Anna Lembke, MD, a psychiatrist, assistant professor, and Chief of Addiction Medicine at Stanford University School of Medicine in California. She has published more than 50 peer-reviewed articles, chapters, and commentaries, and is the author of Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.
In this episode of Huberman Lab, Dr. Huberman sits down with Dr. Anna Lembke to discuss the biology and psychology of why addiction (drug and non-drug) happens, the role of dopamine in addiction, how to overcome addiction, and the science behind relapse.
Host: Andrew Huberman (@hubermanlab)
Life today is more boring in many ways – our survival needs are met; we don’t even have to leave our home to have every single need met
Even the poorest have more excess leisure time than ever before
“Life today is hard in this weird way that we don’t really have anything that we have to do (for our survival) so we’re all forced to make things up.” – Dr. Anna Lembke
The easiness of our ability to survive today can be challenging for people who need friction and lead to addiction
Boredom is a necessary experience but highly anxiety-provoking
“Stop looking for your passion and instead look around where you are. Stop distracting yourself and see what needs to be done – not what I want to do, what needs to be done.” – Dr. Anna Lembke
There’s a burden in finding the perfect thing for you and imaging the key will fit perfectly in the lock
Build a life around what you can do at the moment and what opportunities are available to you right now to benefit yourself and others
Neurotransmitters bridge the gap between two molecules and allow for communication
Examples of neurotransmitters: dopamine, serotonin
Dopamine is associated with reward, pleasure, and movement – it triggers action
Dopamine is always being released in varying levels
If we expose regularly expose ourselves to things that trigger high levels of dopamine release, we will actually lower our baseline levels of dopamine over time
Experiences have an impact on where baseline dopamine level settles
People with naturally impulsive tendencies are more vulnerable to addiction
Impulsivity: difficulty putting space between desire and action and withholding behavior
Impulsivity is not always bad – there isn’t self-editing or worrying about future consequences which can come into use in fight or flight scenarios
We live in a sensory-rich environment and have to constantly check ourselves
There are two sides to pleasure: (1) seeking out high, euphoria – and (2) seeking experiences that dull or avoid pain
Oftentimes initial entry point into drug use is a desire to escape pain, not seeking pleasure
Pleasure and pain are co-located in the brain and work like a balance, tipping inversely
The brain works hard to keep pleasure and pain in constant balance and neutrality
We are not always aware of the pain until we begin to pay attention at the moment
  • Example: you gain traction on social media and can’t stop spending time on it because if you disengage you will have pain in missing that feeling of reinforcement
Pleasure is reduced by way of increasing pain
Pain mechanism has some competitive advantages over pleasure
After you do something pleasurable, the brain immediately compensates by downregulating dopamine
If you wait long enough after high, the brain will go back to its neutral state – but – if you don’t wait because the crash is too rough, you are resetting the brain to a dopamine deficit state
You want a resilient, adaptive balance where you don’t allow yourself to stay in pleasure or pain too long
We really live in a time where we’re invited to become addicted to something – social media, email, checking our phone, etc.
The hallmark of any addictive behavior is that it releases dopamine at high levels
Addiction is a progressive narrowing of the things that bring you pleasure
The addictive process is the same, regardless of whether you’re addicted to gambling, drugs, sex, etc.
Once you’ve become addicted to anything, you’re more vulnerable to addiction to anything
People with severe addiction suffer from a lack of homeostasis in the pleasure-pain balance
Addiction is like having an itch and being told you can’t scratch it – it’s always there and maybe you’ll scratch it in your sleep because an unconscious opportunity
Addicts really cannot, not do it
We all have a propensity for addiction but some channel it into things that are more socially acceptable, like work or success
Focus on just doing today right
Connect with your environment, not trying to escape it
To reset the dopamine system and break an addictive pattern: Do 30 days of zero interaction with drug, person, alcohol, gambling, etc.
  • Days 1-10 will be very uncomfortable – you will feel worse before you feel better
  • By week 2 the sun will come out
  • By weeks 3 and 4 you will feel better than before you started the addiction
The carrot is there’s a better life out there
Addicts want to discuss recovery: oxytocin is linked to dopamine release so when human connection is made, it’s stimulating
Telling the truth about details of life is central to recovery
Recovery isn’t just not lying about using drugs, it’s becoming transparent about everything
The act of righting past wrongdoings is cathartic – asking forgiveness is important in the twelve steps
Truth-telling strengthens circuits in the pre-frontal cortex and enhances connections to the limbic brain and reward brain
Being open and honest creates intimate connections which stimulate dopamine release
Sometimes relapse occurs when things are going really well for the person because there’s a removal of the hypervigilant state
There are people who will die of disease of addiction
There are physiologic changes that will occur with sustained drug use
Thinking about triggers associated with drug use or drug use can already release anticipatory dopamine
The dopamine spike is associated with dopamine deficit where dopamine falls below baseline
Dopamine deficit state drives action to get drug
Another way to frame understanding addiction, recovery, relapse: think about the thing you love doing most in life – and imagine you couldn’t do it
Condensed psychoanalysis + MDMA or drug which allows a person to get out of own head and look at life in a broader sweep
Dr. Lembke is skeptical about the longevity of psychedelic therapy long term for addiction recovery
Please be sure to see a legitimate guided psychedelic experience and don’t DIY
“The first message I want to get across about social media is it really is a drug. And it’s intended to be a drug.” – Dr. Anna Lembke
Use social media with intention and with planning so you don’t get sucked in
No one who is getting addicted thinks they’re addicted
Things we’ve learned from other drugs also applies to social media: put barriers in place that allow you to remain in control of the use
Tip: try even a single day without your phone
The collective mission should be to make sure we’re preserving offline ways to connect
We’re losing the ability to have a sustained thought because we can just look anything up immediately
Social media is fueling a preoccupation with ourselves & success – we’re getting feedback all the time about ourselves