Vollständiges Transkript von „Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Doing To Your Brain!“. Klicke auf einen Zeitstempel, um das Video an dieser Stelle zu öffnen. Du brauchst ein anderes Video? Nutze den YouTube-Transkript-Generator.
0:00 there's a very famous experiment in which rats were engineered to have no dopamine and the scientists discovered that if they put food in the rat's mouth the rat would eat but if you put the food even a body length away the rat will starve to death which tells us that dopamine is fundamental to get the things that we need for our basic survival now every time we're doing something that's pleasurable from sugar to video games work pornography social media that will affect dopamine and the more dopamine that's released the more likely that drug or behavior is to be addictive but also the genetic risk of addiction is about 50 to 60% so if you have a biological parent or grandparent with addiction you are more likely to develop that addiction we have to keep it in balance in order to stay healthy Dr Anna lmy is Professor of Psychiatry at Stanford chief of the Stanford
0:46 addiction clinic and a world leading expert on the subject of doping she will tell you how this one powerful chemical is controlling your life and what to do about it one of the most important findings in Neuroscience in the past 75 years is that the same parts of the brain that process pleasure also process pain and the balance wants to remain level the problem is that we automatically seek out pleasure and avoid pain and we're exposed to all kinds of Pleasures that we have in the modern world and our brains are reeling in response to try to compensate now I need more of my drug and more potent forms to get the same effect which then leads to addiction and that's what happened to me when I got addicted to romance novels take me into that phase of your life I was out of control and I needed to restore a level balance and take the advice I give my patients and what is that advice
1:31 the Diary of a CEO is independently fact checked for any studies or science mentioned in this episode please check the show notes this has always blown my mind a little bit 53% of you that listen to the show regularly haven't yet subscribed to the show so could I ask you for a favor before we start if you like the show and you like what we do here and you want to support us the free simple way that you can do just that is by hitting the Subscribe button and my commitment to you is if you do that then I'll do everything in my power me and my team to make sure that this show is better for you every single week we'll listen to your feedback we'll find the guest that you want me to speak to and we'll continue to do what we do thank you so [Music] much I've sat here for the last 20 minutes trying to figure out how to say this to you so I'm just going to say it
2:17 how it comes out my mouth and I apologize if this is messy but if there was ever an episode this year that you should listen to it is this one I've since this episode was recorded about a month ago all I've been thinking about is how on Earth I get you to watch this and I don't say this often the last time I said this was the first time Mo gordak came on this podcast this is the second time I've said this in almost four years of recording this podcast on YouTube and the reason for that is so many of the things that I know you're struggling with in your life that stand in the way of the person you want to become that relationship you have with your phone the procrastination the cycles of behavior that make you feel embarrassed and full of shame that you've just never been able to crack all of them all of them I genuinely believe for many of you are going to be understood today if you
3:03 listen to this episode it has changed my life and it has changed much of the lives of my team if if I'm wrong here you have the right to message me and tell me that I was wrong please listen to this episode really really I mean that from the bottom of my heart and just to make sure you do throughout this episode there's going to be these popups if you collect eight of these codes that are going to pop up on the screen and put them in the document link below you'll unlock something very special some additional content please listen to this episode Dr Anna lmy you wrote one of the most iconic well-known books about dopamine which propelled the subject matter of dopamine into the public Consciousness but I guess the most important question I should ask you
3:50 is why does dopamine matter ah good question good good place to start I mean dopamine matters because it fundamental to our survival right so it's the chemical that we make in our brain that tells us this is something we should approach explore investigate so it's it's really almost the survival chemical so what is dopamine if you had to explain it to a 10-year-old how would you go about explaining it so dopamine is a chemical that we make in our brain um it has many different functions but one of its most important functions is that it helps us experience pleasure reward and motivation um it may be even more
4:37 important for the motivation to do things than it is for the pleasure itself so for example there's a very famous experiment in which rats were engineered to have no dopamine in the brain's reward pathway and the scientists discovered that if they put food in the rat's mouth the rat would eat the food would seem to get some pleasure from the food if you can deter that from watching a rat eat which I think they felt like they could uh but if you put the food even a body length away the rat will starve to death the idea being that without dopamine we're not motivated to seek out the things that we need for our basic survival that's crazy so you get a rat you put the food an inch from its mouth and it
5:24 will starve to death because it doesn't have dopamine the dopamine required to just reach out and eat yeah essentially maybe it's not an inch maybe it's a little more than an inch but the idea being that dopamine is necessary to be motivated to do the work to get the thing that we need and having an understanding of dopamine how might that improve my life having a basic understanding of how dopamine Works how we process Pleasure and Pain and also what happens with dopamine as we go from adaptive recreational use to Mal adaptive addictive use is something that is really useful especially for those of us living in the modern world where now we're exposed to so many reinforcing
6:09 substances and behaviors that we've all become vulnerable to the problem of addiction and what are the biggest misconceptions of on the subject of dopamine because it's kind of thrown around in society I see it in my group chats people saying I need more dopamine or whatever or you know that person just craves dopamine what what are the biggest misconceptions you've come across the main miscon conception is that somehow we can get addicted to dopamine we're not getting addicted to dopamine itself dopamine is neither good nor bad it's a signal to tell us whether or not something that we're doing is potentially useful for our survival and also it's related to what we predicted about how rewarding or pleasurable something would be and so it's really um
6:56 you know I sort of sometimes I joke it's like the um reward theory of relativity DOP mean is in the sense that Pleasure and Pain really are truly relative to one another and so dopamine gives us information about where we are in that relativity scale between Pleasure and Pain and when you say relative you mean I mean it's it's quite fitting for anyone that can't see we have a a set of scales on the table and scales are relative to each other because if you pour in one end the other end goes up and if you pour in the other end the other end goes up and this end goes down and when you say relative that's what you're describing right yes that's what that's what I'm describing yes okay and what activities that I do every day have an impact on my dopamine well probably almost everything
7:43 you know in some ways um I mean every time we are doing something that's pleasurable reinforcing rewarding that will affect dope mean it's it's really the primary signal that lets us know that this thing is potentially important for our survival as I mentioned um but you know even um aversive stimuli can trigger dopamine what's oh something that's painful or not pleasurable dopamine gets involved in in that um equation anything that's novel or new is something that triggers our dopamine in in our reward pathway dopamine is fundamental for movement so not just pleasure and reward but also movement so
8:28 for example Parkinson's disease which is a disease related to stiffness and Tremor is caused by a depletion of dopamine in a part of the brain called the substantia and as dopamine gets depleted in that part of the brain people lose the ability to move their bodies and it's probably no coincidence that the same neurotransmitter that is so important for pleasure reward motivation is also really important for movement because most organisms have to to locomote toward the object of their desire we want that thing we have to exert effort right we have to put in the work to go get it but in the world today we really don't have to do that right we can swipe right we can swipe left and
9:13 all of a sudden it magically appears at the touch of a finger and that's very confusing for our brains because that's not how we evolved we really evolved for for having to do quite a bit of upfront work for a tiny little bit of reward I just want to before we move on talk about this point you said because I think it's quite foundational to everything we're going to talk about about dopamine being relative to pain and I have this set of scales in front of me and here I have some chemicals that are likely to produce dopamine in my brain I believe right so alcohol I have some rum I have some whiskey I have some vodka and can you explain to me using this rum whiskey and vodka how dopamine is relative to pain and what
9:59 going on in my brain sure okay I'll slide this over to you oh okay so one of the most exciting findings in Neuroscience in the past 75 years is that Pleasure and Pain are collocated in the brain so the same parts of the brain that process pleasure also process pain and in a very simple reductionist kind of way they work like opposite sides of a balance so imagine that deep in your brain's reward pathway which is is another exciting Discovery right that there's this dedicated reward pathway of the brain that consists broadly speaking of the prefrontal CeX which is this large gray matter area right behind our foreheads that's so important for future planning for delayed gratification for appreciating
10:45 future consequences you might think of it as like the brakes on the car if we're going to analogize to to a to an engine and then deep you know in the brain we've got what we call the limic areas or the emotion brain and there you have the nucleus accumbens and the vental tegmental area that are rich in dopamine releasing neurons right and they act like the accelerator on the car so when you've got a healthy functioning brain you've got enough accelerator but not too much right so enough dop Meine being released but not too much and youve got a healthy prefrontal cortex putting the brakes on that dopamine release when people um become addicted there's either a problem with the brakes
11:32 the prefrontal cortex or the accelerator the nucleus accumbens and vental tegmental area or both right what we're finding is that there's actually a disconnect so there are large neuronal circuits and Pathways between those deep lyic structures and the prefrontal cortex that literally get severed or disconnected when people become addicted as we think about Pleasure and Pain being collocated in the same parts of the brain working like opposite sides of the balance in order to understand what happens in the addicted brain is to appreciate that there are fundamental rules governing this balance and one of the most important rules is is that the balance wants to remain level it does not want to be tilted very long to the
12:17 side of either pleasure or pain and in fact what our brain does is first tilt an equal and opposite amount to whatever the initial stimulus is so I'm going to try to illustrate that here so let's say our initial stimulus is alcohol now alcohol Works through its own chemical pathway it works on our endogenous opioid system the opioids that we make we have receptors for opioids in our brains it works on our endogenous Gaba system which is our calming neurotransmitter and at the end of the day it releases dopamine in the reward pathway so any potentially addictive substance will release dopamine in the reward pathway the more that's released and the faster that's released in a given individual the more likely that substance is to be
13:03 addictive now another important concept here is what we call drug of choice which is to say what releases a lot of dopamine in your brain may not release a lot of dopamine in my brain and vice versa right which is this idea that people have predictions to different kinds of drugs and by the way people can get addicted to behaviors too I should emphasize that when you say drug of choice you mean the brain has a particular sensitivity to that drug in terms of dopamine yes okay the more dopamine that's released the faster that it's released the more likely that drug is to be addictive for a given individual so you're holding some whiskey there I'm holding some whiskey there could be a brain that is very sensitive to Whiskey and there could be a different brain that you could pull all the whiskey and you like and the
13:49 dopamine response is sort of limited exactly okay and for many of my patients who become addicted to alcohol they will tell you that from the first moment they had alcohol they knew they were either in trouble or had met their best friend or some combination it was a very potent experience for them all right so let's let's go ahead and put this on the pleasure side of the balance dopamine is being released but no sooner has that happened then my brain will work very hard to restore a level balance and by the way a level balance is what neuroscientists call homeostasis okay and one of the overarching physiologic drives for all living organisms is to return to homeostasis homeostasis is that
14:35 parameter of what's often called called affordances or states of being that are adaptive and healthy for the organism for example like we have a certain homeostasis of body temperature and if we go much too much beyond that either too high or too low we will disintegrate and die right so homeostasis is that that states of being that are compatible with existence and and potentially advantageous too sort of Baseline level that's right yeah Baseline level and by the way we're always releasing dopamine at a kind of tonic Baseline level in our brains I sometimes think of it as the heartbeat of the brain so what's happened here for people that can't see is you've poured a little bit of whiskey into one end of the scale the pleasure side of the scale and the other side of the scale has risen because now there's whiskey um in
15:21 the the pleasure side which I guess is released dopamine exactly so now now we' released dopamine in the reward pathway okay because the pain side went up does that mean there's now less pain in the brain well I think you know again this is a metaphor it's an oversimplification the idea here is just when we press on the pleasure side we're releasing dopamine in the reward pathway and experiencing pleasure okay okay but no sooner has that happened then our brain will try to compensate or adapt to increased dopamine firing by down regulating dopamine transmission for example by involuting post synaptic dopamine receptors that mean okay okay so our brain is a bunch of wires you know um that conduct these electrical
16:06 signals and and these long spindly cells are called neurons and the thing about neurons is that they don't actually touch end to end there's a little Gap or space between them and that Gap is called the synapse and that Gap or synapse is bridged by what we call neurotransmitters and dopamine is one of those neurotransmitters okay and when the pre synaptic neuron pulses and releases dopamine it crosses the synapse and binds to a receptor on the post synaptic neuron which either continues or aborts that electrical signal does that make sense yes okay so one of the ways that our brain can decrease the effects of dopamine decrease dopamine transmission is by involuting or taking inside the neuron the post synaptic
16:54 receptor that way when dopamine is released it has nowhere to bind oh okay so it's like removing the docking station exactly very good it's removing the docking station so essentially getting back to our scale we've we've you know ingested alcohol we've increased dopamine firing in the reward pathway but remember our pleasure pain balance wants to return to the level position level with the ground homeostasis so it's going to decrease dopamine transmission by for example involuting those post synaptic dopamine receptors but one thing about the brain in its process of trying to get back to homeostasis and again I like to think of this neuro adaptation process as these Gremlins hopping on the pain side of the balance to bring it level again you don't have Gremlins here you have these little rocks but let's go ahead and put
17:41 a rock on the pain side of the balance and the these rocks are are friends right their job is to level the balance because remember we got to go back to homeostasis I'm going to put a rock on and you're going to see oh my gosh it overshot right it now I've got it pressed down on the the pain side of the balance but that's exactly what happens in our brains in this process of neuro adaptation those Gremlins hopping on the pain side of the balance don't get off as soon as the balance is level they stay on until we're tilted and equal an opposite amount so is that what a hangover is or a cown as they would say when people take drugs they say I have a come down exactly that's exactly what it is that's the hangover the come down the Blue Monday or on a much smaller scale
18:26 just that moment of craving right that moment of wanting to have one more shot right why does it overshoot why can't it just perfectly hit homeostasis such a great question because then we'd feel fine yeah why did Mother Nature do that to us so cruel right yeah okay I'm going to tell you an evolutionary just so story what we mean by that is we don't really know why you know this mechanism exists but from an evolutionary perspective if you're living in a world of scarcity and everpresent danger this is the perfect mechanism to make sure that we're never satisfied with what we have that we're always wanting more it's made us the ultimate Seekers okay because immediately after
19:12 getting something I'm now feeling a lack of pleasure and I'm at a deficit you know on the pain side of the scale which means that I'm going to go seeking out more dopamine and in a world where everything is quite scarce that could mean going on another 4-Hour hunt the next day to go killer gazelle or something perfect you got yeah you got it interesting yeah okay so that's going to motivate me because this get so Jesus people that have hangovers don't seem very motivated right so now that's a so why is that right it's because alcohol is a product of human engineering that releases so much dopamine all at once in the reward pathway that our brains are reeling to
20:00 compensate right we we really weren't evolved for this much pleasure with this much easy access as you said yourself we were really evolved for to have to do quite a lot of work upfront and to be hungry and to be lonely and to be tired and then get a little bit of reward that would then bring us back up to homostasis so really we were evolved to be pressing on the pain side of the balance in our effort to find pleasure and then when we find it that little bit of food or clothing or shelter or a mate would bring us back to the level position does that makes sense yeah so you're you're telling me essentially that we're all wired to be addicted because if this is how our brain works in a world it's designed to seek out
20:48 more dopamine but the problem we have now is we have all the synthetic dopamine effectively like this so synthetic chemicals and synthetic things and you know an Internet that is wiring us to give us so much dopamine so easily that that means that our brains are effectively like mismatched to the world that we live in and therefore wired to be addicted yeah I think you actually said that I found a quote you said in an interview where you said we all wired to be addicted and if you're not addicted yet it's right around the corner right coming to a website near you yes I I guess I would I would qualify that a little bit by saying we're wired for survival in a world of scarcity that's not the world live in now we live in a world of overwhelming overabundance and so there is a mismatch between this
21:34 ancient wiring that has us relentlessly pursuing pleasure in order to survive and a world that's so infused with pleasure and so many rewarding stimuli that now we're overwhelming our reward system and our brains are reeling in response to try to compensate so what happens to this scale then in such a world where I can get a big hit of dopamine all the time using some of these synthetic things or the internet or pornography or whatever else what's going on with this scale over and over again okay great so let me get there let me first say though that remember after we do something that's highly pleasurable our brain compensates with neuro adaptation tilting an equal and opposite amount to the side of pain and then restoring our balance back to the level position right or what we call
22:21 homeostasis so this doesn't last forever right it's to pleasure then it's to pain then it's back to the level position but if we continue to consume our drug of choice over days to weeks to months to years and we add in a whole bunch of other drugs and now we're consuming you know pornography and smoking pot and eating um donuts and you know you name it all at the same time then essentially what happens is those Gremlins on the pain side of the balance end up camped out there for anyone that see she put all of the Rocks into the pain side to represent All Of The Addictive behaviors that this individual has now taken on right and now we've entered addicted
23:10 brain by which I mean that we've changed our honic or Joy set point to the side of pain now we need more and more of our drug in more potent forms not to get high and feel good but just to level the balance feel normal and this is not going to be enough to level the balance I would have to like keep filling this much more than this container can hold and that would be in Pursuit really of just trying to level that balance so that we can feel normal and when we're not using we're walking around with a balance tilted toward the side of pain experiencing the universal symptoms of withdrawal from any addictive substance or behavior which are anxiety
23:55 irritability insomnia depression and crav so if I managed to get enough vodka whiskey rum and pour it into the pleasure side of the scale now that all the rocks are in the pain side of the scale I managed to outweigh it it would it would what would then happen more rocks more rocks would be added yes more so momentarily yeah I would maybe be in a little bit of pleasure yes but then my brain would remove those docking stations again remove more of them and more rocks would go in and I'd slam down on the pain side again which means I need more alcohol to try and get up to pleasure SL okay so really you want to you want to like dopamine fast you need you need to just balance this and this is so difficult because of the world we
24:40 live in it's almost it's it's it's funny enough because this little scales experiment um analogy here has given me a huge amount of empathy for people that are addicts oh gosh I'm so glad you said that because I think that is the key to empathy for the disease of addiction as well as for people with the disease having empathy for themselves is recognizing that on some level it it's it's out of their control right because when we are tilted to the side of pain the overwhelming drive to restore a level balance or restore homeostasis as quickly as possible overwhelms any other rational thought about the consequences of my drug use right it's just like get back to the level position because if I do that I'll at least feel temporarily
25:27 better one of the things this analogy also highlights for me is that people who are addicted aren't trying to self harm right and this is kind of the prevailing narrative that if you're like why would you do that to yourself right whereas when I look at this analogy I go actually what they're trying to do is to deal with pain and we're all trying to find ways to deal with our pain and but in this analogy what ultimately happens and I guess is what's happening with addicts is the way they're choosing to deal with their pain is becoming self-destructive and that's creating more pain right and it's this vicious downward cycle yes and I think that sort of reframing of what's going on there is really critical because again it begets more empathy absolutely I agree with you
26:12 and and I think you know we this this metaphor it makes an assumption that we all start with a pleasure pain balance that's level with the ground but actually that's probably not true right some people at Baseline may actually be more depressed or more anxious or may have had life experiences that sets them up for a kind of chronic stress reaction and we know that people with co-occurring psychiatric disorders for example are at increased risk of developing addiction probably because they're reaching for that substance to self medicate their psychiatric problem the the issue with that is that it's not medicinal right it's not healing although in the short term substances can help with those kinds of feelings
26:58 feelings of psychological and physical pain over time because of the way the brain adapts as we've discussed substances and other addictive behaviors just make psychiatric problems worse right as we drive ourselves further into the the kind of uh you know the pain side of the balance so is this why trauma often leads to addictive behaviors because the trauma has caused a a pain a stress and we're searching for ways to medicate that pain or stress yeah to numb ourselves to not be present in our reality and have to deal with what's going on there is dopamine what role is dopamine playing in it's all the same dopamine originally was to help us find those
27:43 things that we need to survive food clothing shelter a mate we call those Natural Rewards but today that same reward pathway that relies on dopamine has been hijacked by all of these artificial rewards that our brain confuses as necessary for survival which is why people with severe addiction will be willing to lose you know not consciously but unconsciously their loved ones their homes their jobs everything they have in pursuit of their drug of choice it's because their brain has been hijacked and they now confuse the drug as necessary for survival the other thing about drugs is that they're incredibly potent they release a lot of
28:30 dopamine all at once which again is confusing for our brain Natural Rewards require upfront effort where we do a lot of work and then we get a little bit of dopamine and that's what our brains evolved for I mean I can that makes sense in my own life when I'm most stressed or most challenged by something professionally is when I I immediately notice that my diet goes out the window I start eating things that are bad I actually stop going to the gym as much um and it's it be can form a bit of a downward spiral can't it I guess as we've kind of seen from the dopamine scale um can I can I get back to that your question though about trauma and stress so um there's a very series there's a very interesting series of experiments in rodents mice and rats
29:18 where they first of all rodents very easily get addicted to cocaine they will press a lever for cocaine until exhaustion or death but if that cocaine is then taken away that behavior will extinguish which means that the mice will eventually just stop pressing the lever right because they're not getting any cocaine totally makes sense and then they'll go off and do something else in the cage but if they're then exposed to a very painful foot shock right so a very extreme physical pain which you could equate to a serious life stressor the first thing the rat will do is run over to the lever and start pressing for cocaine which tells us that once our
30:06 brain has discovered a drug that releases a lot of dopamine in our reward pathway even after we stop using that drug if we are exposed to an extreme stressor our brain will tell us immediately go and do that thing that gives us a lot of dopamine because you are under stress and I need to be relieved of stress does that make sense makes perfect sense yeah so if you especially so if you discover your drug of choice when you're younger and it's food or it's pornography or if it's I don't know anything that really made you feel good for a moment a moment of pleasure that will always become in the case of these rodent experiments the thing you run back to
30:51 when life gets hard right and we see that again and again in people in sustained recovery from addtion that when they are under stress that is a trigger potentially for them to relapse so they have to be really thoughtful in their lives for number one trying to avoid stressful situations and and by the way stress can come in many different forms there's a great acronym in in alcoholic synonymous called halt hungry angry lonely tired those kinds of stressors everyday stressors which we all experience hungry angry lonely tired can trigger us to want to use so people in recovery have to be really thoughtful about not getting too hungry not getting too angry not getting too lonely and not
31:38 getting too tired at the end of this conversation I want to go through all of the sort of practical solutions that someone struggling with an addiction to social media pornography food whatever it might be um Can Implement to try and shift that cycle that they might be going through especially when they're halting hungry angry lonely or tired how often have you worked with addicts have you spent much time working with addicts directly oh my gosh yeah so that's the bulk of my career is working uh with people with all different kinds of addictions me an example of the most obscure the most I had a patient who was addicted to water I know hard hard to imagine you have to though understand her narrative so she had a very severe alcohol addiction she got into recovery from
32:24 that addiction and gave up alcohol but she discovered that by drinking copious amounts of water she could become hyponic meaning that she could lower the sodium levels in her bloodstream which would then lead her to become delirious and so in her desire to just be checked out she would do that she would she would drink a large amounts of water she's doing okay no sadly she's not um she she ended up taking her own life so that was very sad gosh in that situation was there was there a root cause of that behavior pattern further Upstream some kind of trauma or experience that had set this sort of cascade cascading set of issues
33:11 off yeah you know I'm just speaking broadly um for for some patients with severe addiction trauma is a huge Factor um especially severe Early Childhood trauma but there are also many folks we see who have kind of great parents and have had happy childhoods and have great social networks and and work that they enjoy and yet they still become addicted and that's because we again we are wired to consume as much as possible of whatever releases dopamine in our brains to have survived Evolution to this date and yet we're living in this world where we have access to so many drug aied
33:58 substances and behaviors that we've all become vulnerable to this problem and the reason I highlight this is because one of the things that I think has happened in the field of addiction medicine that maybe isn't the best is that often times patients themselves as well as their providers are digging really deep to find the trauma or the reason that someone has become addicted and I think that that's important to do in some cases but in in other other cases it can lead to kind of manufacturing trauma where there really isn't any furthermore I would say that when a person is in the throws of their addiction they're not going to be able to really do the complex emotional processing of their trauma while they're
34:44 still using their drug of choice that they really need to get out of that Vortex of addiction and get into some degree of recovery before you would even want to go tackle some of those early traumatic experiences how many people do you think are struggling with some form of addiction well if you think of addiction as a spectrum disorder right there's mild moderate and severe um and there's I would even say a kind of a pre- addiction state where we're all sort of dabbling in compulsive overc consumption I would say the vast majority of us like 90 probably 95% have some degree of compulsive over consumption and you know if and when it tips over into what we would call addiction there's not a brain scan or a blood test to assess that it's not like
35:31 you know switching a light a light switch and it's like oh yeah now you have addiction um it's not like that it's you know it's a gradual often a gradual and Insidious thing and we don't in fact have a biological measurement of addiction we Bas it on what we call phenomenology which is patterns of behavior that re repeat themselves across time and broadly speaking the definition of addiction is the continued compulsive use of a substance or a behavior despite harm to self and or others and so you know that harm can be very subtle um or not right and it can be a judgment call interesting because we do throw the word Addiction around a lot in society but but really the most important part of that is to understand
36:17 if it's harming yourself or someone else the behavior pattern yes that's right and to also recognize that we're not very good judges of that when we're chasing dopamine okay so we sometimes justify behaviors we have as being not harmful and it's fine and it's not impacting me at all and what do you mean exactly and we don't we're not very good at seeing true cause and effect honestly when it comes to these behaviors which is why often times people won't really see the harm until they've stopped using for a period of time in your book dopamine Nation you talk about an addiction that you had yes and it was really surprising to me because I would never have thought that being obsessed with erotic novels could be classified as an addiction what happened what was the behavior take me into that that phase of your life so
37:04 I was in my early 40s um my kids were no longer little um I got a lot of my self-worth and identity from being a mom and my kids were sort of entering adolescence they were doing fine but they didn't need me as much um so I had kind of a grief reaction you know in response to that was trying to figure out you know how to navigate this next phase of my life I'd always been a reader and in particular a reader of novels um in my own way that was how as a child I self soothed was to escape into uh the Fantasy Life of novels um but I never had what what I would call a problem with it and then one day I heard another mother at school said that she was reading this great book it was called Twilight it was about these
37:50 vampires and she was going on and on about it and I read it and I I can't tell you what it was but it was just like the the the key in my particular it was completely transporting it just released a lot of dope mean is all I can imagine in my brains reward pathway and so I read the whole series and then I read the series again and I read it again and of course by the third or fourth time it wasn't as you know reinforcing and I thought to myself I wonder if there are any more vampire romance novels and then for me the real Tipping Point was I got an e-reader I got a Kindle because what happened was I I even before I got the Kindle I started reading you know novels that I would say I would be slightly embarrassed to admit that I was reading like kind of bodice Ripper novels as
38:36 time went on I I needed more and more like graphic kinds of descriptions in order to find it pleasurable and and by the way that's classic for the addiction narrative right where you start out with a little bit and it goes a long way and then over time you build up tolerance that's neuro adaptation the Gremlins pressing down on the pain side of balance now I need more of my drug in more potent forms to get the same effect gradually over time I started um reading you know more and more sort of graphic erotic sexualized versions of this novel and I would I was embarrassed so I would hide that I was reading them and that gets into the whole double life of addiction where now we're lying about our use we're we're using our drug over
39:21 here but pretending like we're not so my kids or my husband would walk in the room and I would be you know hiding behind another book one book behind another book so it looked like I was reading something you know I don't know more sophisticated and then the Tipping Point for me came really when I got a Kindle or an e-reader and then my reading was totally Anonymous I could read these books anywhere any time no one knew what I was reading and as soon as I finished one um I could read another one and I almost overnight became a chain reader like literally when I was n doing something else that I had to do I was reading romance novels one after another after another um which meant I was you know less present for my kids less
40:08 present for my husband I would often stay up till 2: 3 4 in the morning on a week night reading romance novels have to get up two hours later go to work exhausted not able to be present for my patience not enjoying my work gradually getting more depressed more irritable more anxious more insomnia we went on on a a family vacation with an family friends of ours everybody together at this beach house all the kids playing I was like hiding in a room reading romance novels so and this is exactly what happens with addiction is that our Focus Narrows and the things that we used to enjoy are no longer pleasurable only this one thing has salience for us we plan our whole whole day around getting it using it hiding our use um
40:54 and that's what happened to me it's so interesting because I was as you were talking about that I was thinking about all the behaviors that I have that are maybe isolating me or you know I just even things like spending a lot of time on the internet just watching video after video after video on YouTube or um those kinds of things or just like spending tons of time in my WhatsApp group chat talking like roasting my friends about nothing right how do you know if like this is it's cuz on end of the spectrum I could say okay well that's harming my relationship with people in the real world but it's helping making me feel good and it's you know maybe helping me in
41:40 another department because I'm learning more about vampires or you know like so like you know because there's there might be net harm somewhere else but then an upside over here which and then I start rationalizing this Behavior like how' you just distinguish between these behaviors and know what's bad and what's good you know what it's really hard um these digital devices are powerful tools but also very potent drugs there's no doubt that digital media lights up the same reward pathway as drugs and alcohol these devices and platforms were designed to be addictive that is to keep us scrolling and tapping long beyond what we plan for or what we want or even
42:26 what's pleasurable I think we can all relate to using this medium to a point where we don't even like it anymore and yet have difficulty getting ourselves off of it that really speaks to the inherently reinforcing and cognitively adherent nature of this medium it is a drug and so you know if and when and how we're crossing into addictive use I think we need to be very Vig about whether that's happened in our lives and one of the ways to do that is actually to try cutting out that particular digital medium that website or that behavior for a period of time long enough to experience withdrawal
43:14 potentially reset reward Pathways and then re-evaluate because when we're in the behavior as you yourself noted it's very easy to rationalize oh I need to do this for work oh I need need to do this to stay in touch with my friends oh I'm learning so much from this right and all of that may have been true initially but may not be that true anymore and what I often point to is the subtler signs of addiction which are things like depression anxiety in attention insomnia restlessness these can be early signals for our consumption entering into that addiction range but us not realizing it because again we don't see cause and
44:00 effect which is why doing an experiment like I did with my romance novels you know following in the footsteps of my patients and taking the advice I give them and I gave my romance novels up for 30 days right just to see like okay I think this is a problematic Behavior can I give it up how will I feel and the very first day that I the very first 24 hours hours that I did not read any romance novel any novel at all I was astounded at my level of anxiety restlessness and utter insomnia I had completely unlearned the art of putting myself to sleep without this digital
44:46 narrative and that lasted a good 10 to 14 days completely mapping on with the amount of time it takes typically to get out of acute withdrawal that is to say for those neuro adapt PA Gremlins to hop off the pain side of the balance and for homeostasis to to begin to be re restored um but by the time I got to weeks three and four I felt not just better than I had in the first two weeks but actually better than I had felt in a really long time I enjoyed my kids more I was more present for them I enjoyed my husband more my work seemed salian again I had started to think oh maybe I should do something else you know maybe maybe I you know this work I've been doing it a long long time I don't it's not that interesting anymore all of a sudden it was interesting again right so you see
45:33 the relativity of that honic pathway and how when we're doing that behavior or substance that's so reinforcing that everything else loses its salience we can really misidentify what is causing our irritability anxiety insomnia until we stop that substance for long enough to see its impact on our lives how is it making you feel because I think a lot of a lot of people can't understand how you could get addicted to a book I'm sure some people understand that but but for me it's not something I've ever become addicted to so how how did it feel was it like exciting is it arousing is it somewhere in between I mean I think that romance novels are essentially socially
46:19 sanctioned pornography for women okay and the medium is narrative and if you're a person for whom narrative is a powerful drug as it is for me a story a narrative a fiction um very potent since I was a child then you know it was a natural that that that would be the thing that I would get addicted to and basically just like we've hacked and bioengineered everything to make it more potent I mean people there's a formula for writing romance novels like if you take a physical copy if you go to a store and you pick up a romance novel and you literally physically open it to 2third of the way through you will get to the climactic scene pun intended right it's it's like it's engineered I mean I got to a point where
47:05 I wouldn't even read it read after I wouldn't finish the book I would go on to the next book just to get to the climax part and then you'd move yeah and I wouldn't even read the danum ma or like what happens to the characters I didn't care you didn't care about no and also I didn't I got to point where I didn't care about the quality of the writing or the depth of the car it didn't matter it was it was the drug it was that moment I was looking for and you know there are a lot of free books on Amazon some some of which are high quality and some of which are not but like you know any good drug dealer knows free samples that's the way you hook people I would search for these free samples and that's part of it too like the searching for the drug so the Working The Upfront work you do for the drug is part of the drug right it's all that you know the machinations and the hiding and the this and the that that
47:51 gets to be part of like all of the rituals surrounding it as you were talking as well I thought about work and work addiction yes because you earlier used the term excessive consumption and when I think about work even my work I Think Jesus I excessively consume work I start so many bloody businesses and invest in so many things and if you look to that behavior objectively if you're like an alien looking down at me you'd go this guy's got a problem do you know what I mean you think you think that's funny joking you know I feel for you and it's funny cuz in society we then those people are reinforced we clap that's right we clap we got this guy's not sleeping he's working 18 hours a day clap clap clap
48:36 give him a trophy an award name a thing after him or her or right you know um and it's just really interesting that that that addiction of work and you tell me if it is it can be an addiction it's certainly in the scale of one end being sort of consumption excessive consumption in the other hand being addiction it's on there somewhere people can get addicted to work and part of the reason is that we've drug aied work right when when I say drug aied what do I mean we've made it more potent and this is true for all all these drugs we've made them more potent more novel more Bountiful meaning there's more of it and more accessible so if we if we break that down with work how is work more potent well certain types of work are more reinforcing not all types of work so for example Works
49:21 work White Collar work is often now associated with stock options and bonuses right um there's often like a social media aspect to it or maybe even a Fame aspect or as you point out those are our cultural Heroes right so you get all this you know agulation for being a workaholic and that also because we're such social creatures right and human connection stimulates dope mean that that also makes work more of a potent drug personal brand right so you're LinkedIn oh my God this person got a promotion we all clap we the likes the comments you're amazing the agulation the a as you said the awards the trophies and then you've got um the fact the fact of novelty so once we've exposed our brains enough times to a
50:09 certain drug as I said we develop tolerance right and then we need more potent forms or novel forms one of the ways we overcome tolerance is by taking our drug and then changing it slightly like adding a little new molecule on this chemical right or on the Internet you know when we're searching videos we want something similar to what we liked before but just a little bit different and that's what the algorithm does automatically right it offers oh you should check this out oh how about this oh check that out right and that engages our treasure seeking function we're looking for that that novel thing but that's not too novel right it has to be in our category of things we like and I think for work we have that too like there are so many ways now that people can engage in their work and it's not all bad that it's novel but you know certain types of work it makes it very enticing then you have quantity
50:57 right I mean work never ends there's like no natural stopping point for work you know you do a line of cocaine you run out of money you run out of cocaine you're done right but that's not true for work everywhere anytime and then that gets to accessibility one of the biggest risk factors for addiction to any drug or behavior is simple access we know that if you grow up in a neighborhood where drugs are sold on a street corner you're more likely to try them more likely to get addicted if you live in a world where you have access to work 24/7 you're more likely to expose your brain to more work and more likely to get addicted to work again especially if it's got all those other reinforcing qualities this is probably in part why people quit their
51:42 jobs you mean if they just get overwhelmed or it's it's partially why people can never quit but I think it's important to make a distinction between work that's reinforcing in those ways and then work that's completely not reinforcing yeah alienating mind-numbing work in which the the actual task is separated from the meaning of a task I mean they quit their jobs either in search of more dopamine so if I'm working in a job where I don't know maybe it once gave me dopamine and now it's become monotonous and the same right I I need to quit to go find but there's novelty for you that's right yeah and that's true people many people change jobs every two to three years I I recently read that the the average life of a business now is like 15 years whereas you know 50 years
52:29 ago it was 50 years and there's all this turnover all this churn chasing novelty also you know I I do want to emphasize that people who are in work that's not like intrinsically rewarding but is the opposite kind of soul sucking that's also a risk factor for addiction because people just wait till the end of the day till they can go home and then use a drug to numb themselves from the stress of work so it's it's plausible that people who are in lower pleasure jobs are more likely to be overweight or addicted or dependent on alcohol yeah or simply opt out of the workforce as many young men are doing now in the United States and what we know from data that's been collected is many of them are playing video games right they've just completely opted out of the workforce I guess this in part explains why there's
53:15 a drinking culture that's associated with people who are potentially lower class um because they're doing um potentially less pleasurable work and they're therefore they if we think about the scale that they would then end up in the pub after work you know maybe that's partially true but even people doing like doctors and lawyers they're are oh okay yeah equal rates of alcoholism among those groups I think what's happening there though is that the nature of the work is just so stressful whether it's white collar or blue collar that there's this kind of work hard play hard right I'm going to work all day and at the end of the day I'm going to reward myself so now you've got a pleasure pain balance that's going
54:01 pleasure pain pleasure pain and and remember the biological definition of stress is any deviation from neutrality so that every time our brain has to work to restore a level balance we're actually triggering our stress response triggering our own adrenaline it's stressful to have to restore the balance from those extremes of Pleasure and Pain I read in um your book you were talking about how different behaviors and sort of chemicals and substances have different impacts and I was on page 50 of dopamin nation in a study of mice sex increases the release of dopamine by 100% And amphetamines which is like drugs right hardcore drugs increases it by 1,000% by this accounting one hit of a meth pipe is equal to 10 orgasms yes
54:48 it's interesting to think about that the different behaviors we have and how they'll have a bigger impact on our dopamine is there like any in an in in typical order of things that are like extremely dopamine inducing and things that aren't what's it like the top and bottom of the list but in your view you know I really think that it depends on the person and we've got to look at drug of choice right I mean potent drugs like methamphetamine like opioids like alcohol like nicotine like cannabis um are are going to be very reinforcing for many people but not for all people and most people do have their one drug that they sort of prefer above all others so
55:33 although generally speaking intoxicants release a lot of dopamine in the reward pathway um I think every person is going to be different and also we we don't really have good ways of measuring absolute values of dopamine in human beings right we can do that in rats but we can't really do that in humans it's it's relative values I've got this um picture here which shows what looks like brain scans in uh normal person but then in someone who's addicted to different substances I'll put this on the screen and I'll link it below in the description for anyone that needs it and wants to see it but it effectively shows the impact that like cocaine has on the brain meth um alcohol and heroin what is what is going on here so the red in this image represents dopamine transmission
56:19 okay so how much dope mean is being released from the pr synaptic neuron Crossing that synapse binding to receptors on the Sy aptic neuron how much dopamine is kind of swirling around in the reward pathway part of the brain and what this image shows is that on the left hand side in healthy control subjects who do not have addiction there's plenty of red right so there's plenty of dopamine Transmission in the reward pathway specifically here in the nucleus accumbens but if you look at the right hand column you'll see that in these individuals who have been using cocaine meth amphetamine alcohol and heroin in addictive ways there's almost no red which means there's decreased or
57:05 below normal levels of dopamine transmission they are in a chronic dopamine deficit State this is evidence of the brain trying to compensate for too much dopamine being triggered by down regulating its own dopamine production and transmission not just to Baseline but below Baseline and importantly these individuals who are addicted to these substances these brain scans were done two weeks after they stopped using oh wow yeah which tells us that this dop dopamine deficit State persists for some period of Time how long well it
57:51 depends on the person but we know at least from this experiment that the first two weeks are this persistent dopamine deficit state which is consistent with acute withdrawal right people feel when they first stop their drug of choice they feel terrible right they experience all of the symptoms of physical withdrawal that correspond with that particular drug they were using usually the opposite of what the drug did plus the universal symptoms of withdrawal from any addictive substance or behavior anxiety irritability insomnia depression and craving now if they can get through the first 10 to 14 days what we see clinically is those acute withdrawal symptoms slowly start to get better and we think that that is
58:37 mapping on to regenerating dopamine Transmission in the reward pathway and if they can make it to a month that's usually the point for for on average in based on clinical experience when people really can start to get out of that constant state of craving for their drug of choice and begin to see some light at the end of the tunnel for what their lives might look like if they can maintain abstinence from their drug and we can't just inject or drink dopamine I mean I guess that would be like drinking alcohol we can't just artificially mess with the the balances to try and restore the dopamine levels in an addict can we can't just add a little bit of dopamine yeah it's it's a great question because we have some natural experiments that suggest what what might happen if we do
59:23 that so as I mentioned before people with Parkinson's have depletion of DOP mean in the substan That's What Causes That that motor disease the treatment for it is to give L Doopa which is a dopamine precursor if I were to give you a spoonful of dopamine it would do absolutely nothing because it doesn't cross into the bra the brain it doesn't cross the blood brain barrier but I could give you lopa which is a precursor chemical that would cross your blood brain barrier and get turned into dopamine and then diffusely bind dopamine receptors in your brain in the reward pathway but also in the movement Pathways when we give patients with Parkinson's dopamine in this form that can temporarily improve their movements
1:00:08 but in about one in four Parkinson's patients they will develop a denovo addictive disorder shopping addiction sex addiction other types of addiction because we have the same problem we are stimulating the reward pathway with dopamine that is ingested exogenously from the outside and our brain reads that as oh boy got to compensate by downregulating dopamine transmission to below Baseline which then puts us in that addiction Vortex does that make sense it does so we have to I mean it tells me that we have to live lives in a certain sense of we have to live our lives in a certain sort of
1:00:54 homeostasis and it's so easy not to in the world we live in it's like it's like impossible to live in a perfect homeostasis balance in the world we live in right even more than having to try to live within this sort of narrow range of homeostasis in the world we live in today we probably have to intentionally do things that are painful do things that are hard pleasure pain balance like we learn that when we press on the pleasure side of the balance like with alcohol or pornography or romance novels or cannabis or whatever it is right no sooner does that happen than our brain adapts by those neuro adaptation Gremlins hopping on the pain side of the balance to bring it level again but they like it on the
1:01:39 balance so they don't get off right when it's level they stay on until we're tilted an equal an opposite amount to the side of pain that's the come down the hangover Etc but it turns out the opposite is also true if we intentionally press on the pain side of the balance for example with exercise or an ice cold water bath or intermittent fasting those Gremlins will hop on the pleasure side of the balance and we will get our dopamine indirectly by paying for it up front and there are studies in humans showing that when humans expose themselves to exercise for example dopamine levels gradually rise over the latter half of the exercise and then when the exercise stops dopamine levels will remain elevated for hours
1:02:25 after afterwards before going back down to the Baseline level position without ever going into that dopamine deficit state so it's a great way to get our dopamine in directly because it's much less vulnerable to that compulsive craving phenomenon of overuse so you're not going to get an exercise come down you can butc and people can get addicted to exercise right but typically it's it's very unusual because The Upfront cost to to do the work and endure the pain of exercise in the first place mitigates our vulnerability to an exercise addiction and in general H okay CU it's so hard to do that it's going to be it's not like pulling a lever on a slot machine or clicking on a porn website is
1:03:13 difficult yes okay so fighting for the dopamine is insulates us against the chance of an addiction having to really fight hard for it okay yeah and this kind of explains I guess in part why I pulled out some stats ahead of our conversation today that from 1996 to 2008 participation in ultramarathons has increased by 1,676 the ice bath Market is expected to rise from 350 million in 2024 to to nearly half a billion by 2030 the number of people taking part in obstacle course races like tough mut or hrock etc etc has increased by almost 7x from 2010 to 2017 it seems like in society there's
1:04:00 this counter movement towards people seeking out hard dopamine chasing pain yeah those are amazing I didn't know that those are amazing numbers um you know in general there's a part of me that wants to say well that's a good thing um but there there's another part of me that's wary also because we're so good at drug aying everything that we do that there's a way in which these types of behaviors can also be drug aied right made more potent with all of the technology the way that we count ourselves the leaderboards the social comparisons all of that takes this thing which is really in its natural state kind of impervious to addiction like you just typically wouldn't get addicted to these types of painful physical activities you would do what you needed
1:04:46 to do for survival but we've managed to make them addictive in all these different ways I still think it's a better way to get your dopamine like I really encourage exercise we always talk about movement as medicine and in general our our life is so convenient so easy so passive so sedentary that I'm telling patients all the time you know get up off the couch move your body walk around the block I think that's the bigger obstacle right now is just getting people to move but I do think we need to be wary of not going too far in the direction of like the ultra Ultra Ultra whatever it is so what is a better way to live if we're trying to optimize
…
