EVERY SPOKEN WORD
150 min read · 30,018 words- 0:00 – 15:00
(drumbeats) Joe Rogan podcast,…
- ALAnne Lembke
(drumbeats) Joe Rogan podcast, check it out.
- JRJoe Rogan
The Joe Rogan Experience.
- ALAnne Lembke
Train by day, Joe Rogan podcast by night. All day. (instrumental music)
- JRJoe Rogan
All right, hello.
- ALAnne Lembke
Hi.
- JRJoe Rogan
Thanks for doing this. Appreciate it.
- ALAnne Lembke
I'm happy to be here.
- JRJoe Rogan
I'm very excited to talk to you about this. This is a very, uh, interesting subject. I have had problems with addiction my whole life.
- ALAnne Lembke
Okay.
- JRJoe Rogan
Particularly, like, I had a really bad video game addiction at one point in time, and, uh, I had to quit cold turkey. It was like a eight-hour-a-day addiction. Like-
- ALAnne Lembke
And, and when, when was that?
- JRJoe Rogan
20 years ago? Somewhere around then.
- ALAnne Lembke
Okay.
- JRJoe Rogan
Yeah.
- ALAnne Lembke
So-
- JRJoe Rogan
Little more than 20 years ago.
- ALAnne Lembke
Okay. So you were in your 30s?
- JRJoe Rogan
Yeah.
- ALAnne Lembke
And how did you realize that you were addicted?
- JRJoe Rogan
Oh, I knew.
- ALAnne Lembke
Okay. You, you-
- JRJoe Rogan
(laughs) I did, I did the whole time.
- ALAnne Lembke
You, you, you knew from the very beginning?
- JRJoe Rogan
Well, it was very fun. I was playing this, uh, online video game called Quake. And what it is, is you play online and, you know, you, uh, you, you are in this 3D environment.
- ALAnne Lembke
Yes.
- JRJoe Rogan
And you hear, like, sounds in 3D-
- ALAnne Lembke
Mm-hmm.
- JRJoe Rogan
... and s- the graphics are amazing, and you're running around shooting at people, and they're shooting at you, and it's real exciting. It's very thrilling. But it's not real life, and, uh, it'll eat your whole life away.
- ALAnne Lembke
Yeah.
- JRJoe Rogan
(laughs)
- 15:00 – 30:00
(laughs) …
- ALAnne Lembke
(laughs)
- JRJoe Rogan
(laughs)
- ALAnne Lembke
And, and, you know, and this c-
- JRJoe Rogan
But a lot of people do, right?
- ALAnne Lembke
Yes, right. So, this comes up a lot in clinical care. So, for example, I'll, I'll ask a patient, you know, "How many times a, a week do you drink alcohol?" They say, "Oh, just once. It's not a big deal." "Oh, okay. How many times a, a week do you use cocaine?" "Oh, j- just once. No problem."
- JRJoe Rogan
(laughs)
- ALAnne Lembke
Um, you know ... "All right."
- JRJoe Rogan
It's Tuesday.
- ALAnne Lembke
Yeah. Right, right. It's Tuesday. So, what, what, what you end up discovering, and this is increasingly common, is like, daily polypharmacy, right? Where, in their minds, they're not addicted to anything because they're only doing it once a week, but if you add it all up, they're doing something that's addictive every single day.
- JRJoe Rogan
Wow.
- ALAnne Lembke
And all of those substances end up basically working on the same common dopamine pathway, having a compounding effect.
- JRJoe Rogan
What is the evolutionary biology reason for this?
- ALAnne Lembke
Mm-hmm. Yeah. Yeah. I love that. Um, so I mean, you know, these are sort of ... These evolutionary stories are sort of just-so stories, but we, we can ... Well, I think we can speculate and tell them.
- JRJoe Rogan
Mm-hmm.
- ALAnne Lembke
I mean, we evolved over millions of years to approach pleasure and avoid pain, and it is what has kept us alive in a world of scarcity and ever-present danger, right? Um, even if we ... So, i- when, like, we travel across the desert and we, we find some water, woo-hoo, you know, dopamine, that's good.
- JRJoe Rogan
Right.
- ALAnne Lembke
But if we, if we stayed in that, you know, euphoric celebratory state, we really wouldn't be aware of the fact that night's coming or there's a predator that's gonna get us. So, our brains have evolved to very quickly bring us back down to baseline, again by going below baseline, and that keeps us sort of, you know, ever vigilant, ever seeking new and greater rewards, which is exactly what we need in order to survive in a dangerous world, and in a world where we don't have the kind of abundance that we're talking about now. And, and, you know, one of the things that I think has happened, is that humanity has reached this really unprecedented state in which our primitive brains are completely mismatched for our modern ecosystem, which is an ecosystem of incredible, uh, overabundance and quantity, potency and variety of these novel drugs.
- JRJoe Rogan
So, we're designed for essentially like a hunter-gatherer life. That's the ... How the human body's designed. And I'm sure a lot of those obsessive and dopamine reward system, th- all those ... The, the release comes from this idea of finding food.
- ALAnne Lembke
Yeah.
- JRJoe Rogan
The idea of, uh, figuring out how to survive and feed the family.
- ALAnne Lembke
Mm-hmm. Yeah.
- JRJoe Rogan
When you're successful on a fishing trip and you come back with food, everybody's happy. Like, that kind of thing, uh, strive ... Makes people strive to be obsessed with success-
- ALAnne Lembke
Yeah.
- JRJoe Rogan
... in that particular area.
- ALAnne Lembke
Right.
- JRJoe Rogan
In, in hunting.
- ALAnne Lembke
Yeah.Yeah, yeah. We're always looking for the next thing, never satisfied with-
- JRJoe Rogan
Right.
- ALAnne Lembke
... what we have.
- JRJoe Rogan
Because we can't be because we have to get more food tomorrow.
- 30:00 – 45:00
Right. …
- JRJoe Rogan
what you're getting at is that there's a benefit in living in the moment instead of seeking out these constant rewards, so d- difficult things, obsessive things, then a reward for that obsessive thing.
- ALAnne Lembke
Right.
- JRJoe Rogan
What is the benefit of living in the moment?
- ALAnne Lembke
Mm. Mm-hmm. Well, first of all, let me just say that for, like, for a long time, when I would hear people say, you know, "Be in the moment," and I would try to do that, um, like, I thought I was doing it wrong, because I thought if I could just be in the moment, I would, like, experience some sort of bliss, and I never did. But what I eventually realized is that being in the moment means tolerating the distress of just fully being in the moment, right? Um, because ... And that's all the harder to tolerate because we, we have all these rewards that are waiting for us and we'd rather go there.
- JRJoe Rogan
So being in the moment-
- ALAnne Lembke
Yes.
- JRJoe Rogan
... is tolerating the distress of being in the moment?
- ALAnne Lembke
Uh-huh.
- JRJoe Rogan
What's the benefit of being in the moment?
- ALAnne Lembke
Well, uh, the benefit of being in the moment, for me, once I acknowledge that I'm not necessarily going to feel good, is that I can really be, be present, and then open to positive experiences that are not of my own making.
- JRJoe Rogan
Like what?
- ALAnne Lembke
Really unexpected. Really unexpected and not that frequent, but when they do come along, they're, they're lovely.
- JRJoe Rogan
Like, what are these experiences though?
- ALAnne Lembke
Um, they're unpredictable. They're ju- and they're incredibly fleeting, but it's just-
- JRJoe Rogan
Are these miracles? Are you talking about miracles?
- ALAnne Lembke
No.
- JRJoe Rogan
(laughs)
- ALAnne Lembke
No, I'm not talking ... I'm not ... I'm not tal- m- maybe I am talking about miracles, but I don't c- I don't think of them as miracles. I mean, I ... Uh, okay, let me, well, let me, let me ask you this.
- JRJoe Rogan
Okay.
- ALAnne Lembke
W- um, what are some of the happiest moments that you've had in your life? Or just think of one of ha- and, like, where were you and what were you doing?
- JRJoe Rogan
Oh, well, that's very difficult. I've had a very happy life.
- ALAnne Lembke
Okay.
- JRJoe Rogan
I've been very lucky.
- ALAnne Lembke
Okay. Okay.
- JRJoe Rogan
I've had a lot of, uh, very fun experiences.
- ALAnne Lembke
Okay. Okay. So, you know, you could be baseline temperament just a happier person than I am, which is perfectly possible, 'cause I do think we come into life with sort of different degrees of happiness, and I'm probably a little bit on the unhappiness, uh, side of things.
- JRJoe Rogan
This is my position though. My happiness has often come from very hard work.
- ALAnne Lembke
Yes.
- JRJoe Rogan
And then a reward.
- ALAnne Lembke
Right. Right.
- 45:00 – 1:00:00
Hmm. …
- ALAnne Lembke
no pain in the immediate aftermath of their injury. And through his research, he concluded that the reason for that was, number one, they realized they were still alive and happy to be so. And number two, they realized they were probably going home. And so the meaning for them of the injury was going home.
- JRJoe Rogan
Hmm.
- ALAnne Lembke
So it's really the, our ca- our prefrontal cortex, um, you know, that area right behind our forehead communicates with our lower brain stem, lizard brain reward pathway, and incredibly, you know, modifies and modulates that experience to, to, to sort of describe a, you know, a corollary example. There was a case report of a young man, construction worker who jumped on a giant nail that went right through his boot, through his foot. He showed up in the emergency room, intense pain, they gave him opioids, it wasn't enough. Still screaming in pain, they gave him more opioids, it wasn't enough. Still screaming in pain, they finally had to give him so many opioids that he became unconscious. They slowly removed the nail, they slowly removed the boot, and it turns out the nail had gone right between his toes. So he in fact had no tissue injury, but his mind saw the boot.
- JRJoe Rogan
Mm-hmm.
- ALAnne Lembke
The nail sticking up through the boot, and he experienced real pain. And so that pain was real for him. It wasn't made up, but his brain had elaborated that pain.
- JRJoe Rogan
A less charitable person...
- ALAnne Lembke
(laughs)
- JRJoe Rogan
... would not look at that man that way. Especially people who've actually been injured.
- ALAnne Lembke
Well, you know, I, I tell you the, the, the ways in which our brains can manufacture pain.
- JRJoe Rogan
But is that really our brain?
- ALAnne Lembke
Yeah.
- JRJoe Rogan
Or is it... Well, I mean, I guess it is, right? Because it's all happening...
- ALAnne Lembke
Yeah.
- JRJoe Rogan
... inside the mind.
- ALAnne Lembke
Yes.
- JRJoe Rogan
But that seems like a baby.
- ALAnne Lembke
Uh-huh.
- JRJoe Rogan
A big grown man baby.
- ALAnne Lembke
Uh-huh. Uh-huh.
- JRJoe Rogan
Right? Which grow... I'm not saying... Look obviously terrible that the man was injured, sort of, not really injured much, but that's kind of, that's like the caricature of men when they get sick, right? Where...
- ALAnne Lembke
No.
- JRJoe Rogan
Isn't it?
- ALAnne Lembke
No, no, no.
- JRJoe Rogan
Where, where they, their mom has to take care of them or...
- ALAnne Lembke
No.
- JRJoe Rogan
... their wife has to take care of them.
- ALAnne Lembke
No.
- JRJoe Rogan
And they act like a big baby.
- ALAnne Lembke
No, no, no.
- JRJoe Rogan
No?
- 1:00:00 – 1:15:00
Right. …
- JRJoe Rogan
sports.
- ALAnne Lembke
Right.
- JRJoe Rogan
A lot of them like, um, they got into triathlons or Ironman or-
- ALAnne Lembke
Yeah.
- JRJoe Rogan
... you know, marathon running-
- ALAnne Lembke
Yeah.
- JRJoe Rogan
... ultra-marathon running, that kind of thing.
- ALAnne Lembke
Yeah. Yeah. And I actually prescribe exercise to my patients who are trying to quit drugs and alcohol and pornography and gambling and whatever it is, because we do know that exercise is a great way to get that opponent process dopamine, the after-effect dopamine that our own, you know, in our own bodies make. And we do know that it helps tolerate the withdrawal from drugs and alcohol. There are g- good data on that. But there's always a risk then of getting addicted to that, to that behavior.
- JRJoe Rogan
Yeah.
- ALAnne Lembke
And there's some interesting, you know, animal studies showing, um, rats, for example, w- we used to think that... So for ex- if you put a, one of those running wheels in a rat's cage, um, they are less likely to self-administer drugs like cocaine and methamphetamines. So when those, when those studies were first being performed, the, the running wheel was thought to be, um-... a way to just measure baseline activity, or as a healthy alternative to self, you know, drug administration. But over time, scientists began to see that the running wheel was in and of itself reinforcing. So a rat will, or a mouse, will run longer in a running wheel than they will on a flat treadmill or in, or in the wild. Some mice or rats will run so long in the running wheel that they'll actually, their tails will curve up and remain permanently curved in the shape of the running wheel. And some rats will, will run on that running wheel until they die. And that was the first indication that that running wheel in and of itself can be a drug. Um, that it has its own reinforcing properties.
- JRJoe Rogan
Uh, I'm sure you're aware of, uh, the studies that they did with rats with, um, heroin and cocaine, and that they did it in cages. And they found that these rats would self-administer heroin and cocaine and to the point where, where they would drink the water that had heroin and cocaine in it and avoid the regular water.
- ALAnne Lembke
Yeah.
- JRJoe Rogan
And they'd do it until they died.
- ALAnne Lembke
Mm-hmm. Yeah.
- JRJoe Rogan
Until they set up a happy environment for these rats.
- ALAnne Lembke
Mm-hmm. Mm-hmm. Mm-hmm.
- JRJoe Rogan
And this is what gets me to this whole hunter-gatherer thing again. When they set up a happy environment for the rats, they rarely, if ever, used the cocaine or the heroin. And if they did, they just used it and then went about their day.
- ALAnne Lembke
Mm-hmm. Mm-hmm.
- JRJoe Rogan
Because they had a very large environment where there was trees and plants and all sorts of things that seemed normal and natural for them.
- ALAnne Lembke
Mm-hmm. Mm-hmm.
- JRJoe Rogan
And that the environment itself of these cages with the bl- bright fluorescent lights, these were extremely distressful. And so the rats were essentially self-medicating to avoid the distress that they were being put into. Now, are we doing that to ourselves? This is the question. Like, addictive behaviors that exist in human beings today, are they exacerbated by the circumstances of our modern world?
- ALAnne Lembke
Mm-hmm. Mm-hmm.
- JRJoe Rogan
Cubicle life, commuter life.
- ALAnne Lembke
Right. Right.
- JRJoe Rogan
Like, being, you know, on the subway or whatever you're doing, where you're just like droning in and out-
- ALAnne Lembke
Right.
- JRJoe Rogan
... and constantly being around people and constantly being in these unnatural environments. And then again, the, the, this theme of doing something you don't want to do all day long.
- ALAnne Lembke
Mm-hmm. Yeah.
- JRJoe Rogan
Something that's not rewarding and not interesting.
- ALAnne Lembke
Yeah.
- 1:15:00 – 1:20:53
Telling someone to just…
- ALAnne Lembke
is going to reset the reward pathways. But if they're willing to do it, 80% of them will come back after a month and describe that they feel much better. And, and the reason for that is because they've been in this dopamine-deficit state. If they abstain, the gremlins hop off, they start to make their own dopamine again, and then they re- restore homeostasis and then they're able to take pleasure in more modest rewards.
- JRJoe Rogan
Telling someone to just abstain, to just take time. Just, "Hey, put the video games down. Stop gambling for a month." Whatever it is. "Stop drinking for a month." Is that enough or do you give them tools...
- ALAnne Lembke
Mm.
- JRJoe Rogan
... that aid them...
- ALAnne Lembke
Mm-hmm.
- JRJoe Rogan
... in abstaining?
- ALAnne Lembke
Yeah.
- JRJoe Rogan
Is there something that you can do? Like is there a, a guidebook or framework that they can follow?
- ALAnne Lembke
Yeah. So I mean, I've developed this acronym, which, uh, you probably don't want me to go through. But it's-
- JRJoe Rogan
Sure, please do.
- ALAnne Lembke
R- Okay. (laughs)
- JRJoe Rogan
We have all the time in the world.
- ALAnne Lembke
Okay. Okay. (laughs)
- JRJoe Rogan
(laughs)
- ALAnne Lembke
Well first of all, let me say, you know, this is a spectrum disorder and people on the very severe end are not going to be able to stop on their own. Those are individuals who have to go into hospital or go into a residential treatment setting.
- JRJoe Rogan
For games?
- ALAnne Lembke
Oh, yes.
- JRJoe Rogan
Really?
- ALAnne Lembke
Oh, yeah.
- JRJoe Rogan
They go to hospitals?
- ALAnne Lembke
Well, well, there are residential treatment settings for, for video game addiction.
- JRJoe Rogan
So they just lock these kids up and no games?
- ALAnne Lembke
Yes.
- JRJoe Rogan
And, uh...
- ALAnne Lembke
Yes.
- JRJoe Rogan
Do you isolate them in a building and force them to read actual books made out of...
- ALAnne Lembke
Right.
- JRJoe Rogan
... paper or something?
- ALAnne Lembke
Right. Well, I mean... Well, y- you know, um, t- hopefully you're not forcing them. I mean...
- JRJoe Rogan
Right.
Episode duration: 2:19:32
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