Why DOPAMINE is Destroying Us: Dr. Anna Lembke’s Bold Take on Modern Addiction!

Shame is a huge obstacle to getting into recovery and also one of the great motivators for recovery. If we didn't feel shame about some of our behaviors, we would not be motivated to change. But once we get caught in that vortex, we've really lost, in many ways our capacity to choose or to see clearly, true cause and effect. I really do think that addiction is the modern plague, that this is one of the main social problems we'll be dealing with for hundreds of years, and it's probably only going to get worse. And this is a real, I think, tragedy among young people. They're told to find meaning and purpose, but there's really not much that they have to do. So it all feels a little bit made up. Hey, everybody. Great to see you. I'm really excited to have this opportunity to talk with you today. It's been a great day for me. I've met many very interesting people from all different walks of life. This is certainly very different than my usual medical conference that I go to, so that's been very fun. I'm going to Talk for about 30 minutes in order to just lay the groundwork with some science that I think is really exciting, that I think helps inform the way that we live now. I'm also going to put out there to you a kind of hypothesis about what I think may be contributing to our current mental health crisis. And it's a little bit different than the usual stuff that you may hear about or read about or think about. And then I'm going to talk briefly about some things that I think that we can do to combat some compulsive overconsumption that is part of the world that we live in today. This is something that we're doing in our clinic. But then Joe's going to come out, and the two of us are going to sit down and we're going to have a conversation together, which I'm really looking forward to. All right, so let's go ahead and get started. First, I want to talk about a kind of condensed version of the neuroscience of addiction, which I use a metaphor, the pleasure, pain, balance to describe. Then again, this plenty paradox, which is a hypothesis about what's contributing to our mental health crisis, and then finally, what we can do about it, mostly focusing on our individual actions. So lots of exciting work in the neuroscience of pleasure and pain the last 75 to 100 years. And one of the first and most exciting discoveries is that we have a dedicated reward circuit in our brain that consists broadly of the prefrontal cortex which is that large gray matter area right behind our foreheads that's so important for planning, delayed gratification, and also autobiographical narratives and storytelling. And we have these deep limbic structures or emotion brain areas, the nucleus accumbens and the ventral tegmental area that are rich in dopamine releasing neurons. And when it comes to the problem of compulsive overconsumption or addiction, we have a problem either in the prefrontal cortex, which is kind of like a problem in the brakes on the car, the control centers, or. Or a problem in those limbic structures, which are kind of like the accelerator on the car. So another very exciting discovery just in the last 75 years is the discovery of dopamine as a human brain neurotransmitter. Now, dopamine was known long before then as an animal neurotransmitter, but it was only discovered in the 1950s as a human brain neurotransmitter. And for those of you who may not be exactly familiar with what a neurotransmitter is, Neurotransmitters are chemicals that we make in our br that bridge the gap between neurons. Neurons are these long, spindly cells that conduct the electrical circuits that make up who we are, but they do not touch end to end. There's a gap between them called the synapse. That synapse is bridged by molecules called neurotransmitters. Those neurotransmitters allow for fine tuning of that electrical circuit. Dopamine has been discovered as one of the most important neurotransmitters for the experience of pleasure, reward, and motivation. Now, it's not the only neurotransmitter involved in that process, but it is the final common pathway for all reinforcing substances and behaviors. This image represents a series of experiments done in rats and mice where a probe was placed in the nucleus accumbens to measure dopamine firing. We're always releasing dopamine At a kind of baseline tonic level in our brain. When we do something that's pleasurable, rewarding, reinforcing, or simply that. Our brains tell us that this is important for your survival, so you should pay attention to it. We increase dopamine firing temporarily above baseline, and this shows in rats and mice anyway, how much we increase those dopamine levels. For chocolate, it's 55% above baseline. Sex is 100%, nicotine 150, cocaine 225, and amphetamine 1000. Now, the very high amount of dopamine released by Amphetamine is somewhat artifactual in the sense that the mechanism of action of amphetamine is to release dopamine directly into the synapse, whereas these other kinds of reinforcers have their own unique chemical cascade, and dopamine is their final common pathway. So it's not necessarily that amphetamine is so much more addictive than these other things, although in rats it may actually be because in fact, rats will press a lever for cocaine or amphetamine until exhaustion or death. What this also doesn't quite represent is that although we are very similar to rats in terms of this very basic, evolutionarily conserved part of our brain, we're also very different because we have these large gray matter cortices that are overlay these deep limbic structures that we can use to modulate it. And for example, we're also just different from rats in the sense that it's very hard to get a rat addicted to alcohol, but for human beings, it's very simple to get addicted to alcohol. You can actually make genetic strains of rats that get addicted to alcohol, but it's just hard to do. This also doesn't take into account the very important point of inter individual variability. So what releases a lot of dopamine in one person's reward pathway may not release a lot of dopamine in another person's reward pathway, and vice versa. And from an evolutionary point of view, that makes sense. If you've got a tribe of people trying to survive in a world of scarcity, you wouldn't want everyone going for the same reward. You would want some people interested in finding mates, other people interested in meat, other people interested in berries. And this drug of choice concept becomes particularly important when we think about the ecology and the world that we live in now, where we have so many different types of drugs, including many drugs that didn't exist before. Dopamine is also very important for movement. And it's probably no coincidence that the same neurotransmitter that's essential for pleasure, reward and motivation is also important for movement. Even the most primitive nematode will release dopamine in response to food in its environment, and that dopamine allows it to locomote toward the food. One of the big problems today is that we don't actually have to move our bodies in order to get the things we want. So there's this big disconnect between the function of dopamine as something that has us engage in movement in order to get our reward, and the actual getting of the reward, which Is of course, partially what makes things addictive, right? What is the difference between cocaine and broccoli? It's the amount of dopamine that's released and how fast it's released in the reward pathway. But the other thing that's different about what's addictive and what isn't is the relationship between how hard we had to work to get the dopamine and how much dopamine is released. Because really we are physiologically designed for so called natural rewards. Food, clothing, shelter. But really what that means is that we're physiologically designed to go into some kind of physiologic deficit that then drives us to want to do the work, to get the reward, to survive. Whereas today we don't actually need to do that work to survive. And we have all this amazing, highly potent stuff that's handed directly to us that makes our brain very confused in a way that I'm going to talk about now. So to me, the most exciting finding about processing pleasure and pain in the last 75 years is the finding that pleasure and pain are actually co located in the brain. So the same parts of the brain that process pleasure also process pain. And they work like opposite sides of a balance. So imagine that deep in your nucleus accumbens you've got this teeter totter, like in a kid's playground, that represents how we process pleasure and pain. It's an obvious oversimplification, but it gets at a very fundamental aspect of what happens in our brain as we become addicted. So when we experience something pleasurable, the balance tips one way. When we experience pain, it tips the other. But there are certain rules governing this balance. And the first and most important rule is that the balance wants to remain level, or what neuroscientists call homeostasis. So that with any deviation from neutrality, our brains will work very hard to restore a level balance. How do our brains do that? First, by tilting an equal and opposite amount to whatever the initial stimulus was. And I like to imagine that as these neuroadaptation gremlins hopping on the pain side of the balance to bring it level again. But the gremlins like it on the balance, so they don't get off as soon as it's level. They stay on until it's tilted an equal and opposite amount to the side of pain. That's the come down, the hangover, the blue Monday, or maybe even just that moment of wanting to eat one more piece of chocolate, watch one more TikTok video. It can be even outside of conscious Awareness. Now, if we wait long enough, those gremlins get the memo that there's no more dopamine incoming. They get off the balance and homeostasis is restored and we kind of go on our way. But until that happens, while those gremlins are on the pain side of the balance, we are in a state of physiologic craving and wanting. We want to restore homeostasis. And by the way, the work of restoring homeostasis also triggers our adrenaline or our innate stress response, so that it is stressful and it is work inducing in order to bring that balance level again. But what if we don't wait? What if we continue to consume our drug of choice? Over days to weeks, to months, to years, those gremlins start to multiply and pretty soon we've got enough gremlins to fill this whole room. And now they're camped out on the pain side of the balance, tents and barbecues in tow. And now we're entering addicted brain, right? And essentially this means we are changing our hedonic or joy set point such that we need more of our drug and in more potent forms. Not to get high or feel good, but just to level the balance and feel normal. And even more importantly, when we're not using our drug of choice, we're walking around with a balance that's tilted to the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability, insomnia, depression, and craving. And this is why people with severe addiction will relapse even after they can see that when they're not using, their lives are better. It's because their brains aren't better. They're walking around in this state of physiologic pain. This is also why it's so difficult to stop addictive substances and behaviors when we're chasing dopamine. Because we're experiencing that craving that comes from having that pleasure. Pain balance tilted to the side of pain. Now, with enough neuroplasticity and enough sustained abstinence from our drug of choice, and I'll get into how long that needs to be in just a little bit, those gremlins eventually get the memo, they hop off and homeostasis is restored. Just to represent this graphically, at the simplest level, what we're really talking about is dopamine firing. That initial exposure to anything that's reinforcing or rewarding increases dopamine firing above baseline, followed then by neuroadaptation, which is dopamine free fall, not just to baseline but below baseline into a dopamine deficit state where we're in a state of craving, which if we then just wait long enough, we go back to the level balance homeostasis, or a neutral baseline level of dopamine firing. So in other words, initial exposure to reinforcing substances and behaviors brings our dopamine levels up and we feel good. But with repeated exposures over time to the same or similar reinforcing substance and behaviors, and maybe in one person it takes two weeks for this to happen, for another person it could take 10 years. But eventually our brains will adapt such that that initial upward deflection of dopamine gets weaker and shorter in duration, but that after response, that dopamine deficit state gets stronger and longer and we eventually settle out at a new set. And again, now we're in addicted brain. This is a neuroimaging study done by Nora Volkoff and her colleagues. This is now human brains, not rat brains. What you see here is the nucleus accumbens, which is the area that's sort of lighting up in the middle. And red represents dopamine transmission, healthy, robust dopamine transmission. And what you'll see on the left hand side is that in the nucleus accumbens of these healthy control subjects, there's plenty of red, so plenty of dopamine transmission. On the right hand side, you have images of people who have been using cocaine, methamphetamine, alcohol and heroin in an addictive way for a longish period of time. And you can see that there's very little red in their nucleus accumbens. In other words, they have subthreshold or below normal levels of dopamine transmission. And what I find incredibly powerful about this is that on the right hand side, the images of those individuals who were using these addictive substances were taken two weeks after they stopped using. What that tells us is this dopamine deficit state. Those gremlins don't hop off the balance right away. It takes a while for them to get the memo and hop off. And it is also possible that in some individuals, perhaps they've lost the plasticity to ever reset their reward pathway and that they're in a chronic dopamine deficit state for light, for life. And that's why, for example, for some patients with severe opioid addiction, we will actually use opioids to treat their opioid addiction. Things like methadone maintenance or buprenorphine, not to help them get high, but just to level the balance, restore homeostasis and give them a fighting chance of Engaging in recovery. The second rule of the balance is that the balance remembers. So once those gremlins are created, even if they hop off the pain side of the balance, they never entirely go away. They're hiding in the wings, eager to hop on again. Which is why we can see people relapse even after a single exposure to their drug of choice, even after decades of absence. Perhaps you've all seen that in someone that, you know, we certainly see it in clinical care all the time. So since those gremlins are already created and waiting in the wings, what we know from that is that we have a kind of permanent or latent echo, a permanent change to the brain, even once people get into recovery. One of my favorite rat experiments is where they took rats. They gave them an injection of cocaine daily for seven days. And what they found was that with each successive injection of cocaine, the same amount on every day. The rats went from hiding out in the shadows of the cage to being in a running frenzy all around the middle of the cage on day seven. Then they stopped giving those rats injections, and they waited a year. And a year is about a rat lifetime. And then they re injected those rats with cocaine, and they were immediately in a running frenzy, exactly as they had been on day seven. Which tells us that even after a sustained period of not being exposed to our drug of choice, there's a kind of latent echo. Now, this should not be a cause for feeling hopeless or despairing, because we see people get into recovery all the time. And my colleague Edie Sullivan at Stanford has shown that we. What happens in the brain of someone who's getting into recovery is probably not so much that they repair those damaged neural networks, but that they form new neural networks that go around those damaged areas. All right, so let's focus on this graphic here. This is from a series of experiments looking at dopamine levels in the brains of rats and mice. When you give them an injection of cocaine that they have to work for, so they have to press a lever for it. But these are rats and mice who have basically been taught or trained to know that they'll only get cocaine if they first see a light and then press the lever. If they go up and just press the lever on any old occasion, they're not going to get cocaine. So, in other words, this is what we call a cue induced learning. This is classic Pavlovian learning. They know when they see the light, they can go get cocaine if they press the lever. But look at what happens to dopamine levels during this process. Now, if you go all the way to the right side of this graphic, you'll see that when the rat receives cocaine, dopamine levels go up. You know, that's what's happened at least with those initial bouts of exposure. But look at what happens when the rat sees the light. Just seeing the light and knowing that cocaine is on its way increases dopamine firing a little bit above baseline. So we get a little bit high, just anticipating our drug of choice. But look what happens right after that upward deflection. Dopamine levels don't go just back down to baseline. They go a little bit below baseline. So there's a mini dopamine deficit state, which sets up the craving that makes us then want to do the work, to go get our drug of choice. Because, remember, we want to restore homeostasis. And this is why it's so important when people are trying to change a habit of compulsive over consumption, or people are trying to get into recovery from severe addiction, that they insulate themselves not just from their drug of choice, but also from the triggers or reminders that will set them up for this craving cycle that will make them want to go get that drug of choice. What happens when we have learned to anticipate a certain reward and we don't get that reward? Right? So here you see the graphic. The rat has been trained to think that when it sees a light, it presses the lever. It gets cocaine, it sees the light, it presses the lever. No. Cocaine dopamine levels go way below baseline. This, to me, is really, really interesting because there are a lot of inferences you can make from this. First of all, what it says is that as people get into their addiction, their drug of choice essentially stops working and can even turn on them and do the opposite of what they hope for. We see this all the time. For example, with cannabis, right? I use cannabis to help my pain. I use cannabis to go to sleep. I use cannabis to go relax. Now my cannabis makes me anxious, makes me paranoid. Drug turns on them through the process of neuroadaptation. If we are addicted to our drug of choice, we do not learn from that experience. Instead, what we do is we try harder to get more, to bring those dopamine levels back up to baseline or even get them above baseline. I also think, more broadly speaking, in the process of learning, generally, what we're doing is we're kind of making mental maps of the world, and then we're testing them on the world. And when those mental maps work out and We've got it right, we get a little hit of dopamine, and when those mental maps don't work out, meaning we got it wrong, we probably go into a dopamine deficit state. And then we can either fight that awareness or we can change our mental maps. This is just to speak broadly about the importance of childhood and adolescence as a very influential time in terms of the development of the brain. What you see here is a series of brains from about age 5 to about age 20. Red here represents the number of neurons that we have in our brain as well as the number of neuronal synapses. Synapses, again, are where those neurons connect. When we are five years old, we have 50% more neurons and neuronal synapses than we will have for the rest of our lives. We are totipotent cells. We're sponges, right? We can learn anything between about age 5 and age 25, we cut back on or prune, as neuroscientists call it. Other neurons we're not using, and we myelinate and make more efficient with blue here, the neurons that we use most often. So you can see in this graphic, we have a lot of red for neurons at age 5 and a lot of blue for myelin at age 20. And essentially at age 20 or 25, we have the neuronal scaffolding that we'll be left with for the rest of our lives. So a very important time to make sure that we are creating really good and healthy coping strategies for ourselves, for our kids, et cetera. All right, I want to widen the lens now and sort of extrapolate from the neuroscience, really exciting advances in neuroscience of pleasure and pain and addiction, to talk about what I call the plenty paradox. And the plenty paradox is essentially the mismatch between our primitive wiring for processing pleasure and pain and the world that we find ourselves in today. So you might reasonably ask, why on earth would Mother Nature create a pleasure pain processing system consisting of this balance? It seems especially cruel because it means anything that we find pleasurable will eventually become less pleasurable over time and might even be a source of pain for us. Why do that? Well, in a world of scarcity and ever present danger, this is actually a great mechanism because it means we are the ultimate seekers, never satisfied with what we have, always looking for more. It's exactly what's going to keep us alive. But in today's world, a world in which most of our basic survival needs are met, a world of overwhelming overabundance, this actually becomes a Liability. And I would go even so far as to say that almost every aspect of our lives has become drugified in some way. Made more potent in reinforcing, that is to say, releases more dopamine very quickly in the reward pathway. Been made more accessible. Our phones are basically 24. 7 hypodermic syringes delivering digital dopamine made more novel. Novelty is one way to overcome addiction, right? Overcome tolerance. We combine two drugs together to make a third new drug, and we overcome tolerance. And then just sheer quantity. Quantity matters when it comes to highly reinforcing substances and behaviors. The more we use and the more often we use, the more we change our brain. TikTok never runs out. This is an example of the types of things that people can get addicted to. I'll just let you sort of. Oh, can you see it there? Oh, here it is. The print is a little small. I'll read kind of the general categories. So we have our traditional drugs, alcohol, nicotine, cannabis, et cetera. We have medications. These are the things that doctors prescribe to us, mostly with good intentions. We've got media, Internet, technology. I'm personally very vulnerable there. We can get addicted to other people, right? We can get addicted to our own bodies. One of the most common types of addictions we're seeing now is addiction to sex, pornography, compulsive masturbation, love, sex and pornography. This is certainly my own category of vulnerability as well, which I talk about in my book. In my early 40s, I got addicted to romance novels, which I actually think is socially sanctioned pornography for women, which is all good in moderation. But what happened to me as I went from reading the Twilight Saga, which, for those of you who don't know, is teenage vampire romance novels, to reading about butt plugs at 3 o' clock in the morning while reading about 50 shades of gray, reading all the time, got a Kindle. People didn't know what I was reading. I could read anonymously on the bus at work, spending less time with my kids, with my husband, even taking romance novels to work and reading in the 10 minutes between patients. But probably the biggest and most impactful part of it that I really didn't see till later was that I got progressively more depressed and unhappy with my circumstance, even though I had a lot to be grateful for and I had this kind of narrowing of focus where the only thing that I really wanted to be doing was reading romance novels or to be in this escape world and the ways in which continued engagement in our highly reinforcing substances and behaviors ends up with those gremlins on the pain side of the balance Means that we can no longer take pleasure in modest rewards or things that used to give us pleasure. Because we've narrowed our focus on this one thing, and it's the only thing that has salience for us. I would also just emphasize that our food supply in general has become highly drugified, as was mentioned earlier, with the addition of salt, fat, and sugar. Sugar is incredibly addictive. We have lots of good data that it lights up the nucleus accumbens. It's very hard to stop. If you've ever tried to give up sugar, it's very, very difficult. And then, of course, for this audience, work achievement, money. I thought Tommy said it really well. Go get money, but just don't love money. So, again, how do we define addiction? Very broadly, it's the continued compulsive use of a substance or behavior despite harm to self and or others. This is not to trivialize addiction, severe addiction, or. Or even to say that anything can be addictive. But really, it's when a passion or a hobby crosses over into being harmful to self or harmful to others. And recognizing that, we may be the last person to recognize it. So this is really important. When we're chasing dopamine, we often lose a sense of causality. Mark did a really nice job this morning talking about the importance of because statements. Why are because statements so powerful? Because we all want to understand causality, right? We're trying to figure out what leads to what. But just be aware that when we're in our addiction cycle, we don't see causality necessarily. And so we might have to either take some action or go on blind faith when someone else is telling us that this substance or behavior is causing harm to our lives or to the people who love us. So one of the hypotheses that I would just like to put out there Is that our mental health crisis has many different causes, of course. But I would hypothesize that one of the causes may in fact be that we are both at an individual and a sort of national, collective level, in a dopamine deficit state, which may be contributing to the rising rates of depression and anxiety. And this is really important because if that's true, and that means the intervention is quite different from the typical things that you will find recommended or prescribed from a psychologist or a psychiatrist or mental health care provider. One of the interesting paradoxes is that in general, if you look at happiness surveys and wealth, the wealthier people become, the happier they become. And if you look at this from an epidemiologic perspective. As nations get wealthier, especially as they're moving out of poverty, when you do happiness surveys nationally, those populations will endorse getting happier. Something changed about 20 years ago, and the wealthiest nations in the world started reporting that they were less happy than they had been before. Not only that, the richest nations are now showing the highest rates of reported depression, anxiety, and also suicide. And I'll get to that in a second. So you could say, well, you know, maybe the culture's changing it. Stimulated reporting. Now everybody talks about their disorder. I would absolutely agree with you that that's part of the phenomenon. But I don't think that's the whole phenomenon. I actually think people are less happy. And I think the reason that they're less happy is because overabundance itself is a physiological and psychological stressor. We were wired to strive. In the absence of anything to strive for, we are not thriving. And if you had to question on any space around stimulated reporting, I think suicides will tell you that that's no longer just a reporting phenomenon. People are ending their lives more often in the wealthiest nations of the world. You can see here that second bar graph is both men, women, and both. And you'll see that people in high income countries now kill themselves at rates far higher than in the lowest income countries. And this is unprecedented, at least in the time that we've been documenting these data. And finally, in terms of the epidemiology, it is probably the poorest people living in the richest countries who are the most unhappy and vulnerable to the problems of addiction and other forms of mental health. Why? Because they are surrounded by all of these cheap pleasures, have easy access to them without the same kind of access to the kinds of healthy and rewarding sources of dopamine that we really need to thrive. Deaths of despair, you may have heard of it before. How many folks have heard of the term deaths of despair? Okay, so not very many. This is the work of Anne Case and Angus Deaton. These are two Princeton economists that have shown that for the first time in many generations, people, white Americans who are not graduating from high school are dying younger than their parents and grandparents. Okay, so for 200, 300 years, we've all had increased longevity, right? The average person in 1800, 17, 50 used to live to about age 30. Now, on average, especially in wealthy nations, we're living older and older, more centenarians than ever before. But in this generation, for the first time, we saw people who were dying younger. Top three Causes of death in this cohort were alcohol related liver disease, drug overdose, and suicide. And they've called these deaths of despair. And all of this is probably on some level tied to the Internet. In 2021, adults in the US spent on average 8 hours and 5 minutes with digital media each day. This is not digital media for work, okay? This is digital media for entertainment. I don't think in the early 2000s, when the smartphone first came out, anybody would have predicted that we would be spending this much time on digital media. Digital media, digital devices, they're a powerful tool and they're also a very potent drug. They light up the same nucleus accumbens, the same reward pathway. We're seeing more and more people getting addicted to social media, video games, YouTube, and just sort of indiscriminate Internet addictions. All right, and sort of ending this brief talk today, I want to tell you what are some of the somewhat novel but really quite simple things that we're doing about this in our clinical work, which are just a lot different than what we were doing 20 years ago. So 20 years ago, if a patient came in to see me with anxiety, depression, inattention, insomnia, the first thing I would have done was prescribe an antidepressant and or recommend them for some form of psychotherapy. Today, the first thing that I do is actually screen them for their consumption of highly reinforcing drugs and behaviors. And if I'm finding a pattern of repeated use of caffeine, alcohol, cannabis pornography, video games, social media, shopping, romance novels, one of the first things that I might do is to recommend a dopamine fat fast. And the reason I do that is because when patients are willing and able to engage in a dopamine fast, which is essentially giving up their drug of choice for four weeks. And I'll tell you a little bit more about the four weeks. What we find is that they will often return feeling less depressed, less anxious, better able to sleep without our having to do any other intervention. And even if they don't feel better, we still have a lot of information from that. Because if they don't feel better even after they've given up their drug of choice, then we know that there's something else going on. So what we tell patients is we'd like you to abstain from your drug of choice long enough for those neuroadaptation gremlins to hop off the pain side of the balance so that homeostasis can be restored, so that you can have a supple pleasure, pain balance that can respond to cues in your environment of both pleasure and pain. And you can restore your joy in everyday rewards like things as simple as a sunset. We asked for four weeks because we know from Nora Volkoff's work and from clinical practice that two weeks is not enough. Remember that image of the brain? We're still in a dopamine deficit state at two weeks. That tracks exactly to what we see in clinical care. Those first 10 to 14 days are hell, no matter what your drug of choice is. Now, it's true that some drugs of choice, that withdrawal period can be life threatening. Those would be opioids, benzos and alcohol. In which case, if you are physically dependent and at risk of a life threatening withdrawal, you need to go into the hospital for medically monitored detox. But the vast majority of people addicted to those drugs and other drugs can actually stop cold turkey if they are able to. Not everybody is able to. That's why we have rehabs. I'm very grateful for rehabs. They get a bad rap. I'm really glad they exist. Some people need to go into a rehab in order to be at enough distance from their drug of choice to be successful. But essentially what we find is that those first 10 to 14 days are really, really bad. Your gremlins are not off the pain side of the balance. And we warn people that that will be the case. And this is the most important thing that we say to people because if we don't say it, people feel like the pain that they experience in early withdrawal is the pain that they're going to be left with the rest of their lives. And since that is so intolerable, they go back to using their drug of choice. People with a severe addiction, when they come in, they see only two possibilities. I use drugs and I'm miserable. I don't use drugs and I'm miserable. What we have to teach them is there is a third way in which you don't use drugs or you use an extreme moderation and you're not miserable. The way to get there is to abstain for long enough to reset reward pathways, return to homeostasis and then decide what your next steps are. So we recommend four weeks. And we warn people they're going to feel worse before they feel better. We recommend self binding strategies. So what is self binding strategies? That's an acknowledgement that willpower is a limited resource and that if we're relying alone on willpower, we will not be successful. Therefore, we have to create literal and metacognitive barriers between ourselves and our Drug of choice so that we can leverage our willpower and meet our goal of abstention for four weeks. General categories. These are just some general categories. You can make up any categories, but space is a category. So this is both literal barriers between ourselves and our drug of choice. Get the sugar out of the house, get the alcohol out of the house, throw your bong away, run water over your cigarettes and put them in a garbage can far away so you can't go fishing them out again. Delete the app. Unsubscribe yourself from that sports betting website. These are the literal kinds of. You just create that little pause, right? That little pause that allows us to kind of take a breath and say, okay, I don't want to do this. And if there's a little bit of a break, maybe I'll be more successful. Time is a really interesting kind of self binding strategy. So the dopamine and fast itself is really a form of using time as a self binding strategy. But also later, after the dopamine fast, we talk about, well, what do you want to do now? Do you want to continue to abstain or do you want to go back to using in moderation? The vast majority of our patients want to go back to using in moderation. And even if I think they're not a good candidate for that, they often have to learn that for themselves. This is like a PhD, their own little PhD in neuroscience. So what we say is, okay, that's your goal. What is moderation going to look like? And here we really drill down on details. When are you going to use, how much, how often, who are you going to use with? What are going to be your red flags for when you're using more than you said you were going to use or in a way you didn't want to. So part of that could be scheduling specific times for scrolling meaning. So this is really, I think, very helpful looking at sort of what's the larger meaning behind my wanting to abstain. When people report feeling better, which most of them do after the dopamine fast, we have them do a pros and cons list. What was better about not using and what was bad about not using. When people talk about what was better, they'll talk about things like, I was more present in my life, less anxious, less depressed, better able to sleep, able to pay attention. The top of the list of what was bad about not using, couldn't hang out with my friends because all my friends use whatever that drug may be. Right? Number two, was bored, really bored, had a whole bunch of time that I didn't know what to do with. Boredom is a really powerful and scary emotion and we really in the modern world don't have to deal with it very much and we don't really know what to do with it because boredom brings up all kinds of existential issues like, wow, if I don't know what I'm doing with myself right now, what am I supposed to be doing? I'm betting that many people in this room don't deal with a lot of boredom because you guys are way too busy. But I bet also that boredom would be pretty scary to deal with and people is a great way to engage in self binding. So, you know, having doing the dopamine fast with somebody else, doing it together as a family, engaging in a 12 step community or other mutual help community. When we co regulate our behaviors with other people, we are much more likely to be successful. Whereas if we live alone and we have to manage these consumptive behaviors alone and super hard. And then finally there are a lot of interesting medications. Not a lot, but I would say there are more coming down the pike. So for example, we have a medication called naltrexone, which is an opioid receptor blocker that we use to help people quit using opioids. The mechanism there is obvious. If you're blocking the opioid receptor, the opioid that you're ingesting cannot bind and stimulate that receptor. But we also use naltrexone to treat alcohol use disorder. And not just for people who want to stop drinking, also for people who want to reduce their use. Because it turns out that the chemical cascade for alcohol, it works on the gaba, or inhibitory neurotransmitter system, but it also works on our endogenous opioid system. So when we're blocking the opioid receptor with naltrexone, basically what my patients tell me is when I'm on naltrexone and I drink a beer, I really don't want another one. I'm kind of good with one, whereas normally I would want to drink the whole six pack. Also, interestingly, remember that reminder mechanism, how when we're reminded of our drug of choice, we get a little boost in dopamine. Naltrexone actually helps decrease craving because probably when people are reminded or triggered, they don't get that same dopamine boost because the chemical cascade is blocked by the naltrexone, so they don't get triggered in the same way too. We have other Medicines wegovy or Ozempic is being used now to treat binge eating and obesity. And we're also finding that it's helpful for alcohol use disorder. Alcohol, because it's caloric, works on the same appetitive mechanisms as food. This is a really old but very powerful study. This was a cohort of adult males who met criteria for major depressive episode and also alcohol use disorder or alcohol addiction. They were put into a psych unit where they received no treatment for their depression, but they also did not have any access to alcohol for four weeks. At the end of those four weeks, 80% of those individuals no longer met criteria for major depression. So what's very powerful there is again, just by intervening around the consumptive addictive behaviors, symptoms of depression and anxiety get better. Finally, this pleasure pain balance works both ways. Those gremlins are agnostic to whatever the initial stimulus is. If we press on the pleasure side of the balance, they hop on the pain side of the balance. If we press on the pain side of the balance, they will actually hop over onto the pleasure side of the balance, and we will get dopamine indirectly by paying for it up front. The classic and evidence based examples of this are exercise, ice cold water bath, fasting, meditation, and prayer. I put on here. You wouldn't necessarily think of meditation and prayer as doing what's painful, but for most people it's effortful. And anything that requires a kind of sustained and effortful engagement tends to be difficult. And when we do that, and we know that all of these things increase dopamine, but the way that they do it is different from the way that intoxicants do it. So remember intoxicants, you get that burst of dopamine followed by dopamine free fall. Here you get something very different. You get the initiation of the activity with a slow increase in dopamine over the latter half of that activity. And then that dotted line represents when the activity stops. And you see here, dopamine levels remain elevated for hours afterwards before going back down to the baseline position. You never go into that dopamine deficit state that drives the craving. So this is a wonderful way to get your dopamine. However, it's not without its own pitfalls. So anything that gives us dopamine has the potential to be addictive. Most personality types will not be drawn to the kinds of addiction to pain. But I'm guessing that a disproportionate number of people in this room probably have the personality type that could get addicted to pain. And you see that with workaholism or exercise addiction. Addiction and the intervention really is the same where we ask for people to take a break from that activity or the exercise or whatever it might be for a period of time to reset reward pathways and then a plan for re engagement. I also forgot to say that when we think about addictions that it's not possible to completely eliminate. Like a food addiction, you can't just stop eating for four weeks, or a workaholism addiction, you know, you can't just stop running your business for four weeks. What we ask people to do is think of a bullseye and to really drill down what is the specific activity that's problematic, what is the specific food that's problematic, and put that in the center of their bull's eye and have that represent their drug of choice, the thing that they're going to abstain from. So for work, it might be a certain way of engaging with digital media after. After hours or. I don't know, you guys could probably tell me better. For food, it's something like sugar, right? Giving up sugar. Then that second ring of the bullseye represents the trigger behaviors. So these are things that are not the drug itself, but the thing that trigger us to use our drugs. So it might be something like going by a bakery where there's a lot of sweets. And then that outer circle is the things that are healthy sources of dopamine, things we want to do more of, kind of approach behaviors. These are. Oh, sorry. Hormesis is a branch of science that is interested in looking at the ways that exposing ourselves to mild to moderate doses of toxic stimuli actually makes us more resilient. Hormesis is Greek for to set in motion. And basically what's happening is when we expose our bodies to mild to moderate doses of noxious stimuli, our body senses injury and then essentially upregulates feel good neurotransmitters like serotonin, norepinephrine. These are examples of activities that my patients have told me are hermetic for them. You'll see many of them are quite ordinary activities, but they're doing them unplugged. We are living in a time when we're constantly stimulated. So simply sitting quietly and not being stimulated for a period of time gives our brains time to rest and recover. I've talked a little bit about dealing with boredom and other painful emotions and also slightly mentioned getting addicted to pain. Believe it or not, we used to think that rats on a running wheel just simply measured locomotion or physical activity. But then it became apparent that certain strains of rats will actually get addicted to running wheels. And they will run on ever strains smaller running wheels until their little rats or their little tails are curved up in the shape of a running wheel. Some of those rats will in fact run to death. And then I love this experiment that was done in the Netherlands. They took running wheels and they put them in nature and they said, surely in, you know, God's great wonderful nature, nothing's going to go into a running wheel. Not true. Rats, slugs, squirrels, all kinds of animals were intrigued by moving through three dimensional space against gravity in a novel way which maybe explains roller coasters and Ferris wheels and things like that. Finally, this is my last slide. I've really emphasized sort of what we can do at an individual level to cope with our drugified addictogenic ecosystem. But it's obviously not just an individual problem. This is also a problem that needs to be solved at both the community level, the level of governance. This is a meme somebody sent me. Are you 18? Because otherwise you can't go into this porn site. And as you can see, it's pretty easy to access. So. And we're now seeing legislation that's happening in certain states that makes it, for example, harder for people under the age of 21 or under the age of 18 to access certain sites. I think this is really important. We need to have these guardrails. When I think about community, I really think about schools. You know, we were really led to believe that one child, one laptop would solve all of our education problems. Now what we have is one child, one inattentive child who's not learning. So I think that smartphones should essentially be banned from the top down during school hours. There are schools that are doing this now and there are different ways to accomplish it. For example, there are these pouches. Kids put their phone in the pouch, they lock the pouch, it can't transmit or receive, and then they unlock it at the end of the day. That way the school doesn't have to deal with holding onto the phones. Whatever it takes. Let's get the smartphones out of the schools so teachers can teach and kids can learn. Yeah, especially like K through 12. I mean, it's just so obvious that we need to do that. And then in terms of governance, I mean, so we're seeing, you know, the Facebook meta lawsuit. We'll see if that goes anywhere. There's legislation all over the country. In China, the government actually said that kids can't play video games except for two days A week, two hours a day. And that the corporations that make the video games are responsible for creating the facial recognition software to police it. And I know that that could never happen in the United States, but boy, parents in China were jumping for joy when they came up with that. And I really do think that we need some kind of government legislation and guardrail to protect our kids.

Hey, I hope you're enjoying this video. And I want to let you know that I have a new book that's come out and if you'd like to get it absolutely free, there's a link below in the description. Or you can wait till the end of this video or you can Simply go to joe'sfreebook.com and you can get a copy there.

Hey, Dr. Lemke, thank you so much. My name is Dr. Angel Acosta and I'm experiencing a dopamine rush as I'm experiencing this, this wonderful event and hearing your talk.

So that's great.

I was thinking about, you mentioned the role of scarcity in kind of prompting and motivating and activating dopamine in our behavior. So I'm just kind of thinking about 100 years down the line when AI and maybe some of the cybernetic and robotic innovations that will come to be that will generate more abundance for us and the ways in which we might be more disoriented.

Yeah.

And, and so I'm just, just wanted to ask you in terms of what are beyond some of the strategies you laid out, what are some additional things we will probably need to do as to adapt to the abundance that may come? And then lastly, you mentioned neuro transmitters, and I was interested you talking a little bit about neuroreceptors in the role of addiction.

Okay, great. Yeah. So I really do think that addiction is the modern plague, that this is the number one problem or one of the main social problems we'll be dealing with for hundreds of years. And it's probably only going to get worse because part of the problem is that machines do so much of the work for us and do it so well that we don't really have all that much to do. And this is a real, I think, tragedy among young people in general that we see in clinical care is they, you know, they're told to find meaning and purpose, but there's really not much that they have to do. So it all feels a little bit made up. When I think about where to look for answers, I really see people in addiction, in recovery from severe addictions as modern day prophets for the rest of us, these are people who have had to, in order to survive, figure it out in a world that's conspiring against them. So they have a lot of wisdom and a lot of practical ideas that the rest of us can benefit from. And I guess I'm also hopeful that modern science will be able to come in and help us as well. It is amazing in clinical care when you see somebody who has done all the things right, they've done all the things to try to get appetitive control and then one day you give them a medicine. I mean, I'm not touting any one medicine or another, but like, just recently, you know, I've been struck by like WeGovy and just kind of the testimonials of like, I'm not, like, it's not a battle every day, I'm not craving every day. Of course there are problems with WeGovy and there's no FDA black box about intestinal blockage. And you know, some of you may remember Ramonabant, which was a cannabis receptor inhibitor that was going to help with people with binge eating and obesity and weight loss. And it was taken off the market because it caused severe morbid depression. So you know, it's like, it's very tough to try to tweak this particular system which is so evolutionarily conserved and so fundamental to survival and really in a lot of ways simple. Except that now we have, you know, a binge worthy environment. In terms of your second question, I wasn't quite sure what you were asking, so I talked about neurotransmitters. And you want to know about receptors, neuroreceptors. You mean like what we might do differently or what happens to them during addiction? What's that?

What happens to them?

Oh yeah. Thank you. So essentially this dopamine deficit state, so this pleasure, pain, balance, is an obvious oversimplification of a very complex chemical cascade. But neuroscientists use dopamine as kind of this common currency to measure these phenomena. And essentially what you're seeing in the dopamine deficit state is that the postsynaptic dopamine receptors, they involute or they downregulate. That's what is creating that dopamine deficit state, that the brain is trying to compensate for too much dopamine, trying to get back to homeostasis. It does that by down regulating dopamine transmission, both by endogenously making less dopamine, but also involuting those postsynaptic receptors. Also, when you think about innate vulnerability to addiction which we have. People come into this world with different degrees of vulnerability. Some of this is probably mediated by our dopamine receptors. People who are a priori low reward, meaning like low postsynaptic Dopamine receptors are people who are probably more prone to addiction because they need more to kind of have any feeling of joy at all.

That's what I was trying to say.

Exactly.

Yeah. Yeah. So first off, thank you for coming out here and sharing this. And how many of you have a much different perspective now on behavior and addiction and drive from listening to Ana? Yeah. So great news. Let me just go back to. You've already spoken about it, but again, define what addiction is.

Yeah, I always forget to do that. So addiction is the continued compulsive use of a substance or behavior despite harm to self and or others. At the broadest level, there's no brain scan or blood test to diagnose addiction. We base it on phenomenology. These are patterns of behaviors that repeat themselves across cultures, time periods, human beings. We often. We use our DSM categories, 11 criteria, diagnostic criteria. But they can be briefly summarized as the three Cs. Control, Compulsion, and continued use despite consequences. So control is. I keep saying I'm going to cut back. I keep trying to cut back. I'm not able to. I keep saying I'm only going to use X amount of time or X number of drinks. And I keep using more. So control problems, compulsion. That means a lot of our mental real estate is occupied with the drug. When I got to get to romance novels, I couldn't really think about anything else. I just wanted to get to the end of my day and essentially, you know, use right be in that escape place. So a lot of mental real estate taken up with our drug of choice and then continued use despite consequences kind of speaks for itself. Except to say again that we don't necessarily see the consequences. Sometimes we're the last to see the consequences. For my own, I used to joke that I was addicted to romance novels, But I didn't really think I was addicted to romance novels. And it wasn't until I was interacting with a student around how to teach him to screen patients for problematic consumptive behaviors. And so I played the patient because we were one patient short. And I said, well, I have this reading habit. Late night reading habit interferes with my sleep and my performance. I'd like to stop it. But the next day I couldn't unsee it. It was like, oh, wow, I really do have that problem.

So yeah, well, so here's an interesting story. I won't mention the guy's name. He was a famous sex therapist in the 90s. He was on Oprah and best selling books and everything. And I had been going to 12 step meetings for sexual addiction. So sex addicts Anonymous, predominantly super brave.

Right? I mean that's like an addiction that's hard to talk about.

Yeah.

Yeah.

Thank you. Well, you know, it's interesting. The first time I actually talked about it was in one of these annual events and I think that was 2015, 2016, when we launched Artists for Addicts. And I'd never spoken publicly about it. You know, I talked about being a drug addict and whatnot. But I. The sexual addiction had so much shame attached to it. And you know, it took a lot of groups, a lot of therapy. It took before I finally got to the point to where I was like, you know what? I just. You're as sick as your secrets. I've heard that a lot. What does that really mean? And my life became far better and a lot of. I shed a lot of the compulsive cravings after I started talking about it. And that's one of the reasons why I do genius recovery. It's really helpful for my own recovery and were able to help other people. And I had been going through 12 step groups and some therapy and different things. And this very credentialized doctor said, sex addiction is bullshit. It's all made up. There's no such thing as sex addiction. And he was wrong. However, I wanted to believe that was right because there was a part of me that was, is fighting this, saying no, you know, I mean, you know, sex is, you know, and it was really interesting because it was Halloween and he said, oh, me and one of my girlfriends is going to go to a swingers club for Halloween. And he didn't even live. He lived in la, but he was coming down. I'm like, what? I go, aren't you married? He's like, yeah. And I go, does your wife know? Yeah, she has a boyfriend too. But I go, do you say this publicly? And it's a famous sex therapist? Well, if people ask, but not really. And he like. So that became the addict mind is always looking for alibis and rationalizations to go do their stuff. And I look back at that sort of thing because it threw me off, like. And I, it caused me to just discard a lot of the stuff I was doing because you have someone that validates it. So why am I bringing that up? We, you know you talked about a drugified nation, right? We. So the name of her book, which every one of you. I bought everyone a copy. It's called Dopamine Nation. This book is brilliant. We live in this culture where there's just so much temptation and continual things to reinforce it. And all these tech companies with their attention, engineers designing things to be very addictive and it's very hard to navigate. And addiction is real human suffering. I mean, getting sober from drugs was very difficult. I didn't go to treatment. I didn't have the money to do that. It was when I was 18 years old, I went and I lived in a trailer for six months with my father, a mobile home. And I was taking aspirin and Tylenol, like for almost six months straight, just pounding headaches until I finally got through the withdrawal stages and stuff. And that was miserable. It wasn't anything compared to the sexual addiction stuff, which is really hard to say. I wasn't consuming drugs, so I was damaging my body physically, but mentally, oh my God, it was just, it was so difficult. So I have this empathy for people that struggle with addiction, because if you've not been in that sort of craving state and people will say to me, isn't everyone addicted to something? And I don't think so. I mean, a lot of people don't wake up with this compulsive thing that makes their life unmanageable. But I've certainly have been there and I've seen the other side of it. And when an addict has gone through that hell and come out on the other side, I've seen people that were just on all levels kind of despicable that have become the most caring, loving, sweet, compassionate people. It's one of the reasons I resonate with RFK. RFK was a heroin addict for 14, 15 years after his father was assassinated. So he's been in recovery for 40 years, and he goes up to nine 12 step meetings a week now. And there's a lot that you learn in 40 years of recovery. You know, regardless of his political viewpoints, if you agree with him or not, there's something to that. And I'm going to ask him about that. So my, my, my question, having said all that, is when you're sitting with this deep shame and you don't ask for help because most people, and you help people all the time with struggle, with addiction, what are some of the steps that you help them to start coming to their own assistance, to start resourcing themselves, because they rarely, if ever, get out of that trap in isolation, they have to get some sort of help. What do you recommend they do?

Well, let me just say that shame is a huge obstacle to getting into recovery and also one of the great motivators for recovery. If we didn't feel shame about some of our behaviors, we would not be motivated to. To change them. But it has to be the right kind of shame, the right dose of shame. Because if it's just shame about the behaviors, about the addiction, that can drive more addiction and drive people into isolation. One of the things that I think is really de shaming in an important health propelling way is learning about the neuroscience and realizing, you know, the nature of the hijacked brain and how, yes, we may choose initial exposure, but once we get caught in that vortex, we've really lost in many ways our capacity to choose or to see clearly true cause and effect. Part of that dopamine fast intervention is also to get clarity on that. Right. Because patients will come in and, and just feel like either they're. They don't have a problem, it's not problematic in their lives, or it's actually helping them, it's their medicine. But if they stop for long enough in order to reset reward pathways, they can have a real aha moment. I see it happen all the time and Claire, like, wow, I really thought that X was helping medicate my depression, anxiety or whatever was. But I see now it was actually making worse. They see it. I don't need to see it for them, they can see it. So that's really important. And that's just understanding, you know, this homeostatic mechanism and how, again, how that. That driving loop. So I think, you know, working on all those levels, it's a biopsychosocial disease, makes sure we're intervening at the biological aspect, educating them about the biology, using medicine when necessary, psychological interventions, individual and group psychotherapy, and then the contextual piece. Right. That we're living in this incredibly addicted genic environment. If you're not addicted to something like God bless you because you're probably in the minority, it's this stage, right. It's really hard. It's really hard nowadays.

Yeah. So I've got a whole bunch of questions, but I don't have enough time, so I'm thinking through which ones would be the most valuable. So in Dopamine Nation, you explore the balance between pleasure and pain in addiction. So for entrepreneurs, which is pretty much almost everyone in this room, what are the key signs that a healthy drive is tipping into addictive Behavior. And I mean, you kind of discussed.

Talked about it, but I think one of the things that. That comes up a lot in clinical care is my patients who work a lot and are very high functioning and they want to be healthier and get into recovery, but they don't want to change anything about their lives. Right. They want to keep working as much as they're working. But if you think back to this pleasure, pain, balance, what's not good for it is pressing really hard on one side or really hard on the other side. And what people who are hard driving people do is, is they work all day, so they're pressing on the pain side of balance, and then they party afterwards and they're pressing on the pleasure side of balance. And every time you go to these extremes, you're actually triggering your cortisol or your adrenaline response and you're making your brain do this work to restore homeostasis. So that if you really are struggling with a sort of, you know, a more significant compulsive behavioral problem, you probably need to pull back on the amount that you are working. Not anything anybody in this room wants to hear, but you really probably do need to do that in order to put your consumptive behaviors and your health center stage. Because as long as you're that hard driving, a lot of what drives that need for alcohol or cannabis or whatever it is, YouTube to relax at the end of the day is because we were driving so hard so long, more than we really could handle. So I guess for this audience in particular, I would just think about that.

Yeah. Okay. So you've been on Joe Rogan, which your interview's fantastic. Watch it. It's totally worth watching. Andrew Huberman, who's a friend of yours, and you've been on the Huberman.

I don't think the Joe Rogan interview is very good.

But anyway, I thought it was great. I mean, I've listened to a lot of your interviews and watched it. I think they're good. Well, part of it is you have really have to explain and communicate very scientific things to a broader audience. Audience and so.

But Joe was not really interested in hearing it, if you want to know the truth.

I mean, like, I think Joe's.

Because Joe's very pro cannabis, I mean.

Yeah, yeah, no, exactly. So I think he's high all the time.

Yeah.

Did he try to before you went?

He gave me some. Some pill beforehand, like, that I should take. No.

Okay. I think he tries to get everyone stuck.

He had. Had Covid two weeks before and he had A very beautiful nurse who was COVID Testing me, and then he wanted me to take a pill. And I'm like, no, Joe, I'm not. And the studio kind of smelled a little bit, you know, like, that aroma. And I don't know, it was just weird.

Yeah. Yeah. Well, look, it's helpful for getting your message out, I guess.

Yeah. I mean. Yeah, Joe's great.

Yeah. Yeah. The question, though, was you have very scientific stuff, and now you are communicating it to a much broader audience because it's, you know, it's complex to understand this, and I think you do a really good job. So how has that changed your approach to, you know, looking at all this? Because.

Yeah, so, I mean, I've learned a lot over the years about how to translate information for, like, the average person who doesn't isn't doing this all day long every day and is not immersed in the science. And I think Mark Young said it really well when he said that really many of us think in images and in pictures. So I'm always trying to find a visual metaphor to understand something and also not trying to explain too much. I think if we try to explain too much, we end up losing our message. So those are just some things that I've learned.

Yeah. So we've had several zoom conversations about your Dopamine Nation workbook.

Oh, yes. Yeah. Joe's been great about that. Yeah.

Yeah.

And I would like to. It's going to come out in May and covers a lot of things that could help everyone with dopamine fasting, with looking at what they're doing, and how could we start? When could we get a copy of all this for everyone to test it out? I would love to have. I think Genius network members would find what's in there really valuable, and I think it would be very useful for a lot of people's lives.

Yeah. Thanks. So the workbook was inspired by. It's a sort of an addendum to the book, meant to be more interactive, but also I wanted something that could be used by parents and teachers and counselors. I got a lot of requests for that. If you end up reading Dopamine Nation, what you'll see is that the first chapter is called My Masturbation Machine, and that wasn't going to work very well in, like, you know, elementary schools. So.

Yeah, you're going to love how the book starts out, by the way. Yeah.

So. So that was part of what inspired it. But I really wanted to be, like, for parents and families and counselors, it's supposed to come out in May. We'll see if we actually get it done by then.

Okay. Well, if you want to give a pre release version and just, like, test it, I mean, a lot of people are.

That'd be great. That'd be great.

How many of you would actually be interested in something like that? Okay.

Okay, great.

So how has researching and writing Dopamine Nation and talking about it influenced your personal life and habits?

Oh, my gosh. So many ways. I've probably learned more from my patients than I've given to them in advice. I've learned a whole lot in the book. I have a whole chapter on radical honesty, which is trying to go through a whole 24 hours telling the truth, which, it turns out, is really hard to do. The average adult tells one to two lies per day, and I'm no exception to that. But it's something I learned from my patients about how, like, really committing to truth telling just makes your life better and the people around you better, and also helps with compulsive overconsumption. And I sort of explore the ways that it probably stimulates the prefrontal cortex as much as transcranial magnetic stimulation might.

Okay, so when lying. When you say lying, are you talking about lying to others or lying to yourself, too?

Both, because usually they go hand in hand. You know, I think there really is a split brain phenomenon that happens when people get deep in their addiction. They essentially have a double life where it's like they know they're doing that activity, but because they're not articulating it to anybody else, and it's secret on some level, they really don't know. So it's both lying to yourself and lying to others. But what I mean by radical honesty, which I found really interesting, was when people get into their addiction, they're not just lying about their addictive behaviors, and they lie about everything. They lie about what they had for breakfast, where they were an hour ago, where they're going tomorrow, and it doesn't make any sense. It's essentially the lying habit. And when they get into recovery, they have to get into the truth telling habit. That means they can't tell any lies, even about stuff that seems irrelevant, because once they start lying about the little stuff, they'll start lying about the big stuff, and they'll relapse. And I've incorporated that in my life, or at least really tried to, especially as part of parenting. I've just found it by the way. I lie even more than my kids, but they call me out on it. So, I mean, I try not to lie. I really do try, but, you know, it's hard.

You just kind of look like a person that lies.

Yeah. A liar. Yeah.

Interesting.

Mainly it's the lies that we tell to cover up our own shortcomings or even, like. So it's lies of sort of omission. I do this really weird thing where I lie about things, like little stories about my day because I feel like I'm not interesting enough and my day isn't interesting enough. So I'll go home and I'll be like, I had to wait 20 minutes for that guy. It was like two minutes, but two minutes. I'm not going to get a lot of sympathy, and it's not interesting. So I lie about the quantity of time.

Yeah.

Does that make sense?

Okay, well, so, you know, so Chris Voss, who's a genius network member, I was asking him if he had ever done any undercover work when he was, you know, he was the top former international FBI hostage negotiator. And he said, only on the peripheral. I never. You know, there he goes. But I have a lot of, you know, friends and colleagues that have done undercover. And he said, it literally wrecks so many of them. And I'm like, why? He goes, well, because you're spending your entire day lying. And when you spend all day lying. And it's interesting because I've met quite a few actors, actresses, singers, performers that have a ton of addiction problems. And if you look at the 27 Club, from the singers from Jimi Hendrix to Kurt Cobain to Jim Morrison, Amy winehouse dying at 27 years old, a lot of. But it's interesting because you take an actor, their job is pretending to be someone that they're not, right? And then performers that have all of this attention. And so there's this interesting thing with energy and people that I know that have gotten quite famous. I've seen some people. It really changes them. And I've seen a lot of them adopt addictive behaviors. Drinking, smoking, workaholics, and this addiction to fame, this addiction to external validation. And it's very seductive. I mean, you know, who doesn't want people to like them and admire them and appreciate them? And so what would be maybe some suggestions that you have as precautions as people grow in fame and notoriety? Because a lot of people here, this room collectively has literally hundreds of millions of followers, you know.

Well, I have sort of weird views on this, which I'll try to describe briefly, but I basically see Shame as probably one of the oldest and most Primitive emotions, the function of which is to keep us together as tribes. And so we reflexively. I believe we reflexively feel shame when we distinguish ourselves as separate, even if it's in a positive direction. So I think that there's like a ton of dopamine that people get from being lauded and celebrated and being famous and performing. But there's also the comedown. And then I also think it comes with quite a bit of shame, which is really debilitating and toxic. And I guess I think one of the ways to use that in a positive direction, we have, like, this endemically narcissistic culture where we're all encouraged to pursue our individual fame and glory and, you know, feel like. Often feel like we're not enough compared to everything that other people are doing. But I always like to throw in there the reminder that, really, I think some of the most unhappy self loathing. This is speculative, obviously, on my part, based on my clinical experience, my life experience. But some of the people who really struggle the most are people who are isolated because they are famous or successful in some other way. And I do think that that's biologically reflexive. And so, you know, one of the things maybe not to chase for is fame and glory, because shame will come with it, and those two things go hand in hand. That's what I think.

No, totally. So I have my buddy Mark Tarbell, who won Iron Chef. Where is Mark? Mark's right there. And Mark is friends with Shep Gordon. He's good friends with Shep Gordon, which they made the movie Supermensch. He even has a cameo in that movie. And I remember, like, Shep offered Mark if he wanted to become a famous celebrity chef, because Shep Gordon pretty much invented the celebrity chef. And Mark, you know, having seen a lot what happens to. No, I don't really want to go down that path. And in the movie Supermensch that Mike Myers made about Shep Gordon, he says this line. He's like, I've never seen anything good come out of fame. People that rise the highest fall the hardest. And so me and Dean Jackson interviewed Shep on my I Love Marketing podcast. And I said that I was asking him about fame because he had never become famous. He had made other people famous until this movie was made about him. And now all of a sudden, he's, like, becoming famous and dealing with all of the crap that all of his clients have over the years. And I always found this one line from Janis Joplin really interesting. She said, I would go out and make love to 20,000 people. And then I would go back to my hotel room alone. And she died of an overdose. And he was Janis Joplin's manager, and he had never heard that line before. But we talk about it on there, and there's something about that, and I've seen it happen. So I sort of have this. There's part of me that, like, I want. I can see what you can do with fame and followers and everything. But there's another part of me, I'll tell you, most of my marketing colleagues and my business colleagues that started out once, some of them, when they get New York Times bestsellers, they start getting on TV shows, big podcasts. Some of them have just become the biggest assholes. And I'm like, were they already just assholes and the fame just did it or what? Caught. You know, it's weird.

Yeah. And I think you can still pursue excellence, but there always has to be that sense that we're just a vessel, and there has to be, you know, sort of greater meaning and purpose that's really not at all about us. And then you can stay grounded and aware that the whatever, the wealth and the fame, whatever it is, is sort of a meta phenomenon, but not the core phenomenon.

Yeah. So. All right. I mean, I wish we had another hour here, but we don't. What recommendations would you give for everyone here dealing with workaholism? I have to say this, too. So Phoenix, I think, is what, the fifth or sixth largest city in the United States. And I think currently there's one Workaholics Anonymous meeting on. I think it's Wednesday night in Scottsdale. I haven't been for a while because this is pre Covid in the fifth or sixth largest city in the United States. So workaholism. There's a book on workaholism. Is the subtitle the Respectable Addiction? Because you can, you know, the rewards are money and fame and accomplishment and all that. So there's, you know, strategic coaches, like AA for workaholics. And so there's, you know, Dan has the free days, focus days, and buffer days. Have you ever met Dan Solomon in Babs?

No, but he was mentioned many times.

These two sitting up right there.

Yeah, right there.

So they've coached many very successful entrepreneurs. And Dan, you know, teaches Take free days and.

Oh, great. That's great.

And I remember something Dan said years ago. He's like, you know, if it takes you more than 240 days a year to accomplish what you're trying to accomplish in your business, you're probably not a very good entrepreneur, you know, which is a good way to smack someone in the face with like, I love work. I work seven days a week. And you hear that stuff all the time. And so what advice would you give for the dopamine pursuing? I mean, you've already shared some things, you've kind of explained it, but anything that you haven't talked about or that you would say, here's a good thing to start looking at and doing and adopting into your life. Because frankly, I mean, I want everyone here to be a better entrepreneur. I want them to enjoy their lives. I want them to accomplish. Accomplish what they want to accomplish, and not at the cost of their health, their happiness, their relationships. And I think you have a lot of answers to that.

Well, I think there have been great messages all day along those lines, sort of how to maintain that balance. Keep some perspective. Yeah, I think maybe keeping perspective is the most important thing. Balancing that commitment to your company and that, you know, that child that you're. That that is your company and that's so important to you, that you've grown and built, but also recognizing that the kinds of skills that you bring to being a successful entrepreneur are not necessarily the same skills that will make you a successful parent or spouse. And so wanting to, you know, having to make sure that you're not just. Just trying to will the rest of your life in the same way that you can will your company into being that there are time and space when you have to let all of that go.

Yeah. What do you think AI is going to do to dopamine?

You know, I don't. I'm not that. I mean, I don't think AI is all that, you know, I don't know. I mean, it just seems like a sort of a more sophisticated version of what we're already doing. The output is only as good as the inputs that are going into it. I'm not one of these people who thinks that AI is going to take over the world. And like Elon Musk, like, no, I mean, it's a tool. I mean, we can use it for good and we can use it for bad. And mostly we'll probably just spend a lot of time using it for nothing at all but just spending a lot of time there. I don't know. I mean, it's been said many times today, it's like, like it's all about the people and it's all about relationships. When I'm fasting, I'm not exposed to, you know, business people, a lot in this type of meeting. But, you know, at the end of the day, it's all, it really is all about relationships, you know, and, and I don't, I really mean it like, like who's, you know, why do people want to be. Have a successful business? Because they want to help other people. They want to create jobs. They want to be valued members of their community. Yeah. They want to drive the coolest car and have the. Maybe that's part of it too. Which is also about status and comparing yourself to people in a hierarchy. It's all about people connecting to people. And so I think if people can just keep that in mind, you know, no matter what, like, what kind of person do I want to be vis a vis these other people? That's just probably a good guiding light.

Gotcha. So I think one of the biggest entrepreneurial problems is just burnout. Yeah, total burnout. So any recommendations for addressing.

Yeah, fasting from work. Dopamine, Fast from work. Taking a break.

Well, so when I took a one year sabbatical in 2021 that, you know, it took. The truth is it took. It was 2013 when I had David Bok give a 10 minute talk at a Genius network annual event on him taking a one year sabbatical because he had just was utterly burnt out. And he ended up, and he was financially successful. He had a ton of demands, you know, multiple New York Times bestsellers. You know, he was on Oprah numerous times. I mean, back then when, you know, the Oprah show was a big deal. And so he, you know, I'd heard about it and then here I was in strategic coach since 1997 and realizing that, you know, I don't take many free days and I try and I never would have taken any had I not gone to Strategic Coach. And I was like, I really got to, you know, I mean, at what point I don't want to be one of these entrepreneurs that just one day I'm going to do this and this. You never do. And so I did. I took a one year. It was one of the greatest things I ever did. And I did it in the middle of a pandemic. And so it wasn't like, let's go to vacation because it was weird. I had all this time to read and watch things that I wouldn't have had the time before because it would have been consumed with work. Which is also led up to one of the reasons why I'm interviewing Bobby tomorrow, because I think the level of propaganda and deception that has been bestowed upon Humanity from dopamine seeking freaks is off the charts. And so in the midst of taking the sabbatical, I had to get myself to be able to cut off things that I never thought I could do. And it made me realize everyone's capable of doing incredible things if a. They give themselves permission, as simple as that sounds, if they build support around it. Because I could not have done it without my team. I could have not have done it without my genius network members. I mean, there were the people in this room, ran the group that I usually ran, and it worked and it still continued. I mean, Susan here, she did like an amazing job at the 100k meeting. She brought the former prime minister of Canada. Not the lousy one we have right now, but you know. Yeah, yeah. So we. As if I live in the country, but yeah, so Stephen Harper. So basically it is really hard to, you know, let's go back to the just say no Nancy Reagan days. Just say no. The addict brain doesn't say no. And if you just say no to that, it's like, you know, come on. I mean, it's. So my question to you is how. Does one need to set up in order to have the environment and the conditions? Because you have the intellectual knowledge documented, you lay that out. What would give everyone here the highest chances of success in order to do dopamine fasting and set it up that you could recommend before we wrap up.

Oh, gosh. Okay, so let's almost be done though, because I think folks are getting hungry, don't you think?

What's that?

Don't you think folks are hungry?

Yeah, yeah, we're trying to dopamine fast. We're doing it real fast right now.

Okay. All right. So I mean, I think we need to. You need to prepare for it, right? You, first of all, you have to like gather the data and really look honestly at what you're using, how much and how often, and write it down. So just the simple facts that can be really helpful because again, the awareness can leave us. Then I think it's good to think about, why am I doing that behavior? What do I get out of it? Usually we want to escape ourselves, escape our feelings, self medicate something that, you know, there are a gazillion reasons, but usually it's to have fun or solve a problem. Then you want to write down what are the problems associated with it. And you know, these are problems that we may or may not recognize what other people tell us. And then you want to set a quit date for stopping for four Weeks. And I just really can't emphasize enough that two weeks is not enough. Two weeks is just enough to kind of feel the withdrawal, but not get to the place where you actually get the benefits from dopamine fasting. Four weeks is not a cure for your recovery, and some people definitely need to do it a lot longer. But four weeks, in my clinical experience, no matter what the drug is and no matter how severe the addiction is enough time to begin to feel, feel better and also to have some abatement of the cravings, which is really a turning point for people when they realize, oh, it's not like the less I do this thing, the less I'm thinking about, the less that I want to do it. Then you do the dopamine fast. Hopefully you're able to make it for the four weeks again, doing it if someone else is helpful. And then at the end of that time, you write a pros and cons list. What was good about it, what was bad about it? And then you decide what. What do you want to do next? Do you want to continue to fast from that substance or behavior, or do you want to go back to using? If you decide you want to go back to using, as most people do, make a very detailed plan for how much you'll use, how often, in what circumstances, and what will be your red flags. Now, for alcohol, we have good evidence for what is moderate drinking. We don't have that for any other substance or behavior. I cannot tell you how much social media or pornography or video games is too much. I cannot even tell you how much cannabis is too much, or cocaine or heroin or whatever your drug of choice. We don't have data for that. But usually you want to avoid daily use. You want to leave enough time in between for the gremlins to hop off the pain side of the balance and for homeostasis to be restored. And you want to avoid binge use, so you want to avoid using very large amounts of very potent intoxicants so that you're completely, you know, out of it for a period of time. You're looking for moderation, a supple balance, gremlins that are able to hop on and hop off quickly. And that's essentially it. And it's just a circular learning process. Then you go out in the world with your plan. You see how it goes. Many of us will experience what we call the abstinence violation effect. That happened to me. I abstained for a month from romance novels. I thought, I'm good to go. I binged all weekend long, barely slept and went to work bleary eyed on Monday. That happens to my patients all the time. Right. I'm just gonna have one drink. I had way more than that. Abstinence violation effect. So. And this is an argument sometimes against trying to restrict for that period of time because sometimes feels as it just drives the binge and yes and no. I really do think that if you abstain for long enough to really reset reward pathways, even if your long term goal is moderation, you will be much more successful if you have reset reward pathways. So then I abstained for a year and now I actually don't even like romance novels. But that's just me. Everybody's different. Some people it's a lifelong, you know, battle, but it's just sort of this iterative process.

That was really useful.

Okay, thank you.

Yeah. So. And I will say she, hopefully I'm allowed to say this, but I'll just say it anyway. You can smack me. You had food poisoning day before yesterday.

Yes.

She flew from Brazil. She literally was sick and she still said, no, I really want to be there. And she came here, which is awesome. And you, I can't thank you enough because that is a big deal.

So worth it. You guys were great.

So thank you. Thank you. Okay. I hope you found that video awesome and useful. So if you want to get a free copy of my book, I want you to click here. And if you want to watch some more videos that will be useful and awesome, click here. Go ahead, you're over here. Do it now.

Come on.

Thank you.

Watch them.