SUMMARY KEYWORDS

dopamine, addiction, people, pleasure, drug, experiences, life, brain, pain, true, book, smartphone, behavior, feel, world, balance, connections, patients, reward, leads

SPEAKERS

Anna Lembke, Steven Parton

Anna Lembke  00:00

We all have this kind of search and discover mode. That again is is fundamental to our survival and the smartphone just absolutely exploits that feature. Because there is this infinite world that's constantly being repopulated with these novel types of experiences.

Steven Parton  00:36

Hello, everyone, my name is Steven, pardon and you're listening to the feedback loop on singularity radio, where we keep you up to date on the latest technological trends and how they're impacting the transformation of consciousness and culture. This week, our guest is Ana Lemke, who is a psychiatrist currently working as the chief of Addiction Medicine at Stanford's dual diagnosis clinic. Honor came to my attention when she was interviewed for the Netflix documentary, the social dilemma, which explores the dangers of social media in her scenes. Specifically, she was addressing the neurobiology of addiction and how deeply our modern technologies are influencing our brains. I was immediately hooked in wanting to know more and luckily, she has just released a brand new book called dopamine nation, that gave me the perfect excuse to reach out. On this episode, we explore her new book with a real deep focus on the heart of addiction, how it starts, how it controls our behavior, and how to escape its magnetic pool. More specifically, we explore the role of social media and smartphones, and how these tools are hijacking our evolutionary drive for novelty, pleasure, exploration, and connection with other human beings. While this may not be the most optimistic conversation, it was extremely thought provoking, and full of truly useful information. Now, with all that being said, I think it's time we finally jump into this wonderful conversation. So everyone, please welcome to the feedback loop on Lemke. So let's use that as a jumping point to your book, then you're talking there about dopamine, you have a new book coming out called dopamine nation, finding balance in the age of indulgence, can you tell us a little bit about what motivated you to write that book? And what some of the subjects are that you cover in there?

Anna Lembke  02:26

Yeah, I mean, I think what basically what motivated me was a larger life realization that pain and pleasure really are relative. And that, you know, with intensely painful experiences, especially if they're prolonged, if we can endure them, we come out the other side, with a much more, with a stronger ability to actually take joy in small pleasures. And I mean, this is like a universal truth that people have known since the beginning of time, right? But it's a lesson that I think we have to relearn in some important ways. Because our lives are so comfortable. And because there are so many ways in which we can constantly distract ourselves from the uncomfortable feelings. And so I wanted to write write the book to really highlight that age old wisdom in the context of the work that I do, which is dealing with people who have become severely addicted to drugs, alcohol, gambling, sex, you name it, and, and sort of walking with those people through recovery. And coming to appreciate the ingredients of recovery for people who have addiction, and realizing that those those ingredients are actually the very same things that the rest of us can and should probably incorporate into our lives in order to kind of overcome our sort of dopamine saturated world.

Steven Parton  04:03

You know, what is what is the root of addiction for somebody who's just kind of curious about how it actually works? And why we're so susceptible to it? what's actually going on there?

Anna Lembke  04:14

Yeah, well, I mean, you know, our brains have been wired over millions of years of evolution to approach pleasure and avoid pain and that is fundamental to survival. And really all organisms you could argue, you know, on some level wired that way. But the problem is that when we are exposed to highly pleasurable substances or behaviors for a long period of time, it actually rewires our brain. And what what it does is that, it essentially, our brain has to compensate for the excessive pleasure by down regulating Our own dopamine, which is our pleasure neurotransmitter, and our own dopamine transmission, in order to reassert what's called homeostasis or this level, physiologic baseline, we all have a natural physiologic baseline that we kind of go back to, and the brain will work very hard to restore that natural baseline, whatever it is. So so when we, when we are constantly, you know, experiencing some kind of ecstasy or sub threshold ecstasy, our brains will stop making dopamine, the result of which is that when we're then not using that drug, we we are essentially in a dopamine deficit state or something akin to a, you know, a clinical depression. So So I think, you know, if you think about what is the fundamental rewiring that happens in the brain, it's first of all, that, that you get a kind of a dopamine, you get an induced dopamine deficit state as the brain struggles to restore homeostasis. And, and that dopamine deficit state becomes on some level hardwired, it becomes then not impossible, but difficult, even with prolonged abstinence to restore, you know, homeostasis. The other thing that happens is that we get very, oh, you know, the these are, these sort of experiences of pleasure and pain are deeply ingrained in the hippocampus, which is the, you know, Matt, our memory, so that even when our engagement with that drug ultimately leads to bad things, all we can remember is that euphoria, it's this really tricky phenomenon of euphoric recall, that we have, which in and of itself, leads to a little dopamine spike. So even just remembering using drugs, not all the bad things that come after it, but just the it's like, we're like selected to, you know, over remember the positive stuff. And then, of course, that then drives, you know, wanting to read to reuse. So people get into this bit, essentially a vicious cycle of, you know, feeling depressed when they're not using needing to use to feel normal, and not being able to accurately assess the true impact of their use, instead having this distorted recall process where almost all they can remember is, is that euphoric and good effects.

Steven Parton  07:27

Isn't it the case that we have a negativity bias though, and that we have these like conditioned fears, I believe in the basal lateral amygdala, you know, that gets conditioned over time? Why do we not have that fear? Focus on fear instead of pleasure? What is it just that the dopamine creates such a strong motivation that it once it kind of acts as the Lord that overrides the fear?

Anna Lembke  07:52

Yeah, I mean, essentially, you know, what, what, what is the difference between things that are addictive and things that aren't is how much dopamine they release in the reward pathway. And the other aspect of it is, is how quickly they really set up me how much they release that dopamine, and how on some level, we don't have to work for the dopamine. So So what that does is it sort of short circuits, what that intrinsic reward pathway, how it was meant to work, which is, oh, I'm in the desert, you know, 100 miles away, there's no aces, I'm going to do whatever it takes to get there and I'm going to almost die in the process. And then when I get there, there will be this incredible reward. Now I just I go on my phone and two swipes, it's delivered, you know, to my doorstep, it's much more potent than water, right? I didn't have to do any work to get it. So it's a kind of a it's a kind of skipping over a lot of the steps that were meant to occur plus the potency and quantity of the drug is so much more than would have occurred naturally in nature. That that it's just it just overwhelms the system. It's like our evolutionary machinery was just not designed to handle it.

Steven Parton  09:11

Sure any you mentioned the smartphone there I love on the blurb for your book you put the smartphone is the modern day hypodermic needle, delivering digital dopamine 24. Seven for a wider generation. And as such, we've all become vulnerable to compulsive overconsumption. How is the smartphone playing into all of this addictive behavior or technology in general?

Anna Lembke  09:35

Yeah, well, I mean, you know what, again, what makes something addictive is quantity, potency and novelty. And what the smartphone does is introduce unlimited 24 seven quantity, incredible potency in the form of new drugs that didn't even exist before. As well as easy access to traditional drugs like you know, alcohol. And then you've got, you've got novelty. And I think that that's, you know, that's such a key piece of that we all have this kind of search and discover mode, that, again, is is fundamental to our survival. And we're always looking for the next best thing, right? And the smartphone just absolutely exploits that feature. Because there is this infinite world that's constantly being repopulated with these novel types of experiences. You know, and I mean, like, memes are a great example like, No sooner has that become popular, then people are elaborating on that to make some new version of it, which is exactly what the brain wants, it wants that thing with a slight variation, right? And if you can continue to do that millions of times, then you've essentially, we're all hooked, you know, we're endlessly hooked, it's hard to then disengage.

Steven Parton  10:57

That's like, Robert sapolsky talks a lot about the magic of maybe, about how, if you have something that's more around the 50% chance of something happening, you get, I think it's something like a 400% dopamine spike? Is that a lot of what's happening? They're in our search for novelty on the phone and the swipes?

Anna Lembke  11:15

Yes, absolutely. And I think, you know, social media is a great example of that there's a lot of bad reactions we can get when we use social media, but in a way that almost enhances the, you know, the attractiveness of the whole experience. Because again, it's it's uncertain, right? It's that 5050 chance, are we going to get a like, Are we going to get a, you know, this person, we're gonna cancel this person? And that's, that's certainly, you know, what, what drives it? Yeah.

Steven Parton  11:43

You talk about to how it's the smartphone in particular, where social media is interesting, because it exacerbates other addictions, namely, our addiction to social connection. Really? Can you talk a little bit about how that dynamic plays out?

Anna Lembke  11:58

Yeah, so I mean, one thing to recognize is that, you know, having and creating social connections is is fundamentally adaptive, right? When we, I mean, we're social creatures, and when we're in groups, we are more likely to be able to protect ourselves from predators more likely to find you know, a sexual mate in order to procreate better able to use scarce resources. So there are lots of reasons why, you know, we we come together in social groups, and the brain impels us to do that by releasing dopamine mediated by oxytocin, which is our love hormone. And my colleague, Rob, Rob mylincoln. And his team have recently just recently discovered that oxytocin actually causes the direct release of dopamine on dopamine firing neurons in the reward pathway. So that's a relatively new finding. So you know, that it's, it's, we get pleasure out of making human connections, and it's highly adaptive for us. But what, but what you know, the social media and the internet has done is essentially drug ified. That experience, made it more potent, made it more plentiful, taken some of the complexity out of it, some of the ambiguity, so that it just those, you know, right to the reward piece without all the workpiece involved, or the, you know, ambiguity and embarrassment and awkwardness and all that other stuff. If you don't like something that's happening in a chat room, or when someone says no to you or about you, you just go to another one, you just like de Kamp. So, um, so again, that's sort of, you know, the, that's sort of the fundamentals of what makes something addictive is that it's highly potent, it's highly available, there's novelty, and then of course, we can control it and be able to control and change the way we feel in the moment, really does also breed this addictive phenomenon, because then we want to do it again, you know, and then we and we know that we can,

Steven Parton  14:05

I've always wondered if there was something about kind of the external memory that the internet represents, that acts as a constant reminder of our rank of our status of who we're supposed to be. That really kind of screws up our evolutionary wiring. Because in the past, you know, you mentioned ambiguity, it feels like, we would have more nebulous emotions or thoughts about where we existed, like, yeah, they kind of like me, they kind of don't like me, and then you'd go about your day, and you'd kind of forget. But now you look online, and you have exact records of messages and interactions that kind of trap us in grooves of behavior and expectations that undermine our happiness and our mental health.

Anna Lembke  14:52

Oh, I mean, absolutely. I mean, I think you're tapping into a couple important themes. One is the way that the internet and social media This invidious comparisons between ourselves and other people. Now, people are hierarchical creatures. And we all we always have been comparing ourselves, but it was to, you know, your siblings, your neighbors, and the kids you knew at school, or the people that you work with in the adult world. It wasn't the whole universe, right? So now, you know how, how can we not feel less than right? Because there's I mean, there are so many amazing people out there genuinely amazing people that before we weren't aware of, which was bliss, right? Now we know about them. It's like, oh, man, how can I possibly ever achieved that. But the other thing is that people curate their online persona. So half of what you're getting online isn't even true. And yet we can we can tease out what's true and what's not in a way, it doesn't matter, because it seems true. Which again, then leads to this kind of comparison and feeling less than. So it's really fascinating, because we know, we do have anyway a narcissistic culture that kind of promotes self promotion. And then we have social media, which basically leads to, you know, horrid, like constant comparisons, which lead to deflation and self esteem problems and feeling like you can never possibly measure up to whatever the standard is. So yeah, I do think there's like, I think what you're getting out a little bit more is, again, these curated personas, it sounds like you're even suggesting that we ourselves have them too, right? Like, like, where we have sort of an online person or image, which then potentially comes to represent in our own minds who we really are in a weird sort of way, because it's anchored to these, like quantitative likes or dislikes, or whatever tweets or followers. You know, but I mean, it gets into something else, which is really fascinating, which is just the virtual world. And when I say virtual world, I mean, the world, which we are all collectively creating, by investing our time and energy in that space. As we simultaneously divest our time and energy from real life. So it's very strange, because what I really worry about is, even if we want to divest from this strange, virtual universe that we're collectively creating, there's nothing there's nothing left for us to go to, right, nobody's there. Nobody's left in real life. They're all online. And so I mean, I do wonder sometimes, like, maybe it's an I'm trying what I'm, what I'm standing for, is like, hey, let's, let's be balanced about this, let's make sure that we are still meeting up IRL, you know, in real life and creating robust social goods in real life. But But my worry is that, that, that the inevitable, you know, momentum is that there's not going to be anything left and that everybody will be living online.

Steven Parton  18:12

Yeah, like we're using the digital world as a crutch to be a catch all for basically every facet of our lives rather than letting it just be a way that we empower ourselves for certain things like using Google Maps or making a quick connection or something like that.

Anna Lembke  18:27

Yeah, I mean, I wouldn't even say a crutch I would say that we are we do seem to be moving toward a place where the virtual world is the only world I mean that it is the world and that that our time Away From Keyboard is going to be like the the exception right the the rare default the in between the the equivalent of like going to the bathroom.

Steven Parton  18:53

Yeah, I wonder sometimes this might be at a scope for you. So feel free to pass on it. But I can't help but kind of love Carl young and some of his ideas. And what you were talking about before about the difference between the two worlds makes me think about the virtual, the virtual avatar curation of ourselves as kind of like the mask, the persona that normally in a healthy individual would be swapped between depending on circumstances and it'd be kind of a loose attachment. But now it feels like it's like that digital immortality, you know, that record that is immutable, that exists there. We get stuck on that. And then we get that kind of sense of what young would call shadow, you know, Shadow or repression where we start to suppress who we really are in IRL. And then we create this persona that is shaped by the likes and the follows and whatever they want the whatever the virtual community once we let that be the mask we wear to the world and then when we go out into our day to day interactions, we're just projecting and you know, doing a lot of negative behavior because we aren't really sure who we are without that mask as an interface.

Anna Lembke  20:06

Oh, yeah. I mean, you know, as I talked about in the book, Donald Winnicott. He's a psychoanalyst long dead now, but he talked about the false self so long before the internet existed. He talked about, you know, a phenomenon that he observed in his clinical psychoanalytic practice this, this, you know, a pathological pattern of putting on a fake persona, which requires, by the way, a lot of energy, right, I mean, you're constantly having to like, shore up, you know, the castle, so to speak, to make sure because it because it's not a spontaneous self, it's a false self, you have to do a lot to continue to maintain it. And it ends up depriving the individual from the ability to number one, no, no, their real selves. And number two, live spontaneously in the moment. And as I suggest, in my book, I do think that it contributes to, to this sense of depersonalization and derealization, which is a phenomenon that I'm seeing more frequently, where people feel like they're not real in the worlds not real, which I think in turn, you know, contributes to feelings of suicidality, because if I'm not real well in my life doesn't really matter exist and why not in my life? If it's not, it's of no consequence. So I do think there are there is this very, you know, dark side, which I think you know, which I'm glad we're talking about, which is not to say that it's it's everything, but there there is there is this piece of it.

Steven Parton  21:41

Yeah, do you do you think that has to do with the fact that there that the internet and digital technology in particular acts as kind of like a supernormal stimuli and it's setting such a high threshold or or motivational drive that we are really pulled towards that space? And then the real world can't give us enough dopamine to motivate us motivate an attraction to instead?

Anna Lembke  22:08

Yeah, I mean, I think you're hitting on the the key piece, which, which is again, that these these, a lot of these online experiences are drugs, they are addictive, they are they potently release high levels of dopamine, they're highly reinforcing, we get caught up in them in a way that we don't actively perceive. And they make our real life experiences seem dull, boring, depressing, depressing, you know, devoid of like, you know, interest. I mean, you know, I see this all the time patients come in, so I, I thought I was interested in computer science, but my classes are really boring. And I just have to push back on that and say, you know, I don't think we have any idea what you're really interested in, because you're playing video games 24. Seven, who could possibly compete with that with that amazing, virtually? Like, it's not, you're not going to enjoy computer science, while you're playing League of Legends? Do you know what I mean? And, and, and, and I do this experiment with my patients. And I'm telling you, I'm convinced that I'm right, because of the results of the experiment in which they abstain from video games for a month. And then all of a sudden, like, wow, I'm interested in computer science again, it's like, yes, other things have salience when you're not constantly ingesting this highly reinforcing drug.

Steven Parton  23:27

Is that something to do with what you mentioned before? Like the pleasure, pain balance? And the, I guess the maybe the aversion to struggle in that sense?

Anna Lembke  23:35

Yeah, I mean, like the key, the key about the metaphor of the pleasure, pain balance, which I described at length in my, in my book, dopamine nation, is that one of the interesting most interesting findings, I think, in neuroscience in the last 50 years is that the same part of the brain that processes pleasure also processes pain, and that pleasure and pain work like opposite sides of the balance through something called an opponent process mechanism. And really, that the short version of how it works is that there's no free lunch. So when I experience pleasure release a dopamine my reward path and my my, by my balance tips to the site of pleasure, but no sooner has it done that then the brain adapts by tilting my balance in equal and opposite amount to the side of pain, that is the cost of pleasure, right? Now, if I add and that's also that feeling of craving or the come down or the after effects. If I wait long enough, then you know, balance is restored. And I'm I'm at my level level baseline. But if I continue to press on the pleasure side again and again and again, then my brain actually changes over time, and essentially becomes weighted to the side of pain. And it can stay there even long after I've stopped ingesting or using that that drug, which again, is why people who have addiction relapse even weeks and months and years afterward, because it can take a very long time for them to restore homeostasis to regenerate their own dopamine. So the idea with doing something challenging, like, you know, delving into your computer science class, is the idea that, well, if pressing on the pleasure side of the balance leads to a setpoint, weighted to pain, then pressing on the pain side of the bounce, can leave you with a setpoint weighted to pleasure. And there are data showing this, you know that with repeated painful exposures, people actually end up feeling really good, right? And that, that feeling good after a challenging or painful experience can be more enduring than looking for your dopamine app with the easy immediate, pleasurable hits. So that's something that the book really explores, like this idea that, wow, maybe a better way to get pleasure. And dopamine is through effortful engagement with challenging experiences.

Steven Parton  25:58

Yeah, as the Greeks would say, the obstacle is the way right.

Anna Lembke  26:02

Yes, that's right. What is

Steven Parton  26:05

your role in your mind of culture, and maybe like advertising in this because in my mind, I, I feel like we are in a situation where the narratives that do guide a lot of our behavior, because they are kind of the social prerogatives of our hierarchy. They promote pleasure, comfort, you know, get a car where you don't have to drive with other people get a house that has a fence so that you don't have to have other people around, you get all of these things that protect you and make you safe and give you pleasure. How do we how do we push? I mean, you know what I mean? How do we push back against that cultural narrative that is so important to our evolutionary tribes? That is pushing us away from pain and struggle and meaning and towards pleasure? and dopamine?

Anna Lembke  26:57

Yeah, I mean, you said that beautifully. And I, I agree, 100%. That's one of the primary drivers of the problem today, in my opinion, is this, our cultural narratives around any experience of psychological or physical suffering, being bad, being pathological? You know, patients, and my patients coming in expecting that if they're not, you know, happy all the time that they must be sick, there must be something wrong with them, that they're the only ones having this experience, because the culture is telling them that everybody's running around, you know, in ROM das bliss of some sort, which is absolutely not the case. Yeah, and and, I mean, this is an Of course, there's a, you know, there's a feel good pill to fix about every type of suffering now. So yeah, I mean, one of my big reasons for, for writing dopamine nation, is to push back on this narrative and to communicate that, you know, the relentless pursuit of pleasure actually leads to pain. And this idea that, you know, if we're not happy, we're sick, is a totally false narrative that makes people again, feel less than and makes people take pills, they probably shouldn't, that makes people feel isolated and alone in their suffering. I think you know, I mean, it's, it's, you know, Buddha Buddha talked about finding that middle middle path between pleasure and pain. But I think in the culture, and the ecosystem that we live in now, which is so saturated with easy pleasures, and convenience, and every turn, we actually have to intentionally look to make our lives harder. And that's what I'm trying to say in the book. It's like, we have to intentionally seek out pain and things that are inconvenient, and things that are a little bit harder, and a little less convenient in order to make our lives more comfortable.

Steven Parton  28:52

So what are some ways we do that when you know, one of the ways we talk about addiction often is that it has its hooks in us, and that we, in a lot of ways have this limited form of autonomy, because we are being so I don't know evolutionarily hijacked by these substances and behaviors. What are some of the ways we go Okay, I'm gonna do something hard for myself, even though all of this stuff is pulling me in another direction?

Anna Lembke  29:19

Yeah, well, this is where I invoke the lived experiences of my patients in recovery from addiction, because I think they have, there's so much wisdom there from what they do. These are the individuals who are, you know, arguably the most susceptible to the kinds of problems that we're all facing. And if folks with severe addiction can figure it out and get into recovery, I mean, the rest of us can write. So what what I recommend is essentially what I recommend to patients who come to me for even more severe addictions. First of all, I recommend a period of abstinence from your drug of choice. And the reason for that is twofold number one that allows the brain to reach Set, homeostasis to regenerate don't normal dopamine and normal dopamine transmission. Number two. When people are in their pleasurable activity or their addiction, it's really hard to see true cause and effect. It's only when we get a period of distance that we're able to look back and go, Oh, wow, that's so weird that I was so absorbed by that activity or behavior or substance. And it's just, it's fascinating how the brain cannot see it when we're in it. But when we get some distance, in the form of some time, not using, we're able to look back and go, Wow. So to my patients, I recommend 30 days of absence from their drug of choice. And I warn them that the first two weeks will be worse, it gets worse before it gets better. But if they can make it to four weeks on, they'll notice improvement because many of my patients come to me for problems related to depression, anxiety, and insomnia, not for addiction per se. Many of them are not convinced, when I tell them Well, I know you're here for anxiety and depression. But if you would stop playing video games, or stop drinking alcohol, or stop smoking pot for a month, I think you would feel a lot better even if we don't do anything else. No psychotherapy, no antidepressants, just stop your drug for one month. very skeptical, right. But when they do it, they're always amazed. They're like, I feel so much better. And I thought that my you know, cannabis was medicinal for me. But it's only now that I have some distance from it that I'm able to, to see that it was actually making making it worse. And the way it does that, obviously, as we've talked about is to ultimately create a new set point that's tilted to the side of of pain and dysphoria.

Steven Parton  31:44

When you were talking there, it was making me think about the increasing rates that we do have things like depression, anxiety, suicide. And I was thinking, it seems like the addiction is definitely driving and a lot of that is there. Do you ever work with people who are addicted to work? Or do you think our our economic addiction, it could be driving that too, just because it seems like we're in such an epidemic of these mental health struggles? And I, you know, I, and I'm wondering if people have other addictions, besides the ones that we typically think of that might be pushing us in that direction?

Anna Lembke  32:22

Yeah, so great, great questions. Let me answer the first part of that question first. So um, I mean, my basic thesis is that the increasing rates of depression and anxiety that we're seeing all over the world that are higher in rich nations than in poor ones, is not because of primarily unresolved trauma, or income disparity, but but rather a result of having too much of stuff that's not good for us, but feels good in the moment. And it is fascinating when you look at, you know, like the Global Health surveys, or just surveys of rates of you know, depression, anxiety, suicide, it is shocking that it's the wealthy nations that are have the highest rates. And again, I just think it's, it's really, we have to pay attention to that, because saying something really important that we need to listen to about the fact that we've clearly reached some kind of tipping point in terms of, you know, the beneficial effects effects of technology and comfort and feel good pills. In terms of the the other part of your question, which is, can people get addicted to work? Absolutely, they can. And again, it's because work two has become drug ified, right. So here I am, I'm a doctor. And you know, you would think that my primary source of my home reinforcement comes from the glow of altruism, helping other people. But in fact, every month I get a graph showing me how, how many patients I've seen, how many dollars I've billed. And if I fall below a certain amount, you know, I'm going to get dinged in my salary. But if I go up above a certain amount, I'm going to get a bonus. So it's all become monetized in a way that that makes it you know, reinforcing and dry. And I'm just a doctor think about if you were like a, you know, Wall Street investor or a lawyer with billable hours where you can really monetize every passing minute, you know, and then you've got you've got the 24 seven communications revolution, which means there's literally no stopping point we could work everywhere, all the time.

Steven Parton  34:33

Yeah, and with I'm big fan of the self determination theory

Anna Lembke  34:37

is that

Steven Parton  34:39

it is a psychological theory that when we're more intrinsically motivated when we have more autonomy, relatedness and competence in our life were healthier and happier. And when we're more extrinsically motivated, we are more anxious, depressed, we have less life satisfaction. And I'm just wondering if there's a difference maybe in your mind about intrinsic motivations for dopamine versus extrinsic motivations for dopamine?

Anna Lembke  35:10

Well, I love that I'm gonna read about that self determination there. I love that because I that's certainly been true in my own life, you know, when I've had more autonomy, and my reward wasn't linked to some kind of monetary gain or external praise. You know, I felt better about myself in the work that I was doing. So that's neat. I'm going to read about that. And yeah, I think that's right, I think, you know, when we're, when we're treating our lives, as if the whole thing is just one big slot machine, you know, then those immediate rewards are going to be highly reinforcing. And they're going to propagate those behaviors. But again, in the long run, I think it really does feed into feelings of insecurity, of like a lack of authenticity, of not being free. So this is really, really interesting to me, like this idea of freedom, and how we feel free to choose in our lives. And one thing that is really true about addiction is people essentially lose the ability to choose, they be so become so caught up in the vortex of reinforcing dopamine, that, number one, they can't actually see the consequences. So they don't have the information they need to make good choices. But even when they have that information, it is so compelling that pleasure, pain balance, and the physiologic drive to maintain high levels of dopamine is so strong, that people can extricate themselves, even when they want to, or they let me say they extricate themselves with great difficulty, and often need help of other humans to do that. And inevitably, you know, addiction leads to isolation. So the irony, you know, is that, although it's true that people who are isolated, are more vulnerable to addiction, it's also true that people who have a lot of connectedness can become addicted, and then become isolated, and essentially trade off their great social and human connections for you know, this this like proxy, which is so counterfeit, but so compelling. So yeah, I mean, there's something really real and true about that. And maybe that's in a way, that's a good way to think about motivating people to want to want to work to get free of their addictions is to say, you know, it will allow you to be free, right? To be free and to be. I think there's this quote from Kant, like, natural man stands in reverence to moral man within himself, which is something I think that's really true and powerful, this idea that, again, this hard road or this road of abnegation or restraint, kind of we can if we can learn to kind of reverence for, for ourselves for other people who walk that road, which is very empowering.

Steven Parton  38:13

It seems like you're saying like the struggle imparts a sort of strength that shores up ourselves against the manipulative nature or the hijacking nature of addictions and culture for that matter.

Anna Lembke  38:27

Yeah, and it also in genders, self confidence, because then we can always go back to that struggle as the touchstone for withstanding future struggles, you know, and then the narrative, the self narrative was like, Well, you know, I made it through that, like, that was that was hard, and I made it through that I'm strong, I can make it through this next thing, I can do it. Whereas if we're always relying on a substance or a person, or a medication, you know, to kind of get through something, we don't have that sense of being able to rely on ourselves.

Steven Parton  39:03

Do you? Are you familiar with Johann Harare, his work? Yes, connection? Do you put much stock in that notion of the answer to addiction isn't sobriety? It's connection. I've heard some critics say that he didn't have the best data that he was pulling from for that, but I also hear a lot of stuff that supports him. So I'm curious what your thoughts are.

Anna Lembke  39:25

I think there's a ton of truth and wisdom in in that idea. He's not you know, it's not it's he's not the first person to have said that. Like, there's a whole sort of attachment theory of addiction that basically, you know, it's, it's the search for human attachment, that can sometimes lead people to substitute drugs and alcohol instead of, you know, for that need for human attachment. So I think and it's certainly true that when people are getting into recovery from addiction One of the really important things is to strengthen their social networks and to have meaningful, intimate, intimate connections with other human beings. I mean, we are social creatures. And addiction is like the ultimate, anti social sort of disease process. However, having said that, my criticism of that work is that it suggests that if you have really great human connections, that you're somehow immune to the problem of addiction, and that is not true, especially in the world that we live in now. So one of the reasons One of the things I'm actually hoping to communicate with my book is, is this very idea that, you know, in the world that we live in today, even even if you have great human connections, and a great social network, you too can get addicted, because we're bombarded with addictive drugs in every possible form, in every possible medium, 24 seven, so I think that's my piece where I, I, you know, I quibble with it, because it sort of implies that, you know, oh, get good connections, and you'll be great, which is not true. You know, you can have all that great stuff, you can get addicted, then you can pull away from those great social networks, because you've, you know, you're now chasing dopamine.

Steven Parton  41:18

Yeah, as we approach the interim, wondering, in a perfect universe, where you have a magic wand, and you can change some cultural narratives, change some practices and behaviors that we have as a society, what are some of the key things that you would, you know, address kind of wish away or, you know, bring to the surface that you would love to see to help us battle, this current paradigm that you're addressing with the book.

Anna Lembke  41:45

And I think the, the first thing that I would want to communicate is, is that, you know, life is hard. And, and I know that that's like, not new news. But there, I do see a lot of people now in my practice, who who just think that constantly pleasuring themselves is normal and good. So I really want people to understand the neuro chemistry, the neurobiology, and to appreciate that that is not a path that's going to, you know, lead where people want to go, and to also recognize that, you know, it's not happy 24 seven, like, that's just not realistic. And if you're anxious and depressed, a lot of that is kind of normal, and you're not alone. So I think those are some of the main things that, you know, in terms of cultural narratives, I want to communicate along with this idea that in this dopamine saturating environment, we really have to intentionally seek out difficult things, challenging things, things that are painful, things that are inconvenient in order to dial back on all of this dopamine that we're all ingesting. Um, you know, and I guess those are those are some of the main you know, the main messages that that I would really want want people to be thinking about.

Steven Parton  43:02

Well, I want to thank you very much for this wonderful conversation. I really appreciate you taking the time.

Anna Lembke  43:08

Well, my pleasure. Thanks for having me.