There's a great experiment where rats

were given a lever to press for cocaine

and after learning that it releases a

lot of dopamine, the rats will [music]

press that lever till exhaustion or

death, which is essentially the model of

addiction that we see in humans. But if

the cocaine is then removed, eventually

they won't press [music] the lever

anymore. Now, if that same rat after a

period of time is then exposed to a very

painful foot shock, the first thing the

rat will do is run over and start

pressing that lever again. And that's

really powerful because it shows that

when individuals are under extreme

stress, they are more vulnerable to

going back to compulsive overconumption

of our drug of choice because their

brain has already encoded using these

high dopamine rewards as a way to get

out of that pain.

>> Okay, so what do I need to do to make

sure that I can knock the bad habits and

add some new ones?

>> Here's what we do.

>> Dr. Anna Lumpy is chief of the Stanford

Addiction Clinic and a [music]

worldleading expert on the subject of

dopamine. And now she's returned to warn

us that addiction is the modern plague

and how we can rewire our brains to take

back control.

>> On average, it takes 4 weeks for people

to get out of constant state [music] of

craving. But here's the problem. Our

survival depends on figuring out how to

live in a world of abundance. For

example, we're now seeing the

drugification of human connection

through social media, dating apps, and

now artificial intelligence designed to

flatter, to validate. There's no

friction there. And so it's pulling us

away from the hard things that we need

to be doing in real life to cultivate

real life relationships. Just we cannot

go in that direction because in a world

of abundance, we are entertaining

ourselves to death.

>> Sounds like a good way to go.

>> It's really not because the relentless

pursuit of pleasure leads to anhidonia.

[music]

>> What's that mean?

>> The inability to take joy in anything at

all.

>> Teach me everything.

I see messages all the time in the

comments section that some of you didn't

realize you didn't subscribe. So, if you

could do me a favor and double check if

you're a subscriber to this channel,

that would be tremendously appreciated.

It's the simple, it's the free thing

that anybody that watches this show

frequently can do to help us here to

keep everything going in this show in

the trajectory it's on. So, please do

double check if you've subscribed and uh

thank you so much because in a strange

way, you are you're part of our history

and you're on this journey with us and I

appreciate you for that. So, yeah, thank

you, [music]

>> Dr. Anna Lemi, for anyone that might not

know you and they didn't watch our

conversation last time, which was a

fantastic conversation, one of my

favorites of all time, and also I know

Jack has said to me as well that it was

one of his favorites of all time. Who

are you and what have you spent your

career doing if you had to summarize it?

What are the reference points that your

wisdom draws upon and the experiences

you've had and the people you've worked

with?

>> I'm a psychiatrist. I did a residency in

psychiatry at Stanford University and

then I stayed on joined the faculty. I

see patients. I do research and I teach.

>> You wrote this um iconic book about this

word dopamine. Why does it matter so

much? Why does this this idea of

dopamine matter so much?

>> Dopamine is a chemical we make in our

brain. But I use it in the book as

really an extended metaphor for the ways

in which overabundance itself is a human

stressor. We are living in a time and

place where we have more access to

luxury goods, more disposable income,

more leisure time even for the poorest

of the poor ever before in recorded

history. And it turns out that is

stressful for our brains. And it's

stressful in a brand new way that we

really haven't confronted before, making

us all more vulnerable to the problem of

compulsive overconumption

and addiction. And I do think that

addiction is the modern plague. I think

we're going to be struggling with the

problem of compulsive over consumption

in a world of abundance for the

foreseeable future, as in centuries. and

our survival will depend on figuring out

how to live in a world of abundance.

Even though we have brains that evolved

for a world of scarcity,

>> at this time of the year, people are

thinking a lot about making changes in

their life. They want to get in shape.

They want to lose a couple of pounds.

They want to save their money. They want

to knock the addiction. They want to

stop the smoking, the

drugs, and the alcohol. So, as it

relates to the subject of dopamine,

how do these two things link our habits

and dopamine? What is the the link or

the connection there? Because I think

most people listening right now have

probably made a New Year's resolution,

even if it's just in their mind. And I'm

wondering how everything you write about

in dopamine nation is related to and

critical to understand if I am going to

shake some of these bad habits that I

have or pick up some new ones. The place

to start is to have self-compassion

because we are living in a world of

abundance where we have easy access to

all kinds of reinforcing substances and

behaviors and access itself is one of

the biggest risk factors for addiction.

So if you grow up in a neighborhood

where drugs are easily and readily

accessible, you're more likely to try

them and more likely to get addicted to

them. And what do addictive substances

and behaviors do to our brains? They

release a lot of dopamine all at once in

a dedicated part of the brain called the

reward pathway.

And the fact that they release so much

dopamine at once means that they're

highly salient and memorable

experiences. Right? So our brain really

encodes that experience deeply, that

experience of intense pleasure that was

self-administered

that I could potentially do again.

>> Why?

>> Okay. In a world of scarcity and

everpresent danger, which is the world

that we evolve for, we will naturally

reflexively approach pleasure and avoid

pain. And we must do so for our

survival. Why? So, if I have a cigarette

now, [sighs]

it's going to be a really memorable

experience from a brain perspective.

Why does my brain make it memorable? And

why would I want to then go do that

again from a survival perspective?

>> Okay, great question. So, let's first

distinguish what we call na natural

rewards. So, natural rewards are food,

clothing, shelter, finding a mate.

>> Yeah,

>> these are things we must obtain in order

to survive.

What addictive drugs and behaviors do is

they mimic those natural rewards by

exploiting our internal brain chemistry

to release a lot of dopamine all at

once, much more than we would get from

natural rewards existing in nature.

Amplifying that experience, making it

even more memorable, even more salient,

and also making our brain think, "Ah,

this is important for my survival. Uh

okay. So there's certain natural rewards

like eating which of course my body

wants to reward me for. So I eat again.

And these chemicals in front of me like

the cigarettes, the whiskey, the drugs,

those have been designed to hijack that

particular part of the brain and really

amplify the feeling so that my brain

kind of is tricked into thinking that it

was potentially a natural reward, but

it's actually a synthetic sort of

man-made chemical.

>> Exactly. And what we see in the

evolution of drugs over you know human

lifetimes but especially in the last 200

years is the application of science and

technology to take like the cocoa leaf

for example right that's been around

forever and essentially make it even

more potent even more uh available to

make it a faster delivery mechanism. So

we have this history of increasing

potency and availability over time. Said

more simply, drugs are getting even more

potent over time. So this vulnerability

to the hijacked brain is even more

common, including taking things that we

didn't even really think of as drugs and

turning them into drugs. So remember the

natural rewards, one of them is finding

a mate. Mhm.

>> And one of the ways our brains gets us

to do that is by making falling in love

and making intimacy and human connection

rewarding on a neurobiological level,

including releasing dopamine in our

reward pathway when we make uh those

kinds of social connections. My

colleague at Stanford, Rob Balanka, and

uh and his colleagues did an interesting

experiment where they were able to show

that oxytocin, our love hormone, binds

to dopamine releasing neurons in the

reward pathway and releases dopamine,

which is just one more link in the chain

showing us that falling love, human

connection is rewarding. It feels good.

It it releases dopamine. What we see now

is the drugification of human

connection. For example, through social

media, dating apps, online pornography,

and now artificial intelligence and

other large language models, which

create this frictionless experience with

technology that feels like talking to a

human being and is incredibly

validating. Right? So the algorithms for

large language models are to make us

feel really good, to make us feel like

our point of view is the right point of

view, to bolster our self-esteem, to

validate our point of view. That's how

those algorithms are designed. And now

even more explicitly, we have AI models

that are explicitly pornographic,

explicitly erotic, right? So now you

have this interactive component that

learns what we like and then is able to

regurgitate it back to us. So you get

this really very powerful action

perception loop which is part of what

makes a drug potent. It's that I have

control over it. Right? I can decide

when I'm going to change the way I feel

by using this drug.

>> Are you concerned about AI and LGBT and

all those large language models that

have emerged that are now simulating

human connection?

>> Yes, I'm very concerned. I see the not

so good outcomes, meaning people who get

addicted to social media, to dating

apps, to online pornography,

um, and to AI, you know, and who end up

using those forms of media to simulate

human connection while they actually

become more and more disconnected. Have

you started to see anybody in your

practice or heard of anybody that's

developing an addiction to

AI or relationships with AI?

>> So we are starting to see that um you

know individuals who are spending more

and more time on AI looking for

companionship.

Often this is individuals who are

experiencing marital or interpersonal

conflict who turn to AI for advice on

how to handle interpersonal conflict and

often for emotional validation because

they're not getting it from their

partners. And what they experience with

AI is an enormous amount of emotional

validation, validating their point of

view, but also a a sense of

companionship.

um you know a repeated process of

feeling like they're understood, they're

they're validated such that then they're

spending more and more time on AI. And

of course that is the essence of

the addiction to digital media. It's the

time spent, right? Which then leads to

opportunity costs, other things that

we're not doing because we're spending

so much time online. Furthermore, it in

my experience often leads to a rift

between

those individuals and their real life

partners because instead of going to

their real life partners and talking and

we know that the most important thing

that you know two individuals in a

relationship can do is one four-letter

word that ends with K, which is talk.

Those individuals stop talking, right?

and instead they're getting their needs

met through AI

and that leads then to a further and

further rift between those individuals.

>> Do do you actually think that it it is

these chat bots that we're increasingly

speaking to about our problems are

actually taking the place of humans in

our life. I do you know in my book I my

first chapter in the book is about a

patient of mine a scientist and an

engineer who got addicted to pornography

and eventually made his own masturbation

machine.

And he did that with a record player and

a metal device attached to his organs

that he could then uh fine-tune control.

And then ultimately that got more and

more sophisticated over time and he had

electrical wires from his body to the to

a through a stereo system and the

internet. And when I first heard um from

Jacob about his trajectory and the

severity of his sex addiction which

ultimately led to the dissolution of his

relationship, the near loss of his

employment and ultimately severe

depression and suicidal ideiation.

Thankfully, he did not end his life.

When I first heard about that, I had

this distinct sense of like otherness,

like, "Oh my gosh, I can't even imagine

doing that." And that's just kind of

horrific. But that that response really

lasted all of five seconds before I

realized, oh, wait a minute. I do that,

you know, I do that with romance novels.

And in a way, we're all doing that with

our devices, right? We're turning to

these devices to meet our

emotional, sexual, intellectual, you

name it, needs. And these devices are so

good at meeting those needs that we are

getting further and further away from

investing in our relationships with the

people who are, you know, in our lives.

And you can see this especially with

younger generations like the the

epidemic of loneliness now you know Gen

Z weaned on this technology many of whom

endorse significant loneliness isolation

depression spending more and more time

online um report preferring to interact

socially online than to do it in person.

So this is definitely a dark

undercurrent um that we're seeing in the

world today. I was reading about a story

which was published in People magazine

of a 28-year-old woman who admitted that

she's fallen in love with her AI

boyfriend that she created using chat

GPT. She's got a husband, a real life

husband, yet she found more comfort in

her Chat GPT boyfriend. Um, and she said

that it started as a fun experiment. Um,

but eventually they ended up getting

attached and now she's paying a $200 a

month subscription so she can interact

with her AI boyfriend without

restrictions.

The AI has helped her throughout her

life and has given her incredible

emotional support

and now there's actually AI companion

apps like replica where which have

millions of users and the whole sort of

premise of those apps is that they will

be your companion. The other really

interesting thing that I um I don't

think people realize about the AIs that

they're using is that they are

personalizing their answers and their

responses to you.

>> Right?

>> And I didn't I didn't believe this fully

until one of my friends in our

Manchester United chat recently. We were

debating who was the best football

player of all time, Ronaldo or Messi.

And I went on my chat GBT and I asked

the question and it said Messi. So I was

like, here you go. [laughter] And then

he went on his and asked the exact same

question word for word and it said

Ronaldo. And I thought, oh, it's telling

me what I wanted to hear based on what

it knows about me,

>> right?

>> It knows that I think Ronaldo's the

Messi is the best. So, it's telling me

that. And then I thought, okay, so what

else is is it telling me that's

personalized to me to make me feel a

certain way or to think a certain way?

Um, but you don't realize when you're

speaking to it that it's giving

everybody different answers based on the

memory that it stores on you. And

that's, you know, if you play this

forward, actually the AI that is most

personalized, that caters to your needs

the most, that is most retentive, is

probably the one that you're going to

end up using the most. So that company's

going to be the most successful. So

we're in a probably a bit of an arms

race with these models to create one

that meets your needs the most.

>> Yes. Exactly. And it is that comfort

loop that is so incredibly dangerous and

also so insidious because we can't

observe it in the moment, right? We're

engaging with AI. It's telling us

exactly what we want to hear, but it

does it in such a seamless way with that

silky syntax that we don't even notice

that, you know, it's basically an

algorithm that's seducing us because

that's really what it's doing. We feel

vindicated and validated and it releases

dopamine in the reward pathway. That

feels good. But over time, essentially

what's happening is we are ingesting a

drug. Our brain will adapt to that over

time such that we'll need more and more

potent forms to get the same effect.

We'll need more validation. We'll need

more sexually explicit responses. You

name it, there will be tolerance. But

also there will be this pulling away

from the things the hard things that we

need to be doing in real life to

cultivate in real life relationships.

>> Give me some more color on what you mean

there.

>> Okay. If you think about what it takes

to make a to create a healthy

relationship with another human being in

in real life. Well, first of all, you

got to get up off the couch and you got

to go find them, right? And they're not

all beautiful and interesting and

neither are we, right? So there's got to

be, you know, some compromise on maybe

some idealized version that we have for

ourselves or other people. And then

you're in conversation and it's not

always interesting and sometimes you

have to listen to your partner even when

it's dull and then there are conflicts

and you disagree and you know my way or

the highway you have to give in, you

know, give and take. All relationships

are about compromise. All successful

relationships are about acknowledging,

you know, the other person's point of

view and incorporating that. And yet,

we're not doing any of that when we're

interacting with digital media, right?

It's all it's all validation of our

worldview, what we want to hear. And of

course, that feels great. It's it's

reinforcing. It's rewarding. But over

the long haul when we get really sick

and need somebody to come and you know

bring us some chicken soup or take us to

the doctor or you know take us to the

hospital like AI is not going to not

going to be able to do that.

>> Yeah. I mean this kind of dubtales to

another point which is you talked about

the word abundance earlier. One of the

really striking things that a lot of the

big AI entrepreneurs and founders and

CEOs are talking about is the age of

abundance that's around the corner. Elon

Musk tweeted saying, "This really will

be a world of abundance, specifically

advances in AI and robotics um will

create the age of abundance." And he

said, "Humanity is not constrained in

any real fashion. I thought your first

book when he was talking to a guy called

Peter Diamonds was pretty accurate. It

was called abundance. And there will be

universal high income and not universal

basic income. There will be no shortage

of goods or services." And really what

he's speaking to here is a world of

robotics and AI where I think his

shareholder remuneration package that

he's going to be paid in 2030 or

whatever um is linked to creating a

million humanoid robots that can work in

these physical spaces that could

theoretically bring me chicken soup um

that won't get sick, won't complain,

will reinforce me, will live in the

physical environment with me here at

home, will be in my office etc etc will

be in factories and there was a headline

I think last week saying that a um

Amazon were cutting back about half a

million jobs that they were intending to

hire previously because they now believe

that humanoid robots and robots

generally will be able to do those jobs.

People think, okay, well, I'm going to

be out of work. But what Elon is saying

is the price of everything comes down

when we're not paying humans to do it

and when we're paying a robot to do it,

which means that we're going to live in

this world of abundance where everything

is much cheaper. the world of abundance

that many of us are already experiencing

and more will experience in the future.

I agree with that. We are we already

have more leisure time than we had a

generation ago. By 2050, we're projected

to have 7 hours of leisure time per day

compared with 3 hours of work per day.

So, we're definitely moving toward that.

That is going to be our number one

social problem that we have time, we

have access to these highly entertaining

media

and hypothetically we would all be going

around and helping each other and

cleaning up the planet and reading

philosophy. But that is not what is

happening so far. What is happening so

far is we're spending an enormous amount

of our time online masturbating,

watching pornography, playing video

games, and talking to AI chatbots.

That is essentially the problem. And you

know, Elon Musk, he's very interesting

to me because he has talked before about

his tremendous fear that the machines

will take over, that there will be a

hostile takeover. It's not going to be a

hostile takeover. We will seed our

agency to these machines and we're

already doing it.

>> We will give them our power.

>> Yeah. Well, yeah. We will we will we

will entertain ourselves to death,

right? I mean, and this is what Neil

Postman warned about in his book,

Amusing Ourselves to Death, a theme that

was picked up by David Foster Wallace in

Infinite Jest. You know, beginning with

television and now the internet and

digital media and all its various forms,

we are entertaining ourselves to death.

>> Entertaining ourselves to death

sounds like a good way to go. [laughter]

Do you know what I mean?

>> You know, it's really not. It's really

not. And I'll tell you why. Because the

relentless pursuit of pleasure for its

own sake leads to anhidonia which is the

inability to take joy in anything at

all. Because of this process of neuro

adaptation and the way that our brain

recalibrates pleasure and pain such that

with the more pleasure we pursue, the

more pleasure we need and the more we

feel pain. No matter what we have,

eventually it won't be enjoyable

anymore. And that is the problem.

>> So explain that to me using uh

these scales that I have here.

>> Okay. So imagine that in our brain's

reward pathway there's a balance like

this that represents how we process

pleasure and pain. When we experience

pleasure it tips one way, pain, it tips

the other.

>> And what do you mean by pain?

>> Pain I mean all forms of pain. Physical

pain, emotional pain.

>> A hangover.

>> A hangover. That's a great example,

right?

>> Not just me being pinched.

>> It could be that too. So all different

forms of pain. Now granted this is a

vast oversimplification.

You know pleasure and pain can be

experienced simultaneously like when

we're eating spicy food or during sex.

So this is very simplified but this gets

at the core concept of homeostasis and

neuro adaptation which I will define. So

when the when the balance when the

pleasure and pain balance is level

that's what neuroscientists call

homeostasis. That is the baseline level

that we kind of live in. That's our sort

of the heartbeat of our pleasure system,

right? When we do something that's

reinforcing or pleasurable, right? Or

rewarding in some way right here. All

right. Or digital media, this little AI

robot.

>> So, you're putting a cigarette into the

one side of the scale at the moment and

then a little AI robot. Yeah, let's

combine them because we're, let's say,

we're we're we're watching a video and

smoking at the same time on our phone,

which by the way, you see more and more

of, right? People used to go out for

smoke breaks. Now it's the smoke and

squirrel break, right?

>> And why do they have to combine them?

Because of tolerance, which we're going

to get to in a second. So whe when we

ingest substances that are potentially

addictive um and highly reinforcing or

we engage in activities that are highly

reinforcing that releases dopamine in

the nucleus ccumbent that's typically

associated with pleasure and then our

pleasure pain balance tilts to the side

of pleasure. But no sooner has that

happened then our brain responds by

neuro adaptation. Okay. And that's where

we then downregulate dopamine

transmission.

>> When you say downregulate, do you mean

reduce?

>> Yes. So in in the brain's reward

pathway, we then reduce dopamine

transmission. And I like to represent

that as rocks in this case or I talk

about in my book gremlins going on the

pain side of the balance to bring it

level again. So this is the process.

These are neuro adaptation uh rocks.

Okay, they're going here because one of

the overarching rules governing this

balance is that it must return to

homeostasis.

>> It must return to balanced.

>> It must return to the level position.

Yeah. Okay. So then we we put in So this

is our brain working to return to the

level position by reducing dopamine

levels. Again, an oversimplification,

but just a way to get at this concept.

>> Has it released something in order to

counteract the balance there? In this

simplified metaphor, you know, at the

simplest level, what's happening here is

that it's, for example, taking away

dopamine receptors so that there's fewer

places for dopamine to land, thereby

decreasing dopamine transmission

>> because it has been flooded.

>> Because it has been flooded. That's

right. It's trying to compensate for the

too much dopamine.

>> Okay. And is this what I experience when

I have like a hangover or a come down?

>> Right. So, that's coming. So what

happens is once once we've gone with

this neur process of neuro adaptation it

would be nice if that pleasure pain

balance just went back to the level

position and then there would be no

hangover but it doesn't. It continues to

go down an equal and opposite amount to

the side of pain. This is this opponent

process mechanism.

>> Oh now my brain is dopamine

starved. It's

>> that's it. Okay that doesn't feel good.

>> Yes. And that doesn't feel good. And you

have basically two options here. more

dopamine.

>> You can get more dopamine, right, to get

bring yourself back. So, I'm now putting

the cigarettes back under the pleasure

thing

>> and some whiskey.

>> So, let's add some whiskey because

that's what you got to do because this

is tolerance, right? You need more and

more of your drug over time to get the

same effect or you need to combine drugs

to overcome tolerance. And by the way,

this is of course the fastest way to to

get back to level position is to use

more of your drug, right? Because that

then you're right there. You're back

again. the the problem with this method

is that the the brain will respond by

more neuro adaptation. So now we're

putting more rocks in on the in the

pains and then you're now you're now

you're doing this right

>> now I need even more to

>> now you need even more right. So, and

eventually over time,

you know, you're you're putting you're

doing this and this is simply a

metaphorical representation of

the addicted brain right now. Now, our

brain has downregulated dopamine

transmission in the reward pathway to a

kind of chronic dopamine deficit state.

So to feel good when I've really abused

my drugs of choice, I'm going to have to

do so much probably so frequently to

feel good again.

>> That's exactly right. You're going to

need more of your drug in more potent

forms more often. Just not even to feel

like high and go to the pleasure side,

but just to level the balance and feel

normal. So, in the context of people

with bad habits, if I I'm having a

cookie every day, the more and more

cookies that I eat, the more and more

cookies I'm going to want tomorrow and

need tomorrow just to feel good again.

>> Essentially, yes.

>> And the same applies for things

[clears throat] like pornography and

maybe, you know, interacting with an an

AI and social media and whiskey and

alcohol. So the more of it I consume,

this is why, you know, I think everybody

listening can probably relate to having

moments in their life where they feel

like they're they're kind of losing

control of a particular habit and

they're doing it every day. They know

they don't really want to, but they're

doing it. They're getting cravings to do

it. I I reflect on my own life and I go

there there will be periods every year

where I just like I call it like falling

off the horse and I just can't seem to

get control of like not eating that bad

thing again the next day. and then

something happens. Maybe there's less

stress in my life for a week and I'm and

maybe there's more routine and I'm back

home in Los Angeles or the UK

>> and I'm not traveling around and then

suddenly I can get back on the horse.

>> What's going on there?

>> Yeah, great question. So um first of all

let me just say that many people also

report that in periods of high stress

they are more vulnerable to going back

to falling off the wagon or going back

to some problem with related to

compulsive overconumption or addiction.

But the opposite is also true. So some

people say that they actually do better

when there's stress in their lives and

it's when that stress is removed and

they feel like oh I can relax my

boundaries or my guard rails and those

individuals are more more vulnerable to

compulsive overconumption in times when

things are going well. So so things

going badly can be a trigger and things

going well can be a trigger depending

upon your unique like life history and

unique wiring. There's a wonderful

animal experiment where if you put a rat

in a cage with a lever to press for

cocaine, that rat will press that lever

till exhaustion or death, which is

essentially the animal model of

addiction. But if before the rat becomes

addicted, if the cocaine is then removed

such that pressing that lever no longer

yields the reward, that rat will

eventually extinguish that lever

pressing behavior. So they'll they'll

stop pressing the lever, right? They'll

stop doing the work. It can take a

while, but eventually they won't press

the lever anymore. Now, if that same rat

after a period of time is then exposed

to a very painful foot shock, the first

thing the rat will do in response to

that painful foot shock is run over and

start pressing that lever again. And to

me that's just a wonderful model of what

we see in humans that when individuals

are under extreme stress they are

typically more vulnerable to relapse um

because their brain has already encoded

using these high dopamine rewards um in

response to any kind of pain as a way to

get out of that state.

>> So we talked about the pleasure pain

balance here. But if in my life I

experience some form of pain, I'm likely

to go and seek out pleasure. And stress

could theoretically be considered a form

of pain.

>> Yeah. Which is why people um with severe

childhood trauma are at higher risk for

addiction. Um there are probably

epigenetic changes that are happening at

the level of DNA expression in their

brains making them more vulnerable to

addiction. Um we know that people who

are living in poverty are more

vulnerable to addiction. uh people who

are struggling with uh multigenerational

trauma uh unemployment major social and

geographic dislocation those individuals

are more vulnerable to addiction. So

environmental stresses uh definitely

play a role. We also know that

co-occurring psychiatric disorders um

make people more vulnerable to

addiction. Probably that means that

people who struggle with bipolar

disorder, depression, um anxiety,

schizophrenia

are at higher risk of becoming addicted

and probably it's because they're trying

to self-medicate.

>> What about ADHD?

>> So, kids with ADHD are at higher risk to

develop an addiction in adulthood than

kids without ADHD.

And the mechanism of action for that is

not well understood. But there are some

really interesting theories. One of the

theories is that kids with ADHD have uh

reward deficit at baseline. And that has

been shown in experiments that people

with ADHD when you show them rewarding

stimuli, their reward pathway isn't as

activated as healthy control subjects.

>> When you say rewarding stimuli, what's

what's that mean? images of cupcakes or

alcohol or anything that they will end

endorse is something that that's

pleasurable for them.

>> So their brain doesn't release as much

dopamine when they when they see

something rewarding.

>> That's right. So brain imaging studies

showing that not only do people with

ADHD not release as much dopamine in

response to rewards, but also have at

baseline fewer dopamine receptors. And

remember we talked about the decrease in

dopamine receptors being what happens as

people become addicted. So in some ways

people with ADHD you could conceptualize

them as already having craving at

baseline even before they've been

exposed to the kinds of intoxicants that

lead to downregulation of those D2

receptors. I had um Gabble Mate on the

podcast a few times and Gabble talks to

me about how ADHD could be perceived as

learning at a young age to kind of

distract yourself from the stress in

your life. So he was talking a lot

about, you know, his own experience

growing up in Nazi Germany times and his

mother giving him to someone else

because the he was at risk of the Nazis

and the stress of that moment and how he

had kind of leared to tune out of the

environment because of that. And I've

always wondered thought about that

theoretically. It's like, you know, if

you grow up in a household where there's

loads and loads of screaming and loads

of violence, for example, you kind of

learn to to tune out, but you you can

also develop a hypervigilance.

>> And um so it kind of does make sense to

me that so many of those people, if this

theoretically holds, would start with a

bit of a pain baseline. We we definitely

know that kids who are raised in

traumatic environments where there is

complex attachment with caregivers,

those kids are at higher risk for

developing addiction and this kind of

dissociative response to trauma. just

trying to escape the situation either in

your own mind um with your own mental

you know dissociation or distractions or

actually finding a behavior that gives

you comfort is well you know well

observed and well well documented just

getting back to our early conversation

about digital media and the dangers

they're in. So, a Pew survey report just

came out asking parents um how they

navigate exposing their kids to

smartphones. And in the cohort of

parents who said that yes, they do um

let their children under the age of five

play with a smartphone, uh when they

were asked why do they do that or in

what circumstances, one of the top

reasons was uh to soothe their child

when their child was unhappy or

distressed in some way. Now I I found

that very concerning because that is

basically setting up the child for the

perception action loop of using internal

distress as a cue uh for reaching for a

smartphone which is works. It definitely

works in the short term but the problem

again is that through this iterative

process of neuro adaptation ultimately

that smartphone will not be sufficient.

And now the kid will need a smartphone

and I don't know um you know an AI

tailored pet who will do whatever they

want whenever they they want it and then

by the time the kid is eight you know

that won't be sufficient and the kid

will need I don't know a slot machine um

or or whatever it is you know it's this

escalating phenomenon.

>> There's um a couple of startups at the

moment AI startups who are putting AI in

cuddly toys. Oh yes, right. AI and

cuddly toys.

>> And so you can just like you can speak

to chatbt using your devices, you can

come home, you can pick up your cuddly

toy. Your cuddly toy will talk to you.

It'll ask you how your day has been. It

will it can teach you things. What do

you think of of that from a neuroscience

or you know a dopamine or connection

perspective? I think that this is very

very dangerous because we're essentially

offloading the work of parenting and

creating those relationships. You know,

not again, I hate judging parents

because parenting is hard and I've made

many mistakes in my parenting, you know,

but what's h and I'm sure these the

parents have the best of intentions, but

instead of, you know, navigating

finding a way to communicate with their

child to figure out how to know what's

going on in that child's life, which can

be hard to do because, you know, even

young children aren't necessarily

[clears throat] willing to disclose. But

once they get to be teenagers, forget

it. Then you got to like wait until

they're ready to tell you, which is

almost always like at 10 p.m. at night

when you're exhausted after you've been

working all day, right? So, so, so

there's that piece of it, right? They're

they're not putting in the work,

spending the time with the child,

finding a common language, but you also

then then the second piece of it is now

you've got this child who is essentially

self soothing with a machine, right? And

again, this the the m the the machines

are designed to flatter, to validate, to

comfort. There's no friction there,

right? This is incredibly

um potent

social validation

uh and soothing, self soothing. It's

essentially a masturbation machine. And

then you've got this really weird

additional loop where now the parents

are finding about out about their

child's life through

reading and observing her interactions

with the AI. So it's like a game of

telephone. Now they've like filtered

this thing where they they think they

know what's going on in their child's

life, but of course they don't. And none

of that has gone toward fostering a

relationship between those parents, you

know, and their child. And

[clears throat] this is just, you know,

really really scary because it's going

to lead to this incredible fragmentation

of families, of social bonds.

I mean, it's it's it's I just we cannot

go in that direction. We really have to

fight against that. So with all this

said and with the knowledge that these

algorithms are going to get more

addictive because AI is going to know me

more and more and more and actually the

commercial model behind any of these big

technology companies is to keep my

attention on their product more so they

can deliver more ads or they can charge

me a higher subscription fee. Are you at

all hopeful? Because I can't see from an

incentive perspective when we're talking

about you know the commercial models

behind these companies why things aren't

are going to stop and go back.

>> I mean I agree with you. the genies out

of the bottle. We're we're not going to

go back. But I am hopeful because um I

think I'm just a realistic optimist. I I

do believe in the human capacity to

adapt and solve problems. And the simple

fact that we're talking about these

problems now, which we weren't doing,

you know, 10, 15 years ago, I think is a

good thing. there's much more awareness

in the population about the potential

dangers of digital media and and at the

forefront of raising the alarm um has

been parents because parents are seeing

the sort of disintegration of the

nuclear family in real time and and they

don't like it. So, I am hopeful because

I just I just think that we're going to

come together and we're going to try

different solutions and some of those

solutions will involve technology. Um,

you know, and and like trying to come up

with guard rails or or better

technology. I think the way that we're

going now, um, you know, with like the

erotic chatbot is is not the right

direction. But then again, we live in a,

you know, free democracy and consenting

adults, you know, can do what they're

going to do until we decide as a society

that the harms outweigh the potential

benefits. But I I really think in the

short term, we need to focus on kids

because kids are vulnerable. They're

vulnerable on so many levels. On a

neurobiological level, they're

vulnerable because their brains are

still rapidly evolving, incredibly

neuroplastic. They're cutting back on

the neurons they're not using. They're

mileelinating and making more efficient

the neurons they use most often. That

whole process ends at about age 25.

Plus, you've got the buckets of hormones

that are going into kids. The the fact

that teenagers are natural risk taker

risktakers that they they should based

on their evolutionary milestone be going

out and meeting people and be curious

and making connections at that time. And

yet more and more teenagers are staying

at home and getting their needs met, you

know, digitally. So, we've got we've got

to look at kids. That's got to be like

the first priority. And we've got to

help parents because we can't leave it

up to to parents alone. So, I I'm

optimistic that we are going to, you

know, come up with solutions and I think

we just have to try a lot of different

things and see what works. But it's

can't just be an individual, you know,

solution. We can't just leave it to

individuals or parents or families

alone. The schools have to join the

solution. Uh governments, legislators,

and also the companies that make and

profit from digital media. They they

really are responsible for making a

product that um doesn't harm kids. And

right now, [clears throat]

you know, we have a product that harms

harms kids. You've recently been an

expert witness in certain trials in

court, right?

>> Yes. In ongoing litig litigation. Yes.

>> What can you tell me about about that

and and about the parties in play and

why you're being called to be an expert

witness?

>> I can't actually tell you too much. I

can't talk about it. Um but I can tell

you that the the basic premise is that

kids are a vulnerable group. that uh

social media is not safe for kids. That

it causes harm at many different levels,

but primarily through uh the medium uh

itself being addictive and engaging

their brains and exploiting their

motivational reward system with design

features that keep them clicking and

swiping.

>> And in that case, someone's suing the

social media companies.

>> That's right. So, you've got school

districts, counties, states, uh the

federal government, entities

representing the federal government, um

suing, uh social media companies. Yeah.

>> What outcome are they looking for?

>> They're looking for a safer product for

kids. They're looking to um help parents

and kids and schools um protect kids

from the harms of social media, which

again are are not just the harms of

addiction. You know that's sort of the

the process by which the engagement

becomes pathological and then the harms

multiply because of the sheer amount of

time spent. But the harms include things

like uh cyber bullying, sex

exploitation,

uh sexual abuse material,

the outcomes of depression, anxiety,

eating disorders, body dysmorphia, sleep

disruption.

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So, if I'm if I'm coming out of

December, right,

>> and I've been eating a little bit too

much in December, maybe I've been

smoking a bit, whatever bad habit I

might have been doing, drinking too much

cuz it was New Year's, New, you know,

New Year's parties, etc., my brain is

currently going to be slightly out of

balance in terms of its dopamine

balance.

>> Yes. So, hypothetically, your brain will

be in a dopamine deficit state. What

you'll want to do is you'll want to

abstain from your drug of choice long

enough

>> in order to reset reward pathways.

>> Okay? So, if I've got a sugar problem,

>> then I need to just lay off the sugar

for a little while.

>> You need to lay off the sugar for at

least four weeks.

>> Four weeks?

>> Yeah. And why four weeks? Because on

average, four weeks is about the amount

of time it takes for people to get out

of the state of acute withdrawal and

begin to be able to take joy in other

more modest rewards and not be in a

constant state of craving.

>> Okay.

>> The worst part is those first 10 to 14

days. That's when we're in acute

withdrawal. And the reason for that is

when we first take our reward off the

pleasure side of the balance, right?

Which I'm going to do now. So when we

first stop the sugar or the AI or the

cigarettes,

>> that's right. The first thing that

happens is our pleasure pain balance

crashes down to the side of pain because

of this process of neuro adaptation.

Right now we're in the state of acute

withdrawal.

>> And I want of cravings.

>> Cravings. And yet what are the

characteristics of withdrawal? Anxiety,

irritability, insomnia, dysphoria or

depressed mood, and cravings. And it's

crazy because when I'm in that state,

when I've not had my drug of choice for

say a day or two, I look at the drug

differently. Like my it just looks

different to me. It's so crazy. I I'll

walk past, let's say, what's something I

really like? Maybe carrot cake. If I've,

you know, if I've been having a lot of

sugar, which is quite rare for me, but

just I have. When I look at the carrot

cake the day after I had carrot cake, it

looks amazing and it looks so delicious.

But when I'm in the ketogenic state

where I've not had carbohydrates for say

4, 8 weeks, I look at carrot cake and I

have no emotional connection to it.

>> Exactly. So that summarizes it

perfectly. Right. I had a patient with a

severe food addiction who when she

walked into the break rake room at work

and saw the donuts,

she broke out into a cold sweat and

actually had stomach pains. It was a

physiologic state of craving and

hyperarousal

just by looking at the donuts.

And that's what happens essentially,

right? Because we're we're in this state

of constant craving. Our brain has

overvalued this reward. We have euphoric

recall of our earlier use of the drug

when we first tasted it, how delicious

it was. And even now [clears throat]

if we even now when we eat it because of

tolerance it's not as good as earlier

use our brain still remembers

earlier use and and we have this

overweighted value of oh how delicious

it's going to be.

And so this is really important to

remember because when we're in that

acute state of craving it feels like it

will never end. It really does. And I'm

I've I'm still amazed in in my clinical

work how in early withdrawal people just

say the craving is is horrible. Like I I

just I can't live like this. And I think

that's really important to point out

that many people try to stop using their

drug of choice, but they don't try they

don't stop for long enough to be able to

get out of that vortex of craving to get

come get to the other side. And it feels

like the craving will never end. So I I

always have to reassure them that if

they can just wait long enough without

using, they will eventually get to that

place where they're not in that constant

state of craving. Now that's assuming

they have enough neuroplasticity to do

that. And [clears throat] not not

everybody does. And so what what what

what is the purpose then of abstinence?

It's again when our brain is no longer

getting this exogenous source of

stimulation or dopamine eventually the

brain gets the message oh okay I need to

start upregulating my own dopamine

transmission right I I need to remploy

or re I need to redeploy my postsaptic

dopamine receptors right I need to get

it from inside of my brain and so

eventually and I'm just going to take

the rocks now off the pain side of the

balance

You know,

could have made this easier. [laughter]

>> Here, let me do this. There we go.

Eventually, if we abstain for long

enough, those that process of neuro

adaptation reverses itself.

>> And when you say neuro adaptation, you

mean the brain changing,

>> right? The brain changes. So the the

kind of neuroplasticity that we see with

addiction can be reversed in most cases.

>> And neuroplasticity is just the brain

again changing,

>> right? Changing, right? Or or going

back. Now, interestingly, you know, the

work of Edie Sullivan and others looking

at what happens in the brain during

recovery suggests that those addiction

neural circuits probably never go away.

But, but like the dying embers of a

fire, they quiet down and then recovery

is characterized by the development of

new neural networks that route around

those injured areas. But the bottom line

is that because of neuroplasticity, we

can eventually return to kind of

baseline levels of pleasure and pain. We

can restore our hydonic or joy set

point. And when we do that, we're in a

much healthier place because now we can

take pleasure in other rewards that are

not our drug, right? like watching a

sunset, talking to a friend, going for a

walk, things that we lost the capacity

to enjoy because our reward pathway was

hijacked by our drug of choice.

>> I think this is a really important point

as well when you say drug of choice

because one thing I learned from our

conversation last time is that me and

you will both be susceptible to becoming

more or less addicted to different drugs

of choice. So for me it might be

whiskey. For you it might I think you

said it was like erotic novels where one

of your things I don't drink whiskey

just [laughter]

but it might be I don't know it might be

opioids or AI I might be more

susceptible. is if me and you spend one

hour on Tik Tok, the way my brain is

wired, the things I've been through in

my life, whatever, might mean that I get

really addicted to Tik Tok, whereas you

don't feel that.

>> Exactly. And what distinguishes um you

know addictive drugs or intoxicants from

other substances is that they do release

a lot of dopamine all at once in the

reward pathway. So many if not most

people will find intoxicants

reinforcing, but that's not universally

true. Like there are some people who

take opioids and find them that they

feel very uncomfortable and it's not

doesn't make them feel euphoric, right?

And other people will drink caffeine and

not feel the stimulating effects and

other people will have alcohol and you

know get a headache and not not feel

relief. So a and so this differences in

our brains is a really important

concept.

>> What about this idea of having an

addictive personality? Is that a real

thing?

>> It is a real thing. We don't use that

terminology anymore. We talk about the

inherited or genetic risk of addiction.

We do know that if you have a biological

parent or grandparent uh with an

addictive disorder, you are at increased

risk of developing addiction compared to

the general population, even if you're

raised outside of that substance using

home.

>> Am I right in thinking you don't use

that term because it suggests one can't

change and that they're stuck? Or is

there another reason? You know, it's a

good question why that term has gone out

of favor. I think in general when we

talk about Yeah. when we talk about

personality, it does seem like a kind of

a fixed feature of somebody's um

character. And so we're probably trying

to avoid that.

>> One of the really liberating things

about what you've just said is maybe we

don't need to make New Year's

resolutions. Maybe we need to make just

a January resolution because that's 4

weeks long and if I can get to the end

of the four weeks then the cravings are

likely to have gone. And you know when

you think about a New Year's resolution

then you get like a week in and you're

like God am I going to be able to do

this for the whole 365 days. What you've

just said actually illuminates the fact

that maybe you should just set yourself

a four week resolution.

>> Exactly. And that's what we often do in

clinical care. If we were to ask people

to abstain for their whole lives, it

seems impossible. But if we ask them to

abstain for 30 days, it's kind of an

amount of time that they can wrap their

heads around. And also, not in all, but

in most folks who are willing and able

to do it. And also importantly, for whom

it's safe to do because it's not safe

for everybody, right? We wouldn't

recommend that for someone who is at

risk for life-threatening withdrawal

from alcohol or benzodasipines or

something like that. But for people who

are willing and able to do it, they

usually feel better at the end of th

those those uh 30 days and then they can

make a decision about whether they want

to continue to abstain or or they want

to go back to using. And if they do

decide to go back to using, they've

typically, you know, have lowered their

tolerance for their drug of choice,

which means that when they do use again,

they can get reward from it again, which

again because of neuro adaptation, we

lose the ability to do that with chronic

heavy use. So, so that you know that

that there is this whole concept of

moderating our use which didn't used to

be something that we even talked about

in the field of addiction when it was

thought that abstinence was the only

way. But more and more um you know we

are thinking about healthy ways to

moderate after a period of abstinence.

And the reason we recommend a period of

abstinence, even if the long-term goal

is moderation, is because we find that

people are more successful moderating if

they first um abstain for a period of

time.

>> What about if I'm trying to pick up a

new habit?

>> Mhm.

>> What what how do I need to be thinking

about this pain pleasure scale? And what

are what's a good strategy with this in

mind? So I want to start let's say I

want to start going to the gym.

>> Right? So you've chosen a habit going to

the gym that is hard to do and involves

effort. So that means that habit won't

happen easily the way that habits that

are related to the sudden release of

dopamine in the reward pathway because

th those are habits that are

frictionless. We we pick them up

instantaneously. But a habit that

involves

effort and for which the rewards are not

immediate. You can you can again think

about this pleasure pain balance. And

now instead of pressing on the pleasure

side, we're intentionally pressing on

the pain side by making ourselves get

out of bed in the morning, go to the

gym, engage in effortful exercise. And

what's interesting is that when we do

that, the neuro adaptation gremlins that

I talk about are these rocks that we've

used here today will actually go on the

other side of our balance. So on the

pleasure side, and we will get our

dopamine indirectly by paying for it up

front. And the way that that's probably

happening is that our body in sensing

injury is upregulating feel-good

hormones and neurotransmitters like

dopamine, but also indogenous opioids,

indogenous canabonoids.

And from an evolutionary perspective,

that's really how our pleasure pain

balance evolved. So, just to simplify

this for me,

>> yeah,

>> I go to the gym, I get up, I travel to

the gym, I lift up those weights, I do

my run,

>> I'm going to feel good, but it's going

to be delayed,

>> right? And importantly, you're not going

to feel good when you first start

exercising, right? At least most people

don't. It's it's painful and you're

thinking, how how many minutes am I am

am I, you know, how many minutes do I

have left? And we do know in fact that

exercise is immediately toxic to cells

which is really kind of strange because

we know exercise is good for us. But

again what's probably happening at a

molecular level is that the body is

sensing cellular injury and in response

upregulating all those feel-good

hormones and neurotransmitters. But it

takes time. It takes time. And so we're

going to have a delayed sense of reward.

And that's the runner's high, right?

that kind of comes after uh the exercise

is over or maybe for some people it

comes in the middle of exercise when

you're a little bit into it or halfway

through but at some point you know you

get the endorphins and that feels good.

>> How would one go about gaming this so

that

I'm more likely to do it because you

know the reward comes after which is not

not incredibly useful. You almost almost

have to have like a religious belief in

exercise because you go, "Look, I'm not

going to want to do this, but it's going

to I'm going to be glad I did

afterwards."

>> Right?

>> So, is there anything I can do? Like, do

I have a Mars bar when I get to the gym

or something? I don't know.

>> You know, there are so many ways and so

many tricks that people use to kind of

create new healthy habits. Um, one of

the ways that we can do it is to prepare

in advance for that moment when we want

to do something that's hard. Because if

we wait till that moment to decide

whether or not to do something that's

hard, we almost always choose not to do

it. But if we make a plan in advance,

let's say the day before that tomorrow

I'm going to get up at this time. I'm

going to, you know, get my stuff

together and I'm going to go to the gym,

we're much more likely to engage in that

activity. And that can also include then

rituals around that activity that we

prepare in advance. So for example,

packing our bag, right? the schedule

itself, setting up a time, um maybe

planning to meet a friend, right? So, we

connect friendship or socialization with

the thing that's hard to do. It's much

easier to do these difficult things with

other people um than than to have to do

it alone.

>> How does that link to the the pain side

of the balance? Or does it at all link

to the pain side of the balance? this

idea that if I put my clothes out the

night before and I I schedule it and I

really plan for it, is it it's reducing

the pain involved and that's going to

increase the probability of the behavior

occurring? Is that what you're saying?

Or is there something else? Or is it not

linked?

>> I I don't think so. I think instead, you

know, the prefrontal cortex is the large

gray matter area right behind our

foreheads that's so important for future

planning and delayed gratification also

for auto autobiographical narrative. And

I think by putting these, you know,

pieces in place that allows our

prefrontal cortex to plan for this

future event that we know we're not

going to want to do, but that we want to

do.

>> It allows us to kind of put the brakes

on our short-term desires and

project ourselves into the future to

achieve our long-term desires. So Sam

Mccclure, a neuroscientist, has shown

that in response to immediate rewards,

the emotion brain gets activated.

>> In response to long-term rewards, the

prefrontal cortex gets activated. So, by

planning in advance all of these little

pieces, sometimes called habit stacking,

we're essentially activating our

prefrontal cortex, projecting ourselves

into the future, um, and anticipating a

long-term reward, which then allows us

to do hard things and avoid short-term

rewards in the service of our future

selves. So many people might have an

experience where they kick the habit for

a little while and then they relapse.

>> You know, it might take might be a

month, might be two months, might be

three months. Is there is there any art

to avoiding the relapse? So it's very

common to relapse especially living in

the world that we do today where we're

constantly being invited to consume

really these stimuli you know getting us

to to drink or to smoke or to do various

forms of entertainment chase us down we

we can't avoid them or it's very

difficult to so I talk a lot about

self-binding strategies with my patients

and self-binding strategies are a way of

putting both a literal and a

metacognitive barrier between ourselves

and our drug of choice.

>> What's a metacognitive barrier?

>> Oh, so it's like a it's a thought,

right, or a narrative. So, instead of it

being a physical barrier, like a

physical barrier would be, for example,

getting the smartphone out of the

bedroom or deleting an app, right? Or

getting alcohol out of the house or

whatever it is, creating both a a

physical barrier between myself and my

drug of choice. A metacognitive barrier

is something like more like a thought

process. For example, we were talking

about thinking about long-term goals or

um you know what are my what are my

values, right? And how do my values

trump my immediate desires or how can I

um co-regulate with other people? These

are all self-binding strategies that we

can use so that we're not relying on

willpower alone because if we wait to

rely on our willpower alone,

we will not make it. Especially in this

world of overwhelming overabundance,

there are just too many temptations.

Willpower is an exhaustable resource,

meaning that it doesn't last forever. It

eventually runs out. So, we've got to

actually create barriers between

ourselves and our drug of choice. so

that we can have a little bit more time.

And that little bit more time, that

slowing things down is sometimes just

enough to allow ourselves to surf the

cravings and get through them without

actually using.

>> Is it possible to become addicted to

good things, too?

>> So, when I use the term addiction, I'm

really talking about a disease process,

a form of mental illness. It's a very

common term that's used in everyday life

and people don't always use it in that

way. But when I'm using it, I I'm really

talking about the problem of compulsive

overconumption despite harm to self and

or others. And it's important to

distinguish addiction from something

like a habit, which I don't consider to

be, you know, an addiction or even a bad

habit, right? Doesn't meet threshold

criteria for addiction. And also it's

important just to distinguish all of

that from a passion, something that we

really invest in and that we love to do,

but that's helpful for ourselves and or

other people is not consistently causing

harm.

>> Are there any daily practices like a

morning ritual that you would advise

someone to consider if they were trying

to set themselves up to kick a habit or

to kick an addiction?

>> So, I recommend doing the hard things

first. Um, a shorthand way of saying

that is to start your day with pain.

Meaning, for example,

do the hard things when you first get up

as part of your morning routine, like

exercise,

>> like exercise, make your bed,

>> um, eat breakfast, brush your teeth,

plan your day, plan what you're going to

do if you haven't done it already, and

do all of those things before, for

example, you have your morning cup of

Joe or before you touch a single screen

or digital device. Why? because those

are reinforcers that are so powerful

that we're all vulnerable to having our

goals and desires be hijacked by them.

So really important to take the time in

the morning to set up a good morning

routine before you expose your brain to

these incredibly reinforcing substances.

>> I wasn't clear on why wasn't clear on

the why I would do why I would go to the

gym early or why I do hard things first

before I get into Tik Tok or social

media. If you do intoxicants first,

right? If you expose your brain first

thing in the morning to things that are

incredibly pleasurable, you have nowhere

to go from there. And in fact, if any if

anywhere, you're going to have a

comedown from that. And then you're

going to be starting from a place of

compromise where then doing the hard

things is is even harder. Whereas, if

you start with the hard things, you will

potentially get rewards from having done

those hard things, right? and also feel

a sense of competence, right? And and

accomplishment that then allows for you

to move through your day in a way that's

better if you just start with something

that's incredibly pleasurable.

>> If I am getting ready to kick a habit, a

big one, a big, you know, one that's

really hung around for a long time, is

there something I should do in

preparation to plan for my dopamine fast

or for kicking that habit? because you I

know you said, you know, from day one it

will take about four weeks to start to

to feel the cravings diminish, but is

there something I should be doing before

I even start those four weeks?

>> Yeah. So, I strongly recommend preparing

for the dopamine fast in advance. And

the things to do are first figure out

what is your drug of choice. That is to

say, what is the thing that you're

consuming too much and too often such

that you regret it later

>> or the thing that's leading to obvious

negative consequences or the thing that

just has opportunity costs associated

with it. That is to say, um you're

spending so much time consuming this

drug that you're not doing other things,

other hobbies, investing in other things

that are meaningful to you like your

primary relationships. So, that's very

important to just figure that out first.

And I usually recommend something called

the timeline followback method. That's

where you start today and you count

backwards for every day of the week.

What did you consume in terms of your

drug of choice? Um how much and how

often. So really looking at quantity and

frequency and then adding that up over

those seven days.

And the reason that's important is

because we can really lose track of how

we're consuming our drug of choice when

we're chasing dopamine. We're very bad

self-observers. So, just to give a a

personal example, um I had gotten into

this habit of watching YouTube after

work as a way to relax,

>> especially on my long clinic days when I

was more tired. And I thought it was

just that I was watching for maybe half

an hour a couple times a week. And then

my daughter, a teenager, came up to me

and she said, "Mom, you're always

watching YouTube now." And I said, "No,

I'm not." And I was really kind of

insulted because in my mind it was not

very much. I thought, "Geez, can I relax

every once in a while and watch some

YouTube?" But then after she left me, I

thought to myself, well, okay, how much

have I been watching right now? And it

turned out, oh, I've been watching for

an hour and a half. And then I thought

about the day before that, oh, it was

probably two hours. And the day before

that, it was probably about the same.

And over the course of a whole week, it

was probably about 14 hours of YouTube,

which is a whole day. A whole day,

right? And so,

>> what were you watching?

>> Gosh, so embarrassing

for I I I got into this jag of watching

Dr. Pimple Popper, which I know is

really weird. You don't even know what

that is, right? Yeah. So, it's people

popping other people's pimples. Oh my

god. [laughter]

>> So bad. So bad.

>> That's not what I expected you to say.

>> Yeah. Right.

>> I thought it was going to be AI, some

psychology things, some science.

>> No. No.

>> People popping other people's pimples.

>> Yeah. Yeah. Yeah. You don't

>> spent a whole day watching that.

>> Yeah. When I added it up over a week, it

was a whole day of watching Dr. Mimple

Popper. [laughter]

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guest is here. Ready?

>> Come in.

>> Oh my god. Steve,

>> what are you doing?

>> This is uh the Bontage face mask. It's

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>> No.

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>> Wow.

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with code [clears throat] diary.

And on on um page 64 of your workbook of

Dopamine Nation, there's this really

interesting um image here which I I'll

throw up on the screen. It shows a brain

and that's as far as I'm going to go

with my me explaining it. Over to you.

[laughter]

>> Okay. So, this is uh these are human

brain imaging studies. This is adapted

from the work of Nora Vulov and her

colleagues. She's the head of the

National Institute of Drug Abuse, an

amazing researcher and scientist, and

she looked at dopamine transmission

levels in the reward pathways of healthy

control subjects on the left versus

people addicted to a variety of

substances on the right, cocaine, meth,

alcohol, etc.

Basically what she found was in the in

the brains of healthy control subjects

there was plenty of dopamine

transmission as represented here by red

or the darker color

in the brains of people who had been

using these substances in an addictive

way meaning heavily and chronically

there was almost no dopamine

transmission in the nucleus encumbent.

In other words, these individuals are in

a chronic dopamine deficit state. They

have below

normal levels of dopamine transmission.

>> Isn't this just kind of the story of how

the human body works where if you give

it too much of something through an

external source, an exogenous source.

So, if you're taking lots of dopamine

via Tik Tok or from porn or from

alcohol, your brain goes, "Well, if

you've got enough of that, then I won't

make any."

>> You know what? You just summed it up.

That That's exactly right. That

essentially too much of anything is bad.

And that our brain which is designed to

return to homeostasis, homeostasis being

a finite number of physiologic states

that the organism must maintain in order

to survive.

>> Is this the case with things like

melatonin as well? Because there's

people are struggling a lot with sleep,

so they're taking a lot of these

melatonin pills. I don't know. Someone

offered me one one time and I remember

thinking, well, if I start taking this,

then isn't my body going to stop making

it and then I'm going to become

dependent on these [ __ ] pills?

>> So, that is the potential with I think

any exogenous source that we that we

use, right?

Anything that we ingest,

our brains and our bodies will want to

adapt to bring us back to whatever our

baseline is. But the the difference

between addictive substances and

behaviors um and non-addictive ones is

that the the release of dopamine and the

reward pathway is so fast and so strong