Medical Director of Addictive Medicine at Stanford University, Dr. Anna Lembke on ”Dopamine Nation: Finding Balance in the Age of Indulgence”

Neuroscience Meets Social and Emotional Learning

Welcome back to the Neuroscience Meets Social and Emotional Learning Podcast EPISODE #162 with Professor of Psychiatry and Medical Director of Addiction Medicine at Stanford University, Dr. Anna Lembke.[i]

Visit the episode website here. https://www.youtube.com/watch?v=5Pu82wZRZwo

Watch the interview with visuals on YouTube here.

Backstory and Introduction 0-13:00 minutes

Interview with Dr. Lembke 13:00-49:45

Follow Dr. Lembke https://profiles.stanford.edu/anna-lembke

To See Past Episodes of The Neuroscience Meets Social and Emotional Learning Podcast https://www.achieveit360.com/episodes/

In Today's Episode, you will learn: ✔︎ About the addictive nature of social media, as well as why people become addicted to certain behaviors and substances.

✔︎About her 30 Day Dopamine Fast: An 8 step process that she suggests to help us to reset our brains if we have had a surplus of dopamine in our brain due to over-indulgence that helps many people "kick their bad habits" to the curb.

✔︎ What is happening in the brain when we experience withdrawals when we try to stop a habit or behavior and how to overcome this uncomfortable feeling for increased happiness, mental health and awareness.

✔︎What exactly is the pleasure/pain balance and why we should all be able to recognize when we are getting too much of a good thing.

✔︎How to return to whatever it is that you enjoyed in moderation.

You may have seen her in the Netflix Documentary The Social Dilemma [ii] where she discusses the addictive nature of social media, explaining that it taps into “our basic biological imperative to connect with other people—that directly affects the release of dopamine and the reward pathway” (32:35 The Social Dilemma) and she warns us that “there’s no doubt that a vehicle like social media which optimizes this connection between people is going to have the potential for addiction.” Dr. Lembke is more concerned with our children and her children (who appear in the documentary with her) and on today’s podcast, she will arm us with the knowledge that she shares with her own children daily. Her book Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked and Why It’s So Hard to Stop[iii] (2016) is a good overview of what addiction is, and the dangers of prescription drugs. Her NEW book Dopamine Nation: Finding Balance in the Age of Indulgence[iv] that was just released last month, explores the exciting new scientific discoveries that explain why the relentless pursuit of pleasure leads to pain…and what to do about it.

I'm Andrea Samadi, author, and educator from Toronto, Canada, now in Arizona, and like many of our listeners, have been fascinated with learning and understanding the science behind high performance strategies that we can use to improve our own productivity in our schools, our sports, and workplace environments. My vision is to bring the experts to you, share their books, resources, and ideas to help you to implement their proven strategies, whether you are a teacher working in the classroom or online, a student, or parent working in the corporate space.

This week’s interview with Dr. Anna Lembke on her NEW book Dopamine Nation is based on true stories of her patients falling prey to addiction and finding their way out again with stories that many of us might find to be shocking, but she explains that “they are just extreme versions of what we are all capable of.” (Dopamine Nation)

When reading this book, or listening to this interview, I encourage you to think about your own life, your behaviors and what you might be running from since we are all running from something and like we have mentioned many times before on the podcast, awareness is the key to making any behavior change that can have a lasting impact on our productivity and results. My hope is that we can all take an honest look and find places where we might be leaking energy, to close those gaps, and redirect that energy towards our goals.

We covered the topic of addiction at the start of this year with Aneesh Chaudhry (EPISODE 102)[v] on “Mental Health, Well-Being and Meditation: Overcoming Addiction Using Your Brain” and I first mentioned Dr. Lembke on episode #157[vi] “Overcoming Digital Addiction Using Neuroscience” after a discussion with our friends about technology use led me to Dr. Lembke. This episode was a popular one, with over 700 downloads in the first few days of release. Then when I posted that I was working on this episode, over Labor Day weekend, I had many messages from friends and colleagues who shared with me that they were very interested in this topic. I think this is something that we should all be aware of, since most of us also have not ever had any training on the topic of addiction, yet we all know someone who struggles in some way. We can also learn so much about ourselves with this information. Understanding how chemical, behavioral, and even digital addictions are formed/broken can help us all to navigate our lives, with a deeper level of awareness that can close up those gaps where we waste energy, to improve our productivity.

Medical Disclaimer: Just a reminder—I would consider myself a researcher, sharing preventative and supplemental ideas and strategies related to the most current research on the brain, health and wellness education. Always seek the advice of your physician or qualified healthcare provider with any questions you may have about your health and remember that you should never disregard medical advice or delay seeking it because of something you learn through this podcast. Keep in mind, Dr. Lembke recommends her 30 day dopamine fast for people with less severe addictions and anyone who is struggling with a serious drug or alcohol addiction should seek further treatment from their medical provider.

Back to the episode…

Dr. Lembke’s book, Dopamine Nation shows us what happens when we get too much of a good thing, but we can use this understanding to counteract the effects of this neurotransmitter in our brain, bringing us back to balance, and productivity.

PART I The Pursuit of Pleasure

In part 1 of the book, called The Pursuit of Pleasure, Dr. Lembke gives some examples of “how we are constantly trying to distract ourselves from the present moment to be entertained” and “that we’re all running from pain—we’ll do almost anything to distract ourselves from ourselves” and that “we’ve lost the ability to tolerate even minor forms of discomfort.” When I thought about this part of the book, I couldn’t agree more thinking of all the times I grab my phone to distract myself from something, anything difficult that comes my way, instead of staying in the present moment. Chapter three goes deeper into the science of brain chemistry, discussing two key features of the effects of dopamine: the brain's tendency to seek homeostasis, and the development of tolerance

PART 2 Self Binding: Dr Lembke describes some encounters with her patients, and how to keep addictive behaviors under control. She covers Dopamine Fasting with an ACRONYM to help us learn how to use her 30-day Dopamine Fast to reset our brains. Dr. Lembke will explain her 30-day Dopamine Fasting Plan for people with less severe addictions, where she often sees people return to their “drug of choice” in a controlled way.

30 Day Dopamine Fast

Data: what are you using, how much, how often?

Objectives: what does it do for you?

Problems: or downsides does it cause?

Abstinence: stop using it for a month and see what happens

Mindfulness: be prepared to feel worse before you feel better

Insight: abstaining from our drug of choice gives us incredible insight that we cannot see without stopping. What did you learn?

Next Steps: moving forward without the drug/behavior even when you miss it. Can you do that?

Experiment: Go back out into the world, experiment and see what works and what doesn’t.

If there is something that you want to change in your life, try going without it for 30 days, and see what happens. Only you will know if this will work for you or not. Dr. Lembke noted that “even when moderation is achievable, many of her patients report it’s too exhausting to continue, and they ultimately opt for abstinence in the long haul” (Dopamine Nation).

PART 3 The Pursuit of Pain: Dr. Lembke explores the opposite side of the equation: seeking out things that are painful, in order for the brain to tend to increase feelings of pleasure immediately afterward in an attempt to regain homeostasis. Explains the “pain” side of addiction and the importance of finding balance, radical honesty and self-awareness because “people who lean too hard and too long on the pain side of the balance can also end up in a persistent dopamine deficit state.” (Dopamine Nation)

After releasing EPISODE 157 that explained Dr. Lembke’s work and her 30 day dopamine fast, I almost wanted to move on past this topic, as I say often, there are entire podcasts dedicated to addiction[vii], and they do a much better job than I ever could. But there is another reason I would rather skip it, and that’s because it’s a difficult topic. It’s much easier to move on past it than talk about something I’m still trying to learn and understand myself, because we weren’t taught this topic in school for us to know how it to handle it when it shows up in our life.

I remember the extent of my education on this topic was in 9th grade, when our PE teacher said, “don’t drink alcohol to cover up your problems.” I remember she appeared to be uncomfortable with the topic, but it’s an important one. If you ask anyone, we all know someone who suffers with a chemical addiction (alcohol or drugs) and since this topic was never a part of our schooling, it’s easy to criticize what we don’t understand, let alone recognize it in our own behaviors.

When I first encountered someone with an addiction, around 20 years ago, I couldn’t understand why they couldn’t just have one or two drinks and call it a night. Why did they have to keep going? What’s going on in the addicted brain? This was years before we could type our questions into Google and get hundreds of articles to help us (like Dr. Lembke’s work, or even Dr. Amen’s work on the addicted brain), so I would go to our local library and find books that explained addiction to gain some understanding. I wish Dr. Lembke’s first book was there, as it wasn’t easy to navigate this topic. Not being the type to sweep anything under a rug, I found some ideas and solutions for this person to enter into a local rehab program[viii] to get further help, but this opened up a can of worms with a problem that was never discussed and made me really popular in that family, but this understanding gave me a new level of awareness that would help someone else years later.

This awareness helped my husband with one of his best friends from high school who called one day to confide in him that he had a heroin addiction, and was entering a faith-based rehabilitation program, but wanted one of his friends to know what was really going on with him. His initial reaction would have been to say “what the heck is wrong with you? Heroin addiction? Are you an idiot? How did this happen?” but because of all that time I spent researching at the library, I explained to him how addictions happen, often beginning innocently (using pain killers after a surgery) or in his friend’s case, using uppers to help him through his busy days). This explanation helped him to talk with his friend with more understanding and his friend did well in recovery, helping many others for a few years, until one day, it beat him, and he was gone.

I know this is a complex topic, often resulting in death like we saw with my husband’s high school friend, or we see with celebrities who have been unable to break the cycle, and the pandemic has magnified this issue for those who were stuck in their homes for all of this time, but with the understanding of our brain in mind, my hope is that this topic no longer is swept under the rug, but talked about openly to find solutions with our brain in mind.

Let’s meet Dr. Anna Lembke and explore her new book, Dopamine Nation, together to gain a deeper understanding for those who struggle with serious addiction, to those with less severe, and see if her 30 day Dopamine Fast could be a solution to tighten up the gaps and improve our productivity.

Welcome Dr. Lembke, thank you so much for agreeing to speak with me on the podcast today. I’ve got to tell you that before I hit send on your email to invite you on the show as a guest, I thought twice, a bit nervous about you actually replying and saying yes because I knew I needed to talk about a topic that I have avoided going deeper into, but at this point, It was obvious that I couldn’t avoid it any longer, so thank you for agreeing to speak with me so quickly, allowing me to be more authentic and open.

Dr. Lembke, before we get to the questions I have on your most recent book, Dopamine Nation, I wanted to

ask a question that ties into where I first saw you, in the movie The Social Dilemma (which scared the living daylights out of me) where you talk about how “social media is a drug—that directly affects the release of dopamine and the reward pathway”[ix] and you talk about how with all of your knowledge and experience, you are still worried about your own kids and their time spent using these apps. I know your kids are a bit older now since that film was released, but what did you tell your kids DAILY about how our brains respond to certain apps on our cell phones?

NOTE: This question sums up everything I want to ask you in this interview, and that at the end, we can come back to your answer here, and I know it will sum everything up perfectly. I launched this podcast helping educators and those in the workplace to understand how to apply the most current neuroscience research into the classroom and workplace because it’s so important, and many of us need this information, but it wasn’t taught to us in school. Either was the topic of addiction, and this is why I thought it was so important to reach out to you, because your first book on this topic, Drug Dealer MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (2016)[x] explains what is addiction and who is at risk, Dopamine Nation goes beyond chemical addiction (drugs and alcohol) to understanding the Social Dilemma you spoke about in the Netflix movie and beyond that with how our brains respond to anything we do to escape “even minor forms of discomfort.”

Q1: So diving into your book, Dopamine Nation, I thought I’d seen it all, but I’m sure there’s a lot you see in your practice that shows to what extent we distract ourselves from whatever it is that’s painful in our present moment. You give some good examples that drill down this point, and I thought about how often I use my phone to distract me from difficult times in life (From serious life challenges to minor things). I know we can all think of what we do to escape from life, but can you explain why not being In the present moment and dealing with life’s challenges as they come up (whether we are using our phones as an escape/drugs/alcohol, romance novels, binge watching Netflix, whatever it is we do) only make our challenges worse?

Q2: I think I’ve got an understanding of what happens to our brain when we are in a dopamine deficit. Would it be accurate to say this is what happens when we cut something out that we liked, and experience withdrawals?

2B) What happens to our brain when we overindulge?

I had never heard of the idea that you mention in the article one of my friends put on the windshield of my car[xi] about how too much pleasure (with our phones, or video games or whatever it is) can tips us towards feeling pain. I’m not sure I have ever felt this, or I’m not aware of it. What is the pleasure /pain balance and how do we know we have had too much of a good thing?

Q3: But you say there’s good news, and that our brains can reset if we do what you call a dopamine fast (30 days away from whatever we were doing) and our brains can go back to balance or baseline. With the young man who was playing video games, he went back to doing what he enjoyed by modifying his behavior and making sure he kept his work and gaming separate. You talk about after the 30 days, that you experiment and see what works and what doesn’t. I know an alcoholic can’t after a month of abstinence go back to “controlled” drinking (as much as they would like to). How does the dopamine fast work and is there something we should watch out for to make sure our brains don’t get flooded with dopamine again?

Dopamine is not the only neurotransmitter involved in reward processing, but most neuroscientists agree it is among the most important. Dopamine may play a bigger role in the motivation to get a reward than the pleasure of the reward itself. Wanting more than liking.

The more dopamine a drug releases in the brain’s reward pathway (a brain circuit that links the ventral tegmental area, the nucleus accumbens, and the prefrontal cortex), and the faster it releases dopamine, the more addictive the drug.

Q4: When I saw your rewards and dopamine chart that show how much dopamine is released with chocolate vs sex vs drugs, and you say that learning “also increases dopamine firing in the brain.”

Where would learning or other healthy habits fit on your rewards/dopamine release chart?

How can we be sure we are not being “indulgent” with healthier habits like learning/exercise?

In your article[xii], the young man who played video games was able to go back to playing video games with a modified schedule. Then I read about how the brain changes with high dopamine rewards. (Experience dependent plasticity). Does this mean that high reward behaviors you can’t limit, and you can never go back to them? Don’t we eventually experience tolerance with all behaviors, and over time would find them boring anyway? (Your example reading your novels they were never as exciting as the first read, or when we rewatch a Netflix series we loved, it’s never as good as the first time). Where does tolerance fit into the equation?

Experience Dependent Plasticity

The brain encodes long-term memories of reward and their associated cues by changing the shape and size of dopamine-producing neurons. For example, the dendrites, the branches off the neuron, become longer and more numerous in response to high-dopamine rewards. This process is called experience-dependent plasticity. These brain changes can last a lifetime and persist long after the drug is no longer available

PART II Self-Binding chapter four: Dopamine Fasting chapter five: Space, Time, and Meaning chapter six: A Broken Balance?

Q5: Can you explain your ACRONYM for DOPAMINE and what happens to our brain when we take a month off of using our drug of choice? Dr Huberman[xiii] said it really well in his recent interview with you, the first 10 days suck. Why does this dopamine deficit feel so bad?

“A week would be good, but in my experience, a month is usually the minimum amount of time it takes to reset the brain’s reward pathway. If you don’t feel better after four weeks of abstaining, that’s also useful data. That means the cannabis isn’t driving this, and we need to think about what else is. So what do you think? Do you think you would be able and willing to stop cannabis for a month?”

Younger people recalibrate faster than older people, their brains being more plastic. Furthermore, physical withdrawal varies drug to drug. It can be minor for some drugs like video games but potentially life-threatening for others, like alcohol and benzodiazepines.

Mindfulness practices are especially important in the early days of abstinence. Many of us use high-dopamine substances and behaviors to distract ourselves from our own thoughts. When we first stop using dopamine to escape, those painful thoughts, emotions, and sensations come crashing down on us.

Q5B) Why does tolerance occur?

Dr. Lembke, I could spend the next week asking you more questions, but know I’ve got to wrap up this interview.

Q6: To close out our questions, I wanted to give something for our listeners to be able to apply on this topic. I know that you openly talk about something you stopped doing in the book that you enjoyed, and I was on the tail end of letting go of a habit that I loved when someone put the article on my car about your 30 day dopamine fast, showing me how important it was to understanding this at the brain level. Going back to the first question I asked you, “what do you tell your kids daily about dopamine/the pleasure/pain balance and dopamine deficit and the risk of addiction” what should we all know dopamine, and breaking free of its hold over us?

Q7: Final thoughts? What should we all know about Dopamine Nation?

Thank you very much for your time today. I will put the links to Dopamine Nation in the show notes, and for anyone who wants to reach you, is the best way through your Stanford website?

Thank you Dr. Lembke.

BIO:

PROFESSOR OF PSYCHIATRY AND BEHAVIORAL SCIENCES (GENERAL PSYCHIATRY AND PSYCHOLOGY-ADULT)

Dr. Anna Lembke received her undergraduate degree in Humanities from Yale University and her medical degree from Stanford University. She is currently Professor and Medical Director of Addiction Medicine, Stanford University School of Medicine. She is also Program Director of the Stanford Addiction Medicine Fellowship, and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She is a diplomate of the American Board of Psychiatry and Neurology, and a diplomate of the American Board of Addiction Medicine. Dr. Lembke was one of the first in the medical community to sound the alarm regarding opioid overprescribing and the opioid epidemic. In 2016, she published her best-selling book on the prescription drug epidemic, "Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop" (Johns Hopkins University Press, 2016). Her book was highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic (Zuger, 2018). "Drug Dealer, MD" combines case studies with public policy, cultural anthropology, and neuroscience, to explore the complex relationship between doctors and patients around prescribing controlled drugs. It has had an impact on policy makers and legislators across the nation. Dr. Lembke has testified before Congress and consulted with governors and senators from Kentucky to Missouri to Nevada. She was a featured guest on Fresh Air with Terry Gross, MSNBC with Chris Hayes, and numerous other media broadcasts. Using her public platform and her faculty position at Stanford University School of Medicine, Dr. Lembke has developed multiple teaching programs on addiction and safe prescribing, as well as opioid tapering. She has held multiple leadership and mentorship positions and received the Stanford’s Chairman’s Award for Clinical Innovation, and the Stanford Departmental Award for Outstanding Teaching. Dr. Lembke continues to educate policymakers and the public about causes of and solutions for the problem of addiction. Look for her new book, "Dopamine Nation: Finding Balance in the Age of Indulgence" (Dutton/Penguin Random House, August 2021).

FOLLOW DR. ANNA LEMBKE:

https://profiles.stanford.edu/anna-lembke

https://tedx.stanford.edu/lineup/anna-lembke

https://jhupbooks.press.jhu.edu/title/drug-dealer-md

FOLLOW ANDREA SAMADI:

YouTube Channel: https://www.youtube.com/c/AndreaSamadi

Website https://www.achieveit360.com/

LinkedIn: https://www.linkedin.com/in/samadi/

Facebook: https://www.facebook.com/Achieveit360com

Neuroscience Meets SEL Facebook Group https://www.facebook.com/groups/2975814899101697

Twitter: https://twitter.com/andreasamadi

Instagram: https://www.instagram.com/andreasamadi/

RESOURCES:

https://tedx.stanford.edu/lineup/anna-lembke

Reward Pathway in the Brain Khan Academy Lesson https://www.khanacademy.org/test-prep/mcat/processing-the-environment/drug-dependence/v/reward-pathway-in-the-brain

A guide to recognizing and controlling internet addiction by Sean Jackson, Oct 12, 2021 https://www.allconnect.com/blog/how-to-stop-internet-addiction

REFERENCES:

[i] https://profiles.stanford.edu/anna-lembke

[ii] The Social Dilemma Full Feature Netflix Movie Published on YouTube August 17, 2021 https://www.youtube.com/watch?v=7mqR_e2seeM

[iii] Drug Dealer MD: How Doctors Were Duped, Patients Got Hooked and Why It’s So Hard to Stop https://www.amazon.com/Drug-Dealer-MD-Doctors-Patients/dp/1421421402

[iv] Dopamine Nation: Finding Balance in the Age of Indulgence by Dr. Anna Lembke August 24, 2021 https://www.amazon.com/Dopamine-Nation-Finding-Balance-Indulgence-ebook/dp/B08KPKHVXQ

[v]Neuroscience Meets Social and Emotional Learning Podcast EPISODE #102 “Mental Health, Well-Being and Meditation: Overcoming Addiction Using Your Brain”

https://andreasamadi.podbean.com/e/aneesh-choudhry-on-mental-health-well-being-and-meditation-overcoming-addictionusing-your-brain/

[vi] Neuroscience Meets Social and Emotional Learning Podcast EPISODE #157 on “Overcoming Digital Addiction Using Neuroscience” https://andreasamadi.podbean.com/e/brain-fact-friday-overcoming-digital-addiction-using-neuroscience/

[vii] 15 Best Addiction Podcasts for 2021 https://www.choosingtherapy.com/addiction-podcasts/

[viii] https://www.bannerhealth.com/es/services/behavioral-health/treatment-programs

[ix] The Social Dilemma Full Feature Netflix Movie Published on YouTube August 17, 2021 https://www.youtube.com/watch?v=7mqR_e2seeM

[x] Drug Dealer MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Nov.15, 2016) https://www.amazon.com/Drug-Dealer-MD-Doctors-Patients/dp/1421421402

[xi] Digital Addictions are Drowning Us in Dopamine by Dr. Anna Lembke. (Saturday August 14/Sunday August 15, 2021) https://www.wsj.com/articles/digital-addictions-are-drowning-us-in-dopamine-11628861572

[xii] IBID

[xiii] Dr. Andrew Huberman’s Huberman Lab Podcast https://hubermanlab.com/dr-anna-lembke-understanding-and-treating-addiction/