Anna Lembke on How to Be Human in a Dopamine-Driven World | EP 625

0:00Coming up next on PassionStruck.

0:30impacts not just their lives, but the lives of people who love them and the people around them. Welcome to Passion Struck. Hi, I'm your host, John R. Miles. And on the show, we decipher the secrets, tips, and guidance of the world's most inspiring people and turn their wisdom into practical advice for you and those around you. Our mission is to help you unlock the power of intentionality so that you can become the best version of yourself. If you're new to the show, I offer advice and answer listener questions on Fridays. We have long-form interviews the rest of the week with guests ranging from astronauts to authors, CEOs, creators, innovators, scientists, military leaders, visionaries, and athletes.

1:15Now, let's go out there and become PassionStruck. Welcome to Episode 625 of PassionStruck, where intention meets impact and the journey to a connected life begins. If you're new here, welcome. This show is for anyone bold enough to ask life's deeper questions and brave enough to live the answers. If you've been with us for a while, thank you. Your presence is what powers this movement. Today, we're continuing our series on The Connected Life, an exploration of what it truly means to live with death, alignment, and purpose in a world that often keeps us distracted and disconnected. Last week, I welcomed two incredible guests.

1:55First, Suzanne Giesemann, one of the world's most respected spiritual teachers, joined me to help us explore soul-led purpose and what it means to matter to the universe itself. Then, on Thursday, I was joined by Dr. David Hamilton, who unpacked the science of kindness, revealing how compassion isn't just a virtue, but a biological necessity for mental health, connection, and well-being. And if you missed it, I also dropped a solo episode on Friday on Taylor Swift and the art of valuing others, where we explored how one of the most influential artists of our time uses empathy, intention, and presence to build genuine connection in a performative world.

2:38Now, let me ask you this. What happens when pleasure becomes pain? When the things you crave, your phone, social media, alcohol, food, even validation start consuming you? My guest today is Dr. Anna Lemke, the bestselling author of Dopamine Nation and one of the world's foremost voices on addiction, compulsive behavior, and the neuroscience of craving. As a psychiatrist and professor at Stanford University School of Medicine, Dr. Lemke has helped thousands of patients break free from the grip of modern day addiction. Her work challenges us to rethink how we relate to pleasure and how too much of anything can leave us feeling empty, anxious, and disconnected.

3:21In this episode, we explore why dopamine overload is at the root of so many of today's struggles, how the pleasure-pain balance governs our mental health and relationships. We go into the paradox of abundance and why more access often leads to less satisfaction, and how embracing intentional discomfort can lead to deeper fulfillment, focus, and freedom. Whether you're seeking to reset your habits, reclaim your attention, or simply live with more balance and intentionality. This conversation will give you a scientific and deeply human blueprint for navigating the addictive nature of modern life.

3:56And one last reminder, our Ignited Life sub-stack is growing fast. Each week, I share exclusive tools, behind the scenes insights and curated playlists like this one. You can subscribe at the ignitedlife.net or go to passionstruck.com. And don't forget to check out our growing YouTube channels where we post extended interviews on John R. Miles and Clips videos on PassionStruck Clips. Now let's dive into this transformative conversation with the brilliant Dr. Anna Lemke.

4:31I am absolutely honored and thrilled today to have Dr. Anna Lemke join us on PassionStruck. Welcome, Anna. Thank you for inviting me. So it's a few years now since the release of your groundbreaking book, Dopamine Nation, Finding Balance in the Age of Indulgence. But I wanted to start out with your own journey from writing about opioids to exploring digital addiction. Was there a specific moment when you realized we're no longer dealing with just some people struggling, but that it's almost like everyone is becoming vulnerable to addiction? I have to say if there was one moment, it was the moment I met my patient, Jacob, a Stanford professor himself who gave me permission ultimately to share his story anonymously with readers.

5:21A very bright, very successful, very kind man, a good person who had developed this very severe sex addiction, which really took off with the advent of the smartphone, the internet, and then the smartphone, culminating ultimately in, as I write about him, him building his own masturbation machine, and then getting so despair, despairing around his inability to stop this behavior that was ruining his life, that he seriously contemplated ending his life, going so far as to hang a noose. And that was really the moment for me, for a lot of different reasons. It was a window into how the technology has changed our relationship with these behaviors that we are wired over many millions of years of evolution to seek out in order to optimize for survival.

6:17So it was like that the interface between his addiction and the technology, that was a sort of, oh, wow moment. But then also a big piece of it was recognizing myself in him and realizing that my own addiction to romance novels that was really exacerbated by the advent of Kindle, my e-reader, and my ability to essentially chain read without interruption and have access to a universe of romance novels. This is like a very universal problem, especially since I had always thought that I was somehow immune to addiction because although addiction runs in my family in terms of quite a few alcoholics going back the generations, alcohol never did anything for me.

7:05I was never vulnerable to alcohol addiction. So it was a realization, oh, it's not that I'm not vulnerable to addiction. It's that just alcohol isn't my drug of choice. But when I finally encountered my drug of choice, I was off and running. Well, I'm glad you brought up that form of addiction because typically when we think of addiction, we think of drug or alcohol use, but you can be addicted to work, you could be addicted to gaming, you could be addicted to many things in life. And on that same sort of topic line, we tend to live in a dopamine-rich world that, as your research points out, is designed to hijack our pleasure centers.

7:44If you had to describe the modern environment that we're living in one word from an addiction medicine lens, what would it be and why? I would probably use the word drugified. I think we've drugified almost all substances and behaviors, which is to say we've made them more potent, more accessible, more bountiful, and more novel. And all of those things increase the addictive potential of anything, including even traditional drugs. So access is a huge risk factor. If you live in a neighborhood where drugs are available on the street corner, you're more likely to try them and more likely to get addicted to them.

8:23And we live in now a world of really universal access. There's really almost nothing that we can't get. And we have drugs that didn't exist before, including digital media. In terms of potency, the classic trajectory of any drug is that with chemical alterations, we can make it more potent. If you look at the history of opioids, for example, morphine derived from opium is 10 times more potent than opium. And then you ultimately add two acetyl groups to morphine and you get heroin, that's more potent. And then eventually you end up with fentanyl, which is a hundred times more potent. So that's a history of substances.

9:04is. And we see that too, that kind of telescoping of potency with digital media too, or just screen time in general. Access potency, novelty is a way to overcome tolerance. So all of these things, I think we've now infused our entire ecosystem with this kind of drugification of everyday life. Yeah, not too long ago, I read The Revenge of the Tipping Point, Malcolm Gladwell's latest iteration of that famous book. And I'm not sure if you've read it or not, but he really starts out. It was weird he came out with it, right? Yeah. He starts out the first section of the book talking about Purdue Pharma and the opioid epidemic.

9:49And he really brings about two key insights. One you just described in that they needed their drug to be even more addictive. And so they changed the formula to do. And then he brought up about how McKenzie came in and they understood that the blanket way that they were trying to attract all the doctors wasn't working. Attract the doctors who are most addictive to making money off of their product and super focus on their vulnerabilities because they're the super prescribers. And so I never thought of prescribing out of financial desire to be an addiction, but in the way he was describing it, it was almost like these doctors were so addicted to making more money that they were willing to freely write more prescriptions.

10:44Is it possible to have that form of addiction? Oh, absolutely. I think we see addiction to financial gain in many different forms. And we've drugified work by adding all kinds of bonuses and stock options. And even in the medical field, I now get a monthly report telling me whether or not I've met my relative value unit requirements, which is shortened for RVU, which is how much the insurance companies will reimburse per patient seen. And if I go below my graph, I will not get a bonus. And if I go above my graph, I will get a bonus. There are all kinds of visible and invisible incentives inside of medicine that encourage seeing more patients, billing more.

11:34And it's not that doctors are necessarily bad people or that doctors are worse than other people. But when you have a system that incentivizes and rewards certain types of behavior, human beings are very sensitive to rewards and we will work to press a lever to get rewards. That's true, whatever the reward is. Well, I think a lot of people assume that addiction doesn't apply to them. I have met a lot of friends who I think have various forms of addiction, but none of them see it. What's the biggest myth that you wish more people understood about it? There are lots of myths about addiction. One of the myths is that people never get better.

12:27So we do have this vision of a severely addicted individual sleeping under a bench, holding a round paper bag. And that's not to say that those people like that who fit that image don't deserve our empathy. Of course they do. But the point I'm trying to make is that addiction is a spectrum disorder. And there are a lot of people walking around who have a pretty significant addiction. And you would never necessarily know because they can manage it well, just well enough to hide it and to seem to continue to function. But their loved ones know, right? The people close to them. And then there's this sort of throwing up of hands, well, there's nothing I can do.

13:11And I think that's the myth that I most actively want to fight against because we know that treatment for addiction works. And it works just about as well as treatment for other chronic relapsing and remitting disorders with a behavioral component like type 2 diabetes, like obesity, like certain forms of cardiac disease, certain forms of asthma, like depression, right? So we know when we build a treatment infrastructure and people actively engage in treatment, they have response rates that are on par with the response rates from those other chronic disorders. So that's an important, important thing for people to realize.

13:51Thank you so much for sharing that. And on a theme that I explore often on this podcast is how so many people today feel invisible and or insignificant. And I remembered when I first started thinking about this, I kept hearing, we have a hopelessness epidemic. We have a loneliness epidemic. There's so many people who feel burned out, invisible in their own lives, that they just don't matter. And the more I started to look at all these common symptoms, it made me think that they're all just things that we're categorizing of something that's larger. And do you think our turn towards addictive behaviors is in part a coping mechanism for that deeper loss of meaning or connection?

14:44Yeah, it's a great question. And I guess I would answer it by saying, I think it's a feed-forward cycle. And by that, I mean that the lack of meaning and purpose in our lives, and frankly, just sheer boredom, can contribute to addiction. But I think it's really important to recognize that being exposed to a lot of addictive substances and behaviors can also create the absence of meaning and purpose and loneliness. So the point being that while these kinds of unmet existential needs certainly increase the risk of addiction, the reverse is also true in that when we get addicted to something that's just really inherently addicting, we can go from a life of connection and meaning to a life without connection and without meaning.

15:41So it's really a feedforward, bidirectional kind of a phenomenon. In your book, you write that in addition to the discovery of dopamine, one of the most remarkable neuroscientific findings in the past century is that the brain processes pleasure and pain in the same place. Further, pleasure and pain work like opposite sides of a balance or opposite sides of a balancing mechanism. When you think of that topic of mattering and our lack of connection that many people are facing, how do those two different sides of the coin affect someone? Because it seems like it's a battle, almost an inner battle between the two.

16:27gosh I'm not really sure how to answer that how to make a kind of direct link between that pleasure pain balance which is just a metaphor to represent the drive toward homeostasis and how we achieve homeostasis with any deviation from neutrality whether to pleasure or to pain I think a somewhat maybe counter-cultural view that I have on this is that our suffering really, if we can find the meaning in our suffering, then we can find the meaning in our lives. If we feel like our suffering is just gratuitous and pointless, then that really does breed a kind of nihilism. And I say that's countercultural because it implies that suffering is maybe a good thing, which is not that I would wish suffering on anybody.

17:24And I certainly don't like suffering in my own life. But I do know that the most important lessons in my life and the experiences that have informed my own sense of purpose and direction have come from the hard things in my life. So I'm not sure if that's what you're asking, but. I think that's part of it. I recently had a guest on the show. You may or may not be familiar with them, but he's one of the foremost Buddhist teachers. His name is Yonge Mingor Rinpoche, and we were talking, and Rinpoche was talking about how, for him, panic attacks were something that plagued him and were causing him to really disengage from a lot of things in life.

18:10And then he learned to lean into it, to overcome it, and through that learning, it's what led him down the path of now using it as an example of by overcoming it and getting used to the idea that he was having them, it now opened him up in other ways of his life that he never would have been able to feel or observe had it not been for the panic attacks. So very similar kind of theme. I think we live in a culture and we certainly have a medical model that we should do all that we can to escape painful feelings and experiences, whether physically painful or emotionally painful. And I also think that's very reflexive and instinctive.

18:55Like I think we evolved to reflexively approach pleasure and avoid pain. It's how we've survived in a world of scarcity and danger. But it is also very true that like ultimately pain in various forms is really unavoidable. And the more that we try to escape it, the worse it actually gets. And what really needs to happen is we need to turn and face it and even enter into it in a kind of a metaphysical sense. And I think in doing that, we paradoxically get a respite from it. So I want to look at the other side of this. How does the super abundance of pleasure tie into a deeper spiritual or psychological poverty that people are experiencing?

19:41in? Well, if you look at the neuroscience, what we know is that no matter how much pleasure we get, ultimately our brains will adapt to that experience and need more and more over time to get the same effect. Or that even that pleasurable experience because of neuroadaptation will turn on us and we'll get the opposite of what we used to get from it. Just to take a very A common example, people often use cannabis to feel good, get high, or to stop feeling anxious or depressed or to help themselves go to sleep. But with heavy daily use, very often and quite quickly experience that it stops working.

20:24They need more and more to get the same effect or that it actually starts to make them anxious or makes them paranoid or suspicious or wakes them up instead of puts them to sleep. these sort of age-old adages from all the major religions and philosophies that say the pursuit of pleasure and of material gain is not ultimately a rewarding life. We now actually have pretty good neuroscience showing how and why that happens. Speaking of neuroscience, in your view, what happens to the brain when someone internalizes the belief that they don't matter?

21:07Well, I don't think we really know. The belief that you don't matter is probably a very complicated neurological phenomenon. It's probably different in different people. But phenomenologically, it's probably pretty similar to what happens when people get depressed. and what we know from studies of depression is that there's a dampening of neurological firing in different parts of the brain, especially the frontal lobes, but probably also in the motivational and reward systems. So people, I think, kind of decathect or withdraw from life. They stop engaging. They stop paying attention. They stop connecting or seeking out.

21:56Yeah, so I just wanted to bring in my own personal story because I think it typically will help a listener. So I was a high functioning senior executive in the Fortune 500 world. I was a senior executive at Lowe's. And during my time there, I noticed, and it happened really gradually, but it was just like, I couldn't put my finger on it, but the world just didn't feel as bright as it once did. Like the connections weren't as strong. My sense of having a desire to go out and have fun just wasn't there as much. My desire to go above and beyond at work seemed to take a step back. And at first I dismissed it.

22:45And over time, it just seemed to get a little bit darker gradually. And it's so gradual that you almost don't even know what's happening. And I remember as I was going down this path and things in my life seemed to start unraveling, I ended up going to see a psychotherapist who told me that what I was experiencing was dysthymia. And is what I'm describing a similar case of what that feels like if someone's experiencing it? Dysthymia, the difference between dysthymia and depression generally is the chronicity as well as the severity. So dysthymia is like a long-lasting low-grade depression, whereas major depressive disorder is usually more episodic, deeper depressions.

23:40But these characterizations are limited. They'll never fully capture human experience. But certainly what you're describing sounds pretty classic for some form of depression. I was just really, if someone's never been through it, I used to think at this point, having not experienced depression, that when people say someone has a chronic or severe depression and it's keeping them out of work or something else, I never understood what that meant until I went from this gradual to, I would say, a medium grade, then eventually to a severe grade. And when it hit me severely, it just felt like I was completely emotionally dead inside.

24:25something I wouldn't wish on anyone. And it was almost like I would wake up and not want to do anything. So powerful. And unless you've experienced it yourself or seen it in a loved one, it's really hard to understand or imagine. But yeah, that kind of, first of all, I think you highlight something really important. Not all depressions are characterized by sadness, right? Some people just feel the absence of feeling or kind of numbness, which it sounds like you were describing. Other people get very irritable and cranky and angry when they're depressed, can manifest differently. But certainly it's almost like life has been leached of its color, or you have the dark shade over your eyes, or it's a very strange feeling.

25:11It is. And during this time, I had moved on from Lowe's to Dell, and I'm now operating directly with Michael Dell and that level. And from the outside, you would have thought everything in my world was completely fine. But inside, it just felt like everything was falling apart. And so as this was going on, I tried to fill the void because I really felt an absence of mattering at that point. And I started to try to fill the void with alcohol. And what I wanted to ask, and I know I used my story, I probably went longer into it than I should have, but thanks for sharing. It's totally enriches everything because it's yeah, a lot of people out there struggling with these problems.

25:58Well, I, so at this point I was completely burned out. I was emotionally numb. I'm drinking more. And I guess my question to you, for someone who might be in a similar situation is how, whether it's alcohol, drugs, another addiction. How do those addictions make that void deeper? And does it make it deeper? There are a lot of doorways into addiction and certainly trying to quote unquote self-medicate a depressive state is a common pathway. And the reason that it's so common is because in the short term, alcohol makes a depressed person feel a little less depressed. The problem is that it's very short-lived and that ultimately, you know, what daily heavy alcohol use does is essentially cause the brain to say, oh, wait a minute, we're getting all this exogenous dopamine, so to speak, or these exogenous source of these sort of feel-good chemicals that we can, we don't need to make our own anymore.

27:02We can now down-regulate production of our own endogenous opioids, our own endogenous dopamine. And ultimately you get to a point where you're in this chronic dopamine deficit state, where now you need to use alcohol, not to get out of your depression, but just to bring yourself from a state lower than your depressed state, back up to your original depressed state. So it gets to be this very insidious kind of chasing the tail phenomenon. But the problem is that in the immediate moment of using again, there's at least very briefly some relief from those symptoms. And so you get in this kind of vicious cycle.

27:41Which is why I say to patients, you need to abstain from your drug of choice long enough in order for your brain to reset those reward pathways. And even if your baseline was depressed, it was probably less depressed than you are now since you've been drinking. And if you look at sort of large scale epidemiologic data, what is that addiction is rates of addiction are higher in people with co-occurring mental illnesses, but that when people with mental illnesses of all sorts are engaging in their addiction, they have worse outcomes than people with the same mental illness who are not addicted to substances.

28:20So for example, whether it's schizophrenia or major depression or bipolar disorder, somebody who is using a substance to cope with that mental illness is very likely to have more prolonged episodes, to need more medication, to have more hospitalizations, to have more complications, and ultimately to die of their disease. I know, and I don't talk about it a lot on the show, but I've been sober for a while now and life is just completely different. It takes a little bit to get there, but it's just, you sleep so much better. Your cognitive functioning is so much higher. It's just like the world for me is brighter without it.

29:03And I'm not advocating for people on the show to drink or not drink. I just know for me, it's been a godsend that I was able to move away from it because it was no longer serving a point in my life that was helping me in any way. And I found it was the common link between all the moments that seemed to go wrong in my life. So for me, it was just a need to break from it. And I actually just did it to cold turkey. I just told myself starting August 1st, I'm going to just stop. and I initially thought I'd stop for a couple of weeks and then it just felt so good that I just permanently stopped. Oh, that's great.

29:43Was that this past August? A couple, two August ago. Two August ago. Oh, that's great. Yeah. That's why I love this work because when people with addiction get into recovery, they get so good, like their lives are so much better. And I don't know that we see the same kinds of incredible improvements as when we're just like treating run-of-the-mill depression or bipolar disorder. But with addiction, people with severe addiction, when they stop using and they get into recovery, wow, they're often really remarkable people. And there's such a ripple effect because of course, addiction negatively impacts not just their lives, but the lives of people who love them and the people around them.