In The Rising Podcast

Episode 123! Dr. Anna Lembke on Dopamine and Our Behavior

December 28, 2021 Bettina M. Brown/ Dr. Anna Lembke Episode 123
In The Rising Podcast
Episode 123! Dr. Anna Lembke on Dopamine and Our Behavior
Show Notes Transcript

DOPAMINE NATION is a book about pleasure.
 It’s also about pain. 

Most importantly, it’s about the relationship between the two and how understanding that relationship is essential for a life well-lived. 

Why?

Because the world has transformed from a place of scarcity to a place of overwhelming abundance: drugs, food, news, shopping, gambling, social media, and the list goes on and on. 

Today, we’re all vulnerable to the problem of addiction. In Dopamine Nation, Anna Lembke, MD,  shares the true stories of her patients falling prey to addiction and finding their way out again. 

Dr. Lembke has decades of experience in clinical practice and neuroscientific research and in DOPAMINE NATION, readers will learn: 

• The Internet promotes compulsive overconsumption not merely by providing increased access to drugs old and new, but also by suggesting behaviors that otherwise may never have occurred to us. Videos don’t just “go viral.” They’re literally contagious, hence the advent of the meme. 

• Rates of addiction are rising the world over.  The US is dominated by illicit drugs, Russia and Eastern Europe by alcohol addiction. 

• When researchers asked the following question to people in thirty countries around the world – “During the past four weeks, how often have you had bodily aches or pain? Never; seldom; sometimes; often; or very often?” – they found that Americans reported more pain than any other country. 

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

• Exercise increases many of the neurotransmitters involved in positive mood regulation: dopamine, serotonin, and endorphins. Exercise contributes to the birth of new neurons and even reduces the likelihood of using and getting addicted to drugs. 

About the Author: 

  • Anna Lembke is Medical Director and Professor of Stanford Addiction Medicine, program director for the Stanford Addiction Medicine Fellowship, and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. 


  • She is the recipient of numerous awards for outstanding research in mental illness, for excellence in teaching, and for clinical innovation in treatment. 
  • A clinician scholar, she has published more than a hundred peer-reviewed papers, book chapters, and commentaries in prestigious outlets such as The New England Journal of Medicine and JAMA.
  •  She sits on the board of several state and national addiction-focused organizations, has testified before various committees in the United States House of Representatives and Senate, keeps an active speaking calendar, and maintains a thriving clinical practice. 
  • https://www.annalembke.com/

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Speaker 1:

Hello and welcome to in the rising podcast. My name is Betina , and this is the podcast where we talk about living a life. That's actually great, right? That when one day when we reflect back, we are in love with what we've been given. And we are excited about what we have left to offer the world. And my guest today is Dr . Anna Lemke , and she has a long list of accomplishments, including teaching psychiatrists. She is on the Netflix documentary, the social dilemma, and has been on the HBO panel regarding the crime of the century, which is the opioid crisis. But she really talks a lot about addiction and addiction to things that we may not realize are addicting, including that like button and how we are so desperate for connection, that we are now on all these different social media platforms, trying to live up to someone else's and even our own filter of life. That really no one can live up to. She talks about those things today, because this is a new crisis. We want to have a life that's awesome and fantastic, and in alignment with our hopes and dreams, but let's face it. Our hopes and dreams are also compared to other people's fake realities. And so I welcome you to this podcast today. I'm very grateful for your time today because you are a person who talks about something that is on everyone's mind, whether it's conscious or subconscious, and that is living in this age of indulgence and addiction. And I have to just start off, like you're a psychiatrist, your list goes on and on, and I will go on that. But how did you even find an interest in this field to begin with?

Speaker 2:

Oh, okay. So I feel like Paul blat Malco , when I tell this story, because really addiction found me rather than the other way around, but it's really true. And when I initially went , you know, went into my early career, about 20 plus years ago, I had no intention of treating patients with addiction. Didn't wanna see them , uh , specifically told our intake coordinators not to send those patients my way. But what I discovered was that I was actually a bad psychiatrist and by willfully ignoring the problem of addiction, I was harming my patients. Um , we were kind of engaging in a complicit don't ask, don't tell policy, my patients weren't getting better. And then I had one patient who had a very bad outcome and she was in a severe car accident because she had relapsed heroin use. And I had no idea she was even a heroin user. So that was really my wake up call that if I really wanted to help people, I needed to pay attention to the growing problem of addiction.

Speaker 1:

Yes, yes, absolutely. So you have now this growing problem of addiction that you're seeing, you've been , um, you know, you've written about it, you have this new book, dopamine nation , uh , which I read. And you also share something about yourself, share, share with us on the podcast, what you share in that book.

Speaker 2:

Yeah. So I share , um, the behavioral addiction that I developed, which was basically an addiction to reading romance novels. And , um, I joke that the Twilight saga was my gateway drug, but it really was , uh , I really hadn't, you know, read any romance in my earlier life. And then somehow in my early forties, I just kind of got hooked on the Twilight saga. And then I got a Kindle and then I was downloading, you know , um , graphic erotica late into the night. It was interfering with my sleep, my ability to be present for my children and my patients. And this all kind of progressed over the course of about 18 to 24 months until, you know, through kind of an accident. I , I realized that I'd become addicted and then decided to, you know, take a 30 day dopamine fast, which is what I recommend to my patients and what I talk about in the book. And I was gob smacked by how hard that was for me and how much difficulty I experienced doing that. And I talk about that , that in the book, because I think it's important to talk about the ways in which in this modern ecosystem, any of us can get addicted to almost anything. But I also wanted to draw a parallel between the patient story that I relay of Jacob and his severe sex addiction and my own behaviors to, to communicate that this problem of addiction is not a problem of other people. It's really a problem that we're all struggling with now.

Speaker 1:

Yes. And in that too, when I read that , I was like, she's putting herself out there as more human, you know, you're a physician, so that's a different, you know, those are those people and then there's the rest of us. Um , but you put yourself in that you're a regular person and this can happen to absolutely everyone and, and destigmatizing in your own book that this is just a natural thing that can happen. And you go a lot into dopamine. And this, this hit that we get , um, from certain things, describe, describe how you came to dopamine nation and , and where that came from.

Speaker 2:

Yeah. So dopamine is, is the currency that neuroscientists use to measure the addictive potential of, of different types of substances and behaviors. Um, and one of the interesting findings in neuroscience in the , in the past 75 years is that pleasure and pain are co-located. So the same part of the brain that processes pleasure also processes pain, and they work like opposite sides of a balance. So when we do something reinforcing or pleasurable, we get a little release of dopamine, our reward neurotransmitter in a specific area of the brain called the reward pathway. And that tips our balance to the site of pleasure. But one of the overarching rules governing that balance is that it wants to be level and our brains are gonna work really hard to restore a level balance with any deviation from neutrality. And I always imagine that as these neuro adaptation gremlins hopping on the pain side of the balance to bring it level again, but the thing about those gremlins is they really like it on the balance. So they stay on until it's tipped an equal and opposite amount to the side of pain. And that's our brain down regulating dopamine transmission, not just to baseline, but below baseline. That's the come down the after effect the hangover. You know , if we wait long enough, those gremlins hop off and balance is restored and we kind of move on with our day. But what can happen is we can get into this vicious and addictive cycle where if we continue to bombard our reward pathway with highly reinforcing drugs and behaviors, we eventually accumulate so many gremlins on the pain side of the balance that they could fill this whole room. And now they're camped out there, tents and barbecues in tow, which means that we're in this kind of chronic dopamine deficit state, which is a really akin to a clinical depression or an anxiety disorder , um , where, you know, when we're not using our drug, we're, we're in pain, we're experiencing the universal symptoms of withdrawal from any addictive substance, anxiety, irritability, insomnia, depression, craving. And now when we do use, we need greater and greater amounts, higher and higher potency just to level our balance. So it doesn't even get us high anymore. We , we just need to use to feel normal. And of course our ability to take joy and more modest rewards has gone away because we've got gremlins camped out on the pain side of the balance, and then our focus and our energy really narrows onto this one addictive substance or behavior.

Speaker 1:

Yeah. And, and with that, you know, you've also appeared on that Netflix documentary , um , the social dilemma , which I watched, and it was, you know, we call it social, but really how much people study us to help us become addicted to the car that we don't need, but now we want <laugh> , um , the food we don't need and now we want, we are, you know, we have so much food and we're so undernourished and so overweight. Yeah . People study how to use us. Um, what do you, what are your goals, I guess, with the book and just in general, to help people realize what is a , what is a main focus for you?

Speaker 2:

I really want people to understand what's going on the , on, in the brain when we , um, indulge in these reinforcing drugs and behaviors, what's happening with dopamine, with the pleasure pain balance. Cuz I do think that that neuroscience framework and that understanding can allow people to observe their feelings and behaviors in real time and get insight so that they can be motivated to change their behaviors. Um, I also hold up people in recovery from severe addiction as modern day profits for the rest of us, for what we can do to navigate this Domine saturated world. And then I do talk about specifically about technology and the ways that technology has increased access potency , um, variety , um, um, um , quantity to make us all more vulnerable to the problem of addiction.

Speaker 1:

Yeah. Yeah. And in this, you know, a little docu-series that they had, you know, they have a little , uh , family where they're all on their phone and they all put their phone away for dinner and they don't even know what to say to each other. You know ,

Speaker 2:

I know,

Speaker 1:

I know. And , and that, that resonated with me , um, that we are looking for connection and someone's right next to us.

Speaker 2:

Yeah.

Speaker 1:

And we can't.

Speaker 2:

Right. And I think that's a key point that, you know, what , what happens is the more time that we spend online, not only does it hijack our reward pathways such that the , our real lives become less interesting because we're, you know, constantly , um , bombarding our, our, our , our reward pathways with these high dopamine substances and behaviors, but also we're literally spending less time in real life. And so our real life is genuinely less reinforcing it because we're not there. Right. We're not investing in it. So the antidote is to really get, you know, off of the computer. Um, not, you know, never be on it, but get off more and invest in the people around us and the lives we've been given and thereby make those relationships and our real lives more engaging and more interesting. So we actually wanna spend time there.

Speaker 1:

Yes. Yes, absolutely. And in the back of your book, you talk about some things that we can do to help get out. And one of them , you said, you said talk honestly, because honesty creates awareness and more satisfying relationships share a little bit more about this honesty cuz that that's kind of a hard point <laugh> for a lot of people.

Speaker 2:

Yeah. Right. So one of the things I've learned from my patients over the years is that for them to maintain recovery, they have to be radically honest, meaning they have to tell the truth about everything. They can't even lie about little things like why they're late for a meeting because they found that once they do, they slip back into the lying habit and then pretty soon they're relapsed. So I thought that was really interesting , um , because you know, I wondered what's going on in the brain with lying and with truth, telling that that means that truth telling allows us to better manage our consumption. And what I found is that when we tell the truth, especially about shameful things that we , um, allow more intimacy and stronger connections with other people , um, especially if we share it in an IMIT way with one other person and real intimacy, we always talk about, you know , connection, human connection is the antidote to addiction, but we don't ever talk about how to get those human connections. And one way is to be truthful with people in our lives. And of course, once we foster intimacy, that's a very potent and healthy source of dopamine cuz we do release dopamine when we feel intimacy. The other thing is that when we're radically telling the truth about things large and small, we can't hide from the reality of what we're doing and lead this double life. We we're awake to our actual behaviors. And once we're awake to those behaviors, it's, it's harder to deny that they're happening and harder to rationalize them away. I've also discovered over many years of seeing patients that the stories we tell about our lives, aren't just a way to organize the past. They actually inform the future and they shape our future choices. So when we're telling , um, you know, untruthful stories about where we've been and what , what we've done, we're probably likely to repeat the same mistakes going forward. Whereas if we're radically honest about our lives, especially what we've contributed to a problem, we're more likely to be able to encounter those types of challenges in a , in a healthier and more adaptive way going forward.

Speaker 1:

Yeah. So there's a lot of freedom with that honesty.

Speaker 2:

That's right. Enormous freedom. I mean, my patients will say, oh gosh, I don't have to try to remember all the lies which took, you know, it's a heavy cognitive load, right. To remember who did I tell what now I'm free. Like I'm free to be spontaneous in the moment and like live my authentic self.

Speaker 1:

Yeah. Yeah. And I've had another guess one time said that intimacy can also be stated as into me. You see? So you're letting someone into you . Yeah . Um , it's not necessarily just, you know, what intimacy where we think of sexually, it is really that you're connecting on a , on a soul level, on a heart level and really dropping those barriers.

Speaker 2:

I love that. Yeah. I mean, one thing I I've learned is that we all want to be seen for who we really are and we want our insights and outsides to match. And when they don't, there's a profound feeling of inauthenticity and alienation, which can really drive depression and anxiety. So one of the ways to come out of states of depression and anxiety is to be more truthful and more authentic about what's really going on inside of us .

Speaker 1:

Yeah . You know , my podcast is called in the rising as we rise up from whatever ashes, addiction, broken homes, relationships, et cetera . Where do you hope to have us as a nation, as a culture , um , first world, third world country rise up to next? What , what is your hope?

Speaker 2:

I hope that we can embrace , um, a new form of let me call it aestheticism. Um, and by that, I mean , um, a kind of a , a cultural , um, celebration of avoiding pleasure and inviting painful and challenging experiences into our lives in moderation , um, which I think will help us , um, escape, despair, anxiety, depression, suicidality, but also , um, can have higher purpose and meaning in the sense that we're also saving our planet when we're consuming less. Right. We're , we're less likely to deplete our forests, fuel sources and fisheries , uh , when we're consuming less. So I , I hope that it can be a way toward mental health and also a , a way toward higher meaning and purpose.

Speaker 1:

Yeah . Well, thank you for sharing that. What about yourself personally? Where are you still rising up to cuz the list of what you've done is tremendous and your mom <laugh> and

Speaker 2:

I can tell

Speaker 1:

This , you know, like what , what are you still rising up to? What is on your horizon?

Speaker 2:

Oh my gosh. Well, I , I , I think every day is a struggle, honestly, even though I have so many blessings in my life, I , I find that every day is a challenge. When I talk about this pleasure pain balance, I really envision it as me or other people on a plank on a ball. Um, rather than, you know , uh , a sort of a , a triangular based full crimin by that. I mean that in order to stay balanced on a plank, on a ball, we have to constantly be moving around. Right. It's a dynamic state. We have to every day take stock of where we are, how we can improve our , our lives, what , what our lives mean, what our values are, how , how we can live in accordance with our values. Um, so I just struggle, you know, I struggle every day . I , I think I struggle as much as, as anybody. Um, just trying to make it in the world. <laugh>

Speaker 1:

<laugh> well, you have accomplished so much, you've made changes. What, what would you, if you had to give a message that's one lesson or maybe two from working with all these people that entrust you with their story, what would you, how would you sum that up into a sentence or two or , or three <laugh>?

Speaker 2:

Yeah. So I would say if you note that you are unhappy in your life, instead of reaching for something to comfort yourself, you might do something wholly counterintuitive and reach for something that's hard. Um , and you might find surprisingly that, that hard thing, whether it's , um, eliminating some kind of, I intoxicant from your life for a period of time, or actually engaging in a physically or mentally painful activity that that will make you feel better in a more enduring way than reaching for that comfort drug or food or behavior.

Speaker 1:

Yeah. So if people want to know more about what you've done, what you're doing, how can they look it up on the internet? How can they , um, you know, what books have you written so that you can so they can find you?

Speaker 2:

So there's a website on ake.com or dopamine, nation.com that , that talks more about some of my other work as well.

Speaker 1:

Wonderful. Well, I am really, I am blessed to have had this time with you today. Thank you so much for sharing that and giving your insight , um, and, and many blessings to you as you continue to change the world, one person at a time with everything that you're doing

Speaker 2:

Well right back at you. Thank you so much for putting me . It was a real pleasure.

Speaker 1:

Wow. What a powerful podcast, Dr . Lemke hit on so many points and she admitted herself that she's vulnerable. And in that I'm vulnerable, you're vulnerable. We may not all want to talk about those vulnerabilities in a book or a podcast, but this is completely possible. I encourage you to either read her book or watch that Netflix , uh , special, the social dilemma that you know, it is trained because those are a people that know how we're wired. We're wired for a dopamine hit. And it is now our choice of whether or not we're gonna allow someone to program us. Right? We can't be upset if we are being controlled. If we keep walking into that. So everything is in moderation, including moderation. And if you felt this powerful podcast was of benefit to you, I encourage you to share it with others, leave it a five star review because that is what puts it in the hands and ears of those that can make an impact for until next time let's keep building one, another product .