Joe Rogan Experience #1708 - Anne Lembke

Anna Lembke is a psychiatrist, author and specialist in the treatment of addiction. Her new book, "Dopamine Nation: Finding Balance in the Age of Indulgence," is available now.

Anne LembkeguestJoe Roganhost

Jun 27, 20242h 19mWatch on YouTube ↗

EVERY SPOKEN WORD

150 min read · 30,018 words

0:00 – 0:16
Cold open and framing the conversation around addiction
1. ALAnne Lembke
  (drumbeats) Joe Rogan podcast, check it out.
2. JRJoe Rogan
  The Joe Rogan Experience.
3. ALAnne Lembke
  Train by day, Joe Rogan podcast by night. All day. (instrumental music)
4. JRJoe Rogan
  All right, hello.
5. ALAnne Lembke
  Hi.
6. JRJoe Rogan
  Thanks for doing this. Appreciate it.
7. ALAnne Lembke
  I'm happy to be here.
0:16 – 4:10
Joe’s video game addiction: recognizing the tipping point and going cold turkey
1. 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.
2. ALAnne Lembke
  Okay.
3. 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-
4. ALAnne Lembke
  And, and when, when was that?
5. JRJoe Rogan
  20 years ago? Somewhere around then.
6. ALAnne Lembke
  Okay.
7. JRJoe Rogan
  Yeah.
8. ALAnne Lembke
  So-
9. JRJoe Rogan
  Little more than 20 years ago.
10. ALAnne Lembke
  Okay. So you were in your 30s?
11. JRJoe Rogan
  Yeah.
12. ALAnne Lembke
  And how did you realize that you were addicted?
13. JRJoe Rogan
  Oh, I knew.
14. ALAnne Lembke
  Okay. You, you-
15. JRJoe Rogan
  (laughs) I did, I did the whole time.
16. ALAnne Lembke
  You, you, you knew from the very beginning?
17. 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.
18. ALAnne Lembke
  Yes.
19. JRJoe Rogan
  And you hear, like, sounds in 3D-
20. ALAnne Lembke
  Mm-hmm.
21. 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.
22. ALAnne Lembke
  Yeah.
23. JRJoe Rogan
  (laughs)
24. ALAnne Lembke
  So, I'm, I'm curious, how did you ... I mean, did you know from the very beginning that you were addicted, or was-
25. JRJoe Rogan
  No.
26. ALAnne Lembke
  ... there a... So what, at what point, like, how long into it did you say, "Gee, this is a problem. I should change this behavior"?
27. JRJoe Rogan
  Uh, well, when I would w- I would go to bed in the morning.
28. ALAnne Lembke
  (laughs)
29. JRJoe Rogan
  'Cause I would come home from, like, a comedy show and I would literally play all night long.
30. ALAnne Lembke
  Okay.
4:10 – 6:44
From “addictive personality” to the disease model: nature, nurture, neighborhood
1. ALAnne Lembke
  Yeah. Yeah. Yeah. So, I mean, it's a, it's a great-
2. JRJoe Rogan
  It's-
3. ALAnne Lembke
  ... question. Um, it's something that people used to call the addictive personality. We don't really call it that anymore. We just use the idea of the disease model. So, we say that somebody has the disease of addiction. It's a chronic, relapsing, and remitting problem. People come to it with different degrees of vulnerability, and the risk for it can essentially be summarized as nature, nurture, and neighborhood. And just to briefly describe that, if you have a biological parent or grandparent with addiction, you are at increased risk compared to the general population of getting addicted yourself. If you have a co-occurring mental illness, you are at increased risk of getting addicted. If you have certain character traits, like you're more impulsive, you have a hard time putting a break between the idea to do something and actually doing it, you are, are, are at increased risk for addition. So that's kind of all in the sort of nature, um, risk category. There's also the nurture piece of it. So, if you grow up in an environment where you experience a whole lot of trauma, you are at increased risk for becoming addicted. If you grow up in an environment where your caretakers model, um, using drugs and alcohol or other addictive substances or behaviors as a coping strategy, you are at increased risk of becoming addicted. Or even if they just implicitly condone it. And then that brings us to the whole neighborhood idea.And this, I think, is an really under-recognized aspect of our risk for addiction, which is just simple access. So if you live in an environment where you have more access to highly reinforcing drugs and behaviors, you're more likely to try them. And just simply in being exposed, especially with the increasing potency, variety, and novelty of drugs today, you are at increased risk of becoming addicted. So if you go see a doctor who's more free with their prescription pad, you're exposed to opioids or benzos, you're more likely to, to get addicted. If you grow up in a culture where people are playing a lot of video games, you're more likely to try them, more likely to get addicted. So this nature, nurture, and neighborhood are the risk factors. But again, people bring different degrees of vulnerability to this problem of addiction. And some people are more vulnerable than others. And you may indeed be in that category, where you're just some- somebody who, you know, once you find something that's reinforcing for you, you just go whoom. And you just want to do it again and again and again.
6:44 – 14:51
Dopamine deficit and the pleasure–pain balance (“gremlins”): how addiction rewires reward
1. JRJoe Rogan
  When you say reinforcing, what do you mean by that?
2. ALAnne Lembke
  I mean that it's rewarding in some way.
3. JRJoe Rogan
  Rewarding.
4. ALAnne Lembke
  Rewarding, right. So it's, it's, it's pleasurable at first. Now the thing about addiction and the way that it changes our brains is that that thing that initially is pleasurable and has us engaging in approach behaviors, if we continue to consume that substance or engage in that behavior, it ultimately actually puts us in a dopamine deficit state, such that we want to continue to do that behavior, not to feel good, but just to stop feeling bad.
5. JRJoe Rogan
  Mm.
6. ALAnne Lembke
  And that's kind of one of the fundamental things about the disease of addiction. It's i- innate vulnerability to start, added to the changes that occur in the brain as a result of ongoing consumption of our drug. And those brain changes are what drive continued compulsive use.
7. JRJoe Rogan
  So that's the difference between being enthusiastic about something that you enjoy, versus something that consumes your life. So you're kind of chasing the dragon. Like the initial fir- like that's where they talk about it with heroin addiction, right?
8. ALAnne Lembke
  Right.
9. JRJoe Rogan
  Don't they say, "Chasing the dragon?"
10. ALAnne Lembke
  Yeah.
11. JRJoe Rogan
  The initial rush that you get from the first, um, uses of it, you're always chasing that. But really what you're doing later on in life is just trying to not be sick.
12. ALAnne Lembke
  Yes.
13. JRJoe Rogan
  Because not having it in your body makes you feel terrible.
14. ALAnne Lembke
  Right. So, so interesting that, that term, "chasing the dragon," i- it comes in part from, as you describe, like the elusiveness of trying to recreate that initial high, which with continued use becomes harder and harder. But it also literally comes from when heroin is inhaled, so if you put it on a piece of tinfoil and you light it underneath, you get this kind of smoke. And then that plume looks like a dragon's tail.
15. JRJoe Rogan
  Ah.
16. ALAnne Lembke
  So it's, it's got a couple of different meanings. But yes, um, I mean, what you're saying is exactly right. And the way that I describe this to patients and describe it to medical students is, imagine that in your brain there's a balance, um, kind of like a teeter-totter in a kids' playground. And one of the most interesting findings in neuroscience in the past 75 years is that pleasure and pain are co-located, which means the same parts of our brain that process pleasure also process pain. And they work like opposite sides of a balance. So when we do something that's rewarding or reinforcing or pleasurable, our balance tips slightly to the side of pleasure. We get a little release of dopamine, the pleasure neurotransmitter in that part of our brain, our reward pathway, and we feel good. But the thing about that balance is that it wants to remain level. And i- and the brain will work very hard to restore a level balance or what's called homeostasis. And it does that by tipping the brain an equal and opposite amount to the side of pain. So again, the way the balance restores homeostasis is to tip to the opposite side. That's the come down after using, that moment of wanting to do it again, the hangover. If we wait long enough, that feeling passes and balance is restored. But if we don't wait and we continue to use our drug again and again, we end up with a balance that's essentially weighted to the side of pain. And I imagine that like these little neuro adaptation gremlins hopping on the pain side of the balance. Not very scientific, I know. But the point is that with repeated use, we get enough gremlins on the pain side of the balance to fill this whole room. And then we're essentially working from a dopamine deficit state. We've down-regulated our own dopamine. We've down-regulated our own dopamine transmission. And those gremlins like it on the balance. So they don't get off after the hangover is over or the acute withdrawal. They can persist there for weeks to months to years, which is why people with addiction, even when their lives have become so much better, will relapse because they're not walking around with a level pleasure/pain balance. They're walking around with a balance tipped to the side of pain. They're experiencing the universal symptoms of withdrawal from any addictive substance or behavior, anxiety, irritability, insomnia, dysphoria, and intrusive thoughts of wanting to use their drug again. Now with enough time elapsed, and again with people, in people with severe addiction, it can take months to years, those neuro adaptation gremlins will hop off. We will regenerate our own dopamine and our own dopamine receptors and, and our level balance or homeostasis will be restored.
17. JRJoe Rogan
  Is it scientific to call them gremlins?
18. ALAnne Lembke
  Super scientific. (laughs)
19. JRJoe Rogan
  (laughs) 'Cause I'm, I'm hearing it's like, well that's a great way to put it. 'Cause like people that are ad- Like Jamie can attest to this. We, we had a, a relapse of our video game addiction, uh, we, at the old studio, had, um, a bunch of, uh, computers set up.
20. ALAnne Lembke
  Mm-hmm.
21. JRJoe Rogan
  And we started playing again.
22. ALAnne Lembke
  Yeah.
23. JRJoe Rogan
  And then we wind up playing like hours and hours ...
24. ALAnne Lembke
  Yeah.
25. JRJoe Rogan
  ... every day. And I had to go, I had to stop again. I go, "Oh, I see what's happening here."
26. ALAnne Lembke
  Right. Right.
27. JRJoe Rogan
  "I'm, I'm right back into this." But this was like decades later.
28. ALAnne Lembke
  Yes. Well I mean, a- and there, a couple interesting points about that. So one is that...... in, in creating easy access at your other studio, the, the temptation was ... Y- you were not, not able to withstand it. And that, that's, that's how-
29. JRJoe Rogan
  Oh, no. There was no ... It wasn't temptation, it was a plan.
30. ALAnne Lembke
  (laughs) Okay.
14:51 – 15:45
Why “balancing” addictions doesn’t work: poly-addiction and compounding dopamine impacts
1. JRJoe Rogan
  What if you have multiple addictions, and you use those to balance out your dopamine release?
2. ALAnne Lembke
  Yes.
3. JRJoe Rogan
  Would that be a good strategy?
4. ALAnne Lembke
  No.
5. JRJoe Rogan
  (laughs)
6. ALAnne Lembke
  And I ... (laughs)
7. JRJoe Rogan
  (laughs)
8. ALAnne Lembke
  And, and, you know, and this c-
9. JRJoe Rogan
  But a lot of people do, right?
10. 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."
11. JRJoe Rogan
  (laughs)
12. ALAnne Lembke
  Um, you know ... "All right."
13. JRJoe Rogan
  It's Tuesday.
14. 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.
15. JRJoe Rogan
  Wow.
16. ALAnne Lembke
  And all of those substances end up basically working on the same common dopamine pathway, having a compounding effect.
15:45 – 19:12
Evolutionary mismatch: hunter-gatherer brains in an age of abundance
1. JRJoe Rogan
  What is the evolutionary biology reason for this?
2. 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.
3. JRJoe Rogan
  Mm-hmm.
4. 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.
5. JRJoe Rogan
  Right.
6. 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.
7. 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.
8. ALAnne Lembke
  Yeah.
9. JRJoe Rogan
  The idea of, uh, figuring out how to survive and feed the family.
10. ALAnne Lembke
  Mm-hmm. Yeah.
11. 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-
12. ALAnne Lembke
  Yeah.
13. JRJoe Rogan
  ... in that particular area.
14. ALAnne Lembke
  Right.
15. JRJoe Rogan
  In, in hunting.
16. ALAnne Lembke
  Yeah.Yeah, yeah. We're always looking for the next thing, never satisfied with-
17. JRJoe Rogan
  Right.
18. ALAnne Lembke
  ... what we have.
19. JRJoe Rogan
  Because we can't be because we have to get more food tomorrow.
20. ALAnne Lembke
  That's right. That's right.
21. JRJoe Rogan
  So it's, it's sort of like a built-in human reward system.
22. ALAnne Lembke
  That's right. It absolutely is. And one of the things that I think about people with addiction in, in our modern times is that, you know, i-i ... First of all, addiction is endemic in the population. Since the beginning of human history, you can find accounts of people getting a-addicted to intoxicants. It's not a new phenomenon. What is new today is the increasing numbers of people with minor addictions and just the increasing numbers of people with addictions all across the board. But one of the ways that I think about people with addiction is that they're people who, you know, thousands of years ago probably would have been highly adapted to the environment because they would have been our seekers. You know, they would have been the people who, you know, were always pushing the envelope. But in, in the modern world, it can really be, you know, a curse to have that kind of temperament and that kind of physiology because, you know, modern life is ... Everything is sort of, you know ... We, we've got everything we need. We don't have to do anything to survive. We don't even have to really do anything to ... You know, we don't have to get off the couch even just to eat. So it can be very challenging to have that chemical makeup in this modern environment.
19:12 – 26:01
Addiction vs high performance: the four Cs and society’s “approved” obsessions
1. JRJoe Rogan
  Now what's the best method for recognizing whether or not you have an addiction or whether you're just an enthusiast?
2. ALAnne Lembke
  (laughs)
3. JRJoe Rogan
  Right? Like how do you-
4. ALAnne Lembke
  Yes.
5. JRJoe Rogan
  Like if you're-
6. ALAnne Lembke
  Uh-huh.
7. JRJoe Rogan
  ... whatever. If it's a sport or a, you know, whatever.
8. ALAnne Lembke
  Yeah.
9. JRJoe Rogan
  It's maybe a gambling thing.
10. ALAnne Lembke
  Mm-hmm.
11. JRJoe Rogan
  Like how does one know-
12. ALAnne Lembke
  Yeah.
13. JRJoe Rogan
  ... when it's a real problem and what ... And, and how much, how much recreation can you have-
14. ALAnne Lembke
  Mm-hmm.
15. JRJoe Rogan
  ... without it being addictive?
16. ALAnne Lembke
  Mm-hmm. Mm-hmm. So great question, and I think the answer is going to be different for every person. There's not like a one-size-fits-all. In general, when we are diagnosing addiction in clinical care, it's not based on quantity or frequency per se, although daily users tend to be people that we are concerned about. But the diagnosis of addiction is really based on behaviors and can be briefly summarized as the four Cs, control, compulsion, craving, and consequences, especially continued use despite consequences.
17. JRJoe Rogan
  So like what if you're a ad- Like I have friends that are addicted to golf-
18. ALAnne Lembke
  Mm-hmm.
19. JRJoe Rogan
  ... and they just can't wait to go play golf.
20. ALAnne Lembke
  Mm.
21. JRJoe Rogan
  What's the consequences?
22. ALAnne Lembke
  Well, it might be that their spouse says, "Gee-wiz, why are you playing golf all the time?"
23. JRJoe Rogan
  Maybe they just need a new spouse.
24. ALAnne Lembke
  Well, okay.
25. JRJoe Rogan
  (laughs)
26. ALAnne Lembke
  Okay. So, so th- this, this actually comes up a lot in clinical care, like to what extent is it my problem?
27. JRJoe Rogan
  Right.
28. ALAnne Lembke
  And to what extent do I have to change my life?
29. JRJoe Rogan
  Right.
30. ALAnne Lembke
  And, and I always say to patients, "You know, that is a great question and not one that I can answer for you, but maybe together we can find the answer." Because the truth is sometimes it is a question of needing to change your life, right? And I wouldn't presume to necessarily know, especially with cases on the border. Now there are certainly-
26:01 – 34:40
Rewards, discipline, and living in the moment: when “treating yourself” becomes a trap
1. JRJoe Rogan
  W- explain that. W- wanting to control what we're feeling and when we feel it?
2. ALAnne Lembke
  Yeah, so-
3. JRJoe Rogan
  And that's what separates discipline from addiction?
4. ALAnne Lembke
  No, I think, I think those are ... There's overlap there. So, let me-
5. JRJoe Rogan
  Okay.
6. ALAnne Lembke
  Let me go back. So, part of, part of what drives the phenomenon of addiction is that people control what they feel w- when they feel it. So, for example, you know, um, in this moment, let's say I'm struggling, right? But I feel like, oh, I can get through this because when this is over ... I'm not saying I'm struggling, but I mean, if I were-
7. JRJoe Rogan
  I know what you're saying.
8. ALAnne Lembke
  Yeah, but because when this is over, I'm going to reward myself with X, Y, and Z.
9. JRJoe Rogan
  So like, if you go running-
10. ALAnne Lembke
  Mm-hmm.
11. JRJoe Rogan
  ... and then afterwards you can have a slice of pizza.
12. ALAnne Lembke
  That's right, exactly. So it's the way that we bracket our endeavors with rewards. And this is just like deeply embedded into our culture and the control aspect is, is a big part of the addictive aspect because I'm now going to control the way I feel when I feel it, which is a very different way of living if you were to eliminate rewards as a way to shape time. If you were to think, "I'm not going to do anything to reward myself today, I'm just going to get through the day," i- it totally changes the arc of, of our experience in the moment.
13. JRJoe Rogan
  But is there a bad thing with rewarding yourself for doing something that's difficult but it's ultimately beneficial, like getting a run in? Like say, if you're going to run five miles, not easy to run five miles. If you decide, "Okay, I'm going to run five miles and when I get back, I'm going to reward myself with some ice cream." Is that negative?
14. ALAnne Lembke
  I don't think it's negative and we all do it and it's good to do the hard thing before you do the easy thing.
15. JRJoe Rogan
  Right.
16. ALAnne Lembke
  I mean, that's probably, that's just generally a good coping strategy. We should teach our kids to do that. You know, do your homework and then you can have half an hour of video games. But I, what I'm trying to sort of reflect on is the way and the extent to which modern life is completely revolving around this, um, process of rewarding ourselves and it's just really the way that we shape time. And I do think that it's also a way in which we are not present in the moment because actually to be present in the moment i- is mostly unsatisfactory and unpleasant.
17. JRJoe Rogan
  Is that good to be unsatisfactory and unpleasant? You're, you're painting a very gray world. I'm getting sad. (laughs)
18. ALAnne Lembke
  (laughs) You know, I know. This ... Yeah. My message is-
19. JRJoe Rogan
  Stay gray in the moment.
20. ALAnne Lembke
  Right. I ... It, it's not, it's not a dark message. It's really, it's really not, although it's, it's a hard sell.
21. JRJoe Rogan
  Mm-hmm.
22. ALAnne Lembke
  Um, well, let me see how I can put this differently. Um, for a long time, I think this idea of, of using rewards to kind of shape your day can, can work, but eventually, you know, i- it tends to stop working because whatever we do that's rewarding, we develop tolerance to, we need more and more of it and more potent effects.
23. JRJoe Rogan
  Couldn't you just shift the reward?
24. ALAnne Lembke
  Sure. And people do it all the time, but there's cross-addiction. So ultimately-
25. JRJoe Rogan
  Mm-hmm.
26. ALAnne Lembke
  ... that, that new reward will only work for so long or we'll get addicted to the new reward. So I think that there's a better harder solution that is about not using rewards as a way to shape time. Um, but instead letting our experience unfold with uncertainty and embracing that uncertainty. I don't know if I'm communicating this, but you can let me know if it makes no sense. (laughs)
27. JRJoe Rogan
  ... I, I kind of see what you're getting at. And 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.
28. ALAnne Lembke
  Right.
29. JRJoe Rogan
  What is the benefit of living in the moment?
30. 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.
34:40 – 44:35
“Pressing on the pain side”: building dopamine through effort and friction
1. ALAnne Lembke
  Mm-hmm. Mm-hmm. Yeah. So, I mean, what, what, what you're describing is something that I actually recommend to patients who are trying to get into recovery from addiction to things like drugs or alcohol or other highly reinforcing things like games or pornography. If, if y- we think about the, the pleasure-pain balance again, what I actually recommend they do, in addition to abstaining from their drug of choice, is to actually intentionally press on the pain side of the balance, because then those neuroadaptation gremlins I hop- I talked about hop on the pleasure side and ultimately can reset our pleasure-pain pathways to the side of, of pleasure.
2. JRJoe Rogan
  So how does one step intentionally onto the pain side?
3. ALAnne Lembke
  By doing the very kinds of things that you talk about, um, effortful engagement in daily practices that are not easy. So you, you, you know, you've really figured it out, um, in terms of what y- what you ... You need, you need a certain amount of friction in your life.
4. JRJoe Rogan
  100%.
5. ALAnne Lembke
  Right.
6. JRJoe Rogan
  Yeah.
7. ALAnne Lembke
  And you need maybe more friction than average. And you've determined that the best way for you to get f-... that friction is to do things that are hard. A- and that is what I've learned from my patients, and what I now prescribe to them. One of my patients said to me, uh, "If there's one thing I've learned about recovery, it's that the, the hard way is usually the right way." So your reward comes from this effortful engagement, and probably results in you having dopamine release, right? Not as an immediate factor, but as the opponent process or the aftereffect. Um, so that's all very good. But I guess, you know, where my mind goes, you know, thinking about you and your experience, is whether or not... I mean, and certainly, we can, we can get addicted to pain, right? And we c- can push too hard on that side of it, and, and take that too far. I mean, it sounds like what you do is you, you do that for a while with one activity on the pain side, and then you switch to another one, so there's just that little bit of novelty to stretch yourself again. But I guess I wonder, is there a point at which you kind of get burned out on all of that?
8. JRJoe Rogan
  No.
9. ALAnne Lembke
  Okay.
10. JRJoe Rogan
  Well, stand-up comedy, for sure, no. I've been doing that for more than 30 years.
11. ALAnne Lembke
  Mm-hmm.
12. JRJoe Rogan
  Martial arts, for sure, no.
13. ALAnne Lembke
  Mm-hmm.
14. JRJoe Rogan
  I've been doing that more than that.
15. ALAnne Lembke
  Mm-hmm.
16. JRJoe Rogan
  I've been doing that for almost 40 years.
17. ALAnne Lembke
  Mm-hmm.
18. JRJoe Rogan
  Um, no.
19. ALAnne Lembke
  Mm-hmm. Okay, so this is still working for you.
20. JRJoe Rogan
  I just find things (clears throat) that are difficult.
21. ALAnne Lembke
  Mm-hmm.
22. JRJoe Rogan
  Uh, my, my problem, uh, I do have i- issues with obsessive things, like, uh, games.
23. ALAnne Lembke
  Mm-hmm.
24. JRJoe Rogan
  Like I've, I still play pool, um, which I find, um, I think there's a, a mental reward, uh, th- and there's benefit to the focus that I get from the geometry of pool and the calculations of the maneuvers and how to move the ball around, all those different things. I think it's a mental exercise that I think is actually very good for me. But I want to play it eight hours a day.
25. ALAnne Lembke
  Right.
26. JRJoe Rogan
  You know? So I, I have to force myself.
27. ALAnne Lembke
  Mm-hmm.
28. JRJoe Rogan
  I got to go, "Okay, it's X amount of time, and then that's it, and then it's over, and then I got to go home."
29. ALAnne Lembke
  Right.
30. JRJoe Rogan
  I just know my brain.
44:35 – 52:56
Pain, meaning, and resilience: why interpretation changes experience
1. ALAnne Lembke
  that we give to our suffering can absolutely change that experience. So there's a, a very famous, uh, experiment done by, um, a Dr. Beecher who, um, interviewed World War II soldiers right after they had on, on, on, you know, on the battle lines, right after they had received these grotesque injuries, guts spilling out, amputated limbs. And he found that approximately two thirds of them had 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.
2. JRJoe Rogan
  Hmm.
3. 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.
4. JRJoe Rogan
  Mm-hmm.
5. 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.
6. JRJoe Rogan
  A less charitable person...
7. ALAnne Lembke
  (laughs)
8. JRJoe Rogan
  ... would not look at that man that way. Especially people who've actually been injured.
9. ALAnne Lembke
  Well, you know, I, I tell you the, the, the ways in which our brains can manufacture pain.
10. JRJoe Rogan
  But is that really our brain?
11. ALAnne Lembke
  Yeah.
12. JRJoe Rogan
  Or is it... Well, I mean, I guess it is, right? Because it's all happening...
13. ALAnne Lembke
  Yeah.
14. JRJoe Rogan
  ... inside the mind.
15. ALAnne Lembke
  Yes.
16. JRJoe Rogan
  But that seems like a baby.
17. ALAnne Lembke
  Uh-huh.
18. JRJoe Rogan
  A big grown man baby.
19. ALAnne Lembke
  Uh-huh. Uh-huh.
20. 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...
21. ALAnne Lembke
  No.
22. JRJoe Rogan
  Isn't it?
23. ALAnne Lembke
  No, no, no.
24. JRJoe Rogan
  Where, where they, their mom has to take care of them or...
25. ALAnne Lembke
  No.
26. JRJoe Rogan
  ... their wife has to take care of them.
27. ALAnne Lembke
  No.
28. JRJoe Rogan
  And they act like a big baby.
29. ALAnne Lembke
  No, no, no.
30. JRJoe Rogan
  No?
52:56 – 1:01:51
Cold plunges, extreme sports, and cross-tolerance: training the ability to endure
1. JRJoe Rogan
  Exposing them to other difficult things, does that make them more resilient in other ways? Like, uh, one of the things I've gotten into recently is, um, cold plunges.
2. ALAnne Lembke
  Mm-hmm.
3. JRJoe Rogan
  Have you ever done one of those?
4. ALAnne Lembke
  Um, yes.
5. JRJoe Rogan
  Did you enjoy it?
6. ALAnne Lembke
  No (laughs) .
7. JRJoe Rogan
  (laughs) .
8. ALAnne Lembke
  Not at all.
9. JRJoe Rogan
  How ... What did you do? H- explain what you did.
10. ALAnne Lembke
  Uh, we, we were in Iceland and, you know, they have-
11. JRJoe Rogan
  Oh, the real deal.
12. ALAnne Lembke
  Right. Yeah, right. And they have the-the very hot one and the very cold one. And I really could ... I had a very difficult time with the cold water. That's something I really cannot do for any measurable amount of time.
13. JRJoe Rogan
  But I bet you could.
14. ALAnne Lembke
  Yes, if I practiced it.
15. JRJoe Rogan
  Yeah.
16. ALAnne Lembke
  Yes, I could. Yes.
17. JRJoe Rogan
  Yeah.
18. ALAnne Lembke
  Yeah.
19. JRJoe Rogan
  And particularly if you learn some breathing exercises?
20. ALAnne Lembke
  Yes.
21. JRJoe Rogan
  Um-
22. ALAnne Lembke
  Although I've, I've, I've heard about the breathing exercises and I've tried them, and I, I d- I can't get it to work.
23. JRJoe Rogan
  I- with cold?
24. ALAnne Lembke
  Yeah.
25. JRJoe Rogan
  Would it ... How many times have you done this?
26. ALAnne Lembke
  Oh. Well, I tried it quite a lot in ... When we were in Iceland and I just-
27. JRJoe Rogan
  Did you? How many times did you try it? (laughs)
28. ALAnne Lembke
  Like, I don't know, every day for a week. It didn't get any better.
29. JRJoe Rogan
  (laughs)
30. ALAnne Lembke
  Do you know what I mean?
1:01:51 – 1:08:50
Rat Park to “rat amusement park”: technology as the new super-stimulus
1. 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.
2. ALAnne Lembke
  Yeah.
3. JRJoe Rogan
  And they'd do it until they died.
4. ALAnne Lembke
  Mm-hmm. Yeah.
5. JRJoe Rogan
  Until they set up a happy environment for these rats.
6. ALAnne Lembke
  Mm-hmm. Mm-hmm. Mm-hmm.
7. 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.
8. ALAnne Lembke
  Mm-hmm. Mm-hmm.
9. 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.
10. ALAnne Lembke
  Mm-hmm. Mm-hmm.
11. 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?
12. ALAnne Lembke
  Mm-hmm. Mm-hmm.
13. JRJoe Rogan
  Cubicle life, commuter life.
14. ALAnne Lembke
  Right. Right.
15. JRJoe Rogan
  Like, being, you know, on the subway or whatever you're doing, where you're just like droning in and out-
16. ALAnne Lembke
  Right.
17. 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.
18. ALAnne Lembke
  Mm-hmm. Yeah.
19. JRJoe Rogan
  Something that's not rewarding and not interesting.
20. ALAnne Lembke
  Yeah.
21. JRJoe Rogan
  And then you get home and you medicate.
22. ALAnne Lembke
  Right. Right. Okay. So great. I'm, I'm glad... That's the famous rat park experiment.
23. JRJoe Rogan
  Yes.
24. ALAnne Lembke
  I'm really glad you, you, you brought it up because I, I have some thoughts to share about that.
25. JRJoe Rogan
  Cool.
26. ALAnne Lembke
  So, um, yes, uh, you know, absolutely, um, you know, the, this idea of our not being in an enriched environment that's conducive to help, to h- to good health c- can absolutely lead to the problem of addiction. However, I think that a central problem today which is not appreciated is that we have turned rat park into rat amusement park. So even in an ideal environment, people can get addicted because they have access to so many highly reinforcing drugs and behaviors that are mediated through technology, access, potency, novelty. So a couple examples. If you put a running wheel in this enriched rat park, uh, environment that you, you talk about, rats will spend an enorm- an ordinate amount of time on the running wheel and they won't explore the maze. Right?
27. JRJoe Rogan
  Right.
28. ALAnne Lembke
  So there's something about the run-
29. JRJoe Rogan
  A maze in the rat park, but-
30. ALAnne Lembke
  In... Yeah. They won't, they won't explore this wonderful enriched environment. They'll spend a lot of time on the running wheel.
1:08:50 – 1:14:30
Video game addiction in young men: depression, suicidality, and “I’ll be the pro” rationalization
1. JRJoe Rogan
  Do you think that all of those things ... I mean, like, there's a, for sure there's people that make a living out of playing video games.
2. ALAnne Lembke
  Yes.
3. JRJoe Rogan
  Are they addicts too?
4. ALAnne Lembke
  Okay. When I treat young, mostly young men with serious video game addiction, I mean it-
5. JRJoe Rogan
  How many young men do you treat with, uh ...
6. ALAnne Lembke
  I don't, too many.
7. JRJoe Rogan
  Is it common?
8. ALAnne Lembke
  Yes.
9. JRJoe Rogan
  Like how-
10. ALAnne Lembke
  Increasingly common, okay? And, and there's, there, these aren't ambiguous situations. These are, these are young people who are depressed and suicidal primarily because of their video and game-
11. JRJoe Rogan
  Is it mostly men?
12. ALAnne Lembke
  Oh, yes. Far and away, mostly young men.
13. JRJoe Rogan
  Mm-hmm.
14. ALAnne Lembke
  Um, and almost every single one of them will tell me that the way they rationalize to themselves that the amount that they were playing was okay was because they were going to be that guy, you know, who was like a world-famous video ... They were all going to be that guy.
15. JRJoe Rogan
  Mm-hmm.
16. ALAnne Lembke
  Um, a- a- and so, you know, to me, that, that, that's again, that's how our brain ... Even when we're very far from being that guy, everybody thinks they're going to be that guy and that's part of that rationalization or the justification or the denial that can happen in this whole process of addiction.
17. JRJoe Rogan
  But someone is that guy?
18. ALAnne Lembke
  Yeah. Uh-huh. One in a million. I mean, it's, not everybody gets to be Joe Rogan, right? You're that guy. But, but a lot of people won't. And so it does, it's not to say that, like, nobody should try.
19. JRJoe Rogan
  Well, I don't know if I'm a good example because-
20. ALAnne Lembke
  Okay.
21. JRJoe Rogan
  ... the things that I'm talking about, like the things that I've been successful about, I d- I, I don't necessarily think you could call like podcasting an addiction unless I'm addicted to conversation.
22. ALAnne Lembke
  (laughs) Right. I mean, podcasting is maybe a good addiction because people are hopefully learning.
23. JRJoe Rogan
  I don't think it's an addiction.
24. ALAnne Lembke
  Okay. It's a, a, a, a-
25. JRJoe Rogan
  'Cause when it's over, I'm good.
26. ALAnne Lembke
  Okay, not for you, but maybe for some of your, your viewers? I don't know. Your listeners?
27. JRJoe Rogan
  Well, I think people get entertained and, um, they get stimulated by these conversations and they, I'm, I'm g- I, for sure think that many people are enriched by guests like yourself that can provide all this insight to the way the mind works or whatever subject we're discussing. I think there's a great benefit. It, it certainly is for me and I think that's what a lot of people get out of it. They get stimulated.
28. ALAnne Lembke
  Yeah.
29. JRJoe Rogan
  And they get stimulated while they're doing other things.
30. ALAnne Lembke
  Yes.
1:14:30 – 1:29:15
Dopamine fasting and the DOPAMINE framework: a 30-day reset with structure
1. ALAnne Lembke
  Right. So when patients come in to see me, and, and often their chief complaint is depression and anxiety. It's not, "Can you help me stop drinking alcohol?" Or, "Can you help me stop playing video games?" But what I will often recommend as a first pass is a month of abstinence from their drug of choice.
2. JRJoe Rogan
  Mm.
3. ALAnne Lembke
  And I explain the pleasure-pain balance and the way that there's this opponent process mechanism.
4. JRJoe Rogan
  Gremlins.
5. ALAnne Lembke
  The gremlins, thank you.
6. JRJoe Rogan
  (laughs)
7. ALAnne Lembke
  Um, and, and they're very skeptical that, uh, you know, uh, uh, that a month of, of fa- dopamine fasting 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.
8. 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...
9. ALAnne Lembke
  Mm.
10. JRJoe Rogan
  ... that aid them...
11. ALAnne Lembke
  Mm-hmm.
12. JRJoe Rogan
  ... in abstaining?
13. ALAnne Lembke
  Yeah.
14. JRJoe Rogan
  Is there something that you can do? Like is there a, a guidebook or framework that they can follow?
15. 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-
16. JRJoe Rogan
  Sure, please do.
17. ALAnne Lembke
  R- Okay. (laughs)
18. JRJoe Rogan
  We have all the time in the world.
19. ALAnne Lembke
  Okay. Okay. (laughs)
20. JRJoe Rogan
  (laughs)
21. 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.
22. JRJoe Rogan
  For games?
23. ALAnne Lembke
  Oh, yes.
24. JRJoe Rogan
  Really?
25. ALAnne Lembke
  Oh, yeah.
26. JRJoe Rogan
  They go to hospitals?
27. ALAnne Lembke
  Well, well, there are residential treatment settings for, for video game addiction.
28. JRJoe Rogan
  So they just lock these kids up and no games?
29. ALAnne Lembke
  Yes.
30. JRJoe Rogan
  And, uh...

Episode duration: 2:19:32

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Cold open and framing the conversation around addiction

Joe’s video game addiction: recognizing the tipping point and going cold turkey

From “addictive personality” to the disease model: nature, nurture, neighborhood

Dopamine deficit and the pleasure–pain balance (“gremlins”): how addiction rewires reward

Why “balancing” addictions doesn’t work: poly-addiction and compounding dopamine impacts

Evolutionary mismatch: hunter-gatherer brains in an age of abundance

Addiction vs high performance: the four Cs and society’s “approved” obsessions

Rewards, discipline, and living in the moment: when “treating yourself” becomes a trap

“Pressing on the pain side”: building dopamine through effort and friction

Pain, meaning, and resilience: why interpretation changes experience

Cold plunges, extreme sports, and cross-tolerance: training the ability to endure

Rat Park to “rat amusement park”: technology as the new super-stimulus

Video game addiction in young men: depression, suicidality, and “I’ll be the pro” rationalization

Dopamine fasting and the DOPAMINE framework: a 30-day reset with structure

Get more out of YouTube videos.