#1708 – Anna Lembke | Joe Rogan Experience

Key Takeaways

  • Pleasure and pain are co-located in the brain and work as a balance, working in equal and opposite ways
  • After you achieve a high, your brain resets to a dopamine deficit where your dopamine level is actually below baseline
  • You can leverage pain to keep the dopamine system in check: participate in effortful activity daily – this can be a creatively stimulating task, physically challenging exercise, etc.
  • Definition of addiction: continued compulsive use of substance or behavior despite harm to self or others
  • Elements of addiction: nature, nurture, environment
  • Diagnosis of addiction is based on behaviors and control, compulsion, craving, and consequence to self and others
  • Modern life has evolved around a reward system – and it has a negative impact on the way we perceive time and takes away from our ability to be present in the moment
  • “Technology has changed the world such that we are chronically ingesting and engaging in these highly reinforcing drugs and behaviors which have engendered a dopamine deficit state, making us all more anxious and depressed.” – Dr. Anna Lembke

Introduction

Anna Lembke, MD is 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.

Joe Rogan and Dr. Lembke take a deep dive into all things addiction, pleasure, and pain.  

Host: Joe Rogan (@joerogan)

Pleasure-Pain Scale

  • Pleasure and pain are co-located in the brain and work as a balance, tipping inversely
  • The thing we initially get pleasure from will ultimately put us in a dopamine deficit state so we take more to keep chasing the high (or feeling)
  • There are two sides to pleasure: (1) seeking out high, euphoria – and (2) seeking experiences that dull or avoid pain
  • 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, below baseline
  • Every time there’s a big surge of dopamine, you will pay with the equal and opposite response to pain
  • People newly trying to get clean tend to relapse because they are living with a tilt towards the pain side of the scale
  • Leveraging pain: participating in difficult, full effort tasks every day can keep the pleasure-pain balance in check
  • People have different innate pain thresholds

Defining & Understanding Addiction

  • Definition of addiction: continued compulsive use of substance or behavior despite harm to self or others
  • We don’t usually see addiction off the bat – it often takes hitting some sort of consequence or bottom
  • Disease model of addiction: chronic, relapsing problem with varying degrees of vulnerability
  • Addiction risk can be summarized as nature, nurture, neighborhood
  • Nature increased risk factors: co-occurring mental illness, obsessive personality
  • Nurture increased risk factors: growing up in a traumatic environment, caretakers use drugs or alcohol or addictive substances for coping
  • Neighborhood increased risk factors: if you live in an environment with greater access, you are more likely to try
  • We are evolutionarily wired to seek pleasure and avoid pain: hunting provided a rush so we could survive and do it again the next day
  • “Our primitive brains are completely mismatched for our modern ecosystem which is an ecosystem of overabundance.” – Dr. Anna Lembke

Traits Of Addiction

  • Diagnosis of addiction is based on behaviors and based on 4 C’s: control, compulsion, craving, consequence (to self and others)
  • Addiction isn’t about how often you use or how much you use, it’s about whether you use even though the drug has impacted relationships, health, or any important aspect of life
  • Our society rewards certain types of addictions and not others – we reward workaholics, obsessive athletes
  • The same mechanism is in place whether it’s beneficial (e.g., professional athlete) or detrimental (e.g., drug user)
  • We celebrate extreme athletes who are obsessed with their performance and everything that goes into it
  • What we don’t often hear about is what happens when the athlete or high performer stop
  • Part of what drives addiction is people want to control what they feel and when they feel it
  • People with addiction are some of the most tenacious people – if that can be directed in a healthier way, the traits will lend themselves; you often see former addicts turn to endurance sports

Rewards & Living In The Moment

  • We often tie our happiness to hard work, a milestone, an achievement
  • Modern life has evolved around a reward system – and it has a negative impact on the way we perceive time and takes away from our ability to be present in the moment
  • Example: run 5 miles to eat ice cream
  • There’s a benefit in letting our experience unfold with uncertainty and embracing the feeling
  • Living in the moment means tolerating the stress of being in the moment and not waiting for the reward
  • Exposure to do difficult, effortful things can build resilience and confidence

Effect Of Modern Life On Dopamine & Addiction

  • Not being in an enriched environment can lead to addiction
  • 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
  • A central problem today is technology, making us all more vulnerable to addiction
  • We have access to so many highly reinforcing drugs and behaviors
  • “Technology has changed the world such that we are chronically ingesting and engaging in these highly reinforcing drugs and behaviors which have engendered a dopamine deficit state, making us all more anxious and depressed.” – Dr. Anna Lembke
  • We’re all overstimulated and there’s an argument for dialing it back

Steps To Reset Dopamine Pathway

  • Note: the addiction spectrum is wide, if you are facing more serious addiction or depression this method may not be the way to go
  • To reset the dopamine system and break an addictive pattern: 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
  • Dopamine acronym for action steps:
    • D – data: gather specific information about how much you’re using and what you’re using
    • O – objective: why are you using what you’re using
    • P – problems: what are the negative, unintended consequences
    • A – abstinence: 30 days without addiction
    • M – mindfulness: meditation or prayer – there’s a theory that a part of the brain specifically evolved for spiritual practice related to transcendence  
    • I – insight
    • N – next steps
    • E – experiment
  • Reconnect with nature and experience nature

Recovery

  • Addiction is a unique disease – it’s hard to predict who will get better and who won’t
  • Treating the addiction is the important first step – there will be time to reflect on the underpinnings and how you got there later
  • Often, those who frame their story with a lens of blaming others will have a more difficult road to recovery

Ibogaine & Psychedelics

  • Generally speaking, drugs used to help addiction have not had great success in treating the disease (i.e., leading to recovery)
  • Microdosing can be a slippery slope for addicts or those with addictive traits because even when the trip is bad, it’s still taking you to an altered state
  • Ibogaine is being studied for the treatment of addiction (MAPS information)
  • Ibogaine is not a popular recreational drug because it can last 24 hours and there’s really no running away from the elements that make you turn inward and self-explore
  • Drugs can be used in a safe way that won’t lead to addiction: when drugs are used in a ritualized way, there’s a place for it

Self-Worth

  • A healthy sense of self-worth is valuable
  • Our current society is breeding an unhealthy narcissism that is separating us from our tribes and making us lose connection with our authentic self
  • Narcissism is dangerous because the harm is often to others, not oneself – and the narcissist is unlikely to seek treatment
  • For the narcissist, the treatment is breaking down of ego
Joe Rogan Experience : , , , ,
Notes By Maryann

More Notes on these topics

Top Insights and Tactics From

31 Best Podcasts of All Time

FREE when you join over 12,000 subscribers to the
Podcast Notes newsletter

No Thanks