndrew Huberman
And do you think they have that sense, "My brain isn't suited to this world?" Or they simply feel, um, a restlessness and they're constantly seeking stimulation?
- ALAnna Lembke
I think that's right. Yeah. I think it's, it's not really knowing what's wrong with me, um, why am I unhappy? Um, how can I be happier? And of course, as you talk about wha- what's so pervasive in our narrative now is like, find your passion, you know, um, you know, find your, you know, uh, whatever it is to save the world. And in a way that's good because it has people out in the world and seeking. Um, but, but in a way it can also be misleading in the sense that, um, I think people aren't entirely aware that, that the world is a hard place and that, and that life is hard and that, you know, like we're all kind of making it up. Do you know what I mean? (laughs)
- AHAndrew Huberman
Yeah. Well, there's a, a book by Cal Newport, I don't know if you know Cal Newport's work.
- ALAnna Lembke
No.
- AHAndrew Huberman
But, uh, you guys are, um, very symbiotic in your messages, but, uh, he's a professor of computer science at, at Georgetown, uh, yes, at Georgetown, and wrote a book some years ago, really ahead of its time called So Good They Can't Ignore You, which is about not, um, meditating or, uh, doing much work to try and figure out what one's passion is by thinking, but rather go out and acquire skills...
- ALAnna Lembke
Right.
- AHAndrew Huberman
... and get, develop a sense of, of passion for something by your experience of hard work and, and getting better and feedback.
- ALAnna Lembke
Right.
- AHAndrew Huberman
A little bit of the growth mindset thing...
- ALAnna Lembke
Right.
- AHAndrew Huberman
... of our colleague Carol Dweck. But he's gone on to write books, um, Deep Work, and which is all about removing yourself from technology and doing deep work.
- ALAnna Lembke
Yes. Right.
- AHAndrew Huberman
And he's, uh, been a big proponent of the evils of context switching too often throughout the day...
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... for sake of productivity mostly. His new book is called, um, A World Without Email.
- ALAnna Lembke
(laughs)
- 24:00 – 29:10
Pain-Pleasure Balance Controls Addiction
- AHAndrew Huberman
So, um, let's talk about the pleasure pain balance and addiction. And I've heard you use this, uh, see-saw or balance scale...
- ALAnna Lembke
Right.
- AHAndrew Huberman
... um, uh, analogy before, and I think it's a wonderful one, uh, that really for me clarified what addiction is, at least at the mechanistic level.
- ALAnna Lembke
... yeah, so to me one of the most significant findings in neuroscience in the last 75 years is that pleasure and pain are co-located, which means the same parts of the brain that process pleasure also process pain, and they work like a balance. So when we feel pleasure, our balance tips one way. When we feel pain, it tips in the opposite direction. And one of the overriding rules governing this balance is that it wants to stay level, so it doesn't want to remain tipped very long to pleasure or to pain, and with any deviation from neutrality, the brain will work very hard to restore a level balance, or what scientists call homeostasis. And the way the brain does that is with any stimulus to one side, there will be a tip in equal and opposite amount to the other side.
- AHAndrew Huberman
It's like the principal laws of physics.
- ALAnna Lembke
Yes, right.
- AHAndrew Huberman
Yeah.
- ALAnna Lembke
Right? So like, uh, y- I like to watch YouTube videos. When I watch YouTube videos of American Idol, you know, it tips to the side of pleasure, and then when I stop watching it, um, I have a come down, right, which is a tip to the equal and opposite amount, um, on the other side, and that's that moment of wanting to watch one more YouTube video, right?
- AHAndrew Huberman
W- yeah, and I w- I just wanna, um, interject there. So this moment of, of wanting to watch another that is associated with pain, uh, I think, is, are we always aware of that happening? Because you just described it in a very conscious way.
- ALAnna Lembke
Right.
- AHAndrew Huberman
But when I, um, indulge in something I enjoy, I'm usually thinking about just wanting more of that thing.
- ALAnna Lembke
Yes. Yes.
- AHAndrew Huberman
I don't think about the pain.
- ALAnna Lembke
Yes.
- AHAndrew Huberman
I just think about more.
- ALAnna Lembke
Right.
- AHAndrew Huberman
Right.
- ALAnna Lembke
So really excellent point, because we're mostly not aware of it, and it's also reflexive. So we, it's not something that consciously happens or that we're aware of, unless we really begin to pay attention. And, and when we begin to pay attention, we really can become very aware of it in the moment. Again, it's like a falling away, like that mo- you know, you're, you're on social media and, you know, you get a good tweet of something, and then you can't stop yourself because there's this awareness, a latent awareness, that as soon as I disengage from this behavior, I'm going to experience a p- a kind of a pain, right, a falling away, a, a missing that feeling, a wanting more of it. And of course, one way to combat that is to do it more, right, and more and more and more. So I think, I think that is really what I want people to tune into and, and get an awareness around, because once you tune into it you can see it a lot, and then when you begin to see it, you have... and if you, you know, keep the model of the balance in mind, I think it h- it gives people kind of a way to imagine what they're experiencing on a neurobiological level and understand it, and in that understanding, get some mastery over it, which is really what this is all about. Because ultimately, we do need to disengage, right? We can't live in that space all the time, right? We have other things we need to do, and there are also serious consequences that come with trying to repeat and continue that experience or that feeling.
- AHAndrew Huberman
Yeah, so if I understand this correctly, uh, when we find something, or when something finds us-
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
... that we enjoy, that feels pleasureful, uh, social media, food-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... sex, gambling, whatever it happens to be, and we will explore the full range of these, there's a, some dopamine release when we engage-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... in that behavior.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
And then what you're telling me is that very quickly-
- ALAnna Lembke
Yes.
- AHAndrew Huberman
... and beneath my conscious awareness-
- ALAnna Lembke
Mm-hmm.
- 29:10 – 30:47
Dopamine Deficits, Anhedonia
- AHAndrew Huberman
- ALAnna Lembke
Um, but, but what happens right after I do something that is really pleasurable and releases a lot of dopamine is, again, my brain is going to immediately compensate by down-regulating my own dopamine receptors, my own dopamine transmission, to compensate for that, okay? And that's that come down or the hangover, that after-effect, that moment of wanting to do it more. Now if I just wait for that feeling to pass, then my dopamine will re-regulate itself and I'll go back to whatever my chronic baseline is. But if I don't wait, and here's really the key, if I keep indulging again and again and again, ultimately I have, I have so much on the pain side, right, that I've essentially reset my brain to what we call like an anhedonic or lacking-in-joy type of state, which is a dopamine deficit state. So that's really the, the, the way in which pain can become the main driver, is because I've indulged so much in these high reward behaviors or substances, that my brain has had to compensate by way down-regulating my own dopamine, such that even when I'm not doing that drug, I'm in a dopamine deficit state, which is akin to a clinical depression.
- AHAndrew Huberman
I see.
- ALAnna Lembke
I have anxiety, irritability, insomnia, dysphoria, and a lot of mental preoccupation with using again or getting the drug. And so th- that's the piece there. There's the single use.... which easily passes, but it's the chronic use that can then reset really our dopamine thresholds, and then nothing is enjoyable.
- AHAndrew Huberman
Mm-hmm.
- ALAnna Lembke
Right? That then everything sort of pales in comparison to this one drug that I want to keep doing.
- 30:47 – 35:38
Are All Addictions the Same?
- ALAnna Lembke
- AHAndrew Huberman
And that one drug could be a person, right? I mean, I-
- ALAnna Lembke
Yes.
- AHAndrew Huberman
... I know people in my life that are still talking about this one relationship, this one person that was just so great despite all the challenges of that thing, that it's almost like they're addicted to the narrative.
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
Uh, they were maybe or still are addicted to the person.
- ALAnna Lembke
Right.
- AHAndrew Huberman
So it could be to any number of things, video games-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... sex, gambling, a person, a narrative.
- ALAnna Lembke
Right.
- AHAndrew Huberman
To me, and because of the way you described this mechanism, this pleasure-pain balance, that all speaks to the kind of generalizability of our brain circuitry.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
And this is something that fascinates me, uh, and I know it fascinates you as well, which is that, um, nature did not evolve 20 different mechanisms for 20 different types of addiction. Just like anxiety is a couple of core sets of hormones and neurotransmitters and pathways, and one person is triggered by social interactions, another person is triggered by, uh, spiders, but the underlying response is identical. It sounds like with addiction as well there, there may be some nuance, but that there is sort of a core set of processes. So it doesn't really matter if it's gambling or video games or sex or a narrative about a previous lover or partner or whatever. It's the same addictive process underneath that. Is that correct?
- ALAnna Lembke
Yes, exactly.
- AHAndrew Huberman
Okay.
- ALAnna Lembke
And that's where this whole idea of cross-addiction comes in. So once you've been addicted to a substance, severely addicted, that makes you more vulnerable to addiction to any substance.
- AHAndrew Huberman
And when you say substance, uh, does the same d- is what you just said also true for behaviors?
- ALAnna Lembke
Yes. So s- when I u- when I use the word drug-
- AHAndrew Huberman
Yeah.
- ALAnna Lembke
... I'm, I'm talking about substances and behaviors really.
- AHAndrew Huberman
Okay.
- ALAnna Lembke
And b- I'm talking about behaviors like gambling, sex, um, you know-
- AHAndrew Huberman
Porn.
- ALAnna Lembke
... gaming, porn, absolutely.
- AHAndrew Huberman
Work.
- ALAnna Lembke
Shopping, work.
- AHAndrew Huberman
You've accused me-
- ALAnna Lembke
Work. (laughs)
- AHAndrew Huberman
I'll just, for the record, uh, Anna, Dr. Lovejoy has accused me, not accused me, has, um, diagnosed me, uh, outside the clinic-
- 35:38 – 40:35
Boredom & Anxiety Lead to Creativity
- ALAnna Lembke
hold out people in recovery from severe addiction as sort of modern day prophets for the rest of us, because I do think that people who have been addicted and then go get into recovery do have a hard-won wisdom, um, that we can all benefit from. A- and, and the wisdom, I guess, you know, to distill it down, I mean, it's, it's many things, but in terms of, you know, dopamine, the, the wisdom is there are adaptive ways to get your dopamine and there are less than adaptive ways. And in general, um, you could describe the adaptive ways as not too potent, so not tipping that balance too hard or too fast to the side of pleasure.
- AHAndrew Huberman
So does that mean never allowing myself to be absolutely in complete bliss? Or does it mean not allowing myself to stay in that state too long?
- ALAnna Lembke
... the latter. I think the latter. So, a- and th- then that gets to temperament, so I'm gonna get that too in a second. So- so in general, what we want is some kind of flexibility in that balance and the ability to re- easily reassert homeostasis. We don't want to break our balance, which is possible if we overindulge for enough period of time and end up with a balance tipped to the side of pain, this dopamine deficit state we've been talking about. We wanna- we want a flexible, resilient balance, right, which can be sensitive to things going on in the environment, which can experience pleasure and approach, which can experience pain and recoil, right? This is all adaptive and healthy and necessary and good. We would never want a balance that doesn't tilt.
- AHAndrew Huberman
Right.
- ALAnna Lembke
Like that would be a disaster.
- AHAndrew Huberman
Right.
- ALAnna Lembke
We wouldn't be human, um, and we wouldn't want that. It'd be really, really boring. On the other hand, what people in recovery from addiction talk about is to some extent having to learn to live with things being a little boring a lot of the time, right? So trying to avoid some of this intensity and thrill-seeking and escapism that really is at the core of addictive tendencies.
- AHAndrew Huberman
Uh, sorry to interrupt-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... but when you say boring, um, can we add stressful and boring?
- ALAnna Lembke
Yes.
- AHAndrew Huberman
Because there are days where I'm not ex- w- I have to- I'm one of these people, I have to remind myself to have fun-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... because I sort of forgot what the term means-
- ALAnna Lembke
Yeah, right.
- AHAndrew Huberman
... because I've- I like to think that I experience a lot of pleasure in little things-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... but I- I'm a pretty hard-driving guy. I l- I like goals and big milestones, all that stuff.
- ALAnna Lembke
Right.
- AHAndrew Huberman
Anyway, um, the point being that many days, I'm not bored thinking, "Oh, there's nothing to do," but I am kind of overwhelmed by the number of things that are really not pleasureful-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... that I have to do.
- ALAnna Lembke
Right.
- AHAndrew Huberman
I won't mention what they are-
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
... 'cause I- I don't want my (laughs) - I don't want my colleagues to be like, "So that's why you don't respond to emails."
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
Um, no, just your emails.
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
Um, not yours, Anna, but theirs. Um, in any event, um, so anxiety and boredom can hang out together, right?
- 40:35 – 50:05
Finding Your Passion Starts with Boredom & Action Steps
- ALAnna Lembke
this gets back to our conversation a little bit earlier about finding your passion. So I think that o- one of the big problems now that's very misguided about this idea of finding your passion, it's almost as if people are looking to fit the key into the lock of the thing that was meant for them to do.
- AHAndrew Huberman
Right, and then everything will feel like a natural progression.
- ALAnna Lembke
Right, and then everything will be wonderful and, uh-
- AHAndrew Huberman
I can attest to the fact that is not how it works-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... in any endeavor.
- ALAnna Lembke
Right.
- AHAndrew Huberman
It's-
- ALAnna Lembke
And that you'll have all this great success or, you know, but... A- and here- here's where I really think the answer lies, and I really, really believe this. Stop looking for your passion, and instead look around right where you are. Stop distracting yourself, look around right where you are, and see what needs to be done. So not what do I want to do, but what is the work that needs to be done? And more importantly, it doesn't have to be some grandiose work. Like does the garbage need to be taken out, right? Is there some garbage on your neighbor's lawn that someone threw there that you could actually bend over and pick up and put into the garbage can? Look around you. There is so much work that needs to be done that nobody wants to do that is really, really important, and if we all did that, I really think the world would be a much better place. And this is what people who have severe addiction who get into recovery realize. They're like, "It's not about me and my will and what I'm going to will in my life or in the world. It's about looking around. What needs to be done? What is the work that I am called to do in this moment?" Which also is incredibly freeing, because I don't have to search for the perfect thing. There's a lot of burden now on young people, that they have to find that perfect thing and until they've found that perfect thing, they're gonna be miserable. You don't have to do that. Look at the life you were given, look at the people around you, look at the jobs that present themselves to you, and do that job simply and honorably one day at a time, in a- with a kind of humility. I think this is really what- what's so striking to me about the wisdom of people in recovery. There's this incredible humility that comes out of that experience. You feel so broken, so ashamed, but you pick yourself up one day at a time and you build a life that's around......what can I do right in this moment that might benefit another person and thereby benefit me?
- AHAndrew Huberman
Yeah. It's, um, a really important point. And, um, and if you're willing, I'd like to actually stay on this issue of, of passion, um, because, uh, I think the dopamine systems, if I understand them correctly, the dopamine systems merge with this work that you're referring to, this immediacy of things calling to us, like taking out the trash, which sounds frankly really boring-
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
...um, to be honest.
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
I, I hate taking out the trash-
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
...but I do it, 'cause I like a clean home and I like-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
...a home that-
- ALAnna Lembke
Right.
- AHAndrew Huberman
...a home that smells good.
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
Um, or at least doesn't smell bad.
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
Uh, so we do these things and, um, not that we want to offer some larger carrot as a consequence of doing those things, but if I understand correctly, what you're saying is, in the act of looking at one's immediate environment, acting on that immediate environment, we cultivate a relationship to these circuits in our brain about action and reward that, at least to my mind, span the range of small things being rewarding and then lead us to bigger things being rewarding. It's not like all we're going to do is take out trash and, and tend to house. We eventually will venture out and we event- eventually will find careers and, and work on those. But if I understand correctly, you're talking about getting into a sort of functional or adaptive action step, and it's the action step that these days we tend to overlook because most of our mindset is in things that are truly in, outside of the, our immediate reality. Do I have that correct?
- ALAnna Lembke
Yeah. That was beautifully said, and I would just add to that, I see a lot of young people who, for example, spend most of their waking hours playing video games. And they come to me and they say, "I'm anxious and depressed. I'm majoring in computer science. I hate it. I thought I would like it. You know, if I could only find that thing that I was really meant to do, my life would be better." And my first intervention for the many, many people like that that I see in clinical care is, "You have it backwards." I don't say it quite like that. You are waiting for that thing to pull you out of the video game world, and you're never gonna find it as long as you're playing video games, 'cause video games are so powerfully dopaminergic that you have this distorted sense of really pleasure and pain, and you, you will not be able to find that thing that you enjoy. And so of course the intervention is abstain from video games, reset your reward pathways, start with a level balance. And what invariably happens, and I've just seen it over 20 years so many times I've become really a, you know, a believer in this, um, all of a sudden it's like, "Oh, wow, my computer science class is interesting this quarter." It's like, okay, you know, you, you have a receptivity then to experiencing pleasure and reward in a way you just don't have when you're bombarding your reward pathways with these high-dopamine drugs.
- AHAndrew Huberman
Very interesting. Um, and just to underscore this notion that tending to the immediate things can lead to super performance, um, uh, I may have mentioned it earlier this episode, um, but if I didn't, I'll mention now, which is, I have the, the great privilege of having some close friends that were in the SEAL teams and doing some work with those communities. And it's a remarkable community for reasons that I think most people don't understand. We, people think of, they see the images carrying logs down the beach and all the, blowing stuff on, all the, all the stuff that's, that's fun for guys like that, but, uh, all of the guys I know who were in the SEAL teams have this sense of duty about immediate things.
- ALAnna Lembke
Mm.
- AHAndrew Huberman
Um, and not just holding the door and doing the, helping with the dishes and moving things around.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
They are constantly scanning their environment for what can be done.
- 50:05 – 55:25
How to Break an Addiction
- AHAndrew Huberman
that in order to reset the dopamine system, essentially in order to break an addictive pattern, to become unaddicted, 30 days of zero interaction with that substance, that person, et cetera.
- ALAnna Lembke
Right.
- AHAndrew Huberman
Is that correct?
- ALAnna Lembke
Yeah. And- and 30 days is, in my clinical experience, the average amount of t- of time it takes for the brain to reset reward pathways for dopamine transmission to regenerate itself. There's also a little bit of science that suggests that that's true. Some imaging studies showing that, um, our brains are still in a dopamine deficit state two weeks, um, after we've been using our drug, and then a, a study by Schuckit and Brown which took a group of, um, depressed men who also were addicted to alcohol, put them in a hospital where the o- they had received no treatment for depression but they had no, no access to alcohol in that time. And after four weeks, 80% of them no longer met criteria for major depression. So again, eh, this idea that by depriving ourselves of this high dopamine, high reward substance or behavior, we allow our brains to regenerate its own dopamine to, for the balance to really
- NANarrator
(laughs)
- ALAnna Lembke
... quili- right, and then we're in a, a place where we can sort of enjoy other things.
- AHAndrew Huberman
Mm-hmm. So that progressive narrowing...
- ALAnna Lembke
Right.
- AHAndrew Huberman
... of what brings one pleasure-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... eventually expands. So I'd like to, um, dissect out that 30 days a little more-
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
... finally, um, and I also want to address how does one stop doing something for 30 days if the thing is a thought?
- ALAnna Lembke
Mm.
- AHAndrew Huberman
So we'll kind of s- put that on the shelf-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... for the moment. So days one through 10, I would imagine will be very uncomfortable.
- ALAnna Lembke
Yes.
- AHAndrew Huberman
They're gonna suck-
- ALAnna Lembke
Right. (laughs)
- AHAndrew Huberman
... basically, to be quite honest, because what e- the way you described this pleasure-pain balance-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... to my mind says that if you remove what little pleasure one is getting, or a lot of pleasure from engaging in some behavior, that's gone, the pain system is really ramped up-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... and nothing is making me feel good, I'll just use myself as an example, I'm not in recovery, but, you know, that 10 days is gonna be miserable.
- ALAnna Lembke
Right.
- AHAndrew Huberman
Anxiety.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
Trouble sleeping.
- ALAnna Lembke
Yep.
- 55:25 – 1:07:40
Relapse, Craving & Triggers
- AHAndrew Huberman
and over again, sadly often in the same individuals, is they get sober from whatever, they're doing great, these are people with families, these are people that you discard your normal image of an addict and insert the most normal, typical, whatever, healthy person you can imagine, 'cause a lot of these people you wouldn't know were addicts, and then all of a sudden you get this call, "So-and-so's back in jail. So-and-so's wife is going to leave him because he drank two bottles of, of wine and took a Xanax at 7:00 AM, crashed his truck into a pole, has got two beautiful kids." Like how did this happen again? To the point where by the fourth and fifth time people are just done. I mean, uh, maybe people, you might be able to detect the frustration in my voice, I'm dealing with this with somebody that's like, "I, I don't even know that I want to help this time."
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
"It's been so many times. To the point where I'm starting to wonder, is this person just an addict? This is just kind of what they do and who they are."
- ALAnna Lembke
Right.
- AHAndrew Huberman
And I, and you never want to give up on people but, um, and I'm hanging in there for them, but I will say that, um, many people have given up on them.
- ALAnna Lembke
Right.
- AHAndrew Huberman
And so what I'd like to talk about in this context is what sorts of things help other people that we know that are addicted? What really helps?
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
Right, not, uh, not what could help but what really helps. And are there certain people for whom it's hopeless? I mean I don't like to hold the conversation that way but I wouldn't be close to the real life data if, if I didn't ask, is it, is it hopeless? Are there people who just will not be able to quit their substance use or their addictive behavior despite, I have to assume, really wanting to? Yeah.
- ALAnna Lembke
Yeah, so there, there are people who will die of their disease of addiction. You know, and I think conceptualizing it as a disease is a helpful frame. There are other frames that we could use but I do think given the brain physiologic changes that occur with sustained heavy drug use and what we know happens to the brain, it, it is really reasonable to think of it as a brain disease. And, and for me, uh, the real window of, let's say, being able to access my compassion around people who are repeat relapsers even when their life is so much better, when they're in recov-
- AHAndrew Huberman
Right. Oh yeah.
- ALAnna Lembke
Yeah, it's like, it's like a no-brainer, right, um, is, is to conceptualize this balance and the dopamine deficit state and a balance tilt- tilted to the side of pain, and to imagine that for some people after a month or six months or maybe even six years their balance is still tipped to the side of pain. That on some level that balance has lost its resilience and its ability to restore homeostasis.
- AHAndrew Huberman
It's almost like the hinge on that balance-
- ALAnna Lembke
Yes.
- AHAndrew Huberman
... is messed up.
- ALAnna Lembke
Exactly. And so, I mean, for, for someone who's never experienced addiction, like yourself, maybe one, one way to conceptualize it is-
- AHAndrew Huberman
Well I didn't say that.
- ALAnna Lembke
Oh okay. (laughs) I, uh, I did not- (laughs)
- AHAndrew Huberman
No, I was not re- to be clear, I w- I was not referring to myself but I, I, I, in this example I was given, I, if I were I would come clean, I, I would reveal that. Um, but I, I think that, especially after hearing some of your lectures and descriptions of the range of things that are ad- addictive...
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
.. I think, um, I, I've been fortunate in that I don't have a propensity for drugs or alcohol.
- ALAnna Lembke
Right, okay.
- AHAndrew Huberman
I'm l- I'm lucky in that way.
- ALAnna Lembke
Right, right.
- AHAndrew Huberman
That, uh, frankly if they remove all the alcohol from the planet I'll just be relieved because no one will offer it to me anymore.
- ALAnna Lembke
Right, right.
- AHAndrew Huberman
So don't send me any alcohol. (laughs)
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
It won't go to me.
- ALAnna Lembke
Right.
- 1:07:40 – 1:11:45
Can People Get Addicted To “Sobriety”?
- AHAndrew Huberman
it possible that people who were addicted to drugs or alcohol or some, gambling or some other behavior get addicted to the addiction community? Because one thing that I think I observe over and over is that there's some circuit in the brain of human beings that has to tell you about the dream they had the night before, for whatever reason. (laughs)
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
W- um, there's another circuit that leads people to, uh, wake you up if they themselves can't sleep.
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
I don't know what circuit it is. I'm being facetious here. But there does seem to also be a circuit in the brain of addicts to discuss and want to kind of talk about their recovery a lot.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
And I mention this not to poke at them, but rather the opposite, because I think that one thing that is challenging, at least for me in having friends that, that have a propensity for drug or alcohol addiction, not all of them but certainly some of them, is when they're talking about their recovery, I feel like it's all they talk about.
- ALAnna Lembke
Mm-hmm.
- AHAndrew Huberman
This meeting, that meeting, that meeting. Um, w- how are we... So what I'm really asking here is, um, is that some- can we become addicted to sobriety? (laughs)
- ALAnna Lembke
Right. So this is a great question and it links into some of the other things we've been talking about, having to do with where do we settle, settle out? You know, what is the way to live between pleasure and pain? And I implied earlier that ultimately we want a resilient balance that's sensitive to pleasure and pain, but that can easily restore homeostasis after we indulge, even when we indulge greatly. Um, but the truth of the matter is that people with severe addiction, I believe, temperamentally want those extremes and they're wired for that kind of intensity that is more than just the slight adjustments around the fulcrum, right? It's like they want the big highs and the big lows.
- AHAndrew Huberman
They'll say a great meeting.
- ALAnna Lembke
Yeah, right. (laughs)
- AHAndrew Huberman
They're like-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... "That was such an amazing meeting." Or they find a group.
- ALAnna Lembke
Right. Yeah.
- AHAndrew Huberman
They find a group and a location.
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
Like we see, I, this is almost an inside joke in those communities. Again, I'm not reporting, I'm not talking about "a friend" in quotes. This isn't me reporting. Where they'll, um, they'll talk about how attractive people are at a given meeting or how, how bonded they feel-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... to people at a given meeting.
- ALAnna Lembke
Right.
- AHAndrew Huberman
That the meetings themselves-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... become their own form of dopamine hit.
- ALAnna Lembke
Yes. Yes, yes.
- AHAndrew Huberman
And, and again, I'm not being disparaging.
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
I just, I, I want to understand this.
- ALAnna Lembke
Right. So yes. So, uh, so a lot of times patients will say to me, "Oh, you know, I don't want to go to AA. It's a cult." And my response to that is, "Because it's a cult is exactly why it works, okay?"
- 1:11:45 – 1:15:57
Are We All Wired for Addiction?
- AHAndrew Huberman
the second time you've done this during this discussion.
- ALAnna Lembke
(laughs)
- AHAndrew Huberman
But now I have empathy, because the way you describe their enthusiasm about meetings-
- ALAnna Lembke
Yes.
- AHAndrew Huberman
... is probably the way that people feel about me-
- ALAnna Lembke
Yes.
- AHAndrew Huberman
... and my work.
- ALAnna Lembke
Right.
- AHAndrew Huberman
And my, and neuroscience.
- ALAnna Lembke
Yes.
- AHAndrew Huberman
I mean, I've been getting up in front of the class since I was eight years old-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... and talking about things I read over the weekend.
- ALAnna Lembke
Yeah. Yeah.
- AHAndrew Huberman
And now I just happen to have this thing called a podcast.
- ALAnna Lembke
Right.
- AHAndrew Huberman
I've been do- I've been doing it since I was little.
- ALAnna Lembke
Right.
- AHAndrew Huberman
And it annoys a lot of people, right? I've learned to suppress it a little bit.
- ALAnna Lembke
Right.
- AHAndrew Huberman
Some people like it. But I, I'm poking fun at myself just to say that I now can, um, uh, understand that the way I feel about their reports-
- ALAnna Lembke
Yes.
- AHAndrew Huberman
... about yet another amazing meeting-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... or an, or for, there's a different form of this, but there are some people for which they just love intense experiences.
- ALAnna Lembke
Yes.
- AHAndrew Huberman
They're always t- like trying to pull me off to Bali because they're talking about-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... how sensual it is all the time. I'm sure Bali's wonderful.
- ALAnna Lembke
(laughs)
- 1:15:57 – 1:18:14
Bizarre Addiction
- AHAndrew Huberman
what is the most ridiculous-sounding addiction that you've ever witnessed that was actually a, a real addiction along these lines? Um, because I, I think we all know the standard heroin, pill... you've been very... I should mention, um, because it's important, your previous book, um, and we will try to link to that as well, focused on the opioid crisis and, um, what we thought was medication turned out to be just as bad if not worse than a lot of so-called street drugs. Uh, so we understand those, those, you know, gambling, sex addiction, porn addiction, now video games. We'll talk about social media a little bit more in depth. But what's the most, like, "Wow, I didn't realize people could get addicted to that?"
- ALAnna Lembke
Water.
- AHAndrew Huberman
Really?
- ALAnna Lembke
Really. So I had a very lovely patient who was, uh, had a severe alcohol addiction and she got into recovery from her alcohol addiction, um, for many years but she kind of had a, sort of a polydipsia or an urge to be drinking something a lot, and so she drank a lot of water. And slowly over time she realized that if she drank enough water, she could become hyponatremic and delirious and be out of herself which is-
- AHAndrew Huberman
You can die from it, right?
- ALAnna Lembke
Right. Which is w- she just wanted to be out of her own head. And so she would periodically intentionally overdose on water in order, you know, to-
- AHAndrew Huberman
Hmm.
- ALAnna Lembke
... to... I know, it was so sad-
- AHAndrew Huberman
Yeah.
- ALAnna Lembke
... so sad.
- AHAndrew Huberman
Wh- what happened to her?
- ALAnna Lembke
She eventually t- took her own life.
- AHAndrew Huberman
Wow.
- ALAnna Lembke
Yeah, it was really...
- AHAndrew Huberman
That's rough.
- ALAnna Lembke
She was a lovely woman. Uh, she was so bright, she had so many interests and passions, and, and of course it was very sad-
- AHAndrew Huberman
Mm-hmm.
- ALAnna Lembke
... when, you know, when she died. But, but I, that was a wow to me. It was like, "Wow, if you have this disease of addiction, you can even get addicted to water."
- AHAndrew Huberman
Wow. And I think it just underscores the, the generalized ability of these circuits.
- ALAnna Lembke
Right.
- AHAndrew Huberman
There, there isn't a brain circuit for addiction to water that she happened to have. There's a brain circuit for pleasure and pain and-
- ALAnna Lembke
Right.
- AHAndrew Huberman
... addiction, and water plugged into that circuit.
- ALAnna Lembke
Right. Right.
- AHAndrew Huberman
Wow. That's i- that's intense. Um, in your book, uh, Dopamine
- 1:18:14 – 1:20:10
Recovered Addicts Are Heroes
- AHAndrew Huberman
Nation, you also describe some amazing paths to recovery. People that, um, you know, from reading it I would, I won't say which ones and who 'cause there's some great surprises in the book too, both, um, tragic and, and, and triumphant, as they say. Um, you've often described your patients as your heroes.
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
Yeah, tell us a little bit more about that.
- ALAnna Lembke
You know, when you think about how hard it is to give up a drug or a behavior that you're addicted to, how much courage that takes and fortitude and discipline and sticktuitiveness, these people are really amazing people. I mean, that's... I c- I don't know that I could do it, what they, what they do, you know. It's... and like, you know, we talked a little bit about, you know, just the constant, ever-present urge to use even after sustained periods of abstinence for some people. That's really, really hard. And of course, then you double down on the shame that, that they feel because of that urge even when their lives are so much better. I mean, these people are really, really remarkable. And you take their remar- remarkable accomplishment and then you imagine the world that we live in now where we are constantly invited and tempted and really bombarded with opportunities to become addicted and return-
- AHAndrew Huberman
It's like feeling an itch everywhere.
- ALAnna Lembke
Oh yeah.
- AHAndrew Huberman
Yeah.
- ALAnna Lembke
I mean, you can't escape it. You know, you cannot escape it, that you'll get an email in your inbox inviting you to do X, Y or Z, and if you're addicted to that thing and, you know, you tried to like delete all your apps and not go here, all of a sudden your work inbox, you're, you know, you're getting those images, let's say, really, really, really hard. And yet these people find a way to do it. I think it's absolutely amazing. And they're really wise people. They have so much wisdom to offer. They've taught me a lot.
- AHAndrew Huberman
Mm-hmm.
- ALAnna Lembke
You know, as I talk about in my book, I have my own addictions and I really just like took a page right out of their book. I was, "Okay, what do I do now? All right, what did
- 1:20:10 – 1:30:40
Lying, Truth Telling, Guilt & Shame
- ALAnna Lembke
this patient do? What... Okay, I'm gonna try that." (laughs)
- AHAndrew Huberman
It is, it is an amazing community of-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... of, of, of people that-
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
... they are very sage. I wanted to, um, just touch on something that you mentioned which is, uh, the shame.
- ALAnna Lembke
Yeah.
- AHAndrew Huberman
Uh, you know, you can't go to a meeting, uh, o-... or talk to addicts without, um, detecting or, or hearing about, like, lies, shame, et cetera. I heard you say, um, in an interview with somebody else recently that truth-telling and secrets are sort of at the core of recovery. And, um, y- yeah, tell us more about that.
- ALAnna Lembke
(clicks tongue) Yeah, so one of the things that I have found really fascinating about working with people in recovery was how telling the truth, even about the merest detail of their lives, was central to their recovery, and I became really curious about that. Like, why would truth-telling be so important? And of course there is the obvious thing that when people are in their addiction, they're lying about using, you know, so part of getting into recovery is to stop lying to the people they care about about their use. But it's really more than that, because what, what people in recovery have taught me is that it's not, it's not even just not lying about using drugs, I, I have to not lie about anything. I can't lie about why I was late to work this morning, which we all do. "Oh, I hit traffic." No, I didn't hit traffic, I wanted to spend two more minutes reading the paper and drinking my coffee, right? Um, or just lying about, you know, I don't know, where I had dinner. Like, so people with addiction will get into, you know, the lying habit where they're lying about random stuff 'cause they're sort of in the habit of lying, and how recovery is really about telling the truth, uh, you know, in, in all ways. And so one of the things that I, uh, well, I had a lot of fun with in writing the book is sort of exploring the neuroscience around why truth-telling is important to leading a balanced life. And we know, like, every religion since the beginning of time is all about telling the truth. Well, why, right? And there's really interesting neuroscience behind it that suggests that when we tell the truth, we actually potentially strengthen our prefrontal cort- cortical circuits and their connections to our limbic brain and our reward brain. And of course these are the circuits that get disconnected when we're in our addiction, right? Our balance in our reward pathway or limbic brain, our emotion brain, is doing one thing and our cortical circuits are completely disengaged from that, ignoring what's happening. Which is easy to do because it's reflexive. We don't need to think about that balance for the balance to be happening. But we have to reengage those circuits, anticipate future consequences, think through the drink. You know, not just how am I gonna feel now if I use, but how am I gonna feel tomorrow or six months from now? And that telling the truth is in fact a way to do that, to make these connections stronger in there. I talk about some studies in my book that, that kind of indirectly show that. So I find that really fascinating. Plus th- the, just that, like, being open and honest with people really does create very intimate connections, and those intimate connections create dopamine. So we were talking a little bit about how you, you know, know a bunch of people who need, like, intensity in their lives. For me, I need a lot of intensity in my human connections. Like, I'm really not interested in and bored by and made anxious by, um, casual, um, interactions. But, you know, like having this kind of discussion with you that's very intense and also intimate and self-disclosing is very rewarding for me. So that's a, an important source of dopamine. Thank God I became a psychiatrist.
Episode duration: 2:02:31
Install uListen for AI-powered chat & search across the full episode — Get Full Transcript
Transcript of episode p3JLaF_4Tz8
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