Episode 33 – Dr. Anna Lembke: Understanding & Treating Addiction | Huberman Lab

Key Takeaways

  • Dopamine is not only associated with reward and pleasure but also triggers action
  • A dopamine spike is associated with a subsequent dopamine deficit where levels fall below baseline – this is the moment you chase more or ride out the tough part
  • Pleasure and pain work like a balance in the brain where one is only increased by reducing the other
  • The initial entry point into drugs is often a desire to escape pain, not an attempt to seek pleasure
  • You can be addicted to anything
  • Once you become addicted to something you are more vulnerable to addiction to other things
  • To reset the dopamine system and break addictive patterns: go 30 days without interaction with a drug, person, alcohol, social media, gambling, etc.
  • “The first message I want to get across about social media is it really is a drug. And it’s intended to be a drug.” – Dr. Anna Lembke
  • Our collective mission should be to make sure we’re finding ways to connect with others offline

Introduction

Anna Lembke, MD, a psychiatrist, assistant professor, and Chief of Addiction Medicine at Stanford University School of Medicine in California. She has published more than 50 peer-reviewed articles, chapters, and commentaries, and is the author of Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.

In this episode of Huberman Lab, Dr. Huberman sits down with Dr. Anna Lembke to discuss the biology and psychology of why addiction (drug and non-drug) happens, the role of dopamine in addiction, how to overcome addiction, and the science behind relapse.

Host: Andrew Huberman (@hubermanlab)

Dullness Of Modern Life

  • Life today is more boring in many ways – our survival needs are met; we don’t even have to leave our home to have every single need met
  • Even the poorest have more excess leisure time than ever before
  • “Life today is hard in this weird way that we don’t really have anything that we have to do (for our survival) so we’re all forced to make things up.” – Dr. Anna Lembke
  • The easiness of our ability to survive today can be challenging for people who need friction and lead to addiction
  • Boredom is a necessary experience but highly anxiety-provoking
  • “Stop looking for your passion and instead look around where you are. Stop distracting yourself and see what needs to be done – not what I want to do, what needs to be done.” – Dr. Anna Lembke
  • There’s a burden in finding the perfect thing for you and imaging the key will fit perfectly in the lock
  • Build a life around what you can do at the moment and what opportunities are available to you right now to benefit yourself and others

Dopamine

  • Neurotransmitters bridge the gap between two molecules and allow for communication
  • Examples of neurotransmitters: dopamine, serotonin
  • Dopamine is associated with reward, pleasure, and movement – it triggers action
  • Dopamine is always being released in varying levels
  • If we expose regularly expose ourselves to things that trigger high levels of dopamine release, we will actually lower our baseline levels of dopamine over time
  • Experiences have an impact on where baseline dopamine level settles

Impulsivity

  • People with naturally impulsive tendencies are more vulnerable to addiction
  • Impulsivity: difficulty putting space between desire and action and withholding behavior
  • Impulsivity is not always bad – there isn’t self-editing or worrying about future consequences which can come into use in fight or flight scenarios
  • We live in a sensory-rich environment and have to constantly check ourselves

Pleasure-Pain Balance

  • There are two sides to pleasure: (1) seeking out high, euphoria – and (2) seeking experiences that dull or avoid pain
  • Oftentimes initial entry point into drug use is a desire to escape pain, not seeking pleasure
  • Pleasure and pain are co-located in the brain and work like a balance, tipping inversely
  • The brain works hard to keep pleasure and pain in constant balance and neutrality
  • We are not always aware of the pain until we begin to pay attention at the moment
    • Example: you gain traction on social media and can’t stop spending time on it because if you disengage you will have pain in missing that feeling of reinforcement
  • Pleasure is reduced by way of increasing pain
  • Pain mechanism has some competitive advantages over pleasure
  • After you do something pleasurable, the brain immediately compensates by downregulating dopamine
  • If you wait long enough after high, the brain will go back to its neutral state – but – if you don’t wait because the crash is too rough, you are resetting the brain to a dopamine deficit state
  • You want a resilient, adaptive balance where you don’t allow yourself to stay in pleasure or pain too long

Addiction

  • We really live in a time where we’re invited to become addicted to something – social media, email, checking our phone, etc.
  • The hallmark of any addictive behavior is that it releases dopamine at high levels
  • Addiction is a progressive narrowing of the things that bring you pleasure
  • The addictive process is the same, regardless of whether you’re addicted to gambling, drugs, sex, etc.
  • Once you’ve become addicted to anything, you’re more vulnerable to addiction to anything
  • People with severe addiction suffer from a lack of homeostasis in the pleasure-pain balance
  • Addiction is like having an itch and being told you can’t scratch it – it’s always there and maybe you’ll scratch it in your sleep because an unconscious opportunity
  • Addicts really cannot, not do it
  • We all have a propensity for addiction but some channel it into things that are more socially acceptable, like work or success

Recovery & Shame

  • Focus on just doing today right
  • Connect with your environment, not trying to escape it
  • To reset the dopamine system and break an addictive pattern: Do 30 days of zero interaction with drug, person, alcohol, gambling, etc.
    • Days 1-10 will be very uncomfortable – you will feel worse before you feel better
    • By week 2 the sun will come out
    • By weeks 3 and 4 you will feel better than before you started the addiction
  • The carrot is there’s a better life out there
  • Addicts want to discuss recovery: oxytocin is linked to dopamine release so when human connection is made, it’s stimulating
  • Telling the truth about details of life is central to recovery
  • Recovery isn’t just not lying about using drugs, it’s becoming transparent about everything
  • The act of righting past wrongdoings is cathartic – asking forgiveness is important in the twelve steps
  • Truth-telling strengthens circuits in the pre-frontal cortex and enhances connections to the limbic brain and reward brain
  • Being open and honest creates intimate connections which stimulate dopamine release

Relapse

  • Sometimes relapse occurs when things are going really well for the person because there’s a removal of the hypervigilant state
  • There are people who will die of disease of addiction
  • There are physiologic changes that will occur with sustained drug use
  • Thinking about triggers associated with drug use or drug use can already release anticipatory dopamine
  • The dopamine spike is associated with dopamine deficit where dopamine falls below baseline
  • Dopamine deficit state drives action to get drug
  • Another way to frame understanding addiction, recovery, relapse: think about the thing you love doing most in life – and imagine you couldn’t do it

Psychedelics

  • Condensed psychoanalysis + MDMA or drug which allows a person to get out of own head and look at life in a broader sweep
  • Dr. Lembke is skeptical about the longevity of psychedelic therapy long term for addiction recovery
  • Please be sure to see a legitimate guided psychedelic experience and don’t DIY

Social Media

  • “The first message I want to get across about social media is it really is a drug. And it’s intended to be a drug.” – Dr. Anna Lembke
  • Use social media with intention and with planning so you don’t get sucked in
  • No one who is getting addicted thinks they’re addicted
  • Things we’ve learned from other drugs also applies to social media: put barriers in place that allow you to remain in control of the use
  • Tip: try even a single day without your phone
  • The collective mission should be to make sure we’re preserving offline ways to connect
  • We’re losing the ability to have a sustained thought because we can just look anything up immediately
  • Social media is fueling a preoccupation with ourselves & success – we’re getting feedback all the time about ourselves
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Notes By Maryann

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