Kind: captions
Language: en
anna lemke welcome to the show
thank you for inviting me i'm really
excited to be here i am very happy to
have you the first time i heard your
name was from andrew huberman who is
extraordinary and he had mentioned you
and the book dopamine nation and i'm
obsessed with dopamine and certainly its
role in my life
and
i'm going to take a different approach i
think
than most people that have interviewed
you who sort of immediately go to the
dark side of dopamine and addiction and
all of that stuff
i think it may be my superpower and so
the question that i get asked all the
time is like hey i want to achieve
something in my life but i'm struggling
can't get out of bed i'm bored and
whatever and my answer is always you
just don't want it badly enough
and as i learn about dopamine and the
difference between
craving something versus getting
something
and you get into dopamine and how
dopamine's really about wanting
something and that's when i realized i
might just be really good at tying
wanting something to a flood of dopamine
which makes me feel good
and then i'm very careful to make sure
that only the pursuit matters and so
then if you're careful that the pursuit
is what i call exciting and honorable
right so that you're not chasing things
that are self-destructive or detrimental
to other people in fact they elevate
other people
you get into this really interesting
self-reinforcing loop so i'm curious if
you've thought about
the positive side of dopamine
i love the way you articulated that i
that is actually
my
life philosophy as well that the process
is really what matters and not the
outcome but i guess i've never
thought about it or framed it in terms
of the neuroscience of dopamine it seems
that you're suggesting that your drug is
the pursuit and that you get dopamine
from that and whether or not your
efforts lead to
the desired outcome
is separate from
you your your rewarding experience
otherwise you're playing a dangerous
game yeah because a you said in the book
the humans are the ultimate seekers if i
remember the phrase correctly yeah and i
was like oh my god yes that is exactly
true and if you seek poorly meaning
blindly that you don't realize that
you're a seeking machine that nature has
hand crafted you to seek
versus have right because you can never
eat a meal big enough where you don't
need to eat again so it's like nature
had to find that way to keep you going
yes and so so many people think that you
know wealth is usually the one right if
i could just get that amount of money i
would feel good right and of course it
won't work
yeah i mean i think
what the the wisdom that you're offering
which i think is really valuable is
the reward itself whatever it is
might be
rewarding the first time around but then
over time the way that we're wired will
make it less reinforcing less rewarding
so then we need a little bit more and a
little bit more and a little bit more so
ultimately the reward itself is not the
thing to seek because it's the pot of
gold at the end of the rainbow you it's
ever elusive
but i want to ask you something because
um
you know you say that for you the it's
the seeking that is the source of the
reward itself
and yet
you have been very successful in your
life so it's been a positive reinforcing
loop it might be that your trajectory is
very long so that you know you're you're
really good at delaying gratification on
the other hand it seems like you get
there you get your goal so i guess i'm
wondering what you would say
with this kind of frame
um if the goal really is not achieved
and if it's repeatedly not achieved what
how do you
how do you then say to somebody you know
oh it's just about the pursuit yeah
you've gone right to the deep end of the
pool so
here this is really the secret to
success is
i want being a good person to be enough
like when i advise people about business
your goal really does need to be
honorable now in a hyper-connected
social age you'll get raked if you're
not after good things
but unfortunately being a good person
isn't enough and so you have to also be
business savvy so i amended a word to my
phrase around pursuit to be sincere
pursuit
so i wake up every day sincerely
pursuing my goal so my goal is to build
the next disney now that's a dizzying
endeavor right so they have a 90-year
head start they have billions of dollars
and revenue billions of dollars in ip
like the
the odds of me pulling it off are
vanishingly slim
so
i know better than to hold myself
accountable to actually building the
next disney and by the way that's so far
in the future that even if i do it on an
accelerated time frame what are we
talking 10 years 20 years like that
would be astronomically fast
so to be able to sustain myself for two
decades in the case of like just rampant
success i'm murdering it just every day
is is a victory
um
that would be such prolonged
gratification i'd never make it right so
on the days where even i don't feel like
getting out of bed or i'm being kicked
in the face by some just unending string
of failures
you really have to
say the thing i'm going to value myself
for right in this moment
is sincerely pursuing this goal because
it's tempting to just play rhetoric
right and you can actually get away with
that for a while where people buy into
the rhetoric it makes them feel good to
in in today's social climate they can
watch me pursue my dreams my huge dreams
maybe i fail they can live by proxy
and so for some period of time i could
get away with
just rhetoric and i can still gain
followers and all that
but
because i hold myself accountable to
sincere pursuit even if people are
cheering me on and saying that oh my god
this is amazing and i love that you have
this big dream i'm looking at myself
going did i actually
measure myself against the progress i
would need to make to build the next
disney to take the real steps towards
doing that and so being able to assess
from a business perspective what's real
am i actually making progress
but the tricky part is i'm not valuing
myself when the answer is i have failed
and i've let's say even move backwards
it was but did i really play to win and
if i showed up and played to win but
failed i still emotionally reward myself
if i win but i'm not actually playing to
win then i don't cheer myself on
and that is nuanced perhaps but it
really matters and so i end up on a long
time frame because i fail a lot but on a
long time frame because i'm learning
from those failures i actually make
progress
so it sounds like
you have some kind of intrinsic reward
that you give yourself
based on kind of this
sort of morality you've created
around
trying your hardest is that is that sort
of that's part of it but i think a
little bit um
like so in the book you talk about how
you can put a running wheel
like a rat running wheel if people can
imagine that little metal mesh thing um
in the wild and yet the animals will
still go and play on it right and so
there is
and i'd be curious to know what you
think from an evolutionary standpoint is
that the rats or because there it was
like frogs rats snails like all these
different creatures come and play on
this thing
uh is it that nature needed them to be
willing to do hard things in order to
escape predation
well i mean i think we we are hardwired
to approach pleasure and avoid pain and
that's really at the heart of our
dopamine reward system and you're
absolutely right dopamine is not just
about the reward it's also about the
wanting and the motivation
and it's relative dopamine so it's
whether our dopamine is above or below
tonic baseline that really um is
at the heart of this motivational cycle
um you know from an evolutionary
perspective the just so story that we
can tell ourselves is that the reason
that mother nature made a reward pathway
that doesn't just give us the reward but
also makes us pay for it afterwards by
going into this dopamine deficit state
is because that's the ideal biological
system
to drive us to continue to seek to not
never be contented with with what we
have
and what i'm finding very interesting in
talking to you is that your
kind of let's say life hack in the
modern ecosystem where
we have everything we could ever really
want
and where this this type of you know
physiologic with this drive toward
homeostasis and this pleasure pain
balance and dopamine deficit state which
i'm going to assume because you're at
the book you understand we're going to
have to go into the pleasure pain that
that is so interesting yeah but finish
that that will bring us back to it
it's it's like that it's like it's like
a nature's cruel trick in the modern
ecosystem because it you know
essentially turns us all into people
with addiction because we have
everything so that that constant pursuit
that never being you know satisfied with
what what with what we have with always
wanting more
um you know gets us
into this trap of compulsive over
consumption or addiction
but
you have decided that the way
to sort of manage that reality is to
make the pursuit the heart of it knowing
that you may not get it but that that is
not the most important piece but the
most important piece is to pursue
and to be honorable about it right and
to um give it your best shot so to speak
is is that a fair it is and i i do
wonder if my
brain were biopsy
do i just have like a screaming amount
of dopamine receptors and so i'm
particularly receptive to that pleasure
cycle
or or or it's possible that you actually
have
you know opacity of dopamine receptors
so that's interesting so that your
relentless pursuing is because you have
some kind of
um you know difficulty feeling reward
and so you have to get into the chills
and you know there's some science
actually showing that that people who
are vulnerable to addiction are people
who do have this relative insensitivity
to rewarding experiences and so need
more
sensory experiences more input in order
to kind of just bring them you know up
to other people's baseline
um and so you may be you know in that
category
um and i always like to say you know
that that people that are wired for
addiction because we do know that this
is
inheritable that not everybody is
equally vulnerable to the problem of
addiction and i i really believe and
again these are sort of evolutionary
just so stories but i believe
that you know
tens of thousands
of years ago
people who were wired for what we call
addiction today back then were you know
especially valuable to the tribe because
those were the people they were the
seekers right they were the ones who
weren't satisfied who were willing to go
further and work harder to get what we
need of course today it's tricky because
you have to kind of make it up and so
you've you've made it up i mean you've
made this goal and you know you're
relently pursuing it and it has kind of
meaning and purpose and it keeps you
busy and it turns out you're really good
at it so you're successful so that's
wonderful but i just will hold out to
you
that
another response to this modern
conundrum is to do almost the exact
opposite
and
and to sort of say you know
this pursuit of these rewards
is really ultimately empty and so i'm
not going to
i'm not going to play that game at all
i'm not going to frame my life dopamine
rewards the
okay yeah i mean the pursuit i mean
rewards you know are what our dopamine
it's a signal right we do something it
feels good our brain releases dopamine
it says do that thing again and then we
go into a dopamine deficit state and
then that says oh you know that's a very
powerful powerful physiologic drive
that insists that we pursue that thing
again even when we stop liking it so
that that's the vicious cycle but um
i'm just i'm just throwing it out there
like as a philosophical idea that
your
solution to this modern problem and it's
a modern problem that we all have
is to
seek more to try harder
to find the the road with the most
friction
and go there
my pursuit is slightly different than
that okay and so i'll be interested to
see if this resonates with you what i'm
really doing is i had a fundamental
realization so in my early 20s and long
time listeners of the show be tired of
hearing me say this but in my early 20s
i've never heard it so right in my early
20s i was sliding towards depression
i would come home from work and just lay
on the floor of my apartment
and was just like what am i going to do
with my life
and i had early realizations that my
brain was my problem and so i started
reading about the brain and the more i
could understand the mechanisms of my
brain the more i felt in control and so
i'm obsessed with conveying this idea
that you're having a biological
experience and so once i understood okay
wait i have this organ
it works in a certain way
nature has spent millions of years of
evolution fine-tuning it to make sure
that i do the right things to stay alive
long enough to have kids that have kids
and
i was like okay well then if that's
really the game then really life is a
game of neurochemistry and i realized
through the pursuit of success which
early in my career i was sort of
pseudo-successful at and luckily it was
just enough sort of pseudo-success that
i realized oh this is never going to
bring me pleasure
and so i better divorce myself from
outcomes and think only about what would
i enjoy struggling at so struggling well
became a focus but really the the meta
focus was
this is a game of managing my
neurochemistry
and whenever i have a problem in my life
it's because i am in a neurochemical
state that does not feel good and so
nature has all this energy pushing me at
my back to get away from that
and it's moving me away from certain
things and towards others and then
thinking so i in my family thankfully
not my immediate family but my extended
family there's much addiction okay and
so i got to see it up close i was like
that doesn't look like a lot of fun and
so
um i never went down that path but it
became clear to me that people were
doing drugs to manage their
neurochemistry right so i was like okay
this is then the
the game like the with a capital t game
with a capital g like this is the game
it's neurochemical management
and
so
all of my rules in life all of my hard
pursuit and business all of that
even
love
is recognizing oh this is a game of
neurochemistry
and so i've been married now for 19
years and change
uh been together for 21 years
and part of that was once i understood
that relationships are this sort of
ever-changing neurochemical cocktail i
wasn't surprised when that initial
drug-like love of just being consumed by
thoughts of my wife uh when it went away
it wasn't surprising right
so that's sort of the nuances knowing
that wink wink
the meta game is just neurochemistry
what's up everybody tom billy here quick
question for you how many times have you
sat down in your life to write out a
list of goals and said yourself for real
this time i'm gonna make every single
one of these happen and i will not quit
if you're like most people you set a lot
of goals but you don't achieve all of
them in fact you may not have achieved
any of them great news is i don't care
if you are the highest achiever in the
world or if 2021 has beaten you down
hard what i know for a fact is that
humans are wired to adapt and no matter
how difficult the previous year or years
have been you can find your path to
fulfillment and achieving your goals
look my friend trust me learning how to
stick to your goals and achieve them
again and again is a skill and you can't
learn it you can master it and when you
do it will serve you for life
great news is it's a process like
anything else 2021 has been hard for a
lot of people so i'm going to be going
live later this month to host a workshop
on exactly how to run that process
called how to make any goal stick now
you can go to this link or click the
button on your screen and get free
access to this live training and when
you register i'll send you a bonus class
from impact theory university to get you
started alright see you soon over at the
live workshop and until then my friend
be legendary take care
so it's interesting so you have sort of
boiled it down to this purely
reductionistic yeah like chemical soup
i just need to manage the molecules in
my brain
and
you know
taking drugs you know using addictive
substances
is maybe one way to manage it in the
short term but in the long term that's
not going to work out and i know that
because i've seen it you know in people
in my family and maybe you just intuited
it also so so you kind of immediately
went to the pain side of the balance and
said
i'm gonna do
these things which i think are more
likely in the in the long run
to be a good way to manage my
neurochemistry
it was a bit stumblier than that okay in
terms of i wasn't clever like that in my
early 20s it took me a long time to
piece all this together yeah but um
the pleasure pain balance is probably
something we cause it's going to keep
coming up we should take the time to
define that because this is
just revelatory in your work thank you i
didn't
understand that until i read your book
and
yeah so if you can walk people through
that i think it'd be really helpful sure
so one of the most i think one of the
most important findings in neuroscience
in the last hundred years is that
pleasure and pain are co-located by
which i mean that the same parts of the
brain that process pleasure
also process pain that's so crazy i know
and they work like opposite sides of the
balance of a balance like a balance a
teeter-totter in a kid's playground
except when the balance is at rest and
level it's actually parallel with the
earth it's not tipped one way or another
so when we do something that's
pleasurable or reinforcing or rewarding
that balance tips to the side of
pleasure when we experience something
painful like cutting our finger
it tips to the side of pain
but one of the overarching rules
governing this balance is that it wants
to remain level it doesn't want to be
tipped for very long either to pleasure
or pain
and the brain will work very hard to
restore a level balance or what
neuroscientists call homeostasis and one
of the things that i find fascinating is
that it's really a biological imperative
not just in our own physiologic symptoms
but in the universe to
go to homeostasis and that any deviation
from neutrality is actually a form of
stress
in fact biologists define stress as a
deviation uh from neutrality either
direction in either direction right and
that's really that's the key
um you know getting back to sort of
the problem with modern life and one of
the main problems with modern life is
that we have too many pleasurable
substances and behaviors and that is
actually stressing us out it's literally
stressful because we're causing this
huge deviation from from neutrality
but
getting back to the pleasure pain bounce
so when we do something just obviously
pleasurable like you know i don't know
having a beer or playing a video game or
eating a piece of chocolate it depends
who you are because people are different
but in general those things are
pleasurable to many people what we do is
we get a little um tilt to the pleasure
side and we get the release of dopamine
in our brains reward pathway which is
this evolutionarily phylogenetically
conserved very very old part of the
brain that's been unchanged in our
brains for just millennia and is also
identical in other species all the way
down to the lizard which is why it's
sometimes called the lizard brain
you know our evolution meant that we've
piled a whole bunch of other layers on
top but that part is exactly the same as
it's always been and it's the part that
gets us again to approach pleasure and
avoid pain
but here's really the key the way that
the brain restores a level balance or
homeostasis after this deviation to the
pleasure side is to not just bring it
level again but tilt it in equal and
opposite amount to the side of pain and
that's called the opponent process
reaction
and i sort of think that is these little
gremlins that represent neuro adaptation
hopping on the pain side of the balance
but they like it on the balance so they
stay on until it's tipped in equal and
opposite amount
that's that moment of wanting just one
more video game you know another beer
another piece of chocolate now if we
wait a little bit because it's a
powerful physiologic drive to reach for
more if we wait the gremlins hop off
that feeling passes
and homeostasis is restored and we want
homeostasis to be restored it's really
important because it's fundamental to
the resilience of this system because
when the system is at baseline
homeostasis
it's sensitive right it senses new
pleasures it's aware of potential
dangers and painful things so we know to
avoid them
but let's look at what happens if we
instead of waiting for those gremlins to
hop off instead immediately reach for
another beer another piece of chocolate
another video game
another major rule of this balance is
that with repeated exposure to the same
or similar stimuli
that initial response gets weaker and
shorter in duration
and the after response gets stronger and
longer so i think of that as sort of an
arnold schwarzenegger type gremlin
hopping on the pain side to bring it
balance again so we need stronger
gremlins right we need more and
essentially what's happening in the
brain by the way with those with those
neuroadaptation gremlins is that we're
down regulating our own dopamine
transmission we're taking our dopamine
receptors that are on the outside of our
neurons and we're resorbing them into
the neuron all of which is a way to
accommodate this huge increased bolus in
dopamine
but again what ends up happening is now
that opponent process reaction
is stronger and longer so we go from
you know shorter and weaker to stronger
and longer on the pain side of the
balance and that is the fundamental sort
of paradox or vicious cycle that we get
into especially when we're living in a
world in which we have nearly universal
ubiquitous access to highly potent
highly reinforcing drugs and behaviors
which don't just release a little bit of
dopamine but a whole huge bolus and
we're all surrounded by them all the
time every day and over time what that
means is that we're bombarding our
dopamine reward pathway with way more
dopamine than our primitive brains can
handle and the result is that we end up
with enough gremlins on the pain side of
the balance to fill this whole room and
they are now camped out there and that's
called allostasis so we've gone from
homeostasis
to allostasis and allostasis is where
our body has to accommodate and work
very very hard
to try to restore
homeostasis and if it's unable to do
that using the normal mechanisms it
essentially changes our set point so now
we've got those gremlins camped out
there they're not leaving even when we
wait a while they're camped out there
you might also even think of it as sort
of the fulcrum of that balance shifting
slightly to the side that means that
our our our balance is tipped to the
side of pain it's actually easier to tip
it that's right it's easier to tip it to
the side of pain and it's really really
hard now to experience pleasure and we
need a lot more a lot more pleasure to
do it and when we're not using we're in
a state of anxiety universal symptoms of
withdrawal from any addictive substance
anxiety irritability insomnia dysphoria
and craving for our drug and so this is
the fundamental problem and what i
hypothesize in my book because i
actually believe it's true although
somewhat controversial
is
i mean i guess i don't know how
controversial it is i think it's a
relatively new idea
if you look at rates of depression and
anxiety
all over the world today they are going
up
skyrocketing skyrocketing suicide rates
too also physical pain
the richest countries in the world are
the countries that have the most
suicide
anxiety depression and physical pain and
this is by many different measures many
different survey measures many different
types of studies so clearly we have
something very strange going on here
where
the more we have
of the kinds of you know ideal things
that we think would make a good life
right
lots of food lots of fun stuff
um you know lots of medicines to protect
us from you know illness and pain
we've clearly reached some kind of
tipping point where
we're now essentially more miserable
than ever and the question is why why
would that be and i do think that the
pleasure pain balance explains that
because our primitive brains were not
wired for an easy hyper-convenient world
we are suffering as a result of all of
this access to these feel-good things
this is bananas so what i love about
science is that it makes predictions
hypotheses and like you're saying that's
as you were explaining the pleasure pain
pain balance
i was thinking oh this makes certain
hypotheses about what then would result
so for instance that you would start
taking a drug and then you would need
more and more and more of it to get the
same level of pleasure which of course
anybody looking at drug addiction knows
that's exactly what happens when people
are chasing insane amounts of the drug
to get the same hive which they can
never quite recapture right it would
also predict that we'd have these
elevated levels of things like
fibromyalgia where it's just sort of
generalized pain and i don't know why
i'm in pain right
which of course we see
and so it's really i mean it's a little
unnerving but it's nice to have a
potential solve for why all these things
are happening in the book you talk about
somebody who was doing cutting and they
just couldn't stop themselves because it
was making them feel something
and right that is
really crazy but certainly lends a lot
of credence to this pleasure pain
balance yeah so let's talk about cutting
for a second because it gets to
you know the
sort of what to do about this and and we
started out talking by what what you
sort of you know intuitively figured out
what to do about this problem which is
essentially what dopamine nation
recommends which is to say the first
thing that we need to do is to cut out
all of these feel-good substances and
behaviors at least for long enough
for
those neuro-adaptation gremlins to hop
off and for homeostasis to be released
fasting yeah essentially dopamine
fasting right and whatever your source
of dopamine is to cut it out for long
enough now in my clinical experience in
my practice because i have patients who
come in seeking help for anxiety
depression insomnia and the first thing
that i will typically do is to have them
cut out their feel-good drugs and
behaviors very counterintuitive right
because you're going to feel worse
before you feel better because as soon
as you do take the the weight off the
pleasure side you're going to get this
balance slam into the side of pain
because now you've accumulated all these
gremlins right
but
if you wait long enough without using
they eventually do hop off
in my clinical practice it takes a
minimum of a month
abstaining for that to happen once it's
very impressive you got that teenage
girl to cut out marijuana yeah for a
month i was like all right how's she
gonna pull this off right right yeah and
it's hard to do because um you know the
sensation is that that i'm depressed and
anxious and that's why i'm using because
it relieves it and what we're not able
to see is the true cause and effect of
oh
because i'm using this substance
repeatedly and bombarding my you know
dopamine reward pathway
that is why i'm depressed and anxious
and and that's the thing that we're just
that cause and effect loop we're not
good at seeing but you know she was
willing to take that leap of faith to
stop smoking cannabis for a month and
ultimately what she discovered and this
is really the beauty of this
intervention is that she herself
gathered data and realized you know
after first of all she realized the
first two weeks she felt horrific
vomiting you know she had no and she
realized that was her realization oh my
goodness i was really addicted like i
hadn't realized i was but that
physiologic response when she stopped
was a wake-up call for her and then when
she got to four weeks she just felt so
much better you know less depression
less anxiety more time to do other
things more enjoyment and other things
because of course with addiction or our
focus narrows on that one thing
and then she herself was motivated now
did she want to you know continue to
abstain from cannabis no she didn't most
of my patients don't but she wanted to
use really differently than she had
before she wanted to have a different
relationship with cannabis she certainly
wanted to use less
she certainly didn't want to use every
day because there is something important
about that 24 hour cycle and if we're
sort of pinging our reward pathway every
single day we're more likely to
accumulate those gremlins on the pain
side of the balance and to develop
tolerance what is it about weed
people would be smoking weed yeah like
it is crazy there are people in my own
life that be smoking weed okay
is it
is it the sort of perceived harmlessness
or is there like i whatever people get
out of weed i don't get i will say the
one caveat is sex on wheat is crazy
like in like when you first do it and of
course even though i rarely do it i find
that it does diminish over time yeah
but why weed what what what's going on
well i mean so as as with all
intoxicants they mimic a chemical that
our brain makes and our brain makes a
version of cannabis
that binds to the anandamide receptor
and
weed is essentially a super potent form
of a chemical that our brain makes
anyway
and if you look at the evolution of weed
over the past 30 to 50 years
it's slowly been made much more potent
so you know our grandparents weed is not
our kids weed right it's gone from
really a soft drug to a hard drug which
also makes it more addictive if you look
at the the sort of things that make
something addictive it's not considered
uh controversial because for a long time
people like come on you can't get
addicted
you know i guess it is probably still
controversial it's not at all
controversial for me because i would say
about a third of my clinical practices
people coming in and wanting help for a
cannabis addiction whoa oh yeah oh yeah
i mean i'm in northern california you
know cannabis is medicine
and um
a lot of people end up addicted the data
show that about nine to ten percent of
people who use weed will end up addicted
to weed but that's probably an
underestimate especially giving the
rising rates of daily cannabis use the
other thing about cannabis is not only
was it less potent in the 1960s and 70s
but people tended to be
weekend recreational users with friends
what the data show now is that many many
more people are using daily they're
using all day long and they're using a
highly potent form so it's essentially
like smoking a pack of cigarettes people
wake up
they start smoking they smoke all
through the day and then they start
again the next day and there are more
and more weed users like that than there
used to be a generation or two ago
yeah it's really like even when i was a
kid it was like
i remember seeing weed for the first
time and freaking out i was like yo like
that might as well have been heroin i
was like really sketched out by it and i
was like okay i need to get away from
this
and admittedly i grew up with a mother
who was just beating us about the head
neck and chest about staying away from
drugs and if somebody like she used to
quiz us if somebody offers drugs what do
you do where do you go it sounds like me
yeah that's great certainly work neither
my sister or i use uh any drugs um and
now it's like really popular and i don't
have a beef with it if like people have
a healthy this is a weird word to use
when talking about drugs but if they
have a or you know relationship with it
that isn't
detracting from the rest of their life
cool no moral judgments whatsoever but
it is
interesting to me from like a an
anthropological standpoint to watch how
it has changed in culture to go from
this thing that only potheads which used
to be a super derogatory term would use
to now it's like you almost have to do
it to be cool
right and the other thing very important
i mean you know cannabis has become
medicine right i mean and there there is
clearly um short-term medical utility i
will say though that the studies showing
medicinal benefit whether it's for
um seizure spasticity or for pain
um or for you know other indications
are really short-term studies we do not
have good long-term studies showing
long-term benefit especially when used
daily
um but
people have this notion that cannabis is
very safe and that it's not addictive
and we do know you know from studies out
of nida that
the more people associate something as
being medicinal the less likely they are
to be concerned about the dangers or the
harms so is there studies coming out
that show dangers and harms oh yeah of
course i mean especially again with
long-term use first of all smoking
anything is bad for you right so
certainly um lung damage is is huge and
most people who use cannabis whether
recreationally or medicinally smoke it
they're most people are not you know
doing edibles
there are people who do edibles people
do in combination but most people smoke
it
and there are a lot of potential
downsides associated again especially
with daily long-term cannabis use not
the least of which is the potential of
becoming addicted
yeah it's interesting so
yeah addiction is a whole thing that you
go into in the book it's really
fascinating the lengths to which the
human mind will go to get these dopamine
fixes
um
the story that you i think it's the
first story you tell in the book about
the guy using electricity to stimulate
himself which is pretty intense
uh
but the lengths that people will go to
when they get in that cycle
um so he would he created this machine
not to be too graphic that he would
attach to the more sensitive bits of
himself yes
and
he's i think there was one point where
he said he could keep himself like
just below orgasm for like 20 hours
right and that just that was exhausting
to just to read let alone to do what
what's going on for somebody at a sort
of physiological level when they get
into that loop and then how do we begin
to work our way out of it
well i mean he progressed to that right
over he started out just
with compulsive masturbation to images
but over many years he ultimately
progressed to that again that speaks to
tolerance needing more of a drug to get
the same effect over time or more potent
forms
and so the machine for him was this very
potent form i will also say that it also
it it
it enlisted his creativity which was
part of the appeal and which which i
often see with i've read the book so i
know you mean but tell people because i
found this really interesting yeah i
mean well it you know he built the
machine himself right and he's a
scientist so that was something that was
exciting for him um you know research it
and figure it out right figure out how
to put it together part of the shower
ring yeah
you can imagine the anticipation because
what what we experience when we're
either euphorically recalling using our
drug of choice or we get reminded of it
from something in our environment
environment we actually get a little bit
of a dopamine spike just from that
followed by a little dopamine deficit
state which is then you know
triggers our craving or our drought
really makes you want to do it so just
thinking about it feels good for a
second then bad and you're like oh i
gotta go do it yes that's right that's
right what an early trick yes it's very
gnarly
but basically um and then also he he
could program all these different things
i mean that then was part of the
excitement different settings he was
letting people control it over the
internet i mean it really got like
really good from again from an
anthropological standpoint god bless him
for being so vulnerable and like willing
to discuss it which is amazing
yeah but
what a glimpse into the human mind and i
do not take myself out of that i am just
as mired in being a human animal as
anybody else right but right wow it was
right how much he got caught up in it
right how he's destroying his marriage
i mean yeah yeah really fascinating yeah
but the part like so a i've said this
many times i am so glad like
truly you want to have the chills now
gratitude for the fact that internet
pornography did not exist when i was a
teenager
for i can tell like i was right very
uh joyful when you found that one kid
that had like the vhs porno tape uh but
at least then i had to give it back
right right the thought of having access
to that with my undeveloped prefrontal
cortex right oh dear god yeah and that's
really one of the reasons i decided to
lead with that story even though i think
for for some people it was sort of
too much
but i really i really wanted to make the
point that like this is a really serious
problem right you know i mean
pornography addiction is huge and and
we're talking about addiction a lot more
than we ever did before but we're not
really talking about pornography
addiction and it affects a whole lot of
people and when people get caught in
that cycle it's really hard to describe
what it's like but you're really trapped
you're trapped in it you want to stop
it's not even really working it's only
kind of working
you know when you're not doing it you
feel horrible again it's the balance of
reset to the side and yet the compulsion
the drive is so enormous that it's just
really really hard to get out of the
loop and then
when you try to abstain they're just
constant reminders everything you look
at is about sex everything has sexual
images
right that's right well that was that
was well that was part of his
really disciplined approach to
abstinence was that he covered his own
body because he realized that alone
would be a trigger for him i mean talk
about triggers right when you get to
that point but i mean i will say that
like even i
in my stanford
inbox email
get
solicitations for pornography for
middle-aged men with like images images
of naked women i mean i can tell you
i've never looked at any of that online
but somehow
for some reason those come into my inbox
imagine if i actually had a problem with
that i mean you know it's you just see
it and then you're you can't not go
further
so i really do think it's a huge problem
and
i mean as as a parent of teenage boys
how do you deal with it how do you deal
with it i mostly just
well first of all we talk about
addiction a lot in my family and the
kids have heard ad nauseam about the
pleasure pain balance so
i mean i hope that they take that with
them and and that they understand what
to look for as they're becoming to you
know the development of tolerance
needing more and more to get this impact
more potent forms doing things in secret
um you know doing things that are
contrary to your values like all of that
matters those are signals for your brain
that like oh i maybe get getting you
know caught up lying about what you're
doing covering it up feeling ashamed
about it i was shocked about the whole
part about radical honesty talk about a
part i did not expect in a book about
dopamine and that sort of ties into the
the 12-step recovery that you
praised pretty heavily in the book and
i've heard you talk about so okay
i think everybody will relate to there's
something that you have whatever that
thing may be it may be illicit drugs it
may be pornography it may be sex it may
be in my case the drive to accomplish
right it comes in many many forms
how do we if we have an unhealthy
relationship with that so we've talked
about the fasting dopamine fasting but
the 12 steps
why do they work how does radical
honesty work into this right yeah so the
12 steps are really interesting at the
core of the philosophy of the 12 steps
is the idea that a spiritual
transformation is necessary in order to
overcome your addiction
and that's that's an idea that people
have talked about now for at least 100
years
but but really
the 12 steps is very practical it gives
you specific things to do and i think
this is really important because when i
look at sort of mental health treatment
and psychotherapy
what i think is lacking in a lot of
mental health treatment and
psychotherapy is specific things to do
we talk a lot about you know knowing
what your thoughts are and understanding
your emotions and seeing how those are
connected and of course that's great but
people need to know what to do on a
day-to-day basis and this is where i
think the 12 steps is super powerful
because it lays out in those 12 steps
you know cognitive and metacognitive
strategies but also like step four you
need to make a list of your character
defects then you need to share that with
somebody else and your higher power dude
that really works because i've done it
so i i can tell you that it's powerful
and i so and i talk about this in the
chapter on radical honesty i think the
way that it works
is that
we are all naturally inclined to want to
blame other people for our problems and
not see our own our own problems and our
own contribution to the messes in our
lives
but as long as we continue to do that we
are not actually telling true stories
and telling true stories is really
really important
to be able to
get all of the data incorporate the data
in that thing we call our brain you know
punch it through and then come up with
good solutions if you only have part of
the data you can't come up with a good
solution right i mean that's just basic
but as long as we're not telling
ourselves or others the truth about what
is happening in our lives we can't come
up with good solutions so the importance
of telling
true autobiographical narratives or at
least as close as we are able as human
beings to get to that is i think really
really core to well-being and good
mental health so that that's a that's a
key part part of it in the book you talk
about somebody who honestly reading the
book i was like i'm not so sure he
should have told the truth in this
example do you remember the yes
so
one if you can quickly recap that story
and then two did he make the right
decision oh yeah yeah that was great so
this was uh this was a physician that i
saw
um who uh told this oh i thought i saw
him like 10 or 15 years ago and i i
never forgot his story because it to me
was just so powerful
he basically was in medical school he
got a dui
um you know he had been drinking and
driving he went to a party drank too
much the cop was waiting to catch people
because he probably had a quota uh he
got this guy you know slapped with a dui
uh you know smart guy got a lawyer the
lawyer said no problem you just need to
go to court on this date and plead no
not guilty just plead not guilty and
i'll take care of the rest so he's like
okay i can do that so he dresses up he
goes to court you know he they call him
up he's sitting in the stand he said the
judge has said how do you plead
and all of a sudden like he has this
experience where he remembers that his
dad always told him to tell the truth
he looks around and he sees sort of like
the other
you know folks
um not as privileged in himself as
himself sitting in the courtroom with
duis who probably weren't going to be
able to get a fancy lawyer who would you
know help him drop the charges and he
had sort of a sense of like feeling like
he checked his privilege and was like
that's not really right so it was like a
convergence of things he had been taught
his values and he just couldn't bring
himself to lie in that moment and he
said i plead guilty and apparently the
judge just sort of like went you know
the judge was sort of half asleep just
running through the duis in the morning
and sort of like did a double take and
look at himself are you sure and he said
yeah i'm sure i plead guilty and the
point of the story is that
for years i mean even decades afterwards
this dui was a nightmare for this guy
because he was a he was in medical
school so that means every single time
he filled out any kind of paperwork
which was on a regular basis about you
know getting hospital privileges or
going to work here or getting
malpractice he had to say yeah i got a
dui i got a deal he had to do classes he
had to do all this stuff i mean and he
moved to california you know he was
practicing it in california and so it
changed from the first state where he
went through all this then he was in
california has to do it again right he
had to do it for his california
years after like a decade after this or
something and you're like oh do you have
a problem no this was you know a decade
ago but they were worried and so they
sent me to you to make sure everything's
okay and i was just like it's not like
this ended up being uh good on you you
told the truth and everybody recognized
like well done this has been a
never-ending parade of painful things
that you have to go through except that
his take home from it was
i'm really glad
i told the truth
and i think the fact that i told the
truth might have protected me from
becoming an alcoholic
because there was a way in which those
immediate bad consequences from
truth-telling
shifted my behavior
and although it was painful it was much
better than the consequences that i
would have had to suffer had i actually
become an alcoholic which he was
on the road to become especially given
that both of his parents were alcoholics
right they were good parents but they
had addiction so that moment in time
when he chose to tell the truth about
something and incur huge consequences
seemed like the wrong decision
objectively in the immediate aftermath
and for many years afterwards but for
him in terms of what it did to his brain
and his subsequent choices
he makes the link
that it changed his brain and changed
his choices and actually protected him
from worse bad consequences to me that
was a hugely powerful message about the
the virtues of telling the truth and i
give other stories in the book that that
point to the same thing that
there's something
that seems overwhelmingly
wrong and dangerous about telling the
truth in the moment
but that
in the long run might actually be hugely
protective for us and one of the ways it
might do that is that
short short-term immediate bad
consequences
change our behavior that is what changes
when i look at my patients and the ones
who get into recovery from bad
addictions it's often consequences
serious loss and consequences that gets
them to say you know what i don't want
to do this anymore
so if there if there's a way in which
truth-telling can incur those
consequences in a smaller form
immediately
that is enough to shape our behavior in
an iterative fashion over time
to get us in a much better place in fact
maybe the polar opposite might those are
all those moments of truth telling are
all little forks in the road right that
make the difference between ending up
in a really bad place versus a really
good place many years later yes so
intriguing
um
there are addicts that will go through
the horrendous things that they go
through as their life downward spirals
but then as they in fact in the
this might have been an interview i
can't remember she said this in the book
or in an interview but you said that
some of the most profoundly balanced
people that you know are people that are
deep into recovery yeah and that there's
something about the hardship that makes
them find equilibrium in a more profound
way than somebody who's never gone
through something and that some addicts
actually say i'm grateful for my
addiction right which i'm super
surprised to hear what do you think from
a neurochemistry standpoint what's going
on is it just pleasure pain principle or
something else
i think it's more than just the pleasure
pain principle i mean clearly when
they're in recovery they're not using
they've restored homeostasis they've got
more homeostatic resilience you know
able to perceive small pleasures and
enjoy them
but but i think that the fundamental
stance
that for me makes people in recovery
really modern day profits for the rest
of us
is this incredible stance of humility
and a recognition that we're all
vulnerable and we're all flawed and
we're all broken
and we need each other and we need these
practices so again it's not just enough
to think about what i should do or could
do
or to you know have sort of a deep
insight into my psychological makeup i
need to get up every day and i need to
do
these practices i need to tell the truth
i can't lie about anything at all
because that could compromise my
recovery now it turns out that telling
the truth about things large and small
is probably a good thing for all of us
to do for the reasons that we partially
just talked about other reasons as well
that i talk about in the book having to
do with how it fosters deep intimacy etc
creates a plenty mindset as opposed to a
scarcity mindset but but these little
wisdoms and enacted in daily life taken
one day at a time
end up being a powerful philosophical
and spiritual underpinning for how to
live life and that is why peop many
people in recovery from addiction will
just out and out say i'm so grateful
for my addiction because my addiction
oriented me on a way of living my life
which
gives makes it deeply meaningful
in a way that i might never have arrived
at had i not had this obstacle
talk to me about the spiritual element
you there was a really surprising moment
in the book where you were telling the
electro stimulating guy to get down on
his knees and pray
and as somebody who's not religious i
was like whoa was taken aback but as you
explained the like sort of physical
pattern interruption yeah it was like ah
maybe this really does make sense
so i mean there are a lot of layer