Speaker 1: Anything that we experience as reinforcing releases dope mean in
Speaker 1: our brain's reward pathway. Some of those things released dope
Speaker 1: mean directly, like cocaine or methamphetamine. Some of those things
Speaker 1: work through a complex chemical cascade, like alcohol which works
Speaker 1: on our endogenous opioid system or indigenous GABBA system and
Speaker 1: then ultimately releases dope mean in the reward pathway, or
Speaker 1: sex which works on our seratonergic system also our indogenous
Speaker 1: opioid system and ultimately releases dope mean. So we're all
Speaker 1: wired a little bit differently, and what may release a
Speaker 1: lot of dope mean in your brain may not release
Speaker 1: as much dop mean in my brain. And advice VERSA.
Speaker 2: Happy new year and welcome to the twenty twenty five
Speaker 2: season of The Psychology Podcast. I'm doctor Scott Barry Kaufman,
Speaker 2: host of The Psychology Podcast, where we share with you
Speaker 2: the latest science of human potential from scientists who are
Speaker 2: doing cutting edge research that can help you self actualize
Speaker 2: and realize the best version of yourself. To kick off
Speaker 2: our new season, it's a real pleasure to have Stanford
Speaker 2: psychiatrist and addiction expert doctor Anna Lemke on the show.
Speaker 2: Doctor Lempke's latest book, which is the main topic of
Speaker 2: discussion for today, is called Dopamine Nation, Finding Balance in
Speaker 2: the Age of Indulgence. This book is very timely. Dopamine
Speaker 2: is a transmitter that affects our motivation, exploration, and our pleasure.
Speaker 2: While dopamine is not the pleasure molecule necessarily, it is
Speaker 2: involved in setting our expectations of reward in the future
Speaker 2: based on past experiences. This can cause all sorts of problems,
Speaker 2: especially when we are no longer receiving pleasure from engaging
Speaker 2: in something that once gave us pleasure. In this episode,
Speaker 2: we discuss the implications of doctor Lemke's research for helping
Speaker 2: you do a dopamine reset and take control over your
Speaker 2: life and what you actually want to be rewarding. So,
Speaker 2: without further ado, I bring you doctor Anna lem Hey,
Speaker 2: doctor Lemke, welcome to the Psychology Podcast.
Speaker 1: Thank you for inviting me. I'm excited to be here.
Speaker 2: Yes, I've been looking forward to this conversation for a
Speaker 2: long time. Really excited to chat with you and really
Speaker 2: dive into this molecule that is just so fascinating and
Speaker 2: drives quite literally drives so much of our lives. Dopamine
Speaker 2: of course, is what I'm referring to. You know, I
Speaker 2: was wondering if we could just start off with you
Speaker 2: giving me the most succinct and accurate definition of what
Speaker 2: in the world dope mean is for.
Speaker 1: You know, I think the shortest way to describe it
Speaker 1: is that dope mean is crucial for our survival. It
Speaker 1: tells us what we should approach and what we should avoid.
Speaker 1: And in a world of scarcity and ever present danger,
Speaker 1: which is the world that humans have lived in for
Speaker 1: most of the time that we've been on the earth,
Speaker 1: that was really important. Right. You had to know which
Speaker 1: berries were safe to eat and which weren't. You had
Speaker 1: to know where the lions den was, and a lot
Speaker 1: of the purpose of our existence is essentially taking in novelty,
Speaker 1: metabolizing it, so to speak, making sense of it, and
Speaker 1: then using that information to inform our next steps. And
Speaker 1: dopemine is crucial for that. It's the chemical that says, hey,
Speaker 1: this is something you need to pay attention to, potentially approach,
Speaker 1: get more of, investigate because it's important for survival.
Speaker 2: Great, that's a great launching off point because it's just
Speaker 2: so interesting because from an evolutionary perspective, clearly we've had
Speaker 2: some things that have been more reoccurring and have had
Speaker 2: been able to operate on evolutionary mechanisms more than other things.
Speaker 2: So for some reason, for well, for that, for that reason,
Speaker 2: things like sex, uh, well we didn't have money, you know,
Speaker 2: back then, but just what the whole concept of money,
Speaker 2: you know, and and power are things that were The
Speaker 2: things we call competitive rewards seem to be more inherently
Speaker 2: dopamine inducing than intellectual stimulation. But we can get to
Speaker 2: that later because it is interesting. I think some people
Speaker 2: do have what I've called a nerdy dopamine pathway in
Speaker 2: the prefontal cortex. So we could talk about that later.
Speaker 2: But it seems like from evolutionary point of view, is
Speaker 2: that is that right? Is that? Is that? Is that
Speaker 2: a fair statement that there are certain things that are
Speaker 2: just more captivating to our dopamine system because of our
Speaker 2: evolutionary systems.
Speaker 1: It is a great question. I think the answer is
Speaker 1: a little bit more nuanced, which is to say that
Speaker 1: anything that we experience as reinforcing releases dopamine in our
Speaker 1: brain's reward pathway. Some of the things release dopamine directly,
Speaker 1: like cocaine or methamphetamines. Some of those things work through
Speaker 1: a complex chemical cascade, like alcohol which works on our
Speaker 1: endogenous opioid system or indogenous GABBA system and then ultimately
Speaker 1: releases dope mean in the reward pathway, or sex which
Speaker 1: which works on our serotonergic system also our indogenous opioid
Speaker 1: system and ultimately releases dope mean. So you've got both
Speaker 1: proximal and distant levers contributing to the release and how
Speaker 1: much of dope mean in our dedicated reward pathway. And
Speaker 1: then on top of that, you have enormous interindividual variability,
Speaker 1: so we're all wired a little bit differently, and what
Speaker 1: may release a lot of dope mean in your brain
Speaker 1: may not release as much dop mean in my brain,
Speaker 1: and vice versa. And from an evolutionary perspective, that makes sense.
Speaker 1: If you have a tribe that needs to shepherd scarce
Speaker 1: resources in order to survive, you don't want everybody going
Speaker 1: for bison or everybody going for blueberries, right. You want
Speaker 1: folks to be attracted to different things so that collectively
Speaker 1: we have all the things that we need. So that's
Speaker 1: how I would think about that In terms of you're
Speaker 1: mentioning sort of nerdy dopamine, hits or intellectual rewards. We
Speaker 1: know that learning releases dope me in the reward pathway,
Speaker 1: and I could you know, it makes sense that you
Speaker 1: have some people who are wired more for learning than others.
Speaker 1: Sometimes some of us are more cerebral, some of us
Speaker 1: are more physical, So our appetites will differ based on
Speaker 1: our uniqueness. The key thing about substances and behaviors that
Speaker 1: ultimately end up addicting a lot of people are that
Speaker 1: they tend to release a whole lot of dope mean
Speaker 1: very quickly, whereas things that release dope mean that tend
Speaker 1: to be less addictive are things that release less dope
Speaker 1: mean more slowly and often require more upfront effort to
Speaker 1: get them.
Speaker 2: Yes, thank you for that. And I think that it's
Speaker 2: worth mentioning explicitly that there's a basic consensus in the
Speaker 2: field that dope means more about wanting than liking, because
Speaker 2: I think a lot of people will say they'll see
Speaker 2: things in the media like the pleasure molecule, you know,
Speaker 2: as characterized as that, and that that's not quite right right.
Speaker 1: So there is controversy around this, But the way that
Speaker 1: I would describe it is that dope mean is both
Speaker 1: pleasure and motivation. It is both liking and wanting. And
Speaker 1: let me describe that a little bit, because it really
Speaker 1: depends on time sequence. When we initially are exposed to
Speaker 1: a reinforcing substance or behavior, or let me just rephrase that.
Speaker 1: When we're exposed to a substance or behavior initially, if
Speaker 1: it has what's called salience for us, what we mean
Speaker 1: by that is that it releases dopamine, so it is
Speaker 1: triggering our approach response, So it is related to pleasure
Speaker 1: or like the initial exposure, but with repeated exposure, our
Speaker 1: brain adapts and ultimately resets dopamine not at baseline levels
Speaker 1: of dopamine firing, but below baseline in a chronic dopamine
Speaker 1: deficit state, which is the addicted brain. And then then
Speaker 1: our seeking mechanism is propelled primarily by wanting and primarily
Speaker 1: dopaine is then primarily mediating motivation rather than pleasure or liking.
Speaker 1: But it must us to begin with salience, some degree
Speaker 1: of pleasure, some Oh, yes, this is something that felt
Speaker 1: good and I want to do it. I'd like to
Speaker 1: do it again. If that makes any sense.
Speaker 2: It makes tons of sense. And what I see quite
Speaker 2: often is not just pleasure, but I see Hope's there's
Speaker 2: something about this. There's something about dopamine that has so
Speaker 2: much to do with expectations and your hope for I'm
Speaker 2: going to use the word hope for a continual pleasure
Speaker 2: in the future, even if you're no longer receiving that
Speaker 2: pleasure at a certain point. And so it's quite a
Speaker 2: paradox go balkst, isn't it, Because on the one hand,
Speaker 2: it's the thing that keeps us going. It's a thing
Speaker 2: that gets us out of bed in the morning. Yes,
Speaker 2: if we didn't have any dopamine production, you know, as
Speaker 2: as some disorders, right, we see what happens. You know,
Speaker 2: there's a rate with lethargy, you know, lack of motivation.
Speaker 2: So we want it. But at the same time, it
Speaker 2: can cause us to run for things that are no
Speaker 2: longer serving our growth or maybe maybe never even served
Speaker 2: our growth, because there's a differencing pleasure and meaning, right.
Speaker 1: Yeah, So it is a very paradoxical molecule. And what's
Speaker 1: sort of baffling about it is that we tend to
Speaker 1: have very good memory or recollection for initial exposure to
Speaker 1: pleasure and pain, and that encodes itself very deeply in
Speaker 1: our minds and with addictive substances when we get that
Speaker 1: initial pleasure or we solve that initial problem, because sometimes
Speaker 1: the way in is that it's a problem solver, right,
Speaker 1: it's alleviating pain, which is directional when we from a
Speaker 1: directionality perspective, the same as getting pleasure in terms of
Speaker 1: you know, how our brain is reading that largely we
Speaker 1: have a very vivid memory for those initial exposures, but
Speaker 1: with repeated use, after it stops working and then can
Speaker 1: even turn on us and do the opposite of what
Speaker 1: we're seeking, we tend to not encode that with the
Speaker 1: same kind of fidelity, and we have what's often referred
Speaker 1: to in the field as youphic recall, where we're now
Speaker 1: just remembering those initial exposures, the early highs, and the
Speaker 1: rest of our sort of behavior is in the service
Speaker 1: of trying to recreate those initial highs, which can get
Speaker 1: us into a lot of trouble because then we can't
Speaker 1: see clearly when it's no longer serving that purpose. I
Speaker 1: would also just add that you're absolutely right that you
Speaker 1: know we're all releasing dopamine at a kind of tonic
Speaker 1: baseline level, but that can differ between persons and people
Speaker 1: who have depression, for example, are thought to probably have
Speaker 1: lower baseline tonic levels of dopamine firing. The state of
Speaker 1: being addicted is essentially the state of progressing toward a
Speaker 1: lower level of dopamine firing, so really looks very much
Speaker 1: like a clinical depression. So whether you know. In other words,
Speaker 1: some of us come into the world with a lower
Speaker 1: baseline dopamine level, some of us acquire a lower baseline
Speaker 1: dopening levels because of exposing our brains to these high
Speaker 1: rewards over time. And then there are other forms of
Speaker 1: psychopathology characterized by abnormalities in dopamine levels.
Speaker 2: Yeah, I was thinking Parkinson's disease.
Speaker 1: Parkinson's disease is a good one. But interestingly, Parkinson's disease
Speaker 1: is characterized by below normal levels of dopamine in a
Speaker 1: different part of the brain called the substantial niagra, not
Speaker 1: in the reward pathway itself, which gets very complicated in
Speaker 1: terms of the treatment of Parkinson's because what we give
Speaker 1: is dope mean precursors. We don't give dopamine because dopamine
Speaker 1: itself cannot cross the blood brain barrier. So we give
Speaker 1: these dopamine precursors that get converted to dopamine in the
Speaker 1: brain and then bind to dopamine receptors in the substantial
Speaker 1: nigro which allow for a more fluid movement alleviating the
Speaker 1: symptoms of Parkinson's, but problematically also bind to dopamine receptors
Speaker 1: in the reward pathway, the reward circuitry, just like other
Speaker 1: dopeminergic substances and behaviors, i e. Intoxicants do leading to
Speaker 1: addictive behaviors in people who take dopamine precursors for the
Speaker 1: treatment of dopamine. So about a quarter of folks who
Speaker 1: get dopamine precursors to treat their Parkinsons will actually end
Speaker 1: up with a compulsive shopping disorder or a compulsive sex
Speaker 1: to pornography and masturbation disorder. And these disorders tend to
Speaker 1: be dose dependent, So when the dopamine precursor has stopped,
Speaker 1: the symptoms not in all cases, but most often tend
Speaker 1: to get better or resolve.
Speaker 2: Well. I love that you you brought in that nuance
Speaker 2: that there I mean, there are different pathways in the
Speaker 2: brain where dope mean sense its projections, and I think
Speaker 2: one of the one of the projection routes that a
Speaker 2: lot of that's not as often discussed as the one
Speaker 2: to the dorsalato or prefont to cortex. Right, it's not
Speaker 2: it's not all being sent to the like the straatum. Right.
Speaker 2: So so in that sense, you know, as a cognitive
Speaker 2: scientist by the way, who studied intelligence and working memory,
Speaker 2: I don't think we realize the extent to which dope
Speaker 2: mean also plays a role in our working memory and
Speaker 2: how some people have genes. I mean, we can really
Speaker 2: nerd out here d r D for there are certain
Speaker 2: genes that that uh, for certain individuals from an individual
Speaker 2: difference perspective, too much dope mean influx in the prefilt
Speaker 2: the cortex can cause them to have reduced working memory capacity.
Speaker 2: And I find that super super interesting. There seems to
Speaker 2: be like an optimal balance there.
Speaker 1: That is really interesting. I don't know much about that.
Speaker 1: Tell me more.
Speaker 2: There is uh, you know, there are certain genes that
Speaker 2: encode for for how much you know there's going to
Speaker 2: be a natural sort of projection of dopamine to certain
Speaker 2: brain areas. But the one in our higher order of
Speaker 2: courts see is like our prefront our dorsal dorsal area
Speaker 2: or pre prefunt the cortex. There is an interesting relationship
Speaker 2: between dopamine production and the ability to you know, for instance,
Speaker 2: ADHD is relevant here, right, you know, being able to concentrate,
Speaker 2: being able to focus, being able to hold multiple pieces
Speaker 2: of information in your in your cognition at once. And
Speaker 2: I only bring this up as just just to explain
Speaker 2: and to and for just purpose of discussion that we're
Speaker 2: not when we talked about dopamine. It has far reaching
Speaker 2: consequences across the brain, and we're not just talking about
Speaker 2: sex and druss.
Speaker 1: Right, Yes, great, great point. And I've been very impressed
Speaker 1: by how many questions I get about the relationship between
Speaker 1: ADHD and dopamine. I think people are very wanting knowledge
Speaker 1: about that, and I mean, I wouldn't say it's my
Speaker 1: area of real expertise, but what I do know is
Speaker 1: that there are studies showing that people with ADHD may
Speaker 1: indeed come into this world with a lower baseline level
Speaker 1: of dopamine firing, which means that they're relatively insensate to rewards,
Speaker 1: which means that they need more potent rewards a priori
Speaker 1: to get any kind of reward response at all, which
Speaker 1: may go some way into explaining the kind of impulsivity
Speaker 1: that's often associated with ADHD, impulsivity being difficulty putting the
Speaker 1: breaks between a thought or desire to do something and
Speaker 1: actually doing it because they're in an embodied way experiencing
Speaker 1: the stimulus differently than people who don't have ADHD. So
Speaker 1: I think those types of findings are really interesting.
Speaker 2: So interesting, and it seems like either extreme is not
Speaker 2: good because there's some research called about the cliff of schizophrenia.
Speaker 2: Too much dopamine production can cause you to not be
Speaker 2: able to discern what's relevant and what's irrelevant, and so
Speaker 2: you see everything as meaningful apipenia everywhere, and so there
Speaker 2: seems to be like an a level for creativity as well.
Speaker 2: And that's just my own area of research, is a
Speaker 2: link between creativity and mental illness.
Speaker 1: And yeah, yeah, it's even what we characterize as mental illness, right,
Speaker 1: the sort of auditory or visual experiences that people with
Speaker 1: schizophrenia have. You know, we think of that as a
Speaker 1: form of psychopathology, but we could equally well conceptualize that
Speaker 1: as just a different way of processing information, a different
Speaker 1: way of experiencing certain types of emotions, mediated in part
Speaker 1: probably by dopamine because we know that when we give
Speaker 1: dopamine blockers to people those symptoms, those symptoms tend to reduce.
Speaker 1: So we infer from that that don't meine is involved
Speaker 1: in this experience of hearing voices other people don't hear,
Speaker 1: seeing things that other people don't don't see, you know,
Speaker 1: which we have organized into this this bucket we call
Speaker 1: schizophrenicform disorders. But it's all very interesting.
Speaker 2: Yeah, it just it just shows the pervasiveness of this
Speaker 2: molecule in our lives and far reaching about you know,
Speaker 2: almost every aspect of our lives. You can find it
Speaker 2: playing some role. And as your your your subtitle of
Speaker 2: your book notes, it's important to find balance in this
Speaker 2: age of indulgence, and your book is all about the balance.
Speaker 2: It's not about living a life of pure pleasure or
Speaker 2: living a life of pure pain, right, It's about a
Speaker 2: little a little of both. There's one finding in your
Speaker 2: book that really I fell off my chair and I
Speaker 2: just had to I just I can't stop thinking about it.
Speaker 1: Okay, I'm excited to hear.
Speaker 2: And yeah, so it seems like peak dopamine production. Peak
Speaker 2: is when you've had you know, this work, this prior
Speaker 2: learning experience of pleasure, but you start to get to
Speaker 2: the point where it's about fifty to fifty uncertainty whether
Speaker 2: or not it's going to be pain or pleasure if
Speaker 2: you get to this maximumster And now, obviously like gambling
Speaker 2: and casinos, Vegas gets that. But we're not just talking
Speaker 2: about gambling, we're talking about anything, and that is so
Speaker 2: interesting to me. Could you explain that finding a little
Speaker 2: bit more.
Speaker 1: Yeah, So, this was a study that was done comparing
Speaker 1: pathological gamblers to non pathological gamblers. Pathological gamblers being people
Speaker 1: who gamble to the point of continued compulsive use despite
Speaker 1: harm to self and or others, which broadly speaking, is
Speaker 1: the definition of addiction. And what the researchers did was
Speaker 1: they measured dopamine firing when pathological gamblers won at gambling
Speaker 1: and compared that to when non pathological gamblers, what we'll
Speaker 1: call moderate, non risky or healthy gamblers, just recreational gamblers.
Speaker 1: And what they found was that with winning in a
Speaker 1: game that required that it included uncertainty and risk and
Speaker 1: monetary reward, the potential for a monetary award was that
Speaker 1: with winning, both pathological gamblers and recreational gamblers had increased
Speaker 1: dopemin firing, but with losing. Recreational gamblers did not have
Speaker 1: an increase in dope mean, but pathological gamblers had an
Speaker 1: increase in dopamine firing even when losing, which maps very
Speaker 1: nicely onto the phenomenology or the subjective experience of pathological gamblers,
Speaker 1: who will often report what's called loss chain, where they
Speaker 1: actually want to lose because losing justifies in their minds
Speaker 1: staying longer gambling, or staying in the game longer, which
Speaker 1: is essentially what they want. The game itself is the drug,
Speaker 1: it's not necessarily the monetary reward. And for pathological gamblers,
Speaker 1: the highest dopamine release, or the peak and dopamine release
Speaker 1: was when there was an equal chance of winning and losing,
Speaker 1: So that point of maximal uncertainty was the biggest high
Speaker 1: for pathological gamblers, which is really fascinating because what it
Speaker 1: suggests is that on some level we like uncertainty, and
Speaker 1: we crave and need it even as we're making enormous
Speaker 1: efforts in our lives to kind of try to control
Speaker 1: the outcome and control our experience.
Speaker 2: It's so fascinating. Obviously, there's some thing unique about humans
Speaker 2: and other animals in the way dopamine plays out. One
Speaker 2: of my heroes, intellectually heroes, Robert Sapolski, has a lecture
Speaker 2: about dopamine once where he says at the end, he says,
Speaker 2: there's no rat in the world that's going to keep
Speaker 2: lever pressing with the hopes of getting into heaven.
Speaker 1: Well, you know who knows? I don't know. I mean,
Speaker 1: the more the more we find out, the more we
Speaker 1: see homology. For example, you know, unfortunately we don't have
Speaker 1: little smartphones we can give to rats to sort of
Speaker 1: see their dopamine levels in response to social media, for example,
Speaker 1: or pornography or online shopping. But there are some scientists
Speaker 1: in France who did rig up this contraption where mice,
Speaker 1: mice and rats rodents were able to press a lever
Speaker 1: to get a selfie and see a selfie of themselves.
Speaker 1: And initially they paired lever pressing with sugar release, which
Speaker 1: is rewarding for rats, so they will press. Rats will
Speaker 1: press a lever just for sugar water, but they also
Speaker 1: saw the selfie and with repeated use, even when the
Speaker 1: even when the sugar water was stopped, the rats compulsively
Speaker 1: pressed the lever to get selfies of themselves. So in fact,
Speaker 1: even rats like to look at their own image. Who knows,
Speaker 1: maybe there's a rat heaven. They'd be willing to press
Speaker 1: a lever for.
Speaker 2: Too, if they could conceptually understand. Yeah, think think that through. Perhaps,
Speaker 2: you know, we talked about individually. I still want to
Speaker 2: talk about individual differences because it's so fascinating to me.
Speaker 2: We talked a little bit about sex addiction. I think
Speaker 2: people can wrap their head around that, but I don't
Speaker 2: think most people really think about love addiction when they
Speaker 2: think about dopamine. And I've been thinking about that. You know,
Speaker 2: I've seen there's a certain kind of guy that you know,
Speaker 2: has women falling all over him, but he keeps all
Speaker 2: of them at this sort of fifty percent uncertainty and
Speaker 2: he drives them crazy. Now there's this archetype of this guy.
Speaker 2: And I've had friends, I've had guy friends. So I
Speaker 2: think humans can co opt this right to kind of
Speaker 2: like have people dependent on them, And you can see
Speaker 2: it with codependency relationships. Perhaps, so am I making any sense?
Speaker 2: Does this? Can we link this?
Speaker 1: Absolutely? So? First of all, clinically, phenomenologically, we see people
Speaker 1: who are addicted not just to sex, but even more
Speaker 1: to the pursuit of a partner, and once they obtain
Speaker 1: that person, their interest disappears and they're onto the next person.
Speaker 1: We also see people clinically who are in addictive relationships,
Speaker 1: not even around sex, but just around the relationship itself.
Speaker 1: Most often these just happen to be women more often
Speaker 1: than men, who are often connected or pursuing or in
Speaker 1: relationship with a man with more of a narcissistic type
Speaker 1: of character structure. And what we essentially mean by love
Speaker 1: addiction or codependency is that the individual becomes addicted to
Speaker 1: the other individual and then essentially uses that person as
Speaker 1: a way to manage their own emotionality, manage their own
Speaker 1: emotional needs. Often when a codependent person and the term
Speaker 1: codependency originates from the addiction world right where you have
Speaker 1: the person who's the addict, and then you have their
Speaker 1: codependent loved one who is trying, often nominally trying to
Speaker 1: help them, but also simultaneously can in their behaviors, perpetuate
Speaker 1: or what we call enable the addiction. So you have
Speaker 1: a very strange kind of push me, pull me situation
Speaker 1: where it looks on the surface as if the loved
Speaker 1: one is trying to help this person get out of addiction,
Speaker 1: but really they're not because the dynamics of the relationship
Speaker 1: itself become a drug to them, and then they engage
Speaker 1: with that person as a way to try to predict
Speaker 1: and control their emotions. So the evil we know is
Speaker 1: better than the good that seems out of reach. That
Speaker 1: kind of thing. There's also speculation that domestic violence is
Speaker 1: related to dope mean release right right, The kind of
Speaker 1: uncertainty of knowing if your partner will lash out, and
Speaker 1: then the pain when they do, followed by the making
Speaker 1: it up afterwards. This whole cycle can become for some
Speaker 1: individuals reinforcing and quite addictive, and is probably mediated by dopamins.
Speaker 1: So yeah, and I think in this day and age
Speaker 1: of social media, we're all more vulnerable to getting addicted
Speaker 1: to other people because the me itself has distilled human
Speaker 1: relationships down into their most addictive components. So we know that,
Speaker 1: for example, oxytocin, the love hormone, is released when we
Speaker 1: have an intimate connection to another human being. It's involved
Speaker 1: in mother pair bonding and love bonding, and the work
Speaker 1: of my colleague Rob Malenka here at Stanford has shown
Speaker 1: that oxytocin binds to dopamine, releasing neurons in the reward
Speaker 1: pathway and leads to the release of dopamine, which is
Speaker 1: why falling in love feels good. No surprise is there.
Speaker 1: But social media has essentially again distilled human connection down
Speaker 1: to its most addictive components, where for very little upfront work,
Speaker 1: we can have a lot of reward, beautiful face and
Speaker 1: intimate connection, and the moment it becomes distressing or frustrating,
Speaker 1: we can just delete it or swipe right or swipe
Speaker 1: left and find somebody else. So that now more and
Speaker 1: more of us, I think, are engaging with other people
Speaker 1: in a way that is really addictive. And this explicitly
Speaker 1: plays out with dating apps. We see lots of patients
Speaker 1: who are addicted and harmed by dating apps. Dating apps,
Speaker 1: on some level, you could argue, are engineered to be
Speaker 1: addictive because they really don't want people to successfully match
Speaker 1: with a partner and leave the dating app. What they
Speaker 1: want people is to stay in the dating app and
Speaker 1: keep looking for other people. So there's you know, there
Speaker 1: are ways in which the medium itself really does contribute
Speaker 1: to compulsive, addictive orientation on human relationships.
Speaker 2: Oh for sure. And I'm really glad that you bring
Speaker 2: that up, and you talk about that about that a
Speaker 2: lot in the section of your book. The problem we
Speaker 2: talk about, you know, over consumption and the kind of
Speaker 2: society living in. So let's talk about let's get out
Speaker 2: of the darkness a second, and let's talk about what
Speaker 2: people can do to really help themselves if they're caught
Speaker 2: in this bind. So you have this beautiful section in
Speaker 2: the book Self Binding with really, you know, good advice,
Speaker 2: and I thought it was really clever. Part of your
Speaker 2: advice was you would go through you go through each
Speaker 2: other acronym. It's dopamine. You turn out, you turned dopamine
Speaker 2: into an acronym, right, right, So could do you mind
Speaker 2: if we go through that a little bit?
Speaker 1: Sure? So the dopamine acronym is essentially the clinical framework
Speaker 1: that we use with new patients when we're trying to
Speaker 1: discover whether or not they've developed a compulsive consumptive behavior
Speaker 1: and then provide an early intervention to see if you
Speaker 1: know what the causal effects are of that behavior. And
Speaker 1: I want to emphasize early because it's not an intervention
Speaker 1: we would do with somebody who was at risk of
Speaker 1: life threatening withdrawal or who had repeatedly tried to stop
Speaker 1: on their own and wasn't able to. This is really
Speaker 1: an early intervention for people with you know, the sort
Speaker 1: of mild to moderate forms of But D essentially stands
Speaker 1: for data. That's where we try to get information what
Speaker 1: people are consuming, how much and how often, not just
Speaker 1: for drugs and alcohol, but also for all of the
Speaker 1: digital media that essentially represent digital drugs. So how much
Speaker 1: time on social media, on YouTube, on pornography, on online shopping,
Speaker 1: on LinkedIn, on the internet more globally, and when we
Speaker 1: discover heavy daily use and you could you know, we
Speaker 1: don't have a lot of data on what constitutes heavy
Speaker 1: necessarily for a given individual, but you know, you have
Speaker 1: a sort of a good shelt of like, oh gosh,
Speaker 1: this person's repeatedly staying up till one, two three in
Speaker 1: the morning, waking and not getting enough sleep, waking up tired,
Speaker 1: using even when they shouldn't. Those are the types of
Speaker 1: things that we're looking for. So data is a way
Speaker 1: to just get the information what are people doing, how
Speaker 1: much and how often? O of the dopamine acronym stands
Speaker 1: for objectives. Why are they using? Raadly speaking, people use
Speaker 1: for one of two reasons to have fun or to
Speaker 1: solve a problem. Importantly, what starts out is fun and adaptive.
Speaker 1: Often with repeated use becomes not fun and not problem solving.
Speaker 1: But we'll get to the next letter, which is the P,
Speaker 1: which refers to problems related to use. And this is
Speaker 1: where we just asked them talk about what are the physical, mental, relationship, work, school, psychological,
Speaker 1: spiritual problems as a result of this behavior. And sometimes
Speaker 1: the problem is just an opportunity cost, right, the things
Speaker 1: I'm not doing because I'm spending so much time watching YouTube.
Speaker 1: So we try to lay out those things. And then
Speaker 1: the A of the dopamine acronym stands for abstinence and asceticism.
Speaker 1: Abstinence is where we ask them to do a thirty
Speaker 1: day dopamine fast from their drug of choice. So with
Speaker 1: a sex addiction, that means no orgasms with yourself or
Speaker 1: others for thirty days. Somebody, Yeah, yes, it's you know. Admittedly,
Speaker 1: especially if you've been using let's say masturbation as a
Speaker 1: coping strategy for emotion regulation, it's hard to imagine how
Speaker 1: you could go without. But that is the ask. We
Speaker 1: always want people that they're going to feel worse before
Speaker 1: they feel better, because they're going to be in withdrawal,
Speaker 1: but that the bad feelings, the universal symptoms of withdrawal, anxiety, irritability, insomnia, depression,
Speaker 1: and craving are they peak within about ten to fourteen days,
Speaker 1: and then they tend to get better, and people can
Speaker 1: make it the full thirty days, they find that they
Speaker 1: feel so much better, not just better than they did
Speaker 1: when they were going to keete withdrawal, but actually better
Speaker 1: than they have in a really long time. And what
Speaker 1: I want to emphasize here is that actions have to
Speaker 1: come before feelings. We can't wait until people feel like
Speaker 1: giving up their drug of choice, and I use the
Speaker 1: term drug very broadly to encompass behaviors. If we wait
Speaker 1: for that, the day will never come. We have to
Speaker 1: have them experience, in an bodied way a difference in
Speaker 1: their lives to be able to then form cognitions and
Speaker 1: emotions based on this lived experience that will allow them
Speaker 1: to make better choices in the future. So really really
Speaker 1: important to emphasize that, and I think especially in mentalhealth,
Speaker 1: where you know, in many instances we appropriately spend a
Speaker 1: lot of time asking people about their feelings, their motivation,
Speaker 1: their thoughts, but don't necessarily move them to action. We're
Speaker 1: waiting for them to be motivated for action. Sometimes you
Speaker 1: just have to say, you know what, that's not going
Speaker 1: to come. You just have to you have to try
Speaker 1: to change change this behavior, and then the feelings will follow.
Speaker 1: And the A also stands for asceticism, which is this
Speaker 1: idea of doing something more painful than the pain of
Speaker 1: withdrawal as a way to speed up the process of
Speaker 1: resetting reward pathways. Because we know, for example, that exercise
Speaker 1: is immediately taught sick to cells, but we also know
Speaker 1: this exercise is good for us and makes us feel good.
Speaker 1: Why is that Because the body senses injury and then
Speaker 1: in response to that micro injury up regulates feel good
Speaker 1: neurotransmitters like dopamine, and then those dopamine levels will stay
Speaker 1: elevated even hours after we stop exercise, before coming back
Speaker 1: down to baseline levels without going into that dopamine deficit state.
Speaker 1: That set that sets up the craving, which is why
Speaker 1: most of us don't crave exercise the next day. We
Speaker 1: have to remind ourselves, oh wait, I feel better after exercise.
Speaker 1: So the asset of SIMS is leaning into right sized
Speaker 1: pain in order to upregulate dopamine levels. And let me
Speaker 1: just emphasize in our patient population. For many of our
Speaker 1: patients today living in the world today, just getting up
Speaker 1: off the couch, turning off the phone, going outside without
Speaker 1: a device and walking around the block is extraordinarily difficult
Speaker 1: and painful. That is leaning into pain.
Speaker 2: I know a lot of It's interesting because I know
Speaker 2: a lot of people who are addicted exercise. Yes, yeah,
Speaker 2: so it can go the other direction.
Speaker 1: It definitely can that that is a danger. We sometimes
Speaker 1: see that people with exercise addiction don't typically come in
Speaker 1: for treatment, but sometimes they do. And of course, we
Speaker 1: have all of this technology that takes things that used
Speaker 1: to be good for us and has turned them into
Speaker 1: something that's essentially addictive. I talked about social media. You
Speaker 1: know human connection. We know human connection is good for us.
Speaker 1: Digital media has turned human connection into a drug. Same
Speaker 1: thing with exercise. Exercise is good for us, but now
Speaker 1: it's tied to social media. We're now making these comparisons
Speaker 1: on leader boards and other social media sites. People are
Speaker 1: counting themselves and counting their heart rates and their steps,
Speaker 1: and you know, down to the micro how hard they're working.
Speaker 1: And that enumeration also increases the addictive nature of these
Speaker 1: activities because then we get very fixated on the numbers,
Speaker 1: wanting to improve the numbers, improve our rankings. So we've
Speaker 1: also you know, drugified exercise, which is unfortunately unfortunate.
Speaker 2: Did you go through all the acronymics, Oh?
Speaker 1: Sorry, yes, thanks, So the am stance for mindfulness. So
Speaker 1: this is a great opportunity to practice mindfulness. As you
Speaker 1: know and as you teach all the time. Mindfulness is
Speaker 1: a skill that we can learn and practice. It's the
Speaker 1: ability to observe our thoughts and feelings without judgment and
Speaker 1: also without trying to escape those thoughts and feelings. And
Speaker 1: when we give up our drug of choice that we
Speaker 1: usually use to numb our feelings, we're practicing mindfulness. Right.
Speaker 1: We have to learn to sit with those uncomfortable emotions
Speaker 1: and watch them kind of pass over us like a wave.
Speaker 1: The eye stands for insight. It's amazing again how much
Speaker 1: we learn about ourselves when we do a dopamine fast
Speaker 1: and give up our drug of choice. That's really impossible
Speaker 1: knowledge that's impossible to acquire any other way. It is
Speaker 1: experiential knowledge. The end stands for next steps. People come
Speaker 1: back after four weeks of abstaining from their drug. Oftentimes
Speaker 1: they're very surprised at how much better they feel. Some
Speaker 1: don't feel better, and that's information too, But in general,
Speaker 1: even those folks who do feel better, typically they want
Speaker 1: to go back to using their drug of choice, but
Speaker 1: they want to use less. They want to use in moderation.
Speaker 1: So then we talk about exactly what they will look
Speaker 1: that will look like, and the devil's in the details.
Speaker 1: I spend a lot of time with patients going through Okay,
Speaker 1: what days are you going to use, how much, with
Speaker 1: whom in what circumstances, what are your red flags for
Speaker 1: knowing that you're slipping again, or for people who want
Speaker 1: to continue to abstain from their drug of choice, how
Speaker 1: is that going to look? What self binding strategies are
Speaker 1: you going to put in place so that the drug
Speaker 1: is not immediately available? And then E stands for experiment.
Speaker 1: That's where folks then take this new plan and these
Speaker 1: reset reward pathways and they go out into the world
Speaker 1: and they try again. So it's a cyclical thing, you know.
Speaker 1: Sometimes people are able to maintain their gains. Other times
Speaker 1: they slip up immediately and they're back to using possibly
Speaker 1: even more than they were before. Then we have to
Speaker 1: try another discussion, another intervention. So it's an iterative process.
Speaker 2: Thank you for going through that. You know, you have
Speaker 2: so much experience with patients, you know, on the front lines,
Speaker 2: dealing with people who I'm sure you've seen it all.
Speaker 1: You know. That's when I think I've seen it all,
Speaker 1: I see something new, because also the drugs are always changing.
Speaker 1: But yes, I have seen a lot.
Speaker 2: Well, I mean even in your book you bring up
Speaker 2: examples that I've never heard of before, someone who got
Speaker 2: off on electrical currents or something like that, right, And
Speaker 2: so's it's so interesting the way the way doping can
Speaker 2: can kind of manifest itself in modern to humans, you know,
Speaker 2: and a whole variety of different things. And one thing
Speaker 2: that I'm not sure I fully understand and yet as
Speaker 2: a psychologist is what the threshold is for addiction, what
Speaker 2: counts as addiction and what counts as just dopea mein
Speaker 2: coursing through your system. And there's so much heated debates.
Speaker 2: I go to psychological conferences where some people are adamant
Speaker 2: there's no such thing as sex addiction. There's a whole
Speaker 2: group of sex therapists who are well respected, who really
Speaker 2: believe No, it's just a compulsion. But then I'm getting
Speaker 2: all confused. I'm like, then, what's a compul what's the
Speaker 2: difference soon a compulsion and an addiction? I mean, I'm
Speaker 2: a psychologist twenty years of experience, I still don't fully
Speaker 2: wrap my head around around all these distinctions. Can you
Speaker 2: help us shed some light on some of these distinctions
Speaker 2: for me? Sure?
Speaker 1: So, first, it's important to establish that there's no blood
Speaker 1: test or brain scan to diagnose addiction. It's based on
Speaker 1: phenomenology or patterns of behavior that repeat themselves across individuals,
Speaker 1: time periods, geographic locations. Inherent. The definition of addiction is
Speaker 1: the continued compulsive use of a substance or behavior despite
Speaker 1: harm to self and or others, often constituted by the
Speaker 1: three c's, as well as tolerance and withdrawal. So the
Speaker 1: first C is control or out of control use, repeatedly
Speaker 1: planning to use a certain amount and repeatedly going over.
Speaker 1: That second C is compulsive use. What do we mean
Speaker 1: by that? We mean a lot of mental real estate
Speaker 1: occupied with thinking about the drug and a certain level
Speaker 1: of automaticity around initiating drug use even when we planned
Speaker 1: not to. So again, some'm a loss of agency is
Speaker 1: really at the heart of the compulsive aspect of the disease.
Speaker 1: And then the third C is consequences, especially continued use
Speaker 1: despite consequences. So there's sort of this notion that every
Speaker 1: single person with addiction is in denial and doesn't see
Speaker 1: the consequences. Denial is a big problem with this disease,
Speaker 1: where we don't really see true cause and effect of
Speaker 1: our behaviors on our lives, especially the negative behaviors. But
Speaker 1: there are many, many people with addiction who can clearly
Speaker 1: see the harm and still can't stop. So those are
Speaker 1: the behavioral definitions of the behavioral broadly summarize the behavioral
Speaker 1: manifestations of addiction. And then there's tolerance, which speaks to
Speaker 1: the physiologic changes. Tolerance is needing more of the drug
Speaker 1: over time to get the same effect or finding at
Speaker 1: the current dose it stops working. So if we are
Speaker 1: going to think about sex addiction, very often, what we'll
Speaker 1: see clinically as people who start out with kind of
Speaker 1: vanilla toast pornography and over time it stops working, so
Speaker 1: they need more and more deviant forms and might end
Speaker 1: up ultimately using child pornography, getting into trouble with the
Speaker 1: law having serious legal consequences being suicidal. So the continued
Speaker 1: use despite consequences, including life threatening consequences, and we see that,
Speaker 1: which is why I think the argument about whether or
Speaker 1: not you know sex addiction is real. You know, I
Speaker 1: would invite folks if it were possible, to be a
Speaker 1: fly on the wall in my office, because clearly there
Speaker 1: are individuals for whom this phenomenology plays out in an
Speaker 1: identical way with pornography or other forms of sexual gratification,
Speaker 1: as with drugs and alcohol. And then the final one
Speaker 1: is withdrawal. That is to say, when we try to
Speaker 1: stop or reduce our use of the drug, we experience
Speaker 1: it withdrawal phenomenon. For various drugs, the withdrawal phenomenon is
Speaker 1: usually the opposite of whatever the drug does. So people
Speaker 1: who are addicted to alcohol, which is a sedative, when
Speaker 1: they're withdrawing, they have hyper arousal. They can even have seizures,
Speaker 1: a kind of physiologic storm. People who are addicted to
Speaker 1: stimulants like cocaine, their withdrawal will be characterized by extreme
Speaker 1: sedation and depression of the opposite. Again, the universal finems
Speaker 1: of withdrawal from any addictive substance or anxiety or ability,
Speaker 1: and so depression and craving. And for behavioral addictions, we
Speaker 1: see those psychiatric symptoms, but we also often see physical
Speaker 1: signs of withdrawal. So getting back to sex addiction, I
Speaker 1: have lots of patients who when they give up pornography
Speaker 1: and masturbation for a month or try to, they will
Speaker 1: have extreme, debilitating fatigue, extreme insomnia, They will have headaches,
Speaker 1: and as they will have nausea, they will have hyperventilation.
Speaker 1: So it's it can be you know, the mind and
Speaker 1: body are so connective, of course it's going to be physical.
Speaker 1: So yeah, so that that's how you diagnose it. You know,
Speaker 1: at the end of the day, sitting around sort of
Speaker 1: splitting hairs. Is this a you know, is this OCD?
Speaker 1: Is this an eating disorder? Is this an addictive disorder?
Speaker 2: Helping people?
Speaker 1: Yeah? What to me, what I care about is how
Speaker 1: can we help people get better? And what I have
Speaker 1: found is when we use the addiction lens to to
Speaker 1: understand these behaviors and we use an intervention that is
Speaker 1: an addiction intervention, people get better. And it's not gonna
Speaker 1: We're not going to help all people, but there are
Speaker 1: a lot of people with sex addiction or compulsive sexual
Speaker 1: behaviors or eating you know, so called eating disorders, who
Speaker 1: when you use the lens of addiction, can make a
Speaker 1: lot of recovery and really get their lives back. And
Speaker 1: so it works, right, it works. It doesn't work for everybody,
Speaker 1: but it works for enough people that it seems to
Speaker 1: me quite valid to use that addiction lens.
Speaker 2: Well, thank you. It's I mean, it's a real privilege
Speaker 2: to be able to talk to you and the expertise
Speaker 2: that you bring to the table. So, for instance, I
Speaker 2: think that that the flow state of consciousness itself can
Speaker 2: become very I personally love getting fully engaged and absorbed
Speaker 2: in my work and it's a it's a wonderful feeling.
Speaker 2: I can't just snap my fingers and get into it.
Speaker 2: I wish, I wish I could, But I think all
Speaker 2: of us can resonate with that. Something that I found
Speaker 2: so interesting in reading your book is is some of
Speaker 2: the people who were addicted described that they lost track
Speaker 2: of time. Some of the things that they said seemed
Speaker 2: to seem to reflect that flow state of consciousness that
Speaker 2: we can apply towards maybe more healthier pursuits. But it
Speaker 2: just made me think philosophically a lot about I wanted to.
Speaker 2: I want to just like step up a second, you know,
Speaker 2: a level in a very non judgmental way. So I
Speaker 2: guess I think you can have a compulsion without an addiction, right,
Speaker 2: Like you said that addiction involves the compulsion component, but
Speaker 2: also involves uh destroy, you know, like negativity towards harm,
Speaker 2: harm towards yourself and others. You can have a compulsion
Speaker 2: and not have harm. Right, So for me personally, I'll
Speaker 2: give you a personal example. I took up magic as
Speaker 2: a hobby in January of this for actually, for the
Speaker 2: past year, I've become i'll use the word obsessed with mentalism.
Speaker 2: And I've been spending way too much money and magic
Speaker 2: tricks and I can't stop thinking about it now. And
Speaker 2: every day I wake up and I look forward to
Speaker 2: the day I look forward to like mastering a new trick,
Speaker 2: you know. So I'm like, Okay, well, I think maybe
Speaker 2: I'm addicted to check at this point, but it's not
Speaker 2: really I mean, it's causing some harm with money the issues,
Speaker 2: but that aside, it's not like ruining my life, and
Speaker 2: it's bringing people joy. So I guess I'm really having
Speaker 2: a hard time articulating what exactly my point is, but
Speaker 2: it's something I just wanted to like talk through with
Speaker 2: you because I'm so I'm such a non judgmental person,
Speaker 2: and I feel like what brings one person flow and passion? Well,
Speaker 2: you know what's the difference between passion and addiction? You know, Like,
Speaker 2: don't we want people to be passionate about what they do?
Speaker 2: Am I making any sense at all?
Speaker 1: Does?
Speaker 2: Yes?
Speaker 1: And I think I think it's I think it's a
Speaker 1: problem a little bit of language. So when I use
Speaker 1: the term addiction, I'm really talking about a form of
Speaker 1: psychopathology in which there's harm to self and or others.
Speaker 1: You know, if if somebody has certain sexual preferences that
Speaker 1: you know may not fall into whatever you know, we
Speaker 1: consider to be sort of standard categories, I wouldn't diagnose
Speaker 1: that person with anything at all unless they came to
Speaker 1: me and said, these behaviors are causing problems in my
Speaker 1: life because that of control use, compulsive use, continued use
Speaker 1: despite consequences, tolerance, why I need to use more over
Speaker 1: time to get the same effect, and withdraw when I stop.
Speaker 1: So I think that's really important to make that distinction.
Speaker 1: You know, I'm not saying that anybody uses pornography as addictive,
Speaker 1: or anybody who makes pornography as a bad person, or
Speaker 1: any that, oh, there's only one type of sex that
Speaker 1: people should be have. No, I'm saying that the people
Speaker 1: who come to me who identify this as a problematic
Speaker 1: behavior and want help. Okay, let's talk about what's going
Speaker 1: on there now. Your other question, or the related question, was, well,
Speaker 1: how do we distinguish between an addiction and a passion? Right,
Speaker 1: something that's a passionate hobbyer that I'm thinking a lot about.
Speaker 1: You know, we all have very busy minds, and it
Speaker 1: is generally healthy for us to have something for our
Speaker 1: busy minds to land on that's adaptive, contributing to the
Speaker 1: world in a positive way, creative, engaging. We need, we
Speaker 1: need to stay busy. If we don't keep our minds
Speaker 1: engaged in a healthy way, we will ruminate on other
Speaker 1: things that we don't want to be ruminating on, right,
Speaker 1: that are not healthy or adaptive. So again, the same
Speaker 1: thing kind of holds if you're mad. Passion for mad
Speaker 1: is healthy. Gives you a reason to get out of
Speaker 1: bed in the morning, isn't hurting you isn't hurting anybody else.
Speaker 1: You're not going into financial debt because you know you're
Speaker 1: you know, because you're spending all your money you don't
Speaker 1: have on magic tricks. If you don't have a partner
Speaker 1: who says they want to leave you because you never
Speaker 1: pay attention to them because you're always doing magic. I mean,
Speaker 1: these are the things that you know that we would
Speaker 1: look for. And I want to contextualize all of that
Speaker 1: by saying we live in a drugified world where it
Speaker 1: has now become so easy to make all of these
Speaker 1: passionate hobbies more accessible, more potent, more bountiful, more novel,
Speaker 1: such that even something seemingly innocent as learning magic tricks
Speaker 1: actually could become an addiction. Where you know, fifty one hundred,
Speaker 1: one hundred and fifty years ago, it couldn't because there
Speaker 1: weren't a million YouTube videos that you could get sucked into.
Speaker 1: There weren't a million things you could buy on Amazon,
Speaker 1: there wasn't the same amount of leisure time, there wasn't
Speaker 1: the same amount of disposable income. So I think we
Speaker 1: need to qualify and circumscribe what we mean by addiction,
Speaker 1: how it's different from a passion you know how it's
Speaker 1: different from just somebody's preferences, But we also need to
Speaker 1: contextualize it in a world that has pretty much made
Speaker 1: everything addictive, such that even putatively healthy and adaptive behaviors
Speaker 1: now have the potential to be to become compulsive, you know.
Speaker 2: Because people will exploit, exploit that that tendency of humans.
Speaker 2: Do you do you feel comfortable talking about your own
Speaker 2: personal experience what you talk about in your book? Sure, yeah,
Speaker 2: you feel.
Speaker 1: Yep, yep. So just very briefly, you know, in my
Speaker 1: mid forties, my life was going along pretty well. There
Speaker 1: were no major crises. I had never had any prior addictive,
Speaker 1: significant addictive problems, or really even anything I would character
Speaker 1: as addiction. I got into romance novels and they were
Speaker 1: very reinforcing. I'd always been a reader, but this particular
Speaker 1: genre of novel was not something I had ever read before.
Speaker 1: It started with the Twilight Saga, and I was just
Speaker 1: sort of off and running, facilitated by a Kindle that
Speaker 1: I got, which then allowed me to sort of as
Speaker 1: soon as I finished one, I got another. Then I
Speaker 1: got all these free samples, and then I was essentially
Speaker 1: reading twenty four to seven. I couldn't wait to get
Speaker 1: home at night so I could just read. I wanted
Speaker 1: to be done with my kids so I could read.
Speaker 1: I was up till two three in the morning reading,
Speaker 1: took romance novels to work, reading in between patients. I
Speaker 1: just didn't want to be in my own body. I
Speaker 1: just wanted to be in this kind of escape, fantasy place,
Speaker 1: and ultimately started to get more depressed, more anxious, and
Speaker 1: didn't see what was happening to me until it was
Speaker 1: pointed out by somebody else exactly what my patients described
Speaker 1: when they get addicted to drugs. Now, I decided to
Speaker 1: fast from romance novels for four weeks, as I recommend
Speaker 1: my patients. I was shocked by how difficult it was.
Speaker 1: I had a terrible time sleeping at night.
Speaker 2: You said you had an existential crisis.
Speaker 1: Yeah, I mean on some level, yes, right. I was
Speaker 1: certainly buzzing for a while, and then after a month
Speaker 1: felt better. I thought I'd go back to reading. Immediately
Speaker 1: binged and realized, oh, well, I can't. I can't moderate
Speaker 1: this thing. I really need to abstain for a long
Speaker 1: period of time. So that that's what I did, And interestingly,
Speaker 1: now there's no appeal for me in the genre. It's
Speaker 1: like I've sort of burned out those neurons, which is
Speaker 1: that wanting more than liking thing that we started with, right,
Speaker 1: where you get to a point where you've kind of,
Speaker 1: in a way, you've exposed your brain to your drug
Speaker 1: of choice for so long that there's no possibility of
Speaker 1: pleasure there anymore, even though I'm still drawn to them,
Speaker 1: like I see them and I want to read them,
Speaker 1: but then I begin to read them, I don't experienced
Speaker 1: pleasure for them. It's like I've changed my reward threshold
Speaker 1: for romance novels and they probably will never be pleasurable
Speaker 1: pleasurable again, which is sad. Right, It's a grief reaction,
Speaker 1: and that's a lot of what people addicted to drugs
Speaker 1: and alcohol feel knowing they have to give up their
Speaker 1: drug on some level wanting to, but on the other
Speaker 1: level of feeling a real kind of grief reaction.
Speaker 2: To having to do that. Make me, You just made
Speaker 2: me think of a clockwork Orange, the scene where they
Speaker 2: try to reprogram his lust and oversack his brain and
Speaker 2: images so he can't stand it. And yeah, yeah, so
Speaker 2: you talk, you know about other things that really are
Speaker 2: helpful to people like radical honesty and pro social shame.
Speaker 2: And also you say that pain is not necessarily bad.
Speaker 2: You know, we can have a good balance between pain
Speaker 2: and pleasure. I think a lot of people responsively practice BDSM,
Speaker 2: you know, have enjoyed pain, but do it in irresponsible,
Speaker 2: healthy way. As you can tell, I'm very open minded
Speaker 2: and non judgmental about people if they do things in consensual,
Speaker 2: healthy ways, you know. And so people need to I
Speaker 2: think this point of your book is people need to
Speaker 2: find in their own way the best healthiest balance. Yes,
Speaker 2: iain and pleasure. I do agree, and I think.
Speaker 1: It's important to come as a healthcare provider mental health
Speaker 1: care right to become with a non judgmental stance. And
Speaker 1: I try to do that too.
Speaker 2: Yeah, I love it, you say, and I'll end this
Speaker 2: interview today, you say, because I love it. What if
Speaker 2: instead of seeking oblivion by escaping from the world, we
Speaker 2: turn toward it. What if instead of leaving the world behind,
Speaker 2: we immerse ourselves in it. I urge you to find
Speaker 2: a way to immerse yourself full in the life that
Speaker 2: you've been given, To stop running from whatever you're trying
Speaker 2: to escape, and instead to stop and turn and face
Speaker 2: whatever it is, and I dare you to walk toward it.
Speaker 2: In this way, the world may reveal itself to you
Speaker 2: as something magical and all inspiring that does not require escape. Instead,
Speaker 2: the world may become something worth paying attention to. Doctor Lemke.
Speaker 2: Is such an honor to talk to you today and
Speaker 2: thank you for all the work you've done to really
Speaker 2: heal and help people rediscover or discovered, maybe for the
Speaker 2: first time, the meaning and all that exists in the world.
Speaker 1: Oh, thank you. That's such a nice thing to say.
Speaker 1: I appreciate it.