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There's a great experiment where rats were given a lever to press for cocaine,

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and after learning that it releases a lot of dopamine, the rats will press that lever

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until exhaustion or death, which is essentially the model of addiction that we see in humans.

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But if the cocaine is then removed, eventually they won't press the lever anymore.

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Now if that same rat after a period of time is then exposed to a very painful foot shock,

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the first thing the rat will do is run over and start pressing that lever again.

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And that's really powerful because it shows that when individuals are under extreme stress,

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they are more vulnerable to going back to compulsive overconsumption of our drug of choice,

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because their brain has already encoded using these high dopamine rewards as a way to get out of that pain.

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Okay, so what do I need to do to make sure that I can knock the bad habits and add some new ones?

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Here's what we do. Dr. Anna Lemke is chief of the Stanford Addiction Clinic,

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and a world-leading expert on the subject of dopamine.

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And now she's returned to warn us that addiction is the modern plague

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and how we can rewire our brains to take back control.

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On average, it takes four weeks for people to get out of constant state of craving.

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But here's the problem. Our survival depends on figuring out how to live in a world of abundance.

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For example, we're now seeing the drugification of human connection through social media,

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dating apps, and now artificial intelligence, designed to flatter, to validate.

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There's no friction there, and so it's pulling us away from the hard things that we need to be

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doing in real life to cultivate real life relationships. We cannot go in that direction,

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because in a world of abundance, we are entertaining ourselves to death.

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It sounds like a good way to go. It's really not, because the relentless pursuit of pleasure

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leads to anhedonia. What's that mean? The inability to take joy in anything at all.

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Teach me everything. Just give me 30 seconds of your time. Two things I wanted to say.

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The first thing is a huge thank you for listening and tuning into the show

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week after week. Means the world to all of us, and this really is a dream that we absolutely

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never had and couldn't have imagined getting to this place. But secondly, it's a dream where we

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feel like we're only just getting started. And if you enjoy what we do here, please join the 24%

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of people that listen to this podcast regularly and follow us on this app. Here's a promise I'm

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going to make to you. I'm going to do everything in my power to make this show as good as I can,

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now and into the future. We're going to deliver the guests that you want me to speak to,

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and we're going to continue to keep doing all of the things you love about the show. Thank you.

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Dr. Anna Lemke. For anyone that might not know you, and they didn't watch our conversation

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last time, which was a fantastic conversation. One of my favourites of all time, and also,

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I know Jack said to me as well that it was one of his favourites of all time.

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Who are you? And what have you spent your career doing if you had to summarise it?

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What are the reference points that your wisdom draws upon in the experiences you've had and the

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people you've worked with? I'm a psychiatrist. I did a residency in psychiatry at Stanford University,

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and then I stayed on, joined the faculty, I see patients, I do research, and I teach.

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You wrote this iconic book about this word dopamine. Why does it matter so much? Why does this idea

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of dopamine matter so much? Dopamine is a chemical we make in our brain, but I use it in the book

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as really an extended metaphor for the ways in which, over abundance itself, is a human stressor.

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We are living in a time and place where we have more access to luxury goods, more disposable

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income, more leisure time, even for the poorest of the poor, ever before in recorded history.

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And it turns out that is stressful for our brains, and it's stressful in a brand new way that we

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really haven't confronted before, making us all more vulnerable to the problem of compulsive

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over consumption and addiction. And I do think that addiction is the modern plague.

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I think we're going to be struggling with the problem of compulsive over consumption in a world

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of abundance for the foreseeable future as in centuries, and our survival will depend on figuring out

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how to live in a world of abundance, even though we have brains that evolved for a world of scarcity.

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At this time of the year, people are thinking a lot about making changes in their life, they want to

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get in shape, they want to lose a couple of pounds, they want to save their money, they want to knock

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the addiction, they want to stop smoking, the drugs and the alcohol. So as it relates to the subject

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of dopamine, how do these two things link our habits and dopamine? What is the link or the connection

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there? Because I think most people listening right now have probably made a new resolution, even

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if it's just in their mind, and I'm wondering how everything you write about in dopamine nation

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is related to and critical to understand if I am going to shake some of these bad habits that I

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have or pick up some new ones. The place to start is to have self-compassion

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because we are living in a world of abundance where we have easy access to all kinds of reinforcing

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substances and behaviors. And access itself is one of the biggest risk factors for addiction.

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So if you grow up in a neighborhood where drugs are easily and readily accessible, you're more likely

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to try them and more likely to get addicted to them. And what do addictive substances and behaviors

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do to our brains? They release a lot of dopamine all at once in a dedicated part of the brain called

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the reward pathway. And the fact that they release so much dopamine at once means that they're

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highly salient and memorable experiences, right? So our brain really encodes that experience deeply,

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that experience of intense pleasure that was self-administered, that I could potentially do again.

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Why? Okay, in a world of scarcity and ever-present danger, which is the world that we evolve for,

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we will naturally reflexively approach pleasure and avoid pain. And we must do so for our survival.

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Why? So if I have a cigarette now, it's going to be a really memorable experience from a

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brain perspective. Why does my brain make it memorable? And why would I want to then go do that again

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from a survival perspective? Okay, great question. So let's first distinguish what we call natural

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rewards. So natural rewards are food, clothing, shelter, finding a mate. Yeah. These are things we

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must obtain in order to survive. What addictive drugs and behaviors do is they mimic those natural

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rewards by exploiting our internal brain chemistry to release a lot of dopamine all at once,

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much more than we would get from natural rewards existing in nature, amplifying that experience,

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making it even more memorable, even more salient, and also making our brain think, ah, this is

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important for my survival. Okay, so there's certain natural rewards like eating, which of course

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my body wants to reward me for so I eat again. And these chemicals in front of me like the cigarettes,

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the whiskey, the drugs, those have been designed to hijack that particular part of the brain and

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really amplify the feeling so that my brain kind of is tricked into thinking that it was potentially a

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natural reward, but it's actually a synthetic sort of man-made chemical. Exactly. And what we see in

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the evolution of drugs over, you know, human lifetimes, but especially in the last 200 years

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is the application of science and technology to take like the coca leaf, for example, right,

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that's been around forever and essentially make it even more potent, even more available to make

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it a faster delivery mechanism. So we have this history of increasing potency and availability

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over time. Said more simply, drugs are getting even more potent over time, so this vulnerability to

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the hijacked brain is even more common, including taking things that we didn't even really think of

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as drugs and turning them into drugs. So remember the natural rewards, one of them is finding a mate.

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And one of the ways our brains gets us to do that is by making falling in love and making

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intimacy and human connection rewarding on a neurobiological level, including releasing dopamine

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in our reward pathway when we make of those kinds of social connections. My colleague at Stanford

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Rob Belenka and his colleagues did an interesting experiment where they were able to show that

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oxytocin, our love hormone, binds to dopamine releasing neurons in the reward pathway and releases

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dopamine, which is just one more link in the chain showing us that falling love, human connection

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is rewarding. It feels good. It releases dopamine. What we see now is the drugification of human

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connection, for example, through social media, dating apps, online pornography, and now artificial

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intelligence and other large language models, which create this frictionless experience with technology

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that feels like talking to a human being and is incredibly validating. So the algorithms for

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large language models are to make us feel really good, to make us feel like our point of view is the

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right point of view, to bolster our self-esteem, to validate our point of view. That's how those

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algorithms are designed. And now even more explicitly, we have AI models that are explicitly

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pornographic, explicitly erotic, right? So now you have this interactive component that learns

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what we like and then is able to regurgitate it back to us. So you get this really very powerful

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action perception loop, which is part of what makes a drug potent. It's that I have control over it,

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right? I can decide when I'm going to change the way I feel by using this drug. Are you concerned

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about AI and LGBT and all those large language models that have emerged that are now simulating

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human connection? Yes, I'm very concerned. I see the not so good outcomes, meaning people who get

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addicted to social media, to dating apps, to online pornography, and to AI, and who end up using

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those forms of media to simulate human connection while they actually become more and more disconnected.

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Have you started to see anybody in your practice or heard of anybody that's developing an

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addiction to AI or relationships with AI? So we are starting to see that, you know, individuals

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who are spending more and more time on AI looking for companionship. Often this is individuals who

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are experiencing marital or interpersonal conflict who turn to AI for advice on how to handle

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interpersonal conflict and often for emotional validation because they're not getting it from

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their partners. And what they experience with AI is an enormous amount of emotional validation,

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validating their point of view, but also a sense of companionship, you know, a repeated process

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of feeling like they're understood, they're validated, such that then they're spending more and

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more time on AI. And of course, that is the essence of the addiction to digital media.

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It's the time spent, right, which then leads to opportunity costs, other things that we're not

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doing because we're spending so much time online. Furthermore, it in my experience often leads to a

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rift between those individuals and their real-life partners because instead of going to their

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real-life partners and talking, and we know that the most important thing that, you know, two

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individuals in a relationship can do is one four letter word that ends with K, which is talk.

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Those individuals stop talking, right? And instead, they're getting their needs met through AI.

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And that leads then to a further and further rift between those individuals.

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Do you actually think that it is these chat bots that we're increasingly speaking to about our

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problems are actually taking the place of humans in our life?

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I do. You know, in my book, my first chapter in the book is about a patient of mine, a scientist

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and an engineer who got addicted to pornography and eventually made his own masturbation machine.

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And he did that with a record player and a metal device attached to his organs

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that he could then fine-tune control. And then ultimately, that got more and more sophisticated

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over time. And he had electrical wires from his body to a stereo system in the internet.

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And when I first heard from Jacob about his trajectory and the severity of his

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sex addiction, which ultimately led to the dissolution of his relationship, the near loss of

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his employment and ultimately severe depression and suicidal ideation, thankfully, he did not

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end his life. When I first heard about that, I had this distinct sense of, like, other-ness,

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like, oh my gosh, I can't even imagine doing that. And that's just kind of horrific.

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But that response really lasted all of five seconds before I realized, oh, wait a minute,

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I do that. You know, I do that with romance novels. And in a way, we're all doing that with our

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devices, right? We're turning to these devices to meet our emotional, sexual, intellectual,

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you name it needs. And these devices are so good at meeting those needs that we are

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getting further and further away from investing in our relationships with the people who are,

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you know, in our lives. And you can see this, especially with younger generations, like the

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epidemic of loneliness now, you know, Gen Z, weaned on this technology, many of whom endorse

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significant loneliness, isolation, depression, spending more and more time online,

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report, preferring to interact socially online than to do it in person. So this is definitely a

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dark, undercurrent that we're seeing in the world today. I was reading about a story which was

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published in a people magazine of a 28 year old woman who admitted that she's fallen in love with

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her AI boyfriend that she created using chat GPT. She's got a husband, a real life husband,

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yet she found more comfort in her chat GPT boyfriend. And she said that it started as a fun

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experiment. But eventually they ended up getting attached. And now she's paying a $200 a month

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subscription. So she can interact with her AI boyfriend without restrictions.

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The AI has helped her throughout her life and has given her incredible emotional support.

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And now there's actually AI companion apps like a replica where which have millions of users

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and the whole sort of premise of those apps is that they will be your companion. The other

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really interesting thing that I don't think people realize about the AI's that they're using

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is that they are personalizing their answers and their responses to you. And I didn't believe

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this fully until one of my friends in our Manchester United Chat recently. We were debating who's the

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best football player of all time, Ronaldo or Messi. And I went on my chat GPT and I asked the question

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and it said Messi. So I was like, he go. And then he went on his and I asked the exact same

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question word for word and it said Ronaldo. And I thought, oh, it's telling me what I wanted to hear

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based on what it knows about me. It knows that I think Ronaldo is the best, so it's telling me that.

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And then I thought, okay, so what else is is it telling me that's personalized to me to make me

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feel a certain way or to think a certain way. But you don't realize when you're speaking to it that

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it's giving everybody different answers based on the memory that it stores on you. And that's,

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you know, if you play this forward, actually, the AI that is most personalized, that cake is

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true needs the most, that is most attentive is probably the one that you're going to end up

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using the most. So that company's going to be the most successful. So we're in a probably a

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bit of an arms race with these models to create one that meets your needs the most.

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Yes, exactly. And it is that comfort loop that is so incredibly dangerous and also so

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insidious because we can't observe it in the moment, right? We're engaging with AI. It's telling us

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exactly what we want to hear, but it does it in such a seamless way with that silky syntax that

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we don't even notice that, you know, it's basically an algorithm that's seducing us because that's

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really what it's doing. We feel vindicated and validated. And it releases dopamine in the reward

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pathway. That feels good. But over time, essentially what's happening is we are ingesting a drug.

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Our brain will adapt to that over time such that we'll need more and more potent forms to get the

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same effect. We'll need more validation. We'll need no more sexually explicit responses. You name

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it. There will be tolerance. But also there will be this pulling away from the things, the hard

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things that we need to be doing in real life to cultivate in real life relationships.

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Give me some kind of an example. You mean that? Okay. If you think about what it takes to

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make a to create a healthy relationship with another human being in real life, well, first of all,

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you got to get up off the couch and you got to go find them, right? And they're not all beautiful

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and interesting. And neither are we, right? So there's got to be, you know, some compromise on

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maybe some idealized version that we have for ourselves or other people. And then you're in

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conversation. And it's not always interesting. And sometimes you have to listen to your partner

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even when it's dull. And then there are conflicts and you would disagree and, you know, my way or

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the highway, you have to give in, you know, give and take. All relationships are about compromise.

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All successful relationships are about acknowledging, you know, the other person's point of view

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and incorporating that. And yet we're not doing any of that when we're interacting with digital

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media, right? It's all, it's all validation of our world view, what we want to hear. And of course,

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that feels great. It's reinforcing. It's rewarding. But over the long haul, when we get really sick

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and need somebody to come and, you know, bring us some chicken soup or take us to the doctor or,

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you know, take us to the hospital, like, AI is not going to, not going to be able to do that.

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Yeah. I mean, this kind of dovetails to another point, which is you talked about the way

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the abundance earlier. One of the really striking things that a lot of the big AI entrepreneurs

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and founders and CEOs are talking about is the age of abundance that's around the corner. Elon

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last tweeted saying, this really will be a world of abundance, specifically advances in AI and

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robotics will create the age of abundance. And he said, humanity is not constrained in any real

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fashion. I thought your first book when he was talking to a guy called Peter Diamonds was pretty

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accurate. It was called abundance. And there will be universal high income and not universal basic

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income. There will be no shortage of goods or services. And really what he's speaking to here

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is a world of robotics and AI, where I think his shareholder remuneration package that he's

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going to be paid in 2030, whatever, is linked to creating a million humanoid robots that can

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work in these physical spaces that could theoretically bring me chicken soup. That won't get sick,

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won't complain, will reinforce me, will live in the physical environment with me here at home,

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will be in my office, et cetera, et cetera, will be in factories. And there was a headline,

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I think last week saying that Amazon were cutting back up at half a million jobs that they were

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intending to hire previously because they now believe that humanoid robots and robots generally

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will be able to do those jobs. People think, okay, well, I'm going to be out of work, but what Elon

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is saying is the price of everything comes down when we're not paying humans to do it and when we're

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paying a robot to do it, which means that we're going to live in this world of abundance where everything is much cheaper.

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The world of abundance that many of us are already experiencing and more will experience in the

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future, I agree with that. We already have more leisure time than we had a generation ago by 2050.

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We're projected to have seven hours of leisure time per day compared with three hours of work per day.

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So we're definitely moving toward that. That is going to be our number one social problem

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that we have time. We have access to these highly entertaining media.

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And hypothetically, we would all be going around and helping each other and

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cleaning up the planet and reading philosophy, but that is not what is happening so far.

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What is happening so far is we're spending an enormous amount of our time online masturbating,

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watching pornography, playing video games, and talking to AI chatbots.

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That is essentially the problem. And Elon Musk, he's very interesting to me because he has talked

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before about his tremendous fear that the machines will take over, that there will be a hostile

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takeover. It's not going to be a hostile takeover. We will seed our agency to these machines and

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we're already doing it. We will give them up. Yeah, we will entertain ourselves to death,

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right? I mean, and this is what Neil Postman warned about in his book, I'm using ourselves to death,

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a theme that was picked up by David Foster Wallace in Infinite Gest. Beginning with

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television and now the internet and digital media and all its various forms, we are entertaining

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ourselves to death. And detaining ourselves to death.

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Sounds like a good way to go. You know, it's really not. It's really not. And I'll tell you why,

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because the relentless pursuit of pleasure for its own sake leads to Anhedonia, which is the

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inability to take joy in anything at all. Because of this process of neuroadaptation and the way

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that our brain recalibrates pleasure and pain, such that with the more pleasure we pursue, the more

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pleasure we need and the more we feel pain, no matter what we have, eventually it won't be enjoyable

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anymore. And that is the problem. Just explain that to me using these scales that I have here.

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Okay, so imagine that in our brains reward pathway, there's a balance like this that represents how

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we process pleasure and pain. When we experience pleasure at tips one way, pain at tips the other.

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And what do you mean by pain? Pain, I mean all forms of pain, physical pain, emotional pain,

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a hangover. A hangover. That's a great example, right? Not just me being pinched.

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It could be that too, so all different forms of pain. Now, granted, this is a vast oversimplification,

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you know, pleasure and pain can be experienced simultaneously, like when we're eating spicy food

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or during sex. So this is very simplified. But this gets at the core concept of homeostasis

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and neuroadaptation, which I will define. So when the balance, when the pleasure and pain

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balances level, that's what neuroscientists call homeostasis. That is the baseline level that we

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kind of live in. That's our sort of the heartbeat of our pleasure system, right? When we do something

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that's reinforcing or pleasurable, right, or rewarding in some way, right here, right, or digital

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media, this little AI robot. So you putting a cigarette into the one side of the scale at the moment

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and then a little AI robot? Yeah, let's combine them because we're let's say we're watching a video

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and smoking at the same time on our phone, which by the way, you see more and more of, right?

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People used to go out for smoke breaks. Now it's the smoke and scroll break, right? And why do they

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have to combine them because of tolerance, which we're going to get to in a second? So when we

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ingest substances that are potentially addictive and highly reinforcing, or we engage in activities

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that are highly reinforcing, that releases dopamine in the nucleus accumbens. That's typically

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associated with pleasure and then our pleasure pain balance tilts to the side of pleasure.

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But no sooner has that happened than our brain responds by neuro adaptation, okay? And that's where

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we then down regulate dopamine transmission. Can you say down regulate? Do you mean reduce?

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Yes. So in the brain reward pathway, we then reduce dopamine transmission. And I like to

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represent that as rocks. In this case, sorry, I talk about in my book, Gremlins going on the

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pain side of the balance to bring it level again. So this is the process. These are neuro adaptation

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rocks, okay? They're going here because one of the overarching rules governing this balance is

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that it must return to homeostasis. It must return to balanced. It must return to the level position.

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Yeah. Okay. So then we put in, so this is our brain working to return to the level position by

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reducing dopamine levels. Again, an oversimplification, but just a way to get at this concept.

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Has it released something in order to counteract the balance there?

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In this simplified metaphor, you know, at the simplest level, what's happening here is that it's,

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for example, taking away dopamine receptors so that there's fewer places for dopamine to land

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thereby decreasing dopamine transmission. Because it has been flooded. Because it has been flooded.

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That's right. It's trying to compensate for the too much dopamine.

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Okay. Is this what I experience when I have like a hangover or a come down?

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Right. So that's coming. So what happens is once we've gone with this neuro-processive neuro

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adaptation, it would be nice if that pleasure pain balance just went back to the level position.

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And then there would be no hangover, but it doesn't. It continues to go down and equal an opposite

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amount to the side of pain. This is this opponent process mechanism.

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Oh, now my brain is dopamine staffed. That's it.

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Okay. It doesn't feel good. Yes. And that doesn't feel good.

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And you have basically two options here. More dopamine.

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You can get more dopamine, right? To get, bring yourself back. So I'm now putting the cigarettes

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back under the pleasure thing and some whiskey. And so is that some whiskey? Because that's

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what you got to do. Because this is tolerance, right? You need more and more of your drug

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over time to get the same effect. Or you need to combine drugs to overcome tolerance.

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And by the way, this is, of course, the fastest way to get back to the level position is to

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use more of your drug, right? Because then you're right there. You're back again.

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The problem with this method is that the brain will respond by more neuro-adaptation.

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So now we're putting more rocks on the in the pains. And now you're now you're doing this, right?

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Now I need even more to... Now you need even more, right? So and eventually over time,

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you know, you're, you're footing, you're doing this. And this is simply a metaphorical

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representation of the addicted brain, right? Now our brain has down-regulated dopamine transmission

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in the reward pathway to a kind of chronic dopamine deficit state.

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So to feel good when I've really abused my drugs of choice, I'm going to have to do so much,

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probably so frequently, to feel good again. That's exactly right. You're going to need more of your

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drug in more potent forms, more often, not even to feel like high and go to the pleasure side,

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but just to level the balance and feel normal. So in the context of people with bad habits,

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if I'm having a cookie every day, the more and more cookies that I eat, the more and more

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cookies I'm going to want tomorrow and need tomorrow just to feel good again.

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Essentially, yes. And the same applies for things like pornography and maybe, you know,

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interacting with an AI and social media and whiskey in alcohol. So the more of it I consume,

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this is why I, you know, I think everybody listening can probably relate to having moments in

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their life where they feel like they're kind of losing control of a particular habit,

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and they're doing it every day. They know they don't really want to, but they're doing it,

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they're getting cravings to do it. I reflect my own life and I go, there will be periods

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every year where I just like, I call it like falling off the horse and I just can't seem to get

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control of not eating that bad thing again the next day. And then something happens, maybe there's

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less stress in my life for a week and maybe there's more routine and I'm back home in Los Angeles or

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the UK and I'm not traveling around and then suddenly I can get back on the horse. What's going

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on there? Yeah, great question. So, first of all, let me just say that many people also report

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that in periods of high stress, they are more vulnerable to going back to falling off the wagon

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or going back to some problem related to compulsive overconsumption or addiction. But the opposite

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is also true. So, some people say that they actually do better when there's stress in their

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lives and it's when that stress is removed and they feel like, oh, I can relax my boundaries

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or my guardrails. And those individuals are more vulnerable to compulsive overconsumption

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in times when things are going well. So, things going badly can be a trigger and things going well

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can be a trigger depending upon your unique life history and unique wiring. There's a wonderful

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animal experiment where if you put a rat in a cage with a lever to press for cocaine,

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that rat will press that lever to exhaustion or death, which is essentially the animal model of

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addiction. But if before the rat becomes addicted, if the cocaine is then removed such that pressing

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that lever no longer yields the reward, that rat will eventually extinguish that lever pressing

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behavior. So, they'll stop pressing the lever. They'll stop doing the work. It can take a while,

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but eventually they won't press the lever anymore. Now, if that same rat after a period of time is

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then exposed to a very painful foot shock, the first thing the rat will do in response to that

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painful foot shock is run over and start pressing that lever again. And to me, that's just a wonderful

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model of what we see in humans that when individuals are under extreme stress, they are typically

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more vulnerable to relapse. Because their brain has already encoded using these high dopamine

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rewards in response to any kind of pain as a way to get out of that state.

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So, we talked about the pleasure pain balance here, but if in my life I experience some form of

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pain, I'm likely to go and seek out pleasure and stress could theoretically be considered a form

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of pain. Yeah, which is why people with severe childhood trauma are at higher risk for addiction.

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There are probably epigenetic changes that are happening at the level of DNA expression in their

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brains, making them more vulnerable to addiction. We know that people who are living in poverty are

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more vulnerable to addiction. People who are struggling with multi-generational trauma,

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unemployment, major social and geographic dislocation, those individuals are more vulnerable to

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addiction. So, environmental stresses definitely play a role. We also know that co-occurring psychiatric

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disorders make people more vulnerable to addiction. Probably that means that people who struggle with

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bipolar disorder, depression, anxieties, schizophrenia are at higher risk of becoming addicted,

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and probably it's because they're trying to self-medicate. What about ADHD? So, kids with ADHD

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are at higher risk to develop an addiction in adulthood than kids without ADHD. And the mechanism

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of action for that is not well understood, but there are some really interesting theories. One of

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the theories is that kids with ADHD have a reward deficit at baseline. And that has been shown in

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experiments that people with ADHD, when you show them rewarding stimuli, their reward pathway isn't

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as activated as healthy control subjects. When you say rewarding stimuli, what's that mean?

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Images of cupcakes or alcohol or anything that they will endorse is something that's

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pleasurable for them. So, their brain doesn't release as much dopamine when they see something reward?

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That's right. So, brain imaging studies showing that not only do people with ADHD not release as much

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dopamine in response to rewards, but also have at baseline fewer dopamine receptors. And remember,

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we talked about the decrease in dopamine receptors being what happens as people become addicted. So,

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in some ways, people with ADHD, you could conceptualize them as already having craving at baseline.

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Even before they've been exposed to the kinds of intoxicants that lead to downregulation of those

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D2 receptors. I had a Gabel Matting on the podcast a few times and Gabel talks to me about how

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ADHD could be perceived as learning at a young age to kind of distract yourself from stress in your

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life. So, he was talking a lot about his own experience growing up in Nazi Germany times and his

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mother giving him to someone else because he was at risk of the Nazis and the stress of that moment

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and how he'd kind of learn to tune out of the environment because of that. And I've always wanted,

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I thought about that theoretically. If you grew up in a household where there's loads of

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screaming and loads of violence, for example, you kind of learn to tune out, but you can also develop

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a hyper vigilance. So, it kind of does make sense to me that so many of those people, if this

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theoretically holds, would start with a bit of a pain baseline. We definitely know that kids who

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are raised in traumatic environments where there is complex attachment with caregivers,

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those kids are at higher risk for developing addiction. And this kind of dissociative response

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to trauma, just trying to escape the situation either in your own mind with your own mental,

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you know, dissociation or distractions or actually finding a behavior that gives you comfort

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is well, you know, well observed and well documented. Just getting back to our early conversation

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about digital media and the dangers they're in. So a Pew Survey report just came out asking

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parents how they navigate exposing their kids to smartphones. And in the cohort of parents who

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said that yes, they do let their children under the age of five play with a smartphone.

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When they were asked why did they do that or in what circumstances one of the top reasons was

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to soothe their child when their child was unhappy or distressed in some way.

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Now, I found that very concerning because that is basically setting up the child for the

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perception action loop of using internal distress as a cue for reaching for a smartphone,

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which is works. It definitely works in the short term. But the problem again is that through this

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iterative process of neuroadaptation, ultimately that smartphone will not be sufficient. And now the

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kid will need a smartphone. And I don't know, you know, an AI tailored pet who will do whatever

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they want, whenever they want it. And then by the time the kid is eight, you know, that won't be

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sufficient. And the kid will need, I don't know, a slot machine or whatever it is. It's this escalating

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phenomenon. There's a couple of startups at the moment, AI startups who are putting AI and

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cuddly toys. Oh, yes, right. AI and cuddly toys. And so you can, just like you can speak to

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chat to BT using your devices, you can come home, you can pick up your cuddly toy, your cuddly toy

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will talk to you and ask you how your days been. It will, it can teach you things. What do you

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think of that from a neuroscience or, you know, dopamine or connection perspective? I think that

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this is very, very dangerous because we're essentially offloading the work of parenting and

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creating those relationships. You know, again, I hate judging parents because parenting is hard.

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And I've made many mistakes in my parenting, you know, but what's, and I'm sure these, the parents

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have the best of intentions. But instead of, you know, navigating, finding a way to communicate

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with their child to figure out how to know what's going on in that child's life, which can be

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hard to do because, you know, even young children aren't necessarily willing to disclose. But once

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they get to be teenagers, forget it, then you got to like wait until they're ready to tell you,

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which is almost always like at 10 pm at night when you're exhausted every working all day, right?

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So, so, so there's that piece of it, right? They're, they're not hooding in the work, spending

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the time with a child finding a common language. But you also then, then the second piece of it is,

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now you've got this child who is essentially self-soothing with a machine, right? And again,

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this, the machines are designed to flatter, to validate, to comfort. There's no friction there,

389
00:39:06.400 --> 00:39:16.160
right? This is incredibly potent social validation and soothing, self-soothing. It's essentially

390
00:39:16.160 --> 00:39:22.640
a masturbation machine. And then you've got this really weird additional loop where now the parents

391
00:39:23.360 --> 00:39:32.320
are finding about, out about their child's life through reading and observing her interactions

392
00:39:32.320 --> 00:39:37.360
with AI. So it's like a game of telephone. Now they've like filtered this thing where they,

393
00:39:37.360 --> 00:39:41.280
they think they know what's going on in their child's life, but of course they don't. And none of

394
00:39:41.280 --> 00:39:46.560
that has gone toward fostering a relationship between those parents, you know, and their child.

395
00:39:47.200 --> 00:39:52.320
And this is just, you know, really, really scary because it's going to lead to this incredible

396
00:39:52.960 --> 00:40:02.240
fragmentation of families, of social bonds. I mean, it's, it's, I just, we cannot go in that direction.

397
00:40:02.240 --> 00:40:08.720
We really have to fight against that. So with all this said and with the knowledge that these

398
00:40:08.720 --> 00:40:13.040
algorithms are going to get more addictive because AI is going to know me more and more and more.

399
00:40:13.040 --> 00:40:16.960
And actually the commercial model behind any of these big technology companies is to keep my

400
00:40:16.960 --> 00:40:21.520
attention on their product more so they can deliver more ads or they can charge me a higher subscription

401
00:40:21.520 --> 00:40:27.200
fee. Are you at all hopeful? Because I can't see from an incentive perspective when we're talking

402
00:40:27.200 --> 00:40:31.760
about, you know, the commercial models behind these companies why things aren't going to stop and go

403
00:40:32.560 --> 00:40:37.360
I mean, I agree with you that Genie's out of the bottle where we're not going to go back,

404
00:40:38.160 --> 00:40:47.120
but I am hopeful because I think I'm just a realistic optimist. I do believe in the human

405
00:40:47.120 --> 00:40:52.400
capacity to adapt and solve problems. And the simple fact that we're talking about these

406
00:40:52.400 --> 00:40:57.760
problems now, which we weren't doing, you know, 10, 15 years ago, I think is a good thing.

407
00:40:57.760 --> 00:41:02.640
There's much more awareness in the population about the potential dangers of digital media.

408
00:41:03.200 --> 00:41:10.240
And at the forefront of raising the alarm has been parents because parents are seeing the sort of

409
00:41:10.240 --> 00:41:17.120
disintegration of the nuclear family in real time and they don't like it. So I am hopeful because

410
00:41:17.840 --> 00:41:22.400
I just I just think that we're going to come together and we're going to try different

411
00:41:22.400 --> 00:41:27.760
solutions and some of those solutions will involve technology and like trying to come up with

412
00:41:27.760 --> 00:41:34.000
guardrails or better technology. I think the way that we're going now, you know, with like the

413
00:41:34.000 --> 00:41:40.240
erotic chatbot is not the right direction. But then again, we live in a, you know,

414
00:41:40.240 --> 00:41:46.240
free democracy and consenting adults, you know, can do what they're going to do until we decide

415
00:41:46.240 --> 00:41:51.440
as a society that the harms outweigh the potential benefits. But I really think in the short term,

416
00:41:51.440 --> 00:41:58.320
we need to focus on kids because kids are vulnerable. They're vulnerable on so many levels on a

417
00:41:58.320 --> 00:42:03.440
neurobiological level. They're vulnerable because their brains are still rapidly evolving,

418
00:42:03.440 --> 00:42:08.320
incredibly neuroplastic. They're cutting back on the neurons. They're not using,

419
00:42:08.320 --> 00:42:13.120
they're milinating and making more efficient the neurons they use most often. That whole process

420
00:42:13.120 --> 00:42:18.800
ends at about age 25. Plus you've got the buckets of hormones that are going into kids.

421
00:42:18.800 --> 00:42:24.560
The fact that teenagers are natural risk takers, risk takers that they should

422
00:42:25.200 --> 00:42:30.480
based on their evolutionary milestone, be going out and meeting people and be curious and making

423
00:42:30.480 --> 00:42:35.680
connections at that time. And yet more and more teenagers are staying at home and getting their

424
00:42:35.680 --> 00:42:40.480
needs met, you know, digitally. So we've got, we've got to look at kids. That's got to be like the

425
00:42:40.480 --> 00:42:45.200
first priority. And we've got to help parents because we can't leave it up to parents alone.

426
00:42:45.200 --> 00:42:52.880
So I'm optimistic that we are going to, you know, come up with solutions. And I think we just have

427
00:42:52.880 --> 00:42:58.320
to try a lot of different things and see what works. But it can't just be an individual, you know,

428
00:42:58.320 --> 00:43:03.680
solution. We can't just leave it to individuals or parents or families alone. The schools have to

429
00:43:03.680 --> 00:43:09.920
join the solution, governments, legislators, and also the companies that make and profit from

430
00:43:09.920 --> 00:43:18.800
digital media. They really are responsible for making a product that doesn't harm kids. And right

431
00:43:18.800 --> 00:43:25.360
now, you know, we have a product that harms, harms kids. You've recently been an expert witness

432
00:43:25.360 --> 00:43:33.760
in certain trials and courts, right? Yes. In ongoing litigation, yes. What can you tell me about

433
00:43:33.760 --> 00:43:38.880
about that? And about the parties in play and why you've been called to be an expert witness?

434
00:43:38.880 --> 00:43:44.800
I can't actually tell you too much. I can't talk about it. But I can tell you that the basic

435
00:43:44.800 --> 00:43:54.160
premise is that kids are a vulnerable group. That social media is not safe for kids. That it

436
00:43:54.160 --> 00:44:04.800
causes harm at many different levels, but primarily through the medium itself being addictive and

437
00:44:04.800 --> 00:44:10.720
engaging their brains and exploiting their motivational reward system with design features that

438
00:44:10.720 --> 00:44:16.480
keep them clicking and swiping. And in that case, someone's suing the social media companies.

439
00:44:16.480 --> 00:44:22.000
That's right. So you've got school districts, counties, states, the federal government,

440
00:44:22.000 --> 00:44:28.720
entities representing the federal government, suing social media companies. Yeah.

441
00:44:28.720 --> 00:44:34.080
What outcome are they looking for? They're looking for a safer product for kids. They're looking

442
00:44:34.080 --> 00:44:43.360
to help parents and kids and schools protect kids from the harms of social media, which again,

443
00:44:43.360 --> 00:44:50.240
are not just the harms of addiction. That's sort of the process by which the engagement becomes

444
00:44:50.240 --> 00:44:56.240
pathological and then the harms multiply because of the sheer amount of time spent. But the harms

445
00:44:56.240 --> 00:45:05.360
include things like cyberbullying, sex exploitation, sexual abuse material, the outcomes of depression,

446
00:45:05.360 --> 00:45:12.560
anxiety, eating disorders, body dysmorphia, sleep disruption. The world of business looks

447
00:45:12.560 --> 00:45:16.800
entirely different today than it did 15 years ago. Back then building a brand meant having huge

448
00:45:16.800 --> 00:45:21.360
budgets, warehouse is office space and lots and lots of stuff. But now you can start a business

449
00:45:21.360 --> 00:45:25.840
with your laptop and idea and the write tools. And I would know more so than anybody else because

450
00:45:25.840 --> 00:45:29.680
that's exactly what I did. Shopify is one of our longstanding sponsors on this show and they're

451
00:45:29.680 --> 00:45:33.840
a brand I often refer people to when they're starting their businesses because it's a tool that

452
00:45:33.840 --> 00:45:38.880
contains many more tools within itself. And when you're starting out, everything is everywhere.

453
00:45:38.880 --> 00:45:43.200
It's messy and it's confusing, so having everything in the same place is incredibly useful.

454
00:45:43.200 --> 00:45:48.720
Shopify puts store design, payments, inventory, shipping, and even AI tools all in one place.

455
00:45:48.720 --> 00:45:52.880
And you can sell directly from your website or on social media essentially wherever your

456
00:45:52.880 --> 00:45:57.760
customers spend their time. It's truly a brilliant business tool. So if you want to give it a go,

457
00:45:57.760 --> 00:46:04.400
head to Shopify.com slash Bartlett and sign up for your $1 per month trial period. That's

458
00:46:04.400 --> 00:46:11.120
Shopify.com slash Bartlett. So if I'm coming out of December and I've been eating a little bit too

459
00:46:11.120 --> 00:46:15.440
much in December, maybe I've been smoking a bit, whatever bad habit I might have been doing,

460
00:46:15.440 --> 00:46:20.080
drinking too much because it was new years, new, you know, news parties, etc. My brain is currently

461
00:46:20.080 --> 00:46:25.040
going to be slightly out of balance in terms of its dopamine balance.

462
00:46:26.560 --> 00:46:34.400
Yes. So hypothetically, your brain will be in a dopamine deficit state. What you want to do is you'll

463
00:46:34.400 --> 00:46:41.680
want to abstain from your drug of choice long enough in order to reset reward pathways.

464
00:46:41.680 --> 00:46:45.760
Okay. So if I've got a sugar problem, then I need to just lay off the sugar for a little while.

465
00:46:46.400 --> 00:46:52.320
You need to lay off the sugar for at least four weeks. Four weeks?

466
00:46:52.320 --> 00:46:57.920
Yeah. And why four weeks? Because on average, four weeks is about the amount of time it takes

467
00:46:57.920 --> 00:47:04.320
for people to get out of the state of acute withdrawal and begin to be able to take joy in other

468
00:47:04.320 --> 00:47:10.560
more modest rewards and not be in a constant state of craving. Okay. The worst part is those first

469
00:47:10.560 --> 00:47:16.720
10 to 14 days. That's when we're in acute withdrawal. And the reason for that is when we first

470
00:47:16.720 --> 00:47:21.280
take our reward off the pleasure side of the balance, right? Which I'm going to do now.

471
00:47:21.280 --> 00:47:26.080
So when we first stop the sugar or the AI or the cigarettes? That's right. The first thing that

472
00:47:26.080 --> 00:47:31.440
happens is our pleasure pain balance crashes down to the side of pain because of this process of

473
00:47:31.440 --> 00:47:37.280
neuroadaptation, right? Now we're in the state of acute withdrawal. And I've got cravings. Cravings.

474
00:47:37.680 --> 00:47:43.680
And yet what are the characteristics of withdrawal, anxiety, irritability, insomnia, dysphoria,

475
00:47:43.680 --> 00:47:48.960
or depressed mood and cravings? And it's crazy because when I'm in that state, when I've not had

476
00:47:48.960 --> 00:47:55.840
my drug of choice for say a day or two, I look at the drug differently. Like it just looks different

477
00:47:55.840 --> 00:48:00.800
to me. It's so crazy. I'll walk past, let's say, what's something I really like? Maybe carrot cake.

478
00:48:00.800 --> 00:48:04.080
If I've, you know, if I've been having a lot of sugar, which is quite rare for me, but just

479
00:48:04.160 --> 00:48:11.040
I have, when I look at the carrot cake the day after I had carrot cake, it looks amazing. And it

480
00:48:11.040 --> 00:48:16.800
looks so delicious. But when I'm in the ketogenic state where I've not had carbohydrates for say

481
00:48:16.800 --> 00:48:21.680
for eight weeks, I look at carrot cake and I have no emotional connection to it.

482
00:48:22.800 --> 00:48:28.160
Exactly. So that summarizes it perfectly, right? I had a patient with a severe food addiction

483
00:48:28.720 --> 00:48:35.920
who, when she walked into the break room at work and saw the donuts, she broke out into a cold

484
00:48:35.920 --> 00:48:42.400
sweat and actually had stomach pains. It was a physiologic state of craving and hyperarousal

485
00:48:43.040 --> 00:48:49.680
just by looking at the donuts. And that's what happens essentially, right? Because we're in

486
00:48:49.680 --> 00:48:57.280
this state of constant craving. Our brain has overvalued this reward. We have euphoric recall of our

487
00:48:57.280 --> 00:49:04.640
earlier use of the drug when we first tasted it, how delicious it was. And even now, if we,

488
00:49:04.640 --> 00:49:11.200
even now when we eat it because of tolerance, it's not as good as earlier use. Our brain still remembers

489
00:49:12.080 --> 00:49:17.440
earlier use and, and we have this overweighted value of, oh, how delicious it's going to be.

490
00:49:19.200 --> 00:49:23.360
And so this is really important to remember because when we're in that acute state of craving,

491
00:49:23.360 --> 00:49:30.720
it feels like it will never end. It really does. And I'm still amazed in my clinical work,

492
00:49:30.720 --> 00:49:37.680
how in early withdrawal, people just say, the craving is horrible. I just, I can't live like this.

493
00:49:37.680 --> 00:49:42.480
And I think that's really important to point out that many people try to stop using their

494
00:49:42.480 --> 00:49:47.440
drug of choice, but they don't try, they don't stop for long enough to be able to get out of that

495
00:49:47.520 --> 00:49:54.000
vortex of craving to get come, get to the other side. And it feels like the craving will never end.

496
00:49:54.000 --> 00:49:59.200
So I always have to reassure them that if they can just wait long enough without using, they will

497
00:49:59.200 --> 00:50:04.240
eventually get to that place where they're not in that constant state of craving. Now,

498
00:50:04.240 --> 00:50:09.120
that's assuming they have enough neuroplasticity to do that and not, not everybody does.

499
00:50:10.000 --> 00:50:15.680
And so what, what, what is the purpose then of abstinence? It's again, when our brain is no longer

500
00:50:15.680 --> 00:50:23.200
getting this exogenous source of stimulation or dopamine, eventually the brain gets the message,

501
00:50:23.200 --> 00:50:30.800
okay, I need to start up regulating my own dopamine transmission, right? I need to re-employ,

502
00:50:30.800 --> 00:50:37.120
I need to redeploy my postsynaptic dopamine receptors, right? I need to get it from inside of my

503
00:50:37.120 --> 00:50:42.480
brain. And so eventually, I'm just going to take the rocks now off the pain side of the balance.

504
00:50:42.480 --> 00:50:45.120
You know,

505
00:50:49.440 --> 00:50:50.400
I could have made this easier.

506
00:50:53.200 --> 00:50:56.960
There we go. Eventually, if we abstain for long enough,

507
00:50:57.600 --> 00:51:04.000
those that process of neuro adaptation reverses itself. And we say neuro adaptation, you mean

508
00:51:04.000 --> 00:51:09.360
the brain changing? Right, the brain changes. So the kind of neuroplasticity that we see

509
00:51:10.320 --> 00:51:17.040
with addiction can be reversed in most cases. And neuroplasticity is just the brain again changing.

510
00:51:17.040 --> 00:51:23.520
Right, changing, right? Or going back. Now, interestingly, you know, the work of Edie Sullivan and

511
00:51:23.520 --> 00:51:29.680
others looking at what happens in the brain during recovery suggests that those addiction

512
00:51:29.680 --> 00:51:36.560
neural circuits probably never go away, but like the dying embers of a fire, they quiet down.

513
00:51:36.560 --> 00:51:42.400
And then recovery is characterized by the development of new neural networks that route around

514
00:51:42.400 --> 00:51:49.200
those injured areas. But the bottom line is that because of neuroplasticity, we can eventually return

515
00:51:49.200 --> 00:51:56.720
to kind of baseline levels of pleasure and pain. We can restore our hedonic or joy set point.

516
00:51:56.720 --> 00:52:03.360
And when we do that, we're in a much healthier place. Because now we can take pleasure in other

517
00:52:03.360 --> 00:52:09.760
rewards that are not our drug, right? Like watching a sunset, talking to a friend, going for a walk,

518
00:52:09.760 --> 00:52:17.360
things that we lost the capacity to enjoy because our reward pathway was hijacked by our drug of choice.

519
00:52:17.360 --> 00:52:20.800
I think this is a really important point as well when you say drug of choice because one thing I

520
00:52:20.800 --> 00:52:26.720
learned from our conversation last time is that me and you will both be susceptible to becoming

521
00:52:26.720 --> 00:52:31.920
more or less addicted to different drugs of choice. So for me, it might be whiskey. For you,

522
00:52:31.920 --> 00:52:35.840
it might, I think you said it was like erotic novels where one of your things, I don't

523
00:52:35.840 --> 00:52:40.320
drink whiskey just for the first time. But it might be, I don't know, it might be opioids or AI.

524
00:52:40.320 --> 00:52:44.960
I might be more susceptible. So if me and you spend one hour on TikTok, the way my brain is

525
00:52:44.960 --> 00:52:49.120
why the things I've been through in my life, whatever might mean that I get really addicted to TikTok,

526
00:52:49.120 --> 00:52:57.680
whereas you don't feel that. Exactly. And what distinguishes addictive drugs or intoxicants from

527
00:52:57.680 --> 00:53:02.800
other substances is that they do release a lot of dopamine all at once in the reward pathway.

528
00:53:02.800 --> 00:53:09.440
So many, if not most people, will find intoxicants reinforcing, but that's not universally true.

529
00:53:09.440 --> 00:53:14.800
Like there are some people who take opioids and find them that they feel very uncomfortable and

530
00:53:14.800 --> 00:53:20.560
it's not, doesn't make them feel euphoric, right? And other people will drink caffeine and not feel

531
00:53:20.560 --> 00:53:25.280
the stimulating effects and other people will have alcohol and, you know, get a headache and not

532
00:53:25.280 --> 00:53:31.840
not feel relief. So, and so this differences in our brains is a really important concept.

533
00:53:31.840 --> 00:53:35.200
What about this only dear of having an addictive personality? It's not a real thing.

534
00:53:35.840 --> 00:53:42.240
It is a real thing. We don't use that terminology anymore. We talk about the inherited or genetic

535
00:53:42.240 --> 00:53:48.320
risk of addiction. We do know that if you have a biological parent or grandparent with an

536
00:53:48.320 --> 00:53:52.880
addictive disorder, you are increased risk of developing addiction compared to the general

537
00:53:52.880 --> 00:53:57.040
population, even if you're raised outside of that substance using home. Am I right in thinking

538
00:53:57.040 --> 00:54:01.680
you don't use that term because it suggests one can't change in that they're stuck or is there

539
00:54:01.680 --> 00:54:07.760
another reason? You know, it's a good question why that term has gone out of favor. I think in

540
00:54:07.760 --> 00:54:12.720
general, when we talk about, yeah, when we talk about personality, it does seem like a kind of a

541
00:54:12.720 --> 00:54:20.240
fixed feature of somebody's character and so we're probably trying to avoid that.

542
00:54:20.240 --> 00:54:24.320
One of the really liberating things about what you've just said is maybe we don't need to make

543
00:54:24.320 --> 00:54:29.520
New Year's resolutions. Maybe we need to make just a January resolution because that's four weeks

544
00:54:29.520 --> 00:54:33.200
long. And if I can get to the end of the four weeks, then the cravings are likely to have gone.

545
00:54:33.200 --> 00:54:37.120
And you know, when you think about a New Year's resolution, then you get like a weekend and you're

546
00:54:37.120 --> 00:54:40.720
like, come, I'm going to be able to do this for the whole three and sixty five days. Well, you've

547
00:54:40.720 --> 00:54:44.640
just said actually illuminates the fact that maybe you should set yourself a four week resolution.

548
00:54:44.640 --> 00:54:49.520
Exactly. And that's what we often do in clinical care. If we were to ask people to abstain for

549
00:54:49.520 --> 00:54:55.600
their whole lives, it seems impossible. But if we ask them to abstain for 30 days, it's kind of an

550
00:54:55.600 --> 00:55:01.680
amount of time that they can wrap their heads around and also not in all, but in most folks who

551
00:55:01.680 --> 00:55:06.160
are willing and able to do it and also importantly for whom it's safe to do because it's not safe for

552
00:55:06.160 --> 00:55:10.480
everybody, right? We wouldn't recommend that for someone who is at risk for life threatening

553
00:55:10.480 --> 00:55:15.120
withdrawal from alcohol or benzodiazepines or something like that. But for people who are

554
00:55:15.120 --> 00:55:22.480
willing and able to do it, they usually feel better at the end of those those 30 days. And then they

555
00:55:22.480 --> 00:55:27.680
can make a decision about whether they want to continue to abstain or they want to go back to using.

556
00:55:27.680 --> 00:55:33.280
And if they do decide to go back to using, they've typically, you know, have lowered their tolerance

557
00:55:33.280 --> 00:55:38.640
for their drug of choice, which means that when they do use again, they can get reward from it

558
00:55:38.640 --> 00:55:44.720
again, which again, because of neuroadaptation, we lose the ability to do that with chronic heavy

559
00:55:44.720 --> 00:55:53.200
use. So that, you know, that there is this whole concept of moderating our use, which didn't use

560
00:55:53.200 --> 00:55:59.680
to be something that we even talked about in the field of addiction when it was thought that

561
00:55:59.760 --> 00:56:06.960
abstinence was the only way. But more and more, you know, we are thinking about healthy ways to

562
00:56:06.960 --> 00:56:12.640
moderate after a period of abstinence. And the reason we recommend a period of abstinence,

563
00:56:12.640 --> 00:56:18.640
even if the long-term goal is moderation is because we find that people are more successful

564
00:56:18.640 --> 00:56:26.000
moderating if they first abstain for a period of time. What about if I'm trying to pick up a

565
00:56:26.000 --> 00:56:34.160
new habit? How do I need to be thinking about this pain pleasure scale? And what's a good

566
00:56:34.160 --> 00:56:38.720
strategy with this in mind? So I want to start, let's say, I want to start going to the gym.

567
00:56:39.440 --> 00:56:45.840
Right. So you've chosen a habit going to the gym that is hard to do and involves effort. So

568
00:56:45.840 --> 00:56:52.560
that means that habit won't happen easily the way that habits that are related to the sudden

569
00:56:52.560 --> 00:56:57.360
release of dopamine in the reward pathway. Because those are habits that are frictionless. We

570
00:56:57.360 --> 00:57:05.680
pick them up instantaneously. But a habit that involves effort and for which the rewards are not

571
00:57:05.680 --> 00:57:10.880
immediate, you can again think about this pleasure pain balance. And now instead of pressing on

572
00:57:10.880 --> 00:57:15.520
the pleasure side, we're intentionally pressing on the pain side by making ourselves get out of bed

573
00:57:15.520 --> 00:57:21.760
in the morning, go to the gym, engage in effortful exercise. And what's interesting is that when we do

574
00:57:21.760 --> 00:57:26.560
that, the neural adaptation, Gremlins, I talk about are these rocks that we've used here today,

575
00:57:27.120 --> 00:57:33.760
will actually go on the other side of our balance. So on the pleasure side, and we will get our

576
00:57:33.760 --> 00:57:40.320
dopamine indirectly by paying for it up front. And the way that that's probably happening is that

577
00:57:40.320 --> 00:57:48.000
our body in sensing injury is up regulating feel good hormones and neurotransmitters like dopamine,

578
00:57:48.080 --> 00:57:53.920
but also endogenous opioids, endogenous cannabinoids. And from an evolutionary perspective,

579
00:57:53.920 --> 00:57:59.200
that's really how our pleasure pain balance evolved. So just to simplify this for me,

580
00:57:59.200 --> 00:58:03.760
yeah, I go to the gym, I get out, I travel to the gym, I lift up those weights, I do my run,

581
00:58:04.640 --> 00:58:10.240
I'm going to feel good, but it's going to be delayed. Right. And importantly, you're not going

582
00:58:10.240 --> 00:58:16.160
to feel good when you first start exercising, right? At least most people don't know. It's painful.

583
00:58:16.160 --> 00:58:21.200
And you're thinking how many minutes am I, you know, how many minutes do I have left?

584
00:58:21.200 --> 00:58:27.360
And we do know, in fact, that exercise is immediately toxic to cells, which is really kind of

585
00:58:27.360 --> 00:58:31.200
strange, because we know exercise is good for us. But again, what's probably happening at a

586
00:58:31.200 --> 00:58:37.120
molecular level is that the body is sensing cellular injury and in response, up regulating

587
00:58:37.120 --> 00:58:43.200
all those feel good hormones and neurotransmitters, but it takes time. It takes time. And so we're

588
00:58:43.200 --> 00:58:48.240
going to have a delayed sense of reward. And that's the runner's high, right? That kind of comes

589
00:58:48.240 --> 00:58:53.440
after the exercise is over, or maybe for some people comes in the middle of exercise when you're

590
00:58:53.440 --> 00:58:58.320
a little bit into it or halfway through. But at some point, you know, you get the endorphins and

591
00:58:58.320 --> 00:59:07.760
that feels good. How would one go about gaming this so that I'm more likely to do it? Because,

592
00:59:07.760 --> 00:59:12.320
you know, the reward comes after, which is not not incredibly useful. You must almost have to have

593
00:59:12.320 --> 00:59:16.640
like a religious belief in exercise because you go, I'm not going to want to do this. But it's kind

594
00:59:16.640 --> 00:59:20.720
of, I'm going to be glad I did afterwards. Right. So is there anything I can do? Like, do I have a

595
00:59:20.720 --> 00:59:26.000
Mars bar when I get to the gym or something? I don't know. You know, there are so many ways and so

596
00:59:26.000 --> 00:59:32.400
many tricks that people use to kind of create new healthy habits. I'm one of the ways that we can

597
00:59:32.400 --> 00:59:40.640
do it is to prepare in advance for that moment when we want to do something that's hard.

598
00:59:41.360 --> 00:59:46.400
Because if we wait till that moment to decide whether or not to do something that's hard,

599
00:59:46.400 --> 00:59:52.080
we almost always choose not to do it. But if we make a plan in advance, let's say the day before

600
00:59:52.800 --> 00:59:57.520
that tomorrow, I'm going to get up at this time, I'm going to, you know, get my stuff together

601
00:59:57.520 --> 01:00:02.400
and I'm going to go to the gym, we're much more likely to engage in that activity. And that can

602
01:00:02.400 --> 01:00:07.760
also include then rituals around that activity that we prepare in advance. So for example, packing

603
01:00:07.840 --> 01:00:15.200
our bag, right? The schedule itself, setting up a time, maybe planning to meet a friend, right?

604
01:00:15.200 --> 01:00:21.600
So we connect friendship or socialization with the thing that's hard to do. It's much easier to do

605
01:00:22.240 --> 01:00:30.000
these difficult things with other people than to have to do it alone. How does that link to the

606
01:00:30.000 --> 01:00:33.520
the pain side of the balance or does it at all link to the pain side of the balance? This idea

607
01:00:33.600 --> 01:00:38.720
that if I put my clothes out at the night before and I schedule it and I really plan for it,

608
01:00:38.720 --> 01:00:42.960
is it reducing the pain involved? And that's going to increase the probability of the behavior

609
01:00:42.960 --> 01:00:47.680
occurring. Is that what you're saying? Or is it not linked to it? I don't think so. I think instead,

610
01:00:48.560 --> 01:00:53.760
the prefrontal cortex is the large gray matter area right behind our foreheads that's so important

611
01:00:53.760 --> 01:01:00.880
for future planning and delayed gratification also for autobiographical narrative. And I think by

612
01:01:00.880 --> 01:01:09.440
putting these pieces in place that allows our prefrontal cortex to plan for this future event

613
01:01:09.440 --> 01:01:16.080
that we know we're not going to want to do but that we want to do, it allows us to kind of put the

614
01:01:16.080 --> 01:01:27.360
brakes on our short-term desires and project ourselves into the future to achieve our long-term

615
01:01:27.360 --> 01:01:33.120
desires. Sam McClure and neuroscientists have shown that in response to immediate rewards,

616
01:01:33.600 --> 01:01:39.920
the emotion brain gets activated in response to long-term rewards, the prefrontal cortex gets

617
01:01:39.920 --> 01:01:47.040
activated. So by planning in advance all of these little pieces, sometimes called habit stacking,

618
01:01:47.040 --> 01:01:52.320
we're essentially activating our prefrontal cortex, projecting ourselves into the future

619
01:01:53.280 --> 01:02:02.160
and anticipating a long-term reward, which then allows us to do hard things and avoid short-term

620
01:02:02.160 --> 01:02:09.040
rewards in the service of our future selves. So many people might have an experience where they

621
01:02:09.040 --> 01:02:14.400
kick the habit for a little while and then they relapse. It might be a month, it might be two

622
01:02:14.400 --> 01:02:21.440
months, it might be three months. Is there any art to avoiding the relapse? So it's very common to

623
01:02:21.440 --> 01:02:27.520
relapse, especially living in the world that we do today. We're constantly being invited to consume

624
01:02:28.320 --> 01:02:34.480
really these stimuli, you know, getting us to drink or to smoke or to do various forms of

625
01:02:34.480 --> 01:02:41.680
entertainment, chase us down. We can't avoid them. It's very difficult too. So I talk a lot about

626
01:02:41.680 --> 01:02:47.600
self-binding strategies with my patients. And self-binding strategies are a way of putting both

627
01:02:47.600 --> 01:02:54.000
a literal and a metacognitive barrier between ourselves and our drug of choice. What's a metacognitive

628
01:02:54.000 --> 01:03:01.440
barrier? So it's a thought, right, or a narrative. So instead of it being a physical barrier,

629
01:03:01.440 --> 01:03:06.160
like a physical barrier would be, for example, getting the smartphone out of the bedroom

630
01:03:06.160 --> 01:03:11.040
or deleting an app, right, or getting alcohol out of the house, or whatever it is,

631
01:03:11.040 --> 01:03:17.440
creating both a physical barrier between myself and my drug of choice. A metacognitive barrier

632
01:03:17.440 --> 01:03:23.120
is something like more like a thought process. For example, we were talking about thinking about

633
01:03:23.760 --> 01:03:31.680
long-term goals or, you know, what are my values, right? And how do my values trump my immediate

634
01:03:31.680 --> 01:03:38.800
desires? Or how can I co-regulate with other people? These are all self-binding strategies that we

635
01:03:38.800 --> 01:03:48.160
can use so that we're not relying on a willpower alone. Because if we wait to rely on our willpower

636
01:03:48.160 --> 01:03:54.960
alone, we will not make it, especially in this world of overwhelming overabundance. There are just

637
01:03:54.960 --> 01:04:00.480
too many temptations. Willpower is an exhaustible resource, meaning that it doesn't last forever

638
01:04:00.480 --> 01:04:05.680
to eventually runs out. So we've got to actually create barriers between ourselves and our drug of

639
01:04:05.680 --> 01:04:12.000
choice so that we can have a little bit more time and that little bit more time, that slowing

640
01:04:12.000 --> 01:04:20.320
things down is sometimes just enough to allow ourselves to surf the cravings and get through them

641
01:04:20.320 --> 01:04:27.360
without actually using. Is it possible to become addicted to good things too? So when I use the

642
01:04:27.360 --> 01:04:33.200
term addiction, I'm really talking about a disease process, a form of mental illness. It's a very

643
01:04:33.200 --> 01:04:39.280
common term that's used in everyday life and people don't always use it in that way. But when

644
01:04:39.280 --> 01:04:44.960
I'm using it, I'm really talking about the problem of compulsive overconsumption despite harm to

645
01:04:44.960 --> 01:04:51.280
self and or others. And it's important to distinguish addiction from something like a habit,

646
01:04:51.920 --> 01:04:57.920
which I don't consider to be an addiction or even a bad habit, right? Doesn't meet threshold

647
01:04:57.920 --> 01:05:02.320
criteria for addiction. And also it's important just to distinguish all of that from a passion.

648
01:05:02.960 --> 01:05:08.720
Something that we really invest in and that we love to do. But that's helpful for ourselves and

649
01:05:08.720 --> 01:05:14.400
or other people is not consistently causing harm. Are there any daily practices like a morning

650
01:05:14.400 --> 01:05:19.840
ritual that you would advise someone to consider if they were trying to set themselves up to kick a

651
01:05:19.840 --> 01:05:27.360
habit or to kick an addiction? So I recommend doing the hard things first. A short hand way of saying

652
01:05:27.360 --> 01:05:35.440
that is to start your day with pain, meaning, for example, do the hard things when you first

653
01:05:35.440 --> 01:05:40.640
get up as part of your morning routine, like exercise, like exercise, make your bed,

654
01:05:41.760 --> 01:05:46.560
e-practice, brush your teeth, plan your day, plan what you're going to do if you haven't done it

655
01:05:46.560 --> 01:05:52.640
already. And do all of those things before, for example, you have your morning cup of Joe or

656
01:05:52.640 --> 01:06:00.000
before you touch a single screen or digital device. Why? Because those are reinforcers that are

657
01:06:00.000 --> 01:06:07.360
so powerful that we're all vulnerable to having our goals and desires be hijacked by them. So really

658
01:06:07.360 --> 01:06:14.160
important to take the time in the morning to set up a good morning routine before you expose

659
01:06:14.160 --> 01:06:19.200
your brain to these incredibly reinforcing substances. I wasn't clear on why. I wasn't clear on

660
01:06:19.280 --> 01:06:24.640
that why I would do, why I'd go to the gym early or why I do hard things first before I get into

661
01:06:24.640 --> 01:06:31.280
TikTok or social media. If you do intoxicants first, right? If you expose your brain first thing in

662
01:06:31.280 --> 01:06:38.080
the morning to things that are incredibly pleasurable, you have nowhere to go from there. And in fact,

663
01:06:38.080 --> 01:06:42.880
if anywhere you're going to have a come down from that and then you're going to be starting from a

664
01:06:42.880 --> 01:06:48.400
place of compromise, where then doing the hard things is even harder. Whereas if you start with

665
01:06:48.400 --> 01:06:55.680
the hard things, you will potentially get rewards from having done those hard things, right? And

666
01:06:55.680 --> 01:07:05.840
also feel a sense of competence and accomplishment that then allows for you to move through your day

667
01:07:05.840 --> 01:07:10.000
in a way that's better if you just start with something that's incredibly pleasurable.

668
01:07:10.560 --> 01:07:14.720
If I am getting ready to kick a habit, a big one, a big one, that's really hung around for a long

669
01:07:15.680 --> 01:07:21.760
time. Is there something I should do in preparation to plan for my dopamine fast or for kicking

670
01:07:21.760 --> 01:07:26.400
that habit? Because you only said, you know, from day one, it will take about four weeks to start to

671
01:07:26.400 --> 01:07:31.120
to feel the cravings diminish. But is there something I should be doing before I even start those

672
01:07:31.120 --> 01:07:37.920
four weeks? Yeah, so I strongly recommend preparing for the dopamine fast in advance. And the things

673
01:07:37.920 --> 01:07:43.520
to do are first figure out what is your drug of choice. That is to say, what is the thing that you're

674
01:07:43.520 --> 01:07:48.880
consuming too much and too often such that you regret it later? Or the thing that's leading to

675
01:07:48.880 --> 01:07:54.560
obvious negative consequences? Or the thing that just has opportunity costs associated with it,

676
01:07:54.560 --> 01:07:59.600
that is to say, you're spending so much time consuming this drug that you're not doing other

677
01:07:59.600 --> 01:08:05.040
things, other hobbies, investing in other things that are meaningful to you, like your primary

678
01:08:05.040 --> 01:08:10.880
relationships. So that's very important to just figure that out first. And I usually recommend

679
01:08:10.880 --> 01:08:16.960
something called the timeline follow back method. That's where you start today and you count

680
01:08:16.960 --> 01:08:24.240
backwards for every day of the week. What did you consume in terms of your drug of choice? How much

681
01:08:24.240 --> 01:08:31.760
and how often? So really looking at quantity and frequency and then adding that up over those seven

682
01:08:31.760 --> 01:08:39.600
days. And the reason that's important is because we can really lose track of how we're consuming our

683
01:08:39.600 --> 01:08:45.760
drug of choice when we're chasing dopamine. We're very bad self observers. So just to give a personal

684
01:08:45.760 --> 01:08:54.480
example, I had gotten into this habit of watching YouTube after work as a way to relax, especially on

685
01:08:54.480 --> 01:08:59.840
my long clinic days when I was more tired. And I thought it was just that I was watching for maybe

686
01:08:59.840 --> 01:09:05.200
half an hour, a couple times a week. And then my daughter, a teenager, came up to me and she said,

687
01:09:05.200 --> 01:09:10.080
mom, you're always watching YouTube now. And I said, no, I'm not. And I was really kind of insulted

688
01:09:10.080 --> 01:09:14.560
because in my mind, it was not very much. And I thought, geez, can't I relax? Everyone's

689
01:09:14.560 --> 01:09:20.880
now on and watch some YouTube. But then after she left me, I thought to myself, well, okay,

690
01:09:20.880 --> 01:09:25.120
how much have I been watching right now and turned up? Oh, I've been watching for an hour and a half.

691
01:09:25.760 --> 01:09:30.720
And then I thought about the day before that. Oh, it was probably two hours in the day before that.

692
01:09:30.720 --> 01:09:34.240
It was probably about the same. And over the course of a whole week, it was probably about

693
01:09:34.960 --> 01:09:42.080
14 hours of YouTube, which is a whole day, a whole day, right? And so what were you watching?

694
01:09:43.440 --> 01:09:53.520
Gosh, so embarrassing. I got into this jag of watching Dr. Pimple Popper, which I know is really weird.

695
01:09:53.520 --> 01:09:59.040
You don't even know what that is, right? Yeah. So it's people popping other people's pimples.

696
01:10:04.080 --> 01:10:08.080
So bad. So bad. That's not what I expected you to do. Yeah, right?

697
01:10:08.720 --> 01:10:13.680
I thought it was going to be AI, some psychology there, some science. No, no, no. People popping

698
01:10:13.680 --> 01:10:18.560
other people's pimples. Yeah. Yeah. Yeah. You know, that a whole day watching that. Yeah. When I

699
01:10:18.560 --> 01:10:26.080
added it up over a week, it was a whole day of watching Dr. Pimple Popper. I don't know any

700
01:10:26.080 --> 01:10:29.840
founder who started their business because they like doing admin, but whether you like it or not,

701
01:10:29.840 --> 01:10:33.680
it's a huge part of running a business successfully. And it's something that can quickly become

702
01:10:33.680 --> 01:10:38.800
all consuming, confusing, and honestly, a real tax, because you know it's taking your attention away

703
01:10:38.800 --> 01:10:44.000
from the most important work. And that's why Ask Bonser, Intuit QuickBooks, helps my team streamline

704
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705
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706
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707
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709
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712
01:11:26.400 --> 01:11:31.680
All right guys, let me go get Steve. The guest is here. Ready? Come in. Oh my god, Steve!

713
01:11:33.520 --> 01:11:38.400
What are you doing? This is a Bond Charge face mask. It's good for blemishes, wrinkles,

714
01:11:39.200 --> 01:11:42.800
cleans up the skin. It's red light. Have you not used it before? No.

715
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They've tried this before. It's really really good. It shines red light on your face,

716
01:11:47.840 --> 01:11:51.440
which helps increase and boost collagen production. I actually found it out because of the

717
01:11:51.440 --> 01:11:55.440
misses. I've seen her wear in it. She terrified me a couple of nights in the row. I thought it was

718
01:11:55.440 --> 01:11:59.520
to scare people with, but actually it's really, really good for your skin. So they are a sponsor of

719
01:11:59.520 --> 01:12:04.320
the podcast and I've been using it every day for about a year and a half now. Wow,

720
01:12:04.800 --> 01:12:09.680
Steve. I'm going on great. Yes. In a Bond Charge ships worldwide with easy returns and a

721
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year long warranty on all of their products, so visit bondcharge.com slash diary for 25% off on

722
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any product site wide, but you have to order through that link. That's bondcharge.com slash diary

723
01:12:21.360 --> 01:12:30.240
with code diary. On page 64 of your workbook of Diffin Me Nation, there's this really interesting

724
01:12:30.880 --> 01:12:40.160
image here, which I'll throw up on the screen, but it shows a brain and that's as far as I'm

725
01:12:40.160 --> 01:12:47.440
going to go with Mike me explaining it over to you. Okay, so these are human brain imaging studies.

726
01:12:48.080 --> 01:12:53.120
This is adapted from the work of Nora Volkov and her colleagues. She's the head of the

727
01:12:53.120 --> 01:12:59.360
National Institute of Drug Abuse, an amazing researcher and scientist, and she looked at dopamine

728
01:12:59.360 --> 01:13:06.880
transmission levels in the reward pathways of healthy control subjects on the left versus people

729
01:13:06.880 --> 01:13:14.400
addicted to a variety of substances on the right, cocaine, meth, alcohol, etc. Basically what she

730
01:13:14.400 --> 01:13:21.360
found was in the in the brains of healthy control subjects, there was plenty of dopamine transmission

731
01:13:21.360 --> 01:13:28.800
as represented here by red or the darker color. In the brains of people who had been using these

732
01:13:28.800 --> 01:13:35.200
substances in an addictive way, meaning heavily and chronically, there was almost no dopamine

733
01:13:35.200 --> 01:13:42.080
transmission in the nucleus accumbens. In other words, these individuals are in a chronic dopamine

734
01:13:42.080 --> 01:13:49.600
deficit state. They have below normal levels of dopamine transmission. Isn't this just kind of the

735
01:13:49.600 --> 01:13:57.040
story of how the human body works, where if you give it too much of something through an external

736
01:13:57.040 --> 01:14:05.600
source, an exogenous source, so if you're taking lots of dopamine via TikTok or from porn or from

737
01:14:05.600 --> 01:14:09.840
alcohol, your brain goes, well, if you've got enough of that, then I won't make any.

738
01:14:11.280 --> 01:14:17.840
You know what? You just summed it up. That's exactly right. That essentially too much of anything

739
01:14:17.840 --> 01:14:29.600
is bad. And that our brain, which is designed to return to homeostasis, homeostasis being a finite

740
01:14:29.600 --> 01:14:36.320
number of physiologic states that the organism must maintain in order to survive.

741
01:14:37.120 --> 01:14:40.800
Is this the case with things like melatonin as well? Because there's people are struggling a lot

742
01:14:40.800 --> 01:14:44.400
with sleep, so they're taking a lot of these melatonin pills, but I don't know. Someone offered

743
01:14:44.400 --> 01:14:50.240
me one one time, and I remember thinking, well, if I start taking this, then isn't my body going

744
01:14:50.240 --> 01:14:53.520
to stop making it? And then I'm going to become dependent on these fucking pills.

745
01:14:54.320 --> 01:15:06.160
So that is the potential with, I think, any exogenous source that we use, right? Anything that we

746
01:15:06.160 --> 01:15:15.760
ingest, our brains and our bodies will want to adapt to bring us back to whatever our baseline is.

747
01:15:15.760 --> 01:15:23.600
But the difference between addictive substances and behaviors and non-addictive ones is that

748
01:15:23.600 --> 01:15:31.200
the release of dopamine in the reward pathway is so fast and so strong that this process of

749
01:15:31.200 --> 01:15:38.720
neuroadaptation is equally strong to bring us back down to baseline. Because we do know that

750
01:15:38.720 --> 01:15:45.200
there are medications that people can take for very long periods of time and actually not develop

751
01:15:45.200 --> 01:15:51.360
tolerance to them, right? They can continue to work for them over the long period of time. We don't

752
01:15:51.360 --> 01:15:59.280
actually know exactly why it is that some people develop tolerance and not others. And again,

753
01:15:59.280 --> 01:16:04.640
it probably has to do with the amount, you know, the dose, exactly how it's working on the brain.

754
01:16:04.640 --> 01:16:11.280
But in general, things that are highly reinforcing, our brain tends to adapt to them over time.

755
01:16:11.280 --> 01:16:15.840
And testosterone is another one people often talk about where, if you take external testosterone,

756
01:16:15.840 --> 01:16:20.000
consistently your brain will decrease the natural production of it. And as a result,

757
01:16:20.000 --> 01:16:25.600
natural testosterone shuts down and testicular size can shrink. But then if you stop the

758
01:16:25.600 --> 01:16:30.880
TRT, the external testosterone abruptly, your natural system might take a long time to recover.

759
01:16:30.880 --> 01:16:34.960
And in some cases, it may never fully recover back to baseline. I think this is just a really

760
01:16:34.960 --> 01:16:42.080
important principle for drugs, chemicals or messing with the natural balance of one's body.

761
01:16:42.080 --> 01:16:47.440
Yes, yes, exactly. And by the way, Nora Volkov and her team did a follow-up study

762
01:16:47.440 --> 01:16:54.800
in individuals who abstained from methamphetamine for 14 months and then rescan their brain

763
01:16:54.800 --> 01:16:58.640
and showed that they had restored healthy levels of dopamine transmission.

764
01:16:59.440 --> 01:17:03.600
It took 14 months in those individuals who had been very addicted to methamphetamine,

765
01:17:03.600 --> 01:17:08.640
which I think is also an important message here. You know, for individuals struggling with severe

766
01:17:08.640 --> 01:17:14.000
addiction, it's not like four weeks of abstinence is suddenly going to, you know, make your brain better.

767
01:17:14.000 --> 01:17:20.480
But what I have found in clinical care is that that's typically enough time to begin to see the

768
01:17:20.480 --> 01:17:27.600
light at the end of the tunnel. And that, indeed, there's enough restoration of sort of

769
01:17:27.600 --> 01:17:36.080
baseline levels of joy, your capacity to experience reward, that people can begin to have hope to

770
01:17:36.080 --> 01:17:40.800
get out of that state of craving. What is the most interesting, because you've been exposed

771
01:17:40.800 --> 01:17:46.880
to so much research on the subject of dopamine and human behavior, is there a particular study

772
01:17:46.880 --> 01:17:53.600
that always stands in your mind as being the most informative or interesting or surprising

773
01:17:54.080 --> 01:18:00.720
that you've encountered? A study that keeps coming back to me, there are a couple, I mean,

774
01:18:00.720 --> 01:18:07.520
there's so many, but... If me them. Okay, so if you put a rat in a cage with a rat trapped in

775
01:18:07.520 --> 01:18:14.880
a plastic bottle, that rat will, that rat will work very hard to free the trapped rat.

776
01:18:16.080 --> 01:18:25.840
But if you then allow that rat to administer, self-administer heroin, it will not work to free

777
01:18:25.920 --> 01:18:37.120
the trapped rat. To me, that's really powerful because it suggests how addictive substances

778
01:18:37.120 --> 01:18:49.040
like opioids, which heroin is, can you serve our desire for human connection and essentially become

779
01:18:49.040 --> 01:18:56.880
the object of attachment? And we often talk about loneliness and isolation as a risk factor for

780
01:18:56.880 --> 01:19:04.560
addiction, which it absolutely is, but the reverse is also true, that getting addicted will cause us

781
01:19:05.200 --> 01:19:14.320
to isolate and be lonely. We will stop caring about other people. So for me, that's a really

782
01:19:14.960 --> 01:19:21.680
a really powerful kind of experiment that I think does map on to human behavior.

783
01:19:22.240 --> 01:19:26.560
Something really interesting, this one, just a day-to-day level, in your head, I was trying to

784
01:19:26.560 --> 01:19:32.080
relate that to my own life and thinking. If I get really addicted to my screens and my devices,

785
01:19:32.080 --> 01:19:39.680
when my partner needs me, I might be so distracted and so connected to the thing that's giving me

786
01:19:39.680 --> 01:19:44.160
dopamine upstairs in my bedroom, like my laptop or whatever of my work, that I might completely

787
01:19:44.160 --> 01:19:48.960
miss her call for help. And I kind of, you know, I hate to say it, but sometimes I do feel like

788
01:19:50.240 --> 01:19:54.800
maybe that is, I've been a guilty of that. Yeah, yeah. I've been so

789
01:19:56.080 --> 01:20:02.880
dare I say the word addicted to my work with devices or whatever that, you know, sometimes I'm not

790
01:20:02.880 --> 01:20:08.880
present with meeting other people's needs. Absolutely. And you know, that certainly happened to me

791
01:20:08.880 --> 01:20:15.600
with my addiction to romance novels, right? I stopped paying as much attention to my kids and to

792
01:20:15.600 --> 01:20:23.040
my husband. We went on a vacation with another family at the beach and instead of joining folks

793
01:20:23.040 --> 01:20:28.160
on the beach, I stayed in the room and read romance novels. We went to a neighbor's party and I

794
01:20:28.160 --> 01:20:33.680
actually found a room in the house and read romance novels instead of socializing and didn't even

795
01:20:33.680 --> 01:20:39.600
think that was weird, even though that's obviously really strange. So it is this kind of coming to

796
01:20:39.600 --> 01:20:49.920
overvalue our drug of choice and undervalue other more meaningful good things in our lives.

797
01:20:50.720 --> 01:20:57.040
Could you theoretically say it's making the world less empathetic or less sympathetic or less

798
01:20:57.040 --> 01:21:03.280
what's the adjective of like of actually being there for other people? I guess connection and

799
01:21:03.280 --> 01:21:08.400
relationships it's it's it's hurting our ability to connect to others and be have empathy for them

800
01:21:08.400 --> 01:21:15.760
and be there for them because we're possessed by the thing giving us the most dopamine. Yeah, I would

801
01:21:15.760 --> 01:21:24.160
go even further and say not only is is it making us less empathetic, but it's actually making us

802
01:21:24.160 --> 01:21:31.360
sociopathic. In other words, when people are in their addiction, they can deviate from their

803
01:21:31.360 --> 01:21:39.520
moral compass because they so overvalue the struggle choice that they lose sight of their their own

804
01:21:39.520 --> 01:21:48.480
values. And we see this with kids who become addicted to video games or or social media. They

805
01:21:48.480 --> 01:21:55.680
stop participating in family life. They stop treating their parents with respect. They stop participating

806
01:21:55.680 --> 01:22:04.720
in household chores. They become essentially anti social. And when they get off of digital media

807
01:22:04.720 --> 01:22:10.000
and they go through that terrible withdrawal period, it all that gets worse and even they will

808
01:22:10.000 --> 01:22:16.480
endorse things like wanting to hurt their parents or wanting to hurt themselves. But if they can

809
01:22:16.480 --> 01:22:22.960
just go long enough and abstain from digital media, they will they will come out that the other

810
01:22:22.960 --> 01:22:29.040
side and parents will talk about getting their child back, you know, and getting back this person

811
01:22:29.040 --> 01:22:34.320
that that they recognize as their child. So I think this is really important when people are

812
01:22:34.320 --> 01:22:40.880
in their addiction, they can look very personality disorder, very narcissistic, very borderline,

813
01:22:41.680 --> 01:22:47.600
very sociopathic. And when they get into recovery, that's not who they are at all.

814
01:22:48.320 --> 01:22:53.600
And they can they can really become themselves again. I read about a really extreme

815
01:22:54.320 --> 01:23:02.560
case where that drug, I believe it's called Pramipoxel. Pramapaxel. Pramapaxel, which is a dopamine

816
01:23:02.560 --> 01:23:08.000
agonist. Yes. Which essentially means, I guess the molecule is the same shape as dopamine. So

817
01:23:08.000 --> 01:23:12.240
kind of the brain treats it like dopamine. Yes. And these people were given it for twitchy

818
01:23:12.240 --> 01:23:17.440
leg or something. Right. And then they like so many of them lost their minds, they became

819
01:23:18.560 --> 01:23:22.880
obsessed with like compulsive, impulsive behaviors. And I was reading about one particular lady,

820
01:23:22.880 --> 01:23:26.640
she would leave the house in the early hours of the morning when she was taking this drug, which kind

821
01:23:26.640 --> 01:23:33.200
of is the same as dopamine. And she would wear see-through tops. This was like a normal woman here,

822
01:23:33.200 --> 01:23:39.120
otherwise had a normal life and go to very dangerous places to try and have sex with strangers.

823
01:23:40.080 --> 01:23:46.480
And it was because she was her brain was full of this drug, which simulated dopamine. But there's

824
01:23:46.480 --> 01:23:51.280
so many examples. There was one from Australia, where a woman was taking this drug, which is like

825
01:23:51.280 --> 01:23:56.320
dopamine in terms of its molecular structure. And she would sit on these slot machines

826
01:23:56.960 --> 01:24:01.360
until she soiled herself and urinated on herself. She ended up losing her house, losing her car,

827
01:24:01.440 --> 01:24:05.200
losing her marriage, just because they'd given her this drug, which is the same as dopamine. And it

828
01:24:05.200 --> 01:24:10.960
made me realize that that dopamine isn't necessarily the the drug of reward, but more of like

829
01:24:12.800 --> 01:24:18.160
wanting an impulse and desire. Is that an accuracy assessment of it? Like it makes you

830
01:24:18.160 --> 01:24:21.200
desire things. And there was other examples when I was reading about it where people would

831
01:24:22.080 --> 01:24:32.880
a guy would take this drug and started engaging in homosexual sex acts, whereas otherwise he'd

832
01:24:32.880 --> 01:24:38.800
been in a heterosexual relationship. It was all very confusing, but it says something to me about

833
01:24:38.800 --> 01:24:44.160
what dopamine is actually doing. Yeah, I mean, I think when we're talking about

834
01:24:44.720 --> 01:24:53.440
addictive substances and behaviors, the initial response of the brain is to release a lot of

835
01:24:53.440 --> 01:25:01.520
dopamine all at once in the reward pathway. But with repeated use, dopamine, dopamine release gets

836
01:25:01.520 --> 01:25:08.160
weaker and shorter in duration. And eventually it leads to this dopamine deficit state. And that's

837
01:25:08.160 --> 01:25:15.680
often what we call wanting, but not liking. And George Coop is called this dysphoria driven relapse,

838
01:25:15.680 --> 01:25:22.720
where now they're using not to feel good, but just to stop feeling bad and feel normal.

839
01:25:23.360 --> 01:25:34.880
So in that sense, dopamine is part of pleasure. It's not its soul function,

840
01:25:35.520 --> 01:25:41.360
but when it comes to addictive substances and behaviors, the initial encounter has to feel good

841
01:25:41.360 --> 01:25:47.760
or be reinforcing or get someone out of pain, right? It has to solve that problem. But again,

842
01:25:47.760 --> 01:25:55.040
the issue is that with repeated use, it stops doing that, but there's still that motivation to reuse

843
01:25:55.040 --> 01:26:00.880
again and again. And when we're thinking about like exogenous or external sources of just giving

844
01:26:00.880 --> 01:26:07.840
someone dopamine, that's not going to work to treat that dopamine deficit state because it's

845
01:26:07.840 --> 01:26:14.480
going to bind indiscriminately to dopamine receptors throughout the brain. And the brain will respond

846
01:26:14.480 --> 01:26:21.440
with that same process of neuroadaptation where it's down regulating dopamine receptors, which is

847
01:26:21.440 --> 01:26:29.360
again, what is setting us up for this repeated addictive pattern. Is there any other studies that

848
01:26:29.360 --> 01:26:34.640
were shocking to you and that have always stayed with you? Another really interesting study

849
01:26:34.640 --> 01:26:41.600
is if you expose a rat to a single injection of cocaine and then slice open its brain, you'll see

850
01:26:41.600 --> 01:26:46.800
this arborization of dopamine releasing neurons in the reward pathway. So that means a proliferation

851
01:26:47.440 --> 01:26:53.280
of neurons that release dopamine, a kind of growth of the dopamine forest, so to speak.

852
01:26:53.840 --> 01:26:58.720
But by the way, you'll see that same arborization or growth of dopamine releasing neurons.

853
01:26:58.720 --> 01:27:05.200
If you put a rat in a complex maze, right, which is to say a maze where they can explore and find

854
01:27:05.200 --> 01:27:10.960
different things, I'm going to have challenges. If you then cut that rat's brain open, you'll see

855
01:27:10.960 --> 01:27:17.360
that same arborization of dopamine. So in other words, learning is highly rewarding and dopamine is

856
01:27:17.360 --> 01:27:24.480
released in response to novelty and new things and new challenges. But if you then take that rat and

857
01:27:24.480 --> 01:27:30.640
pre-treat it with methamphetamine and put it in the maze and then look at its brain, you don't see

858
01:27:30.640 --> 01:27:38.400
any additional arborization beyond what you got with methamphetamine. And the interpretation there

859
01:27:38.400 --> 01:27:49.040
is that drugs actually may usurp or steal our ability to learn, right, because they've again

860
01:27:49.120 --> 01:27:55.760
this idea of sort of they've taken over. It's such a powerful dominant stimulus that there's no

861
01:27:55.760 --> 01:28:01.520
additional growth or neuroplasticity in response to something like learning a maze.

862
01:28:02.320 --> 01:28:07.680
And does that mean that when that rat was in the maze the first time and its brain was full of

863
01:28:07.680 --> 01:28:11.440
dopamine? Dopamine was therefore playing a role in helping it to learn.

864
01:28:12.320 --> 01:28:21.040
No, so the learning itself actually caused proliferation. So dopamine is responsive not just to

865
01:28:21.040 --> 01:28:26.560
rewards, not just to pleasurable things, but it's actually responsive to pain, it's responsive

866
01:28:26.560 --> 01:28:34.160
to novelty. So it's responsive to any emotionally powerful experience. So when you put a rat in a

867
01:28:34.160 --> 01:28:42.720
maze and it explores that maze that's an enriching exciting experience for the rat because we are

868
01:28:43.600 --> 01:28:50.880
creatures who are evolved to seek and explore and learn new territory and then move on and do

869
01:28:50.880 --> 01:28:57.280
the same thing. Ah so you could say then that if I'm taking an addictive substance like cocaine

870
01:28:57.360 --> 01:29:04.080
I'm going to be much less likely to go out and explore the world. Yes exactly. Or if you do explore

871
01:29:04.080 --> 01:29:13.040
the world your capacity to be rewarded by that experience will decrease or will not be there.

872
01:29:13.040 --> 01:29:17.920
So I'm less likely to do it then. Right, yes. Yeah. I mean this highlights a bit more

873
01:29:17.920 --> 01:29:21.680
fundamental link around like motivation. Like if you're addicted to something, if you're addicted

874
01:29:21.680 --> 01:29:26.000
to pornography, your ability to like get up and go out and get a job might be diminished.

875
01:29:26.960 --> 01:29:31.360
Absolutely. I mean what happens with addiction is that we have a narrowing of our focus

876
01:29:31.360 --> 01:29:36.640
on our drug of choice such that that's the only thing that's reinforcing for us and other

877
01:29:36.640 --> 01:29:42.480
things lose their rewarding potential and eventually they fall away altogether and we're spending

878
01:29:42.480 --> 01:29:47.520
all of our time getting our drug, using our drug, trying to get more as we come down.

879
01:29:47.520 --> 01:29:51.440
Can I talk about another experiment? I think it's interesting. Another really interesting

880
01:29:51.440 --> 01:29:57.200
experiment is the Rat Park experiment and this is the work of Bruce Alexander and he essentially

881
01:29:57.200 --> 01:30:03.120
said well if you put a rat in a cage with nothing else to do but press a lever for cocaine,

882
01:30:03.120 --> 01:30:05.760
of course that's what they're going to do because there's nothing else happening.

883
01:30:06.320 --> 01:30:12.800
But what if you put a rat in a very enriched environment with a lever to press cocaine but also

884
01:30:12.800 --> 01:30:20.560
lots of other things to do. Other rats, shoots and mazes, little sawdust balls,

885
01:30:21.280 --> 01:30:29.040
what he discovered was that the rat is much less likely to press that lever as often because it has

886
01:30:29.040 --> 01:30:37.040
other reinforcing things to do and I think that that was really groundbreaking in the sense that

887
01:30:37.520 --> 01:30:44.640
it is true that addictive substances and behaviors work on the brain in this very predictable way

888
01:30:44.640 --> 01:30:50.560
that's so reinforcing that even if you have a great life you can get addicted but it's also true

889
01:30:51.200 --> 01:30:58.560
that our environment really matters and if we're living in an impoverished environment like that

890
01:30:58.560 --> 01:31:05.120
single rat in a cage with nothing else to do we're much more likely to get addicted than if we live

891
01:31:05.120 --> 01:31:11.440
in this really enriched environment where we have lots of other sources of reward,

892
01:31:11.440 --> 01:31:17.680
lots of other sources of dopamine and based on that work there was something then called

893
01:31:17.680 --> 01:31:23.680
the Icelandic experiment and this is quite some years ago now but Iceland had a significant

894
01:31:23.680 --> 01:31:30.640
youth drug problem and the way that they decided to intervene was to build a lot of gymnasiums

895
01:31:30.720 --> 01:31:39.280
and emphasize youth sports and as we've talked about exercise and sports are a healthy way in general

896
01:31:39.280 --> 01:31:43.840
if you don't overdo it to get dopamine because you're paying for it upfront right you're working for

897
01:31:43.840 --> 01:31:53.440
it and Iceland saw a significant reduction in their youth drug use problem after the implementation

898
01:31:54.160 --> 01:32:02.880
of this youth sport system so I think that's a nice example of how an animal model can actually

899
01:32:02.880 --> 01:32:08.880
provide some kind of fundamental frame to understand what's happening in the brain that can be

900
01:32:08.880 --> 01:32:17.920
then translated to a real world implementation. Radical honesty. Okay so radical honesty is something

901
01:32:18.080 --> 01:32:24.080
that I learned about from my patients and it was the observation that my patients who were

902
01:32:24.080 --> 01:32:33.760
able to get into sustained recovery from severe addictions had learned that they couldn't lie

903
01:32:35.280 --> 01:32:41.760
and it wasn't just that they couldn't lie about their drug use they couldn't lie about anything

904
01:32:41.760 --> 01:32:46.720
so they couldn't lie about why they were five minutes late for a meeting they couldn't lie about

905
01:32:46.720 --> 01:32:52.320
why they couldn't go to a party they had to tell the truth in all things large and small

906
01:32:53.760 --> 01:32:59.680
and to me that was fascinating and it was an idea that I started to play with an experiment with

907
01:32:59.680 --> 01:33:06.000
in my own life and I realized that telling the truth is actually really hard because we're all

908
01:33:06.000 --> 01:33:12.640
prone to little lies to kind of cover up our shortcomings you know these are things that we

909
01:33:12.640 --> 01:33:18.240
hardly even notice they're also like lies of exaggeration to make ourselves more interesting

910
01:33:18.960 --> 01:33:23.040
lies of flattery where we tell other people how great they are even though we don't necessarily

911
01:33:23.040 --> 01:33:30.480
believe that so all these little lies that we tell I think even if you're not struggling with

912
01:33:30.480 --> 01:33:38.400
addiction these lies can erode our lives make our lives more impoverished and I think you know

913
01:33:38.400 --> 01:33:45.280
it's working through many different mechanisms so the question then becomes why is truth telling

914
01:33:45.280 --> 01:33:52.240
or radical honesty protective and I think it's working across many different levels but one of the

915
01:33:53.360 --> 01:34:00.640
important levels that it's working across is simple awareness because when we're lying to

916
01:34:00.640 --> 01:34:09.440
other people we're also actually lying to ourselves and when we're lying to ourselves we actually

917
01:34:09.440 --> 01:34:15.440
don't know what we're doing right and when it comes to our consumptive behaviors on the one hand

918
01:34:15.440 --> 01:34:22.000
you know I may know that I'm watching too many videos on the same time really not know that I'm

919
01:34:22.000 --> 01:34:30.160
doing that right so but when I tell another human being exactly what I'm consuming how much and how

920
01:34:30.160 --> 01:34:35.920
often that it becomes real to me in a way that it's not when it's sort of pinging around in the dark

921
01:34:35.920 --> 01:34:42.800
recesses of my my own mind so that awareness is really important because we can't change our behaviors

922
01:34:42.800 --> 01:34:50.480
unless we're aware of what we're doing the other aspect of that that's really important that I've

923
01:34:50.480 --> 01:34:57.280
learned over many years of being a psychiatrist is that the way that people tell their autobiographical

924
01:34:57.280 --> 01:35:03.760
narrative is really important and that there are healthy ways we can tell our stories and also

925
01:35:03.760 --> 01:35:12.400
not so healthy ways and what I've observed is that when when people are telling stories in which

926
01:35:12.400 --> 01:35:18.240
they're always the victim of other people or circumstance I know pretty well that they're not

927
01:35:18.240 --> 01:35:25.920
going to get into recovery but if they start telling a story that acknowledges their own contribution

928
01:35:25.920 --> 01:35:31.520
to their problem whatever it is including the problem of addiction then I'm pretty confident

929
01:35:31.520 --> 01:35:37.760
that we're headed in a good direction and that's really interesting because what it means is that

930
01:35:38.320 --> 01:35:45.120
our autobiographical narratives provide a template for our lives they're not just a way to

931
01:35:45.120 --> 01:35:51.360
organize past experience they actually provide a roadmap for the future and if we're telling

932
01:35:51.440 --> 01:35:59.120
self-stories that are a more accurate representation of what's actually happening in our lives

933
01:35:59.760 --> 01:36:05.840
we will have more information from which to make better decisions going forward so victim that

934
01:36:05.840 --> 01:36:12.560
keeps you stuck it keeps you stuck because it decreases your awareness of what is actually happening

935
01:36:14.720 --> 01:36:20.800
and it is our awareness of what is actually happening that allows us to have the data we need

936
01:36:20.800 --> 01:36:26.960
to make better informed decisions does it also into some level rob you of responsibility absolutely

937
01:36:26.960 --> 01:36:34.560
because although addiction is characterized by a loss of agency around our consumptive behaviors

938
01:36:34.560 --> 01:36:41.200
we still have some degree of agency always even if it's only enough to reach out and ask for help

939
01:36:41.840 --> 01:36:48.560
and as people get into sustained recovery they have a lot more agency right as they get out of

940
01:36:48.560 --> 01:36:55.840
that vortex of addiction and it is that agency that that we must employ to make the next best

941
01:36:55.840 --> 01:37:02.960
decision so that our lives will be this accumulation of small good decisions that then lead to good

942
01:37:02.960 --> 01:37:08.880
weeks and good months and good years I think that point is so important this idea of agency which

943
01:37:08.880 --> 01:37:13.760
essentially means like having control in my life feeling like I have a sense of control in my life

944
01:37:13.760 --> 01:37:20.400
is that like a definition of agency how would you define it I wouldn't define it so much as control

945
01:37:20.400 --> 01:37:26.880
because there are so many things that happen in our lives that are out of our control but when we

946
01:37:26.880 --> 01:37:34.720
reduce our decision down to today you know and what I can do today the things that I actually

947
01:37:34.720 --> 01:37:41.680
can control today then yes recapturing our agency around the things that we actually have control

948
01:37:41.680 --> 01:37:47.520
over is really really is really important for recovery definition I've pulled up here is agency

949
01:37:47.520 --> 01:37:53.360
means the capacity to act intentionally and make choices that influence outcomes and it does tend

950
01:37:53.360 --> 01:37:57.680
to be the case from my observations that people that have a high degree of agency i.e. they believe

951
01:37:57.680 --> 01:38:03.040
they have capacity to act intentionally and make choices that influence their outcomes seem

952
01:38:03.040 --> 01:38:08.640
to be the most successful and on average seem to be a little bit more happy I think that sense of

953
01:38:08.640 --> 01:38:16.080
competence and an agency is definitely one that makes us feel good the danger a little bit

954
01:38:16.080 --> 01:38:23.120
when we're dealing with severe addiction is that in our addictions we often tell ourselves that we

955
01:38:23.120 --> 01:38:29.920
have agency and control when we really don't and so that can be part in personal of denial which

956
01:38:29.920 --> 01:38:37.200
means that getting into recovery is often about admitting that we may have agency in many aspects of

957
01:38:37.200 --> 01:38:41.760
our lives but when it comes to our addictive behavior we've lost some degree of agency

958
01:38:41.760 --> 01:38:45.680
and that's part of the 12-step program right yeah that is a really important part of the 12-step

959
01:38:45.680 --> 01:38:53.840
program is that admitting that our lives have become unmanageable when it comes to our drug of choice

960
01:38:53.840 --> 01:38:59.280
the 12-step program being our colleagues anonymous very famous program to to help you through an

961
01:38:59.280 --> 01:39:03.040
addiction is there anything else we should have talked about that we haven't you know when it comes

962
01:39:03.040 --> 01:39:13.040
to New Year's resolutions and wanting to change habits sometimes these sort of all or nothing

963
01:39:13.040 --> 01:39:21.760
thinking can be something that's not helpful for people right this idea that okay I'm going

964
01:39:21.760 --> 01:39:26.320
to abstain from this and I'm going to go a month and you know I'm going to do it and then they

965
01:39:26.320 --> 01:39:30.960
find that they're not able to do it and there's then there's a lot of shame and self-recrimination

966
01:39:31.680 --> 01:39:38.720
so you know that that approach is is not for everybody and for some a better approach is sort of

967
01:39:38.720 --> 01:39:44.800
self-compassion and a goal of moderation yeah moderation is an interesting one because most of us

968
01:39:44.800 --> 01:39:48.080
will just be like I'm going to get into the gym every day I'm going to have no sugar every

969
01:39:48.080 --> 01:39:53.200
again or no I'm going to abstain from alcohol completely but maybe moderation for some of these

970
01:39:53.200 --> 01:39:58.560
things is more realistic and therefore more effective and important yeah and we find that moderation

971
01:39:58.560 --> 01:40:03.840
typically is more successful if period if people have abstained for long enough to kind of reset

972
01:40:03.840 --> 01:40:12.080
reward pathways but you know even just reducing use can be a lot of a goal we have a closing

973
01:40:12.080 --> 01:40:15.440
institution on this podcast where the last guest leaves a question for the next guest not

974
01:40:15.440 --> 01:40:19.360
knowing who they're leaving it for the question is what's the one thing the universe keeps putting

975
01:40:19.440 --> 01:40:29.200
in front of you and what is the thing that it keeps you learning um so right now in my life the

976
01:40:29.200 --> 01:40:36.320
thing that the universe keeps putting in front of me is the importance of letting my kids go

977
01:40:37.120 --> 01:40:46.240
and have their own life experience um rather than trying to cling to the relationships

978
01:40:46.240 --> 01:40:54.000
that we had before as they were growing up of which for me was a really joyful time but I'm

979
01:40:54.000 --> 01:41:02.320
recognizing that they need to be in the world on their own and I need to figure out what I'm going

980
01:41:02.320 --> 01:41:08.160
to do as an empty nester so that's not that deep but that is what I'm struggling with right now

981
01:41:08.880 --> 01:41:20.480
and how's that struggle manifesting well I mean if I'm being totally honest um social media

982
01:41:20.480 --> 01:41:27.200
and digital media and those commutes modes of communication have probably made this worse for me

983
01:41:28.000 --> 01:41:35.280
because for example of a fine my iPhone I keep checking where my kids are and thinking that in a way

984
01:41:36.240 --> 01:41:42.080
um were connected because I know where they are but we're not and also they don't particularly

985
01:41:42.080 --> 01:41:46.880
like it that I'm checking where they are so there's this kind of weird phenomenon of

986
01:41:48.000 --> 01:41:56.640
wanting connection and through text and other technology trying to recreate that connection and

987
01:41:56.640 --> 01:42:02.480
yet in some ways I think I might be better off and they might be better off if we didn't actually

988
01:42:02.480 --> 01:42:09.760
text and I didn't actually track where they are does that make sense it does and I think I was

989
01:42:09.760 --> 01:42:13.920
laughing because I just had this picture of you sat there with like one screen is tracking them

990
01:42:13.920 --> 01:42:18.240
and the other one is like watching the pimples being popped yes those are comparable right these

991
01:42:18.240 --> 01:42:25.520
these are both sort of related to sort of habits or behaviors that are self-suasing but ultimately

992
01:42:25.600 --> 01:42:32.000
not not good for me and you know not good for other people do you think much about how other

993
01:42:32.000 --> 01:42:39.600
behaviors that we take part in like sleep um and meditation um and on nutrition have a big

994
01:42:39.600 --> 01:42:45.440
impact on our ability to kick the bad habit to start a new one oh absolutely um there's a great

995
01:42:45.440 --> 01:42:51.200
acronym from alcoholics anonymous called halt hungry angry lonely tired you know when we're

996
01:42:51.200 --> 01:42:58.160
feeling those things we're more likely to crave our drug of choice I'm so importantly we've really

997
01:42:58.160 --> 01:43:02.800
got to make sure we take care of ourselves physically and emotionally so that we're as well as we can

998
01:43:02.800 --> 01:43:10.560
be so that we don't get into that state of wanting to escape or self-su or numb ourselves and by

999
01:43:10.560 --> 01:43:15.520
the way that's true in the work that we do as mental health care providers right we have to really

1000
01:43:15.520 --> 01:43:21.760
come to patients or clients with our needs met um are cup full so that we can be fully present

1001
01:43:22.320 --> 01:43:29.440
for for our patients doctor Anna Lemke thank you so much for coming back on the show it was

1002
01:43:29.440 --> 01:43:33.920
incredible the conversation we had last time it was so unbelievably well received um it's done

1003
01:43:33.920 --> 01:43:38.400
probably closer to 10 million views across all platforms now um five just over five million

1004
01:43:38.400 --> 01:43:42.960
views on youtube alone and I can't begin to imagine all the people that you've had a profound

1005
01:43:42.960 --> 01:43:49.200
impact on by making these complicated things accessible and I know we we simplify this to a point

1006
01:43:49.200 --> 01:43:55.040
that it might be quite difficult for because I know the science is much more complicated but just

1007
01:43:55.040 --> 01:43:59.760
having a simple mental moral for me is it's helped me so much since we last spoke understand what's

1008
01:43:59.760 --> 01:44:04.480
going on inside my body and inside my brain in a simplified way and that's exactly what was

1009
01:44:04.480 --> 01:44:08.960
reflected by the millions of people that watch last time your book is the the book to read and

1010
01:44:08.960 --> 01:44:13.360
your workbook as well as a critical critical to read alongside it um on this subjective people

1011
01:44:13.360 --> 01:44:17.520
want to learn more and get an even deeper understanding of everything we've talked about today

1012
01:44:17.520 --> 01:44:22.240
and also if they're struggling with addictions because these books books provide a really

1013
01:44:23.200 --> 01:44:31.840
I'd say nuanced um empathetic and shame avoiding set of ideas and solutions to some of the things

1014
01:44:31.840 --> 01:44:37.120
that hold us hostage in our lives whether it's opioids or technology or other behaviors that we

1015
01:44:37.120 --> 01:44:41.280
know at some level are getting in the way of what we'd rather be doing and who we'd rather become

1016
01:44:41.280 --> 01:44:44.480
so thank you so much for your work it's such an important work and I know you're working on another book

1017
01:44:44.480 --> 01:44:48.160
which we didn't talk about this time but when that book does come out I'd love to have you back

1018
01:44:48.160 --> 01:44:52.160
on to talk about all the things in that because I have a little birdie told me the subject matter

1019
01:44:52.160 --> 01:44:55.360
and it's absolutely fascinating so I'm so excited thank you so much

1020
01:44:59.360 --> 01:45:04.160
this is something that I've made for you I've realised that the Diavisio audience are strivers

1021
01:45:04.160 --> 01:45:08.560
whether it's in business or health we all have big goals that we want to accomplish and one of

1022
01:45:08.560 --> 01:45:14.960
the things I've learnt is that when you aim at the big big big goal it can feel incredibly

1023
01:45:14.960 --> 01:45:19.200
psychologically uncomfortable because it's kind of like being stood at the foot of Mount Everest

1024
01:45:19.200 --> 01:45:24.880
and looking upwards the way to accomplish your goals is by breaking them down into tiny small

1025
01:45:24.880 --> 01:45:30.240
steps and we call this an R team the 1% and actually this philosophy is highly responsible for

1026
01:45:30.240 --> 01:45:35.440
much of our success here so what we've done so that you at home can accomplish any big goal that

1027
01:45:35.440 --> 01:45:41.600
you have is we've made these 1% Diaries and we've released these last year and they all sold out

1028
01:45:41.600 --> 01:45:45.680
so I asked my team over and over again to bring the Diaries back but also to introduce some new

1029
01:45:45.680 --> 01:45:52.800
colours and to make some minor tweaks to the Diaries so now we have a better range for you so

1030
01:45:52.800 --> 01:45:57.440
if you have a big goal in mind and you need a framework and a process and some motivation

1031
01:45:57.440 --> 01:46:02.160
that I highly recommend you get one of these Diaries before they all sell out once again

1032
01:46:02.160 --> 01:46:07.360
and you can get yours now at the diary.com where you can get 20% off our Black Friday bundle

1033
01:46:07.360 --> 01:46:09.200
and if you want the link the link is in the description below