Understanding & Treating Addiction | Dr. Anna Lembke

Andrew Huberman 0:00 (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.

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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. 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Andrew Huberman 7:00 Lembke. All right. Great to have you here.

Anna Lembke 7:04 Thank you for having me. I'm excited to be here.

Andrew Huberman 7:07 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?

Anna Lembke 7:44 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.

Andrew Huberman 9:20 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?

Anna Lembke 9:41 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.

Andrew Huberman 10:31 Interesting. And is- would- is it, um, the case that our baseline levels of dopamine are set by our genetics, by our heredity?

Anna Lembke 10:39 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.

Andrew Huberman 10:59 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-

Anna Lembke 11:16 (laughs)

Andrew Huberman 11:16 ... harder to budge, like my bulldog Costello.

Anna Lembke 11:19 (laughs)

Andrew Huberman 11:19 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?

Anna Lembke 11:40 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-

Andrew Huberman 12:50 Mm-hmm.

Anna Lembke 12:51 ... are people who are more vulnerable to addiction.

Andrew Huberman 12:54 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?"

Anna Lembke 13:11 (laughs)

Andrew Huberman 13:12 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.

Anna Lembke 13:22 (laughs)

Andrew Huberman 13:22 Um, and other people will jump the moment I say their name.

Anna Lembke 13:26 Mm-hmm.

Andrew Huberman 13:26 They actually have a, uh, a kind of a heightened, um, startle reflex.

Anna Lembke 13:30 Right.

Andrew Huberman 13:30 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?

Anna Lembke 13:40 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-

Andrew Huberman 14:41 Where hesitation can cost you your life.

Anna Lembke 14:42 Right. Yes.

Andrew Huberman 14:43 Yeah.

Anna Lembke 14:43 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.

Andrew Huberman 15:48 I see.

Anna Lembke 15:49 Yeah.

Andrew Huberman 15:49 Yeah, and it's, I, I'm beginning to realize there's a fine line between spontaneity and impulsivity.

Anna Lembke 15:53 Yeah.

Andrew Huberman 15:54 Uh,

Andrew Huberman 15:56 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?

Anna Lembke 16:23 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-

Andrew Huberman 17:41 Mm-hmm.

Anna Lembke 17:41 ... you know, wanting to feel pleasure.

Andrew Huberman 17:43 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,

Andrew Huberman 18:20 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...

Anna Lembke 18:29 (laughs)

Andrew Huberman 18:30 ... um, have this feeling that normal life isn't interesting enough.

Anna Lembke 18:34 Mm-hmm.

Andrew Huberman 18:35 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...

Anna Lembke 18:53 Mm-hmm.

Andrew Huberman 18:53 ... for people.

Anna Lembke 18:54 Mm-hmm.

Andrew Huberman 18:54 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.

Anna Lembke 19:06 Mm-hmm.

Andrew Huberman 19:06 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.

Anna Lembke 19:24 Yeah.

Andrew Huberman 19:24 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.

Anna Lembke 19:41 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.

Andrew Huberman 21:48 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?

Anna Lembke 21:58 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)

Andrew Huberman 22:41 Yeah. Well, there's a, a book by Cal Newport, I don't know if you know Cal Newport's work.

Anna Lembke 22:45 No.

Andrew Huberman 22:45 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...

Anna Lembke 23:10 Right.

Andrew Huberman 23:11 ... and get, develop a sense of, of passion for something by your experience of hard work and, and getting better and feedback.

Anna Lembke 23:18 Right.

Andrew Huberman 23:18 A little bit of the growth mindset thing...

Anna Lembke 23:19 Right.

Andrew Huberman 23:19 ... 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.

Anna Lembke 23:28 Yes. Right.

Andrew Huberman 23:29 And he's, uh, been a big proponent of the evils of context switching too often throughout the day...

Anna Lembke 23:34 Yeah.

Andrew Huberman 23:35 ... for sake of productivity mostly. His new book is called, um, A World Without Email.

Anna Lembke 23:39 (laughs)

Andrew Huberman 23:39 I'm beginning to realize as I cite off these books and your book, Dopamine Nation, uh, Finding Balance, uh, in the Age of Indulgence, that, uh, maybe the reason why you two don't know about one another is because neither of you are on social media.

Anna Lembke 23:51 That's it.

Andrew Huberman 23:51 Right.

Anna Lembke 23:51 That's it. (laughs)

Andrew Huberman 23:51 And yet you're two of the most productive people that I know, um, including productive authors. So that's a discussion unto itself. But I find this fascinating.

Andrew Huberman 24:00 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...

Anna Lembke 24:09 Right.

Andrew Huberman 24:09 ... 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.

Anna Lembke 24:21 ... 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.

Andrew Huberman 25:07 It's like the principal laws of physics.

Anna Lembke 25:09 Yes, right.

Andrew Huberman 25:10 Yeah.

Anna Lembke 25:10 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?

Andrew Huberman 25:30 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.

Anna Lembke 25:45 Right.

Andrew Huberman 25:46 But when I, um, indulge in something I enjoy, I'm usually thinking about just wanting more of that thing.

Anna Lembke 25:52 Yes. Yes.

Andrew Huberman 25:53 I don't think about the pain.

Anna Lembke 25:54 Yes.

Andrew Huberman 25:54 I just think about more.

Anna Lembke 25:56 Right.

Andrew Huberman 25:56 Right.

Anna Lembke 25:57 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.

Andrew Huberman 27:31 Yeah, so if I understand this correctly, uh, when we find something, or when something finds us-

Anna Lembke 27:36 (laughs)

Andrew Huberman 27:37 ... that we enjoy, that feels pleasureful, uh, social media, food-

Anna Lembke 27:42 Right.

Andrew Huberman 27:42 ... 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-

Anna Lembke 27:50 Right.

Andrew Huberman 27:50 ... in that behavior.

Anna Lembke 27:51 Mm-hmm.

Andrew Huberman 27:52 And then what you're telling me is that very quickly-

Anna Lembke 27:55 Yes.

Andrew Huberman 27:55 ... and beneath my conscious awareness-

Anna Lembke 27:57 Mm-hmm.

Andrew Huberman 27:58 ... there's a tilting back of the scale where pleasure is reduced by way of increasing pain.

Anna Lembke 28:05 Right.

Andrew Huberman 28:06 And I've heard you say before that the pain mechanism has some competitive advantages over the pleasure mechanism, such that it doesn't just bring the scale back to level.

Anna Lembke 28:19 Mm-hmm.

Andrew Huberman 28:19 It actually brings pain higher-

Anna Lembke 28:21 Mm-hmm.

Andrew Huberman 28:21 ... than pleasure.

Anna Lembke 28:22 Mm-hmm.

Andrew Huberman 28:23 Could you tell us a little bit more about that?

Anna Lembke 28:25 Yeah, yeah. So, uh, so what happens... a- again, so the, the, the hallmark of any addictive substance or behavior is that it releases a lot of dopamine in our brain's reward pathway, like, right? Like broccoli just doesn't release a lot of dopamine. Just doesn't, right? (laughs)

Andrew Huberman 28:40 The... I'm trying to imagine. I was about to say maybe there... and I th- I stopped myself because no, b- broccoli's good.

Anna Lembke 28:46 (laughing) Yeah.

Andrew Huberman 28:46 It can be really good.

Anna Lembke 28:47 Right.

Andrew Huberman 28:47 But broc- broccoli is never amazing.

Anna Lembke 28:50 Right. Broccoli's never amazing. I mean-

Andrew Huberman 28:51 Yeah. We're never like, "This is the most amazing broccoli."

Anna Lembke 28:52 Honestly, we can probably find somebody on the planet-

Andrew Huberman 28:54 Yeah.

Anna Lembke 28:55 ... for whom broccoli is amazing. And of course if I'm starving, broccoli-

Andrew Huberman 28:58 Yeah.

Anna Lembke 28:58 ... broccoli is amazing, right? So... (laughs)

Andrew Huberman 28:59 Yeah. Rich Roll, Rich Roll is big on plants-

Anna Lembke 29:01 Yeah, right. (laughs)

Andrew Huberman 29:01 ... and he, he has a good, like, relationship to plants.

Anna Lembke 29:04 Right.

Andrew Huberman 29:04 Uh, Rich?

Anna Lembke 29:05 (laughs)

Andrew Huberman 29:05 Uh, tell us how to make broccoli amazing. Uh, if anyone could do it, it'd be Rich.

Anna Lembke 29:08 Yeah, yeah.

Andrew Huberman 29:09 Huh.

Anna Lembke 29:10 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.

Andrew Huberman 30:20 I see.

Anna Lembke 30:20 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.

Andrew Huberman 30:40 Mm-hmm.

Anna Lembke 30:41 Right? That then everything sort of pales in comparison to this one drug that I want to keep doing.

Andrew Huberman 30:47 And that one drug could be a person, right? I mean, I-

Anna Lembke 30:50 Yes.

Andrew Huberman 30:50 ... 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.

Anna Lembke 31:03 Yeah.

Andrew Huberman 31:04 Uh, they were maybe or still are addicted to the person.

Anna Lembke 31:07 Right.

Andrew Huberman 31:07 So it could be to any number of things, video games-

Anna Lembke 31:10 Right.

Andrew Huberman 31:10 ... sex, gambling, a person, a narrative.

Anna Lembke 31:13 Right.

Andrew Huberman 31:13 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.

Anna Lembke 31:26 Mm-hmm.

Andrew Huberman 31:26 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?

Anna Lembke 32:11 Yes, exactly.

Andrew Huberman 32:13 Okay.

Anna Lembke 32:13 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.

Andrew Huberman 32:23 And when you say substance, uh, does the same d- is what you just said also true for behaviors?

Anna Lembke 32:28 Yes. So s- when I u- when I use the word drug-

Andrew Huberman 32:30 Yeah.

Anna Lembke 32:30 ... I'm, I'm talking about substances and behaviors really.

Andrew Huberman 32:32 Okay.

Anna Lembke 32:32 And b- I'm talking about behaviors like gambling, sex, um, you know-

Andrew Huberman 32:37 Porn.

Anna Lembke 32:37 ... gaming, porn, absolutely.

Andrew Huberman 32:39 Work.

Anna Lembke 32:39 Shopping, work.

Andrew Huberman 32:41 You've accused me-

Anna Lembke 32:41 Work. (laughs)

Andrew Huberman 32:41 I'll just, for the record, uh, Anna, Dr. Lovejoy has accused me, not accused me, has, um, diagnosed me, uh, outside the clinic-

Anna Lembke 32:49 (laughs)

Andrew Huberman 32:50 ... uh, in a playful way, of being work addicted. You're probably right.

Anna Lembke 32:53 Yes.

Andrew Huberman 32:53 I, the first thoughts I have when I wake up are typically about work.

Anna Lembke 32:56 Right.

Andrew Huberman 32:56 Certainly within 50 milliseconds or so of waking. And, um, probably the last thoughts I have, I would hope are not about work. But yeah, I work constantly. I, I don't... I do other things, but I-

Anna Lembke 33:06 Right.

Andrew Huberman 33:06 ... have to actively turn that off.

Anna Lembke 33:08 Yes.

Andrew Huberman 33:09 Nice.

Anna Lembke 33:09 That's exactly right, and you're certainly not alone i- in that. And of course-

Andrew Huberman 33:12 At Stanford? No.

Anna Lembke 33:13 Right.

Andrew Huberman 33:13 No, no, no. (laughs)

Anna Lembke 33:14 I mean, here in Silicon Valley, right? It's highly rewarded, right? So that-

Andrew Huberman 33:17 Yeah.

Anna Lembke 33:17 ... kind of, that kind of addiction-

Andrew Huberman 33:18 It's embedded in the culture.

Anna Lembke 33:19 Oh, yeah. Absolutely.

Andrew Huberman 33:20 Absolutely, yeah.

Anna Lembke 33:20 Yeah.

Andrew Huberman 33:20 Yeah. And, and there's this other city, I think it's called New York, where they also work a lot out here.

Anna Lembke 33:25 (laughs)

Andrew Huberman 33:25 And it's heavily rewarded. Um, I once said, and I'm sure that I'm not the first person to say it, but, um, I was thinking about addiction and I was thinking about the underlying circuits and e- and I posted something to the, uh, to d- to the, to social media, which said that addiction is a progressive narrowing of the things that bring you pleasure. That was the way that I kind of crystallized the literature in my mind. And then we met and you s- and you of course came and, uh, gave these amazing lectures in the neuroanatomy course for the medical students, and, and the rest is history. But I, uh, I tossed out a kind of, uh, mirroring statement for that as well, which was a bit, um, overstepping, I admit, which I said, "Addiction is a progressive narrowing of the things that bring you pleasure." And I said, (laughs) dare I say, "Enlightenment is a progressive expansion of the things that bring you pleasure." Not that anybody knows what enlightenment is.

Anna Lembke 34:20 (laughs)

Andrew Huberman 34:20 But it was my attempt to take a little bit of a jab at the fact that nobody knows.

Anna Lembke 34:23 Yeah.

Andrew Huberman 34:23 And so why not? Why wouldn't I throw-

Anna Lembke 34:25 Yeah.

Andrew Huberman 34:25 ... a neurobiological explanation-

Anna Lembke 34:26 Right.

Andrew Huberman 34:26 ... just to, just to kind of sample the waters? Um, and people had varying levels of response. But I would am- the reason I bring that up is that I would imagine that being able to derive pleasure from many things would be a wonderful attribute. W- we know people like this, that, um, can experience pleasure in little things and in big events, uh, not just, you know, the big milestones of life, but also the, the subtle, you know, as the, like the, them yogis would say, the subtle ripples of life. Uh, i- if such an ability exists, would... do you think that that reflects a healthily tuned dopamine system, one that can engage and enjoy but then disengage? Is that what we should be seeking? And, and t- to underscore, I know nothing about enlightenment, meditation, or the-

Anna Lembke 35:19 (laughs)

Andrew Huberman 35:19 ... or any of it. I just, um, I use these as opportunities to explore.

Anna Lembke 35:24 Yeah. So it's a great question. Um, e- I'm in- and I, I understand the question as, so where, what should we be striving for, right? Where, where should we settle out? And, you know, m- in my book, I really

Anna Lembke 35:38 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.

Andrew Huberman 36:28 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?

Anna Lembke 36:38 ... 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.

Andrew Huberman 37:22 Right.

Anna Lembke 37:22 Like that would be a disaster.

Andrew Huberman 37:23 Right.

Anna Lembke 37:23 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.

Andrew Huberman 37:49 Uh, sorry to interrupt-

Anna Lembke 37:49 Yeah.

Andrew Huberman 37:49 ... but when you say boring, um, can we add stressful and boring?

Anna Lembke 37:53 Yes.

Andrew Huberman 37:54 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-

Anna Lembke 38:00 Yeah.

Andrew Huberman 38:00 ... because I sort of forgot what the term means-

Anna Lembke 38:02 Yeah, right.

Andrew Huberman 38:02 ... because I've- I like to think that I experience a lot of pleasure in little things-

Anna Lembke 38:06 Right.

Andrew Huberman 38:06 ... but I- I'm a pretty hard-driving guy. I l- I like goals and big milestones, all that stuff.

Anna Lembke 38:10 Right.

Andrew Huberman 38:10 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-

Anna Lembke 38:23 Yeah.

Andrew Huberman 38:23 ... that I have to do.

Anna Lembke 38:24 Right.

Andrew Huberman 38:25 I won't mention what they are-

Anna Lembke 38:26 (laughs)

Andrew Huberman 38:26 ... '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."

Anna Lembke 38:32 Yeah.

Andrew Huberman 38:32 Um, no, just your emails.

Anna Lembke 38:34 (laughs)

Andrew Huberman 38:34 Um, not yours, Anna, but theirs. Um, in any event, um, so anxiety and boredom can hang out together, right?

Anna Lembke 38:41 Mm-hmm.

Andrew Huberman 38:42 Am- am I correct in...

Anna Lembke 38:43 Oh, for sure.

Andrew Huberman 38:44 Okay.

Anna Lembke 38:44 I mean actually boredom is highly anxiety-provoking.

Andrew Huberman 38:47 Okay.

Anna Lembke 38:47 'Cause once-

Andrew Huberman 38:48 Well that's good to know 'cause-

Anna Lembke 38:49 Yeah.

Andrew Huberman 38:49 ... I think people hear boredom-

Anna Lembke 38:50 Yeah.

Andrew Huberman 38:50 ... and they think like, "Oh, there's nothing to do here."

Anna Lembke 38:53 Right.

Andrew Huberman 38:53 Th- there's noth- it's us-

Anna Lembke 38:54 Right.

Andrew Huberman 38:54 I feel like we have a ton to do, we just don't really want to do it-

Anna Lembke 38:57 Right, right.

Andrew Huberman 38:57 ... as opposed to something that we're excited to do.

Anna Lembke 39:00 Right, okay. So- so th- this gets to sort of some of the core things also we were talking about earlier, about finding your passion, so I'm gonna try to link it all together.

Andrew Huberman 39:08 Mm-hmm.

Anna Lembke 39:09 Um, but- but basically is boredom... First of all, boredom is a rare experience for modern humans because we're constantly distracting ourselves from the present moment and we have an infinite number of ways to do that, right? Um, but boredom is really, I think, an important and necessary experience. But it is scary, because when you allow yourself to be bored, and let's say you were- had that list of all the things you hate to do and you actually got them all done, imagine that, and you got your forthcoming book done-

Andrew Huberman 39:40 Ha.

Anna Lembke 39:40 ... and you did all your interviews-

Andrew Huberman 39:42 (laughs) No.

Anna Lembke 39:42 ... and- and then-

Andrew Huberman 39:42 It- it could happen. Lightning could strike.

Anna Lembke 39:45 Right.

Andrew Huberman 39:45 Yeah.

Anna Lembke 39:45 And you walked your dog and you cleaned your house and you went shopping. Imagine that for a moment. You would be sitting in your house and my guess is you would be terrified, because, wow, what am I supposed to do now, right? There's nothing I really have to do. And that is really, really scary. That can feel like free fall. And yet that's really an important and good experience to have, and I think that is an experience out of which we can have a lot of creative, um, initiative, but also really consider our priorities and values. Okay, here I am on planet Earth. What the hee-haw am I gonna do with my life? What do I really care about? How do I really want to spend my time when I'm not distracting myself i- in- you know, in order to- to spend it? And th- you know, then

Anna Lembke 40:35 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.

Andrew Huberman 40:51 Right, and then everything will feel like a natural progression.

Anna Lembke 40:53 Right, and then everything will be wonderful and, uh-

Andrew Huberman 40:55 I can attest to the fact that is not how it works-

Anna Lembke 40:57 Yeah.

Andrew Huberman 40:57 ... in any endeavor.

Anna Lembke 40:58 Right.

Andrew Huberman 40:59 It's-

Anna Lembke 40:59 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?

Andrew Huberman 43:09 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-

Anna Lembke 43:35 (laughs)

Andrew Huberman 43:36 ...um, to be honest.

Anna Lembke 43:37 Yeah.

Andrew Huberman 43:37 I, I hate taking out the trash-

Anna Lembke 43:39 (laughs)

Andrew Huberman 43:39 ...but I do it, 'cause I like a clean home and I like-

Anna Lembke 43:41 Yeah.

Andrew Huberman 43:42 ...a home that-

Anna Lembke 43:42 Right.

Andrew Huberman 43:42 ...a home that smells good.

Anna Lembke 43:43 Yeah.

Andrew Huberman 43:43 Um, or at least doesn't smell bad.

Anna Lembke 43:45 (laughs)

Andrew Huberman 43:46 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?

Anna Lembke 44:44 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.

Andrew Huberman 46:08 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.

Anna Lembke 46:45 Mm.

Andrew Huberman 46:46 Um, and not just holding the door and doing the, helping with the dishes and moving things around.

Anna Lembke 46:49 Mm-hmm.

Andrew Huberman 46:49 They are constantly scanning their environment for what can be done.

Anna Lembke 46:53 Ah.

Andrew Huberman 46:53 They essentially-

Anna Lembke 46:55 Yeah.

Andrew Huberman 46:55 ...conquer every environment they're in.

Anna Lembke 46:56 Mm-hmm.

Andrew Huberman 46:57 They are also some of the m- the most competitive human beings, but they do-

Anna Lembke 47:00 (laughs)

Andrew Huberman 47:00 ...in the world, and they do it unless they're, they're in the act of war fighting, which is their, their real job, uh, they do it in every environment in a very benevolent way.

Anna Lembke 47:09 Mm-hmm.

Andrew Huberman 47:10 And it's a remarkable thing because it, I think it's what is part of what they're selected for.

Anna Lembke 47:15 Mm-hmm.

Andrew Huberman 47:16 And, um, and you know, there, there's a range there, but I think when we hear about tending to the immediate things-

Anna Lembke 47:22 Right.

Andrew Huberman 47:22 ...uh, or this phrase, uh, you know, how you do one thing is how you do anything, that's a tru- tricky one for me because there are certain things I just don't do well.

Anna Lembke 47:29 (laughs)

Andrew Huberman 47:29 Um, but, but should we always be trying? I, I think that the tending to, setting the horizon in closely, um, and tending to things in one's immediate environment I think i- is very powerful and translates.

Anna Lembke 47:42 Yes.

Andrew Huberman 47:42 Because again, I think the nervous system, it performs algorithms. It has action steps.

Anna Lembke 47:46 Yeah. Mm-hmm.

Andrew Huberman 47:46 The brain doesn't evolve to do one thing.

Anna Lembke 47:49 Right.

Andrew Huberman 47:49 It evolves to be able to use the same approach-

Anna Lembke 47:52 Right.

Andrew Huberman 47:52 ...to doing lots of different things.

Anna Lembke 47:53 Yes.

Andrew Huberman 47:54 Um-

Anna Lembke 47:55 I want, just want to add-

Andrew Huberman 47:56 Yeah.

Anna Lembke 47:56 ...so even beyond that, 'cause th- that totally resonates for me and is very consistent with people in recovery from addiction who learn to take it one day at a time-

Andrew Huberman 48:04 Mm-hmm.

Anna Lembke 48:04 ...which is one of the, you know, standard lingo from Alcoholics Anonymous and other 12-step groups, but, but I think also, as you say, you know, our brain is really wired for the 24-hour period. We're not very good at sort of the, you know, ten-year, 20... I mean we're, we have these huge frontal lobes and yes, we're great planners and we can... But if we live too much in that space, we can really get very anxious and depressed and lost and either catastrophize or get grandiose. But if you can chunk it down to a day w- what people in recovery talk about is how if I can just do today right, then I will get a chain of days that seem insignificant in their individual units, but after six months or a year or two years of those good days, I've got two very good years, right? And I look back and it's like, "Oh wow, w- I, I guess I, I did all that." But I think that's really, you know, one of the keys, is, is really taking it one day at a time, which, which your SEALs... And also this connecting with the environment, right? So being awake and alert-... to your environment and connecting with your environment, not trying to escape it. And of course, escapism is what we all want and desire, that experience of non-being, and we get it from the internet or from drugs or whatever it is, but it is, it's the booby prize. We- because ultimately, it takes you further and further away from your immediate environment, which is where we really have to connect to get that sense of groundedness and authenticity and, like, of being in our own lives.

Andrew Huberman 49:36 Mm-hmm well, I think the unit of the day is something that comes up again and again, of, in my discussions with colleagues who are extremely, uh, successful and who also have balanced lives.

Anna Lembke 49:47 Right.

Andrew Huberman 49:47 Uh, this actually came up in the discussion with Karl Deisseroth-

Anna Lembke 49:50 Mm-hmm.

Andrew Huberman 49:50 ... who is also, it's a successful scientist and clinician and, uh, and, you know, manages a family, et cetera. So the unit of the day, I think, is fundamental, and those stack up, as you mentioned. So along those lines, I've heard you say

Andrew Huberman 50:05 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.

Anna Lembke 50:21 Right.

Andrew Huberman 50:21 Is that correct?

Anna Lembke 50:22 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

Narrator 51:18 (laughs)

Anna Lembke 51:18 ... quili- right, and then we're in a, a place where we can sort of enjoy other things.

Andrew Huberman 51:22 Mm-hmm. So that progressive narrowing...

Anna Lembke 51:24 Right.

Andrew Huberman 51:24 ... of what brings one pleasure-

Anna Lembke 51:26 Yeah.

Andrew Huberman 51:26 ... eventually expands. So I'd like to, um, dissect out that 30 days a little more-

Anna Lembke 51:30 Mm-hmm.

Andrew Huberman 51:30 ... finally, um, and I also want to address how does one stop doing something for 30 days if the thing is a thought?

Anna Lembke 51:40 Mm.

Andrew Huberman 51:40 So we'll kind of s- put that on the shelf-

Anna Lembke 51:42 Yeah.

Andrew Huberman 51:42 ... for the moment. So days one through 10, I would imagine will be very uncomfortable.

Anna Lembke 51:49 Yes.

Andrew Huberman 51:50 They're gonna suck-

Anna Lembke 51:51 Right. (laughs)

Andrew Huberman 51:51 ... basically, to be quite honest, because what e- the way you described this pleasure-pain balance-

Anna Lembke 51:57 Yeah.

Andrew Huberman 51:57 ... 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-

Anna Lembke 52:08 Right.

Andrew Huberman 52:08 ... 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.

Anna Lembke 52:18 Right.

Andrew Huberman 52:19 Anxiety.

Anna Lembke 52:20 Mm-hmm.

Andrew Huberman 52:20 Trouble sleeping.

Anna Lembke 52:21 Yep.

Andrew Huberman 52:21 Um, physical agitation and-

Anna Lembke 52:23 Yes.

Andrew Huberman 52:23 ... to the point where-

Anna Lembke 52:24 Mm-hmm.

Andrew Huberman 52:25 ... eh, you know, um, maybe impulsive, angry.

Anna Lembke 52:28 Yes.

Andrew Huberman 52:28 Should- should one expect all of that? Should the family members of people expect all of that?

Anna Lembke 52:34 Yeah. So what I say to patients, and it's a really important piece of this intervention, is that you will feel worse before you feel better. I'm j-

Andrew Huberman 52:42 For how long?

Anna Lembke 52:43 Yeah. So-

Andrew Huberman 52:43 This is probably the first question they ask-

Anna Lembke 52:45 Right, yes.

Andrew Huberman 52:45 ... right?

Anna Lembke 52:45 And- and I say, usually, in my clinical experience, you'll feel worse for two weeks, but if you can make it through those first two weeks, the sun will start to come out in week three, and by week four, most people are feeling a whole lot better than they were before they stopped using their stub- substance. So, um, yeah, you have to, it's- it's a hard thing, like you have to sign up for it. And I will say, obviously, there are people with addictions that are so severe that as long as they have access to their drug or behavior, they're not able to stop themselves. An- and that's why we have, you know, higher levels of care-

Andrew Huberman 53:20 Sure.

Anna Lembke 53:20 ... or residential treatment. So this is not going to be for everybody, this intervention, but it's amazing how many people with really severe addictions to things like heroin, cocaine, you know, very severe pornography addictions, I posit this, eh, and I do it as an experiment, I said, "You know what? Let's try this experiment." I'm always amazed, number one, how many of them are willing, and number two, how many of them are actually able to do it. They are able-

Andrew Huberman 53:45 Mm-hmm.

Anna Lembke 53:45 ... to do it. An- and so that little nudge is sort of just what they need, and the carrot is, y- you know, there's a better life out there for you, and you'll be able to taste it in a month. You really will be able to begin to see that you can feel better and that there's another way.

Andrew Huberman 54:04 So the way you describe it, um, seems like it's hard.

Anna Lembke 54:09 Mm-hmm.

Andrew Huberman 54:09 But it's doable-

Anna Lembke 54:10 Yes.

Andrew Huberman 54:10 ... for most people.

Anna Lembke 54:11 Yeah.

Andrew Huberman 54:11 Not everybody.

Anna Lembke 54:12 Right.

Andrew Huberman 54:12 And we'll return to the, that category of people who can't do that on their own. Um, well, then days 21 through 30, uh, people are feeling better, the sun is starting to come out, as you mentioned, they, eh, which translates in the narrative we've created here and supported by biology that dopamine is starting to be released in response to the taste of a really good cup of coffee, for instance.

Anna Lembke 54:38 Yes, exactly.

Andrew Huberman 54:39 But whereas before, it was only to insert, you know, addictive behavior-

Anna Lembke 54:44 Right. That's right.

Andrew Huberman 54:45 (laughs) Whate- whichever it happens to be.

Anna Lembke 54:45 Of course, coffee can be addictive too, but- but we'll leave that aside. (laughs)

Andrew Huberman 54:48 Sure. Yeah. I feel like coffee has a kind of, um, consumption-limiting mechanism built in where at some point you just can't ingest any more.

Anna Lembke 54:57 Yeah.

Andrew Huberman 54:57 Um, but maybe that's wrong. Sorry to give lift-

Anna Lembke 55:00 (laughs)

Andrew Huberman 55:01 ... to the caffeine addicts out there. As I cl- as I clutch my-

Anna Lembke 55:05 (laughs)

Andrew Huberman 55:06 ... m- my mug. Um, so days 21 through 30. Um, I've seen a lot of people go through... addiction and addiction treatment. I've spent a lot of time in those places actually, um, looking at it, researching. I've got friends in that community. I, I'm close with that community. One thing I've seen over

Andrew Huberman 55:25 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."

Anna Lembke 56:22 Yeah.

Andrew Huberman 56:22 "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."

Anna Lembke 56:32 Right.

Andrew Huberman 56:32 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.

Anna Lembke 56:41 Right.

Andrew Huberman 56:41 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?

Anna Lembke 56:50 Mm-hmm.

Andrew Huberman 56:51 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.

Anna Lembke 57:20 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-

Andrew Huberman 58:00 Right. Oh yeah.

Anna Lembke 58:00 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.

Andrew Huberman 58:26 It's almost like the hinge on that balance-

Anna Lembke 58:28 Yes.

Andrew Huberman 58:28 ... is messed up.

Anna Lembke 58:28 Exactly. And so, I mean, for, for someone who's never experienced addiction, like yourself, maybe one, one way to conceptualize it is-

Andrew Huberman 58:37 Well I didn't say that.

Anna Lembke 58:38 Oh okay. (laughs) I, uh, I did not- (laughs)

Andrew Huberman 58:39 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...

Anna Lembke 58:56 Yeah.

Andrew Huberman 58:56 .. I think, um, I, I've been fortunate in that I don't have a propensity for drugs or alcohol.

Anna Lembke 59:00 Right, okay.

Andrew Huberman 59:01 I'm l- I'm lucky in that way.

Anna Lembke 59:02 Right, right.

Andrew Huberman 59:02 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.

Anna Lembke 59:08 Right, right.

Andrew Huberman 59:08 So don't send me any alcohol. (laughs)

Anna Lembke 59:10 (laughs)

Andrew Huberman 59:11 It won't go to me.

Anna Lembke 59:12 Right.

Andrew Huberman 59:12 Um, but, uh, but I don't have that, um... I like to think I have the compassion, um, but I don't have that, uh, empathy for, you know, taking a really good situation and what from the outside-

Anna Lembke 59:31 Right.

Andrew Huberman 59:32 ... looks to be throwing it in the trash.

Anna Lembke 59:33 Right, yeah.

Andrew Huberman 59:34 You know?

Anna Lembke 59:34 So, okay, so, so that let, let me... And this is really I think important because I, I also had to come to an understanding of this and I feel that I have in my 20 years of seeing these patients. And of course addiction is a spectrum disease, right?

Andrew Huberman 59:47 Sure.

Anna Lembke 59:47 And so you've got the severe end of things. Um, imagine that you had an itch somewhere on your body, okay, and it was in, I mean we've all had that like, you know, whatever the source, and it was super, super itchy. You can go for a, you know, if you really focus you could go for a pretty good amount of time not scratching it, but the moment you stopped focusing on not scratching it you would scratch it, and maybe you'd do it while you were asleep, right? That s- and that is what happens to people with severe addiction. That balance is essentially broken, homeostasis does not get restored despite sustained abstinence, they're living with that constant specter, that pull. It never goes away. So let me say there are lots of people with addiction for whom that does go away and it goes away at four weeks for many of them, but in severe cases that's always there and it's lingering and it's the moment when they're not focusing on not using, it's like a reflex, they fall back into it. It's not purposeful, it's not because they want to get high, it's not because they value using drugs more than they do their family, none of that. It's that really they, they, they cannot not do it when given the opportunity and that moment when they're not thinking about it. Does that make sense?

Andrew Huberman 1:01:09 That's a great description and actually in that description I can feel a bit of empathy because the way you describe scratching an itch in your sleep...

Anna Lembke 1:01:18 Yeah.

Andrew Huberman 1:01:19 You know, I've, I've done that with mosquito bites...

Anna Lembke 1:01:21 Right.

Andrew Huberman 1:01:21 .. in summer, you're scratching-

Anna Lembke 1:01:22 Right.

Andrew Huberman 1:01:22 .. and like then you wake up scratching that-

Anna Lembke 1:01:23 Right.

Andrew Huberman 1:01:24 .. that, that m- mosquito bite. And I also have to admit that... I've experienced not feeling like I want to pick up my phone because it's so rewarding, but just finding myself doing it.

Anna Lembke 1:01:36 Yes, of course. Yes.

Andrew Huberman 1:01:37 Like, I'm not going to use this thing, I'm not going to use this thing and-

Anna Lembke 1:01:40 Right.

Andrew Huberman 1:01:40 ... and then just finding myself doing it.

Anna Lembke 1:01:41 Yes.

Andrew Huberman 1:01:41 Like, what am I doing here?

Anna Lembke 1:01:42 Right. Right.

Andrew Huberman 1:01:43 Sort of the, how did I get back here again?

Anna Lembke 1:01:45 Yes. Right.

Andrew Huberman 1:01:45 And I, I know enough about brain function to understand that we have circuits that generate deliberate behavior, and we have circuits that generate reflexive behavior. And one of the goals of the nervous system is to make the deliberate stuff reflexive so you don't have to make the decision, because decision-making is a very costly thing to do.

Anna Lembke 1:02:05 E- e- exactly.

Andrew Huberman 1:02:06 Decision-making of any kind.

Anna Lembke 1:02:07 Right. Right.

Andrew Huberman 1:02:08 So that does really help. Um, in, the, uh, I want to just try and weave together this, um, this dopamine puzzle, however, because if by week... So first phase of this, uh, 30 or 40-day, um, detox, it's like a dopamine fast.

Anna Lembke 1:02:27 Right.

Andrew Huberman 1:02:27 Right? Okay. First 10 days are miserable. Middle 10 days, the clouds are out, there may be some shards of sunlight coming through, and then all of a sudden, sun starts to come out, it gets brighter and brighter. Why is it then that people will relapse not just after getting fired from a job or their spouse leaving them, but when things are going really well?

Anna Lembke 1:02:48 Yeah.

Andrew Huberman 1:02:48 Is it this s- unconscious mechanism? 'Cause I've seen this before, is, uh, they have a great win. I have a friend who's a really impressive creative, um, I don't want to reveal any more than that, but, uh, and relapsed upon getting another really terrific opportunity to create for the entire world. And I was like, "How can that happen?"

Anna Lembke 1:03:09 Hm.

Andrew Huberman 1:03:09 But now I'm beginning to wonder, was it the dopamine associated with that win-

Anna Lembke 1:03:12 Hm. Mm-hmm.

Andrew Huberman 1:03:13 ... that opened the spigot on his dopamine system?

Anna Lembke 1:03:15 Mm-hmm. Mm-hmm. Yep.

Andrew Huberman 1:03:16 Because, um, it happened in a phase of, of a really great stretch of life.

Anna Lembke 1:03:22 Yeah. Right. Yeah. So you, you raised that great point about triggers, right? And triggers are things that make us want to go back to using our drug. And the key thing about triggers, whatever they are, is they also release a little bit of dopamine, right? So just thinking about, um, whatever the trigger is that we associate with drug use, or just thinking about drug use, can already release this anticipatory dopamine, this new little mini spike. But here's the part that I think is really fascinating. That mini spike is followed by a mini deficit state. So it goes up, and then it doesn't go back down to baseline, it goes below baseline tonic levels, and that's craving, right? So that anticipation is immediately followed by wanting the drug, and it's that dopamine deficit state that drives the motivation to go and get the drug. So many people talk about dopamine as not really about pleasure, but about wanting and about motivation. And so it is that deficit state that then drives the locomotion to get it.

Andrew Huberman 1:04:26 Mm-hmm. And earlier, your description of dopamine being involved in the desire for more, giving the sense of reward, but also movement-

Anna Lembke 1:04:33 Right.

Andrew Huberman 1:04:34 ... I have to assume that those things are braided together-

Anna Lembke 1:04:36 Yes.

Andrew Huberman 1:04:36 ... in our nervous system-

Anna Lembke 1:04:37 Yes.

Andrew Huberman 1:04:37 ... for the specific intention of when you feel something-

Anna Lembke 1:04:39 Yes.

Andrew Huberman 1:04:40 ... good, then you feel the pain-

Anna Lembke 1:04:42 Yes.

Andrew Huberman 1:04:42 ... or maybe you don't notice it-

Anna Lembke 1:04:43 Yeah.

Andrew Huberman 1:04:43 ... and then the next thing you know, you're pursuing more of the thing-

Anna Lembke 1:04:46 Yes.

Andrew Huberman 1:04:46 ... that

Narrator 1:04:46 could deliver pleasure.

Anna Lembke 1:04:46 And I love the way you used the word 'braided' together. That's beautiful. And let me also just say, uh, something that I find also fascinating in my work with patients, and I see this all the time. There are people for whom bad life experiences, loss, you know, in any form, stress, in many different forms, that's a trigger, but there are absolutely people for whom the trigger is things going well. And the things going well can be like the reward of the things going well, but very often, what it is is the removal of the hypervigilant state that's required to keep their use in check. So it's this sense of, I want to celebrate, you know, or I want to, this reward happened, I want to put more reward on there. And it's really, really fascinating because when people come to that realization, th- about themselves, that they're most vulnerable when things are going well, um, see that's really a valuable insight, because then they can put some, you know, things in place or barriers in place, or go to more meetings or whatever it is that they do, you know, to protect themselves.

Andrew Huberman 1:05:50 Along those lines, I have a friend, uh, 40 years sober, was a severe drug and alcohol addict from a very young age, really impressive person, does a lot of important work in the, um, kind of at-risk youth community out in Hawaii, and he said something to me, he said, uh, as former addicts often do, they've got these great sayings, um, but I think it fits very well with what you're describing, he said, you know, "No matter how far you drive, you're always the same distance from the ditch."

Anna Lembke 1:06:16 (laughs)

Andrew Huberman 1:06:17 And I, and, and I said, "Well that's kind of depressing," and he said, "No, that's actually what gives me peace."

Anna Lembke 1:06:22 Yeah.

Andrew Huberman 1:06:23 Because what would happen is for so many years of relapsing and relapsing and getting, recovering and relapsing, he felt like it was hopeless, and then somehow conceptualizing that the vigilance can never go away-

Anna Lembke 1:06:38 Mm-hmm. Mm-hmm.

Andrew Huberman 1:06:39 ... instead of making him feel burdened-

Anna Lembke 1:06:40 Yeah.

Andrew Huberman 1:06:41 ... it made him feel relieved. So I often think about that, th- that statement, you know, "No matter how far you drive, you're always the same distance from the ditch," because in my mind I conceptualize that as, gosh, that's a, that's a tough way to drive down the road. But actually, on a road where you know where the ditch is and where you know where the lane lines are, it's actually a pretty nice drive. It's when you don't know where the shoulder is that you constantly have to be looking around. So there's this, we're, we're speaking now in, in analogies and, and imagery, uh, and science, but I, one of the things I find so incredible about this community of 12 step, and there are var- a variety of them, are the, um, the communities that they create for themselves, um, and some of these sayings which I do believe link back to really core biological mechanisms.

Anna Lembke 1:07:29 Yes. Yes.

Andrew Huberman 1:07:30 I do want to ask about those communities. Uh, I have a question which might be a little bit, um, controversial, uh-

Anna Lembke 1:07:36 Great. (laughs)

Andrew Huberman 1:07:37 ... for which, which is-... is

Andrew Huberman 1:07:40 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)

Anna Lembke 1:08:02 (laughs)

Andrew Huberman 1:08:02 W- um, there's another circuit that leads people to, uh, wake you up if they themselves can't sleep.

Anna Lembke 1:08:07 (laughs)

Andrew Huberman 1:08:07 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.

Anna Lembke 1:08:21 Mm-hmm.

Andrew Huberman 1:08:21 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.

Anna Lembke 1:08:40 Mm-hmm.

Andrew Huberman 1:08:40 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)

Anna Lembke 1:08:52 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.

Andrew Huberman 1:09:35 They'll say a great meeting.

Anna Lembke 1:09:36 Yeah, right. (laughs)

Andrew Huberman 1:09:36 They're like-

Anna Lembke 1:09:37 Right.

Andrew Huberman 1:09:37 ... "That was such an amazing meeting." Or they find a group.

Anna Lembke 1:09:39 Right. Yeah.

Andrew Huberman 1:09:39 They find a group and a location.

Anna Lembke 1:09:41 Yeah.

Andrew Huberman 1:09:41 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-

Anna Lembke 1:09:54 Right.

Andrew Huberman 1:09:54 ... to people at a given meeting.

Anna Lembke 1:09:55 Right.

Andrew Huberman 1:09:56 That the meetings themselves-

Anna Lembke 1:09:57 Right.

Andrew Huberman 1:09:57 ... become their own form of dopamine hit.

Anna Lembke 1:10:00 Yes. Yes, yes.

Andrew Huberman 1:10:01 And, and again, I'm not being disparaging.

Anna Lembke 1:10:02 Yeah.

Andrew Huberman 1:10:03 I just, I, I want to understand this.

Anna Lembke 1:10:04 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?"

Andrew Huberman 1:10:18 (laughs) Right.

Anna Lembke 1:10:18 Because yes, it is much better for you to be addicted to AA and to recovery than almost any other addiction I could think of. And we know from Rob Malenka's work, who's here at Stanford, that oxytocin, um, you know, is the hormone that's involved in human pair bonding and relationships and love, and it directly links to dopamine neurons and causes the release of dopamine. So yes, when we connect with other humans, especially in a kind of transcendent, spiritual way, that's a huge dopamine hit, and it does replace the dopamine that people get from drugs. And for people who have this, uh, addiction temperament, they need it on a more intense level. They're not gonna be generally satisfied with kind of, you know, an, uh, sort of acquaintanceship, right? They, they, they want that intensity of the intimacy that you get with people when you're cathartically exposing, you know, warts and all. So yes, people can get addicted to recovery, and good for them. Go for it, you know? And of course this can be disruptive for friendships and, and relationships where the one person is not in recovery, and like, "You're going to so many meetings, you're always talking about recovery." But you know what? Much better than them being intoxicated, right? I mean, so although you may tire of your friends talking about their, their, you know, meetings all the time, I'm sure you would rather have them do that than, than, you know, be in their addiction. So...

Andrew Huberman 1:11:43 Yeah. Absolutely. And, um, this is now

Andrew Huberman 1:11:45 the second time you've done this during this discussion.

Anna Lembke 1:11:47 (laughs)

Andrew Huberman 1:11:47 But now I have empathy, because the way you describe their enthusiasm about meetings-

Anna Lembke 1:11:52 Yes.

Andrew Huberman 1:11:52 ... is probably the way that people feel about me-

Anna Lembke 1:11:55 Yes.

Andrew Huberman 1:11:55 ... and my work.

Anna Lembke 1:11:56 Right.

Andrew Huberman 1:11:56 And my, and neuroscience.

Anna Lembke 1:11:57 Yes.

Andrew Huberman 1:11:57 I mean, I've been getting up in front of the class since I was eight years old-

Anna Lembke 1:12:02 Yeah.

Andrew Huberman 1:12:02 ... and talking about things I read over the weekend.

Anna Lembke 1:12:04 Yeah. Yeah.

Andrew Huberman 1:12:04 And now I just happen to have this thing called a podcast.

Anna Lembke 1:12:06 Right.

Andrew Huberman 1:12:07 I've been do- I've been doing it since I was little.

Anna Lembke 1:12:08 Right.

Andrew Huberman 1:12:08 And it annoys a lot of people, right? I've learned to suppress it a little bit.

Anna Lembke 1:12:12 Right.

Andrew Huberman 1:12:12 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-

Anna Lembke 1:12:22 Yes.

Andrew Huberman 1:12:22 ... about yet another amazing meeting-

Anna Lembke 1:12:23 Right.

Andrew Huberman 1:12:24 ... or an, or for, there's a different form of this, but there are some people for which they just love intense experiences.

Anna Lembke 1:12:31 Yes.

Andrew Huberman 1:12:32 They're always t- like trying to pull me off to Bali because they're talking about-

Anna Lembke 1:12:36 Right.

Andrew Huberman 1:12:36 ... how sensual it is all the time. I'm sure Bali's wonderful.

Anna Lembke 1:12:39 (laughs)

Andrew Huberman 1:12:39 But there's this kind of ratcheting up.

Anna Lembke 1:12:41 Yes.

Andrew Huberman 1:12:41 It's like seeking Burning Man all year long.

Anna Lembke 1:12:43 Right. Yeah.

Andrew Huberman 1:12:43 I've never been to Burning Man. No desire to go to Burning Man.

Anna Lembke 1:12:46 Right. (laughs)

Andrew Huberman 1:12:48 Um... (laughs) Um, but inside of academia, I mean, if I were to just turn the mirror at myself-

Anna Lembke 1:12:54 Yeah.

Andrew Huberman 1:12:54 ... inside of academia or here in Silicon Valley, work-

Anna Lembke 1:12:58 Right.

Andrew Huberman 1:12:58 ... and the pursuit of more success, even if money is kind of divorced from that, sometimes it is, sometimes it isn't-

Anna Lembke 1:13:05 Mm-hmm.

Andrew Huberman 1:13:05 ... academic work is, you know, for sake of pursuit of knowledge. It sounds to me-

Anna Lembke 1:13:10 Yeah.

Andrew Huberman 1:13:10 ... like the same mechanism.

Anna Lembke 1:13:12 Yeah.

Andrew Huberman 1:13:12 In fact, it feels to me very much like the, the, the same mechanism.

Anna Lembke 1:13:16 So Andrew, here's what I love about you. First of all, you're willing to bring your own flaws and foibles to this conversation.

Andrew Huberman 1:13:22 Well, they're everywhere. (laughs)

Anna Lembke 1:13:23 Well, you know what? G- it's wonderful. And then you're really open and curious and wanting to understand. 'Cause I can't tell you how many people I have met who really see addiction as some kind of otherness. But the truth is, we're all wired for addiction, and if you're not addicted yet, it's, it's just, it's right around the corner. Do you know what I mean?

Andrew Huberman 1:13:44 Mm-hmm. Mm-hmm.

Anna Lembke 1:13:44 Especially with the incredible panoply of new drugs and behaviors that are out there. So I love that you're willing to...... take a moment and really try to understand this because it is, it is... we can all relate. And your relating it to your, essentially your work addiction is right and, and apt. You just happen to be addicted to something that is really socially rewarded. You know, you figured that out at an early age, "Oh, when I do X, Y, and Z, all these people go, 'Look at that smart kid,'" or whatever it is, you know, you-

Andrew Huberman 1:14:15 Well for me it made me feel safe.

Anna Lembke 1:14:16 Okay.

Andrew Huberman 1:14:17 I felt like, um... yeah. I just felt like this, and, and I pause there 'cause it's like, it's like peace. I'm like, "Ah, I can relax for a moment."

Anna Lembke 1:14:27 When you're talking about neuroscience?

Andrew Huberman 1:14:28 When no- or just when I'm, when I've, when I feel like I'm on the right path-

Anna Lembke 1:14:32 Yeah.

Andrew Huberman 1:14:33 ... and I'm-

Anna Lembke 1:14:33 Okay.

Andrew Huberman 1:14:33 ... onto something, or if I see something that I'm excited about-

Anna Lembke 1:14:36 Right.

Andrew Huberman 1:14:36 ... I'm like, I feel, um, filled with... it must be dopamine.

Anna Lembke 1:14:41 Yes.

Andrew Huberman 1:14:41 I feel flooded with pleasure-

Anna Lembke 1:14:42 Mm-hmm. Right.

Andrew Huberman 1:14:42 ... literally from head to toe.

Anna Lembke 1:14:43 Yeah.

Andrew Huberman 1:14:44 And then my next thought is, "More." (laughs)

Anna Lembke 1:14:47 (laughs) So true. You're a t-

Andrew Huberman 1:14:48 You know.

Anna Lembke 1:14:48 You're, you're really-

Andrew Huberman 1:14:49 Yeah.

Anna Lembke 1:14:49 You're a true addict.

Andrew Huberman 1:14:50 Yeah. Okay.

Anna Lembke 1:14:50 You, you are.

Andrew Huberman 1:14:50 Thank you.

Anna Lembke 1:14:51 You are.

Andrew Huberman 1:14:51 Okay.

Anna Lembke 1:14:51 But you just got really-

Andrew Huberman 1:14:52 I think thank you.

Anna Lembke 1:14:53 You really got lucky-

Andrew Huberman 1:14:55 Uh-huh.

Anna Lembke 1:14:55 ... with the fact that-

Andrew Huberman 1:14:55 Yep.

Anna Lembke 1:14:56 ... that what, you know, what you're drawn to is, is adaptive, essentially, you know. Um, and, and then your challenge is going to be that your life doesn't get too out of balance in the sense that you're 24/7 work and you don't stop and do some other things-

Andrew Huberman 1:15:11 Sure.

Anna Lembke 1:15:11 ... or think about the... and it's-

Andrew Huberman 1:15:12 And my life, and my life admittedly is somewhat asymmetric.

Anna Lembke 1:15:15 Right.

Andrew Huberman 1:15:15 I mean, it has other components of physical health-

Anna Lembke 1:15:16 Right.

Andrew Huberman 1:15:17 ... etc., but it is, uh-

Anna Lembke 1:15:18 Right.

Andrew Huberman 1:15:18 ... um, somewhat asymmetric, um, which is why I got a dog. Although I talk about him an awful lot, so, um...

Anna Lembke 1:15:24 But the dog is good because that draws you out of yourself and a little bit away from the work. But again, you know, I think the key here is for people who feel like they don't- they've never experienced addiction or they don't know anybody with addiction, or if they do, they don't get it, just think of that one thing that is the most important thing in your life that you do that gives you pleasure and meaning and purpose, and then imagine if you couldn't do it.

Andrew Huberman 1:15:46 Oh yeah. Let's not talk about that. (laughs)

Anna Lembke 1:15:50 (laughs) Right.

Andrew Huberman 1:15:51 Uh, well, I appreciate the, the feedback and, uh, you can send me a bill at the-

Anna Lembke 1:15:55 (laughs)

Andrew Huberman 1:15:55 ... at the, at the end. Um,

Andrew Huberman 1:15:58 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?"

Anna Lembke 1:16:44 Water.

Andrew Huberman 1:16:45 Really?

Anna Lembke 1:16:47 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-

Andrew Huberman 1:17:14 You can die from it, right?

Anna Lembke 1:17:15 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-

Andrew Huberman 1:17:26 Hmm.

Anna Lembke 1:17:26 ... to... I know, it was so sad-

Andrew Huberman 1:17:28 Yeah.

Anna Lembke 1:17:28 ... so sad.

Andrew Huberman 1:17:29 Wh- what happened to her?

Anna Lembke 1:17:31 She eventually t- took her own life.

Andrew Huberman 1:17:33 Wow.

Anna Lembke 1:17:33 Yeah, it was really...

Andrew Huberman 1:17:34 That's rough.

Anna Lembke 1:17:34 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-

Andrew Huberman 1:17:43 Mm-hmm.

Anna Lembke 1:17:43 ... 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."

Andrew Huberman 1:17:53 Wow. And I think it just underscores the, the generalized ability of these circuits.

Anna Lembke 1:17:58 Right.

Andrew Huberman 1:17:58 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-

Anna Lembke 1:18:04 Right.

Andrew Huberman 1:18:05 ... addiction, and water plugged into that circuit.

Anna Lembke 1:18:08 Right. Right.

Andrew Huberman 1:18:09 Wow. That's i- that's intense. Um, in your book, uh, Dopamine

Andrew Huberman 1:18:14 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.

Anna Lembke 1:18:35 Yeah.

Andrew Huberman 1:18:36 Yeah, tell us a little bit more about that.

Anna Lembke 1:18:38 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-

Andrew Huberman 1:19:35 It's like feeling an itch everywhere.

Anna Lembke 1:19:37 Oh yeah.

Andrew Huberman 1:19:37 Yeah.

Anna Lembke 1:19:37 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.

Andrew Huberman 1:20:03 Mm-hmm.

Anna Lembke 1:20:03 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

Anna Lembke 1:20:10 this patient do? What... Okay, I'm gonna try that." (laughs)

Andrew Huberman 1:20:12 It is, it is an amazing community of-

Anna Lembke 1:20:14 Yeah.

Andrew Huberman 1:20:15 ... of, of, of people that-

Anna Lembke 1:20:15 Yeah.

Andrew Huberman 1:20:16 ... they are very sage. I wanted to, um, just touch on something that you mentioned which is, uh, the shame.

Anna Lembke 1:20:23 Yeah.

Andrew Huberman 1:20:23 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.

Anna Lembke 1:20:48 (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