Someone says I want to quit smoking. A

good clinician will say why why would

you want to do that? So say so tell me

why would you want what do you want to

get out of this because it's work. I

mean I'm happy to work with you but you

know what is it? What are your what are

your motives? And and sort of helping

them build up you know in their own mind

because again this is about them not

you. What do you get? And that's what

the therapist does. The other thing

that's really important is that like any

other anytime you're making a behavior

change hang out with other people who

are trying to make the same change. You

want to start jogging? Join a jogging

group. you want to stop drinking, I

would, you know, suggest go check into

an AA meeting or one of the other

fellowships we have. Having other people

on the same journey is good for us. It I

mean everything shows that no matter

what you're doing, I'm losing weight.

I'm exercising. I'm more whatever. I'm

quitting smoking because it gives you

two things. It gives you support, but it

also gives you some accountability. It's

like, hey, you were going jogging and uh

Tuesday, you weren't there. What's up?

Are you going to be part of this group

or not? And that is uh helpful for

people. Welcome to the Huberman Lab

podcast where we discuss science and

science-based tools for everyday life.

I'm Andrew Huberman and I'm a professor

of neurobiology and opthalmology at

Stamford School of Medicine. My guest

today is Dr. Keith Humphre. Dr. Dr.

Keith Humphre is a professor of

psychiatry and behavioral sciences at

Stamford School of Medicine. And he is

one of the world's foremost experts on

addictive substances and behaviors and

how to overcome addictions of all kinds.

He is also an expert on how science,

commercial marketing, lobbying, and the

legal system interact to create what are

called addiction for-profit businesses.

The alcohol, food, and opioid industries

come to mind as just a few examples of

these, and he's an expert on how all of

that shapes things like legal policy.

Today we discuss all the major

addictions to give you the most

up-to-date information on alcohol,

cannabis, opioids, gambling, and much

more. Dr. Humphre gives us the unbiased

facts, and more importantly, he explains

how to think about the health risks of

any substance or behavior in a logical

way. For instance, while it may be true

that a certain amount of alcohol could

afford you some heart health benefits,

we hear this, then we hear it's not

true. It goes back and forth. He

explains that any heart benefits that

exist from alcohol are greatly offset by

the increased cancer and other risks of

alcohol. And with respect to cannabis,

he explains who may be okay to use it,

but who should absolutely not. We also

discuss the most effective ways to get

over any addiction. That includes

alcohol, pornography, stimulants, and

much more. As you'll soon see, Dr. Keith

Humphre is no ordinary scientist or

psychologist or addiction expert. He has

the big picture on addiction and what it

means to try and navigate life nowadays

in an ocean of addiction forprofit

marketing and confusing health

information. I assure you that today he

doesn't tell you what to think or what

to do about various substances and

addictive behaviors, but rather how to

think about them and in doing so how to

avoid and overcome essentially any

addiction. It's a powerful conversation

that I'm certain will help millions of

people make better decisions. Before we

begin, I'd like to emphasize that this

podcast is separate from my teaching and

research roles at Stanford. It is

however part of my desire and effort to

bring zero cost to consumer information

about science and science related tools

to the general public. In keeping with

that theme, today's episode does include

sponsors. And now for my discussion with

Dr. Keith Humphre. Dr. Keith Humphre,

welcome.

>> Good to meet you, Andrew. Addiction is a

big topic but I think for a lot of

people it gets slotted into one small

drawer. Uh but if we were to compare it

to say mental illness many many things

depression manic bipolar OCD and on and

on. How do you parse this thing that we

call addiction in thinking about how

best to possibly treat addiction

especially when it comes to trying to

treat addiction in mass at the level of

policy which we'll also talk about

today. So uh put simply how do you frame

addiction uh and how should people think

about it?

>> Yeah it's hard because it's a word

unlike say you know maybe it's a little

like schizophrenia where people say like

ah you know schizophrenic person what

they actually mean is you know he's a

person with different moods and that

sort of thing. addiction is even more

like that. It's in common parlance.

People say, you know, I'm addicted to,

you know, you know, uh, a TV show or I'm

addicted to my my phone or that sort of

thing. But, you know, it's not just

stuff you do a lot, uh, you know, which

we sometimes, you know, colloally call

addiction. It's the persistence of doing

something that is harmful. So like the

classic animal study, you know, is, you

know, James's old study with rats done

in the 50s showing that you could give a

a rat uh uh the opportunity to give

itself brain stimulation, which they

enjoy, and that they would continue to

do that even as they were starving to

death next to a pile of food pellets or

or run out of water while they were next

to water. That is what it was. It's not

the doing the things over and over or

even being compulsive about things. It's

doing them to the point of destruction

when you would normally, you know, any

other behavior you would think, well,

you would just stop doing that. But

people don't and that's the sinquan of

addiction.

>> I've tried to uh create a definition for

addiction, which is that it's a

progressive narrowing of the things that

bring one pleasure that it doesn't

happen all at once. Like someone doesn't

take heroin once and then stop doing

everything else. It's a tends to be

progressive. I suppose it could be

overnight, but um is that true? I'm

happy to revise the definition.

>> No, that that is true. So, you see um

the other types of rewards, particularly

natural rewards, start to fall away from

the person's life. So, I'll sacrifice,

you know, my relationship with my my

parents or my my spouse or my friends. I

will stop going to work when I, you

know, which uh would normally generate

the things I needed to to eat or I'll

I'll give up my housing for the sake of

this substance. And then you become not

only more physically dependent on it,

but essentially you're psychologically

dependent on it because it's the one

thing left that is still rewarding.

Everything else has been stripped away.

And that makes it easier to understand

why people would still hang on to it in

that situation when it feels like it's

look, it's the only time I feel good is

that that moment when I take that hit.

These days there are a lot of industries

that are um addiction for money

basically industries and we're going to

talk about all of them.

>> Nicotine, alcohol, cannabis, social

media, all of these. Um but for the time

being, do you think that there is truly

something to the quote unquote genetic

bias for becoming an addict? And is it

very substance or behavior specific?

>> Um let's start with maybe alcohol for

example. Yeah, that's a great question.

So, let let me start by just um getting

rid of one myth where we say people are

born addicted. You'll sometimes read,

you know, uh if if mom was addicted to

fennel, then the baby is born addicted.

That is not possible because, you know,

a a fetus has no association between

their behavior and the exposure to the

drug. So, they can be physically

dependent, meaning they'll go through

withdrawal upon birth, but they're not

they're not addicted. But you can have

risk from birth in your genes. And those

those shared the estimation of you know

how much of that shared it's actually

quite a bit. You know we look at studies

where kids were adopted out of families

with parents who you know were addicted

to alcohol. Much higher likelihood of

developing an alcohol problem even if

they were raised by tea toters for for

example. How big is that? You know it

varies across you know studies. It

varies across uh substances but it's

large. It might be like you know 3

point4.5

uh for for most of them and you know you

you can imagine that the same gene some

might be specific and some might be more

general. So here's an example of a

specific one. Um, if you are born into a

group like Honchinese are and you lack

the enzyme or don't have much of a

particular enzyme that is used to

metabolize alcohol, it is just a less

enjoyable experience to drink.

>> You, you know, you can't break it down

acetal alahhide and acetic acid and all

that sort of thing. And so that one is

but that would lower your risk for

anything else but at least specific for

alcohol. But other genes for things like

impulsivity

um that that would put you at risk for

you know across substances being

sensation seeking um you're going to try

more drugs that means it's more likely

that you know you're going to get

exposed to one another thing we see

happening which is really fascinating

and poorly understood I've I of course

know doing what I do lots of people are

in recovery and I've uh known people and

had people in my studies who have been

say clean and sober in their you sense

for 20 years and then all of a sudden

they develop like a very strong sexual

compulsion or they gain 30 pounds

because they're just eating and eating

and eating and it's like, you know, the

the underlying diiathesis, whatever it

is, has found a new phenotypic

expression because it was never actually

resolved. What was resolved was the

particular set of behaviors that went

with the addictions they had when they

got into recovery. When it comes to

alcohol, I've heard it said that there's

a subset of people with um I guess

nowadays they call alcohol use disorder.

Can we just call it alcoholism today?

Sure.

>> Okay. Sometimes people will lash back at

me if I call refer to someone as an

alcoholic. But I have enough friends who

are alcoholics. That joke is only on

them by the way who are recovered. So I

can make the joke um because they're

impressive recovery uh stories and they

all just say just call it what it is

which is alcoholism. There's just so

much splitting of names now. Are you I

don't want to put you in a position of

saying something that's gonna offend

anyone whereas I I can do that.

>> This is worth getting into. So use

disorder is a much broader spectrum

thing. So you know when when you if you

diagnose them with alcohol use disorder,

it can be mild, moderate or severe. And

the people at the mild end, everyone at

AA would laugh at, you know, this is a

person who occasionally drinks too much,

has some harms, but basically life is

still put together. They would, you

know, and people would be like, you got

to be kidding me. that's that's your

problem. It's only when you get up to

the severe end where we we see the

things that it looks like addiction. So,

they aren't they aren't actually the

same thing. Addiction and use disorder.

Use disorders is broader. And it was it

was there to sort of

>> um move alcohol like other health

behaviors that you might start

addressing particularly in like primary

care. So you know just like we would

like you know doctors to intervene when

someone is 15 pounds overweight and has

moderate high blood pressure so that you

they don't you know later you know

develop a more serious problem. That was

the idea well let's have you know a

lower severity problem that a doctor

might while the person still has a fair

amount of control advise you hey you

know if you could just cut back a bit

now you could avoid a lot of suffering

later. That's where that came from. But

I'm I'm comfortable talking about

addiction. It's a good word. It's

scientifically meaningful and it's

something the public understands.

>> Yeah. And if you go to an AA meeting, uh

they go around the room saying, "I'm so

and so and I'm an alcoholic." They don't

say, "I'm so and so and I have alcohol

use disorder."

>> Oh, that's right. Yeah. So many people

who have who are in recovery um define

at some level of their identity, not

their total identity, as an alcoholic.

It's actually an important part of the

12step recovery process, which we'll

talk about. In any case, not to split

hairs here, but I'm grateful that you're

willing to embrace that nomenclature.

And thanks for clarifying that why it

was split. Um, because sometimes these

clinical uh and naming things are split

because of quote unquote sensitivities.

We don't want to offend etc. And we

don't want to offend. Okay. So, alcohol.

Um, I've heard it said that there's a

subset of people somewhere around 8 to

10% for whom they they drink alcohol and

they experience it very differently.

They experience it more as a, for lack

of a better term, kind of a

dopamineergic, you know, energizing

experience for um, and this could relate

to tolerance, but that they have a very

different experience subjectively of

alcohol than most everybody else who can

build up tolerance. anyone can build up

tolerance. Um, and then it takes longer

to get into the sedative effects, the

depressive effects of alcohol, but I've

heard it said that this 8 to 10% are

particularly susceptible to becoming

alcoholics because they drink and they

feel spectacularly good and they can

keep drinking in a way that many other

people either pass out, blackout, crash

their car, end up in jail or dead. And

so in some sense this 8 to 10 percent

may be at greater risk than everyone

else.

>> Yeah. So uh Mark Shookett who's a superb

psychiatrist was based in Southern

California for most of his career did

some wonderful studies of male uh

children of alcoholic fathers. And one

of the things he showed is that when

given alcohol, their body sway is less

at a level you can't even perceive, but

he couldn't measure that, you know,

yeah. Like how much they moved, like how

how hard the alcohol hit them.

>> And they had uh fewer hangovers the next

day. And then you might think, well,

that's great. It doesn't hit you that

hard, but you know, you can drink a lot.

Like, no, that's the problem because

someone else would get the signal of

like, whoa, I I you know, I'm feeling

kind of dizzy here. I must have had too

much to drink or the next morning they

get up and go, "Oh god, I'm never doing

that again." They don't get that signal.

It's, you know, less less punishing,

more rewarding. And you see that across

drugs. Uh, and this is almost surely

genetic. Um, how much people like

different drugs, you know, varies

enormously. I I'll be personal about

this. So, I uh, you know, had an injury.

Uh, I broke my, you know, I I had to

take Vicodin for the pain afterwards. I

find taking opioids so unpleasant. I

feel bound up, you know, miserable,

groggy that I just took one and said,

"Pain is better than this."

I have worked with people clinically who

say the first time I had an opioid, it

was like a hole in my chest that had

been there my whole life filled up for

the very first time. That has everything

to do with genes. There's no, it's not

due, there's no learning history there,

right? But there's something, you know,

I'm just wired differently for that

particular drug than people who get in

trouble uh with it is. And these don't

necessarily go in groups. So someone

can, you know, hate opioids, but you

know, love cannabis or love alcohol. Um,

and that of course is going to change

their their risk. How could it not?

>> This is such an important point, and I

didn't realize that it extended to

things outside of alcohol. uh because

oftentimes when a discussion starts to

surface about addiction and whether or

not zero is better than any, whether or

not things can be done in moderation, I

think this is actually a big um unspoken

point of friction because some people

really can drink five or six drinks.

>> Oh yeah.

>> And then the next day they're at work

hammering away and they're going to say,

"Listen, my life's going great."

>> Yep.

>> And you know, liver markers are still

within range. Eventually they'll

decline. you know, they'll get worse,

but the conversation becomes very

difficult to have because it's high, it

sounds like it's highly individual how

people will react. And there are the

behavioral impacts. Like for instance,

um I've heard the statistic that one of

the greatest risks for becoming an

alcoholic is if your first drink is

before the age of 14. So I find that

some people will, you know,

have their first drink like you said and

it's like a magic elixir for their

physiology. And there are very few

things that can get somebody like that

to stop drinking except the risk of

losing everything and sometimes even

then.

>> Sometimes even then.

>> And so maybe alcohol is the best, you

know, template for for talking about

this because it's socially acceptable in

most places for adults anyway.

>> It's legal. It's marketed.

>> It's legal. it's marketed and um and yet

how does one know whether or not they

have a predisposition

um because those people might want to

avoid using something because our

colleague Anna LMK has said that um you

can't get addicted to something that

you've never done or taken.

>> Yes, that that is the most helpful

advice, you know. So I I can never tell

you if you know in this game of Russian

roulette, the bullet will not be in your

chamber for sure. You know, I can say

like you're less likely for this, more

likely for that. But the only way to

determine that a substance will not

damage your life is to never use it in

the first place. There's always going to

be some some risk. There's been a lot of

work on like kind of genotyping to try

to figure out could I tell you tell

people, you know, what their genetic

risk is for alcohol. And nothing is as

good as just saying your parents

alcoholic yeah or no. And if they were,

that's like the most useful bit of

information. or does you know does

problem drinking run in your family?

That kind of is crude to question as

that is that's more useful than anything

we have from snips or anything like

that.

>> Does it cross sex? So like if if a a

daughter uh um has a father who's

alcoholic, does it cross sex as readily

as it goes from say father to son or

mother to daughter?

>> Uh no. I mean there is there is still

risk there for sure, but the father to

son link is the is the strongest one you

see in in genetic studies. Now, of

course, there's in a sense it's hard,

right? Because men drink more than women

do. I mean, in in our culture anyway.

And and they drink to excess more than

women do anyway, whether they've got an

alcohol problem or not. So, if you think

this is some sort of unfolding process,

right, then men carrying risk would be

more likely to have that risk realized

through the behavior than a woman would.

Well, there's still a fair amount of

women who don't drink or or drink, you

know, hardly any. food. So, it's sort of

like the thing if you, you know, if you

had all the genetic loading for cocaine

in 1800, it didn't matter. There was no

cocaine. If you had all the genetic

loading for alcohol and you've never

drank, then it's really irrelevant.

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Women are drinking more or less now.

Women, unfortunately,

um you know, in the late 90s, early

odds, the alcohol industry figured out

that uh women had more money and but

they weren't drinking the way men were.

So they uh engaged in a long-term

campaign to try to increase women's

drinking. So things like, you know,

mommy mommy wine juice and those wine

wine mommy wine chats online and all

that that was really engineered by them.

Even some of the ones that look organic

online were engineered by the industry

and it worked. Women's drinking went up

a lot. Um and the damage per drink is

more for women for most things than it

is for men for partly due to body size

but also partly probably due to some

hormonal things. And so it's been you

know a exploitation as I see it you know

of women and I notice a lot of young

women now like undergraduates I talked

to re-evaluating that like looking at

their mom's experience and saying you

know I don't think I want to do that and

I I'm really encouraged by that. I not

not that I want to control you know the

decisions we make but I don't want them

making them just because the industry

slickly marketed to them um because the

industry's sole interest is always going

to be to generate profit and you do that

with addiction because you know

something like what 10% of our country

drinks about half the alcohol so you

have yeah you're shocked yeah

>> 10% of the country drinks alcohol

alcohol right United States so if you're

running the industry you want that group

to be as big as possible you do not make

money off people who have a, you know,

half a bottle of wine on special

occasions. You make your money on the

people who drink drink the equivalent of

multiple bottles of wine every single

day. So you have a fundamentally these

industries, the more addiction there is,

the the better off they do financially.

>> Wow. There's a lot there. The statistics

say that drinking is at an all-time low

in the United States right now. At least

>> some statist Yeah. Yeah. statistics

something seems to have changed and and

this may have something to do with this

new generation.

>> You know there there's less risk

behavior in lots of things on you know

over the last 10 years. So uh you know

less uh you know cutting class less uh

less chance of uh dropping out of high

school u fewer unwanted pregnancies all

that stuff. So there is that generation

will probably be a drier generation than

their parents were.

>> Is cannabis use higher in that group?

Everyone likes to just default to well

cannabis is up so alcohol is down

implying that you have to do something

that people have to be using some sort

of mindaltering substance.

>> Yeah. With the legalization of cannabis

um we certainly have seen a lot more use

and a lot stronger products but youth

use really has only changed pretty

slightly. So the growth has really been

among adults including adults who

probably stopped at some point and have

now gone back in later life to uh using

cannabis. We'll get back to cannabis,

but I want to um parse the alcohol stats

a bit more also as it relates to uh to

women.

Maybe we can just either put to rest or

not this argument that some amount of

alcohol, typically it's red wine is

couched this way, is more beneficial for

you than not drinking at all. My read of

the data, and we covered this in a long

episode on alcohol a few years ago, was

that zero is better than any. And that

two per week, two drinks per week, and

that's getting very specific about

ounces for, you know, spirits versus two

per week is sort of the upper limit for

adult non-alcoholics that um don't want

to incur any additional health risk. Um

the cancer risk very clear the uh

disruption to sleep which probably

cascades into other things inflammation

etc. But is zero better than any is too

safe for non-alcoholic adults because

every week it seems I see a new article

that says zero is better than any. No

wait it turns out there's some benefit

from two drinks per week and I'm getting

frank I'm not tired of it but it's

almost getting funny.

>> Yeah. the extent to which the uh it's

traditional media, not to poke on them,

but they just keep flip-flopping. And

then the questions that always come up

are, well, did the alcohol industry sort

of encourage this study? Because if

we're honest, there's a lot of

advertising of alcohol in traditional

media outlets.

>> Oh, absolutely. So, uh, statement

against interest because I like red

wine. I would love to believe it is

healthy. It's not. Uh and the whole

thing about red wine per se by the way

was never made any sense like why would

there be a benefit to red wine that

wasn't you know in other alcoholic

beverages right and it came from a

60-minute story I think it was in the

'9s was about why do French people why

do why why do Mediterranean the red wine

red wine cells exploded you know you

know this is so great

>> resveratrol was an argument

>> yes that's right you know there's such

trace amounts that just like ludicrous

you know in a grape skin um and so that

was just spread and it was just so great

for the industry it's better for you

than not drinking. Um, and you know,

that's just not true. Uh, you know, it's

it's um when you look at they would look

at studies and say, well, look, you

know, the the the non-drinking group

have higher mortality than the low

drinking group and the famous called the

J-shaped curve, you know, like that.

Problem is non-drinkers include people

who are like in alcoholic synonymous.

That's why they don't drink. They had a,

you know, a wretched experience with

alcohol. And so, um, you know, they had

they've had different kinds of damage to

their bodies. Maybe their health is

isn't as good. They're not going to live

as long, but it's not that they would be

better off if they went back to

drinking. They would things would would

go to hell basically for them. And, uh,

that just got, you know, marketed and

and and spread. And it and it's not

true. There might be some cardiac

benefit, okay? But, you know, we don't

we don't get to, you know, live our

lives as single organs. We have a whole

body. You have to weigh that if that is

true. And it is wobbly. If that's true,

it's smaller than the cancer risk. So

your net is you're not going to get any

mortality gain from mortality reduction

from drinking alcohol. If you have two

drinks a week, and by a drink I mean

like a 12 ounce beer, uh a a 1 oz shot

or a uh a glass of wine, a 4 oz glass of

wine, you you have slightly higher risk,

but it is very very very small. And you

know, it's not the kind of thing if I,

you know, if I were giving health advice

to the country, that would not be on my

top 10 things to be, you know, really

frightened about. I think it's it's very

small. It's just not good for you.

That's what science has overturned the

industry message that this is will

extend your life and you'll be more

healthy if you drink than if you don't.

There's there's no way we can establish

that as being true. You said it very

clearly, but I'm going to um just repeat

it because I think it's super important

for people to take note of that the

cardiac benefit is less than the cancer

risk. And I think that's a very

important way to view these stats. The

episode that we did about alcohol um

had a lot of different responses. U

there's obviously a selection bias in

the responses. Many people gave up

drinking who I later learned wanted to

quit drinking. They didn't like it. the

downstream effects of the disruption to

sleep from alcohol and so on. Probably

part of the effect. Um it was very

interesting as it relates to women

because um many people including some

members of my family really like their

post-work glass of wine or want a drink

to just kind of mark an end to the day

and and relax. Um

my observation was that many women who

stopped drinking

either because of that discussion about

alcohol or others that they had heard

did so when they learned that women have

a particular risk to cancer as it

relates to alcohol meaning if the breast

cancer risk and other hormone um

>> ovarian cancer hormone related cancers

and so forth not always hormone related

but the moment it move that the it's

probably best to avoid alcohol entirely

conversation moved into women's specific

health. It had a a very potent impact.

Uh which is interesting in its own

right.

>> Um and it speaks to what's perhaps

required to override some of the

marketing because let's be fair, it's

nice to relax with friends. And if

people think relaxing with friends is

easier to do over a glass of wine or

two, then that's a great not just

marketing scheme, it's also somewhat

true for them until there's counter

evidence. And so what I'm really getting

at here is, you know, how is it that

people should frame what they know to be

risky versus the other benefits of

alcohol that clearly exist like helps

people relax. Um it's social, they

stress less

>> and so on and so forth.

>> You know, as I mentioned, I'm someone

who drinks wine and I know that it is,

you know, on average, you know, it's not

healthy. Um why do I do that? It's like

well because it creates other things

particularly with exactly that situation

that you know uh getting together with

friends is enjoyable uh enriching good

food is enriching good food and a and a

good wine tastes good uh and I value

those things and there are many other

decisions we make like that where we

endure some risk because uh we care

about something else. you know, it's

it's dangerous to, you know, for for

someone my age to, you know, hike up a

mountain side probably. Um, but, uh, if

if the view is spectacular, I can I say,

I'm going to accept that risk. You maybe

I'm more prone to twist my ankle or

something, but this is just really

beautiful. That that's okay. I think I

think what the place we got in alcohol

that was bad was needing an explanation

to stop. So, how often have you ever

said to someone at a party or seen

someone say at a party, "Why are you

drinking?" I've never heard that, but

I've certainly heard a million times,

"Why aren't you drinking?"

>> If you don't drink at parties or you

refuse an offer of alcohol, people think

there's something wrong with you.

>> Yeah. And you have to have to have an

explanation like, "Well, I I got a exam

tomorrow morning or uh I've got a cold

or or or something." It's like, you

shouldn't need an explanation. Um, but

people do feel feel that social

pressure. And so that's one way health

information can work. Why didn't a

person just quit beforehand because they

may not have had an explanation that

worked in their uh their circle and now

you can say well you know I I see those

data on uh you know ovarian cancer and

uh you know I just I decided to quit

drinking. Um and you know that is you

know health is a reason people still

accept I think as a uh legitimate for

changing behavior. you can make that you

know because you know cancer is scary

and that may be why uh people quit. Um,

you know, same thing happened when, you

know, first surgeon general smoking, uh,

thinking about everybody smoked. You had

to to sort of fit in at work, you had to

smoke. And when that came out, there

were a lot of people who just quit

immediately. They clearly were capable

of quitting, wanted to quit, but they

needed some exp to tell everybody, why

are you not smoking anymore? Why can't

Why don't you carry cigarettes anymore?

I can't bum one off you anymore. It's

like that that's why.

>> Why do you think people who drink uh

feel uncomfortable about people not

drinking around them? When people would

ask me uh if I wanted to drink and I'd

say no and they'd say why. They often

say that I would say the truth which is

I'll say anything that's on my mind

without drinking.

>> You don't want me to drink cuz then I'll

tell you everything that's on my mind.

>> Oh good.

>> It's true. I I mean like I I will tell

people what I'm thinking. Uh I don't

need to like loosen up. I'm pretty

relaxed in social settings. I don't have

much social anxiety, but I realize some

people might have trouble with social

anxiety.

>> Yeah. You know, I I I spent a little

time in Japan when I was a young man and

there's this, you know, culture of

getting going out after work like the

salary man go to work and and someone

getting really really drunk and

everyone's drinking and you're

vulnerable with each other and you and

then you know that I will I will it's

like a trust exercise like that falling

backwards thing except it is that we're

all drunk and if someone weren't doing

it's like why why are you not undergoing

any so we're all going to be vulnerable

and you're not and like are you going to

exploit us in some way or I'm going to

say you I think I hate the boss and then

you're going to repeat that at work

because you know you you're you're the

one person sober enough to remember I

said that. I think that is a real thing

that that people have anxiety about. Or

I can imagine you say what what if uh

you know a uh a man woman are on a date

and the guy keeps giving drinks to the

woman and doesn't drink himself like you

know what is the natural thing to think

are you trying to get me drunk? Are you

going to take advantage of me because

you you know you're going to be with it

and I'm not because I'm going to be

drunk. So those kinds of fears may be in

the soup. Um but I I don't think you

know so say maybe that's you know

rational at some level but I don't think

that should drive our sort of routine

social interaction with our friends. It

should just be a non-issue you know of

what do you want? And if you I want

sparkling water I just give you a glass

of sparkling water and don't say why

haven't you why aren't you drinking this

intoxicating beverage? You know you

shouldn't need to explain it to me.

>> The trust piece is super interesting. So

is the vulnerability piece. Um, a couple

thoughts about this and they're just

editorial thoughts, so forgive me, but

one is for years I thought how crazy it

was. I would go to these meetings with

doctors and scientists who ostensibly

were working on issues related to health

and everyone would just get trashed at

the bar

>> and I wasn't into that. Um, and I wasn't

judgmental. I actually kind of liked it

cuz by the third day of the meeting I'm

cranking and they're all just I can tell

they're all just blery and they and

they're also aging much faster than I

am. They they they would get what the

tenur look as we would call it or as I

would call it like you see them in five

years. I'm like what happened to you?

You aged 15 years. And and I these

people tended to drink a lot both at

meetings and outside meetings.

>> Alcohol was paid for often by the

meeting fees. Gets a little I'm not

trying to, you know, point a finger

here. And then a lot of the stuff that

happened at meetings that turned out

cost people jobs was always

alcoholrelated.

>> Yeah. In the instance of the the man and

woman on a date drinking or a group of

uh people at work drinking together in

Japan, it sounded like it was men

getting drunk with other men. Yes.

>> In my mental picture of the the male

female dynamic and drinking,

>> I'm going to simplify this. If she

drinks, it makes her vulnerable. If he

drinks, it makes him more stupid and

impulsive. Mhm.

>> And so in the the world where she's

drinking and he's not, you gave the

example that perhaps, you know, he would

take advantage of her if he's

encouraging it. Certainly there's that

picture in one's mind. He's also can get

her home safely. If he's drinking, he

can't get her home safely and he might

say or do something really dumb.

>> So I feel like no matter how the math is

arranged, it always ends up drinking

ends up being kind of a bad idea. I

mean, not trying to be judgmental here,

like I because I'm not I don't judge

what people do. do as you wish, but know

what you're doing is my my philosophy.

But I just don't see a world where

drinking with your co-workers or

drinking on a date with somebody that

you don't know very well, male or

female, right, for either of them. It's

just like a lack of safety all around.

Um it just seems like a bad idea.

>> As women move into more professions that

may have changed that that norm of, you

know, everybody goes out and gets drunk

because the consequences aren't the

same. and and you know I I know a lot of

you know professional women and friends

I don't want to do that you know um you

know I don't want to be around the boss

when he's drunk you know and so let's

let's have a Christmas lunch together at

work instead of you know uh drinks

afterwards so I I definitely see that I

think in the dating now of course I'm

haven't thankfully had to worry about

dating for 40 years I but what I I I

think most people would say is just the

anxiety you know is you know intense for

some people and alcohol is anxolytic

right and so it's probably that that

people are you know sort of feeling uh

you know it's just it's you know they're

too nervous you know and whether they

should or they shouldn't that's just I

think probably probably in the soup one

of those benefits people people uh care

about and there are people it has to be

said who are more socially uh engaging

when they've had a drink than when they

haven't because they're kind of wound up

people when they relax some other stuff

comes out and they may seem

uh more appealing.

>> It's interesting. We could uh dissect it

a number of ways, but I think that's

enough contour for people to be able to

think about whether or not they have a

genetic predisposition, understand that

zero is better than any. um if we hear

about some uh cardiac benefit to weigh

that against the cancer risk and not

just take it as an independent piece of

information and then to think about

vulnerabilities of um other people's

actions and vulnerabilities of one's own

actions and words uh if drinking and

then people can make an informed

decision. That's kind of how I

>> a good summary

>> how I uh feel about it. Again, do as you

wish but know what you're doing is like

the the purpose here. Let's talk about

cannabis a bit. Uh because eventually

I'd like to weave back to how industries

impact use and abuse. Um

cannabis when I was growing up was

illegal. You could go to jail for it.

>> Mhm.

>> People still smoke pot. It happened. Um

the idea was that it was much less

potent. We can talk about that. But now

it's a whole industry.

>> Yes. And the edible industry has

contributed to this greatly because it

bypasses the um the blowing of smoke um

the the smell um and a number of other

things. So what are your thoughts about

cannabis as something that can be used

quote unquote recreationally,

medically,

and its potential for abuse?

and then let's talk about how those

things have been amplified or reduced by

the fact that it's essentially legal or

decriminalized.

So what are your thoughts on cannabis?

>> Yeah, so I whenever we talk about I I

make a distinction between sort of old

and new cannabis. So, you know, if you

go back to the 80s and 90s, uh, when, as

you mentioned, it was illegal

everywhere, the THC content, that's the

principal intoxicant, would be, you

know, 3, four, 5%, something like that

on average. And now, you know, studies

of legal sales show the average product

is about 20%. So, it's dramatically

stronger. The other point is how people

use it is different, perhaps related to

that high potency. uh Jonathan Caulkins

uh pulled together a lot of really

interesting data that got a lot of play

and it showed that about 40 I think it's

42% of people who use cannabis use it

every day or almost every day that is

also different so back if you go back in

the past you know the more modal user

might have been once or twice a week so

you put those things together some so

you take somebody you know what was like

an 80s pot smoke well on weekends you

know I'd smoke a joint at you know 5%

but now if it's means every day I'm

consuming 20% % you quickly realize like

their brain exposure is dramatically

higher about 65 times higher uh between

the modes of those two two uh

experiences and what you know what so

what is 65 times mean well it

coincidentally is also the potency

difference between a cocoa leaf and

cocaine that is that is 65 times two so

it's a big difference and as you know

you know you know dose makes the poison

so so it is a just a really different

drug than what was back there and this

is very hard to get across to parents

because their view is like ah I smoked

weed you know is is is you know who

cares if my you know 15-year-old is

using it. It's like but that's kind

saying you drank low alcohol beer and

you're not you're you're not concerned

that your 15-year-old is guzzling vodka.

That's that's kind of the difference and

it's just a bigger deal than it used to

be. Even when you take away the fact

that you have an industry really pushing

it just the drug is stronger, more

addictive. Does it have any uh medical

applications? Almost surely you know the

canabonoid receptor system

evolutionarily is you know one of the

oldest in the the uh in history of homo

sapiens. It is both in the brain but

it's also in the body. There are clearly

going to be some applications for pain.

Um you know you know there's many people

would say they spontaneously get relief.

It's hard to tell always what that means

because sometimes that's just relief

from withdrawal, but but you know,

probably some some type of medical

applications for pain will come out of

this plant. We do have some out of the

CBD, which is the non- intoxicating part

is a medication that is used uh in

seizure disorders in kids, you know. So,

there'll be some other things like that

for sure. Um and you know, you know, the

it's easier to study this than has ever

been before. um you know that um about

2020 Congress changed the way uh

research works. So it's a lot a lot

simpler to to uh do it. So we we'll

we'll figure those things out. Um but it

is just a more a more dangerous drug

than it was, you know, when I was a

young person.

>> I had a guest on the podcast uh who's a

cannabis researcher, runs an animal lab.

Um and we invited him on because I had

released a solo episode about cannabis.

We touched on some of the risk for

psychosis. Yeah.

>> In uh young men um and made some points

about frankly concerns about cannabis

because of the high THC content. Uh he

was not happy with the things I said. He

made that clear on social media. So um

by the way, this isn't the way to get

invited on the podcast, but we invited

him on and I I think we had a very

fruitful discussion where he clarified a

few things for me. And one of the things

that he claims uh is that despite the

higher THC content that there's a

distinct difference between smoked

versus edible cannabis whereby people

who smoke cannabis even the high THC

cannabis um are very good at gauging the

kind of level of high so that they don't

go into paranoid modes. they don't

surpass the the plane of high that would

make them feel paranoid or um put them

into a psychotic episode, but that

people who take edibles because it's

harder to gauge where you're at if you

can just swallow an edible or even

nibble on an edible um often surpass the

level at which they would be

comfortable, meaning at which there's a

psychotic episode or there's paranoia.

So he was making this kind of um soft

argument for the fact that the elevated

T THC levels in cannabis are not such a

problem because people are essentially

taking less to offset the the

difference.

>> Yeah, I think there's no evidence for

that at all. In fact, and and uh people

are surprisingly bad, even experienced

pot smokers at judging in lab studies of

like how strong different cannabis is. I

don't agree with that part, but I do

agree we should think about the edibles

differently because of the onset is

different through the gut, you know. So

when you smoke anything you know you get

that that goes very efficiently you know

to the brain but when you eat something

you know it takes a while you know to

have its effect and so

>> particularly when these products came

out and a lot of people were uh new to

them they would uh you know bite down on

you know one piece of the whatever the

bar the cookie or whatever five minutes

later I feel the same take another bite

still feel the same and then just eat

the whole thing and then it would all

hit them like like a train. And you know

that that does happen. The other thing

that is true is that a lot of these uh

products are not wellmade or they're not

up to like the standards of like you

would have a cookie. You would you would

never open up a bag of chocolate chip

cookies in the United States and find

all the chocolate chips at one end and

just dough and the rest. But that does

happen with cannabis products in legal

markets. And so if you just bite on the

wrong part, you're getting the, you

know, the whole enchilada, so to speak.

um that because it's not evenly blended

through and there are some people who've

gotten gotten into trouble uh on that as

well.

>> Interesting.

What about the psychosis risk?

>> Yeah. So, I was very skeptical of this

literature for years. Not not to say

that the science was bad, but just like

it seemed to me there were lots of ways

to explain it. Um, and I'm a lot less

skeptical now, candidly, because, you

know, in the in the old studies, they

would be there men who had used cannabis

in teen years and then they would have

higher rates of of uh psychotic

disorders in adult. These were studies

based on like Swedish uh registries

because everybody has to register for

the uh the military, you know, um and um

they would track people and it's quite

amazing data. So it is a whole national

data that's good but there's lots of

reasons that could come about you know

could be a common factor between those

two things um you know but um the

evidence has gotten stronger as the drug

has gotten stronger and again we got to

got to realize people are using it um

much more intensely. So if this effect

is there it's much more plausible that

it would be from a much stronger drug

used you know every day could generate

higher rates of psychosis. It's hard to

test this because it's a rare thankfully

condition, but I think there is, you

know, probably something there. I am sad

to say. I wish it I wish there weren't,

but there probably is something there.

Um, I would not use cannabis if I had

any first-degree relatives with any, you

know, schizophrenia, schizoid

personality, anything in the psych

bipolar disorder. I would not personally

uh recommend that for anybody. I think

that's probably uh probably quite risky.

>> What about the cardiac risk and other

health risks? I've heard recently that

there's a direct risk of cannabis even

if it's not smoked or vaped uh on

cardiac health.

>> I'm not sure of that of non-smoked

cannabis in the heart. I mean, I haven't

looked at that literature, so I don't I

don't know the answer to that. Um I

realize there's some one point uh I

should touch on that you also raised

earlier about first drinking which is

everything is different when the brain

is plastic and our brains are most

highly plastic um you know when we're

young and so a lot of these effects the

worst things are going to be because

people start when they're in teen or you

know late late single single digit.

That's where addictions overwhelmingly

start. And that is where if there is a a

psychotic risk, it's almost surely then

during that period of brain development

before people get their first psychotic

break, which tends to be around 18, 19,

20, 21. I worry about it less for

anything. You know, initiating a

substance when you're 50 is far less

likely to end you up with an addiction

or some other terrible thing than uh

when you're young.

I'm sure everyone knows at least one

person or or has heard of one person

who's uh very productive in their life,

healthy family, job, etc. Um high energy

who uses cannabis. Um in my observation,

they are the rare exception. Um and

there are a lot of examples of people

who use cannabis who um don't really go

anywhere in life. They they don't go

through the normal developmental

progression of finding a job that can

sustain them, right? Of

organizing their life, their

relationship life, their professional

life. And clearly there are other

aspects to life, but those are key ones,

right? And um what are the data on high

THC or just frequency of cannabis use as

it relates to life progression? Failure

to launch we call it now for typically

it's guys that young men that fail to

launch. Um

>> and I want to be clear uh not for

political reasons but I want to be clear

when I say fail to launch. I don't mean

that every kid has to go to college and,

you know, be a, you know, a varsity

athlete or any of this, but just moving

out of one's home eventually, getting a

regular job, keeping the job, hopefully

having healthy relationships of various

kinds and being self- sustaining. That's

what I'm talking about.

>> Yeah, absolutely true. I mean, for

example, I did Ezra Klein show. He's

obviously a very successful guy and he

mentioned that he sometimes uses

cannabis edibles. I mean,

>> he has that look. No, I'm just kidding.

Sorry, Ezra. Just teasing. Yeah. I mean,

so yeah, there's and you know, you could

there are very very very successful

people who use cannabis for sure.

Overall though, I mean, I'll steal a

phrase Caulkins. It's like, you know, we

have performance enhancement drugs. It's

kind of a performance degrading drug.

So, it's not it's not fentanyl. you

know, your your your odds of your death

being directly tra traced to it are

extraordinarily low. But it does with

regular use undermine certain things

that you need to succeed in the modern

world like short-term memory and

concentration and being able to keep

track of details. And for some people

also, it it undermines their sort of

motivation to do much of anything. I

mean, the couch lock is a real thing.

Um, you know, I I know families in Palo

Alto, where I'm from, very achiev

uh, you know, a straight A son, you

know, doing everything, starring on

sports, whatever, who, you know, 6

months later was just smoking cannabis

all day and had no interest in the team

he used to star on and the math he used

to be great on. And like, that's that's

pretty frightening. And all those things

are not conducive to succeeding in in

again in a modern world. If maybe back

in an agrarian society, it didn't matter

because we you know everything was on

muscle power, right? Um but you know to

succeed in in this society, you have to

be able to do those things. And and you

you are in competition, you know, if you

want a job, you know, computer coding,

you're you're in competition not just

with the smartest kids in your

neighborhood. you're in competition with

the smartest kids who are in Mumbai, you

know, and and in Tokyo. And if you can't

focus or you're just slower and you

can't remember things, um or you have

trouble like making sure you uh keep

track of time, um that is going to put

you at a disadvantage. uh and and uh you

can end up that stereotype of you know

living in mom's basement that

unfortunately is true of a a chunk of

people who are heavy users of cannabis.

>> Yeah. I worry a lot about examples of so

and so is very high achieving and they

use cannabis. Um I had a friend growing

up who desperately wanted to be a

professional golf player and he would

cite all these professional golf players

who were heavy drinkers. He ended up

just being good at the heavy drinking

part. Yeah.

>> Um sadly, um I think he turned his life

around at some point. But these examples

of people who can use very addictive

substances and are open about that and

are very high achieving. I think there's

a there's a real detriment to that

messaging. Now, of course, you don't

want people to cloak their reality, but

it's it's complicated.

>> Yeah. And and it also has policy risk,

too. I mean, you know, when you make up

the rules, uh, you know, you know, your

laws and regulations to to think, well,

you know, I'm I'm accomplished. I I'm

able to use this, so that must mean it's

pretty safe. It's like, that just

doesn't follow logically. The fact that

you occasionally, you know, take a snort

of cocaine or whatever, and and you're

still a state senator. Uh, that doesn't

prove that that would be safe for

everyone. And, you know, we we know

people have different levels of risk.

They have different social capital. they

have different incentives in their lives

and um you you can't overgeneralize from

a sort of a lucky life or a costed life.

Sometimes you can do more of that than

you can when you know there's not many

uh you know uh nets sort of between the

person and the you know and the ground.

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>> one of the members of the Kennedy

family. it wasn't Robert Patrick

Kennedy, excuse me, who's been very open

about his own recovery and so many gems

in that talk. We'll put a link to it and

we'll touch on some of those things

again, but just as such an important

conversation.

>> Um, and you know, it came up in that

discussion that many industries are

industries of addiction, alcohol,

cannabis, gambling. Nowadays, I was

thinking about what you guys were

talking about. And nowadays, it's very

difficult to look at any industry and

not see it that way at some level.

>> They talk about it themselves that way,

you know, they they'll if you get

together with app developers, they'll

say, "How do we make this more

addictive?" You know, so it's it's and

it and it is good for business. There is

no customer like an addicted customer.

So, of course, that's going to be

appealing if you're trying to sell

something. I guess the question is

healthy addictions or adaptive

addictions or things that fall outside

the progressive narrowing of the things

that bring you pleasure because a kid

getting quote unquote addicted to a

learning app

>> uh that carries over into a number of

things one hopes um in school and uh or

even social media. I've learned a lot

from YouTube videos. Heck, I even

watched that YouTube video of you and

Patrick uh you know uh uh on YouTube. So

there's this double-edged blade piece.

Uh, but when it comes to alcohol and

cannabis, what you told us earlier, like

getting women to drink more by making it

seem like an important part of being a

woman in the United States to drink.

>> Yeah.

>> That sounds diabolical.

>> Yeah.

>> Convincing people that cannabis is going

to make them more creative and it's not

as bad as alcohol, that to me is very

diabolical. And I and I worry about

this. Well, it's not as bad as alcohol

argument because I mean shooting

yourself in the head is way worse than

stabbing yourself in the head.

>> Well, alcohol also kills, you know,

about 150,000 Americans a year. So, if

that's our bar, we should have hand

grenades in the drugstore there. You

know, that killed tens of thousands but

not 150,000. You know, we should

legalize drunk driving because, you

know, that only kills 10,000 people. I

mean, that's just a crazy thing to set

as the well, as long as it kills less

than 150,000 people a year, it sounds

great to me. No, that doesn't make any

sense. I mean, I I am clear like

economically I am a capitalist. I'm glad

we have companies. I love living in

Silicon Valley. I love all the things

people create there. And um and I think

that is an important part for society to

work to have a private sector. Um and at

the same time, you have to regulate

addictive uh goods. temptation goods

very intelligently and tightly because

you can't count on the sort of rational

consumer to protect themselves like you

can when you're dealing with cabbage or

lettuce which nobody ever overdoses on.

But we do see people burning down their

lives over all these drugs. And for that

reason, you know, to pro to protect

those people, but also to protect the

rest of us from the consequences of

that, that's why, you know, you need

things like advertising restrictions.

That's why taxes to which people are

people, even heavy users respond to

price. Um, you know, that's a really

important tool to regulate them. I would

do I would do much more with cannabis

particularly, you know, just some of the

promotion is so naked and a lot of it is

in places where kids are exposed

particularly and this has just been a

long-term fight. You know, we had it

with the tobacco industry. Almost any

nasty thing you could say about the

tobacco industry turned out to be true.

I mean, you know, they did work to make

it more addictive. They worked to defeat

uh any type of health regulation. They

were marketing to kids, all that stuff.

So, that those are the economic

incentives. And so you you you should

not be naive um if you work in this

space about what the financial

incentives are if you're making an

addictive product. More addiction is

good for your bottom line. So us on the

on the other side have to say we're

going to put in laws and regulations so

that that is harder to achieve. Never

going to get rid of all of it. But you

can make it a lot lot harder. Gambling

is a great example. I mean, I'm just

amazed that we have just given up on any

restrictions on gambling now. I mean,

when I was a kid, Pete Rose was not

allowed to go into the Hall of Fame

because he had once placed a better on

his own team. He wasn't even doing

anything corrupt, but he was he bet on

his own team would win. He was kept out

of the Hall of Fame. Now, you can't

watch a sporting event without having

gambling ads shoved in your face. Like,

that's an example of something that

should just not be the case. That is

terrible for anyone who's trying to quit

gambling. It's terrible. A lot of young

men particularly, but not just young

men, are just ruining themselves

economically over over sports gambling.

And we we did we don't need this. We we

can we can do without it. The gambling

thing is a real concern. We had a guest

on this podcast who's a self-admitted uh

gambling addict. And um

a friend of mine who treats gambling

addicts said uh it's among the worst of

the addictions because they live with

the reality. It's true that the next

time really could change at all.

>> And he said eventually they get addicted

to the shame of losing.

>> They just get so winning becomes a thing

of the distant past. I mean, this sounds

crazy to to the rest of us, but it's

fascinating.

>> Um, it's fascinating and it um and

disturbing. Um, and gambling addicts

will say that every addiction is

gambling.

>> Yeah, that's good. That's good. There's

a tremendous book uh Addiction by Design

and I'm afraid I'm going to mispronounce

the the name of the person who wrote I

think it's Schull but I'm not sure but I

know the title Addiction by Design about

gambling and she profiles people who

play video poker uh many of whom work in

the casino. They basically get paid and

then they go pay the casino back by

giving it away. But some of them will

take a toothpick and bend it and force

the bet button down and they won't even

touch it. They'll just sit there and

watch in kind of a dissociative state as

as it just runs and runs and runs until

their money is gone. You know, that's

like, you know, it's like zombification,

you know, of this stuff. And that tech

has been perfected to be addicted. If

you I do I do go to Las Vegas like once

every couple years. I just find I not

for gamma, but I just enjoy the sort of

pageantry and the food and all that. Um

it's very hard to see dealers at tables

anymore because dealers don't give the

perfect timing of reinforcement that

machines can do and you know they don't

you know you have to wait you know for

your reward and all that kind of thing

and you wait till you find out and

there's a social component. Well that

all slows down the process whereas a

machine can give you exact timing

between your press the button and then

you get your reward or or you know your

your win or your loss. Uh and you and it

can just go infinitely 24 hours a day

unlike a dealer never gets tired. And so

all the casinos like chopped up dealers

and now you're just playing with a

machine.

>> Incredible. Um I don't want to spill off

into too many anecdotes on my side. Um

but I will share uh something that was

shared by a previous guest on the

podcast you may find interesting. Um

Michael Easter is uh is at a university

out in Las Vegas and he got access to

one of these. Um he wrote the comfort

crisis about getting outdoors, getting

away from things and

>> basically carrying weight on your back

and walking as a therapy of sorts. Um an

important one to do regularly. Um but he

got access to one of these uh research

casinos.

>> And it turns out that

>> slot machines used to be a small

fraction of what the of the income of

casinos. Now it's 80% or more. Yeah. And

he said that that came about because um

a father who worked for the casino

industry was at home watching his kids

play video games. And he realized that

the kids weren't playing to win. They

were playing for the novelty of what was

on the next screen. And the kids didn't

realize this, but it became clear to

him. So now, and I think this will help

people. This is why I'm taking the time

to share this once again. Uh

now, if you play a slot machine, you

think you're trying to win. and hear

that ching ching ching ching ching ching

and the bells go off and you and you

won. You think that's the dopamine

reward. But they figured out that unlike

the old rotor machines where you have

some cherries and bells and stuff in the

electronic landscape, you could have an

infinite amount of novelty through novel

combinations. So now they figured out

that people will play to win 50 cents on

the dollar. So they lost 50 cents,

right? and they know that rationally or

they could know that rationally, but

they'll continue to play until it's all

gone

as long as you give them novelty. So,

people aren't even really playing for

the money anymore. They think they are.

They're actually just being stimulated

with enough novel combinations that

their bank account gets drained, the

house takes it all.

>> Yeah.

>> Yeah.

>> When I heard that, I it changed my view

of gambling and because I always thought

it was about winning money and leaving.

It's actually more about playing and

it's more about the novelty that's

introduced in each quote unquote hand or

spin. And the I think knowing that

carries over certainly to sports and the

excitement that you're feeling about the

potential that you could win, but that

that it's a a novel combination of

things um might prevent hopefully

somebody from becoming a gambling addict

or might help people realize that what

they're addicted to, if not already

shame, might actually just be the

novelty. And that's why they're losing

all their money.

>> Yeah. There's an industry term for that.

It's LDWS, losses disguised as wins. So,

you know, you put in a dollar and you

get a hundred credits and then you pull

the thing and it, you know, it does its

thing and then it goes like, you know, d

you you've matched this way, you've won

10 and it goes off and you've matched

that way 20. Oh my god, I've won again

40. I've won 40 20 and 10 with all these

exciting things. I just lost, you know,

30% of what I put in. But it feels like

a win. And they realized, as you say,

people will keep playing even while

objectively they're just pouring money

down a sewer.

So glad I'm not addicted to gambling.

But I could see how I could be. Even

though I would like to say I couldn't

be, I could see how I could be. Um

because

the brain is just so prone to these

kinds of things. We all have these

circuits.

>> Absolutely. And uh it's interesting too,

you know, casinos are one of the few

places where you can still smoke uh you

know, indoors and uh you get free

drinks. And so it's it's really like um

absolute dense pack of of addictions and

and a huge number of people problem

gamers are problem drinkers and and also

are addicted to cigarettes. Um and and

so when I when I go to Las Vegas, it's

almost like a anthropology experience

for me. I just look at all this like,

wow. And there there was a story in

Scho's book which I just found amazing

with a bunch of people playing playing

playing playing and somebody had a heart

attack at one of the machines fell over

on the floor in a group of them and none

of them even reacted. They just kept

playing as this person died.

>> What a metaphor for society. Well, I

just decided if I'm ever going to Las

Vegas, I'm going with you. Okay.

>> Sorry to invite myself, but you seem

like a safe person to go.

>> I'm pretty safe. Yes. You you may win or

lose five bucks and that'll be the end

of it.

>> Love it.

So, industries that drive this stuff,

okay, alcohol,

um, cannabis, it's going to be very

interesting to see what happens with

cannabis now and going forward. Is it

the case that in states where it's

legalized or decriminalized that the

state collects it taxes on it?

>> Yeah, it depend depends. Those are

different regimes and and this is a

really important point to get into when

you think about policy. So,

decriminalization is about the user and

that's to say, look, we're not going to

punish you for using pot. Okay? And that

is a pretty popular it's always it's

been a popular policy for a long time

and doesn't it seem to really affect use

that much you know maybe a little bit

but not a lot. Legalization is making

the production processing marketing and

sale legal bringing in a corporation and

that is fundamentally different um you

know because the corporation is going to

have very smart people who are you know

good at selling and they will increase

you know consumption of the product. Um

it at this point, you know, I I don't

know the exact state count, but it's mo

most people in the United States

population-wise have access at this

point to a recreational uh cannabis. And

virtually every state, I believe, has

something if it's not recreational, it's

medical or there were these uh due to

hemp, there was sort of a way mistake

they made in regulation. There's a way

to process hemp that you can make these

like delta 8s and delta 9. Even in

states that are prohibited, there's

quite a bit of like, you know, hemp

laced beverages which are quite strong.

>> Is cannabis a gateway drug? We were told

that when we were in school.

>> Yeah. So, all drugs are gateway drugs.

The the lie in that was that you know

cannabis had some unique role um you

know that was going to lead you to use

heroin use. But the truth is anything

like you know if you're a teenager and

you start smoking or you start drinking

or you start uh you know using cannabis

or or you know stealing prescription

opioids from your parents or whatever

that will increase your likelihood of

progressing to other substances you know

for multiple reasons you know one you

might like it say okay well I guess I'm

convers let me try some others two your

social networks may change so you're

around other people who do this and so

they're you're comfortable with them

they're comfortable with you and they're

also more likely to have something else

you might want to try. And then the

third thing is it could be some brain

sensitization you know going on uh that

you know makes you know drugs more

rewarding and there is some interesting

work with like identical twins and

different states which seem to suggest

that you could be starting some

unfolding process when you expose a

young young brain to it. So all those

processes is how gateways work. The lie

was that it was just cannabis. And this

actually fits with the general lie I

would say is that alcohol is a drug and

we pretend that it isn't. So you you

know you you mentioned like people

getting drunk at science conferences or

health conferences. I have seen

conferences, political events where

people spend all day demonizing drug

users and talking about, you know, the

threat of drugs and how evil drugs are

and how we have to, you know, destroy

all drugs and then they all go to the

bar and get drunk as if they are not

drug users. not wanting to admit that

alcohol is a drug is a very useful for

the industry but it was also disuseful

politically because you know you could

say well the big threat to kids is

cannabis when you know it's much much

more likely a kid was going to get in

trouble with alcohol than with cannabis

these days there's a lot of discussion

about psychedelics

broad category of drugs LSDs psilocybin

MDMA is an empath not a psychedelic but

somehow it's been lumped into it mmethyl

uh it's a methylene dioxymeth

Methamphetamine, MDMA, ecstasy, folks,

it's methamphetamine with some

modification. So, it's not a

psychedelic. It's an impathogen. Um, but

it gets lumped with that. Ketamine gets

lumped with it. Dissociative anesthetic.

It's not a psychedelic. So, if we're

going to have a conversation about

psychedelics, I want to be really clear.

Um, maybe we just put psilocybin

>> and LSD on the table and then talk about

the impathogens and ketamine and all the

rest separately because so often these

get lumped and and it leads to a lot of

confusion.

I know several people who feel they've

benefited tremendously from doing

clinical work meaning with a guide in

safe setting etc on highdose psilocybin

maybe only two or three times total and

that's it.

>> Mhm.

>> For treatment of depression sometimes

for alcohol issues and other issues. I'm

not talking about micro doing they do a

high dose to two two to five grams. Mhm.

>> A lot of addicts who use other things

are interested in or currently using or

considering using psilocybin LSD less so