951: Anna Lembke | Finding Dopamine Balance in the Age of Indulgence

951: Anna Lembke | Finding Dopamine Balance in the Age of Indulgence

[00:00:00] Jordan Harbinger: Thanks again to Nissan for sponsoring this episode of The Jordan Harbinger Show. Learn more at nissanusa.com.

[00:00:06] Coming up next on The Jordan Harbinger Show.

[00:00:09] Anna Lembke: We are so insulated from pain in our everyday lives. Most of us don't even really move our bodies very much at all. So we have more leisure time, more disposable income, more access to luxury goods, and now with the internet, instant access to digital drugs. I believe that that is a major contributor to the growing rates of unhappiness. That's because there's too much pleasure and too little of the right kinds of pain for our brains to be able to stay in a healthy balance.

[00:00:41] Jordan Harbinger: Welcome to the show. I'm Jordan Harbinger. On The Jordan Harbinger Show, we decode the stories, secrets, and skills of the world's most fascinating people and turn their wisdom into practical advice that you can use to impact your own life and those around you. Our mission is to help you become a better informed, more critical thinker through long form conversations with a variety of amazing folks, from spies to CEOs, athletes, authors, thinkers, performers, even the occasional economic hitman, gold smuggler, astronaut, legendary Hollywood filmmaker or actor. If you're new to the show or you want to tell your friends about the show, I suggest our episode starter packs. These are collections of our favorite episodes on persuasion and negotiation, psychology, geopolitics, disinformation, cyber warfare, crime, and cults and more, that'll help new listeners get a taste of everything we do here on the show. Just visit jordanharbinger.com/start or you can search for us in your Spotify app to get started.

[00:01:32] Today on the show, Dr. Anna Lembke, psychiatrist at the Stanford School of Medicine, we're talking about dopamine and addiction and dopamine addiction. Not only are we going to hit upon addiction to drugs and substances, but how about gambling, video games, even erotic novels?

[00:01:47] This isn't a Nancy Reagan Just Say No episode, but a dive into how addiction and dopamine function in the brain. How our minds and bodies respond to the poll of substances and activities, even if we're not addicted. Antidepressants, tolerance, something called the hedonic setpoint, and our innate ability to experience pleasure in the first place, cross addiction, dopamine overload, and a whole lot more. A fascinating look into addiction and into the brain here today, with Anna Lembke.

[00:02:13] The soft core vampire porn novels, eh?

[00:02:20] Anna Lembke: Yeah. Yeah, that's right. That's how it all began for me.

[00:02:26] Jordan Harbinger: Tell me about that. Because that's not your usual foray into most brain science. I mean, at least as far as this podcast is concerned, most people don't dive into it because they got addicted to Twilight or whatever.

[00:02:37] Anna Lembke: Right. So way to embarrass me up front, but here —

[00:02:40] Jordan Harbinger: Yeah. That's how we roll.

[00:02:41] Anna Lembke: Okay. Here we go. So somewhere in my early 40s, which was some years hence now, I did get addicted to romance novels and it started with the Twilight Saga, which for those not in the know is a vampire romance series written for teenagers, and I certainly wasn't a teenager. But for whatever reason, that was the thing that all the moms at the local elementary school were reading. And I thought, "What the heck?" Because I've always been a reader. I've always enjoyed fiction and nonfiction throughout my life. But there was something about that book that was just incredibly reinforcing. It was sort of transportive for me this kind of incredible escape. Not that I had a whole lot to escape from, which I really think it's important to emphasize. I have a wonderful husband, great kids, meaningful work, I'm privileged in many ways. So there wasn't like, you know, my life was not in any way particularly hard. But for whatever reason, that novel was just a wonderful experience. So I read the whole series and I read it again, and I read it again. And I went from there to other vampire romance novels, of which turns out there are a lot. And then I read werewolf romance novels and witches romance novels and you know, you name it. There's a whole universe out there. All that was still like reasonably manageable until I got a Kindle, and then I became a real chain reader. Like as soon as I finished one, I was reading another, I was staying up later and later at night. I developed what we call the "addiction business tolerance", which means that I needed more potent forms and more of my drug over time to get the same effect. So I progressed from relatively tame romance novels to kind of socially sanctioned pornography for women, very graphic kinds of novels. I got to a point where I would just like rush through the first two thirds. Because it turns out, if you open any romance novel to about two thirds of the way through, you will get right to the point.

[00:04:42] Jordan Harbinger: This, that's very familiar for most men, I think. Where we're like, "Oh, I can relate to that."

[00:04:46] Anna Lembke: Right, exactly. And then eventually, I was like downloading really terrible romance novels from Amazon because they were free. I would like rush to the climax and then I wouldn't even finish the books. I would be already onto the next one. The long and the short of it is, as much as it is possible to get addicted to romance novels, I really did develop a kind of a minor addiction despite the fact that I am an addiction expert. I didn't really see it as it was happening. It took a specific event for me to go, "Oh wow. I think I might have a problem here."

[00:05:20] Jordan Harbinger: If you're addicted to heroin and you get kicked out of your home and your friends leave you and you wake up in a park one day and you're like, "I've been here for two weeks. There's something wrong." What is that rock bottom event when you're like, "My Kindle is run out of memory." I mean, what's that event for romance novels?

[00:05:37] Anna Lembke: Right. So for me, it was a couple of things. First of all, it was finding myself up at three in the morning on a weeknight reading 50 Shades of Gray, which is like state of masochistic porn, basically, and being like, "What am I doing?" It was a particular scene of with butt plugs, and I read the word butt plugs and I thought, "How did I get here? I'm not interested in butt plugs. Like what happened?" So that was sort of a low for me. But then, it was also just some of the behaviors where, I mean, we went on a family vacation where we rented a beach place with some friends of ours, and I spent most of that weekend hiding in my room reading romance novels. I just — it became the most salient thing for me, the most interesting, compelling, pleasurable thing. Other things became less pleasurable. And then one day, I even brought a romance novel to work and was like reading it in the 10 minutes between patients. And some of that, all of that sort of swirling around together at one point. Even that, frankly, well, like I didn't realize. But the tipping point for me was, I actually was in a role play with a student where I had to be a patient. And the psychiatrist who's a student, was supposed to get me to think about behavior change. So he said, what is a behavior in your life that you'd like to change? And I said, I hadn't pre-planned it, but in that moment I was like, "Oh, yeah. I think I'd like to change my late night reading habit." I did not share with this young person what I was reading. I just said my late night reading habit. And he said, "Oh, well, how is that interfering with your goals and your values?" So, you know, very vaguely describe that. But the point is that it wasn't until I said it out loud to him that I realized, "Oh wow, this really is a problem."

[00:07:23] Jordan Harbinger: Yeah.

[00:07:23] Anna Lembke: And the next day, I couldn't unsee it. So to get back to your question though, addiction is a spectrum disorder. People who are way on one end of that spectrum, I think we could all agree, there's a serious problem here. People who are on the other end of that spectrum, there could be an enormous amount of debate like is spending all weekend long watching sports on television to the exclusion of spending time with your family, is that an addiction? Is that a passion, a hobby? People would probably maybe land differently, talking about those types of like less obvious addictions, especially when it's kind of a socially sanctioned behavior.

[00:08:00] Jordan Harbinger: Sure. Like work.

[00:08:01] Anna Lembke: Yeah, like work.

[00:08:01] Jordan Harbinger: Zero inbox.

[00:08:02] Anna Lembke: Yeah.

[00:08:03] Jordan Harbinger: Yeah. I'd love to see my dopamine levels when I finally close out that last starred email. I know that it spikes because I tell my wife about it.

[00:08:11] Anna Lembke: Oh yeah.

[00:08:11] Jordan Harbinger: "I'm done. There's no starred left." She's like, "Cool. Cold chicken on the table, you weirdo." Yeah.

[00:08:18] Anna Lembke: Right.

[00:08:19] Jordan Harbinger: I mean, I know that it happens.

[00:08:20] Anna Lembke: Yeah.

[00:08:20] Jordan Harbinger: But this is interesting, and what it says about dopamine in addiction is kind of terrifying. Look, the romance novel thing is kind of a funny admission, and it's good for you that you had that random exercise where you were forced to think through this example, and it turned out to be something that you really wanted to get through. I think we need to define addiction then, because I think most people will say things like, "Well, you're not really addicted to work. Because you don't get sick when you stop doing it." Or you know, romance novels. Yeah. Okay, fine. It's hard for you to stop, but you're not — you don't chain yourself to a stump in the middle of the woods to come down from romance novels, right? Like a heroin addict or something like that might do. So can we define addiction more clearly?

[00:09:02] Anna Lembke: Okay. So addiction is defined as the continued compulsive use of a substance or behavior despite harm to self and/or others. In the Diagnostic and Statistical manual, there are 11 criteria that we use. The more criteria that you meet, the further you are on this mild, moderate to severe spectrum of addictive disorders. The criteria are somewhat physiologic in terms of like, do you have tolerance? Do you need more of your drug over time to get the same effect? Do you have withdrawal? Do you have psychological and physical manifestations when you stop? But most of the criteria have to do with what we call the three Cs — control, compulsion, and consequences. Is your use out of control? In the sense that you plan to use a certain amount, and then you're repeatedly using more, or you keep planning to cut back and the cutback just never happens, or not consistently. Do you have compulsive use? Which is to say, is there like a level of automaticity in your use where your mind is really preoccupied with using your focused on it all day? You can't wait till you get it, you arrange your whole life around it. And then, continued use to spike consequences. So whether you see the consequences or only other people see the consequences. When they're pointed out to you, do you take that in and kind of process it and say, "Gee whiz, maybe I should change this behavior."? Or do you find that you continue to use your drug of choice, whether a substance or behavior, despite those consequences? Importantly, there is no brain scan or blood test to diagnose addiction. This is based on phenomenology, that is patterns of behavior that we see repeatedly across cultures, across decades, across continents.

[00:10:36] Jordan Harbinger: That's interesting that there's no blood. I mean, of course there's no blood test for it. But it seems like the definition is not super malleable, but it certainly seems like there's a little bit of flexibility, which is I think why people use that to rationalize that they're not addicted to something, even if they know all about addiction like yourself. You weren't immediately like — I mean, if you were doing cocaine between patients, you'd be like, "I have an addiction and I need to go get help for this, right now." But you're like, "I'm just reading. I'm just reading a book, whatever."

[00:11:05] Anna Lembke: Interestingly, I wasn't even having that conversation with myself, right? And that's the extent that denial can take. I wasn't even saying, "Oh gee, I'm in the 10 minutes I have instead of contemplating the case or writing it up or reading about it, or preparing for my next patient." I'm just compulsively wanting to escape myself and where I am. There's not even the conversation happening. Here's the thing. Even though there's no blood test or brain scan, it doesn't mean that addiction is not biological. It's actually highly biological. And the more we expose ourselves to addictive substances and behaviors, the more we change our brain. And there's an explosion in neuroscience that tells us exactly what is going on there. Not exactly, but you know, there's a lot of information about what's happening in the brain as become addicted. But it's not the kind of information that you can sort of use diagnostically.

[00:11:54] Jordan Harbinger: We hear a lot about opiates and now the conversation, at least online, maybe only on Reddit, I don't know, is there's a lot of conversation about men and using online porn. Because I think a lot of guys have finally come to the conclusion that after our brains, guys my age, especially, I'm 43, we've had really good internet for, I don't know what, 25 years now?

[00:12:17] Anna Lembke: Right.

[00:12:18] Jordan Harbinger: So a lot of guys my age are like, "Uh-oh. That wasn't good for me, going to college and having super fast bandwidth." And now, I think a lot of younger guys are starting to get the message too, where they're like, "Wait a minute. I wasn't really good with the opposite sex in high school and I didn't have to worry about it. And now I'm a grown ass man working at General Motors, and I'm still just like — I'm not doing anything about that because I can just go home and use my phone or whatever." We're starting to see this as a real risk factor, not as severe as dying from an opiate addiction, but it's definitely something where people are expanding the idea of what they might label an addiction.

[00:12:55] Anna Lembke: Yeah. Thanks for highlighting that. Any and every addiction is a source of suffering in our lives. But I do think that the shame associated with sex and pornography addiction is almost more, than with other addictions because of the social and cultural climate right now, especially for men. The smartphone essentially came out in 2001, and it was almost exactly at that time that we started seeing more and more men coming into the clinic with sex pornography and compulsive masturbation addictions. And when I talk about addictions, I'm talking about massively out of control use with incredibly severe consequences and harm to these individuals. Destructions of their marriage, loss of job, depression, anxiety, suicidal thinking, attempted suicide. Completely consequential and directly relatable to their compulsive use of pornography masturbation, or whatever their particular sex related addiction is. And without fail, what the men described was that they used pornography recreationally in the 80s and 90s, and it was manageable. Once the internet was invented, and especially then the portable digital devices known as the smartphones, it became unmanageable. Which really speaks to one of the big risk factors for addiction that we often don't talk about, which is simple access to our drug of choice.

[00:14:20] Jordan Harbinger: Mm-hmm.

[00:14:20] Anna Lembke: If you have more access, you're going to use more, you're going to change your brain more, and you're more likely to get addicted. So, super important that people recognize that these moving images are drugs. They light up the same part of the reward pathway as drugs and alcohol. The phenomenology of addiction is identical to addiction to drugs and alcohol. People start out using for one or two reasons, to have fun or to solve a problem. If it works, they return to it with repeated use, they develop tolerance. Getting more potent forms and more of the drug over time to get the same effect. With sex addiction, the way that manifest is they start out with vanilla toast pornography, then it's more deviant pornography, then it's actually chat rooms and movie cams, and then it's actually meeting up and hookups and more and more risky behavior because the vanilla toast pornography they started out using, doesn't work anymore. Because now their brains are changed. And this is what happens with addiction. Incredible shame and guilt. And then when people stop, a physiologic withdrawal. I've seen with sex addiction when people, what we ask for is for them to abstain from orgasms with themselves and others for four weeks as sort of the initial intervention. And people will have nausea, vomiting, headaches. Not to mention the kind of universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability, depression, anxiety, those types of things.

[00:15:44] Jordan Harbinger: Wow. And you're right, drugs are digital now, right? Porn, gambling, I think just for some people, video games, probably.

[00:15:52] Anna Lembke: Oh, for sure. We see a lot of that.

[00:15:54] Jordan Harbinger: Among gamers, there's kind of this, I'm not super familiar, but there's this kind of uproar because a lot of the companies have figured out how to — it's called "loot". Have you heard of loot in games? I don't even know exactly how it works, but it'll be like, "You can get a different kind of character skin or uniform or gun or whatever for your —" and people get super addicted to this stuff. And they made it randomized and they do all the things to get your brain kind of excited about the uncertainty. And there'll be people who make like $37,000 a year, spending eight or 10 or more thousand dollars on Fortnite skins and character stuff.

[00:16:30] Anna Lembke: Oh yeah. Yeah, this is well known. It's sometimes referred to as the gamblification of gaming. It's the treasure chest. It's all the things that you can win if you either put up money or spend more time on the site. One very interesting patient that I had told me that he can gambled recreationally for years and actually never had a problem with it. He was always able to manage his gambling with money. But what really led to severe addiction was a game online that didn't involve real money, it was fake money. So it wasn't even real money that he was winning or losing, but that he got in the cycle of it and just got so addicted to the betting around the fake money that what was happening was that all his time and attention was being usurped by the game. So it doesn't even have to be real money for people to get addicted to it.

[00:17:22] Jordan Harbinger: I mean, the Kindle book thing is also wild, which is a good reminder for our show fans to use our links in the show notes to buy your soft core vampire porn and support the show when purchasing things from Amazon. But I remember my language arts teacher in middle school saying, "Be careful of marijuana. Not because marijuana's bad for you. I smoked marijuana when I was young." She was kind of like this, you know, hippie woman who was probably in her 50s, 60s back then. And she said, "But now, it's so much more potent."

[00:17:49] Anna Lembke: Mm-hmm.

[00:17:49] Jordan Harbinger: Before, it was just crap that grew in a field and people would plant the seeds that fell out of the bag they bought and that was their marijuana plant. And now, it's all like genetically engineered and cross bred and it's 43 percent THC instead of one or whatever they had back in the 60s.

[00:18:06] Anna Lembke: Right.

[00:18:06] Jordan Harbinger: And she's like, "And processed food is going to be the same thing." We didn't have Cheetos back then. We ate cheese and you didn't — you know, that was it. You stopped and you were full. Now, it's tricking your brain. And I feel like she was right, now that I read things like Dopamine Nation. They are trying to figure this out so that it's more potent and more accessible.

[00:18:27] Anna Lembke: Yeah. Your teacher was prescient. There's no doubt about it. What we've seen now is that almost every aspect of human experience has become drugified in some way. By that, I mean, it's been made more potent, and when things are more potent, they release more dopamine, our reward neurotransmitter more quickly in the reward pathways in the brain. Drugs are more accessible. We can get them 24/7 delivered to our doorstep. They're more bountiful, so they don't run out. There's no natural stopping point. If cocaine were as abundant as TikTok, we would have many, many more cocaine addicted individuals. And then there's also novelty. One of the ways to overcome tolerance with drugs is to make them more potent by combining two drugs together. So, for example, combining an opioid with a benzodiazepine increases the potency of the high of the opioid. The same thing happens with digital drugs, right? You've got a game and now you gamblify it, right? Or you've got a YouTube video or a YouTube show with singing, which is of course, reinforcing for people who like music. And now you gamify it, you make it a competition. That's happening all the time. You make it more potent by making it shorter duration. So the TikTok videos, the reason that they're so difficult to stop watching once you start is because they're so short and so potent that they cause a really huge surge, most likely of dopamine, unfollowed by dopamine free fall right afterwards. And it's that plunge in dopamine below baseline firing levels that then creates the craving to want to do it again and again and again. So, you've got potency, access, quantity, and novelty, and you can apply that to almost everything that humans in wealthy nations do. Whether it's the food we eat, or the games we play, or the books we read, or the exercise that we do or what have you.

[00:20:13] Jordan Harbinger: It's scary for somebody who creates long form content, right? Because everyone's like, "You need to be creating short form stuff." But then you find yourself creating for this weird algorithm, and it's all kind of meaningless. How much am I really going to fit into? Is it 90 seconds? I don't have the app because I don't want to be spied on by China. Although, I'd rather be spied on by Mark Zuckerberg, which is— or whoever. But I don't have it because I don't like that kind of content. But it's really hard as a creator to get around it because people will say, "YouTube shorts, TikTok shorts, Instagram reels." And it is incredibly popular, but it's a little scary because I've tested it, it doesn't lead to people coming to the long form content because they don't want that anymore.

[00:20:54] Anna Lembke: Yeah, it's interesting. I think you're getting a very different experience with short form versus long form content. I think with short form content, you're getting the dopamine hit and that's what people are looking for. But with long form content, I think people will stick around for that because that's where you kind of settle into a softer brain rhythm that is like more receptive potentially, to learning and having kind of a shared slower experience. I'm optimistic about long form. I think people will realize that in the long run, it's probably better.

[00:21:29] Jordan Harbinger: So far so good, right? I mean, this show is growing and podcasting is growing and I think part of the reason is because people go, "Oh, I'm not sure what I'm getting from watching 500 TikTok videos per day. Maybe I want a deeper dive into something that's interesting." And then they stick around for years at a time.

[00:21:47] Anna Lembke: Yeah. Oh, that's great.

[00:21:47] Jordan Harbinger: With one yutz like me talking to a bunch of brilliant people like you. And that seems to work, which is kind of a miracle given what you've just told me about dopamine.

[00:21:55] Anna Lembke: It is. And getting back to your comment about pornography and a whole generation of men kind of maturing through pornography and then kind of looking back and going like, "What was that?" and changing course. That's very encouraging. There's a — you maybe or may or may not be aware, but there's a NoFap movement.

[00:22:16] Jordan Harbinger: Yes. There is.

[00:22:17] Anna Lembke: Yes.

[00:22:17] Jordan Harbinger: That's so funny to hear somebody else say that out loud. Yeah. That's really — NoFap.

[00:22:21] Anna Lembke: But that's real. And believe it or not, it's international. And for those of your listeners, that means people who are committing to not masturbating, mostly men committing to not masturbating, not watching pornography. And it's international. So my book is available in Korea, so I've had lots of nice contact with readers in Korea. And this is a big deal in South Korea, too. Like a whole generation of men kind of going, "You know what, I'm not going to auto stimulate anymore and I'm going to feel better for it." So it's kind of exciting. People are starting to talk about this and make some efforts to kind of correct.

[00:23:00] Jordan Harbinger: You are listening to The Jordan Harbinger Show with our guest, Anna Lembke. We'll be right back.

[00:23:05] This episode is sponsored in part by Shopify. Shopify is a platform where simplicity meets efficiency. Akin to the ease of GPS navigation, keyless car starts, or seamless digital payments. That's the sweet sound of another sale made on Shopify. If you run an e-commerce shop, Shopify is the ultimate tool. If you're dreaming of launching a business on, I don't know, innovative science kits or school workbooks, but you're unsure where to begin, Shopify emerges as your global e-commerce ally. From the initial setup of your online store, Shopify acts as your guide, steering you through the intricacies of e-commerce. Are you considering a leap in a brick and mortar presence? Shopify has got a robust in-person POS system. And as your sales climb, Shopify effortlessly scales alongside your business. The real game changer is Shopify's checkout efficiency, which boasts a conversion rate of up to 36 percent higher than competing platforms. Shopify powers 10 percent of all e-commerce in the US, including brands like Allbirds, Rothy's Brooklyn, and available in 175 countries. Shopify is the backbone of e-commerce success.

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[00:24:11] Jordan Harbinger: This episode is also sponsored by BetterHelp. Jen and I have been together for over a decade. Wow, time flies, kind of. And during the rollercoaster that life has thrown our way from the heartache of losing a business to the excitement and challenges of starting a new, navigating four significant relocations, embracing the joys and demands of raising two kids, through every high and low, we've managed to strengthen our bond, transforming obstacles into stepping stones for our relationship. And a critical component of this resilience and growth has been my commitment to therapy over the years. It's equipped me with tools and insights needed to navigate through life's toughest moments, enabling us to build a stronger, more understanding partnership. This really underscores the profound impact that professional support like BetterHelp therapy can offer, providing a foundation for individuals and couples alike to thrive amidst life's unpredictability. I mean, we were OG with therapy, like the first couple months we were dating and starting to take things more serious, it was like, "Ah, lemme go just run you by my therapist. She's pretty cool." Get the old sanity check. If you're thinking of starting therapy — I wonder how that date was. If you're starting to think of therapy, give BetterHelp a try. It's entirely online, flexible, and suited to your schedule. Just fill out a brief questionnaire to get matched with a licensed therapist and switch therapist anytime for no additional charge.

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[00:25:26] Jordan Harbinger: If you're wondering how I managed to book all these great authors, thinkers, scientists, creators, every single week, it is because of my network. The circle of people I know, like, and trust. And now I'm teaching you how to build the same thing for yourself for free over at sixminutenetworking.com. This course is all about improving your relationship building skills. It's not cringey. It's very easy. It's only going to take a few minutes a today. It'll make you a better colleague, a better friend, a better peer. By the way, many of the guests on the show already subscribe and contribute to the course, so come join us. You'll be in smart company where you belong. All for free at sixminutenetworking.com.

[00:25:58] Now back to Anna Lembke.

[00:26:02] You mentioned in the book, we humanity, or at least the United States maybe, is on this quest to live in a pain-free world. What have you noticed about that? Because it seems to be the reason for us diving into a lot of these issues headfirst, antidepressants, the massive, I guess, over-prescription of those? I'm not even sure if — are they over-prescribed? It sure sounds like they are, given the numbers that you mention in the book. And if you have those numbers handy, that would be interesting. Do you, by any chance?

[00:26:32] Anna Lembke: I don't have them handy. I'd have to go get a copy of the book and crack them open.

[00:26:35] Jordan Harbinger: Okay. I wrote down one, but it sounds like —

[00:26:37] Anna Lembke: Okay, great.

[00:26:38] Jordan Harbinger: Fully one in five people, including maybe children, were taking stimulants and/or antidepressants, which is honestly fricking unbelievable. And I think it's something we're going to look back on in a few decades with utter shock and total shame. Because the amount of people on pills to modify their brains today, it'll be like — we'll think of that like we think of the lobotomy now.

[00:26:58] Anna Lembke: Right.

[00:26:58] Jordan Harbinger: People just won't believe that we did this to ourselves.

[00:27:01] Anna Lembke: So I think that statistic is one in five adults take some type of psychotropic and one in 10 children, which I find especially scary. Takes some kind of psychotropic or intentionally, you know, mind or mood altering substance. Either an antidepressant or an anxiolytic or a stimulant or something like that. So that's really, it's scary. Look, I was educated in the 90s. That's the decade of the brain. That was the decade where psychopharmacology was going to come to the rescue of mental health and there was going to be a pill for everything that ailed us. There was so much excitement and so much promise, and here we are 25 years later and there's this realization that, "Gee whiz, the drugs aren't working as well as we'd hoped." in fact, rates of depression, anxiety are going up despite destigmatizing mental illness and creating more access to these psychotropic drugs. So that's one big clue that we're getting something fundamentally wrong. And then I think the other conversation that we're having that we needed to have is that there's probably no free lunch. And that these drugs have potential marked downsides that we've been ignoring. Some of them life-threatening and some of them more subtle, but important. Like gee, if I'm on an antidepressant, yeah, it's true, I'm not as depressed, but I also don't feel very much. My mom just died and I couldn't even cry at her funeral, for example. Patients will say to me things like that.

[00:28:30] Jordan Harbinger: Wow.

[00:28:30] Anna Lembke: So it's like, what are we really — what's going on there? Plus, you've got the sociodemographic data that suggests that we prescribe a lot more psychotropics to poor people and minorities and people who are disenfranchised, the unemployed, which really does suggest some kind of Orwellian phenomenon where we're actually using the medications to pacify large segments of society who have really good reason to be unhappy with their circumstances.

[00:29:01] Jordan Harbinger: I do want to caveat that there's — it's not that there's no place for these medications, I want to be clear about that. I don't want people to be like, "Jordan and Anna Lembke are shaming me because I'm on SSRIs or whatever." But it seems clear that they're over-prescribed, in some way.

[00:29:16] Anna Lembke: Thank you for that. I mean, I'm a psychiatrist. I make my living essentially prescribing medications. They're absolutely lifesaving in some instances. So it's not at all to say, we want to throw the baby out with the bath water. These are useful tools, I'm very grateful for them. But it's just that we probably prescribe them too often at too high doses for too long. And polypharmacy is a known serious problem in the field where you've got somebody who's not really doing well, not responding, instead of taking the medicine away, we just pile on more and more, and then you don't know what's working. So again, it's not to condemn the whole field that I'm an active part of. It's just to sort of get people thinking about some of these other aspects.

[00:29:58] Jordan Harbinger: I've never heard of that polypharmacy. Is that just when you're on multiple medications?

[00:30:02] Anna Lembke: Yeah. So we see many people who are on 10, 15, 20 different psychotropic medications.

[00:30:09] Jordan Harbinger: What? That's ridiculous.

[00:30:11] Anna Lembke: Oh, it's very common. These are often severely mentally ill people. The intention is to try to help them, but obviously when you're on that many different meds, you just don't know what it's doing anymore.

[00:30:22] Jordan Harbinger: Yeah. How do they even know that that's not interacting? I mean, it just seems so complicated. I wouldn't even take 20 vitamins, right? That just seems dangerous to me.

[00:30:32] Anna Lembke: I just saw a patient yesterday who was on like 10 different psychotropics and 10 different vitamins, that a vitamin doctor had recommended.

[00:30:40] Jordan Harbinger: Ugh.

[00:30:40] Anna Lembke: You know, I always say like, I don't know much about vitamins, so.

[00:30:43] Jordan Harbinger: Vitamins are — they're all in like one thing. I guess I'm sort of exaggerating here, but a drug that says, "This one makes you feel better. But this one helps with the side effects of the other one." And you hear about that. But I thought, "Okay, three or four, gosh, that's a lot." But 15 to 20?

[00:30:57] Anna Lembke: Oh yeah.

[00:30:58] Jordan Harbinger: It just seems impossible to manage that. You'd need a computer algorithm to make sure you weren't creating another substance just in your stomach that's causing your liver to die or something like that.

[00:31:09] Anna Lembke: It's partially a function of our dysfunctional healthcare system. You know, they got somebody who's really suffering, the doctor doesn't know what to do. The medicines they're on may be helping, but it's not clear, but they're not doing well. So then you add another one, thinking that that may help. And then their insurance changes and they go see another doctor, and it's just really — there's so much churn in the system and there's so little psychosocial support, that medicines are sort of like the default or the go-to in our healthcare system. But we know that this kind of polypharmacy is not optimal. So sometimes what we'll do is we'll admit patients who are very mentally ill to the hospital, solely for the purpose of getting them off of pretty much everything and starting over again and seeing what's underneath there.

[00:31:53] Jordan Harbinger: Oh, man. Hitting the reset button. So then they're just miserable during the withdrawal period and then you slowly add things back in. Ugh, these poor people.

[00:32:00] Anna Lembke: Yeah.

[00:32:00] Jordan Harbinger: I know in the book, you said Americans report being unhappier in 2018 than in 2008 and here we are, halfway from there to 2028, I guess. Americans frequently report being in pain, physical or otherwise, and you said in the book that you think this is in part due to our obsession with avoiding feeling uncomfortable or feeling pain. What do you mean by that? Are we talking about physical pain or are we just talking about everything in general?

[00:32:27] Anna Lembke: Talking about both physical and mental suffering, I talk a lot in the book about the basic neuroscience of how we process pleasure and pain. It turns out that pleasure and pain are co-located in the brain to the same parts of the brain that process. Pleasure also process pain. They work like opposite sides of a balance. I mean, that's an oversimplification, but it really gets at the heart of how we manage those fundamental reflexive systems. And what happens when we do something that's really pleasurable, it releases dopamine, our reward neurotransmitter, in that reward circuit, and that balance tilts to the side of pleasure. But there are certain rules governing that balance. The first and most important is the balance wants to remain level, which is what neuroscientists call homeostasis. And in order to level the balance, what it does is first, tilt an equal and opposite amount to the side of pain. So that's the opponent process mechanism that calm down the craving, the after effect, the hangover. I like to imagine that as these neuroadaptation gremlins hopping on the pain side of the balance to bring it level again, what they like at there. So they don't get off when it's level, they stay on until it's tilted to the side of pain. Now, if we wait long enough and we don't repeat that behavior or ingest the substance again, those gremlins hop off and homeostasis is restored. But if we continue to expose our brain repeatedly to highly reinforcing substances and behaviors, those gremlins essentially multiply until there's enough to fill this whole room. And now we're entering into addicted brain or a kind of chronic dopamine deficit state. Where in order to compensate for all of the reinforcing substances and behaviors that our brains were not evolved for, because our brains were evolved for a world of scarcity and ever present danger, what we've done is we've sort of changed our hedonic or joy set point by downregulating dopamine transmission into this below normal threshold. I think that's what we are doing both individually and as nations. We're exposing our brains to so many pleasures and we're so insulated from pain that our brains are essentially reeling in an effort to compensate. And they're doing that by downregulating all those feel-good neurotransmitters. And that's important if it's true, because it means that the intervention's going to be very different, right? Our main mental health intervention now is like, "You're uncomfortable? Make yourself more comfortable." right? "You're experiencing pain? Oh, you can't be experiencing that pain. We need to give you a pill or do something else to take that pain away." But because of the way that pain and pleasure work like these opposite sides of a balance, the truth is, that will never work. And the more we try to make ourselves comfortable, the more we're going to end up unhappy. Instead, what we need to do is intentionally seek out challenging and even painful experiences to a degree and avoid intoxicants as a way to reset healthy dopamine levels.

[00:35:18] Jordan Harbinger: Is this what addict talk about when they say, "Alright, I need X amount of heroin just to feel normal." It's not about getting high anymore, it's about just being able to function and they have to shoot up to just do anything.

[00:35:28] Anna Lembke: Right. Exactly. So once you accumulate all those gremlins on the pain side of the balance, and you're in that chronic dopamine deficit state, you've changed your hedonic set point. Remember, we're always releasing dopamine at a baseline tonic level, kind of like the heartbeat of the brain. But if we overexpose our brains to highly reinforcing substances and behaviors, our brains compensate by decreasing baseline dopamine release to this dopamine deficit state, visualized as the gremlins, really camped out on the pain side of the balance. Now I need more of my drug in more potent forms. Not to get high, but just to level the balance and feel normal. And when I'm not using, I'm walking around with a balance tilted to the side of pain, experiencing the universal symptoms of withdrawal, which are anxiety, irritability, insomnia, depression, craving. And really, all of my energy is taking up with just thinking about getting my drug so I can restore homeostasis. Because the drive to restore homeostasis is one of the most powerful physiologic rules governing all living organisms.

[00:36:27] Jordan Harbinger: What is the absence of pleasure is what, anhedonia?

[00:36:30] Anna Lembke: Right.

[00:36:30] Jordan Harbinger: Something like that. It just sounds absolutely miserable where it's not just chasing the dragon, right? Where your tolerance is built up and you're like, "Oh, I want that really high, high." That's long gone. Now it's just you want to wake up without a slamming headache and feeling sick and unable to focus. That sounds like one of the worst ways to exist. You have to put this poison, an illegal poison into your body to just do anything without feeling awful.

[00:36:57] Anna Lembke: Right. And it's important to understand how intense and overwhelming those feelings are, in order to understand why people with addiction will relapse even after they can see objectively that their lives would be better off if they didn't use. It's because their brains are screaming out for them to go get the drug and use the drug in order to restore homeostasis. So it's not about seeking a pleasure, it's really about trying to not no longer be in pain.

[00:37:23] Jordan Harbinger: What scared me in the book is drugs like Adderall, which a ton of people take, increased dopamine output by a thousand percent. I took Adderall in law school because a lot of people were doing it and I took the ADD test and I was like, "Yeah, sure, I have ADD. And now I can function and study really hard." And I just — I was 20 years ago, was not thinking about this kind of stuff at all. And I felt so good while I was on it, but I thought it was because, "Wow, this is how normal people feel every day. They're just so focused. My ADD really is a disability. This is crazy." And now I realize, no, it just my brain's just bathing in dopamine at the time. And that was not how normal people feel at all. That's how drugged up amphetamine addicts feel, because that's what I was taking.

[00:38:08] Anna Lembke: Yeah. So this is an important point because it highlights a fallacy in the mental health field, which is that if you take a medicine and it does for you what it was intended to do, so then you must have the disorder that the medication was meant to treat. So for example, if you take attention deficit disorder, and it is true that people with that label probably do have a different processing brain, a different way of processing information than other people. Now, whether or not we should label that pathological, people can disagree, and I might even disagree with that. I think it's a different way of processing, but not necessarily a pathological way of processing. But what we've done is we've said, "Take this stimulant. Oh, does that help your brain process in this more neurotypical way? If it does, then you must have ADHD. But the truth is, if you gave anybody a stimulant or most people a stimulant, they would be better at a certain kind of sustained attention and repetitive behavior that stimulants promote. You don't have to have ADHD to get that effect. So that kind of backward, causal thinking, I think, you know, permeates a psychiatry and mental health and isn't really a good way to think about it. I do prescribe stimulants to a few rare patients who have shown that they really benefit from it. But I also do it in the context of opening the discussion about with pros and cons. Because again, there's no free lunch with any of these medications and even people who can manage their stimulants and report benefit. We'll admit that it makes them more anxious. It makes them — gives them more insomnia that there's a come down in their mood. And those are really important to acknowledge because there's a tipping point where you reach it where it's like, "Well, really, is it really worth it?" Plus, of course, there's the risk for addiction. Again, addiction is a spectrum disorder. Not everybody who is exposed to a stimulant is going to get addicted to stimulants. Not everybody who drinks alcohol is going to get addicted to alcohol. But there will be a subset of individuals who will go there. And it will be largely outside of their volitional control.

[00:40:10] Jordan Harbinger: You mentioned before that drug and alcohol use change the brain forever. In the book, there's a rats and cocaine example, and this is really, well, a bummer is kind of an understatement. This is really scary, I think, because it seems like no matter how much time off you take from a substance, you're just as vulnerable to it. If you take it again, even years down the line, it's almost like the drug tattoos your brain in some way.

[00:40:34] Anna Lembke: Yeah. So there's quite a bit of evidence both in the animal literature but as well as in our clinical observation that once an individual has become severely addicted to a substance or behavior, even after they've abstained and gone into re remission or recovery for, in some cases, decades. If they're re-exposed to that substance or a similar related substance, that can reignite those addictive behaviors almost instantly. Yeah, that is kind of depressing. But I think it's important to just acknowledge that that's very often the case, not in every case. I mean, humans are really complicated, and our brains are — we're only at the sort of brink of understanding what's happening. So again, none of these things are a hundred percent. But in most people, that is the case. What we think happens with recovery is those damaged areas probably never repair themselves, but people are able to create new neural networks that route around those damaged areas. So I always like to emphasize that recovery is real. Recovery happens on a neurological level. Recovery is robust. People will get into recovery from even very severe addictions and remain in recovery for the rest of their lives, but they'll always probably remain vulnerable, and so it's good to keep that in mind.

[00:41:49] Jordan Harbinger: Earlier, you mentioned that we live in this world of abundance, but our brains are evolved for scarcity. In the book, you write that we're cacti in the rainforest and we're drowning in dopamine. I think that's a really interesting metaphor because it really does seem like there's so much food around, there's so many drugs around, there's so much whatever it online. It sounds like from reading the book though, it takes more pleasure now to produce dopamine and less injury or whatever to produce pain. So are we more fragile now? Has our ability to bounce back from things, has that been degraded by our environment?

[00:42:24] Anna Lembke: I think so. What we're dealing with now is a mismatch between our ancient wiring for processing pleasure and pain, and the world that we have created, which is, you know, in this era of the Anthropocene where human activity for the first time in human history, has actually changed the environment. We usually use global warming as the example of that, or whatever you want to call it, the way that we've polluted our environment. But this phenomenon of the drugification of everyday life is also a real thing that is impacting our lived experience because we are so insulated from pain in our everyday lives. Most of us don't even really move our bodies very much at all or many of us. And we're also have more access than ever to reinforcing substances and behaviors, importantly even among the poorest of the poor. So we have more leisure time, more disposable income, more access to luxury goods. And now with the internet, instant access to digital drugs, which can have the same effect. I believe that that is a major contributor to the growing rates of unhappiness, growing rates of anxiety, depression, the mental health crisis that we're seeing among our youth. It's because there's too much pleasure and too little of the right kinds of pain for our brains to be able to stay in healthy balance.

[00:43:45] Jordan Harbinger: This is The Jordan Harbinger Show with our guest, Anna Lembke. We'll be right back.

[00:43:49] This episode is sponsored in part by Progressive. Hey listeners, whether you love true crime or comedies, celebrity interviews, news, or even motivational speakers, you call the shots on what's in your podcast queue, right? And guess what? Now you can call the shots on your auto insurance too. Enter the Name Your Price Tool from Progressive. The Name Your Price Tool puts you in charge of your auto insurance by working just the way it sounds. You tell Progressive how much you want to pay for car insurance, they'll show you a variety of coverages that fit within your budget, giving you options. Now, that's something you'll want to press play on. It's easy to start a quote and you'll be able to choose the best option for you, fast. It's just one of the many ways you can save with Progressive Insurance. Quote today at progressive.com, and try the Name Your Price Tool yourself and join the over 28 million drivers who trust Progressive. Progressive casualty insurance company and affiliates. Pricing coverage match limited by state law.

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[00:45:54] Now for the rest of my conversation with Anna Lembke.

[00:45:56] The gambling example you gave in the book was really interesting and counterintuitive. I think you'd said something along the lines of, "The dopamine reaction in gamblers was highest, not when they won, but when the probability of winning and losing was about 50-50." So this — I never saw coming. So it seems like it's actually the uncertainty that triggers the dopamine hit, not winning money in the game. And gambling for me, personally, never really clicked. I felt kind of good when I won, and I felt really dumb when I lost, and I only felt anxiety in between.

[00:46:31] Anna Lembke: Right.

[00:46:31] Jordan Harbinger: So it wasn't hard for me to decide that that was not something I wanted to keep doing.

[00:46:35] Anna Lembke: Right.

[00:46:36] Jordan Harbinger: It was just like you go to a bachelor party, you make your piddly little $80 budget, and you sit there with your friends and you're like, "All right, this is me sitting with my friends. But I had no desire to stay up till 3:00 AM with the other — like the hardcore guys, trading sleep for dopamine." Sports betting, same thing. It probably helps that I don't like sports. And as it turns out, being a giant dork has actually saved me quite a bit of money. But I wonder how social media compares to gambling, with respect to the dopamine and the ups and the downs, but the uncertainty of what you're going to see on Instagram or TikTok, or whether people are going to like your stuff. Is that uncertainty at play here as well?

[00:47:15] Anna Lembke: Oh, absolutely. I think that's part of what makes social media potentially so addictive for some individuals. It's that you can post and get a really positive response and get a nice burst of dopamine and feel really good. But then, the next time around you post again, you don't get that response. And probably what's happening in the brain is not that then dopamine levels are neutral, they actually go below baseline. Because we know that when we anticipate or expect a certain reward and we don't get that reward, that dopamine firing goes below baseline. And so if we are predisposed to be addicted to that activity, because people differ as you yourself, acknowledged in terms of what their drug of choice is. If we're predisposed not to be addicted to that activity, we'll have that negative experience and we'll walk away, right? "Well, so that wasn't any fun." If we're predisposed to get addicted to activity, we'll have that negative experience and that will then motivate us to want to do it even more.

[00:48:10] Jordan Harbinger: Mm-hmm.

[00:48:10] Anna Lembke: To post even more or to, in the case of gambling, gamble even more. Spend more time there in order to bring dopamine levels back up and potentially above baseline again.

[00:48:20] Jordan Harbinger: That stuff scares me because it's hard to get a kid, for example, away from social media because they look at it like, "I'm talking to my friends. This is how my friends interact." so you're essentially, you're ripping them away from their social circle. If you told your kid to stop vaping because it's bad for them, they probably know that. But if you tell them, "Hey, stop liking your friend's outfits on Instagram.", they're going to be like, "What is wrong with you? Why is dad so triggered by this stupid thing? Who cares?"

[00:48:47] Anna Lembke: Yeah.

[00:48:48] Jordan Harbinger: I'm literally just telling my friend she looks good in a dress and meanwhile, her brain is going crazy.

[00:48:53] Anna Lembke: Yeah. Well, there's plenty of evidence now to show that the longer that people, including young people spend on social media, the more likely they are to be depressed, anxious, unable to sleep, and generally unhappy. I think that the field is coming to consensus, that this is not just correlative, but actually causative. And that it's the time on social media that's driving those feelings of unhappiness, anxiety, depression, insomnia, and I think that there's even a slight shift among young people themselves. For example, my kids are in their teenage years and a lot of their friends will actually say, "I actually hate social media." like, I want to stop, but I don't feel that I can or I have difficulty stopping.

[00:49:38] Jordan Harbinger: Yikes.

[00:49:39] Anna Lembke: Or I feel that my entire identity is there. Yeah, so young people are beginning, sort of like the way you reported, young men who lived through a certain period of time are looking back and going like, "Hmm, pornography may not be the thing." I think we're going to have a sort of reckoning with this generation of Gen Xers sort of realizing, "Wow, like all that time I've spent on social media made me feel bad, and I want to try to change it." But as you say, very difficult because when all your friends are hanging out there, if you try to change it alone, you're alone. For example, in California, there's a group of young people who call themselves the Luddites. They've decided to not carry their phones around and they're doing it together. So I think that's great. That gives me a lot of hope that we're going to collectivel move toward a healthier relationship with the technology.

[00:50:26] Jordan Harbinger: Yeah. I suppose there will be and are ways to limit these things. I've been thinking about this a lot because I have two young kids. One is four, one is not even two. And I'm like, we have to be able to find them and get ahold of them, but I don't want them to be sitting on a web browsers or apps. The sort of interim solution that I won't have to apply for another decade, but the interim solution now, I would imagine for people who are listening and they're freaking out about their own kids, is get 'em an Apple watch that has the cellular in it, so they don't need their phone to use it because you can't browse on that thing. But you can get texts, you can make a call, you can receive a call, but you can't like anything. I mean, maybe you can, but it's such a pain in the ass, right? You've got this little crown, it's like you're just not going to do it.

[00:51:09] Anna Lembke: Right.

[00:51:09] Jordan Harbinger: But you can have all the functions. And for parents, you can still track your kid and find out where they are and reach them at any time without them, I don't know, getting accosted by a predator, generally on some online forum or through dms.

[00:51:23] Anna Lembke: Yeah, right. Yeah, so I think that's right. There's these interim solutions, right? You can get your kid a dumb phone, just a flip phone, right? That just does text and phone calls. There are even these things called light phones that even have ride share and some other features, but don't allow access to the internet for anything else. They've maps, ride share, texting, phone. I also think that we have to like push back a little bit on this idea that like we, as parents have to know exactly where our kids are all the time and the way that we kind of track them. Obviously, for a small child.

[00:51:53] Jordan Harbinger: Yeah, for small kids, definitely. But yeah, you're right. For a teenager, maybe we don't need to be like, "I know where you are."

[00:51:59] Anna Lembke: Right, right. Or even the teenagers going off to college now and their parents still, I mean —

[00:52:04] Jordan Harbinger: Yeah. That's weird.

[00:52:04] Anna Lembke: It's the culture in a way it's just normalized and you could say, "Well it's a nice way to keep families close." and that's partially true, but I think that there's a real danger there that your kid like just doesn't get the kind of autonomy that they need in order to be independent in the world. So these are all interesting.

[00:52:22] Jordan Harbinger: No, you're right. I don't want to know if my daughter's at a frat party

[00:52:25] Anna Lembke: Exactly.

[00:52:25] Jordan Harbinger: Because I will not sleep until I see the dot float back to her dorm room or whatever. And this is a problem I'm going to have in what, two decades? I probably shouldn't even be thinking about this right now.

[00:52:35] Anna Lembke: Probably not. There'll be something all new by the time you get there.

[00:52:38] Jordan Harbinger: Yeah, exactly. Addiction distorting our time horizons. This was an interesting bit in the book. I had no idea that addiction could do this. Can you speak to this a little bit? It's not just instant gratification, but there was all kinds of distortion of how we perceive time that I just never thought of.

[00:52:53] Anna Lembke: Yeah, so we really lose track of time when we're chasing dopamine, and in fact, that's part of the appeal, right? That we get lost in the space time continuum. We're not thinking about schedules or what we have to do next or appointments. We're just sort of lost to time. But that's also really problematic because we're on our phones and we think it's half an hour and it's really been two hours. That's part of what contributes to the harm that's caused by these highly reinforcing substances and behaviors. The other thing that can happen is that we can engage in what's sometimes referred to as delayed discounting, where we overvalue short-term rewards and undervalue long-term rewards. So for example, if I offered you $10 right now or a hundred dollars in a week, just to take an extreme example, you would probably choose a hundred dollars in a week.

[00:53:46] Jordan Harbinger: For sure, yeah.

[00:53:47] Anna Lembke: Right, as would what most people. But if you are severely addicted to heroin, what experiments show is that many more people severely addicted to heroin would take $10 right now, over a hundred dollars in a week. Not all of them, but many of them at least the curve would be shifted. And what that says is that you're in a really different mental state when you are in an addiction. You're liable without even necessarily realizing it to really overvalue short-term rewards and not be able to, not only not be able to delay gratification, but not even to see the need for it.

[00:54:21] Jordan Harbinger: What I thought was very, very interesting was that growing up in resource poor environments as opposed to growing up in resource rich environments, that also shifted the curve. So heroine aside, how we react to short term needs, instant gratification is completely different. So people, I think you or the researcher had tested people who grew up in favelas, they tended to gravitate towards instant gratification. And I started to think about that and you think, okay, rap in a lot of hip hop is like, "Go get the money right now. Like cash only. Get it right now." And I remember when I worked in Detroit, I worked with a lot of people who were sort of adjacent to that. And they would get paid that night and they would go spend the money right away. And I was like, "What are you doing? We just had a conversation about how you're sick of living with your mom or your car's broken and you can't —" and you're like, "Yeah, but I want to go get this chain." I'm like, "It's 3:00 AM man, it's three o'clock in the mo—" "Oh, the pawn shop's open all day, all night." I'm like, "Just put it under your mattress and go to bed for God's sake." and they like could not do that. Athletes going broke, right? A lot of these guys grow up in that environment and they can't— the money is burning a hole in their pocket. This was quite intuitive once you mentioned it in the book. I personally, I don't worry about resources. I know whatever it is I want is going to be there later. I didn't even want to pay the $10 to get my LSAT, which is the law school entrance exam. I didn't want to pay $10 to get my score a month earlier. And people around me were like, "What are you doing? You don't know what your score is?" And I'm like, "They have to mail it to me. I'm not giving 'em much extra money." right? And it's just something I grew up being able to do because I grew up in a middle class environment. I wasn't like, "Where's my next meal coming from?" I wasn't worried about any of that. Others that don't have that certainty, this pattern is set growing up. But one, that's terrifying. But two, can this be reprogrammed or do we just have to be careful forever if we grew up with less?

[00:56:17] Anna Lembke: Well, I think this really speaks to, if you grow up in a world of extreme scarcity where people are in survival mode, then to grab as much as you can, as fast as you can of scarce resources is actually healthy and adaptive and increases your likelihood of survival in that environment. So it can be really difficult to make the shift to an environment of plenty, where those resources are going to be there tomorrow. It's hard to believe it when you've grown up an environment where you were taught that that was not the case. But of course, people can shift, of course, with repeated exposures of letting the resource be there and seeing that it's not going to go away. People can make changes. But still, those early experiences do have a powerful impact our whole lives.

[00:57:05] Jordan Harbinger: What can we do about some of this? It seems it's a little bit desperate, right? You mentioned earlier, stopping the behavior for, was it four weeks?

[00:57:14] Anna Lembke: Right.

[00:57:14] Jordan Harbinger: And is that what dopamine fasting is? Is that essentially —

[00:57:17] Anna Lembke: Yes.

[00:57:18] Jordan Harbinger: Tell me more about that. Because it easier said than done. "Oh, just stop your addictive behavior for a month." Like, "Okay, I hadn't thought about that before getting arrested twice or getting caught by my wife, or whatever."

[00:57:29] Anna Lembke: Yes. I mean, much easier said than done, but what I hope is that once people understand what's going on in our brains, they will be more motivated to give it a try. Whether with a substance or behavior that they know they have a problem with, or maybe a substance or behavior that they are not sure or they even don't think they have a problem with, but maybe other people have commented that it's a problem. Giving it up for four weeks is about the average amount of time it takes to reset dopamine reward pathways. So to have those metaphorical gremlins hop off the pain side of the balance and have homeostasis be restored. The reason that it's important to do that is because, number one, when we reset reward pathways, we're able to take joy in other more modest rewards again. And number two, we're able to look back at the impact of our drug use on our lives with more objective clarity. Because when we're in it, because of things like delay discounting and losing sense of space time, we really aren't very good judges of the true impact of our use on our lives. It's only when we get some distance. I've often had patients who will come back after four weeks of abstaining and be shocked to look back at their former selves and how much energy and time and money they invested in chasing their drug. So it's really important to take a break, to give your brain a break, even if after that break you decide you want to go back to using, which many of our patients do, but they almost all universally want to use differently. They want to use less, they want to have a different kind of attachment to their drug of choice, a healthier attachment.

[00:59:01] So I think it's a really important and well-informed experiment that people can just do in their lives. Now, importantly, this is not something I would recommend for somebody who was so severely addicted that they could never stop on their own. They had repeatedly tried and just couldn't do it. Or somebody who was at risk for life-threatening withdrawal from a substance like alcohol or a benzodiazepine like Xanax or an opioid.

[00:59:26] Jordan Harbinger: You can die if you stop taking those? I didn't realize that you could die from that.

[00:59:30] Anna Lembke: Yes. Specifically alcohol and benzodiazepines like Xanax, Valium, Klonopin in particular. If you become very physiologically dependent, so you really change your brain physiology with repeated use. If you stop suddenly, you can experience a profound physiologic storm that can lead to death. In some instances, you can have seize and you can die.

[00:59:51] Jordan Harbinger: Wow.

[00:59:52] Anna Lembke: So for those kinds of drugs, people really need to see a medical professional and to be monitored and potentially get medicines to help them withdraw.

[01:00:01] Jordan Harbinger: I think a lot of people, unfortunately, they just trade one addiction for another. I remember I went to a bunch of these meetings like NA and AA, just to see what they were like because I was giving advice on my show and I was like, "I should probably know what I'm recommending." I had friends that were in there like, "Yeah, come with me." So I noticed that, for example, with AA, a ton of people were smoking and vaping outside of the meeting. And not trying to be judgy here, but it really seemed like a lot of the people had went from either smoking and drinking or just drinking, and now they're just smoking a lot or vaping a lot. And I wondered how many people just traded one addiction for another one.

[01:00:39] Anna Lembke: This concept of cross addiction is really important because people with addiction who give up one drug are very vulnerable to increase use of another drug or even take on a drug, a new drug or switch to a behavior and engage in that behavior in addictive way. So we always talk about the risk of cross addiction. But I do want to emphasize that in our work with patients, when we talk about dopamine fasting, we're not asking patients to necessarily give up every single drug or vice, quote-unquote "vice" that they have. We're really asking them to identify that substance or that behavior that is causing problems in their lives, and to really focus on that one. If their use of alcohol is, for example, linked to their use of cigarettes, like every time they smoke a cigarette, they want to drink, but otherwise they don't want to drink, then we might say, "Well, geez, you, maybe you should give up the cigarettes and the alcohol at the same time." there are a few studies showing that when people give up cigarettes and alcohol at the same time, they actually have better outcomes for both than if they try to give up one but not the other. And the hypothesis there is that, as long as you're using anything that sort of pings your reward pathway, you're kind of setting yourself up for relapse.

[01:01:49] Because all rewarding substances and behaviors work on the same final common pathway. They all release dopamine in the reward circuitry. But now having said that, if somebody identifies in their life that like alcohol is super destructive to themselves and others, et cetera, but that nicotine, although yes, obviously harmful for health, is something that they want to keep doing, we support patients in that. It's good that they're willing to give up to one substance, even if they're going to continue the other. We just really caution them against not increasing use of the other. And then over time, we will maybe reenter the discussion like, "Well, you know, you've been able to stop drinking, you're doing so much better. Do you want to take a look at quitting smoking? Quitting cigarettes." What's very interesting is when people use cannabis and nicotine, they will almost always tell you that they want to quit smoking cigarettes, but they almost never want to quit cannabis because cannabis is their medicine. So you have these funny cultural overlays too, of sort of what's healthy, what's a medicine, what's a drug, what's addictive, what isn't?

[01:02:52] Jordan Harbinger: I know we talked about things like weed and food becoming more and more potent. I know there's — Man, for the last 20, 30, whatever years, there's been a lot of manipulation of drug formulation. Even Breaking Bad, right? It was about the super methamphetamine. I dont know if you saw that series.

[01:03:08] Anna Lembke: No. But my sons absolutely love that series, so.

[01:03:11] Jordan Harbinger: Well, you might enjoy it. I mean, it's —

[01:03:13] Anna Lembke: Yeah, I'm sure I would. I'm sure.

[01:03:14] Jordan Harbinger: With all the free time you have.

[01:03:16] Anna Lembke: Yeah.

[01:03:16] Jordan Harbinger: I mean, I won't say it beats vampire porn, but it's pretty damn good.

[01:03:21] Anna Lembke: I bet it's way up there. Yeah.

[01:03:23] Jordan Harbinger: I know that law enforcement is also concerned about this. It's been a factor, a significant factor in the explosion of mental illness and homelessness in America, according to some of the sources that I saw. Just drugs being crazy, crazy potent methamphetamine and things like that. Do you believe that there are some substances which are so disruptive to the brain that recovery is impossible or highly improbable, or is that too catastrophic for us?

[01:03:48] Anna Lembke: Yeah, and so, I always believe that recovery is possible. I have seen people with very severe addictions after decades of use, get into recovery. So there's always hope. Recovery is always possible. We need to never give up on people. But it is true that the longer that people use their drug of choice, and the more potent that drug, the more potential damage to the brain, which is the ultimate end organ that is being damaged by addictive drugs and behaviors. I mean, fentanyl is the perfect example. It's the highly potent opioid, 50 to a hundred times more potent than heroin. It's available cheaply on the streets of every major city. It's also very lethal because it slows down heart rates, slows down breathing. People fall asleep and don't wake up again. People aren't using it for that reason. They're using it for its psychotropic effects, euphorigenic effects. But they accidentally overdosed. So, obviously these really potent drugs, which by the way, are a result of our scientific revolution, right? It's the dark side of technology and innovation that's allowed us to manufacture drugs that are this incredibly potent.

[01:04:54] Jordan Harbinger: This is totally off topic, but I worry about the brain machine interfaces that we're going to have in a few decades, and you'll be able to get feelings from those things. That's just going to be a whole — you're going to have a whole sub practice, if you're still practicing by then of people who can't stop, I don't know, shocking their dopamine centers. That's just going to be crazy.

[01:05:12] Anna Lembke: I think we're already there. Our digital devices essentially are auto stimulators, auto erotic stimulators there, they're the ways in which we meet all of these deep, physical and psychological needs without another human being, right? We're just doing it with a device. I think it's a real danger, especially we have so many people who do live in isolation who are experiencing loneliness. Now you've got a device that can sort of take care of your needs, which then contributes to more loneliness and isolation. People not really needing to go out to find other people, to meet these basic human needs for connection. I mean, it's already upon us.

[01:05:49] Jordan Harbinger: I read Michael Pollan's How to Change Your Mind a few years ago. He was on the show, it's episode 81, by the way, and I was left with the impression that psychedelics are largely the cure for a lot of this stuff or could be. What do you think of substances like LSD, ketamine, MDMA being the future of psychiatry to treat things like hardcore trauma and, I don't know, neurosis? Asking for a friend, of course.

[01:06:15] Anna Lembke: Right. Yeah. So I think it's really unfortunate that the hype about these drugs have so outstripped the evidence. You know, the evidence is really preliminary. It's also in the context of an augmentation strategy for psychotherapy. So when people talk about the evidence that that's out there, it's really studies in which the medium for healing is psychotherapy. You know, talking to somebody and then using the psychedelics to strengthen that therapeutic alliance or augment, that connection or the work that's done there. Which by the way, I fundamentally oppose because it seems to me that one of our major missions is to help people create alliances with other people without using drugs, right? We've got lots of patients who that's the only way they know how to connect with other people, and it's really sad to me. You're saying, well now you're going to use — now you need a drug to have a and a connection with your therapist.

[01:07:09] Having said that, I can imagine scenarios in which there may be utility, like at the very end of life, where people don't have the time that you might need to make that kind of connection. But what's very sad is that, of course, this idea of using psychedelics in a therapeutic context, has become individuals using it with their friends or by themselves at home, not in the context of medical treatment, to have some kind of spiritual awakening. And I think that's — people should be very, very skeptical. These drugs are addictive. Anything that changes the way you feel has the potential to be addictive. We're seeing more and more people getting addicted to psychedelics, showing up in emergency rooms dying from psychedelics. People really underestimate the harms and the potential harms and really overestimate the benefits and the utility. So I just proceed with caution. I would also say, if you look at sort of the spirituality measures, the questions that they ask people to sort of measure spiritual awakening, look a whole heck of a lot like the questions you would get around what it feels like to be high. Did you feel a sense of expansiveness as if you were floating above at all, a deep connection to other people? I mean, that's how people feel when they get high. So this idea that you take a shortcut to a spiritual awakening —

[01:08:31] Jordan Harbinger: You're skeptical.

[01:08:32] Anna Lembke: Yes.

[01:08:32] Jordan Harbinger: From the sound of it. This book really did help me understand how addiction works in a new way, and especially just the dopamine centers in the brain. It's kind of dopamines almost buzzwordy these days because you hear about it with respect to everything from Instagram to opiates to Cheetos, and this really does provide a lot of foundation to, I think, the conversation that we're having now, which is interesting because this is not a brand new book. You were just ahead of the curve, I think. So one, thank you for that. But two, leave us with something positive because, "Okay. Psychedelics. Oh no, just kidding. And what about this? Well, also highly addictive. Oh, and your brain might never change, but you know. Bye."

[01:09:12] Anna Lembke: Yeah, right. I mean, I'm very optimistic, actually. I think the one thing about humans is how adaptive we are. And I do think that addiction is the modern plague, but I also believe we'll figure it out. Part of that result will be a new modern form of asceticism, which is to say the intentional seeking out of difficult or painful circumstances and activities as a way to reset reward pathways. And so inviting challenge into our life, encouraging our children to have challenging experiences, not immediately rushing to the rescue to make sure that people get out of pain, but instead acknowledging the utility of pain in our lives. And in fact, the ways in which we're wired for pain. We are meant to strive. If we don't have something to strive for, we're a lot less happy.

[01:09:57] Jordan Harbinger: Thank you very much. Really appreciate your time and expertise. This is fascinating, even if it is a little bit terrifying, then I appreciate it.

[01:10:04] Anna Lembke: Well, you're very welcome. Thanks for having me.

[01:10:08] Jordan Harbinger: Ever wonder why seemingly rational individuals can wholeheartedly embrace the most irrational beliefs? You're about to hear a preview of The Jordan Harbinger Show where, Dan Ariely, uncovers the captivating psychology behind these puzzling convictions.

[01:10:21] Dan Ariely: I'm a social scientist. The moment you adopt this misbelieving perspective where you distrust everything and you just look for signals for bad things that are happening, you can find them. We can deteriorate quickly into a very undesirable state of beliefs. It affects people's wellbeing and optimism. It affects people's willingness to help, to donate money. We are very much attuned to bad things. So when bad things happen, we really want to understand the mechanism. And I think this is really the goal of social science, is to take those things we have no intuition, but help us understand them and give us some better rules for life. If we understand that misbeliefs are bad reactions to a real problem, can we help our friends have better reactions to a bad problem? Where's reality? Where's the truth? We are becoming more politicized, more identity driven, more separatist. It feels like that the things that divide us are becoming larger than the things that unite us. And the moment we have these feelings of intolerance, we are just chasing those people away from our lives. And one of the best antidotes is resilience. You know, at the end of the day, society's strength is in our unity and in our trust with each other. Trust is the unobserved lubricant of society.

[01:11:48] Jordan Harbinger: To hear more about Dan Ariely's own chilling encounters with conspiracy theorists, check out episode 903 of The Jordan Harbinger Show.

[01:11:57] This brain stuff, man, it never gets old. I could just listen — I should have been a brain scientist. If I were smarter, I would've done that. What I didn't know is that any substance or activity that pushes on the pleasure center has the capacity to become addictive. I mean, it makes sense now that I hear it. But it's sort of scary because I'm thinking of all the things that I kind of like doing and I'm like, "Oh man, can I get addicted to that?" That's right, folks, let your imagination run wild with that one. It's very important to treat the underlying condition. So gastric bypass surgery, right? Where they sort of staple off part of your stomach. They probably don't do that anymore, but you know, same kind of idea. Maybe people lose weight, but they still have addictive behavior, so they might start drinking, they might start popping pills, and of course they're at higher risk because they absorb booze and other substances faster because they had gastric bypass. So it's really interesting what happens, interesting in a bad way, I suppose, what happens if you don't treat the underlying condition to this whole thing. So really, a lot to be said here for the way we treat addiction, substance abuse, et cetera.

[01:12:56] All things Anna Lembke will be in the show notes at jordanharbinger.com. Transcripts in the show notes, as well. Advertisers, deals, discount codes, ways to support the show, all at jordanharbinger.com/deals. Please consider supporting those who support the show. We've also got our newsletter each week. The team and I dig into an older episode of the show and dissect the lessons from it. So if you are a fan of the show, you want to recap of important highlights and takeaways, or you just want to know what to listen to next, the newsletter's a great place to do that. jordanharbinger.com/news is where you can find it. Don't forget about Six-Minute Networking as well over at sixminutenetworking.com. I'd love to hear from you anywhere on any platform. I'm @JordanHarbinger on Twitter and Instagram. You can even connect with me on LinkedIn.

[01:13:37] This show is created in association with PodcastOne. My team is Jen Harbinger, Jase Sanderson, Robert Fogarty, Millie Ocampo, Ian Baird, and Gabriel Mizrahi. Remember, we rise by lifting others. The fee for the show is you share it with friends when you find something useful or interesting. The greatest compliment you can give us is to share the show with those you care about. If you know somebody who's interested in brain science, addiction, dopamine, definitely share this episode with them. In the meantime, I hope you apply what you hear on the show so you can live what you learn, and we'll see you next time.

[01:14:09] Thanks again to Nissan for sponsoring this episode of The Jordan Harbinger Show. Learn more at nissanusa.com.

[01:14:17] Jillian Jalali: Hi, everyone. This is Jillian with Court Junkie. Court Junkie is a true crime podcast that covers court cases and criminal trials, using audio clips and interviews with people close to the cases. Court Junkie is available on Apple Podcasts and podcastone.com.