951: Anna Lembke | Finding Dopamine Balance in the Age of Indulgence

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25:33It'll make you a better colleague, a better friend, a better peer. By the way, many of the guests on the show already subscribe and contribute to the course. So come join us. You'll be in smart company where you belong. All for free at 6minutenetworking.com. Now, back to Anna Lemke. You mentioned in the book where humanity, or at least the United States maybe, is on this quest to live in a pain-free world. What have you noticed about that? Because it seems to be the reason for us diving into a lot of these issues, headfirst antidepressants, the massive, I guess, overprescription of those. I'm not even sure if, are they overprescribed?

26:12It sure sounds like they are, given the numbers that you mentioned in the book. And if you have those numbers handy, that would be interesting. Do you, by any chance? I don't have them handy. I'd have to go get a copy of the book and crack them open. Okay, I wrote down one, but it sounds like fully one in five people, including maybe children, were taking stimulants and or antidepressants, which is honestly freaking unbelievable. And I think it's something we're going to look back on in a few decades with utter shock and total shame. because the amount of people on pills to modify their brains today, it'll be like, well, think of that like we think of the lobotomy now.

26:46People just won't believe that we did this to ourselves. So I think that statistic is one in five adults take some type of psychotropic and one in 10 children, which I find especially scary, take some kind of psychotropic or intentionally, you know, mind or mood altering substance, either an antidepressant or an anxiolytic or a stimulant or something like that. So that's really, it's scary. I mean, look, I was educated in the 90s. That's the decade of the brain. That was the decade where psychopharmacology was going to come to the rescue of mental health, and there was going to be a pill for everything that ailed us.

27:22And there was so much excitement and so much promise. And, you know, here we are 25 years later, and there's this realization that, gee whiz, the drugs aren't working as well as we'd hoped. In fact, rates of depression, anxiety are going up. despite destigmatizing mental illness and creating more access to these psychotropic drugs. So that's one big clue that we're getting something fundamentally wrong. And then I think the other conversation that we're having that we needed to have is that there's probably no free lunch and that these drugs have potential marked downsides that we've been ignoring, some of them life-threatening and some of them more subtle, but important.

28:05Like, you know, gee, if I'm on an antidepressant, yeah, it's true. I'm not as depressed, but I also don't feel very much. You know, my mom just died and I couldn't even cry at her funeral. For example, you know, patients will say to me things like that. So it's like, well, what are we really, you know, what's going on there? Plus you've got the sociodemographic data that suggests that we prescribe a lot more psychotropics to poor people and minorities and people who are disenfranchised, the unemployed, which really does suggest some kind of Orwellian phenomenon where we're actually using the medications to sort of pacify large segments of society who have really good reason to be unhappy with their circumstances.

28:49I do want to caveat that it's not that there's no place for these medications. I want to be clear about that. I don't want people to be like, Jordan, and analemgayers shaming me because I'm on SSRIs or whatever, but it seems clear that they're over-prescribed in some way. So yeah, thank you for that. I mean, I'm a psychiatrist. I make my living essentially prescribing medications. They're absolutely life-saving in some instances. So it's not at all to say that we want to throw the baby out with the bathwater. These are useful tools. I'm very grateful for them, but it's just that we probably prescribe them too often at too high doses for too long.

29:25And polypharmacy is a known serious problem in the field where you've got somebody who's not really doing well, not responding. Instead of taking the medicine away, we just pile on more and more and then you don't know what's working. So again, it's not to condemn the whole field that I'm an active part of. It's just to sort of get people thinking about some of these other aspects. I've never heard of that polypharmacy. Is that just when you're on multiple medications? Yeah. So we see, you know, many people who are on 10, 15, 20 different psychotropic medications. What? That's ridiculous. Oh, it's very common.

30:00These are often severely mentally ill people. The intention is to try to help them. But obviously, when you're on that many different meds, you just don't know what it's doing anymore. Yeah. How do they even know that that's not interacting? I mean, it just seems so complicated. I wouldn't even take 20 vitamins, right? It just seems dangerous to me. I just saw a patient yesterday who was on like 10 different psychotropics and 10 different vitamins that a vitamin doctor had recommended. So, you know, I always say like, I don't know much about vitamins. Vitamins are, they're all in like one thing.

30:33I guess I'm sort of exaggerating here, but a drug that says this one makes you feel better, but it's, you know, this one helps with the side effects of the other one. And you hear about that, but I thought, okay, three or four, gosh, that's a lot. But 15 to 20, it just seems impossible to manage that. You'd need a computer algorithm to make sure you weren't creating another substance just in your stomach that's causing your liver to die or something like that. It's partially a function of our dysfunctional health care system. You know, you got somebody who's really suffering. The doctor doesn't know what to do.

31:04The medicines they're on may be helping, but it's not clear, but they're not doing well. So then you add another one thinking that that may help. and then their insurance changes and they go see another doctor. And it's just really, there's so much churn in the system and there's so little psychosocial support that medicines are sort of like the default or the go-to in our healthcare system. But we know that this kind of polypharmacy is not optimal. So sometimes what we'll do is we'll admit patients who are very mentally ill to the hospital solely for the purpose of getting them off of pretty much everything and starting over again and seeing what's underneath there.

31:41Oh, man, hitting the reset button. So then they're just miserable during the withdrawal period. And then you slowly add things back in. These poor people. Yeah, I know in the book, you said Americans report being unhappier in 2018 than in 2008. And here we are halfway to from there to 2028, I guess. Americans frequently report being in pain, physical or otherwise. And you said in the book that you think this is in part due to our obsession with avoiding feeling uncomfortable or feeling pain. What do you mean by that? Are we talking about physical pain or are we just talking about everything in general?

32:14Talking about both physical and mental suffering, I talk a lot in the book about sort of the basic neuroscience of how we process pleasure and pain. And it turns out that pleasure and pain are co-located in the brain to the same parts of the brain that process pleasure also process pain. They work like opposite sides of a balance. I mean, that's an oversimplification, but it really gets at the heart of how we manage those fundamental reflexive systems. And what happens when we do something that's really pleasurable, it releases dopamine, our reward neurotransmitter in that reward circuit, and that balance tilts to the side of pleasure.

32:50But there are certain rules governing that balance. The first and most important is the balance wants to remain level, which is what neuroscientists call homeostasis. And in order to level the balance, what it does is first tilt an equal and opposite amount to the side of pain. So that's the opponent process mechanism, the come down, the craving, the after effect, the hangover. I like to imagine that as these neuroadaptation gremlins hopping on the pain side of the balance to bring it level again, but they like it there. So they don't get off when it's level, they stay on until it's tilted to the side of pain.

33:19Now, if we wait long enough and we don't repeat that behavior or ingest the substance Again, those gremlins hop off and homeostasis is restored. But if we continue to expose our brain repeatedly to highly reinforcing substances and behaviors, those gremlins essentially multiply until there's enough to fill this whole room. And now we're entering into addicted brain or a kind of chronic dopamine deficit state, where in order to compensate for all the reinforcing substances and behaviors that our brains were not evolved for, because our brains were evolved for a world of scarcity and ever-present danger, what we've done is we've sort of changed our hedonic or joy set point by down-regulating dopamine transmission into this below-normal threshold.

34:04And I think that's what we are doing both individually and as nations. We're exposing our brains to so many pleasures, and we're so insulated from pain that our brains are essentially reeling in an effort to compensate, and they're doing that by down-regulating all those feel-good neurotransmitters. And that's important if it's true, because it means that the intervention is going to be very different, right? Our main mental health intervention now is like, you're uncomfortable, make yourself more comfortable, right? You're experiencing pain, you can't be experiencing that pain, we need to give you a pill or do something else to take that pain away.

34:41But, you know, because of the way that pain and pleasure work like these opposite sides of a balance, the truth is that will never work. And the more we try to make ourselves comfortable, the more we're going to end up unhappy. And instead, what we need to do is intentionally seek out challenging and even painful experiences to a degree and avoid intoxicants as a way to reset healthy dopamine levels. Is this what addicts talk about when they say there's, all right, I need X amount of heroin just to feel normal. It's not about getting high anymore. It's about just being able to function and they have to shoot up to just like do anything.

35:15Right, exactly. So once you accumulate all those gremlins on the pain side of the balance and you're in that chronic dopamine deficit state, you've changed your hedonic set point. Remember, we're always releasing dopamine at a baseline tonic level, kind of like the heartbeat of the brain. But if we overexpose our brains to highly reinforcing substances and behaviors, our brains compensate by decreasing baseline dopamine release to this dopamine deficit state, visualized as the gremlins really camped out on the pain side of the balance. Now I need more of my drug in more potent forms, not to get high, but just to level the balance and feel normal.

35:51And when I'm not using, I'm walking around with a balance tilted to the side of pain, experiencing the universal symptoms of withdrawal, which are anxiety, irritability, insomnia, depression, craving. And really all of my energy is taking up with just thinking about getting my drug so I can restore homeostasis because the drive to restore homeostasis is one of the most powerful physiologic rules governing all living organisms. What is the absence of pleasure is what anhedonia, something like that. It just sounds absolutely miserable where it's not just chasing the dragon, right? Where your tolerance is built up and you're like, I want that really high, high.

36:26That's long gone. Now it's just, you want to wake up without a slamming headache and feeling sick and unable to focus, that sounds like one of the worst ways to exist. You have to put this poison, illegal poison into your body to just do anything without feeling awful. Right. And it's important to understand how intense and overwhelming those feelings are in order to understand why people with addiction will relapse, even after they can see objectively that their lives would be better off if they didn't use. It's because their brains are screaming out for them to go get the drug and use the drug in order to restore homeostasis.

37:05So it's not about seeking a pleasure. It's really about trying to not no longer be in pain. What scared me in the book is drugs like Adderall, which a ton of people take, increase dopamine output by a thousand percent. And I took Adderall in law school because a lot of people were doing it. And I took the ADD test and I was like, this is, yeah, sure. I have ADD and now I can function and study really hard. And I just, you know, it was 20 years ago, I was not thinking about this kind of stuff at all. And I felt so good while I was on it. But I thought it was because, wow, this is how normal people feel every day.

37:39They're just so focused. My ADD really is a disability. This is crazy. And now I realize, no, just my brain is just bathing in dopamine at the time. And that was not how normal people feel at all. That's how drugged up amphetamine addicts feel because that's what I was taking. Yeah, so this is an important point because it highlights a fallacy in the mental health field, which is that if you take a medicine and it does for you what it was intended to do, then you must have the disorder that the medication was meant to treat. So, for example, if you take attention deficit disorder, and it is true that people with that label probably do have a different processing brain, a different way of processing information than other people.

38:25Now, whether or not we should label that pathological, people can disagree. And I might even disagree with that. I think it's a different way of processing, but not necessarily a pathological way of processing. But what we've done is we've said, take this stimulant. Oh, does that help your brain process in this more neurotypical way? If it does, then you must have ADHD. But the truth is, if you gave anybody a stimulant or most people a stimulant, they would be better at a certain kind of sustained attention and repetitive behavior that stimulants promote. You don't have to have ADHD to get that effect.

38:57So that kind of backward causal thinking, I think, you know, permeates a psychiatry and mental health and isn't really a good way to think about it. I do prescribe stimulants to a few rare patients who have shown that they really benefit from it. But I also do it in the context of opening the discussion about, you know, the pros and cons. Because again, there's no free lunch with any of these medications. And even people who can manage their stimulants and report benefit will admit that it makes them more anxious. It makes them, gives them more insomnia, that there's a come down in their mood.

39:31You know, and those are really important to acknowledge because, you know, there's a tipping point where you reach it where it's like, well, really, is it really worth it? Plus, of course, there's the risk for addiction. Again, addiction is a spectrum disorder. Not everybody who is exposed to a stimulant is going to get addicted to stimulants. It's not everybody who drinks alcohol is going to get addicted to alcohol, but there will be a subset of individuals who will go there and it will be largely outside of their volitional control. You mentioned before that drug and alcohol use change the brain forever.

40:02In the book, there's a rats and cocaine example. And this is really, well, a bummer is kind of an understatement. This is really scary, I think, because it seems like no matter how much time off you take from a substance, you're just as vulnerable to it if you take it again, even years down the line. It's almost like the drug tattoos your brain in some way. So there's quite a bit of evidence, both in the animal literature, but as well as in our clinical observation, that once an individual has become severely addicted to a substance or behavior, even after they've abstained and gone into remission or recovery for, in some cases, decades, if they're re-exposed to that substance or a similar related substance, that can reignite those addictive behaviors almost instantly.

40:49And yeah, that is kind of depressing, but I think it's important to just acknowledge that that's very often the case. Not in every case. I mean, humans are really complicated and our brains are, we're only at the sort of brink of understanding what's happening. So again, none of these things are 100%. But in most people, that is the case. What we think happens with recovery is those damaged areas probably never repair themselves, but people are able to create new neural networks that route around those damaged areas. So I always like to emphasize that recovery is real. Recovery happens on a neurological level.

41:25Recovery is robust. People will get into recovery from even very severe addictions and remain in recovery for the rest of their lives. But they'll always probably remain vulnerable. And so it's good to keep that in mind. Earlier, you mentioned that we live in this world of abundance, but our brains are evolved for scarcity. In the book, you write that we're cacti in the rainforest and we're drowning in dopamine. I think that's a really interesting metaphor because it really does seem like there's so much food around, there's so many drugs around, there's so much whatever online. It sounds like from reading the book, though, it takes more pleasure now to produce dopamine and less injury or whatever to produce pain.

42:03So are we more fragile now? Has our ability to bounce back from things, has that been degraded by our environment? I think so. What we're dealing with now is a mismatch between our ancient wiring for processing pleasure and pain and the world that we have created, which is in this era of the Anthropocene where human activity for the first time in human history has actually changed the environment. We usually use global warming as the example of that or whatever you want to call it, the way that we've polluted our environment. But this phenomenon of the drugification of everyday life is also a real thing that is impacting our lived experience because we are so insulated from pain in our everyday lives.

42:48Most of us don't even really move our bodies very much at all, or many of us. And we also have more access than ever to reinforcing substances and behaviors, importantly, even among the poorest of the poor. So we have more leisure time, more disposable income, more access to luxury goods, and now with the internet, instant access to digital drugs, which can have the same effect. I believe that that is a major contributor to the growing rates of unhappiness, growing rates of anxiety, depression, the mental health crisis that we're seeing among our youth. It's because there's too much pleasure and too little of the right kinds of pain for our brains to be able to stay in a healthy balance.

43:32This is the Jordan Harbinger Show with our guest, Anna Lemke. We'll be right back. If you like this episode of the show, I invite you to do what other smart and considerate listeners do, which is take a moment and support our sponsors. All the deals, discount codes, and ways to support the show are at jordanharbinger.com slash deals. Hey, and if you can't remember the name of a sponsor, you can't find that code, go ahead and email me, jordan at jordanharbinger.com. I am more than happy to surface that code for you. It's that important. Thank you for supporting those who support the show. Now for the rest of my conversation with Anna Lemke.

44:05The gambling example you gave in the book was really interesting and counterintuitive. I think you'd said something along the lines of the dopamine reaction in gamblers was highest not when they won, but when the probability of winning and losing was about 50-50. So this I never saw coming. So it seems like it's actually the uncertainty that triggers the dopamine hit, not winning money in the game. And gambling for me personally never really clicked. I felt kind of good when I won and I felt really dumb when I lost and I only felt anxiety in between. So it wasn't hard for me to decide that that was not something I wanted to keep doing.

44:42You know, it was just like you go to a bachelor party, you make your piddly little$80 budget and you sit there with your friends and you're like, all right, this is me sitting with my friends, but I had no desire to stay up till 3 a.m. with the other like the hardcore guys trading sleep for dopamine. Sports betting, same thing. I mean, it probably helps that I don't like sports. And as it turns out, being a giant dork has actually saved me quite a bit of money. But I wonder how social media compares to gambling with respect to the dopamine and the ups and the downs, but the uncertainty of what you're going to see on Instagram or TikTok or whether people are going to like your stuff.

45:20Is that uncertainty at play here as well? Oh, absolutely. I think that's part of what makes social media potentially so addictive for some individuals. It's that you can post and get a really positive response and get a nice burst of dopamine and feel really good. But then the next time around you post again, you don't get that response. And probably what's happening in the brain is not that then dopamine levels are neutral, they actually go below baseline because we know that when we anticipate or expect a certain reward and we don't get that reward, that dopamine firing goes below baseline. And so if we are predisposed to be addicted to that activity, because people differ as you yourself acknowledged in terms of what their drug of choice is, if we're predisposed not to be addicted to that activity, we'll have that negative experience and we'll walk away, right?

46:08We'll say that wasn't any fun. But if we're predisposed to get addicted to that activity, we'll have that negative experience and that will then motivate us to want to do it even more to post even more or to in the case of gambling, you know, gamble even more, spend more time there in order to bring dopamine levels back up and potentially above baseline again. That stuff scares me because it's hard to get a kid, for example, away from social media because they look at it like I'm talking to my friends. This is how my friends interact. So you're essentially you're ripping them away from their social circle.

46:39If you told your kid to stop vaping because it's bad for them, they probably know that. But if you tell them, hey, stop liking your friend's outfits on Instagram, they're going to be like, what is wrong with you? Why is dad so triggered by this stupid thing? Who cares? Yeah. I'm literally just telling my friend she looks good in a dress. And meanwhile, her brain is going crazy. Yeah, well, there's plenty of evidence now to show that the longer that people, including young people, spend on social media, the more likely they are to be depressed, anxious, unable to sleep, and generally unhappy. be.

47:14And I think that the field is coming to consensus that this is not just correlative, but actually causative. And that it's the time on social media that's driving those feelings of unhappiness, anxiety, depression, insomnia. And I think that there's even a slight shift among young people themselves. For example, my kids are in their teenage years and a lot of their friends will actually say, I actually hate social media. Like I want to stop, but I don't feel that I can, or I have difficulty stopping, or I feel that my entire identity is there. Yeah. So young people are beginning, sort of like the way you reported young men who lived through a certain period of time and looking back and going like, pornography may not be the thing.

47:58I think we're going to have a sort of reckoning with this generation of Gen Xers sort of realizing, wow, like all that time I've spent on social media made me feel bad. And I want to try to change it. But as you say, very difficult because when all your friends are hanging out there, if you try to change it alone, you're alone. For example, in California, there's a group of young people who call themselves the Luddites and they've decided to not carry their phones around and they're doing it together. You know, so I think that's great. That gives me a lot of hope that we're going to collectively, you know, move toward a healthier relationship with the technology.

48:33Yeah, I suppose there will be and are ways to limit these things. I've been thinking about this a lot because I have two young kids. One is four, one is not even two. And I'm like, we have to be able to find them and get a hold of them. But I don't want them to be sitting on a web browser or apps. And the sort of interim solution that I won't have to apply for another decade. but the interim solution now I would imagine for people who are listening and they're freaking out about their own kids is get them an Apple Watch that has the cellular in it so they don't need their phone to use it because you can't browse on that thing.

49:06But you can get texts, you can make a call, you can receive a call, but you can't like anything. I mean, maybe you can, but it's such a pain in the ass, right, you've got this little crown, it's like you're just not gonna do it. But you can have all the functions, and for parents you can still track your kid and find out where they are and reach them at any time without them, I don't know, getting accosted by a predator generally on some online forum or through DMs. Yeah, right. Yeah. So I think that that's right. There's these interim solutions, right? You can get your kid a dumb phone, just a flip phone, right?

49:37That just does text and phone calls. There are even these things called light phones that even have rideshare and some other features, but don't allow access to the internet for anything else. They have maps, rideshare, texting, phone. I also think that we have to like push back a little bit on this idea that like we as parents have to know exactly where our kids are all the time and the way that we kind of track them, obviously for a small child. Yeah, for small kids, definitely. But yeah, you're right. For a teenager, maybe we don't need to be like, I know where you are. Right, right. Or even the teenagers going off to college now and their parents still, I mean.

50:11Yeah, that's weird. It's the culture in a way. It's just normalized. You could say, well, it's a nice way to keep families close. And that's partially true. But I think there's a real danger there that your kid just doesn't get the kind of autonomy that they need in order to be independent in the world. So I don't know, these are all interesting. You're right. I don't want to know if my daughter's at a frat party because I will not sleep until I see the dot float back to her dorm room or whatever. And this is a problem I'm going to have in what, two decades? I probably shouldn't even be thinking about this right now.

50:42Probably not. There'll be something all new by the time you get there. Yeah, exactly. Addiction, distorting our time horizons. This was an interesting bit in the book. I had no idea that addiction could do this. Can you speak to this a little bit? It's not just instant gratification, but there was all kinds of distortion of how we perceive time that I just never thought of. Yeah. So we really lose track of time when we're chasing dopamine. And in fact, that's part of the appeal, right? That we get lost in the space-time continuum. We're not thinking about schedules or what we have to do next or appointments.

51:14We're just sort of lost to time. But that's also really problematic because we're on our phones and we think it's half an hour and it's really been two hours. That's part of what contributes to the harm that's caused by these highly reinforcing substances and behaviors. The other thing that can happen is that we can engage in what's sometimes referred to as delayed discounting, where we overvalue short-term rewards and undervalue long-term rewards. So for example, if I offered you$10 right now or$100 in a week, just to take an extreme example, you would probably choose$100 in a week. For sure.

51:54Right, as would most people. But if you are severely addicted to heroin, what experiments show is that many more people with severely addicted to heroin would take$10 right now over$100 in a week. Not all of them, but many of them. At least the curve would be shifted. And what that says is that you're in a really different mental state when you are in an addiction. You're liable without even necessarily realizing it to really overvalue short-term rewards and not be able to, not only not be able to delay gratification, but not even to see the need for it. What I thought was very, very interesting was that growing up in resource-poor environments, as opposed to growing up in resource-rich environments, that also shifted the curve.

52:39So heroin aside, how we react to short-term needs, instant gratification, is completely different. So people, I think you or the researcher had tested people who grew up in favelas, they tended to gravitate towards instant gratification. And I started to think about that. And you think, okay, rap and a lot of hip hop is like, go get the money right now, like cash only, get it right now. And I remember when I worked in Detroit, I worked with a lot of people who are sort of adjacent to that. And they would get paid that night and they would go spend the money right away. And I was like, what are you doing?

53:13We just had a conversation about how you're sick of living with your mom or your car's broken and And you're like, yeah, but I want to go get this chain. I'm like, it's 3 a.m., man. It's 3 o 'clock in the morning. Oh, the pawn shop's open all day, all night. I'm like, just put it under your mattress and go to bed for God's sake. And they like could not do that. And athletes going broke, right? A lot of these guys grow up in that environment and they can't. The money is burning a hole in their pocket. This was quite intuitive once you mentioned it in the book. I personally, I don't worry about resources.

53:44I know whatever it is I want is going to be there later. I didn't even want to pay the$10 to get my LSAT, which is the law school entrance exam. I didn't want to pay$10 to get my score a month earlier. And people around me were like, what are you doing? I don't, you don't know what your score is. And I'm like, they have to mail it to me. I'm not giving them much for money, right? And it is, it's just something I grew up being able to do because I grew up in a middle-class environment. I wasn't like, where's my next meal coming from? I wasn't worried about any of that. Others that don't have that certainty, this pattern is set growing up.

54:15But one, that's terrifying. But two, can this be reprogrammed or do we just have to be careful forever if we grew up with less? Well, I think this really speaks to if you grow up in a world of extreme scarcity where people are in survival mode, then to grab as much as you can, as fast as you can, of scarce resources is actually healthy and adaptive and increases your likelihood of survival in that environment. So it can be really difficult to make the shift to an environment of plenty where those resources are going to be there tomorrow. It's hard to believe it when you've grown up in an environment where you were taught that that was not the case.

54:56But of course, people can shift, of course, with repeated exposures of letting the resource be there and seeing that it's not going to go away. People can make changes, but still those early experiences do have a powerful impact our whole lives. What can we do about some of this? It seems a little bit desperate, right? You mentioned earlier stopping the behavior for, was it four weeks? Right. And is that what dopamine fasting is? Is that essentially? Yes. Tell me more about that because easier said than done. Oh, just stop your addictive behavior for a month. Like, okay, I hadn't thought about that before getting arrested twice or getting caught by my wife or whatever.

55:36Yes. I mean, much easier said than done. But what I hope is that once people understand what's going on in our brains, they will be more motivated to give it a try. Whether with a substance or behavior that they know they have a problem with or maybe a substance or behavior that they are not sure or they even don't think they have a problem with. but maybe other people have commented that it's a problem. Giving it up for four weeks is about the average amount of time it takes to reset dopamine reward pathways. So to have those metaphorical gremlins hop off the pain side of the balance and have homeostasis be restored.

56:10And the reason that it's important to do that is because, number one, when we reset reward pathways, we're able to take joy in other more modest rewards again. And number two, we're able to look back at the impact of our drug use on our lives with more objective clarity. Because when we're in it, because of things like delayed discounting and losing a sense of space-time, we really aren't very good judges of the true impact of our use on our lives. It's only when we get some distance. I've often had patients who will come back after four weeks of abstaining and be shocked to look back at their former selves and how much energy and time and money they invested in chasing their drug.

56:50So it's really important to take a break, to give your brain a break. Even if after that break, you decide you want to go back to using, which many of our patients do, but they almost all universally want to use differently. They want to use less. They want to have a different kind of attachment to their drug of choice, a healthier attachment. So I think it's a really important and well-informed experiment that people can just do in their lives. Now, importantly, this is not something I would recommend for somebody who is so severely addicted that they could never stop on their own. They had repeatedly tried and just couldn't do it.

57:25Or somebody who was at risk for life-threatening withdrawal from a substance like alcohol or a benzodiazepine like Xanax or an opioid. You can die if you stop taking those? I didn't realize that you could die from that. Yes, specifically alcohol and benzodiazepines like Xanax, Valium, Klonopin in particular. If you become very physiologically dependent, so you really change your brain physiology with repeated use, if you stop suddenly, you can experience a profound physiologic storm that can lead to death. In some instances, you can have C's and you can die. So for those kinds of drugs, people really need to see a medical professional and to be monitored and potentially get medicines to help them withdraw.

58:08I think a lot of people, unfortunately, they just trade one addiction for another. I remember I went to a bunch of these meetings like NA and AA just to see what they were like because I was giving advice on my show and I was like, I should probably know what I'm recommending. I had friends that were in there like, yeah, come with me. So I noticed that, for example, with AA, a ton of people were smoking and vaping outside of the meeting. And I'm not trying to be judgy here, but it really seemed like a lot of the people had went from either smoking and drinking or just drinking, and now they're just smoking a lot or vaping a lot.

58:42And I wondered how many people just traded one addiction for another one. This concept of cross addiction is really important because people with addiction who give up one drug are very vulnerable to increased use of another drug or even take on a drug, a new drug, or switch to a behavior and engage in that behavior in an addictive way. So we always talk about the risk of cross addiction. But I do want to emphasize that, you know, in our work with patients, when we talk about dopamine fasting, we're not asking patients to necessarily give up every single drug or vice, quote unquote, vice that they have.

59:16We're really asking them to identify that substance or that behavior that is causing problems in their lives and to really focus on that one. If their use of alcohol is, for example, linked to their use of cigarettes, like every time they smoke a cigarette, they want to drink, but otherwise they don't want to drink, then we might say, well, geez, maybe you should give up the cigarettes and the alcohol at the same time. There are a few studies showing that when people give up cigarettes and alcohol at the same time, they actually have better outcomes for both than if they try to give up one but not the other.

59:47And the hypothesis there is that as long as you're using anything that sort of pings your reward pathway, you're kind of setting yourself up for relapse because all rewarding substances and behaviors work on the same final common pathway. They all release dopamine in the reward circuitry. But now having said that, if somebody identifies in their life that alcohol is super destructive to themselves and others, et cetera, but that nicotine, although yes, obviously harmful for health, is something that they want to keep doing. We support patients in that. It's good that they're willing to give up to one substance, even if they're going to continue the other.

1:00:25We just really caution them against not increasing use of the other. And then over time, we will maybe re-enter the discussion like, well, you've been able to stop drinking. You're doing so much better. Do you want to take a look at quitting smoking or quitting cigarettes? What's very interesting is when people use cannabis and nicotine, they will almost always tell you that They want to quit smoking cigarettes, but they almost never want to quit cannabis because, you know, cannabis is their medicine. So you have these funny cultural overlays to sort of what's healthy, what's a medicine, you know, what's a drug, you know, what's addictive, what isn't.

1:00:59I know we talked about things like weed and food becoming more and more potent. Right. I know there's, man, for the last 20, 30, whatever years, there's been a lot of manipulation of drug formulation. Even Breaking Bad, right, was about the super methamphetamine. I don't know if you saw that series. No, but my sons absolutely love that series. Well, you might enjoy it. I mean, yeah, I'm sure I would. I'm sure. With all the free time you have. Yeah. But I mean, I won't say it beats vampire porn, but it's pretty damn good. I bet it's way up there. Yeah. I know that law enforcement is also concerned about this.

1:01:32It's been a factor, a significant factor in the explosion of mental illness and homelessness in America, according to some of the sources that I saw. Just drugs being crazy, crazy potent. and methamphetamine and things like that. Do you believe that there are some substances which are so disruptive to the brain that recovery is impossible or highly improbable? Or is that too catastrophic for us? Yeah, I mean, I always believe that recovery is possible. I have seen people with very severe addictions after decades of use get into recovery. So there's always hope. Recovery is always possible. We need to never give up on people.

1:02:08But it is true that the longer that people use their drug of choice and the more potent that drug, the more potential damage to the brain, which is the ultimate end organ that is being damaged by addictive drugs and behaviors. I mean, fentanyl is the perfect example. It's a highly potent opioid, 50 to 100 times more potent than heroin. It's available cheaply on the streets of every major city. It's also very lethal because it slows down heart rate, slows down breathing. People fall asleep and don't wake up again. People aren't using it for that reason, you know, they're using it for its psychotropic effects or euphorogenic effects, but they accidentally overdose.

1:02:48So, you know, obviously these really potent drugs, which by the way, are, you know, a result of our scientific revolution, right? It's the dark side of technology and innovation that's allowed us to manufacture drugs that are this incredibly potent. This is totally off topic, but I worry about the brain machine interfaces that we're going to have in a few decades, and you'll be able to get feelings from those things. That's just going to be a whole, you're going to have a whole sub practice if you're still practicing by then of people who can't stop, I don't know, shocking their dopamine centers.

1:03:18I mean, that's just going to be crazy. I think we're already there. Our digital devices essentially are auto stimulators, auto erotic stimulators. They're the ways in which we meet all of these deep physical and psychological needs without another human being, right? We're just doing it with a device. I think it's a real danger, especially we have so many people who do live in isolation who are experiencing loneliness. Now you've got a device that can sort of take care of your needs, which then contributes to more loneliness and isolation, people not really needing to go out to find other people to meet these basic human needs for connection.

1:03:54I mean, it's already upon us. I read Michael Pollan's How to Change Your Mind a few years ago. He was on the show's episode 81, by the way. And I was left with the impression that psychedelics are largely the cure for a lot of this stuff or could be, what do you think of substances like LSD, ketamine, MDMA being the future of psychiatry to treat things like hardcore trauma and, I don't know, neurosis? Asking for a friend, of course. Right. Yeah. So, I mean, I think it's really unfortunate that the hype about these drugs have so outstripped the evidence. You know, the evidence is really preliminary.

1:04:32It's also in the context of an augmentation strategy for psychotherapy. So when people talk about the evidence that's out there, it's really studies in which the medium for healing is psychotherapy, talking to somebody and then using the psychedelics to strengthen that therapeutic alliance or augment that connection or the work that's done there, which by the way, I fundamentally oppose because it seems to me that one of our major missions is to help people create alliances with other people without using drugs, right? We've got lots of patients who that's the only way they know how to connect with other people.

1:05:10And it's really sad to me. You're saying, well, now you're going to use, you know, now you need a drug to have a connection with your therapist. Having said that, I can imagine scenarios in which there may be utility, like at the very end of life, where people don't have the time that you might need to make that kind of connection. But what's very sad is that, of course, this idea of using psychedelics in a therapeutic context has become individuals using it with their friends or by themselves at home, not in the context of medical treatment, to have some kind of spiritual awakening. And I think people should be very, very skeptical.

1:05:48These drugs are addictive. Anything that changes the way you feel has the potential to be addictive. We're seeing more and more people getting addicted to psychedelics, showing up in emergency rooms, dying from psychedelics. I mean, people really underestimate the harms and the potential harms and really overestimate the benefits and the utility. So I just proceed with caution. I would also say if you look at like sort of the spirituality measures, the questions that they ask people, you know, to sort of measure spiritual awakening look a whole heck of a lot like the questions you would get around what it feels like to be high.

1:06:25Did you feel a sense of expansiveness as if you were floating above at all, deep connection to other people? I mean, that's how people feel when they get high. So this idea that you take a shortcut to a spiritual awakening. You're skeptical. Yes. From the sound of it. This book really did help me understand how addiction works in a new way, and especially just the dopamine centers in the brain. It's kind of, dopamine's almost buzzwordy these days because you hear about it with respect to everything from Instagram to opiates to Cheetos. And this really does provide a lot of foundation to, I think, the conversation that we're having now, which is interesting because this is not a brand new book.

1:07:05You were just ahead of the curve, I think. So one, thank you for that. But two, leave us with something positive because, okay, psychedelics. Oh, no, just kidding. And what about this? Well, also highly addictive. Oh, and your brain might never change, but you know, Bye. Yeah, right. Well, I mean, I'm very optimistic, actually. I think the one thing about humans is how adaptive we are. And I do think that addiction is the modern plague, but I also believe we'll figure it out. Part of that result will be a new modern form of asceticism, which is to say the intentional seeking out of difficult or painful circumstances and activities as a way to reset reward pathways.

1:07:41And so inviting challenge into our life, encouraging our children to have challenging experiences, not immediately rushing to the rescue to make sure that people get out of pain, but instead acknowledging the utility of pain in our lives and, in fact, the ways in which we're wired for pain. We are meant to strive. If we don't have something to strive for, we're a lot less happy. Thank you very much. Really appreciate your time and expertise. This is fascinating, even if it is a little bit terrifying. And I appreciate it. Well, you're very welcome. Thanks for having me. Ever wonder why seemingly rational individuals can wholeheartedly embrace the most irrational beliefs?

1:08:20You're about to hear a preview of The Jordan Harbinger Show, where Dan Ariely uncovers the captivating psychology behind these puzzling convictions. I'm a social scientist. The moment you adopt this misbelieving perspective, where you distrust everything and you just look for signals for bad things that are happening, you can find them. We can deteriorate quickly. into a very undesirable state of beliefs. It affects people's well-being and optimism. It affects people's willingness to help, to donate money. We are very much attuned to bad things. So when bad things happen, we really want to understand the mechanism.

1:08:58And I think this is really the goal of social science, is to take those things we have no intuition about, help us understand them, and give us some better rules for life. If we understand that misbeliefs are bad reactions to a real problem, can we help our friends have better reactions to a bad problem? Where's reality? Where's the truth? We are becoming more politicized, more identity-driven, more separatist. It feels like the things that divide us are becoming larger than the things that unite us. And the moment we have these feelings of intolerance, we are just chasing those people away from our lives.

1:09:39And one of the best antidotes is resilience. You know, at the end of the day, society's strength is in our unity, in our trust with each other. Trust is the unobserved lubricant of society. To hear more about Dan Ariely's own chilling encounters with conspiracy theorists, check out episode 903 of The Jordan Harbinger Show. This brain stuff, man, it never gets old. I should have just listened. I should have been a brain scientist. If I were smarter, I would have done that. What I didn't know is that any substance or activity that pushes on the pleasure center has the capacity to become addictive.

1:10:17I mean, it makes sense now that I hear it, but it's sort of scary because I'm thinking of all the things that I kind of like doing, and I'm like, oh man, can I get addicted to that? That's right, folks. Let your imagination run wild with that one. It's very important to treat the underlying condition. So gastric bypass surgery, right, where they sort of staple off part of your stomach, they probably don't do that anymore, but, you know, same kind of idea. Maybe people lose weight, but they still have addictive behavior. So they might start drinking, they might start popping pills, and, of course, they're at higher risk because they absorb booze and other substances faster because they had gastric bypass.

1:10:50So it's really interesting what happens, interesting in a bad way, I suppose, what happens if you don't treat the underlying condition to this whole thing. So really sort of a lot to be said here for the way we treat addiction, substance abuse, et cetera. All things Anna Lemke will be in the show notes at jordanharbinger.com. Transcripts in the show notes as well. Advertisers, deals, discount codes, ways to support the show, all at jordanharbinger.com slash deals. Please consider supporting those who support the show. We've also got our newsletter. Each week, the team and I dig into an older episode of the show and dissect the lessons from it.

1:11:23So if you are a fan of the show, you want a recap of important highlights and takeaways, or you just want to know what to listen to next, the newsletter's a great place to do that. JordanHarbinger.com slash news is where you can find it. Don't forget about 6-Minute Networking as well over at 6MinuteNetworking.com. I'd love to hear from you anywhere on any platform. I'm at JordanHarbinger on Twitter and Instagram. You can even connect with me on LinkedIn. This show is created in association with Podcast One. My team is Jen Harbinger, Jace Sanderson, Robert Fogarty, Millie Ocampo, Ian Baird, and Gabriel Mizrahi.

1:11:53Remember, we rise by lifting others. The fee for the show is you share it with friends and you find something useful or interesting. The greatest compliment you can give us is to share the show with those you care about. If you know somebody who's interested in brain science, addiction, dopamine, definitely share this episode with them. In the meantime, I hope you apply what you hear on the show so you can live what you learn. And we'll see you next time. This episode is sponsored in part by the Something You Should Know podcast. Finding a great new podcast can feel like searching for a needle in a haystack.

1:12:20Let me save you some hassle. Check out Something You Should Know with my friend Mike Carruthers. Every episode is packed with fascinating insights that you can actually use. Mike interviews top experts on topics that shape your life, like how to optimize your brain chemistry, the best and worst ways to apologize, probably could have used that recently, why couples hate to talk about money. No matter the topic, Mike asks the questions you'd want to ask, getting straight to the good stuff, and the conversations are always engaging, always insightful, guaranteed to leave you a little smarter than before.

1:12:45They've got thousands of five-star reviews. But do you even need that? I'm recommending it. You don't need other people's opinion, right, at this point, I would hope. Anyway, give it a listen. Just search for Something You Should Know wherever you get your podcasts. Look for the bright yellow light bulb and start listening to Something You Should Know.