Addiction & Flourishing: Why Our Addiction to Pleasure is Making Us Unhappy

Hi, it's Joshua with the Flow Research Collective radio production team. Today we have a special episode featuring two of our coaches, Dr. Jonathan Beale and Dr. Nick Holton. Enjoy.

There are many reasons why people might be vulnerable to addiction, but at the end of the day, we're all vulnerable in the sense that we all have the same kind of motivational reward circuitry that makes us instinctively approach pleasure and avoid pain. And Once we find our drug of choice and that reward circuitry gets hijacked, we're in the physiology of addiction that is indifferent to what might have made us reach for that drug in the first place. What does it take to do the impossible? What does it take to level up your game like never before?

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Hi, Anna, how you doing?

Good, good.

Such a pleasure to meet you.

Honor to meet you. Thank you for joining us today, Anna.

This is a real treat for us. Yeah, we appreciate you taking the time. We're sure you're very, very busy, so it's incredibly kind of you.

Thank you for inviting me. I'm excited to be here.

Great, great. Yeah, it's our pleasure. So, uh, congratulations on the immense success of Dopamine Nation, one of the many projects I think that you've had your hands and expertise in. Um, I've read it I think twice at this point. I recommend it constantly. I recently just had a client who's a screenwriter in LA read it, struggles with distraction, especially with the phone. And not only did he tell me how much he loved it, but he just talked about how uniquely human it is, the stories that you tell, not only about your patients, but the stories you tell about yourself as well. So you just— it's this really beautifully woven, I think, balance between really hard, thoughtful science, right? But just sort of the human experience as well. So congrats on that.

Thank you.

I want to start there. I once interviewed Lydia Denworth, who's written a really great book on kind of the biology of friendship. And when I was chatting with her, she just talked about, you know, committing to writing a book is a pretty serious, significant commitment, right? Can oftentimes take years, right? Now, you're an expert in a lot of what you've written about in Dopamine Nation, but ultimately you're an expert, I think, in a lot of things. You probably could have written a lot of different books. Why'd you choose this one?

I think this is the most pressing problem of our time. I am very worried for younger people growing up in this world. Um, I feel like I've had a front seat as a psychiatrist, and especially as a psychiatrist who treats addiction, on the growing problem of addiction in the modern world. Not just for people who are sort of innately vulnerable to that problem, but really for all of us because of the ways in which the modern world has drug-ified almost all human experience. So I wrote it, you know, for my kids, for my kids' friends, for the world to come, um, really wanting to be thoughtful about how to navigate you know, an environment that is just begging all of us to get addicted, um, in every waking moment and really hunting us down, um, for that purpose. And I've learned so much from my patients. As you know, I hold up my patients in recovery from severe addictions as modern-day prophets for the rest of us. And so I've learned a lot from them, have incorporated in my own life to good effect, and wanted to share that with others.

Yeah, yeah. Would you say— just curious as a follow-up— would you say that most people— I don't know if there's any clear data on this— but do most people on some level struggle with— I don't know, maybe not the technical definition of addiction, right, the clinical definition, but maybe addictive behaviors? And this, you probably kind of slide on a spectrum here, but you think this is something that most people wrestle with on some level?

Yes, I do now. So I used to think that I personally was immune to the problem of addiction because growing up alcohol and drugs literally had no effect on me. Even caffeine doesn't wake me up. So I thought, gee, I guess, you know, that gene skipped me. And then midlife, you know, as I write about in the book, I became quite seriously addicted to romance novels, which of course people laugh, you know, it is sort of funny. Twilight was my gateway drug. Like my Kindle was my hypodermic syringe. But truthfully, it got to a point where it was interfering with my life and my relationships and my happiness. And that was really a eureka moment for me in the sense that I realized, oh, it's not that I was immune to addiction, it's that I hadn't yet discovered my drug of choice. And had I lived 100 years ago, I never would've discovered my drug of choice. But the world we live in now has such a quantity and variety of drugs, including drugs that didn't exist before, that now we're really all vulnerable to this problem.

Will you just explain a little more when you say drugs? I think we all know what you're talking about, but why don't you just kind of— I think you're using it a little more generally than many people might, which I think is important and useful in this context, but explain by what might be included when you say drugs.

Yeah, so I mean anything that we ingest or any behavior that we use that affects our dopamine reward pathways in this way that makes us vulnerable to compulsive overconsumption, which can ultimately lead to the problem of addiction. How do we define addiction? Addiction, you know, is defined in a number of different ways, but the sort of fundamental definition of addiction is the continued compulsive use of a substance or a behavior despite harm to self and/or others. And one of the main messages in the book is that there is some serious physiology or brain science behind this phenomenon. I mean, there are many reasons why people might be vulnerable to addiction, but at the end of the day, we're all vulnerable in the sense that we all have the same kind of motivational reward circuitry that makes us instinctively approach pleasure and avoid pain. And once we find our drug of choice and that reward circuitry gets hijacked, we're in the physiology of addiction that is indifferent to what might have made us reach for that drug in the first place.

So yeah, the phrase, I guess the phrase drug of choice is useful here as the extension of the concept of drug, right? And it's not, yeah, and you said something you ingest, but also behavior. So it can literally be anything a human being does. That results in these compulsive obsessive behaviors that stimulate dopamine, that give dopamine rewards?

Absolutely. Yes, absolutely. And to give examples, you know, it could be cannabis and alcohol and cocaine and opioids. And it can also be video games and pornography and compulsive masturbation and shopping and sugar and social media. And romance novels. So the list goes on and on.

Yeah, great, thank you. So as you know, this is a podcast about human flourishing, and I mean, there's a kind of a— there's been a growing movement for some time that, you know, well, this is nothing new, that the aim of life is happiness and what pathways that— that's, that's nothing new, that goes back, you know, centuries. And we've interviewed some for this podcast, you know, that have emphasized the importance of, you know, taking into account things like negative emotions in our life. Your work kind of sheds light on kind of maybe a slightly different take on one of the problems with happiness as, you know, a way of defining a good life, because one way of defining that might be just to receive lots and lots of dopamine rewards because you might feel, you know, really happy about that. So how do you define happiness and how do you define human flourishing, more importantly, in relation to your research on this work?

Oh, wow, you just— you got right to the heart of it.

Yeah, we're getting out here.

We're going for it. Yeah, I was going to say that's impressive. Yeah, I mean, I think, you know, I have searched lifelong to try to figure out the answer to that question, and I don't claim to have discovered it. But what I think I can say with confidence about the times that we live in now is that our conception of what makes for happiness or the good life has been adulterated by our consumeristic seeking of pleasure. And pleasure is certainly not happiness. In fact, what we've learned from the neuroscience of addiction that has really blossomed in the last 50 to 100 years is that the relentless pursuit of pleasure for its own sake actually leads to the inability to experience pleasure. And this is the great paradox and the great irony, but something that is very, very pressing for our times because of the incredible access we have to pleasure for its own sake. That is to say, you know, the ways in which, again, various behaviors that we would— that we have for thousands of years associated with human flourishing, like making intimate human connections, has now become adulterated by the technology and our having cracked the code on motivational reward systems such that now what can appear on the face of it as about human connection can really be just a drug. And of course, you know, social media comes to mind here, and this is not to vilify all forms of social media, but the point is just that, um, you know, we have to be much clearer about really what is happiness and the good life and what is pleasure and how those two things can really be at odds with one another.

Well, you just hit the nail on the head, almost the exact quote about the paradox we were going to read off to you. So we're going to come back to that. I didn't necessarily hear an answer there. So I'm curious. You said you've got a lifelong search. Just how do you feel? If you think about it on a— I don't know. Do you think about it on a biological level, a physiological level? Do you think about it on a psychological level? Maybe all of those. When you talk about the good life, generally what seems to be in place in your experience? Like, can people be suffering from addiction and be flourishing? Can they be suffering from addiction and be happy, right? What are some of the, I don't know, the prerequisites in your opinion?

Yeah, right. So, wow, that's a great question. Okay, so to sort of try to, you're right, I didn't really quite answer the question. And let me see if I can get back to it. A little bit. So I guess I would say that I've been thinking a lot about Sisyphus lately. And I don't know exactly why this particular metaphor has come to mind. But of course, you know, I'm not— I'm no Greek scholar.

Will you share the metaphor? Because our audience might not know it. But I know where you're going with this.

Hopefully, hopefully, I'll get it right. But you know, Sisyphus, and I remember learning about Sisyphus as a young person and just thinking to myself, Wow, that guy really got life wrong. And, you know, and what Sisyphus had to do every day was he had to roll this huge boulder up a hill only to have that boulder fall back down again. And then every day he would have to start over again. And I remember learning about that as a young, you know, sort of, you know, sort of the starting of my life and thinking, oh God, that, you know, poor schmuck. Like he, he really doesn't— he, he got like the worst kind of life, right, where his efforts led to nothing. Now, and maybe it's because I'm middle-aged, and so maybe this is just something that middle age brings, but now I think, oh no, we are all Sisyphus. Like, that, that's— that is, that is all of our lives. We're pushing a boulder up against gravity and then we have to deal with it rolling down again. Mm-hmm. And that's all of us. But here's the thing, if we can be Sisyphus and still find meaning and purpose in rolling that boulder up every day, then we've really figured it out.

And the thought that occurred to me as you were laying this out, I don't know if you meant it this way or not, you can tell me, but occurred to me that every time you roll that boulder up, let's say you get it to the top of the hill, it seems to me that there's your quote unquote extension of the metaphor, the quote unquote dopamine reward. The ball rolls back down, AKA neuroadaptation, and you start over again. Right? So I hear a couple of things. I hear like some synergy with some of the messages from the book, and maybe that's our entry point to come back to the paradox that you mentioned, the pleasure pain balance, right? Adaptation, baseline levels, all those things. I want to hit all those things. But I also just on a real simple level heard what I, what I hear a lot, which is it's often about the journey, not the destination, because you're going to adapt to the destination. You might get satisfaction from the destination, but it ain't going to last. So you better enjoy the ride. That was, that was kind of my immediate takeaway.

Yeah, I mean, I agree with you that I think that's right. That's what, that's what I'm thinking. But I think I would take it even a little bit further and and say the apparent futility of our lives is not futile if we deeply— if we're deeply present, and also if we trust that there is some greater meaning here and that we're participating in something much larger than ourselves. And that, that's really— that's a kind of a trust, really, because there's ultimately no proof of that. Yeah.

Well, we— what was it, last week, John? Two weeks ago, we chatted with Emily Esfahani-Smith, author of The Power of Meaning. So we dug into that, actually.

Yeah.

Yeah. I mean, I really want to dig deep on this.

John's a philosopher, so you just created an intellectual itch for him. Yeah.

I have to be careful not to just spend the rest of this interview chatting about this. But we really should, because this is absolutely fascinating. On a number of levels. So, I mean, on the first level, it seems that— if I understand this kind of analogy correctly with Sisyphus— is that we've got ourselves into this position rather than we are just in this position, you know, and we can't get out of it, which is one interesting take on this, right? So, you know, for example, I mean, one way which your thought experiment here resonates philosophically is with, you know, the work of Albert Camus, who has his book The Myth of Sisyphus, where, you know, it's a right— it's a piece of existentialist literature on the absurdity of life and how we can try and find meaning in a life which, you know, he thinks analogous to Sisyphus's plight in Hades. Um, but so, but in your analogy, it seems that human beings have got themselves into this analogous situation in life, and it's quite a pessimistic view of our predicament now. Life is like this It's just repeated struggle. I was trying to see how exactly it's analogous to our addiction to dopamine. It struck me that for this to— I thought one way you might go with this is that we're pushing the boulder up the hill and rolling it down, but every time we need a bigger fix, a bigger hit from dopamine. So it's like, I don't know, as our muscles get stronger as we keep pushing the boulder, we need a bigger boulder to push, right? We need to push it a bit faster and run after it quicker. We're not getting enough out of this quite meaningless behavior, which might be analogous to scrolling or some other addictive behavior that perhaps we're, unbeknownst to us, bored of doing. So I guess, yeah, there's so many questions I want to ask you. So I guess one thing is, should we not be trying to get ourselves out of this Sisyphus-style predicament? And how might we do that? And that's going to get to the broader question of how we battle our dopamine addiction, a number of questions Nick and I would like to ask you. But is it the case that you think that we weren't in this Sisyphus-style predicament in life and that's what our dopamine addiction has brought us to? Or are you seeing this more as a wider analogy with human flourishing in general that dopamine addiction is kind of just exacerbated?

Yeah. Oh, gosh, good questions. I mean, I would say that the way that I was really conceptualizing this analogy which is related to, you know, my thoughts that I write about in Dopamine Nation, is more along the lines of that we have created a world now in which we really don't need to do anything in order to survive. I mean, of course, that's not true for many people. That's not true for people living in certain countries. Obviously, people living in, you know, war-torn Ukraine are facing a very different type of scenario. But for modern people, you know, living in the modern world, it is very difficult now to find a sense of true meaning and purpose because, you know, our basic survival needs are all met. And so I think I was thinking of the metaphor not so negatively, but just sort of like, given that, like, given that reality that we, we, we do in fact need to find meaning and purpose somehow.

Survival, you used to be the boulder?

Well, you didn't even have time to think about it, right?

Yeah, right.

You just had to push. Yeah.

Yeah. And so, so, you know, whether we're drawing that meaning out of ourselves or looking to something higher than ourselves or a greater power to draw that meaning, you know, the point is that Even with, I mean, we have these lives now that are very circumscribed, right? And many, if not most of us have these little routines that like really, like we don't have to do them, right? But we do them and they're like, we're devoted to them. And they're like this, you know? And so there's a way in which we can be devoted to this cycle that I think is potentially healthy and another way in which we can be devoted to our little project, whatever it may be, which is potentially very destructive.

Let's, let's go with that, that notion of cycle here for a second. Thank you for those answers. That was helpful and fun to kind of chew on. And I don't know that you necessarily describe it as a cycle, but in the book you really talk about this, this teeter-totter effect. Right. Um, the idea that what goes up must come down. Will you just start with sort of the basic fundamentals of what you describe as the pleasure-pain balance? We'll get to anhedonia, we'll get to the paradox, but you just kind of set this up mechanistically for our listeners.

Sure. So to me, one of the most important findings in neuroscience in the past 50 to 100 years is that the same parts of the brain that process pleasure also process pain. So those are co-located and they work like opposite sides of a balance. So if you imagine that in your brain, in that special part of your brain called the reward circuit, there's like a teeter-totter, you know, in a kid's playground, a beam on a central fulcrum. And when that teeter-totter, that balance, is at rest, it's level with the ground. When we do something pleasurable, it tilts one way, and when we do something painful or have an experience of pain, it tilts the opposite way. One of the overarching rules governing this balance, which we have now discovered through very interesting neuroscientific methods, whether in animals or humans, is that that balance wants to stay level. And with any deviation from neutrality, our brains are going to work very hard to restore a level balance, or what neuroscientists call homeostasis. So let's take, for example, if I eat a piece of chocolate— I really like chocolate— My balance tips to the side of pleasure. I get a little release of dopamine, our reward neurotransmitter, in my reward circuit in the brain, and yay, I feel good. But no sooner has that happened than I get these little neuroadaptation gremlins hopping on the pain side of my balance to bring it level again. But the gremlins like it on the balance, so they don't hop off as soon as I've achieved homeostasis. They stay on until I've tipped an equal and opposite amount to the side of pain. And that's that moment of wanting one more piece of chocolate, or the comedown, or the aftereffect, or the hangover. Now, if I—

can I ask about this real quick? Yes, this is super interesting because just yesterday I was listening— I'm a big fan of your colleague Andrew Huberman and his podcast— just yesterday I was listening to the episode on sugar.

Yes.

And sugar cravings. And I'm going to forget the exact details of this, you know, the mechanism behind this. I'm just a psychologist. But essentially, I think he described something similar where when you have that whatever the sugar is, right? Sucrose, fructose, that you get, I think, kind of an immediate satisfaction. But that satisfaction really only lasts, he said, I think somewhere around 15 minutes or so. Is that a similar sort of mechanism that you're describing here? Like, we got our satisfaction, now it's tipping back the other way and kind of saying, hey, you want more of this thing to bring me back into balance?

Yes, that's exactly it. And people can definitely get addicted to sugar. It's a potent releaser of dopamine. And again, the key here is that with sugar or any other reward, rewarding substance or behavior, you get a release of dopamine, but your brain is going to immediately respond to those increased levels of dopamine by downregulating endogenous dopamine production and dopamine receptors, not just to baseline level but below baseline level before going back to baseline, which is homeostasis. And again, if you imagine that as you've got a pleasure-pain balance, you get a release of dopamine, it tips the side of pleasure, the gremlins hop on the pain side, and they tip you to the side of pain. That's the comedown, the dopamine deficit state, that moment of wanting to get out of that uncomfortable state by reaching for another bit of sugar or whatever it is.

Right.

But if you wait, right, the gremlins hop off and homeostasis is restored. So the key point here is that the way that the brain restores a level balance is first by tipping an equal and opposite amount to whatever the initial stimulus was. It doesn't just go back to baseline after a deviation. It goes from the deviation to the initial pleasurable experience, to pain, wanting more of that pleasurable experience, to a level balance.

And is this proportionate? Generally, whatever the spike is, you're going to see an equal comedown?

That is what the experiments show, that typically it's proportional. It can be qualitatively. What's interesting is it's qualitatively, potentially not exactly the opposite of whatever the initial stimulus is, but it's broadly speaking a reinforcing or positive experience, followed by a negative or aversive experience.

Okay. Okay.

And how does the— well, can I just ask, how does the baseline over time shift with those spikes and downward— well, inversions of the spike? So will the baseline generally with more and more dopamine stimulation over time go down? Now I'm thinking of baseline here as general state of mind, general mood. Or is there a way in which it goes up? Or does it generally— does homeostasis kind of always restore it to roughly the same baseline?

Right. So now you're getting to the key of what happens in the brain as people become addicted, that essentially once those gremlins have been formed in response to, you know, a rewarding stimulus, they might hop off the balance, but they never entirely go away. And they like it on the balance, so they're waiting in the wings to hop on again. So that means with repeated exposure to the same or similar reinforcing stimulus, those gremlins start to multiply. And over time, you start to get more and more gremlins hopping on the pain side of the balance, which means that with repeated exposure, that initial deviation to the side of pleasure gets weaker and shorter in duration, and that after-response to pain gets stronger and longer in duration. So eventually you end up with enough gremlins on the pain side of the balance to fill this whole room. They're camped out there. They're not going anywhere. And that's when we've changed our hedonic or joy set point. So when people, when people become addicted, what's essentially happened is they're walking around with a pleasure-pain balance tilted to the side of pain, right? So that means when they need— that means first of all, they need more and more to get the same effect, right? Not to feel good, but just to feel normal and level the balance. And when they're not using, they're walking around with a balance tilted to the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability, insomnia, depression, and intrusive thoughts of wanting to use.

So to push the, the Sisyphus analogy a bit further on this and just map that out as a useful way, it's as if kind of Sisyphus has to push the boulder higher each time to get the same stimulation that he felt before, but also has to watch it go even further down the hill and then go and pick it up for, you know, and his kind of baseline mood in doing this goes even further down. So he needs that further stimulation to go up. Is that one way of stretching this?

Yeah, that works.

That, that works. That works well.

And I think the mechanism you just— and you referenced this earlier, right? But we, we, we— you said it quickly, we glossed over it a little bit. I want to just kind of reiterate the exact quote from the book because I think we really want to hammer home this point. So I'll read it word for word. You're right. The paradox is that hedonism, the pursuit of pleasure for its own sake, actually can lead to anhedonia, the ability to enjoy pleasure of any kind.

That's right. That's right.

So this is the primary pathway to addiction, right? Or is it an outcome of addiction? Are we talking chicken and egg here a little bit, or is there a causal direction?

I think it gets to be a cycle of what we call negative reinforcement, right? Where we generally think in popular culture that people who become addicted are hedonists and they're just relentlessly pursuing pleasure. But what very quickly happens in the brain as these neuroadaptation gremlins accumulate on the pain side of the balance and put them in a dopamine deficit state is that They are compulsively driven to seek out their drug, not to feel good, but to stop feeling bad and level that balance.

So it's in that moment, right, on the comedown, when we're kind of feeling bad, as I understand it, that a lot of us— and I'm guilty of this, I think most humans are guilty of this on some level— in that comedown, during that moment, is usually where we actually kind of respond by trying to go for more pleasure. And what we act, you know, tip that teeter-totter back over to the other direction. As I understand it, what we really need to be doing is sort of endure that comedown, right? And sort of resensitize or desensitize ourselves a little bit. We talk a little bit about in that moment what might be some good things for us to practice.

Yeah, I mean, I think so, just the awareness of what's going on in our brains at that moment when, for example, we finish a really good Netflix episode and then the little next episode button comes up and it's like, all we can do not to press that next episode button. Is it that we really want to watch another episode, or is it that we're experiencing dopamine freefall? We've got gremlins on the pain side of our balance, and we're just trying to restore a baseline homeostasis. I think that's a really important frame or awareness. I had a reader who emailed me and said, the balance and gremlins analogy really has helped me quit smoking because every time I have a craving for cigarettes, I just imagine the gremlins wildly hopping up and down on the pain side of my balance. And I'm like, those nasty gremlins, I'm going to beat them. And I'm going to wait long enough for them to hop off and for that craving to pass. And so I think that that's kind of that framework, you know, I think can be, you know, really, really helpful. And then more importantly, taking it one step further, you know, in addition to thinking about what we can do when we're in the dopamine deficit state is to acknowledge that the continual consumption of these highly reinforcing drugs and behaviors creates the dopamine deficit state in the first place, such that we might actually want to avoid these pleasures because of the enormously high price that we have to pay for them.

Just because it feels good doesn't mean it is good.

Well, it's not just that it doesn't mean it is, but it's that just because it feels good in the moment, doesn't mean it's going to feel good down the road. And that the cumulative effect on your feeling is that you will feel, in fact, bad.

Right. So it's not something like delayed gratification. It's more than that. It's long-term thinking of this enjoyment now isn't at the cost of greater enjoyment later. It's that this enjoyment now may in fact lead to me feeling worse later.

This is really the key, John. This is really the key that I want to communicate to people. It's not just that, oh, you know, I'm kind of depleting my dopamine source such that this thing isn't going to be as fun next time around. It's that, wow, doing this thing puts me in a dopamine deficit state such that I will actually be anxious depressed, not able to sleep, um, and all kinds of other dysphoric types of experiences. I see so many people coming into my practice now who are seeking help for depression, anxiety, thoughts of wanting to die, not being able to sleep, not being able to concentrate. 20 years ago, the first thing I would have done for most of these individuals was prescribe them an antidepressant. Today, the first thing I do is I say, what are you consuming? How much? How often? Such that what can we assume you've done to your baseline dopamine firing? Such that the first thing that we need to do to intervene is actually have you stop using your drug of choice for long enough for those neuroadaptation gremlins to hop off so that you can restore baseline homeostasis. After almost 10+ years of doing this as a first-line intervention, I am really convinced that the leading cause of unhappiness in the modern world today is that we have way too much dopamine. That to compensate for this firehose of dopamine, our brains have had to physiologically readjust and put us in a dopamine deficit state akin to a depression in order to try wildly to restore homeostasis.

Pardon the interruption, and thanks for tuning in to Flow Research Collective Radio. If you're listening to this, here's a bold bet I'm willing to make about you. My guess is even though you're a high performer, you're still only performing at about half of your capacity, maybe even 10%. Now, even if I'm wrong, assuming that you're performing at less than your full potential, opens up the possibility for you to improve. And that's good news when you've already outperformed most of your peers by a long shot. You've got a skill stack that people envy. That's why you earn what you earn. And yet you're just warming up. You know those days when you knock out more in your morning than most do in an entire day? Well, what if you could perform at that level every day, reliably, consistently? What would that unlock for you? Now, here at the Flow Research Collective, we study the human nervous system when it's functioning at its absolute best. After training thousands of high performers from Navy SEALs to Fortune 100 executives, here's what we've found: you're evolutionary hardwired to perform at your best. All it takes is pressing the right mental buttons and pulling the right biological levers, so to speak. It's about getting your neurobiology to work for you instead of against you. Now, if you want to make operating at a 10 out of 10 level as natural as breathing, just go to getmoreflow.com. We'll show you how to reliably trigger a flow state where you feel limitless and you do your very best work. This won't require any biohacking or nootropics or gadgets or caffeine guzzling. This higher gear is endogenous, which means it's a state that your brain produces on its own. No external stimulus is required. Just go to getmoreflow.com to learn how to get your biology working for you instead of against you so you can make peak performance second nature.

All the best.

Wow.

Now there's some Some stark warnings, I think, for listeners here. Let's go further. I mean, Nick, I know you'd like to explore something here further.

For context here, John and I do some coaching together for an organization called the Flow Research Collective, right? So we try to help people understand how to shift into states of hyperfocus, the flow state even, right? As kind of an extreme of that. And so you can't have those conversations without talking about dopamine specifically, right? Along with a host of other neurochemicals. One of the things that's come up, I think, is this idea of dopamine fasting or dopamine detoxing. Now, you write about it in the book, I think, from the standpoint of addiction, and I want to hear about that. I'd love for you to tell our listeners about that relationship, but that might also lead us into conversations about distraction more generally, right? And I definitely want to make sure we get into some of the how-to pieces, like what happens when we talk about dopamine fasting or detoxing, or the correct vernacular, and what's happening on a mechanistic level. So can we— and I don't expect to throw all those questions out to you at once, we'll stack them a little bit— but can we start here? What do we mean by dopamine fasting or dopamine detoxing, and why is that a useful exercise for the average person to engage in?

Great. So let me, let me answer this by, by telling you what I've learned from patients over the years. So my practice 20 years ago was focused on helping people primarily with drug and alcohol addiction. And in that context, you know, there's— people don't really question that they should stop their drugs and the alcohol that they're addicted to. It's sort of a given, right, that, gee, you know, this has taken over my life and I need to stop. And what I learned again and again, which was just so fascinating to observe experientially was that when people were able to get into sustained recovery, um, which is to say abstain from their drug of choice, they experienced flourishing, right? They experienced a palpable improvement in their mood, in their levels of anxiety, in their sleep, in their ability to concentrate, in their ability to be present, in their cognitive abilities, in their ability to live according to their goals and values. It became very obvious to me that this would be the most important intervention and that would take patients a lot further than what I could do with psychotherapy or antidepressants or anxiolytics. That just by changing their brain chemistry, which is to say abstaining for long enough for the neuroadaptation gremlins to hop off the pain side of the balance and for dopamine homeostasis to be restored, these patients were in many ways reborn. It didn't mean that their life was easy. Addiction is a chronic relapsing and remitting disorder. Craving, all of that, it's difficult. And of course, then you have to live with the emotions that you are distracting yourself. I mean, it's very complicated. But the fit— the power of that physiology is just so incredibly overwhelming that it then became a place where I then began with patients who were not coming in for addiction, but who were coming in for other things— depression, anxiety, feelings of alienation, feelings of disconnection, chronic body pain, right? And it's not to be like overly reductionistic, but when you're dealing with a physiology that's that powerful, and that involves not giving your patient a drug, but actually having them remove drugs such that their own brains and physiology can upregulate the hormones and neurotransmitters that are good for them. And seeing that work again and again and again, I mean, I just became powerfully convinced of that intervention. And so when you ask, you know, is it helpful for the average person Who's not addicted, you know, doesn't meet DSM criteria. I mean, I, yes. I mean, this is, I really, and I became convinced that actually, again, the problem with our lives is not that they're too hard. Our lives are too easy. We are not wired for this easy life. We are wired for striving, for friction, to walk tens of kilometers a day to get a drink of water and a handful of berries. Our brains are not evolved for the world that we live in now. And the consumption of all of these ready-made kind of distractors and pleasers and comforters is making us sick. And I really believe that.

I mean, this is bringing us on to what you say about abstinence and a kind of asceticism. And what you said there, you used the word kind of flourishing as a way that you described some people had seen— you'd seen people kind of in a different way after they'd had therapy, um, in response to their dopamine addiction. You said, you know, they, they did seem to be flourishing more because they'd been freed to a degree, at least, of the, these addictions. Um, moving from dopamine fasting as a kind of a temporary measure that someone might try out to get over there or remove themselves from their addiction to a kind of more permanent way of living and hence to flourish more broadly. I was quite taken by your argument in Dopamine Nation that we need to embrace abstinence, as you just said there, and a kind of asceticism as a new way of life. And to bring in some of the technical terms you speak about, because thanks to neuroplasticity, homeostasis will be restored after enough of a break from dopamine such that it becomes your kind of your way of life, your way of being. So could you describe the kind of form of abstinence and asceticism you have in mind as a full way of life rather than just a kind of a dopamine fast?

Yeah. I mean, I think, first of all, it takes a major cultural reframe because we have this notion in modern life that pain is bad and that we should avoid pain at all costs and that if we're experiencing pain, something's wrong with our brains, or something's wrong with our spouse, or something's wrong with our job. What I'm asking people to do is to really befriend pain. This is not like a brand new idea, but what I'm trying to say is that there's extra urgency around it because in ways large and small, we are insulated from pain and we're inundating ourselves with pleasure. The idea is to abstain from that thing that you reach for when you're in distress, to tolerate, you know, the discomfort, in fact, to turn toward it and immerse yourself in it and embrace it and tolerate it and, and be curious about it. And then potentially to go even one step further and to intentionally do things that are physically and emotionally painful. And why is that? Because those neuroadaptation gremlins are agnostic to which side of the balance gets tilted first. If we do something pleasurable, they are very happy to hop on the pain side. But if we do something painful, they're happy to hop on the pleasure side. And ultimately, by doing things that are hard, what we do is we tell our bodies, oh, there's an injury here. It's time to start to make more of our own dopamine. Right. And we see that in lots and lots of science. This is the science of hormesis. Hormesis is Greek for to set in motion. And essentially it's all about how by using mild to moderate noxious stimuli on purpose, we can increase our resilience. And the way that we do that is by upregulating dopamine. So for example, if you look at studies in humans who immerse themselves in ice cold water baths, what you see is a gradual increase over the course of that ice cold water immersion in dopamine levels. Which are then sustained for hours afterwards before coming back down to baseline. Same thing with exercise, right? And so essentially, if you compare and contrast that with an intoxicant, what you get with an intoxicant, you get a sudden spike in dopamine, then you get dopamine freefall below baseline levels. That's that withdrawal, the dysphoria, the anxiety, the dopamine deficit state. And then you go back to baseline. But with painful stimuli, you never have to do that because you're paying for your dopamine upfront, right? You're doing the hard thing first. You're intentionally inviting that into your lives. And then you get a very nice reward. And the reason that's important is because we are creatures of desire. We cannot expect ourselves to just never, you know, reach for dopamine. That's not— we're strivers. We want to reach for dopamine, but how can we do it in ways that are healthy and adaptive? And I think the ways that we can do it that are healthy and adaptive are by doing things that are hard and creating that friction that then allows us to get that dopamine rush indirectly, which will make it less vulnerable to the problem of, uh, tolerance, dependence, withdrawal, and addiction. Not totally invulnerable, but less, less vulnerable.

So I'd love to go that route for a second and just stick on the how-to. So the cold exposure is a great example, really wonderful science around that. We mentioned your colleague Andrew Huberman, right? Just released another episode on it, I think this week. Have you had a chance to read Paul Bloom's new book?

I read about it. I've read about it. I've heard it's great, but I haven't had a chance to read it yet.

It's great. And John mentioned we chatted with Todd Kashdan. You know, when I think about the psychology of, uh, well, I think what you're describing. So I was curious if you had read it, because I'm wondering if you just described the mechanism that we see as sort of, you know, from psychological experience, which is basically chosen suffering, if you will. Key point here: chosen, right? In many cases can be— and this goes back to Sisyphus— can be a very meaningful experience, and through that can be a, I guess, in effect, a pleasurable experience, right? Or a positive experience, if you will.

Yeah. And I love how you brought Sisyphus in because when I think of Sisyphus, I'm really trying to reframe a myth that, that is supposed to exemplify futility into something that we could actually reframe as very positive, right? Sisyphus chooses every day. I mean, yeah, granted he's in Hades, so maybe he doesn't choose it, but we're kind of living in Hades now. So he just says, okay, I'm going to make the best of pushing this boulder up and I'm going to make it work for me. And so that's exactly what we need to do every day we wake up.

So will you tell us more how? Like cold exposure, great. What else might be on the list? Simple, tangible that people could do almost any space, any time.

So I've gotten lots of emails from readers who talk about martial arts, all different forms of martial arts that also reframe pain and really embrace pain and think of pain as something positive. It doesn't just have to be a physical type of painful stimulus. It can also be something that's emotionally difficult or challenging or cognitively difficult or challenging. I'm sure you all talk about that all the time in your flow work, right? Where you do this kind of, you know, mental immersion into this space that's importantly very immersive, free of distractions, but also effortful. Like, there are moments— I mean, it's so funny, we talk about alerts and all these things that interrupt us now, but what I experience personally is my mind is always wanting to interrupt itself, right? So I'll be doing something and I'll be like, well, I could really check my email now. I could do that, I could do that, but that will really distract me. So sitting with that feeling and then Allowing myself to not do that and then to continue to move forward with the task, the immersive. That's very effortful.

It's difficult. Like you said, right? I'm so glad you're bringing us to this bridge. Because so first of all, part of what we teach with Flow Research Collective, our executive director, Stephen Kotler, uses this language. First step to get into flow is struggle. Yeah, you have to engage in something. He has this great line: flow happens when you say yes to the fight. I love that line, right? Yeah, you got to rise to the occasion, you got to push the boulder, right? All the things involved with that. But in the meantime, right, when you're in that struggle and it's unpleasant, if you can't endure that, if you can't navigate that, right, what's going to creep in and pull you away? Distraction. And saying, this is easier, this is more pleasant, this is more fun, come engage with me. And so this is why I think your work is so important. Addiction and distraction and focus and these other things that can— John talks about all the time, right? Attention being one of our most precious resources.

Yeah. And I think one of the things that we have to really emphasize here is that I see a lot of people who are convinced that this experience of distraction is unique to them. And that it's a form of psychopathology and that their brains uniquely do this to them. And what I try to say is, um, no, you know, like, that's the human experience. I deal with that too. Yeah, we're all— and I, I'll never forget, I had a patient came and she said, I think I have ADHD. I said, tell me, tell me why you think that. She said, well, whenever I have to do something hard, like, you know, I find it a real struggle. I said, well, can you give me something else? She's like, for example, 'When I'm washing the dishes, I find I really don't want to wash the dishes.' And I thought to myself, 'Mm-hmm.' 'And when I'm folding the laundry, I really don't want to fold the laundry.' Mm-hmm. And you know, by the end of her list, I was like, 'I guess we all have ADHD.' And you know, and again, it's not to suggest that this frontal lobe phenomenon that we have come to call ADHD doesn't exist. I'm not saying that. There's no doubt that people have differing capacities in their ability to focus and sustain that focus. But what's happened today is that people think that like their little brain thing is like some unique bizarro phenomenon. For example, I remember when I saw Elon Musk on Joe Rogan and Elon said, you know, I constantly have thoughts all the time. They're going on and on. I can't stop them. And you could tell by the way he said it that he thought that his brain was— I just felt like, where's the speed dial to Elon? It's like, Elon, that's the human condition. Yeah, I mean, yeah, you're richer than the rest of us, but I don't think your brain is all that different. I'm sorry.

I'm so glad, Anna, that you spoke about emotional and cognitive pain or endurance as something really key as a practical step because When you're outlining this in response to the question I asked about the kind of the life of abstinence you recommend and asceticism and kind of endurance, I couldn't help but primarily think of physical endurance. And that seems to be one where people are doing a lot of these things you recommended, where there's a huge fitness industry, physical fitness industry right now. And a lot of things are in fashion which you know, people find difficult to do, like cold water swimming, ice baths, taking cold showers. The physical side of things seems to be one where people are taking the kind of advice you're offering in this book, and martial arts, and so on. But it's more the emotional and cognitive that's more difficult. It's interesting you said that kind of effortful cognitive effort is something maybe we don't like to do, but it has benefits. I mean, you know, research in the science of learning shows that when learning is effortful, we get longer-term gains. Learning gets embedded in our long-term memories more. But I mean, if— can we just go a bit further on this? What kind of advice do you have for kind of emotional endurance then? Because I think that's going to get us more to the core of one of the problems with flourishing and happiness and the obsession that people have nowadays with happiness.

Or pleasure-based happiness specifically.

It's, you know, the ask is for— a kind of patient acceptance, you know, which is very counterculture, right? Because we also want to have agency and be in control and be like acting on these feelings one way or another. And I mean, I have that too. And, you know, that's why I do my daily, you know, exercise, right? Because I'm going to cash in on my dopamine that's going to help me maintain some kind of equilibrium through the rest of my day. What's much, much harder for me. And again, I always like to come back to concrete examples. But what's frankly much, much harder for me is just to go to bed every night. And to— I actually have quite a bit of anxiety. Yeah, I have a lot of anxiety right around my bedtime. Because I both want to be asleep and I know that the transition into sleep will be painful for me. Why is it painful? Well, in part because that's when I used to use my drug of choice, um, you know, which is romance novels and something else which you can guess, in order to put myself to sleep. And now I don't do that anymore. So essentially I am practicing abstinence which is a wonderful opportunity to practice tolerating psychological distress. Because it's really, it's not the action of doing something, it's actually the action of not doing something. It's restraint. And so I have to lie in bed. And I mean, it's pretty much every freaking night. I lie there and I, you know, feel anxiety as I wait for sleep to come. And I just have to patiently endure that and trust that I will pass into sleep, which I eventually do. But I could also very easily reach for my drug of choice again or take a sleeping pill, which would work great initially but would eventually stop working because of the process of neuroadaptation. And then I'd have a new problem because then I'd be physiologically dependent on Ambien or Xanax or Ativan. Plus it wouldn't work anymore. So then I would need more. So, you know, it's, so it's that just kind of tolerating it and also importantly normalizing it. Like, so I hope that by my sharing my really kind of, you know, slightly embarrassing journey into sleep, Hopefully that resonates with other people who have a similarly embarrassing peak anxiety before bed. And just like, you're not alone, folks. Like, this is our lives, right?

It's very human. That's what I mentioned earlier, right? It's very human story.

Plus I'm having hot flashes and that's really uncomfortable. There's a lot more going on.

Yeah, yeah, hard to patiently endure that, right? Or patiently accept that sometimes.

Yeah.

It seems from some of the points you're taking here, it seems to me that one problem that perhaps your research points to is a modern obsession with productivity. You mentioned earlier how, yeah, you could be talking to someone and then in your head pops, hey, I should check my emails now. And when you said that, I was like, yeah, this happens to me all the time. I'm like, why? Why would I do that? Part of me wants to think I get a dopamine reward from it, but also And this, you know, it could be this as well, or perhaps this is what I get the dopamine reward from, is an obsession with I should be productive all the time, right? And there is an obsession with productivity widespread nowadays, right?

Yes.

But this connects with a question I want to ask, which is that, you know, sometimes research suggests that we get dopamine rewards from accomplishing things such as ticking things off a to-do list, right? And that seems like a healthy dopamine rewards. You know, it's often recommended, you know, make a to-do list, tick the things off, makes you feel good. Make your bed first thing in the morning, start the day in a good way, makes you feel good. Um, and the question I originally wanted to ask was, you know, are there kind of healthy dopamine rewards like this? And does this absence you're recommending— and dopamine fasting involves abstaining from practices that release dopamine that are clearly good for our lives, such as ticking items off your to-do list— but now And the way this has taken a different form now is I'm wondering if that kind of obsession with productivity is rooted in the same kind of thing. You get this dopamine fix from it. So my question there is, is there a connection, do you think, in your research between dopamine addiction and productivity? Is one of the reasons perhaps we're obsessed with productivity, or maybe the reason, that we're getting these dopamine rewards from it? And so Does the life of abstinence involve also in itself a kind of— and the life you're recommending— a movement away from this obsession with productivity?

Yes. OK, so this is really good because basically, the messaging in Dopamine Nation is, hey, we're pressing way too hard and too often on the pleasure side. We're resetting our balance to the side of pain. We're unhappy because of it. One of the things you can do to try to restore homeostasis better, faster, and also get your dopamine fix is press on the pain side, which includes to-do lists and all of the, those, you know, effortful things that we do for work or whatever, you know, it is, which are true and real and a source of dopamine and make us feel good and are reinforcing. We also probably tied to making money or getting social, you know, affirmation and all of that stuff. And that's what I argue for in Dopamine Nation. And I believe that to be true. But, but obviously, we can and do take all of that too far. And our world is created for us to take it too far. So, you know, we have drugified work, right? We have made it more potent, We have made it like a 24/7 thing. There's no endpoint to it. It never ends. There's no stopping point. We've made it more potent. I don't know about you, but I get charts every week that tell me whether or not I've met my billing quota here seeing patients. When I'm below, I'm unhappy. When I go above my billing quota, it's like, yeah, a little hit of dopamine. Even in the world of effortful engagement, whether it's physical or mental, whether it's work, you know, we've created, we've turned that into something that is ripe for addiction as well. So then where does that leave us? You know, what are the healthy sources of dopamine? And, you know, I think what it means is that whether you're pressing on the pleasure side or the pain side, You have to be very mindful of turning that into a drug. How does it turn into a drug? It's too much or it's too often. The deviation one way or another is too strong. And that whether your drug is a pleasure or something that's an effortful, painful thing like work, you know, you need to take a step back from it. Right? And you need to lay off of it. And you need to allow yourself to tolerate the withdrawal from it and to restore kind of that, that balance that I think we all know when we're there and we feel it. Now, COVID was a really interesting sort of social experiment on a grand scale. Because for many people, you know, it was it was a huge step back from work and productivity that was imposed by the environment, which was for so many, although, you know, obviously a hard time for many people, but for what's, you know, not as freely discussed was what an incredible relief it was for so many, right? That the sort of the rat race of productivity stopped for a while. And you didn't have to feel the same fear of missing out because everybody had to slow down. And so this slower life that we all led then, you know, I think a lot of us felt a relief, you know, and like kind of a, an ability to just catch our breaths and feel more centered and to connect with things that are sort of restorative without getting us into the chasing dopamine, you know, kind of compulsion. That is exactly what we need to avoid. I would also say that this phenomenon of like, you're talking to somebody, and then you think about checking your email, which happens to me, you know, all the time.

Yeah.

So that's playing out on a couple of different levels. On one level, it's yes, the dopamine hit of something in the email that might be either really good or really bad because dopamine responds to aversive stimuli too, like a fire that we need to put out or just wanting to get to the zero inbox, right? Like the Sisyphus goal of the zero, the zero, I'm gonna keep calling it zero inbox, right? Which is elusive, right? We never get to the zero inbox. So, So that's playing out and is related to opening, but on another really interesting level, it's also like a defense against investing in the relationship with the person that we're talking to. It's easier to slide out than to say, okay, how can I make this conversation like actually meaningful and interesting? So this is where we get into the thing where it's not It's both the avoidance distractions, you know, that, that result from thinking of our drug of choice, but it's also avoidance more generally.

Yeah.

Like our fear of truly engaging deeply in the moment. There's— we have a great deal of fear around that and, and, and what we might be risking in doing that.

Right. Closely connected. You kind of referenced it earlier, but to procrastination, I think, which is, I understand it on a, on a sort of neurobiological level is basically like the presence of unpleasantness, right. And the avoidance of it on a conscious or maybe even subconscious level. Right.

Yeah. Yeah. Yeah. I think procrastination, there's a lot of what I see in my patients is there's also a lot of perfectionism that comes into play with procrastination and that, that fear of if I can't do it perfectly, I'm not going to do it at all, or I can't even begin. And so for that, I think it has to be kind of an embracing doing it imperfectly or doing it even badly and being okay with that.

Yeah.

Fantastic. Well, we want to respect your time, Anna. We've already been talking for a very long time and we know you're extremely busy, so— And you nailed it.

So much good stuff already. This is really great.

Thank you. Yeah, it's been very immersive talking to both of you.

Would you mind if we asked you our final question today?

Yes, please.

Okay. So we have this signature question we like to ask all of our guests. We call it the flourishing question. It's very simple. It's practical. What's the one lesson on flourishing that you'd like our listeners to walk away with? And what might be a practical step for putting that lesson into action?

All right. Well, the one lesson I will leave you with is if you find yourself in a moment of feeling anxious or low or unhappy, and you of course instinctually want to reach for something to relieve that feeling, what I suggest you try as an experiment is to do something opposite of that and do something really hard in that moment that you really don't want to do. To see whether or not by embracing something that's either physically or mentally very challenging for you, you can, through the theory of emotional relativity, find yourself feeling better afterward.

Love it. Wow. It's really excellent. That's great. That's great. So that's Einstein's—

that's Einstein's theory, by the way. Einstein's theory of emotional relativity.

Noted. Appropriately cited. So, uh, this is— this was a real pleasure. Um, Dr. Anna Lembke, your most recent book, Dopamine Nation: Finding Balance in an Age of Indulgence. Uh, this has been a real treat. I'm a huge fan of yours. I know John is too. We're really looking forward to this. Thank you for the time. This is really wonderful.

Yeah, thank you. It was a real joy for me.

Good, good. Thanks so much. So, uh, where can people find you, interact with you? Social media, Stanford website? How can How can people get in touch?

So I'm not on social media. Yeah, I, you know, I wouldn't be able to handle it, I think.

Abstinence.

Yeah. Yes, that's right. But, you know, folks can find out more about my work at annalempke.com.

Okay, great. Excellent. Anna, thank you so much. Really appreciate it and look forward to hopefully keeping in touch.

Yeah, that would be great. I'd love to hear, you know, how this whole venture goes for all of you and also, you know, hear more about your work going forward. Thank you for your thoughtfulness. Yeah.

Hey, it's Joshua here with the production team. According to the World Health Organization, poor worker mental health will cost the global economy $1 trillion this year. And without intervention, 122 billion workers working days or 500 million years of work will be lost between now and 2030. Can you believe that? So our mission at the Flow Research Collective is to solve this problem by decoding the neurobiology of flow states and helping humans access peak performance on demand. And that's exactly what we do in our flagship program, Zero to Dangerous. Zero meaning you're distracted, you're on the brink of burnout, and you're rarely in flow. But when you become dangerous, you get into flow reliably ably, regularly, and surprise yourself with your new capacity. By working with hundreds of thousands of peak performers, we've perfected the 3 conditions for inevitable flow. So if you're interested in training with us, just go to getmoreflow.com. We'll free you to thrive in the face of pressing demands and endless distractions. That's getmoreflow.com. Thanks for your time, energy, and attention. All the best.

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