Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Doing To Your Brain!

There's a very famous experiment in which rats were engineered to have no dopamine. 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 would starve to death. This tells us that dopamine is fundamental to getting the things we need for our basic survival. Now, every time we're doing something pleasurable—from sugar to video games, work, pornography, social media—that will affect dopamine. 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 Lembke is Professor of Psychiatry at Stanford, chief of the Stanford Addiction Clinic, and a world-leading expert on the subject of dopamine. 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? 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. 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 guests that you want me to speak to, and we'll continue to do what we do. Thank you so 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 how it comes out of 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. 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 Gawdat came on this podcast. This is the second time I've said this in almost four years of recording this podcast on YouTube. 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 listen to this episode. It has changed my life, and it has changed much of the lives of my team. 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 pop-ups. 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 Lembke, 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 is: why does dopamine matter?

Book one book behind another book, so it looked like I was reading something, you know, more sophisticated. Then the tipping point for me came really when I got a Kindle or an e-reader. My reading was totally anonymous; I could read these books anywhere, anytime. No one knew what I was reading, and as soon as I finished one, um, I could read another one. I almost overnight became a chain reader—literally. When I wasn't doing something else I had to do, I was reading romance novels, one after another after another. This meant I was less present for my kids, less present for my husband. I would often stay up till 2, 3, 4 in the morning on a weeknight reading romance novels. I had to get up two hours later, go to work exhausted, not able to be present for my patients, not enjoying my work, gradually getting more depressed, more irritable, more anxious, more insomnia. We went on a family vacation with family friends, everybody together at this beach house, all the kids playing; I was hiding in a room reading romance novels. So, this is exactly what happens with addiction: our focus narrows, and the things we used to enjoy are no longer pleasurable. Only this one thing has salience for us. We plan our whole day around getting it, using it, hiding our use. That's what happened to me.

It's so interesting because, as you were talking about that, I was thinking about all the behaviors I have that are maybe isolating me, or even things like spending a lot of time on the internet just watching video after video after video on YouTube, or those kinds of things, or just spending tons of time in my WhatsApp group chat, talking—like roasting my friends about nothing. Right? How do you know if this is it? Because on one end of the spectrum I could say, okay, well that's harming my relationship with people in the real world, but it's helping me feel good, and it's maybe helping me in another department because I'm learning more about vampires, or you know, so like, because there might be net harm somewhere else but then an upside over here. Then I start rationalizing this behavior. How do you distinguish between these behaviors and know what's bad and what's good? You know, what's really hard.

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—to keep us scrolling and tapping long beyond what we plan for, or what we want, or even 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. So, if and when and how we're crossing into addictive use, I think we need to be very vigilant about whether that's happened in our lives. 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, 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 to do this to stay in touch with my friends," "Oh, I'm learning so much from this," right? All of that may have been true initially but may not be that true anymore. What I often point to are the subtler signs of addiction, which are things like depression, anxiety, inattention, 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 effect. That's why doing an experiment like I did with my romance novels—following in the footsteps of my patients and taking the advice I give them—I gave my romance novels up for 30 days, right? Just to see: "Okay, I think this is a problematic behavior. Can I give it up? How will I feel?" The very first day, the very first 24 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 narrative. 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-adaptive gremlins to hop off the pain side of the balance and for homeostasis to begin to be restored. 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 salient again. I had started to think, "Oh, maybe I should do something else. 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 the relativity of that dopaminergic 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 people can't understand how you could get addicted to a book. I'm sure some people understand that, but for me it's not something I've ever become addicted to, so 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 sanctioned pornography for women, okay? 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—very potent since I was a child, then, you know, it was natural that that would be the thing that I would get addicted to. 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 two-thirds of the way through, you will get to the climactic scene—pun intended, right? It's like it's engineered. I mean, I got to a point where I wouldn't even read—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 denouement 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 a point where I didn't care about the quality of the writing or the depth of the characters. It didn't matter; 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 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 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 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. 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 at 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 that's funny, joking. You know, I feel for you. And it's funny 'cause 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. 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 on the scale of one end being sort of consumption, excessive consumption, on 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 "drugafied" work, right? When I say "drugafied," what do I mean? We've made it more potent, and this is true for 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 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, work—white-collar work is often now associated with stock options and bonuses, right? 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, aggrandizement for being a workaholic, and that also—because we're such social creatures, right?—and human connection stimulates dopamine, that that also makes work more of a potent drug—personal brand, right? So you're on LinkedIn: "Oh my God, this person got a promotion." We all clap, we like, the comments: "You're amazing!" The aggrandizement, the, as you said, the awards, the trophies. And then you've got the fact—the fact of novelty. So once we've exposed our brains enough times to a 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, 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 jobs—you mean if they just get overwhelmed—or 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 actual task is separated from the meaning of the 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 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 recently read that the average life of a business now is like 15 years, whereas, you know, 50 years ago it was 50 years, and there's all this turnover, all this churn, chasing novelty. Also, you know, 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 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; they've just completely opted out of the workforce. I guess this in part explains why there's 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—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… 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 pleasure-pain, pleasure-pain. 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 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 *Dopamine Nation*. In a study of mice, sex increases the release of dopamine by 100%, and amphetamines, which are 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, it's interesting to think about the different behaviors we have and how they'll have a bigger impact on our dopamine. Is there like any—in a typical order of things that are like extremely dopamine-inducing and things that aren't? What's 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 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 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 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 relative values. I've got this, um, picture here which shows what looks like brain scans in a 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, okay? How much dopamine is being released from the presynaptic neuron, crossing that synapse, binding to receptors on the postsynaptic 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 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 downregulating 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 dopamine deficit state persists for some period of time. How long? Well, it 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 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 a great question because we have some natural experiments that suggest what—what might happen if we do that. So as I mentioned before, people with Parkinson's have depletion of dopamine in the substantia nigra; that's what causes that—that motor disease. The treatment for it is to give L-dopa, 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 L-dopa, 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, but in about one in four Parkinson's patients they will develop a de novo 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 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 balance, so they don't get off, right? When it's level, they stay on until we're tilted an equal and 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 upfront. 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 afterward 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 indirectly 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, but… And people can get addicted to exercise, right? But typically it's—it's very unusual because the upfront cost—to do the work and endure the pain of exercise in the first place—mitigates our vulnerability to an exercise addiction. And in general…

Okay. 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; it's difficult. Yes. Okay. So fighting for the dopamine 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 nearly half a billion by 2030; the number of people taking part in obstacle course races like Tough Mudder or Spartan Race, etc., etc., has increased by almost 7x from 2010 to 2017. It seems like in society there's 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's another part of me that's wary also because we're so good at drugafying everything that we do that there's a way in which these types of behaviors can also be drugafied, 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 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 happiness and to keep our dopamine in balance and not have the crashes, etc., and come-downs and hangovers? What is an optimal way to live our lives? Do we have to look back at our caveman ancestors and live like them? I think that part of the problem is that we've organized our lives now around rewards; almost everything that we do is predicated on the feel-good moment we'll have at the end of it. And because of that, that we are missing out on the process; we're projecting our psyche forward into the future toward the reward and not able to really be here in the moment. Okay, this is going to sound weird; I'm going to give you a weird example. So driving over here today, I found I was nervous for this interview, and in a way looking forward to it, but in a way wanting it to be over, right? And in seeing that in myself, I thought, "That's so sad," like, that's—that's so sad that we live our lives that way, myself included—always this weird blend of wanting whatever we're doing to be over so that, in a way, we can just go hide and do whatever that self-soothing thing is that we do where we're safe and we're like, you know, stimulating ourselves in some way. And then I thought, "Well, what if I knew that I was going to die right after this?" Going to come off really weird now, but what if I knew that I was actually going to die right after our conversation today? That totally changes my perspective, doesn't it? Because this time you and I have—that's all I got; it's over for me when this—so this—this conversation is it; I really better be right here right now and really taking joy in whatever you and I can find together. And I think the more we can do that, the better. What's happening there? You're removing the thought of the outcome, the rewards, the potential, you know, failure or whatever, and you're focusing on just being present. And in doing so, what is happening?

It's a great question, and I've actually given this quite a lot of thought because I remember when I was in college and I, you know, met some like Zen people, and they were like, "Be here now, be here now," and I thought, "Well, whenever I'm here now, I'm miserable. Like, I—I—I don't like me, and I don't like being in the world. I—I don't want to be here now; I want to be somewhere else." So I didn't really understand what they were getting at. It really took me, you know, till I had lived quite a lot of life and had some, you know, some significant experiences and given it some thought that I realized, "Oh, 'be here now' means 'be here now' and be uncomfortable and be okay with being uncomfortable and being okay with not being able to control my pleasure or my pain or my comfort level, but just being open to whatever comes." And I think that's a really—a key shift—that I'm not trying to control my experience in the moment, and that it's okay to be unhappy or restless or uncomfortable and not trying to run away from that, but just really turn and face it and embrace the discomfort, which I also think is quite universal. I don't think I'm—I'm alone in that. And then the key piece about not—not anticipating the reward is helps me be in the moment, right? Because I'm not just waiting for the good thing to come after; I'm saying to myself, "Imagine there's nothing good coming after, nothing at all, right? There's just—there aren't rewards; this is it." And then also being able to say, "And it's okay if in the moment—like it's not great—like I—I can embrace that, you know? I can be unhappy or restless or anxious or whatever it is." And then when I do that, you know, I feel like there's a funny—funny thing that happens, and all of a sudden I—I'm not as anxious, right? And I am present, and it—there is some joy there.

Interesting. So when you allow yourself to deal with being uncomfortable in the moment, it turns out you—it removes the thing that was making you uncomfortable in the moment, which is like the avoidance or the worry or overthinking, whatever else. Yeah, I—I think we have this, and it's fed by modern culture—this kind of expectancy that really we should be happy all the time. And if, you know, if we've arranged things appropriately for our lives and if we've done our work and, you know, aimed true, then we should just be like, "Life is great!" And I don't believe that anymore. I think that, you know, I mean, like Buddha said, "Life is suffering," but I really think that fundamentally, like, it's uncomfortable to be alive, and that it's a kind of a constant state of restlessness and discomfort if we're being really honest and tuning in. When I really let myself see that and feel that, all of a sudden I'm—I'm freed from—from some of that. What has caused your anxiety throughout your life? In the moment you referenced earlier that some things have happened that have led you to understand this better and understand yourself better. What is—what am I missing from this jigsaw puzzle?

Yeah, well, you're—you're good; you could have been a psychiatrist. Oh, really? Yeah, it's always time—this doesn't work out; there's still time, right? It's not too late; you get a new profession! Yay! Um, I think, you know, for me, the—the big turning point, um, was that we lost our—we lost a child, and, um, in the immediate aftermath of our child's death, I was just determined to, like, sort of undo the experience and, um, you know, get enough psychotherapy and enough whatever—whatever it took to sort of not feel that pain. And it wasn't until I really just said, "Oh, like, I'm going to feel this pain for the rest of my life; it's never going away," that suddenly I felt some relief from that pain. And that was a real window for me. So interesting that the—it's acceptance. Yeah. And—and you know—and I think, you know, one of the reasons I love treating patients with addiction is because I really relate to that hitting-bottom moment, you know, that moment when it's like you just have the feeling that like everything I try to do to manage this behavior or to make my life better only makes it worse. I felt like I had a very similar experience, um, and that it was only when I kind of realized, "Oh, yeah, I—I can't run from this; I cannot run from this pain," uh, that I—I begin to have some—the beginnings of relief from that experience. I can't outrun this pain. It's all natural sort of disposition to try and outrun pain, isn't it? That's the irony, right? We're really wired to outrun the pain; we are—like, we reflexively seek out pleasure and avoid pain, and yet that's the very thing—thing that doesn't get us to where we want to go. But we do now live in a world where it's very easy to outrun the pain. Yes, this is a lion that's chasing me; this could be a bad email, and then I open up a tab and start doomscrolling or open up a tab and start watching video, playing video games, or pornography, or whatever. Yeah, that's exactly right; there are so many ways that we can now distract ourselves from, you know, our own suffering or our own awareness.

Where do you find yourself now with dealing with that grief and the pain as we sit here? Yeah, I mean, I—I feel like in many ways it's been a real gift in my life, you know? It's really informed my life in—in ways that—I mean, I—I've learned things from that experience that I think it would have been almost impossible for me to learn otherwise. You deal with a lot of people that are in a state of suffering; I imagine that's a weight because I—um, even hearing the story of the lady that passed away after that water addiction, it was like a—it was like a weight on my shoulders just to hear it. So if your profession puts you right at the heart of this type of suffering, how do you manage that—to hold that weight? A couple of things: first of all, a lot of people get better, and when people with addiction get better, it's so much better that it's incredibly rewarding to see. And they're amazing people—absolutely like the most tenacious, talented people you'll ever meet. And when they get better, it impacts so many other people, right? Their friends, their family, the people they work with. So it's very rewarding work and not at all burdensome. Of course, you know, for patients who don't—don't get better or patients who die, it's a terrible feeling, and there is a sense of, um, responsibility and—and guilt even when I feel like there was nothing that I could have done otherwise, um, you know, I carry those losses with me. So it's hard. Is there any particular cases that have stayed with you the most? I mean, every patient I've had who's died while under my care, those are incredibly painful, um, and I will never—you know, those are sort of a—those people will be with me as a part of me for all of my life. Young and old. Yeah, young and old. Yeah, it's especially tragic to—to lose young people, and it always feels like their second-guessing—like, "Oh, if only I had done that, or if only we had intervened here." But I just think that's the nature of death; we—we can't get away from the feelings of guilt around it no matter who we are and no matter the circumstances.

How young can addiction and the consequences of addiction ruin someone's life? Like, how young can someone be when their life is ruined from—from the work you've done and the—the patients you've worked with, and what are those addictions typically that seem to be most—um, susceptible to those that are young? Well, I mean, you know, some—some kids start with drugs and alcohol, you know, five, six, seven, eight… Five, six… Yeah, I mean, it's—you know, some—some—some kids use with their parents or their caregivers; they're exposed very early. If we seriously conceptualize digital media as a drug, I mean, then we've got, you know, even younger cohorts starting with that, and we do know that kids can get addicted to digital media and, as a result, um, die from that. I mean, there was just this tragic case of a young man who essentially got addicted to a chatbot; I think he was 14—not my patient; it was written up, um, in the *New York Times*, in the *Wall Street Journal*, and he fell in love with this chatbot, started to isolate, wasn't spending time with his family or friends, and then eventually took his own life, purportedly so he could join this imaginary person. What's the youngest patient you've ever seen? The youngest I've seen is probably around 15, 14, 1

Really think that we have individually and collectively reset our reward pathways to the side of pain. Meaning that the gremlins have now accumulated on the pain side; we've tipped ourselves to the side of pain because we've had so much pleasure. Yes, thanks for having me clarify so that you now understand we need more and more pleasure to feel any pleasure at all, and the slightest little pain and we're, you know, experiencing excruciating pain. You add to that the fact that we have a culture that tells us we should never be in pain, and that if we are, something's wrong with our life, or something's wrong with our wife, or something's wrong with our job. So now you've got, you know, a whole generation of folks who feels like they're experiencing more pain because they literally do not have the mental calluses to tolerate pain. And now they're being told, and if you have any pain at all, you must have something wrong with your brain; go see a doctor, go take a pill. I think this is really—this is not a direction we want to keep going in. We have a mental health culture where we assume most things are mental health illness.

On page 186 of your book, you say, "I've become convinced that the way we tell our personal stories is a marker and predictor of mental health." Now, if you live in a society where everything has a label and it's a disease or an illness, or, "I don't feel good today, so I've got this disorder and therefore I need this medication," I guess there's two questions: Is my assessment of this situation correct? And B, is this a bad place to be in a society where we think everything—every feeling we have, every—we think everything that makes us different is a deficiency?

Let me let me start. Let me answer this by talking a little bit about the role of language and narrative because I think this is very fascinating. And you know, as a psychiatrist and a therapist, that is my bread and butter, right? Is narrative—how people tell their stories. By giving language to our experience, we gain awareness of our conceptual models of the world. Okay, okay. And what I have learned over time is that the way people tell their stories is a window into their model of the world, and that there are healthy narratives and not so healthy narratives. And in general, in my clinical experience, when people come into the room and they tell their life story in such a way that they're always the victim of other people and circumstance in the world, those are people who are number one, not doing well, and number two, not going to do well going forward unless they change that narrative to acknowledge what they've contributed to the problem.

The reason for that is because the way that we narrate our lives is not just a way to understand our past; it actually is our road map for the future. So if I see myself as a victim and that's my narrative, I will literally create victimhood for myself going forward. I will literally change my sensed experience so that whatever happens, I'll make sure I end up as a victim. When people with severe addiction get into recovery, one of the most palpable changes that I see is the way that they narrate their lives. They go from, in addiction, talking about their lives as if it's always everybody else's fault, to, in recovery, talking about their lives in a way that says, "Oh, you know what? I could have done better here," or, "You know what? That's something that I keep doing that really messes with my life that I want to change, and I'm going to figure out how to change that."

Why is it so hard to take responsibility in such a way? Great question. We just hate to do it because when we do it, we feel shame, and shame is an incredible painful emotion. It's like a gut punch of an emotion that is associated with fear of abandonment, fear of being shunned by our tribe. We'd much rather paper that shame over with anger and resentment toward others. It's interesting because there'll be different groups of people listening to this now. There'll be the high responsibility group that just love and revel in taking responsibility because they think taking responsibility means that they are strong. It means, "I'm so strong I can take the blame and withstand it." And it's funny 'cause the more I've learned to take responsibility for things in certain areas of my life, the more I've become proud of myself and the more I think I'm strong. And I'm like, "Oh, look at me, I can take responsibility for anything," and it doesn't—and then if you go down this spectrum, you'll eventually get to the end of the spectrum where you've got people who, even as they heard you say that, will feel cognitive dissonance. They'll feel a sense—like a little—it'll irritate them, it'll piss them off, and they will be the "what about" gang. They'll be saying, "Yes, but what about Dave? He did this to me," and you know, they'll immediately—like the immediate reaction would be they—they're pissed off. They've probably gone—they've gone, so we're not even talking to them anymore. But if you—but it's fine, we can talk about them; they're no longer here. But that group of people—my question really is how do you speak to that group of people and convince them that actually taking personal responsibility is a good thing for them? And if they're focused on what their core values or their North Star is in their life, then personal responsibility is the path there—not blame, not victimhood. You know, like, how do you turn those people around?

Great question, and I have to say what I know about this I learned from Alcoholics Anonymous and what they do because they do something that's really incredible. First of all, it's necessary to validate somebody's victimhood. So this is to say, "You have been wronged," if they really have been wronged, to validate that, or, "You experienced this trauma," or, "You were born into this crappy situation and you were just a kid and you had no choice about that," and to really acknowledge that. But then the fourth step of the 12 steps of Alcoholics Anonymous talks about looking at each of those situations and after writing down, "This person wronged me," and exactly what they did—so you know, taking time to focus on the resentment, right?—then only after that to say, "Okay, but is there anything that I did that contributed to that problem? Is there anything at all that I could have done differently?" And for a little kid, you know, born into a horrific situation, you—there's not much, right, that that a kid could have—you know, we don't—we don't expect a child to take responsibility. But the adult who was that child who continues to perpetuate some of the harms they experienced on other people—now we're talking—now you can begin to take responsibility for your actions in the world. So I think starting with validating, you know, the trauma or the victimhood or the way in which we were wronged, processing it—so giving it airtime, right—but not stopping there, which is, by the way, which is, by the way, often, you know, in therapy—certain types of therapy—that's often where we stop. We don't then take it that very important next step and say, "But you know, let's go and look at that again and like, is there anything at all that you're contributing to this problem? Maybe it's just that you continue to ruminate about it, right? That like you're ruminating on your resentments is, in a way, your happy place, and maybe that's what you need to stop doing." So that form of sort of psychotherapy that stops there can help keep us sick and make us sick. It—it—it's interesting because someone that's in that therapy room who has ruminated themselves all the way down to having low self-esteem, being depressed, or whatever—um, it appears to me that people who are at that sort of ground floor state find it hardest to take responsibility for some reason. Just—that's an observation in my life—that the people that I have met that are the worst or that struggle the most with taking responsibility are those that have very low self-esteem. So it's almost this double-edged, like Catch-22. And then I—I've also pondered whether, you know, someone that never takes responsibility is more likely to have bad things happen to them, make mistakes, which are then going to further hurt their self-esteem, which are going to make it even harder to take responsibility. So I guess the question is, is there this relationship—is there a relationship between my current self-esteem and my ability or inability to take responsibility for a situation?

Yeah, great, great question. It brings to mind a patient of mine who—who said to me that—um, you know, that—and he had very, very low self-esteem—and he said essentially, "Dr. Ly, I'm the piece of crap around which the universe revolves." Meaning that he had his own brand of narcissism in which he wasn't the most successful person; he was the most successful at being the least successful person, and that became his identity, right? That was sort of how he saw himself and also how he saw the world, and it became very entrenched, and it was a kind of a narcissism because he created then situations in order to perpetuate, like, "I'm the worst of the worst." So I think the ways in which we get these sort of entrenched ideas about ourselves and the world can really hold us back from seeing clearly who we are, who other people are, and what—what the possibilities are.

Does our personal narrative need to be positive? I mean, what—I guess what do you mean by positive? Like, "I'm great!" Almost like have a—have a positive ending? Because I was thinking about the personal narrative I've created in my life, and my personal narrative is like, "Kid born in Africa, came to the UK, little bit of racial abuse here and there, felt different, shame, insecurity, parents weren't around, this made me independent, the shame made me motivated, and then I did this, this, this, and it went well." That's like my personal narrative. Um, but if my personal narrative was, "Moved to Plymouth from Botswana in Africa, a little bit of shame, little bit of pain, parents weren't around, my parents didn't love me, people don't love me," right? Right. If my personal narrative ended there, would it be, you know, would it be detrimental to me ever becoming successful, happy, healthy? I'm just wondering if because we all have a personal narrative—we have like a story—if we're up on stage and someone passes a mic to us and says, "Tell us your story," we'll narrate this version of events—um, skewed towards victimhood to heroism to, you know—

Yeah, I mean, as I said before, how we narrate our lives is important, right? It's—it's not trivial, and there are healthier narratives and there are not healthy narratives. And—and I would argue that the—you know, the victim narrative where—you know—perpetuates victimhood. You could make the same argument that the hero's journey narrative perpetuates hero—good. Having said that, if we get too stuck in any fixed identity or any narrative, I think that can become its own trap, right? And then we wall ourselves off feeling like we have to show up in a certain way or be a certain person. And I wonder if you have that experience, like, you know, you have this hero's journey, and now you got to be this hero. And I mean, I could imagine that that would be burdensome at times.

Yeah, I think it causes a lot of like dissonance internally. What I mean—like dissonance—I mean discomfort internally because people meet a version of you that doesn't reflect the version of you that you know. So like, that—the experience you have when you go—like I go to the gym or something—yes—and I say this to my team all the time—anyone that knows me personally has heard me say this 50 times—I will say the phrase, "I just don't understand what these people are talking about. Like I just don't get it." And I said to my team the other day in the office, I went, "It's almost like I think they're lying to me." And I said I was in this—I was in this meeting group—when you say you don't understand, you mean when they—when they praise you? Or—okay—yeah—yeah—it's so—yeah—unbelievable what they're saying to me that it—that it feels like you're—I've not even watched the Truman Show, I just know what it means, but it feels like this is—these people are just all lying to you. Yeah, and I—I was—I think I was talking to Jack and the team the other day about going to Thailand and being so far away from home and people coming up to you—like thousands of people—we're doing this meet-and-greet thing—and saying these things to you—and you—and I said to the team, I was like, "I think it's like—it's part of my brain that's like, 'These people are lying to me.'" And also—yeah, you can see how it can be a slippery slope to slide into their narrative of you, right? And you've got to do quite a lot to just like stay at home. What I mean by stay at home, I don't mean like physical location; I mean like staying grounded in like who you actually are, right? Um, and this goes for people that obviously, you know, have a public platform or don't. It's very easy for one person on the internet to say something to you and then you to start to accept that as your narrative. It's easy for your parents to tell you that you should be a doctor and then you go to university and you study to be a doctor and you become a doctor and then you start thinking you're a doctor, and how that can sway you away from the full array of things that make you who you are—the music, you know, the—the whatever hobbies you had.

Narratives are comfortable sometimes. They make us feel heard and understood; they make us fit. Yeah. But they also are a double-edged sword because they can take us away from like who we actually are. Yes. Yeah. So when I think about, you know, your experience of feeling like people must be lying to you—I mean, sometimes we call this something like the imposter syndrome. Where you—never thought of it like that—you know—it—yeah—projected personal—that is—is, you know, true in a way, but also doesn't capture the fullness of who you are or maybe is so extreme in terms of um, looking good that it's inevitable that you'll feel some dissonance with that kind of heroic figure. And I think the way to think about that and also, you know, um, not become like cynically suspicious of people who—who—who praise you when they meet you is just to recognize that you have become a kind of cipher or a vehicle for their projections. So they've listened to you; they've had a very positive experience or maybe they learned something, and it meant a lot in their lives, and you were the vehicle for that. And so you're a symbol for them, and they're projecting positive feelings onto you. And because you're now integrated in their mental tapestry as kind of a, you know, a totemic figure or a token—something important.

Interesting, 'cause part of what you just—as you were talking—I was thinking, you know what's interesting, I don't even—I'm not even the smart one in this. I'm interviewing these smart people—no—and the smart people are changing their lives, and then someone comes up to me in Thailand and says, "Well, you're wrong about that," so you're obviously really smart, and you also have, you know, a really high emotional quotient, right, which is its own kind of underappreciated smarts where you read people really well and you have intuitive reasoning. And I mean, I don't know you, but you also seem very humble and real. And so all of these things that people have a craving for—you know, authenticity—someone they can relate to—someone familiar—I mean, keep in mind, too, that more and more people live alone and have maybe fewer close contacts. So a person like you with a regular show that they tune into regularly—you become—you're in their living room. Yeah, you're not just some distant celebrity; like you are—your voice is there, your face is there; they feel they know you because they've seen you in all these different situations. And I think that's really natural and normal and not a bad thing. So you just have to realize when you go out into the world, you know, you—you've become a symbol for people; they're projecting onto you. You don't have to necessarily identify with that, but it's okay to let them have, you know, their experience through you, if that makes any sense.

It makes a lot of sense. Okay. Yeah, no, it makes a lot of sense. I felt the same imposter syndrome as you said. Everything there, I was like, that's—um—very kind of you to say, but it's—it's just very—I think part of the dissonance comes from the fact that I sit here in a room with you, and there's only the person in this whole room. We're in this big studio here in Los Angeles; it's Jack. Yeah. And so there's part of your brain—the like prehistoric brain—that thinks the three people that are aware of what happened in this room are me, you, and Jack. That's it. Yeah. And then you—you go to—you go to Kuwait, right? Amazing, and someone comes up to you in the gym and goes, "That conversation that you had about addiction," right? And that—that's the dissonance—like you went there. Yeah, but it's—I don't know—the prehistoric brain might—might not be able to fully comprehend the idea of cameras and numbers—you know—people are listening at the moment. Oh, no, they feel that they're there, and they—and again, you—you know, the guests are totally secondary because they're watching because they're identifying with you, and the questions that you ask, as you yourself said, are questions that you anticipate they would want to ask, right? You said that, so you are also channeling them.

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On this point of how we help someone in our lives who's suffering with some of the things we've talked about today—what is a bad way to try and help someone? Because we're in our—in our love for them, sometimes we do things which—even in my own experience of people that are struggling in my life—I think actually—I think in my pursuit of helping them, I've actually hurt them in some way.

Yes. Well, you know, there's this whole—sort of area of the addiction field called codependency, and codependency refers to the ways in which a loved one of the addicted person can actually enable or make their addiction worse without realizing it and without intending to. And the way that essentially happens is that we can—well, number one, addiction can—is very often a family systems problem. So the person who gets addicted, their addiction affects everybody in the family, and in order to cope and compensate, families can end up in these very strange, maladaptive places. But they often have difficulty seeing how to get out of those situations or how their behavior is harming their addicted loved one because, in a sense, they themselves get addicted to the addicted person and then use that addicted person to regulate the way that they feel. So, for example, I treat a lot of families where, like, the adult child is deep in their addiction, the parents know that the money they're giving the child is mostly going to drugs, and yet cannot bring themselves to stop giving the money. And often they're manipulated by the child—the adult child saying something like, "Well, if you don't give me money for drugs, I'm going to go get it off the streets, and it's going to be laced with fentanyl, then I'll—I'm going to die, and it's going to be on your hands." So this kind of like emotional hostage taking. But even when it's not that blatant, what can happen is just this very fascinating, very twisted and meshed relationship between the addicted person and the codependent person where, again, having the person engage in their addiction in a way is a predictable scenario for the codependent person. So even though they may say, on the face of it, they want this person to stop their addiction, on another—another level, they really don't. They get to be the martyr; they get to be the savior, or they even just get to predict what that person is doing based on their use.

I've had experiences in my life, and this is why I really wanted to ask this question, where I thought I was helping someone, yeah, and then the minute I withdrew the help and basically completely gave up, the person got better. Yes. But for six, seven, eight years, this person struggled, and the minute I stopped helping, they got better. I was like, so—I—I said to my partner before when I was talking about this, I was like, "It's possible to prop someone up in their like compulsive behavior and not realize you're doing it." In fact, there's three examples which me and my friends are aware of, and one of my friends talks openly about this where I was propping him up. Yeah, I was letting him stay at my house; I was providing for him while he was in his struggles. The minute I had a difficult conversation with him—when he was—I think I was 25 years old and he was 30—and I said, "You got to go. You got to go. You got to get out of my house," he went back, moved in with his parents in his childhood room, he built up his whole life again; he's out of the compulsive behaviors; he's very successful, very rich, living abroad now. I was like, "God, if I hadn't have pushed him out my like basement, he probably would still be there." I thought I was doing him a favor. And there's another really poignant example to me quite recently where someone who I've known for many, many, many years—minute I said to them, "Listen," and this sounds really harsh, right, because I tried paying for their therapy, tried paying for everything for this person, and eventually I got to the point where I said, "Honestly, I tried. Don't talk to me about this anymore. Yeah, stop talking to me about it; just don't message me about it; don't talk to me about it anymore," they got better. Yep. Yeah, it's really—

So—so there—Kai Erikson wrote this book on deviants where he studied Puritan societies and found that no matter what group of humans you looked at, there was always—there were always going to be people who were on the margins of the society. He—he used the word "deviant." His point being that groups of humans—we just have these roles and we have these hierarchies, and there's always somebody on top and always somebody below. And when—when we're occupying a certain niche or when we stop occupying it, we make room for somebody else. So when you stop being the hero and the savior, that person had room to stop being the sick victim. Interesting. Yeah. And my last question on this then is how do you approach that conversation with that person? Because so often it's approached through frustration or shame or blame—um—what's the best way to approach someone who's struggling with a behavior to express that your concerned and to—I don't know—offer your help if that's a good thing?

I think we can always try to find our empathy for them without necessarily—um—doing things that would perpetuate or enable that behavior. And we need to recognize that for many people with severe addiction, the—the—the only thing that will get them into recovery is real-life consequences—real-life negative consequences. And that our trying to protect them from that is not protecting them at all. We've got to let them hit rock bottom. I mean, this is a hard one because you have a lot of families now dealing with children who are severely addicted to opioids for whom, you know, being out on the streets might really result in their death. So this is not for every situation, but I can tell you in my clinical experience after 25-plus years, the majority of people with severe addiction who get into recovery get into recovery as the result of real-life negative consequences—lost their job, lost their partner, ended up in jail—whatever it was. Until there are those significant consequences, for some people they just won't be able to have the motivation to make a change. Guys, back to a quote I had a long time ago—some 10 years ago—that said, "Change happens when the pain of staying the same becomes greater than the pain of making a change." There you go. That's a good one.

I want to talk about digital drugs, one of the subjects that's been a recurring theme on this podcast, inspired initially, I think it was mentioned in an episode we had, but then it was—um—such a huge amount of the feedback we got in the comment section that I thought we need to talk about this more because clearly there's a lot of people suffering. We also then used a tool—um—which looks at what people are Googling and searching a lot, and one of the most popular searches around the subject matter of addiction is pornography addiction. Yeah, it's actually—it was number one and four in the—the search tool that we used, and the phrases people are using are, "How to stop pornography addiction," "How to help someone with pornography addiction," "How to rewire my brain," which are sort of all sort of correlated themes. So pornography addiction—something you see a lot.

Oh my gosh, I have to create a little bit of a space actually before I ask this question because I did a porn debate on the show, and I got a very long voice note from a good friend of mine who said, "Just watch the porn debate. There was two women there and a guy and me, Steven." Um, but I just wish someone had mentioned that women get addicted to—addicted to porn, too. Yeah. And then on the episode, one of the top three comments on the episode is, "I'm a woman—it wasn't mentioned, but I also have a pornography addiction." And you've also kind of echoed that with the erotic—like novels that you—you mentioned—romantic novels. So pornography addiction—do you see that often? And I guess critically, how does one go about overcoming that, and how do you know it's a pornography addiction? I guess it goes back to the point of harm, but yeah—yes—yeah.

So—um—I do think that pornography addiction is one of the biggest addictions and the most silent and the most shameful addictions that we have now in the modern world. Um, we will not infrequently have a patient come in to the clinic who claims to have other problems, and it's not until visit three or four that they finally fess up, "I'm really here for a pornography addiction." There's so much shame around it; it's so incredibly shameful for people to admit that they are spending their time looking at these images, often associated with compulsive masturbation. Some people—their addiction manifests by actually pursuing partners—so dating apps are highly addictive, and—and meetups—all of this is related to sex and orgasm, which releases dopamine in the reward pathway, but it's not just the moment of orgasm; it's all of the rituals and the buildup and the searching—um—that's related to it. Women can get addicted to pornography as well as men, although I would say that men outnumber women—probably, you know, in my clinical experience—um—I don't know, 10 to one. Women, however, are much more vulnerable to love addiction, which is also real, right?—the pathological compulsive falling in love with partners—um—and then getting into these relationships that are really dramatic and not healthy and then falling out of love and then pursuing—doing another love partner. So these addictions are real; they are very harmful for people who get addicted. Ultimately, they're not even about sex; they're about human attachment and the desire for human attachment and also just as a way to self-soothe and escape our own everyday suffering. And I'm particularly concerned about girls and boys who now have access to all kinds of sexual images that would not have been possible for them to get access to a generation or two ago. And now, you know, a child with a five—with an iPad can accidentally end up—um—on a site that has very graphic—um—sexual images and videos.

So what's the harm of pornography—watching pornography? Well, there's a lot—lot of potential harms. One of the harms, especially if combined with, you know, compulsive masturbation, is that it's just simply addictive, which means that the more people do it, the more they want to do it, then they have the comedown where they don't feel good, and then pretty soon it becomes like a—a compulsive, repetitive loop where they're spending large amounts of their day—um—engaging in this activity, and that—that in itself is highly debilitating. But other harms—um—I think that are significant are it really does change a person's conceptualization of what sex is—is and what sex is for. And I don't want to get into the whole thing of like, you know, sex is exercise or sex is recreational fun compared with sex, you know, as something that's maybe more sacred, because I—I—I—I'm not here to judge any of that, except to say that if a main pathway for a young person to learn about sex is through watching pornography, that's going to give them a very distorted view of what, you know, real sex—um—is like, not to mention what relationships are like, right? And how sex—um—becomes a part of—um—an intimate relationship.

I've heard a few people say that pornography lowers our motivation to go out there in the world and to pursue getting a job and getting a career and going to the gym, etc., etc. And through the lens of what we've talked about today where dopamine was this motivating force for those rats to just reach out and eat the food—if you remove the dopamine from the rats and it wouldn't even eat food in front of it and it will starve to death—when we think about men—you said roughly in your practice about 90% of the people that come in with a pornography addiction are men—this all kind of overlaps to create this picture that in the modern world, when we think about why more men are lonely, why they're more often in their basements playing video games now or watching pornography than ever before, why they're having less sex and having sex later—um—why they're struggling to form relationships—um—why less men are potentially in college at the moment—maybe some of the answers are in the fact of just like how men are wired. Because if they've—thinking this through—if men are more likely to have a disposition to these kinds of behaviors, then these kinds of behaviors are more likely to impact and demotivate and destabilize men. Is that all like roughly—broadly accurate?

I absolutely agree, which is why I've talked about the smartphone as a masturbation machine, essentially. These devices have become the way that we meet our physical, emotional, sexual, intellectual needs, and taken to the extreme that would mean that we're no longer relying on other people to meet those needs; we're meeting the needs ourselves with—with this technology and with the devices. And I don't think that's a future that anybody wants, taken to the extreme, right? Because we are social creatures; we need to connect with each other. Human connection is vital to a thriving life and survival in general. So yes, I have a lot of concerns that that pornography is now replacing intimacy with people in real life or disrupting our expectations of intimacy with people in real life.

When you say expectations, do you mean like hard work we have to do to create and find intimacy? That too. And also just expectations around sex. A lot of folks that I work with with sex addiction—as they try to give up pornography, compulsive masturbation, or whatever they define as their—uh—sexually addictive behaviors—what they find is that they almost go in the opposite direction, and they kind of have zero interest in sex or they just don't have interest in sex with their real-life partner or they can't enjoy sex with their real-life partner, you know, which all kind of makes sense, right? When you hijack the reward pathway with this incredibly potent version of sex, you come back down to earth with your actual partner who's got his or her own needs and, you know, aging bodies or whatever it is—um—it's hard to experience pleasure in that realm.

In an attempt to offer people out there now that are struggling with some kind of form of compulsive behavior or addiction a pathway to turn this around—what is step one? In my book, I talk—I've read all these incredible ideas—is around the wisdom we can learn from addicts. I learned about dopamine fasting, and I also learned about radical honesty in the role that that plays. What is the process? So someone listening to this right now—they're struggling with one of these addictions—they've got a pornography addiction; they're addicted to gaming; maybe it's food; maybe it's erotic novels; maybe they're on—they're—reading Twilight at the moment. What—what do you say to that person?

Step one is—step one is really just acknowledging the behavior—that it's problematic and that it might require some changing in our lives—um—um. The next step is being honest with ourselves and maybe another person about why we do the behavior—what we get out of it—what's positive—uh. Step three would be honestly making a list of all of the problems with the behavior—how is it interfering with my goals? And as we talked about—my values—what do other people say to me about how it's problematic? Is one of the problems potentially that it's just not working anymore the way that it used to, right? I'm developing tolerance; I need more to get the same effect; it's doing the opposite of what I want it to do. And after we've done all that—really done a really honest self-assessment about the behavior—I recommend a 30-day dopamine fast. Now, we're not really fasting from dopamine, right? Because we're not really ingesting dopamine. What we're doing a fast from is whatever that substance or behavior is that is causing these kinds of problems—potentially—maybe we aren't even really sure, but we think it might be—give it up for 30 days. Why 30 days? Well, we know that two weeks is not enough, right? We know that from this imaging study, right? That people are still in that dopamine deficit state two weeks after stopping, but 30 days—based on clinical experience—not just mine, but that of many other people who do this work—that—no—for most people—no matter the drug and no matter sort of the severity and chronicity—once they get to about 30 days, they begin to feel better; they

I've also wondered if dopamine is responsible for what people almost call the sugar cravings that we have. So what I've observed is, in previous years of my life, when I was eating lots of sugar, I would go into about a two-week cycle of binging on sugar. Right now, I'm in a really great cycle with my food where I have no cravings for sugar. I'm staying in a hotel here in LA; there's a minibar in the room with Oreos, gummy bears, chocolates, and all these things, and I haven't touched them. Because, for some reason, in this couple of weeks, I just don't have the cravings anymore. But I kind of suspect that if I start eating them, the next four weeks will be a car crash. Why does this happen? Yeah, it's so fascinating, and I think this is sort of a universal experience.

First of all, sugar is addictive. It lights up the same reward pathway as drugs and alcohol—clear dopamine release in the nucleus accumbens, part of the reward pathway, in response to sugar. When we quit sugar, we have a come-down; we go into withdrawal, and it's manifested in all the different ways that we've talked about. It lasts for about two weeks, and one of the most salient symptoms is intense craving for sugar. It's so amazing how intense it is. But if we can get through that period and get out of that vortex of addictive craving, the craving gradually gets better and then eventually goes away. Which is, by the way, very paradoxical because whatever our drug is, when we first stop it, we have intense cravings, and we have the feeling that the cravings will only get worse with time, even though we logically may have experienced otherwise by giving it up before. We have the feeling this is going to last forever; it never does. With time, the craving goes away. Once we're in that arena where we're not constantly craving, we might have something that triggers the craving—like stress—but generally, we're not dealing with a craving. If we were then to re-expose our brains to a little bit of sugar, immediately, back in the vortex of craving.

There's an experiment I love that illustrates this. It's an experiment in rats where rats were injected with cocaine—the same amount of cocaine every day for seven days. Over the course of those seven days, the rats went from kind of hiding in the shadows of the cage to progressively running a little bit more and a little bit more, and by day seven, they were in a running frenzy, as measured by these beams of light that they were crossing. Then there was no more cocaine injected after seven days, and no cocaine or any addictive substance administered to the rats for a year—a rat lifetime, a really long time. That would make you think, "Oh, you know, that there's no more cocaine in the system; none of that." And then the rats were injected with a single dose of cocaine, and immediately they were plunged back into that running frenzy that you saw on day seven. Really important information because it tells us that there's some kind of permanent latent echo in our brains once we've been exposed to, and especially if we become addicted to, a particular substance, such that even with sustained abstinence on the order of years and decades, if we are re-exposed to that drug, we can immediately be plunged into the depths of our addiction. There's no ramp-up period that happens.

Of course, we see this all the time: people with alcohol addiction who are then exposed to alcohol and right back to their max use, or even exposed to something like opioids. Alcohol also works on our endogenous opioid system, so there's some homology or similarity between alcohol and opioids, and then immediately being plunged into opioid addiction, which then leads them back to their alcohol addiction. It made me think about children because if I'm a five-year-old and I'm binging on sugar, this sets me up for a life where I'm going to be—I mean, based on the analogy, the experiment I just heard—it sets me up for a life where I'm going to so easily slip right back into that addiction for sugar. Also, I know that the brain isn't fully developed when we're children, so maybe the effect is even more lasting; significant. Is any of that true? Yeah, it's all true, which is why a big focus of the addiction medicine field is prevention and trying to make sure that we protect kids' brains from the harms of these addictive substances and behaviors—from sugar to digital media, video games, pornography, social media, or any other drug. You know, nicotine—so many kids are vaping now, taking 50-plus puffs a day on their nicotine vape; cannabis, alcohol—what's going on in the brain if a kid is exposed to those things?

Essentially, at age five, we have more neurons and neuronal connections than we have in the rest of our adult lives—about 50% more neuronal connections than we'll have as adults. Which is what makes us such good learners when we're kids. Kids can just absorb anything because they're sort of like these totipotent sponges with all these neurons and all these neuronal connections. But we age through adolescence to about age 25; we cut back, or what's called prune, the neural circuits that we don't use, and we myelinate, or make more efficient, the neural circuits that we use most often. Such that by age 25, we are left with the neurological scaffolding that will serve us for the rest of our adult lives. That means that if we're engaging in addictive, maladaptive coping at a young age, we're elaborating a neural circuitry based on that maladaptive coping, which is going to set us up for addiction in adulthood. I always like to emphasize, though, that because the child and adolescent brain is so plastic, or totipotent, or so changeable, that's also a very hopeful message. It means that even a young person exposed at a young age to an addictive substance, if we can get in there early enough while their brain is still plastic enough, we can rewire them. Whereas when I treat people in their 70s and 80s who have been, you know, smoking pot their whole lives or drinking alcohol—mainly it was manageable; now all of a sudden they retire, they're in their 60s, all this time the pot's a lot more potent—they can develop these full-blown addictive disorders late in life, and it's very hard to treat them because they've lost a lot of that plasticity that would allow them to regenerate new neural pathways once they abstain.

What is the most important thing that we didn't talk about that we should have, as it relates to dopamine? Oh my God, we talked about so much; I don't even know. It seems like it was a lot of stuff. I guess based on the questions you're exposed to from the general public, is there anything that we missed that someone at home right now is going to be screaming at the screen? Talk about, yeah. Well, I mean, I guess I would emphasize that when I talk about dopamine fasting, it's an early intervention; it's not an intervention that I would recommend for someone who had repeatedly tried to quit on their own and been unable to. Clearly, that would be an exercise in futility; that person should go and get professional help; maybe they need to go to a residential treatment center. I also wouldn't recommend dopamine fasting or just quitting your drug of choice if you're at risk for a life-threatening withdrawal. So we can have life-threatening withdrawal from alcohol and benzodiazepines like Klonopin, Xanax, Ativan. In those cases, go see a professional; get help with a medical detoxification before you try to sustain abstinence for a period of time. So, you know, I would blanket the whole thing with like the caveat: go see your addiction—go see the addiction medicine specialist near you.

Thank you so much. You're wel… it's been so unbelievably thought-provoking for me in so many ways. I thought I knew what dopamine was; I thought I had covered all the ground there was to cover on these subjects of sort of compulsive behaviors, but I was so unbelievably wrong. And it wasn't until I got into your book and started reading through your work that I was like, "Oh my God, most people have a clue about dopamine and the role it plays on us." And this scale analogy is particularly memorable because that helps me to think through many of the behaviors that I have in my life that I've either struggled with or become quite stubborn in various ways, but also has turned a couple of lights on to some of the things I said about, like, my sugar—eating sugar—and even like going to the gym, and why like my motivation can seem to fluctuate. With the gym, sometimes it's so unbelievably important because this little neurotransmitter seems to control so much of our lives, and we're never taught anything about it. So we become these kind of puppets, and the puppet master is this brain, which is firing off all of these neurotransmitters that are determining who we are, who we become, and also who we don't become. Thank you so, so, so much. I know you were nervous coming here today, but I have to tell you, you are very brilliant; you're exceptionally brilliant in so many ways. You—that's why I said you should start a podcast because you're really built for this medium. Thank you. You have a certain warmth and empathy to you while also being incredibly smart and accessible in the way that you communicate. So please carry on because I don't think—although you overcame that difficulty of those nerves—I think there's so many hundreds of thousands and millions of people listening now that are so thankful that you did; oh, like, really thankful that you did. And if you've just nudged their life a little bit in a better direction, that's worthwhile. So thank you.

We have a closing tradition on this podcast where the last guest leaves a question for the next guest without knowing who they're going to be leaving it for. What is the most recent piece of information that changed your life? I think the most recent piece of information that was very impactful for me was the realization that we are probably going to be cybernetically enhanced in the future and interfacing with technology in a way that's completely seamless, and that this is inevitable. We're going to become cyborgs, or at least we're going to be surrounded by the technology in a way that's invisible, and it's going—it's going to be just completely integrated into our lives. Whether it'll actually be under the skin, I think it will be, but I can see in that so much potential good and promise, and so much that's really terrifying, especially when I think about the way it's going to change us as humans. And my big fear about it is that we will become more and more isolated and that we'll end up sort of in these little cubicles of our own making, scattered alone all across, you know, planet Earth. I hope it doesn't lead to that, but that's that's my word. It's interesting when we become connected to the internet and we truly interface with the internet; we really don't need to use our physical being anymore because we can experience all the joy and adventure and travel digitally, and that's—I mean, it just messes with the incentive structures like we've talked about with dopamine. Yeah, changes our ability to get up and go and to do things. I mean, that's a lovely hopeful ending for us. Thank you so much. Yeah, thanks for the opportunity to, you know, teach people about this information; I hope it's helpful for people.

Super helpful, and I'm going to link both of these books below. I've got the *Dopamine Nation* book, which was the original, I believe. Yes. And then following that, you released the *Dopamine Nation Workbook*, which is a practical guide to find balance in an age of indulgence. I highly recommend everybody reads these. I'm going to go and reread them on my journey home back to London tonight. So I really, really appreciate you. Read these books, and honestly, everyone needs to go read these books. I'm sure they will. So thank you. Than you so much. Thank you so much. Do you know that 80% of New Year's resolutions fail by February? It's because we focus too much on the end goal and we forget the small daily actions that actually move us forward. Those actions that are easy to do are also easy not to do. In life, it's easy to save a dollar, so it's also easy not to. Making one small improvement each day, one tiny step in the right direction, has a big difference over time, and that is the 1% mindset, which is why we created the 1% Diary, a 90-day journal designed to help you stay consistent and focus on the small wins and make real progress over time. It also gives you access to the 1% Community, a space where you can stay accountable, motivated, inspired, along with many others on the same journey. We launched the 1% Diary in November, and it sold out, so now we're doing a second drop. Join the waitlist at thediary.com, and you'll be the first to know as soon as it's back in stock. I'll put the link below. [Music] ah [Music] [Music]