YT YouTube2Text

YouTube2Text → Transcripts → Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Doing To Your Brain!

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

by The Diary Of A CEO · 23,452 words · 3,350 segments · language en · Watch on YouTube

Open in transcriber Summarize with AI Download SRT/VTT

Full transcript

0:00there's a very famous experiment in
0:02which rats were engineered to have no
0:04dopamine and the scientists discovered
0:06that if they put food in the rat's mouth
0:07the rat would eat but if you put the
0:09food even a body length away the rat
0:11will starve to death which tells us that
0:13dopamine is fundamental to get the
0:15things that we need for our basic
0:17survival now every time we're doing
0:19something that's pleasurable from sugar
0:21to video games work pornography social
0:23media that will affect dopamine and the
0:25more dopamine that's released the more
0:27likely that drug or behavior is to be
0:29addictive but also the genetic risk of
0:31addiction is about 50 to 60% so if you
0:34have a biological parent or grandparent
0:36with addiction you are more likely to
0:38develop that addiction we have to keep
0:40it in balance in order to stay healthy
0:42Dr Anna lmy is Professor of Psychiatry
0:44at Stanford chief of the Stanford
0:46addiction clinic and a world leading
0:47expert on the subject of doping she will
0:49tell you how this one powerful chemical
0:51is controlling your life and what to do
0:52about it one of the most important
0:54findings in Neuroscience in the past 75
0:56years is that the same parts of the
0:58brain that process pleasure also process
1:00pain and the balance wants to remain
1:02level the problem is that we
1:04automatically seek out pleasure and
1:06avoid pain and we're exposed to all
1:07kinds of Pleasures that we have in the
1:09modern world and our brains are reeling
1:11in response to try to compensate now I
1:13need more of my drug and more potent
1:14forms to get the same effect which then
1:16leads to addiction and that's what
1:17happened to me when I got addicted to
1:19romance novels take me into that phase
1:21of your life I was out of control and I
1:23needed to restore a level balance and
1:25take the advice I give my patients and
1:27what is that advice
1:31the Diary of a CEO is independently fact
1:34checked for any studies or science
1:35mentioned in this episode please check
1:37the show notes this has always blown my
1:38mind a little bit 53% of you that listen
1:41to the show regularly haven't yet
1:43subscribed to the show so could I ask
1:45you for a favor before we start if you
1:46like the show and you like what we do
1:48here and you want to support us the free
1:49simple way that you can do just that is
1:51by hitting the Subscribe button and my
1:53commitment to you is if you do that then
1:55I'll do everything in my power me and my
1:56team to make sure that this show is
1:58better for you every single week we'll
2:00listen to your feedback we'll find the
2:02guest that you want me to speak to and
2:03we'll continue to do what we do thank
2:05you so
2:06[Music]
2:11much I've sat here for the last 20
2:14minutes trying to figure out how to say
2:15this to you so I'm just going to say it
2:17how it comes out my mouth and I
2:18apologize if this is messy but if there
2:20was ever an episode this year that you
2:22should listen to it is this one I've
2:24since this episode was recorded about a
2:26month ago all I've been thinking about
2:28is how on Earth I get you to watch this
2:30and I don't say this often the last time
2:32I said this was the first time Mo gordak
2:34came on this podcast this is the second
2:36time I've said this in almost four years
2:38of recording this podcast on YouTube and
2:40the reason for that is so many of the
2:42things that I know you're struggling
2:43with in your life that stand in the way
2:45of the person you want to become that
2:47relationship you have with your phone
2:49the
2:50procrastination the cycles of behavior
2:53that make you feel embarrassed and full
2:54of shame that you've just never been
2:56able to crack all of them all of them I
2:59genuinely believe for many of you are
3:01going to be understood today if you
3:03listen to this episode it has changed my
3:05life and it has changed much of the
3:07lives of my team if if I'm wrong here
3:11you have the right to message me and
3:12tell me that I was wrong please listen
3:15to this episode really really I mean
3:17that from the bottom of my heart and
3:18just to make sure you do throughout this
3:20episode there's going to be these popups
3:21if you collect eight of these codes that
3:23are going to pop up on the screen and
3:25put them in the document link below
3:26you'll unlock something very special
3:28some additional content please listen to
3:30this
3:34episode Dr Anna
3:37lmy you wrote one of the most iconic
3:39well-known books about dopamine which
3:43propelled the subject matter of dopamine
3:44into the public
3:45Consciousness but I guess the most
3:47important question I should ask you
3:50is why does dopamine matter ah good
3:54question good good place to start I mean
3:57dopamine matters because it
4:00fundamental to our survival right so
4:03it's the chemical that we make in our
4:04brain that tells us this is something we
4:07should approach explore investigate so
4:10it's it's really almost the survival
4:13chemical so what is dopamine if you had
4:15to explain it to a 10-year-old how would
4:17you go about explaining it so dopamine
4:19is a chemical that we make in our brain
4:23um it has many different functions but
4:27one of its most important functions is
4:29that it helps us experience pleasure
4:32reward and
4:34motivation um it may be even more
4:37important for the motivation to do
4:39things than it is for the pleasure
4:41itself so for example there's a very
4:43famous experiment in which rats were
4:46engineered to have no dopamine in the
4:49brain's reward pathway and the
4:51scientists discovered that if they put
4:53food in the rat's mouth the rat would
4:55eat the food would seem to get some
4:57pleasure from the food if you can deter
4:59that from watching a rat eat which I
5:01think they felt like they could uh but
5:04if you put the food even a body length
5:06away the rat will starve to death the
5:09idea being that without dopamine we're
5:12not motivated to seek out the things
5:15that we need for our basic survival
5:18that's crazy so you get a rat you put
5:20the food an inch from its mouth and it
5:24will starve to death because it doesn't
5:25have dopamine the dopamine required to
5:27just reach out and eat yeah essentially
5:29maybe it's not an inch maybe it's a
5:31little more than an inch but the idea
5:33being that dopamine is necessary to be
5:36motivated to do the work to get the
5:39thing that we need and having an
5:43understanding of dopamine how might that
5:45improve my life having a basic
5:48understanding of how dopamine Works how
5:51we process Pleasure and Pain and also
5:54what happens with dopamine as we go from
5:57adaptive recreational use to Mal
5:59adaptive addictive use is something that
6:02is really useful especially for those of
6:04us living in the modern world where now
6:07we're exposed to so many reinforcing
6:09substances and behaviors that we've all
6:12become vulnerable to the problem of
6:13addiction and what are the biggest
6:15misconceptions of on the subject of
6:17dopamine because it's kind of thrown
6:19around in society I see it in my group
6:20chats people saying I need more dopamine
6:22or whatever or you know that person just
6:24craves dopamine what what are the
6:26biggest misconceptions you've come
6:28across the main miscon conception is
6:30that somehow we can get addicted to
6:32dopamine we're not getting addicted to
6:34dopamine itself dopamine is neither good
6:37nor bad it's a signal to tell us whether
6:41or not something that we're doing is
6:44potentially useful for our survival and
6:47also it's related to what we predicted
6:51about how rewarding or pleasurable
6:53something would be and so it's really um
6:56you know I sort of sometimes I joke it's
6:58like the um reward theory of relativity
7:02DOP mean is in the sense that Pleasure
7:04and Pain really are truly relative to
7:07one another and so dopamine gives us
7:09information about where we are in that
7:12relativity scale between Pleasure and
7:14Pain and when you say relative you mean
7:16I mean it's it's quite fitting for
7:18anyone that can't see we have a a set of
7:19scales on the table and scales are
7:22relative to each other because if you
7:23pour in one end the other end goes up
7:26and if you pour in the other end the
7:27other end goes up and this end goes down
7:29and when you say relative that's what
7:30you're describing right yes that's what
7:32that's what I'm describing yes okay and
7:35what activities that I do every day have
7:38an impact on my
7:39dopamine well probably almost everything
7:43you know in some ways um I mean every
7:45time we are doing something that's
7:48pleasurable reinforcing rewarding that
7:52will affect dope mean it's it's really
7:54the primary signal that lets us know
7:57that this thing is potentially important
7:59for our survival as I mentioned um but
8:02you know even um aversive stimuli can
8:06trigger dopamine what's oh something
8:09that's painful or not pleasurable
8:11dopamine gets involved in in that um
8:14equation anything that's novel or new is
8:17something that triggers our dopamine in
8:20in our reward pathway dopamine is
8:23fundamental for movement so not just
8:26pleasure and reward but also movement so
8:28for example Parkinson's disease which is
8:31a disease related to stiffness and
8:34Tremor is caused by a depletion of
8:37dopamine in a part of the brain called
8:39the substantia and as dopamine
8:42gets depleted in that part of the brain
8:44people lose the ability to move their
8:47bodies and it's probably no coincidence
8:50that the same neurotransmitter that is
8:52so important for pleasure reward
8:54motivation is also really important for
8:56movement because most organisms have to
8:59to locomote toward the object of their
9:02desire we want that thing we have to
9:04exert effort right we have to put in the
9:06work to go get it but in the world today
9:09we really don't have to do that right we
9:11can swipe right we can swipe left and
9:13all of a sudden it magically appears at
9:16the touch of a finger and that's very
9:18confusing for our brains because that's
9:20not how we evolved we really evolved for
9:23for having to do quite a bit of upfront
9:26work for a tiny little bit of reward
9:29I just want to before we move on talk
9:32about this point you said because I
9:33think it's quite foundational to
9:34everything we're going to talk about
9:35about dopamine being relative to pain
9:38and I have this set of scales in front
9:39of me and here I have some chemicals
9:43that are likely to produce dopamine in
9:46my brain I believe right so alcohol I
9:49have some rum I have some whiskey I have
9:51some vodka and can you explain to me
9:53using this rum whiskey and vodka how
9:56dopamine is relative to pain and what
9:59going on in my brain sure okay I'll
10:01slide this over to you oh
10:03okay so one of the most exciting
10:06findings in Neuroscience in the past 75
10:09years is that Pleasure and Pain are
10:12collocated in the brain so the same
10:14parts of the brain that process pleasure
10:17also process pain and in a very simple
10:20reductionist kind of way they work like
10:23opposite sides of a balance so imagine
10:26that deep in your brain's reward pathway
10:29which is is another exciting Discovery
10:31right that there's this dedicated reward
10:33pathway of the brain that consists
10:35broadly speaking of the prefrontal CeX
10:37which is this large gray matter area
10:39right behind our foreheads that's so
10:41important for future planning for
10:43delayed gratification for appreciating
10:45future consequences you might think of
10:48it as like the brakes on the car if
10:50we're going to analogize to to a to an
10:52engine and then deep you know in the
10:55brain we've got what we call the limic
10:58areas or the emotion brain and there you
11:01have the nucleus accumbens and the
11:02vental tegmental area that are rich in
11:06dopamine releasing neurons right and
11:09they act like the accelerator on the car
11:11so when you've got a healthy functioning
11:13brain you've got enough accelerator but
11:17not too much right so enough dop Meine
11:19being released but not too much and
11:20youve got a healthy prefrontal cortex
11:23putting the brakes on that dopamine
11:25release when people um become addicted
11:29there's either a problem with the brakes
11:32the prefrontal cortex or the accelerator
11:35the nucleus accumbens and vental
11:36tegmental area or both right what we're
11:39finding is that there's actually a
11:42disconnect so there are large neuronal
11:45circuits and Pathways between those deep
11:47lyic structures and the prefrontal
11:48cortex that literally get severed or
11:51disconnected when people become addicted
11:54as we think about Pleasure and Pain
11:57being collocated in the same parts of
11:58the brain working like opposite sides of
12:00the
12:01balance in order to understand what
12:04happens in the addicted brain is to
12:06appreciate that there are fundamental
12:08rules governing this balance and one of
12:11the most important rules is is that the
12:13balance wants to remain level it does
12:15not want to be tilted very long to the
12:17side of either pleasure or pain and in
12:20fact what our brain does is first tilt
12:22an equal and opposite amount to whatever
12:25the initial stimulus is so I'm going to
12:27try to illustrate that here so let's say
12:28our
12:29initial stimulus is alcohol now alcohol
12:32Works through its own chemical pathway
12:35it works on our endogenous opioid system
12:37the opioids that we make we have
12:39receptors for opioids in our brains it
12:41works on our endogenous Gaba system
12:43which is our calming
12:44neurotransmitter and at the end of the
12:46day it releases dopamine in the reward
12:49pathway so any potentially addictive
12:52substance will release dopamine in the
12:54reward pathway the more that's released
12:57and the faster that's released in a
12:59given individual the more likely that
13:01substance is to be
13:03addictive now another important concept
13:06here is what we call drug of choice
13:08which is to say what releases a lot of
13:10dopamine in your brain may not release a
13:13lot of dopamine in my brain and vice
13:14versa right which is this idea that
13:16people have predictions to different
13:18kinds of drugs and by the way people can
13:20get addicted to behaviors too I should
13:22emphasize that when you say drug of
13:25choice you mean the brain has a
13:28particular sensitivity to that drug in
13:31terms of dopamine yes okay the more
13:34dopamine that's released the faster that
13:36it's released the more likely that drug
13:38is to be addictive for a given
13:39individual so you're holding some
13:41whiskey there I'm holding some whiskey
13:42there could be a brain that is very
13:44sensitive to Whiskey and there could be
13:46a different brain that you could pull
13:48all the whiskey and you like and the
13:49dopamine response is sort of limited
13:52exactly okay and for many of my patients
13:56who become addicted to alcohol they will
13:58tell you that from the first moment they
14:01had alcohol they knew they were either
14:03in trouble or had met their best friend
14:05or some combination it was a very potent
14:09experience for them all right so let's
14:11let's go ahead and put this on the
14:13pleasure side of the
14:14balance dopamine is being released but
14:16no sooner has that happened then my
14:19brain will work very hard to restore a
14:22level balance and by the way a level
14:24balance is what neuroscientists call
14:26homeostasis okay and one of the
14:29overarching physiologic drives for all
14:31living organisms is to return to
14:32homeostasis homeostasis is that
14:35parameter of what's often called called
14:38affordances or states of being that are
14:41adaptive and healthy for the organism
14:43for example like we have a certain
14:45homeostasis of body temperature and if
14:47we go much too much beyond that either
14:50too high or too low we will disintegrate
14:53and die right so homeostasis is that
14:55that states of being that are compatible
14:58with existence
14:59and and potentially advantageous too
15:01sort of Baseline level that's right yeah
15:04Baseline level and by the way we're
15:05always releasing dopamine at a kind of
15:07tonic Baseline level in our brains I
15:08sometimes think of it as the heartbeat
15:10of the brain so what's happened here for
15:11people that can't see is you've poured a
15:13little bit of whiskey into one end of
15:14the scale the pleasure side of the scale
15:17and the other side of the scale has
15:18risen because now there's whiskey um in
15:21the the pleasure side which I guess is
15:22released dopamine exactly so now now we'
15:25released dopamine in the reward pathway
15:27okay because the pain side went up does
15:29that mean there's now less pain in the
15:31brain well I think you know again this
15:34is a metaphor it's an oversimplification
15:36the idea here is just when we press on
15:38the pleasure side we're releasing
15:40dopamine in the reward pathway and
15:42experiencing pleasure okay okay but no
15:45sooner has that happened then our brain
15:47will try to compensate or adapt to
15:50increased dopamine firing by down
15:52regulating dopamine transmission for
15:54example by involuting post synaptic
15:57dopamine receptors that mean okay okay
16:00so our brain is a bunch of wires you
16:04know um that conduct these electrical
16:06signals and and these long spindly cells
16:09are called neurons and the thing about
16:11neurons is that they don't actually
16:13touch end to end there's a little Gap or
16:15space between them and that Gap is
16:17called the synapse and that Gap or
16:20synapse is bridged by what we call
16:21neurotransmitters and dopamine is one of
16:23those neurotransmitters okay and when
16:27the pre synaptic neuron pulses and
16:29releases dopamine it crosses the synapse
16:32and binds to a receptor on the post
16:35synaptic neuron which either continues
16:38or aborts that electrical signal does
16:40that make sense yes okay so one of the
16:42ways that our brain can decrease the
16:46effects of dopamine decrease dopamine
16:48transmission is by involuting or taking
16:51inside the neuron the post synaptic
16:54receptor that way when dopamine is
16:56released it has nowhere to bind oh okay
16:58so it's like removing the docking
17:00station exactly very good it's removing
17:02the docking station so essentially
17:04getting back to our scale we've we've
17:06you know ingested alcohol we've
17:08increased dopamine firing in the reward
17:10pathway but remember our pleasure pain
17:12balance wants to return to the level
17:14position level with the ground
17:16homeostasis so it's going to decrease
17:19dopamine transmission by for example
17:21involuting those post synaptic dopamine
17:24receptors but one thing about the brain
17:27in its process of trying to get back to
17:29homeostasis and again I like to think of
17:31this neuro adaptation process as these
17:33Gremlins hopping on the pain side of the
17:36balance to bring it level again you
17:38don't have Gremlins here you have these
17:39little rocks but let's go ahead and put
17:41a rock on the pain side of the balance
17:43and the these rocks are are friends
17:45right their job is to level the balance
17:47because remember we got to go back to
17:48homeostasis I'm going to put a rock on
17:50and you're going to see oh my gosh it
17:53overshot right it now I've got it
17:55pressed down on the the pain side of the
17:57balance but that's exactly what happens
18:00in our brains in this process of neuro
18:02adaptation those Gremlins hopping on the
18:04pain side of the balance don't get off
18:07as soon as the balance is level they
18:08stay on until we're tilted and equal an
18:11opposite amount so is that what a
18:13hangover is or a cown as they would say
18:16when people take drugs they say I have a
18:18come down exactly that's exactly what it
18:21is that's the hangover the come down the
18:23Blue Monday or on a much smaller scale
18:26just that moment of craving right that
18:29moment of wanting to have one more shot
18:31right why does it overshoot why can't it
18:33just perfectly hit homeostasis such a
18:36great question because then we'd feel
18:38fine yeah why did Mother Nature do that
18:40to us so cruel right yeah okay I'm going
18:45to tell you an evolutionary just so
18:47story what we mean by that is we don't
18:49really know why you know this mechanism
18:51exists but from an evolutionary
18:54perspective if you're living in a world
18:56of scarcity and everpresent danger this
19:00is the perfect mechanism to make sure
19:03that we're never satisfied with what we
19:05have that we're always wanting more it's
19:08made us the ultimate
19:10Seekers okay because immediately after
19:12getting something I'm now feeling a lack
19:15of pleasure and I'm at a deficit you
19:17know on the pain side of the scale which
19:19means that I'm going to go seeking out
19:21more dopamine and in a world where
19:23everything is quite scarce that could
19:25mean going on another 4-Hour hunt the
19:27next day to go killer gazelle or
19:29something perfect you got yeah you got
19:31it interesting yeah okay so that's going
19:34to motivate me because this get so Jesus
19:39people that have hangovers don't seem
19:40very
19:41motivated right so now that's a so why
19:44is that right it's because alcohol is a
19:49product of human
19:51engineering that releases so much
19:54dopamine all at once in the reward
19:56pathway that our brains are reeling to
20:00compensate right we we really weren't
20:03evolved for this much pleasure with this
20:06much easy access as you said yourself we
20:09were really evolved for to have to do
20:12quite a lot of work upfront and to be
20:15hungry and to be lonely and to be tired
20:17and then get a little bit of reward that
20:20would then bring us back up to
20:22homostasis so really we were evolved to
20:25be pressing on the pain side of the
20:26balance in our effort to find pleasure
20:29and then when we find it that little bit
20:31of food or clothing or shelter or a mate
20:34would bring us back to the level
20:35position does that makes sense yeah so
20:37you're you're telling me essentially
20:38that we're all wired to be addicted
20:42because if this is how our brain works
20:44in a world it's designed to seek out
20:48more dopamine but the problem we have
20:50now is we have all the synthetic
20:51dopamine effectively like this so
20:53synthetic chemicals and synthetic things
20:55and you know an Internet that is wiring
20:58us to give us so much dopamine so easily
21:01that that means that our brains are
21:02effectively like mismatched to the world
21:05that we live in and therefore wired to
21:06be addicted yeah I think you actually
21:08said that I found a quote you said in an
21:10interview where you said we all wired to
21:12be addicted and if you're not addicted
21:14yet it's right around the corner right
21:17coming to a website near you yes I I
21:19guess I would I would qualify that a
21:21little bit by saying we're wired for
21:24survival in a world of scarcity that's
21:27not the world live in now we live in a
21:29world of overwhelming overabundance and
21:32so there is a mismatch between this
21:34ancient wiring that has us relentlessly
21:36pursuing pleasure in order to survive
21:40and a world that's so infused with
21:42pleasure and so many rewarding stimuli
21:44that now we're overwhelming our reward
21:47system and our brains are reeling in
21:49response to try to compensate so what
21:51happens to this scale then in such a
21:53world where I can get a big hit of
21:55dopamine all the time using some of
21:57these synthetic things or the internet
21:59or pornography or whatever else what's
22:01going on with this scale over and over
22:02again okay great so let me get there let
22:04me first say though that remember after
22:07we do something that's highly
22:09pleasurable our brain compensates with
22:11neuro adaptation tilting an equal and
22:13opposite amount to the side of pain and
22:16then restoring our balance back to the
22:19level position right or what we call
22:21homeostasis so this doesn't last forever
22:23right it's to pleasure then it's to pain
22:26then it's back to the level position but
22:28if we continue to consume our drug of
22:31choice over days to weeks to months to
22:34years and we add in a whole bunch of
22:36other drugs and now we're consuming you
22:40know pornography and smoking pot and
22:43eating um donuts and you know you name
22:47it all at the same time then essentially
22:50what happens is those Gremlins on the
22:53pain side of the balance end up camped
22:56out there for anyone that see she put
22:59all of the Rocks into the pain side to
23:01represent All Of The Addictive behaviors
23:03that this individual has now taken on
23:06right and now we've entered addicted
23:10brain by which I mean that we've changed
23:12our honic or Joy set point to the side
23:17of pain now we need more and more of our
23:21drug in more potent forms not to get
23:24high and feel good but just to level the
23:28balance feel normal and this is not
23:29going to be enough to level the balance
23:31I would have to like keep filling this
23:34much more than this container can hold
23:36and that would be in Pursuit really of
23:38just trying to level that balance so
23:40that we can feel normal and when we're
23:42not using we're walking around with a
23:44balance tilted toward the side of pain
23:47experiencing the universal symptoms of
23:49withdrawal from any addictive substance
23:52or behavior which are anxiety
23:55irritability insomnia depression and
23:58crav
23:59so if I managed to get enough vodka
24:01whiskey rum and pour it into the
24:03pleasure side of the scale now that all
24:05the rocks are in the pain side of the
24:06scale I managed to outweigh
24:09it it would it would what would then
24:11happen more rocks more rocks would be
24:14added yes more so momentarily yeah I
24:17would maybe be in a little bit of
24:19pleasure yes but then my brain would
24:21remove those docking stations again
24:22remove more of them and more rocks would
24:24go in and I'd slam
24:26down on the pain side again which means
24:28I need more alcohol to try and get up to
24:30pleasure SL okay so really you want to
24:33you want to like dopamine fast you need
24:37you need to just balance this and this
24:39is so difficult because of the world we
24:40live in it's almost it's it's it's funny
24:42enough because this little scales
24:44experiment um analogy here has given me
24:46a huge amount of empathy for people that
24:48are addicts oh gosh I'm so glad you said
24:50that because I think that is the key to
24:53empathy for the disease of addiction as
24:56well as for people with the disease
24:57having empathy for themselves is
25:00recognizing that on some level it it's
25:04it's out of their control right because
25:07when we are tilted to the side of pain
25:09the overwhelming drive to restore a
25:12level balance or restore homeostasis as
25:14quickly as possible overwhelms any other
25:18rational thought about the consequences
25:20of my drug use right it's just like get
25:22back to the level position because if I
25:25do that I'll at least feel temporarily
25:27better
25:29one of the things this analogy also
25:31highlights for me is that people who are
25:34addicted aren't trying to self harm
25:37right and this is kind of the prevailing
25:39narrative that if you're like why would
25:41you do that to yourself right whereas
25:43when I look at this analogy I go
25:45actually what they're trying to do is
25:47to deal with pain and we're all trying
25:50to find ways to deal with our pain and
25:53but in this analogy what ultimately
25:54happens and I guess is what's happening
25:56with addicts is the way they're choosing
25:58to deal with their pain is becoming
26:00self-destructive and that's creating
26:01more pain right and it's this vicious
26:04downward cycle yes and I think that sort
26:05of reframing of what's going on there is
26:07really critical because again it begets
26:09more empathy absolutely I agree with you
26:12and and I think you know we this this
26:15metaphor it makes an assumption that we
26:18all start with a pleasure pain balance
26:20that's level with the ground but
26:21actually that's probably not true right
26:24some people at Baseline may actually be
26:26more depressed or more anxious or may
26:29have had life experiences that sets them
26:31up for a kind of chronic stress reaction
26:34and we know that people with
26:35co-occurring psychiatric disorders for
26:37example are at increased risk of
26:39developing addiction probably because
26:41they're reaching for that substance to
26:43self medicate their psychiatric problem
26:47the the issue with that is that it's not
26:50medicinal right it's not healing
26:53although in the short term substances
26:56can help with those kinds of feelings
26:58feelings of psychological and physical
27:00pain over time because of the way the
27:03brain adapts as we've
27:06discussed substances and other addictive
27:09behaviors just make psychiatric problems
27:11worse right as we drive ourselves
27:13further into the the kind of uh you know
27:16the pain side of the balance so is this
27:18why trauma often leads to addictive
27:20behaviors because the trauma has caused
27:23a a pain a stress and we're searching
27:26for ways to
27:29medicate that pain or stress yeah to
27:31numb ourselves to not be present in our
27:33reality and have to deal with what's
27:35going on there is dopamine what role is
27:37dopamine playing in it's all the same
27:39dopamine
27:41originally was to help us find those
27:43things that we need to survive food
27:46clothing shelter a mate we call those
27:48Natural Rewards but
27:51today that same reward pathway that
27:54relies on dopamine has been hijacked by
27:57all of these
27:58artificial rewards that our brain
28:01confuses as necessary for survival which
28:05is why people with severe addiction will
28:07be willing to lose you know not
28:10consciously but unconsciously their
28:12loved ones their homes their jobs
28:15everything they have in pursuit of their
28:17drug of choice it's because their brain
28:19has been hijacked and they now confuse
28:23the drug as necessary for survival the
28:26other thing about drugs is that they're
28:28incredibly potent they release a lot of
28:30dopamine all at once which again is
28:32confusing for our brain Natural Rewards
28:36require upfront effort where we do a lot
28:38of work and then we get a little bit of
28:41dopamine and that's what our brains
28:43evolved for I mean I can that makes
28:45sense in my own life when I'm most
28:47stressed or most challenged by something
28:50professionally is when I I immediately
28:52notice that my diet goes out the window
28:54I start eating things that are bad I
28:56actually stop going to the gym as much
28:58um and it's it be can form a bit of a
29:01downward spiral can't it I guess as
29:03we've kind of seen from the dopamine
29:04scale um can I can I get back to that
29:07your question though about trauma and
29:09stress so um there's a very series
29:13there's a very interesting series of
29:14experiments in rodents mice and rats
29:18where they first of all rodents very
29:22easily get addicted to cocaine they will
29:25press a lever for cocaine until
29:27exhaustion or death but if that cocaine
29:31is then taken away that behavior will
29:34extinguish which means that the mice
29:37will eventually just stop pressing the
29:38lever right because they're not getting
29:40any cocaine totally makes sense and then
29:42they'll go off and do something else in
29:43the cage but if they're then exposed to
29:46a very painful foot shock right so a
29:50very extreme physical pain which you
29:52could equate to a serious life stressor
29:55the first thing the rat will do is run
29:58over to the lever and start pressing for
30:02cocaine which tells us that once our
30:06brain has discovered a drug that
30:08releases a lot of dopamine in our reward
30:12pathway even after we stop using that
30:15drug if we are exposed to an extreme
30:20stressor our brain will tell us
30:23immediately go and do that thing that
30:25gives us a lot of dopamine because you
30:28are under stress and I need to be
30:30relieved of stress does that make sense
30:32makes perfect sense yeah so if you
30:33especially so if you discover your drug
30:35of choice when you're younger and it's
30:36food or it's pornography or if it's I
30:39don't know anything that really made you
30:41feel good for a moment a moment of
30:43pleasure that will always become in the
30:46case of these rodent
30:48experiments the thing you run back to
30:51when life gets hard right and we see
30:54that again and again in people in
30:56sustained recovery from addtion that
30:59when they are under stress that is a
31:03trigger potentially for them to relapse
31:06so they have to be really thoughtful in
31:08their lives for number one trying to
31:10avoid stressful situations and and by
31:12the way stress can come in many
31:14different forms there's a great acronym
31:16in in alcoholic synonymous called halt
31:19hungry angry lonely tired those kinds of
31:23stressors everyday stressors which we
31:26all experience hungry angry lonely tired
31:29can trigger us to want to use so people
31:31in recovery have to be really thoughtful
31:33about not getting too hungry not getting
31:35too angry not getting too lonely and not
31:38getting too tired at the end of this
31:40conversation I want to go through all of
31:41the sort of practical solutions that
31:43someone struggling with an addiction to
31:44social media pornography food whatever
31:47it might be um Can Implement to try and
31:50shift that cycle that they might be
31:53going through especially when they're
31:54halting hungry angry lonely or tired how
31:57often have you worked with addicts have
31:59you spent much time working with addicts
32:00directly oh my gosh yeah so that's the
32:02bulk of my career is working uh with
32:05people with all different kinds of
32:07addictions me an example of the most
32:09obscure the most I had a patient who was
32:11addicted to
32:13water I know hard hard to imagine you
32:16have to though understand her narrative
32:19so she had a very severe alcohol
32:21addiction she got into recovery from
32:24that addiction and gave up alcohol but
32:26she discovered that by drinking copious
32:29amounts of water she could become
32:32hyponic meaning that she could lower the
32:36sodium levels in her bloodstream which
32:38would then lead her to become delirious
32:40and so in her desire to just be checked
32:42out she would do that she would she
32:45would drink a large amounts of water
32:48she's doing okay no sadly she's not um
32:51she she ended up taking her own life so
32:54that was very sad
32:59gosh in that situation was there was
33:02there a root cause of that behavior
33:04pattern further Upstream some kind of
33:06trauma or experience that had set this
33:09sort of cascade cascading set of issues
33:11off yeah you know I'm just speaking
33:14broadly um for for some patients with
33:17severe addiction trauma is a huge Factor
33:21um especially severe Early Childhood
33:24trauma but there are also many folks we
33:27see
33:28who have kind of great parents and have
33:31had happy childhoods and have great
33:34social networks and and work that they
33:36enjoy and yet they still become addicted
33:40and that's because we again we are wired
33:44to consume as much as possible of
33:47whatever releases dopamine in our brains
33:50to have survived Evolution to this date
33:53and yet we're living in this world where
33:55we have access to so many drug aied
33:58substances and behaviors that we've all
34:00become vulnerable to this problem and
34:02the reason I highlight this is because
34:05one of the things that I think has
34:06happened in the field of addiction
34:08medicine that maybe isn't the best is
34:12that often times patients themselves as
34:14well as their providers are digging
34:17really deep to find the trauma or the
34:20reason that someone has become addicted
34:23and I think that that's important to do
34:25in some cases but in in other other
34:28cases it can lead to kind of
34:30manufacturing trauma where there really
34:32isn't any furthermore I would say that
34:35when a person is in the throws of their
34:37addiction they're not going to be able
34:39to really do the complex emotional
34:42processing of their trauma while they're
34:44still using their drug of choice that
34:46they really need to get out of that
34:48Vortex of addiction and get into some
34:50degree of recovery before you would even
34:53want to go tackle some of those early
34:55traumatic experiences how many people do
34:58you think are struggling with some form
34:59of
35:00addiction well if you think of addiction
35:02as a spectrum disorder right there's
35:04mild moderate and severe um and there's
35:08I would even say a kind of a pre-
35:09addiction state where we're all sort of
35:11dabbling in compulsive overc consumption
35:14I would say the vast majority of us like
35:1690 probably
35:1995% have some degree of compulsive over
35:22consumption and you know if and when it
35:25tips over into what we would call
35:26addiction there's not a brain scan or a
35:29blood test to assess that it's not like
35:31you know switching a light a light
35:32switch and it's like oh yeah now you
35:33have addiction um it's not like that
35:36it's you know it's a gradual often a
35:37gradual and Insidious thing and we don't
35:40in fact have a biological measurement of
35:42addiction we Bas it on what we call
35:45phenomenology which is patterns of
35:47behavior that re repeat themselves
35:49across time and broadly speaking the
35:52definition of addiction is the continued
35:54compulsive use of a substance or a
35:57behavior despite harm to self and or
36:00others and so you know that harm can be
36:03very subtle um or not right and it can
36:07be a judgment call interesting because
36:10we do throw the word Addiction around a
36:12lot in society but but really the most
36:15important part of that is to understand
36:17if it's harming yourself or someone else
36:18the behavior pattern yes that's right
36:20and to also recognize that we're not
36:22very good judges of that when we're
36:24chasing dopamine okay so we sometimes
36:26justify behaviors we have as being not
36:29harmful and it's fine and it's not
36:30impacting me at all and what do you mean
36:32exactly and we don't we're not very good
36:34at seeing true cause and effect honestly
36:36when it comes to these behaviors which
36:38is why often times people won't really
36:40see the harm until they've stopped using
36:43for a period of time in your book
36:45dopamine Nation you talk about an
36:47addiction that you had yes and it was
36:49really surprising to me because I would
36:51never have thought that being obsessed
36:53with erotic
36:54novels could be classified as an
36:57addiction
36:59what happened what was the behavior take
37:01me into that that phase of your life so
37:04I was in my early 40s um my kids were no
37:08longer little um I got a lot of my
37:10self-worth and identity from being a mom
37:14and my kids were sort of entering
37:15adolescence they were doing fine but
37:18they didn't need me as much um so I had
37:20kind of a grief reaction you know in
37:22response to that was trying to figure
37:24out you know how to navigate this next
37:26phase of my life I'd always been a
37:28reader and in particular a reader of
37:30novels um in my own way that was how as
37:33a child I self soothed was to escape
37:36into uh the Fantasy Life of novels um
37:39but I never had what what I would call a
37:42problem with it and then one day I heard
37:44another mother at school said that she
37:46was reading this great book it was
37:48called Twilight it was about these
37:50vampires and she was going on and on
37:52about it and I read it and I I can't
37:53tell you what it was but it was just
37:55like the the the key in my particular it
37:57was completely
37:59transporting it just released a lot of
38:01dope mean is all I can imagine in my
38:03brains reward pathway and so I read the
38:06whole series and then I read the series
38:08again and I read it again and of course
38:10by the third or fourth time it wasn't as
38:13you know reinforcing and I thought to
38:14myself I wonder if there are any more
38:17vampire romance novels and then for me
38:20the real Tipping Point was I got an
38:22e-reader I got a Kindle because what
38:24happened was I I even before I got the
38:27Kindle I started reading you know novels
38:30that I would say I would be slightly
38:31embarrassed to admit that I was reading
38:33like kind of bodice Ripper novels as
38:36time went on I I needed more and more
38:39like graphic kinds of descriptions in
38:42order to find it pleasurable and and by
38:45the way that's classic for the addiction
38:48narrative right where you start out with
38:50a little bit and it goes a long way and
38:52then over time you build up tolerance
38:54that's neuro adaptation the Gremlins
38:57pressing down on the pain side of
38:58balance now I need more of my drug in
39:00more potent forms to get the same effect
39:02gradually over time I started um reading
39:06you know more and more sort of graphic
39:09erotic sexualized versions of this novel
39:12and I would I was embarrassed so I would
39:14hide that I was reading them and that
39:16gets into the whole double life of
39:17addiction where now we're lying about
39:19our use we're we're using our drug over
39:21here but pretending like we're not so my
39:24kids or my husband would walk in the
39:25room and I would be you know hiding
39:27behind another book one book behind
39:30another book so it looked like I was
39:32reading something you know I don't know
39:34more
39:36sophisticated and then the Tipping Point
39:38for me came really when I got a Kindle
39:40or an e-reader and then my reading was
39:43totally Anonymous I could read these
39:45books anywhere any time no one knew what
39:47I was reading and as soon as I finished
39:49one um I could read another one and I
39:53almost overnight became a chain reader
39:55like literally when I was n doing
39:58something else that I had to do I was
40:00reading romance novels one after another
40:03after another um which meant I was you
40:06know less present for my kids less
40:08present for my husband I would often
40:10stay up till 2: 3 4 in the morning on a
40:12week night reading romance novels have
40:15to get up two hours later go to work
40:17exhausted not able to be present for my
40:19patience not enjoying my work gradually
40:22getting more depressed more irritable
40:24more anxious more insomnia we went on on
40:27a a family vacation with an family
40:29friends of ours everybody together at
40:31this beach house all the kids playing I
40:33was like hiding in a room reading
40:35romance novels so and this is exactly
40:37what happens with addiction is that our
40:40Focus Narrows and the things that we
40:43used to enjoy are no longer pleasurable
40:45only this one thing has salience for us
40:48we plan our whole whole day around
40:50getting it using it hiding our use um
40:54and that's what happened to me
40:58it's so interesting because I was as you
41:00were talking about that I was thinking
41:01about all the behaviors that I have that
41:04are maybe isolating me or you know I
41:08just even things like spending a lot of
41:10time on the internet just watching video
41:12after video after video on YouTube or um
41:17those kinds of things or just like
41:18spending tons of time in my WhatsApp
41:20group chat talking like roasting my
41:22friends about nothing right how do you
41:24know if like this is it's cuz on end of
41:27the spectrum I could say okay well
41:28that's harming my relationship with
41:31people in the real world but
41:34it's helping making me feel good and
41:38it's you know maybe helping me in
41:40another department because I'm learning
41:42more about vampires or you know like so
41:46like you know because there's there
41:47might be net harm somewhere else but
41:50then an upside over here which and then
41:52I start rationalizing this Behavior like
41:55how' you just distinguish between these
41:57behaviors and know what's bad and what's
41:59good you know what it's really hard um
42:03these digital devices are powerful tools
42:07but also very potent drugs there's no
42:09doubt that digital media lights up the
42:13same reward pathway as drugs and alcohol
42:16these devices and platforms were
42:18designed to be addictive that is to keep
42:20us scrolling and tapping long beyond
42:23what we plan for or what we want or even
42:26what's pleasurable I think we can all
42:28relate to using this
42:31medium to a point where we don't even
42:35like it anymore and yet have difficulty
42:37getting ourselves off of it that really
42:39speaks to the inherently reinforcing and
42:43cognitively adherent nature of this
42:46medium it is a drug and so you know if
42:51and when and how we're crossing into
42:53addictive
42:54use I think we need to be very Vig
42:58about whether that's happened in our
43:00lives and one of the ways to do that is
43:03actually to try cutting out that
43:05particular digital medium that website
43:08or that behavior for a period of time
43:11long enough to experience withdrawal
43:14potentially reset reward Pathways and
43:17then re-evaluate because when we're in
43:19the behavior as you yourself noted it's
43:22very easy to rationalize oh I need to do
43:25this for work oh I need need to do this
43:27to stay in touch with my friends oh I'm
43:29learning so much from this right and all
43:32of that may have been true initially but
43:35may not be that true anymore and what I
43:39often point to is the subtler signs of
43:41addiction which are things like
43:43depression anxiety in attention insomnia
43:47restlessness these can be early signals
43:51for our consumption entering into that
43:54addiction range but us not realizing it
43:57because again we don't see cause and
44:00effect which is why doing an experiment
44:03like I did with my romance novels you
44:06know following in the footsteps of my
44:09patients and taking the advice I give
44:11them and I gave my romance novels up for
44:1530 days right just to see like okay I
44:18think this is a problematic Behavior can
44:20I give it up how will I feel and the
44:23very first day that I the very first 24
44:26hours hours that I did not read any
44:29romance novel any novel at all I was
44:32astounded at my level of anxiety
44:36restlessness and utter insomnia I had
44:39completely unlearned the art of putting
44:42myself to sleep without this digital
44:46narrative and that lasted a good 10 to
44:4814 days completely mapping on with the
44:50amount of time it takes typically to get
44:53out of acute withdrawal that is to say
44:55for those neuro adapt PA Gremlins to hop
44:57off the pain side of the balance and for
44:59homeostasis to to begin to be re
45:03restored um but by the time I got to
45:05weeks three and four I felt not just
45:09better than I had in the first two weeks
45:10but actually better than I had felt in a
45:12really long time I enjoyed my kids more
45:16I was more present for them I enjoyed my
45:18husband more my work seemed salian again
45:21I had started to think oh maybe I should
45:22do something else you know maybe maybe I
45:25you know this work I've been doing it a
45:26long long time I don't it's not that
45:28interesting anymore all of a sudden it
45:30was interesting again right so you see
45:33the relativity of that honic pathway and
45:36how when we're doing that behavior or
45:38substance that's so reinforcing that
45:40everything else loses its salience we
45:42can really
45:44misidentify what is causing our
45:47irritability anxiety insomnia until we
45:51stop that substance for long enough to
45:53see its impact on our lives how is it
45:55making you feel because I think a lot of
45:58a lot of people can't understand how you
45:59could get addicted to a book I'm sure
46:03some people understand that but but for
46:04me it's not something I've ever become
46:07addicted to so how how did it feel was
46:09it like exciting is it arousing is it
46:13somewhere in
46:14between I mean I think that romance
46:17novels are essentially socially
46:19sanctioned pornography for women okay
46:22and the medium is narrative and if
46:24you're a person for whom narrative is a
46:26powerful drug as it is for me a story a
46:28narrative a fiction um very potent since
46:32I was a child then you know it was a
46:35natural that that that would be the
46:37thing that I would get addicted to and
46:39basically just like we've hacked and
46:41bioengineered everything to make it more
46:44potent I mean people there's a formula
46:46for writing romance novels like if you
46:48take a physical copy if you go to a
46:50store and you pick up a romance novel
46:52and you literally physically open it to
46:542third of the way through you will get
46:56to the climactic scene pun intended
46:59right it's it's like it's
47:01engineered I mean I got to a point where
47:05I wouldn't even read it read after I
47:06wouldn't finish the book I would go on
47:08to the next book just to get to the
47:10climax part and then you'd move yeah and
47:12I wouldn't even read the danum ma or
47:13like what happens to the characters I
47:15didn't care you didn't care about no and
47:17also I didn't I got to point where I
47:19didn't care about the quality of the
47:20writing or the depth of the car it
47:22didn't matter it was it was the drug it
47:24was that moment I was looking for and
47:26you know there are a lot of free books
47:28on Amazon some some of which are high
47:30quality and some of which are not but
47:32like you know any good drug dealer knows
47:33free samples that's the way you hook
47:35people I would search for these free
47:37samples and that's part of it too like
47:39the searching for the drug so the
47:40Working The Upfront work you do for the
47:43drug is part of the drug right it's all
47:46that you know the machinations and the
47:48hiding and the this and the that that
47:51gets to be part of like all of the
47:53rituals surrounding it as you were
47:55talking as well I thought about work and
47:57work addiction yes because you earlier
47:59used the term excessive consumption and
48:02when I think about work even my work I
48:04Think Jesus I excessively consume work I
48:08start so many bloody businesses and
48:10invest in so many things and if you look
48:12to that behavior objectively if you're
48:13like an alien looking down at me you'd
48:15go this guy's got a problem do
48:17you know what I mean you think you think
48:18that's funny joking you
48:24know I feel for you and it's funny cuz
48:27in society we then those people are
48:29reinforced we clap that's right we clap
48:32we got this guy's not sleeping he's
48:33working 18 hours a day clap clap clap
48:36give him a trophy an award name a thing
48:39after him or her or right you know um
48:42and it's just really interesting that
48:44that that addiction of work and you tell
48:46me if it is it can be an addiction it's
48:48certainly in the scale of one end being
48:50sort of consumption excessive
48:52consumption in the other hand being
48:53addiction it's on there somewhere people
48:55can get addicted to work
48:57and part of the reason is that we've
48:59drug aied work right when when I say
49:01drug aied what do I mean we've made it
49:02more potent and this is true for all all
49:04these drugs we've made them more potent
49:06more novel more Bountiful meaning
49:09there's more of it and more accessible
49:11so if we if we break that down with work
49:13how is work more potent well certain
49:16types of work are more reinforcing not
49:18all types of work so for example Works
49:21work White Collar work is often now
49:24associated with stock options and
49:27bonuses right um there's often like a
49:29social media aspect to it or maybe even
49:32a Fame aspect or as you point out those
49:35are our cultural Heroes right so you get
49:37all this you know agulation for being a
49:41workaholic and that also because we're
49:43such social creatures right and human
49:45connection stimulates dope mean that
49:47that also makes work more of a potent
49:50drug personal brand right so you're
49:52LinkedIn oh my God this person got a
49:54promotion we all clap we the likes the
49:57comments you're amazing the agulation
49:58the a as you said the awards the
50:00trophies and then you've got um the fact
50:04the fact of novelty so once we've
50:06exposed our brains enough times to a
50:09certain drug as I said we develop
50:11tolerance right and then we need more
50:13potent forms or novel forms one of the
50:15ways we overcome tolerance is by taking
50:18our drug and then changing it slightly
50:20like adding a little new molecule on
50:23this chemical right or on the Internet
50:25you know when we're searching videos we
50:27want something similar to what we liked
50:29before but just a little bit different
50:31and that's what the algorithm does
50:32automatically right it offers oh you
50:34should check this out oh how about this
50:35oh check that out right and that engages
50:37our treasure seeking function we're
50:39looking for that that novel thing but
50:41that's not too novel right it has to be
50:43in our category of things we like and I
50:45think for work we have that too like
50:47there are so many ways now that people
50:48can engage in their work and it's not
50:50all bad that it's novel but you know
50:52certain types of work it makes it very
50:54enticing then you have quantity
50:57right I mean work never ends there's
50:59like no natural stopping point for work
51:01you know you do a line of cocaine you
51:04run out of money you run out of cocaine
51:05you're done right but that's not true
51:08for work everywhere anytime and then
51:11that gets to
51:12accessibility one of the biggest risk
51:14factors for addiction to any drug or
51:16behavior is simple access we know that
51:19if you grow up in a neighborhood where
51:21drugs are sold on a street corner you're
51:22more likely to try them more likely to
51:24get addicted if you live in a world
51:27where you have access to work
51:2924/7 you're more likely to expose your
51:32brain to more work and more likely to
51:34get addicted to work again especially if
51:36it's got all those other reinforcing
51:38qualities this is probably in part why
51:41people quit their
51:42jobs you mean if they just get
51:44overwhelmed or it's it's partially why
51:46people can never quit but I think it's
51:48important to make a distinction between
51:49work that's reinforcing in those ways
51:52and then work that's completely not
51:55reinforcing yeah
51:57alienating mind-numbing work in which
52:00the the actual task is separated from
52:03the meaning of a task I mean they quit
52:05their jobs either in search of more
52:07dopamine so if I'm working in a job
52:09where I don't know maybe it once gave me
52:11dopamine and now it's become monotonous
52:13and the same right I I need to quit to
52:15go find but there's novelty for you
52:17that's right yeah and that's true people
52:19many people change jobs every two to
52:21three years I I recently read that the
52:24the average life of a business now is
52:26like 15 years whereas you know 50 years
52:29ago it was 50 years and there's all this
52:32turnover all this churn chasing novelty
52:35also you know I I do want to emphasize
52:36that people who are in work that's not
52:38like intrinsically rewarding but is the
52:41opposite kind of soul sucking that's
52:44also a risk factor for addiction because
52:46people just wait till the end of the day
52:47till they can go home and then use a
52:50drug to numb themselves from the stress
52:52of work so it's it's plausible that
52:55people who are in lower pleasure jobs
52:57are more likely to be overweight or
52:59addicted or dependent on alcohol yeah or
53:02simply opt out of the workforce as many
53:04young men are doing now in the United
53:06States and what we know from data that's
53:08been collected is many of them are
53:09playing video games right they've just
53:11completely opted out of the workforce I
53:14guess this in part explains why there's
53:15a drinking culture that's associated
53:18with people who are potentially lower
53:21class um because they're doing um
53:25potentially
53:27less pleasurable work
53:30and they're therefore they if we think
53:33about the scale that they would then end
53:35up in the pub after work you know maybe
53:38that's partially true but even people
53:40doing like doctors and lawyers they're
53:42are oh okay yeah equal rates of
53:44alcoholism among those groups I think
53:47what's happening there though is that
53:49the nature of the work is just so
53:51stressful whether it's white collar or
53:53blue collar that there's this kind of
53:55work hard play hard right I'm going to
53:56work all day and at the end of the day
53:58I'm going to reward myself so now you've
53:59got a pleasure pain balance that's going
54:01pleasure pain pleasure pain and and
54:02remember the biological definition of
54:04stress is any deviation from
54:08neutrality so that every time our brain
54:11has to work to restore a level balance
54:14we're actually triggering our stress
54:15response triggering our own adrenaline
54:18it's stressful to have to restore the
54:21balance from those extremes of Pleasure
54:23and Pain I read in um your book you were
54:25talking about how different behaviors
54:27and sort of chemicals and substances
54:29have different impacts and I was on page
54:3150 of dopamin nation in a study of mice
54:34sex increases the release of dopamine by
54:36100% And amphetamines which is like
54:39drugs right hardcore drugs increases it
54:42by 1,000% by this accounting one hit of
54:45a meth pipe is equal to 10 orgasms yes
54:48it's interesting to think about that the
54:50different behaviors we have and how
54:52they'll have a bigger impact on our
54:53dopamine is there like any in an in in
54:58typical order of things that are like
54:59extremely dopamine inducing and things
55:01that aren't what's it like the top and
55:03bottom of the list but in your view you
55:06know I really think that it depends on
55:09the person and we've got to look at drug
55:11of choice right I mean potent drugs like
55:15methamphetamine like opioids like
55:17alcohol like nicotine like cannabis um
55:21are are going to be very reinforcing for
55:25many people but not for all people and
55:28most people do have their one drug that
55:30they sort of prefer above all others so
55:33although generally speaking intoxicants
55:36release a lot of dopamine in the reward
55:37pathway um I think every person is going
55:40to be different and also we we don't
55:42really have good ways of measuring
55:44absolute values of dopamine in human
55:47beings right we can do that in rats but
55:50we can't really do that in humans it's
55:51it's relative values I've got this um
55:54picture here which shows what looks like
55:56brain scans in uh normal person but then
56:00in someone who's addicted to different
56:01substances I'll put this on the screen
56:03and I'll link it below in the
56:04description for anyone that needs it and
56:06wants to see it but it effectively shows
56:08the impact that like cocaine has on the
56:10brain meth um alcohol and heroin what is
56:13what is going on here so the red in this
56:16image represents dopamine transmission
56:19okay so how much dope mean is being
56:21released from the pr synaptic neuron
56:23Crossing that synapse binding to
56:25receptors on the Sy aptic neuron how
56:27much dopamine is kind of swirling around
56:29in the reward pathway part of the brain
56:32and what this image shows is that on the
56:35left hand side in healthy control
56:37subjects who do not have addiction
56:40there's plenty of red right so there's
56:43plenty of dopamine Transmission in the
56:45reward pathway specifically here in the
56:48nucleus accumbens but if you look at the
56:50right hand column you'll see that in
56:52these individuals who have been using
56:55cocaine meth amphetamine alcohol and
56:57heroin in addictive ways there's almost
57:01no red which means there's decreased or
57:05below normal levels of dopamine
57:08transmission they are in a chronic
57:11dopamine deficit
57:14State this is evidence of the brain
57:18trying to
57:20compensate for too much dopamine being
57:24triggered by down regulating its own
57:27dopamine production and transmission not
57:29just to Baseline but below
57:31Baseline and importantly these
57:34individuals who are addicted to these
57:36substances these brain scans were done
57:39two weeks after they stopped
57:41using oh wow yeah which tells us that
57:45this dop dopamine deficit State persists
57:48for some period of Time how long well it
57:51depends on the person but we know at
57:53least from this experiment that the
57:55first two weeks are this persistent
57:58dopamine deficit state which is
58:00consistent with acute withdrawal right
58:03people feel when they first stop their
58:05drug of choice they feel terrible right
58:07they experience all of the symptoms of
58:10physical withdrawal that correspond with
58:12that particular drug they were using
58:14usually the opposite of what the drug
58:16did plus the universal symptoms of
58:18withdrawal from any addictive substance
58:20or behavior anxiety irritability
58:22insomnia depression and craving now if
58:25they can get through the first 10 to 14
58:28days what we see clinically is those
58:31acute withdrawal symptoms slowly start
58:34to get better and we think that that is
58:37mapping on to regenerating dopamine
58:40Transmission in the reward pathway and
58:43if they can make it to a month that's
58:46usually the point for for on average in
58:48based on clinical experience when people
58:51really can start to get out of that
58:54constant state of craving for their drug
58:56of choice and begin to see some light at
58:58the end of the tunnel for what their
59:00lives might look like if they can
59:03maintain abstinence from their drug and
59:05we can't just inject or drink dopamine I
59:07mean I guess that would be like drinking
59:09alcohol we can't just artificially mess
59:11with the the balances to try and restore
59:13the dopamine levels in an addict can we
59:15can't just add a little bit of dopamine
59:16yeah it's it's a great question because
59:18we have some natural experiments that
59:21suggest what what might happen if we do
59:23that so as I mentioned before people
59:25with Parkinson's have depletion of DOP
59:27mean in the substan That's What
59:29Causes That that motor disease the
59:32treatment for it is to give L Doopa
59:36which is a dopamine precursor if I were
59:38to give you a spoonful of dopamine it
59:39would do absolutely nothing because it
59:41doesn't cross into the bra the brain it
59:42doesn't cross the blood brain barrier
59:44but I could give you lopa which is a
59:46precursor chemical that would cross your
59:48blood brain barrier and get turned into
59:51dopamine and then diffusely bind
59:54dopamine receptors in your brain in the
59:56reward pathway but also in the movement
59:58Pathways when we give patients with
1:00:02Parkinson's dopamine in this form that
1:00:06can temporarily improve their movements
1:00:08but in about one in four Parkinson's
1:00:11patients they will develop a denovo
1:00:14addictive disorder shopping addiction
1:00:17sex addiction other types of addiction
1:00:20because we have the same problem we are
1:00:23stimulating
1:00:26the reward pathway with dopamine that is
1:00:29ingested exogenously from the
1:00:32outside and our brain reads that as oh
1:00:35boy got to compensate by downregulating
1:00:38dopamine transmission to below Baseline
1:00:41which then puts us in that addiction
1:00:43Vortex does that make sense it does so
1:00:45we have to I mean it tells me that we
1:00:47have to live lives in a certain sense of
1:00:51we have to live our lives in a certain
1:00:53sort of
1:00:54homeostasis and
1:00:56it's so easy not to in the world we live
1:00:58in it's like it's like impossible to
1:01:00live in a perfect homeostasis balance in
1:01:04the world we live in right even more
1:01:07than having to try to live within this
1:01:09sort of narrow range of homeostasis in
1:01:12the world we live in today we probably
1:01:13have to intentionally do things that are
1:01:16painful do things that are hard pleasure
1:01:19pain balance like we learn that when we
1:01:21press on the pleasure side of the
1:01:23balance like with alcohol or pornography
1:01:26or romance novels or cannabis or
1:01:28whatever it is right no sooner does that
1:01:31happen than our brain adapts by those
1:01:35neuro adaptation Gremlins hopping on the
1:01:36pain side of the balance to bring it
1:01:38level again but they like it on the
1:01:39balance so they don't get off right when
1:01:41it's level they stay on until we're
1:01:43tilted an equal an opposite amount to
1:01:45the side of pain that's the come down
1:01:46the hangover Etc but it turns out the
1:01:49opposite is also true if we
1:01:51intentionally press on the pain side of
1:01:53the balance for example with exercise or
1:01:56an ice cold water bath or intermittent
1:01:58fasting those Gremlins will hop on the
1:02:01pleasure side of the balance and we will
1:02:03get our dopamine indirectly by paying
1:02:05for it up front and there are studies in
1:02:09humans showing that when humans expose
1:02:12themselves to exercise for
1:02:15example dopamine levels gradually rise
1:02:18over the latter half of the exercise and
1:02:20then when the exercise stops dopamine
1:02:22levels will remain elevated for hours
1:02:25after afterwards before going back down
1:02:28to the Baseline level position without
1:02:31ever going into that dopamine deficit
1:02:33state so it's a great way to get our
1:02:35dopamine in directly because it's much
1:02:37less vulnerable to that compulsive
1:02:41craving phenomenon of overuse so you're
1:02:43not going to get an exercise come down
1:02:46you can butc and people can get addicted
1:02:49to exercise right but typically it's
1:02:52it's very unusual because The Upfront
1:02:55cost
1:02:56to to do the work and endure the pain of
1:02:59exercise in the first place mitigates
1:03:02our vulnerability to an exercise
1:03:04addiction and in general H okay CU it's
1:03:06so hard to do that it's going to be it's
1:03:09not like pulling a lever on a slot
1:03:10machine or clicking on a porn website is
1:03:13difficult yes okay so fighting for the
1:03:16dopamine
1:03:18is insulates us against the chance of an
1:03:21addiction having to really fight hard
1:03:22for it okay yeah and this kind of
1:03:24explains I guess in part why
1:03:26I pulled out some stats ahead of our
1:03:28conversation today that from 1996 to
1:03:312008 participation in ultramarathons has
1:03:35increased by
1:03:391,676 the ice bath Market is expected to
1:03:42rise from 350 million in 2024 to to
1:03:45nearly half a billion by 2030 the number
1:03:49of people taking part in obstacle course
1:03:51races like tough mut or hrock etc etc
1:03:54has increased by almost 7x from 2010 to
1:03:582017 it seems like in society there's
1:04:00this counter movement towards people
1:04:02seeking out hard dopamine chasing pain
1:04:06yeah those are amazing I didn't know
1:04:07that those are amazing numbers um you
1:04:10know in general there's a part of me
1:04:11that wants to say well that's a good
1:04:13thing um but there there's another part
1:04:15of me that's wary also because we're so
1:04:18good at drug aying everything that we do
1:04:21that there's a way in which these types
1:04:23of behaviors can also be drug aied right
1:04:26made more potent with all of the
1:04:28technology the way that we count
1:04:30ourselves the leaderboards the social
1:04:32comparisons all of that takes this thing
1:04:34which is really in its natural state
1:04:38kind of impervious to addiction like you
1:04:40just typically wouldn't get addicted to
1:04:42these types of painful physical
1:04:44activities you would do what you needed
1:04:46to do for survival but we've managed to
1:04:49make them addictive in all these
1:04:51different ways I still think it's a
1:04:53better way to get your dopamine like I
1:04:55really encourage exercise we always talk
1:04:57about movement as medicine and in
1:05:00general our our life is so convenient so
1:05:02easy so passive so sedentary that I'm
1:05:05telling patients all the time you know
1:05:07get up off the couch move your body walk
1:05:10around the block I think that's the
1:05:12bigger obstacle right now is just
1:05:14getting people to move but I do think we
1:05:16need to be wary of not going too far in
1:05:19the direction of like the ultra Ultra
1:05:21Ultra whatever it is so what is a better
1:05:23way to live if we're trying to optimize
1:05:25happiness and to keep our dopamine in
1:05:27balance and not have the crashes Etc and
1:05:29come downs and hangover what is a
1:05:31optimal way to live our lives do we have
1:05:33to look back at our caveman ancestors
1:05:36and live like them I think that part of
1:05:39the problem is that we've
1:05:41organized Our Lives now around
1:05:45rewards almost everything that we do is
1:05:49predicated on the Feelgood moment we'll
1:05:52have at the end of it and because of
1:05:55that that we
1:05:56are missing out on the
1:05:59process we're projecting our psyche
1:06:02forward into the future toward the
1:06:04reward and not able to really be here in
1:06:08the moment okay this is going to be
1:06:10sound weird I'm going to give you a
1:06:11weird example so driving over here today
1:06:13I found I was nervous for this interview
1:06:16and in a way looking forward to it but
1:06:19in a way wanting it to be over right and
1:06:22and in seeing that in myself I thought
1:06:24that's so sad like that's that's so sad
1:06:27that we live our lives that way myself
1:06:29included always this weird blend of
1:06:31wanting whatever we're doing to be over
1:06:34so that in a way we can just go hide and
1:06:35do whatever that self- steem thing is
1:06:37that we do where we're safe and we're
1:06:39like you know stimulating ourselves in
1:06:41some way and then I thought well what if
1:06:44I knew that I was going to die right
1:06:47after this going come off really weird
1:06:50now but what if I knew that I was
1:06:52actually going to die right after our
1:06:54conversation today
1:06:56that totally changes my perspective
1:06:58doesn't it because this time you and I
1:07:00have that's all I got it's over for me
1:07:02when this so this this conversation is
1:07:04it I really better be right here right
1:07:06now and really taking joy in whatever
1:07:10you and I can find together and and I
1:07:13think the more we can do that the better
1:07:17what's happening there you're removing
1:07:18the thought of the outcome the rewards
1:07:20the potential you know failure or
1:07:22whatever and you're focusing on just
1:07:24being present and in doing so what is
1:07:27happening it's a great question and I've
1:07:29actually given this quite a lot of
1:07:31thought because I remember when I was in
1:07:32college and I you know met some like Zen
1:07:36people and they were like be here now be
1:07:39here now and I thought well whenever I'm
1:07:42here now I'm miserable like I I I don't
1:07:45like me and I don't like being in the
1:07:48world I I don't want to be here now I
1:07:50want to be somewhere else so I didn't
1:07:53really understand what they were getting
1:07:55at
1:07:55it really took me you know till I had
1:07:58lived quite a lot of life and had some
1:08:00you know some significant experiences
1:08:02and given it some thought that I
1:08:04realized oh be here now means be here
1:08:07now and be
1:08:09uncomfortable and be okay with being
1:08:12uncomfortable and being okay with not
1:08:14being able to
1:08:16control my pleasure or my pain or my
1:08:19comfort level but just being open to
1:08:21whatever comes and I think that's a
1:08:24really a key shift
1:08:26that I'm not trying to control my
1:08:29experience in the moment and that it's
1:08:31okay to be unhappy or Restless or
1:08:35uncomfortable and not trying to run away
1:08:37from that but just really turn and face
1:08:39it and embrace the discomfort which I
1:08:42also think is quite Universal I don't
1:08:44think I'm I'm alone in that and then the
1:08:48key piece about not not anticipating the
1:08:50reward is helps me be in the moment
1:08:54right because I'm not just waiting for
1:08:56the good thing to come after I'm saying
1:08:58to myself imagine there's nothing good
1:09:00coming after nothing at all right
1:09:02there's just there aren't rewards this
1:09:04is it and then also being able to say
1:09:07and it's okay if in the moment like it's
1:09:10not great like I I can Embrace that you
1:09:13know I can be unhappy or Restless or
1:09:18anxious or whatever it is and then when
1:09:20I do that you know I feel like there's a
1:09:23funny funny thing that happens and all
1:09:25the sudden I I'm not as anxious right
1:09:28and I am present and it there is some
1:09:32Joy there interesting so when you allow
1:09:35yourself to deal with being
1:09:36uncomfortable in the moment it turns out
1:09:39you it removes the thing that was making
1:09:41you uncomfortable in the moment which is
1:09:43like the avoidance or the worry or
1:09:45overthinking whatever else yeah I I
1:09:48think we have this and it's fed by
1:09:49modern culture this kind of expectancy
1:09:52that really we should be happy all the
1:09:54time and if you know if we've arranged
1:09:56things appropriately for our lives and
1:09:59if we've done our work and you know
1:10:01aimed true then we should just be like
1:10:04life is great and I don't believe that
1:10:07anymore I think that you know I mean
1:10:10like Buddha said life is suffering but I
1:10:13really think that
1:10:16fundamentally like it's uncomfortable to
1:10:19be
1:10:20alive and that it's a kind of a constant
1:10:22state of restlessness and discomfort if
1:10:25we're being really honest and and tuning
1:10:27in when I really let myself see that and
1:10:30feel that all of a sudden I'm I'm freed
1:10:34from from some of
1:10:38that what has caused your anxiety
1:10:40throughout your life in the moment you
1:10:42you referenced earlier that some things
1:10:43have happened that have led you to
1:10:46understand this better and understand
1:10:47yourself better what is what am I
1:10:49missing from this jsaw puzzle yeah well
1:10:51you're you're good you could have been a
1:10:53psychiatrist oh really yeah it's always
1:10:55time this doesn't work out there's still
1:10:57time right it's not too late you get a
1:10:59new profession yay um I think you know
1:11:01for me the the big Turning Point um was
1:11:05that we lost our we lost a child and um
1:11:10in the immediate aftermath of our
1:11:12child's death I was just determined to
1:11:16like sort of undo the experience
1:11:19and um you know get enough Psychotherapy
1:11:24and enough whatever whatever it took to
1:11:28sort of not feel that pain and it wasn't
1:11:31until I really just said oh like I'm
1:11:33going to feel this pain for the rest of
1:11:35my life it's never going away that
1:11:36suddenly I felt some relief from that
1:11:38pain and that was a real window for
1:11:42me so interesting that the
1:11:46it's
1:11:49acceptance yeah and and you know and and
1:11:52I think you know one of the reasons I
1:11:53love treating patients with addiction is
1:11:56because I really relate to that hitting
1:11:59bottom moment you know that moment when
1:12:01it's like you just have the feeling that
1:12:05like everything I try to do to manage
1:12:08this Behavior or to make my life better
1:12:10only makes it worse I felt like I had a
1:12:13very similar
1:12:14experience um and that it was only when
1:12:17I kind of realized oh I yeah I I can't
1:12:22run from this I cannot run this pain uh
1:12:25that I I begin to have some the
1:12:27beginnings of relief from that
1:12:29experience I can't outrun this
1:12:32pain it's all natural sort of
1:12:35disposition to try and outrun pain isn't
1:12:37it that's the irony right we're really
1:12:39wired to outrun the pain we are like we
1:12:42reflexively seek out pleasure and avoid
1:12:44pain and yet that's the very thing thing
1:12:46that doesn't get us to where we want to
1:12:48go but we do now live in a world where
1:12:52it's very easy to outrun the pain yes
1:12:54this is a lion that's chasing me this
1:12:56could be a bad email and then I open up
1:12:58a tab and start Doom scrolling or open
1:13:01up a tab and start watching video
1:13:03playing video games or pornography or
1:13:05whatever yeah that's exactly right there
1:13:07are so many ways that we can now
1:13:09distract ourselves from you know our own
1:13:12suffering or our own
1:13:14awareness and where do you find yourself
1:13:16now with dealing with that grief and the
1:13:18pain as we sit here yeah I mean I I feel
1:13:22like in many ways it's been a real gift
1:13:24in my life you know it's really informed
1:13:26my life in in ways that um I mean I I've
1:13:31learned things from that experience that
1:13:33I think it would have been almost
1:13:35impossible for me to learn otherwise you
1:13:38deal with a lot of people that are in a
1:13:40state of
1:13:42suffering
1:13:44I imagine that's a
1:13:47weight because I um even hearing the
1:13:50story of the lady that passed away after
1:13:51that water addiction it was like a it
1:13:53was like a weight on my shoulders just
1:13:54to hear it
1:13:55so if your profession puts you right at
1:13:58the heart of this type of suffering how
1:14:00do
1:14:01you manage that to to hold that
1:14:05weight a couple things um first of all a
1:14:09lot of people get better and when people
1:14:11with addiction get better
1:14:14it's so much better that it's incredibly
1:14:17rewarding to see and they're amazing
1:14:19people Absolut like the most tenacious
1:14:22talented people you'll ever meet and
1:14:25when they get better it impacts so many
1:14:28other people right their friends their
1:14:30family the people they work with so it's
1:14:33very rewarding work and and not at all
1:14:35burdensome of course you know for
1:14:38patients who don't don't get better or
1:14:41patients who die it's a terrible feeling
1:14:44and there is a sense of um
1:14:47responsibility and and guilt even when I
1:14:49feel like there was nothing that I could
1:14:51have done otherwise um you know I carry
1:14:53those losses with me so it's hard is
1:14:56there any particular cases that have
1:14:58stayed with you the most I mean every
1:15:00patient I've had who's died while under
1:15:03my care those are incredibly painful um
1:15:07and I will never you know those are sort
1:15:10of a those people will be with me as a
1:15:14part of me for all of my life young and
1:15:17old yeah young and old yeah it's
1:15:19especially tragic to you to lose young
1:15:21people and it always feels like their
1:15:24second gu ing like oh if only I had done
1:15:26that or if only we had intervened here
1:15:29but I just think that's the nature of
1:15:31death we we can't get away from the
1:15:33feelings of guilt around it no matter
1:15:35who we are and no matter the
1:15:37circumstances how young can addiction
1:15:40and the consequences of
1:15:42addiction ruin someone's life like how
1:15:44young can someone be when their life is
1:15:46ruined from from the work you've done
1:15:47and the the patients you've worked with
1:15:49and what are those addictions typically
1:15:51that seem to be most um susceptible to
1:15:54those that are young
1:15:56well I mean you know some some kids
1:15:59start with drugs and alcohol you know
1:16:03five six seven eight five six yeah I
1:16:06mean it's you know some some some kids
1:16:08use with their parents or their
1:16:09caregivers they're exposed very early if
1:16:13we seriously conceptualize digital media
1:16:16as a drug I mean then we've got you know
1:16:18even younger cohorts starting with that
1:16:20and we do know that kids can get
1:16:23addicted to digital media
1:16:25and as a result um die from that I mean
1:16:29there was just this tragic case of a
1:16:31young man who essentially got addicted
1:16:34to a chat box I think he was 14 not my
1:16:37patient it was written up um in the New
1:16:39York Times in the Wall Street Journal
1:16:41and he fell in love with this chat box
1:16:43started to isolate wasn't spending time
1:16:45with his family or friends and then
1:16:47eventually took his own life purportedly
1:16:50so he could join this imaginary person
1:16:55what's the youngest patient you've ever
1:16:57seen the youngest I've seen is probably
1:16:59around 15 14 15 and they had an
1:17:02addiction yeah usually cannabis alcohol
1:17:06nicotine can you get addicted to
1:17:07cannabis oh yeah oh my gosh cannabis is
1:17:12very addictive really oh yeah
1:17:15yeah harmful very harmful the target
1:17:19organ that it damages the most is the
1:17:22brain um it's harmful in many ways I
1:17:25mean it number one it demotivates people
1:17:29often and so they can have the feeling
1:17:32that they're getting stuff done or that
1:17:34they're creative when in fact they're
1:17:35not doing
1:17:37anything um it most people smoke it and
1:17:41so it can be damaging to the lungs and
1:17:43and other other organs um a lot of
1:17:46people say that well cannabis isn't
1:17:47addictive because I don't have this
1:17:49standard withdrawal phenomenon when I
1:17:51stop like I don't have the shakes or
1:17:53anything like that but keep in mind the
1:17:55universal symptoms of addiction are
1:17:57psychological symptoms anxiety
1:17:59irritability depression insomnia craving
1:18:02and people have that in Spades when they
1:18:04try to stop using cannabis plus we often
1:18:07see something called the hyperemesis
1:18:09syndrome so cannabis can help with
1:18:12nausea and vomiting it can help decrease
1:18:14the feeling of wanting to vomit but
1:18:18again as the brain continues to be
1:18:20exposed to it there's this process of
1:18:22neuro adaptation it stops working and it
1:18:25can even turn on them and do the
1:18:27opposite So eventually people can
1:18:29actually have a cyclical vomiting
1:18:31syndrome as a result of cannabis so
1:18:34they'll show up in the emergency room
1:18:35and say I can't stop I can't stop
1:18:37vomiting and the reason is because of
1:18:39the Cannabis that they maybe initially
1:18:41started uh to stop feelings of
1:18:45nausea on page 40 of dopamine Nation you
1:18:48say we've lost the ability to tolerate
1:18:50even minor forms of discomfort yeah and
1:18:52as I was reading through this section of
1:18:54your book I was thinking it sounds like
1:18:56we've gone a little bit soft in society
1:18:59um we've reset our pleasure pain
1:19:02threshold to the side of pain that even
1:19:04the slightest thing feels like trauma to
1:19:06us even things that objectively speaking
1:19:08a generation or two ago would not have
1:19:10been considered traumatic are now trauma
1:19:13we live in a bit of a trauma Society uh
1:19:15one that doesn't appear to be very
1:19:16resilient and the only measure of that
1:19:17that I have is if I think about the work
1:19:19that my grandfather had to do versus the
1:19:21work that you know people maybe in my
1:19:23generation do in complain about and seem
1:19:26to be like objectively suffering over
1:19:28and stressed about it seems like there's
1:19:29been a shift in our threshold our
1:19:32tolerance levels can this be explained
1:19:34through dopamine what's going on here
1:19:35and do you believe that's true have we
1:19:37gone a bit soft I would say succinctly
1:19:40yes I do believe we have gone a bit soft
1:19:43but I don't think it's a moral problem
1:19:45or a character problem I actually think
1:19:47it's a physiological problem based on
1:19:49the fact that we're insulated from Pain
1:19:52and we're exposed to all kinds of
1:19:53Pleasures so I really think that we have
1:19:56individually and collectively reset our
1:19:58reward Pathways to the side of pain
1:20:00meaning that the Gremlins have now
1:20:02accumulated on the pain side we've
1:20:03tipped ourselves to the side of pain
1:20:06because we've had so much pleasure
1:20:07because we've had so much pleasure yes
1:20:08thanks for having me clarify so that you
1:20:11now we need more and more pleasure to
1:20:13feel any pleasure at all and the
1:20:15slightest little pain and we're you know
1:20:17experiencing excruciating pain you add
1:20:21to that the fact that we have a culture
1:20:22that tells us we should never be in pain
1:20:25and that if we are something's wrong
1:20:26with our life or something's wrong with
1:20:27our wife or something's wrong with our
1:20:30job and so now you've got you know a
1:20:32whole generation of folks who feels
1:20:35like they're experiencing more pain
1:20:38because they're literally don't do not
1:20:40have the mental calluses to tolerate
1:20:42pain and now they're being told and if
1:20:44you have any pain at all you must have
1:20:47you know something wrong with your brain
1:20:48go see a doctor go take a pill and I
1:20:50think this is really uh this is not a
1:20:52direction we want to keep going in
1:20:55we have a mental health culture where we
1:20:58assume most things are mental health
1:21:00illness um in page 186 of your book you
1:21:03say I've become convinced that the way
1:21:05we tell our personal stories is a marker
1:21:07and predictor of mental health now if
1:21:09you live in a society where everything
1:21:11has a label and it's a it's a disease or
1:21:13an illness or you know I I don't feel
1:21:15good today so I've got this disorder and
1:21:17therefore I need this
1:21:20medication I guess there's two questions
1:21:22is my assessment of this situation
1:21:23correct and
1:21:25be is this a bad place to be in a
1:21:28society where we think everything every
1:21:29feeling we have every you know we think
1:21:31everything that makes us different is a
1:21:34deficiency let me let me start let me
1:21:37let me answer this by talking a little
1:21:38bit about the role of language and
1:21:41narrative because I think this is very
1:21:43fascinating and you know as a
1:21:45psychiatrist and a therapist that is my
1:21:47bread and butter right is is narrative
1:21:50how people tell their stories by by
1:21:52giving language to our experience
1:21:55we gain awareness of our conceptual
1:21:58models of the world okay okay and what I
1:22:03have learned over time is that the way
1:22:06people tell their stories is a window
1:22:09into their model of the world and that
1:22:11there are healthy narratives and not so
1:22:14healthy narratives and in general in my
1:22:17clinical experience when people come
1:22:19into the room and they tell their life
1:22:23story in such a way that they're always
1:22:25the victim of other people and
1:22:28Circumstance in the world those are
1:22:30people who are number one not doing well
1:22:36and number two not going to do well
1:22:39going forward unless they change that
1:22:41narrative to acknowledge what they've
1:22:44contributed to the problem and the
1:22:46reason for that is because the way that
1:22:48we narrate Our Lives is not just a way
1:22:52to understand our past it actually is
1:22:55our road map for the future so if I see
1:22:58myself as a victim and that's my
1:23:01narrative I will literally create
1:23:03victimhood for myself going forward I
1:23:06will literally change my sensed
1:23:09experience so that whatever happens I'll
1:23:12make sure I end up as a victim when
1:23:15people with severe addiction get into
1:23:17recovery one of the most palpable
1:23:19changes that I see is the way that they
1:23:22narrate their lives they go from in
1:23:25addiction talking about their lives as
1:23:27if it's always everybody else's fault to
1:23:30in recovery talking about their lives in
1:23:33a way that says oh you know what I could
1:23:36have done better here or you know what
1:23:38that's something that I keep doing that
1:23:41really messes with my life that I want
1:23:43to change and I'm going to figure out
1:23:44how to change that why is it so hard to
1:23:46take responsibility in such a way great
1:23:48question we just hate to do it because
1:23:51when we do it we feel shame and shame is
1:23:53an incredible painful emotion it's like
1:23:55a gut punch of an emotion that is
1:23:58associated with fear of Abandonment fear
1:24:01of being shunn by our tribe we'd much
1:24:04rather paper that shame over with anger
1:24:07and resentment toward others it's it's
1:24:08interesting
1:24:10because there'll be a different groups
1:24:13of people listening to this now there'll
1:24:15be the high responsibility group that
1:24:16just love and revel and taking
1:24:17responsibility because they think taking
1:24:19responsibility means that they are
1:24:21strong it means that I'm so strong I can
1:24:24take the blame and withstand it and it's
1:24:26funny cuz the more I've learned to take
1:24:28responsibility for things in certain
1:24:29areas of my life The more I've become
1:24:31proud of myself and the more I think I'm
1:24:33strong and I'm like oh look at me I can
1:24:34take responsibility for anything and it
1:24:35doesn't and then if you go down this
1:24:37spectrum you'll eventually get to the
1:24:38end of the spectrum where you've got
1:24:40people who even as they heard you say
1:24:42that will feel cognitive dis they'll
1:24:45feel a sense like a little it'll
1:24:47irritate them it'll piss them off and
1:24:49they will be the whatab about gang
1:24:50they'll be saying yes but what about
1:24:52Dave he did this to me and you know
1:24:55they'll immed like the immediate
1:24:57reaction would be they they're pissed
1:24:59off they've probably gone now they've
1:25:00gone so we're not even talking to them
1:25:02anymore but if you but it's fine we can
1:25:04talk about them they're no longer here
1:25:06but that group of people my question
1:25:07really is how do you speak to that group
1:25:10of people and convince them that
1:25:11actually taking personal responsibility
1:25:13is a good thing for them and if they're
1:25:15focused on what their core values or
1:25:16their North Star is in their life then
1:25:18personal responsibility is the path
1:25:20there not blame not victimhood you know
1:25:22like how do you turn those people around
1:25:25great question and I have to say what I
1:25:28know about this I learned from Al
1:25:30Alcoholics Anonymous and what they do
1:25:32because they do something that's really
1:25:34incredible first of all it's necessary
1:25:37to validate somebody's victimhood so
1:25:42this is to say you have been wrong if if
1:25:44they really have been wronged to
1:25:46validate that or you experience this
1:25:48trauma or you were born into this crappy
1:25:50situation and you were just a kid and
1:25:52you had no choice about that and to
1:25:55really acknowledge that but then the
1:25:59fourth step of the 12 steps of Alcoholic
1:26:01Anonymous talks about looking at each of
1:26:05those
1:26:06situations and after writing down like
1:26:09this person wronged me and exactly what
1:26:10they did so you know taking time to
1:26:13focus on the resentment
1:26:16right then only after that to say okay
1:26:21but is there
1:26:22anything that I did that contributed to
1:26:26that problem is there anything at all
1:26:28that I could have done differently and
1:26:30for a little kid you know born into a
1:26:32horrific situation you there's not much
1:26:36right that that a kid could have you
1:26:38know we don't we don't expect a child to
1:26:40take responsibility but the adult who
1:26:44was that child who continues to
1:26:46perpetuate some of th the harms they
1:26:49experienced on other people now we're
1:26:52talking now you can begin to take
1:26:54responsibility for your actions in the
1:26:57world so I think starting with
1:27:00validating you know the trauma or the
1:27:02victimhood or the way in which we were
1:27:05wronged processing it so giving it
1:27:08airtime right but not stopping there
1:27:11which is by the way which is by the way
1:27:14often you know in therapy certain types
1:27:18of therapy that's often where we stop we
1:27:21don't then take it that very important
1:27:23next up and say but you know let's go
1:27:26and look at that again and like is there
1:27:29anything at all that you're contributing
1:27:31to this problem maybe it's just that you
1:27:34continue to ruminate about it right that
1:27:37like you're ruminating on your
1:27:39resentments is in a way your happy place
1:27:42and maybe that's what you need to stop
1:27:43doing so that form of sort of
1:27:45psychotherapy that stops there can help
1:27:47keep us sick and make us sick it it it's
1:27:52interesting because someone that's in
1:27:53that therapy room who has ruminated
1:27:56themselves all the way down to having a
1:27:57low self-esteem being depressed or
1:27:59whatever um it appears to me that people
1:28:01who are at that sort of ground floor
1:28:03State find it hardest to take
1:28:05responsibility for some reason just
1:28:07that's an observation in my life that
1:28:09the the people that I have met that are
1:28:12the worst or that struggle the most with
1:28:14taking responsibility are those that
1:28:15have a very low self-esteem so it's
1:28:17almost this double-edged like Catch 22
1:28:19and then I I've also P pondered whether
1:28:22you know someone that never takes
1:28:24responsibility is more likely to have
1:28:25bad things happen to them make mistakes
1:28:28which are then going to further hurt
1:28:30their self-esteem which are going to
1:28:31make it even harder to take
1:28:32responsibility so I guess the question
1:28:33is is there this Rel is there a
1:28:35relationship between my current
1:28:36self-esteem and my ability or inability
1:28:38to take responsibility for a situation
1:28:41yeah great great question it brings to
1:28:43mind a a patient of mine who um who said
1:28:46to me that
1:28:48um you know that and he had very very
1:28:51low self-esteem and he said essentially
1:28:54Dr ly I'm the piece of crap around which
1:28:57the universe
1:29:00revolves meaning that he had his own
1:29:04brand of
1:29:06narcissism in which he wasn't the most
1:29:08successful person he was the most
1:29:10successful at being the least successful
1:29:13person and that became his identity
1:29:16right that was sort of how he saw
1:29:20himself and also how he saw the world
1:29:23and it became very entrenched and it was
1:29:25a kind of a narcissism
1:29:27because he created then situations in
1:29:31order to perpetuate like I'm the worst
1:29:33of the worst so I think the ways in
1:29:37which we get these sort of entrenched
1:29:39ideas about ourselves and the world can
1:29:42really hold us back from seeing clearly
1:29:45Who We Are Who other people are and what
1:29:48what the possibilities are does our
1:29:50personal narrative need to be positive I
1:29:52mean what do I guess what do you mean by
1:29:53positive like ra I'm great almost like
1:29:56have a have a positive ending because I
1:29:58was thinking about the personal
1:29:59narrative I've created in my life and my
1:30:00personal narrative is like kid born in
1:30:02Africa came to the UK little bit of
1:30:04racial abuse here and there felt
1:30:06different shame insecurity parents
1:30:08weren't around this made me independent
1:30:10the shame made me motivated and then I
1:30:12did this this this and it went well
1:30:14that's like my personal narrative um but
1:30:16if my personal narrative was moved to
1:30:18Plymouth from Botswana in Africa a
1:30:21little bit of Shame little bit of pain
1:30:22parents weren't around my parents didn't
1:30:24love me people don't love me right right
1:30:28if my personal narrative ended there
1:30:29would it be you know would it be
1:30:32detrimental to me ever becoming
1:30:33successful happy healthy I'm just
1:30:36wondering if because we all have a
1:30:37personal narrative we have like a story
1:30:39if we're up on stage and someone passes
1:30:40a mic to us and says tell us your story
1:30:42we'll narrate this version of events um
1:30:45skewed towards victimhood to heroism to
1:30:48you know yeah I mean as I said before
1:30:50how we narrate Our Lives is important
1:30:53right it's it's not trivial and there
1:30:57are healthier narratives and there are
1:30:59not healthy narratives and and I would
1:31:01argue that the you know the victim
1:31:03narrative where you know perpetuates
1:31:05victimhood you could make the same
1:31:07argument that the the hero's journey
1:31:09narrative perpetuates hero good having
1:31:12said that if we get too stuck in any
1:31:16fixed Identity or any narrative I think
1:31:19that can become its own trap right and
1:31:21then we wall ourselves off feeling like
1:31:23we have to show up in a certain way or
1:31:25be a certain person and I wonder if you
1:31:28have that experience like you know you
1:31:29have this hero's journey and now you got
1:31:31to be this hero and I mean I could
1:31:33imagine that that would be burdensome at
1:31:35times yeah I think it causes a lot of
1:31:37like dissonance internally what I mean
1:31:39like dis so when I say dissonance I mean
1:31:40discomfort internally because people
1:31:43meet a version of you that doesn't
1:31:45reflect the version of you that you know
1:31:46so like that the experience you have
1:31:48when you go like I go to the gym or
1:31:49something yes and I say this to my team
1:31:51all the time anyone that knows me
1:31:53personally his head me say this 50 times
1:31:55I will say the phrase I just don't
1:31:56understand what these people are talking
1:31:58about like I just don't get it and I
1:32:00said to my team the other day in the
1:32:01office I went it's almost like I think
1:32:03they're lying to me and I said I was in
1:32:05this I was in this meeting group when
1:32:06you say you don't understand you mean
1:32:07when they when they praise you or okay
1:32:09yeah yeah it's so yeah unbelievable what
1:32:13they're saying to me that it
1:32:16um that it feels like you're I've not
1:32:19even watched the trumman show I just
1:32:20know what it means but it feels like
1:32:22this is these people are just all lying
1:32:24to you yeah and I I was I think I was
1:32:27talking to Jack and the team the other
1:32:28day about going to Thailand and being so
1:32:29far away from home and people coming up
1:32:31to you like thousands of people we doing
1:32:33this meet and greet thing and saying
1:32:34these things to you and you and I said
1:32:36to the team I was like I think it's like
1:32:37it's part of my brain that's like these
1:32:38people are lying to me and also
1:32:41um yeah you can see how it can be a
1:32:45slippery slope to slide in to their
1:32:47Narrative of you right and you've got to
1:32:49do quite a lot to just like stay at home
1:32:52what I mean by stay at home I don't mean
1:32:54like physical location I mean like
1:32:56staying grounded in like who you
1:32:57actually are right um and this goes for
1:33:00people that obviously you know have a a
1:33:02public platform or don't it's very easy
1:33:04for one person on the internet to say
1:33:05something to you and then you to start
1:33:07to accept that as your narrative it's
1:33:08easy for your parents to tell you that
1:33:10you should be a doctor and then you go
1:33:12to university and you study to be a
1:33:13doctor and you become a doctor and then
1:33:15you start thinking you're a doctor and
1:33:17how that can sway you away from the full
1:33:20array of things that make you who you
1:33:22are the music you know the the whatever
1:33:24Hobbies you had yeah narratives are
1:33:28comfortable sometimes they make us feel
1:33:30heard and understood they make us fit
1:33:32yeah but they also are a double-edged
1:33:33sword because they can take us away from
1:33:36like who we actually are yes yeah so
1:33:39when I think about you know your
1:33:41experience of feeling like people must
1:33:43be lying to you I mean sometimes we call
1:33:45this something like the impostor
1:33:47syndrome where you never thought of it
1:33:50like that you know it yeah projected
1:33:53personal
1:33:55that is is you know true in a way but
1:33:58also doesn't capture the fullness of who
1:34:00you are or maybe is so extreme in terms
1:34:04of um looking good that it's inevitable
1:34:08that you'll feel some dissonance with
1:34:10that kind of heroic figure and I think
1:34:13the way to think about that and
1:34:16also you know um not become like
1:34:19cynically suspicious of people who who
1:34:22who praise you when they meet you is
1:34:24just to recognize that you have become a
1:34:27kind of Cipher or a vehicle for their
1:34:29projections so they've listened to you
1:34:31they've had a very positive experience
1:34:33or maybe they learned something and it
1:34:35meant a lot in their lives and you were
1:34:37the vehicle for that and so you're a
1:34:39symbol for them and they're projecting
1:34:42positive feelings onto you and because
1:34:45you're now integrated in their mental
1:34:47tapestry as kind of a you know a totemic
1:34:51figure or a token something important Sy
1:34:54interesting cuz part of what you just as
1:34:56you were talking I was thinking you know
1:34:57what's interesting I don't even I'm not
1:34:58even the smart one in
1:34:59this I'm interviewing these smart people
1:35:02no and the smart people are changing
1:35:04their lives and then someone comes up to
1:35:06me in Thailand and says well you're
1:35:08wrong about that so you're obviously
1:35:10really smart and you also have you know
1:35:12a really high emotion quotient right
1:35:15which is its own kind of
1:35:17underappreciated smarts where you read
1:35:19people really well and you have
1:35:21intuitive reasoning
1:35:23and I mean I don't know you but you also
1:35:25seem very humble and real and so all of
1:35:28these things that people have a craving
1:35:30for you know authenticity someone they
1:35:33can relate to um someone familiar I mean
1:35:36keep in mind too that more and more
1:35:38people live alone and have maybe fewer
1:35:43close contacts so a person like you with
1:35:46a regular show that they tune into to
1:35:48regularly you become you're in their
1:35:51living room yeah you're not just some
1:35:55distant celebrity like you are your
1:35:56voice is there your face is there they
1:35:59feel they know you because they've seen
1:36:01you in all these different situations
1:36:03and I think that's really natural and
1:36:05normal and not a bad thing so you just
1:36:07have to realize when you go out into the
1:36:11world you know you You' become a symbol
1:36:14for people they're projecting onto you
1:36:16you don't have to necessarily identify
1:36:19with that but it's okay to let them have
1:36:22you know their experience through you if
1:36:24that makes any sense it makes a lot of
1:36:26sense okay yeah no it makes a lot of
1:36:28sense I felt the same imposter syndrome
1:36:29as you said everything there I was like
1:36:30that's um very kind of you to say but
1:36:32it's it's just very I think part of the
1:36:34dissonance comes from the fact that I
1:36:35sit here in a room with you and there's
1:36:37only the person in this whole room we're
1:36:39in this big Studio here in Los Angeles
1:36:41is Jack yeah and so there's part of your
1:36:44brain the like prehistoric brain that
1:36:45thinks the three people that are aware
1:36:47of what happened in this room are me you
1:36:49and Jack that's it yeah and then you you
1:36:51go to you go to Kuwait right
1:36:54amazing and a comes up to you in the gym
1:36:56and goes that conversation that you had
1:36:58about addiction right and that that's
1:37:00the dissonance like you went there yeah
1:37:03but it's I don't know the preo brain
1:37:04might might not be able to fully
1:37:05comprehend the idea of cameras and
1:37:07numbers you know people are listening at
1:37:08the moment oh no they feel that they're
1:37:10there and they and and again you you
1:37:12know the guests are totally secondary
1:37:15because they're watching because they're
1:37:17identifying with you and the questions
1:37:20that you ask as you yourself said are
1:37:22questions that you anticipate they would
1:37:24want to ask right you said that so you
1:37:26are also channeling
1:37:28them when it comes to food I trust my
1:37:31gut and I trust Zoe a business I'm an
1:37:33investor in and today's sponsor of this
1:37:35podcast all the nutritionists I've
1:37:37spoken to have highlighted just how
1:37:38misleading information is out there when
1:37:40it comes to food take healthy Halos the
1:37:42claims you see on packaging that say
1:37:44things like low sugar and nothing
1:37:46artificial are often a sign of foods to
1:37:48avoid have you ever noticed a health
1:37:50claim on fresh fruit you probably get my
1:37:52point understandably there's loads of
1:37:54distrust out there who should you turn
1:37:56to for accurate information I use Zoe
1:37:59which is backed by one of the world's
1:38:00largest microbiome databases and most
1:38:03scientifically Advanced atome gut health
1:38:05tests Zoe gives you proven science
1:38:07whenever you need it as a Zoe member
1:38:09you'll get an at-home test kit and
1:38:11personalized nutrition program to help
1:38:13you make smarter food choices that
1:38:14support your gut to sign up visit
1:38:16zoe.com and use my code stepen 10 for
1:38:2010% off your membership that's zoe.com
1:38:22code Steven 10 trust your gut trust Zoe
1:38:27on this point of how we help someone in
1:38:29our lives who's suffering with some of
1:38:31the things we've talked about
1:38:33today what is a bad way to try and help
1:38:35someone because we're in our in our love
1:38:38for them sometimes we do things which
1:38:40even in my own experience of people that
1:38:42are struggling in my life I think
1:38:43actually I think in my pursuit of
1:38:45helping them I've actually hurt them in
1:38:46some way yes well you know there's this
1:38:48whole uh sort of area of the addiction
1:38:52field called
1:38:54codependency and codependency refers to
1:38:57the ways in which a loved one of the
1:39:00addicted person can actually enable or
1:39:03make their addiction worse without
1:39:05realizing it and without intending to
1:39:09and the way that essentially happens is
1:39:11that we can well number one addiction
1:39:14can is very often a family systems
1:39:16problem so the person who gets addicted
1:39:19their addiction affects everybody in the
1:39:21family and in order to cope and compens
1:39:23say families can end up in these very
1:39:25strange maladaptive places but they
1:39:28often have difficulty seeing how to get
1:39:31out of those situations or how their
1:39:33behavior is harming their addicted loved
1:39:35one because in a sense they themselves
1:39:38get addicted to the addicted person and
1:39:41then use that addicted person to
1:39:43regulate the way that they feel so for
1:39:45example I treat a lot of families where
1:39:47like the adult child is deep in their
1:39:52addiction the parents know that the
1:39:54money they're giving the child is mostly
1:39:56going to drugs and yet cannot bring
1:39:59themselves to stop giving the money and
1:40:02often they're manipulated by the child
1:40:04the child saying well the adult child
1:40:06saying something like well if you don't
1:40:07give me money for drugs I'm going to go
1:40:08get it off the streets and it's going to
1:40:10be laced with fentel then I'll I'm going
1:40:11to die and it's going to be on your
1:40:12hands so this kind of like emotional
1:40:14hostage taking but even when it's not
1:40:17that blatant what can happen is just
1:40:19this very
1:40:21fascinating very twisted and meshed
1:40:24relationship between the addicted person
1:40:27and the codependent person where again
1:40:31having the person engage in their
1:40:33Addiction in a way is a predictable
1:40:36scenario for the codependent person so
1:40:39even though they may say on the face of
1:40:40it they want this person to stop their
1:40:42Addiction on another another level they
1:40:44really don't they get to be the Martyr
1:40:46they get to be the Savior or they even
1:40:48just get
1:40:49to
1:40:51predict what that person is doing based
1:40:54on their use I've had experiences in my
1:40:57life and this is why I really wanted to
1:40:58ask this question where I thought I was
1:41:01helping someone yeah and then the minute
1:41:04I withdrew the help and basically
1:41:05completely gave up the person got better
1:41:07yes but for six seven eight years this
1:41:11person struggled and the minute I
1:41:12stopped helping they got better I was
1:41:15like so I I I said to my partner before
1:41:18when I was talking about this I was like
1:41:19it's possible to prop someone up in
1:41:21their like compulsive behavior and not
1:41:23realize you're doing it in fact there's
1:41:24three examples which me and my friends
1:41:26are aware of and one of my friends talks
1:41:27openly about this where I was propping
1:41:30him up yeah I was letting him stay at my
1:41:32house I was providing for him while he
1:41:33was in his struggles the minute I had a
1:41:35difficult conversation with him when he
1:41:36was I think I was 25 years old and he
1:41:38was 30 and I said you got to go you got
1:41:41to go you got to get out of my house he
1:41:43went back moved in with his parents in
1:41:45his childhood room he built up his whole
1:41:47life again he's out of the compulsive
1:41:49behaviors he's very successful very rich
1:41:51living abroad now I was like God if I
1:41:53hadn't have pushed him out my like
1:41:55basement he probably would still be
1:41:57there I thought I was doing him a favor
1:41:59and there's another really poent example
1:42:00to me quite recently where someone who
1:42:02I've known for many many many years um
1:42:05minute I said to them listen and this
1:42:07sounds really harsh right because I
1:42:09tried paying for their therapy tried
1:42:11paying for everything for this person
1:42:12and eventually I got to the point where
1:42:13I said honestly I tried don't talk to me
1:42:16about this anymore yeah stop talking to
1:42:18me about it just don't message me about
1:42:19it don't talk to me about it anymore
1:42:20they got better yep yeah it's really F
1:42:23so so there um Kai Erikson wrote this
1:42:26book on deviants where he studied
1:42:28Puritan societies and found that no
1:42:30matter what group of humans you looked
1:42:33at there was always there were always
1:42:35going to be people who were on the
1:42:37margins of the society he he use the
1:42:39word deviant his point being
1:42:42that groups of
1:42:44humans we just have these roles and we
1:42:47have these hierarchies and there's
1:42:48always somebody on top and always
1:42:50somebody below and when when we're
1:42:54occupying a certain Niche or when we
1:42:56stop occupying it we make room for
1:42:58somebody else so when you stop being the
1:43:00hero and the Savior that person had room
1:43:03to stop being the sick victim
1:43:06interesting yeah and my last question on
1:43:09this then is how do you approach that
1:43:11conversation with that person because so
1:43:13often it's approached through
1:43:14frustration or shame or blame um what's
1:43:17the best way to approach someone who's
1:43:18struggling with a behavior to express
1:43:20that your concerned and to I don't know
1:43:22offer your help if that's a good thing I
1:43:25think we can always try to find our
1:43:28empathy for them without
1:43:30necessarily um doing things that would
1:43:33perpetuate or enable that behavior and
1:43:36we need to recognize that for many
1:43:39people with severe addiction the the the
1:43:41only thing that will get them into
1:43:44recovery is real life
1:43:47consequences real life negative
1:43:49consequences and that our trying to
1:43:51protect them from that is not protecting
1:43:53them at all we've got to let them hit
1:43:55the rock bottom I mean this is a hard
1:43:57one because you have a lot of families
1:44:00now dealing with children who are
1:44:01severely addicted to opioids for whom
1:44:04you know being out on the streets might
1:44:06really result in their death so this is
1:44:09not for every situation but I can tell
1:44:12you in my clinical experience after 25
1:44:14plus
1:44:15years the majority of people with severe
1:44:19addiction who get into recovery get into
1:44:21recovery as the result
1:44:23of a real life negative consequences
1:44:26lost their job lost their partner ended
1:44:28up in jail what whatever it was until
1:44:31there are those significant consequences
1:44:33for some people they just won't be able
1:44:35to have the motivation to make a change
1:44:38guys back to a quote I had a long time
1:44:40ago some 10 years ago that said change
1:44:42happens when the pain of staying the
1:44:44same becomes greater than than the pain
1:44:46of making a change there you go that's a
1:44:48good one I want to talk about digital
1:44:51drugs one of the subjects that's been
1:44:53recurring theme on this podcast inspired
1:44:55initially I think it was mentioned in an
1:44:56episode we had but then it was um such a
1:44:59huge amount of the feedback we got in
1:45:01the comment section that I thought we
1:45:02need to talk about this more because
1:45:03clearly there's a lot of people
1:45:04suffering we also then used a tool um
1:45:07which looks at what people are Googling
1:45:09in searching a lot and one of the most
1:45:10popular searches around the subject
1:45:12matter of addiction is pornography
1:45:14addiction yeah it's actually it was
1:45:16number number one and four in the The
1:45:19Search tool that we used and the phrases
1:45:21people are using are how to stop
1:45:22pornograph addiction how to help someone
1:45:24with pornography addiction how to rewire
1:45:27my brain which are sort of all sort of
1:45:29correlated themes so pornography
1:45:31addiction something you see a lot oh my
1:45:33gosh I have to create a little bit of a
1:45:34space actually before I ask this
1:45:35question because I did a porn debate on
1:45:38the show and I got a very long voice
1:45:41note from a good friend of mine who said
1:45:43just watch the porn debate there was two
1:45:44women there and a guy and me stevenh um
1:45:48but I just wish someone had mentioned
1:45:49that women get addicted to addicted to
1:45:52porn too yeah and then on the episode
1:45:54one of the top three comments on the
1:45:56episode is I'm a woman um it wasn't
1:45:59mentioned but I also have a pornography
1:46:00addiction and you've also kind of echoed
1:46:02that with the erotic like novels that
1:46:04you you mentioned romantic novels so
1:46:06pornography addiction do you see that
1:46:08often and I guess critically how does
1:46:10one go about overcoming that and how do
1:46:13you know it's a pornography addiction I
1:46:14guess it goes back to the point of harm
1:46:16but yeah yes yeah so um I do think that
1:46:20pornography addiction is
1:46:23one of the biggest addictions and the
1:46:27most silent and the most shameful
1:46:29addictions that we have now in the
1:46:30modern
1:46:31world um we will not infrequently have a
1:46:35patient come in to the clinic who claims
1:46:38to have other problems and it's not
1:46:40until visit three or four that they
1:46:42finally fess up I'm really here for a
1:46:43pornography
1:46:45addiction there's so much shame around
1:46:47it it's so incredibly shameful for
1:46:50people to admit that they are spending
1:46:53their time looking at these images often
1:46:57associated with compulsive
1:46:58masturbation some people their addiction
1:47:02manifests by actually pursuing Partners
1:47:04so dating apps are highly addictive and
1:47:07and meetups all of this is related to
1:47:10sex an orgasm which releases dopamine in
1:47:13the reward pathway but it's not just the
1:47:15moment of orgasm it's all of the rituals
1:47:17and the buildup and the searching um
1:47:20that's related to it women can get
1:47:23addicted to pornography as well as men
1:47:25although I would say that men outnumber
1:47:27women um probably you know in my
1:47:29clinical experience um I don't know 10
1:47:32to one women however are much more
1:47:36vulnerable to love addiction which is
1:47:39also real right uh the pathological
1:47:43compulsive falling in love with Partners
1:47:46um and then getting into these
1:47:47relationships that are really dramatic
1:47:49and not healthy and then falling out of
1:47:51love and then pursuing doing another
1:47:53love partner so the these addictions are
1:47:56real um they are very harmful for people
1:48:00who get addicted ultimately they're not
1:48:03even about sex they're about human
1:48:06attachment and the desire for human
1:48:07attachment and also just as a way to
1:48:10self- soothe and Escape our own everyday
1:48:13suffering
1:48:14and I'm particularly concerned about
1:48:17girls and boys who now have access to
1:48:20all kinds of sexual images that would
1:48:24not have been possible for them to get
1:48:27access to a generation or two ago and
1:48:29now you know a child with five with an
1:48:31iPad can accidentally end up um on a
1:48:35site that has very graphic uh sexual
1:48:38images and videos so what's the harm of
1:48:42pornography watching
1:48:43pornography well there's a lot lot of
1:48:45potential harms one of the harms
1:48:48especially if combined with you know
1:48:50compulsive masturbation is that just
1:48:52simply addictive which means that the
1:48:54more people do it the more they want to
1:48:56do it then they have the come down where
1:48:58they don't feel good and then pretty
1:49:00soon it becomes like a a compulsive
1:49:02repetitive Loop where they're spending
1:49:04large amounts of their day uh engaging
1:49:07in this activity and that that in itself
1:49:11is highly
1:49:12debilitating but other harms um I think
1:49:15that are significant are it really does
1:49:17change a person's conceptualization of
1:49:21what sex is is and what sex is for and I
1:49:25don't want to get into the whole thing
1:49:26of like you know sex is exercise or sex
1:49:29is recreational fun compared with sex
1:49:33you know as something that's maybe more
1:49:35sacred because I I I I'm not here to
1:49:37judge any of that except to say that if
1:49:41a main pathway for a young person to
1:49:44learn about sex is through watching
1:49:46pornography that's going to give them a
1:49:48very distorted view of what you know
1:49:51real sex uh is like not to mention what
1:49:55relationships are like right and how sex
1:49:59um becomes a part of um an intimate
1:50:02relationship I've heard a few people say
1:50:04that pornography lowers our motivation
1:50:08to go out there in the world and to
1:50:09pursue getting a job and getting a
1:50:11career and going to the gym etc etc and
1:50:13through the lens of what we've talked
1:50:15about today where dopamine was this
1:50:17motivating force for those rats to just
1:50:19reach out and eat the food if you remove
1:50:21the dopamine from the rat's and it
1:50:22wouldn't even eat food in front of it
1:50:24and it will starve to death when we
1:50:26think about men you said roughly in your
1:50:29practice about 90% of the people that
1:50:30come in with a pornography addiction of
1:50:32men this all kind of overlaps to create
1:50:35this picture that in the modern world
1:50:37when we think about why more men are
1:50:39lonely why they're more often in their
1:50:42basements playing video games now or
1:50:44watching pornography than ever before
1:50:46why they're having less sex and having
1:50:49sex later um why they're struggling to
1:50:52form Rel
1:50:53relationships um why less men are
1:50:55potentially in college at the moment um
1:50:58maybe some of the answers are in the
1:51:01fact of just like how men are wired
1:51:02because if they've thinking this through
1:51:05if men are more likely to have a
1:51:07disposition to these kinds of behaviors
1:51:09then these kinds of behaviors are more
1:51:11likely to impact and demotivate and
1:51:14destabilize men is that all like rough
1:51:16broadly accurate I absolutely agree
1:51:19which is why I've talked about the
1:51:21smartphone as a masturbation machine
1:51:25essentially these devices have become
1:51:28the way that we meet our physical
1:51:30emotional sexual intellectual needs and
1:51:34taken to the extreme that would mean
1:51:36that we're no longer relying on other
1:51:39people to meet those needs we're meeting
1:51:42the needs ourselves with with this
1:51:44technology and with the devices and I
1:51:46don't think that's a future that anybody
1:51:47wants taken to the extreme right because
1:51:50we are social creatures we need to
1:51:52connect with each other human connection
1:51:55is vital to a thriving life and survival
1:51:59in general so yes I have a lot of
1:52:01concerns that that pornography is now
1:52:05replacing intimacy with people in real
1:52:08life or disrupting our expectations of
1:52:11intimacy with people in real life when
1:52:13you say expectations do you mean like
1:52:15hard work we have to do to create and
1:52:17find intimacy that too and also just
1:52:20expectations around sex
1:52:23a lot of folks that I work with with sex
1:52:26addiction as they try to give up
1:52:28pornography compulsive masturbation or
1:52:30whatever they Define as their uh sexual
1:52:33adct sexually addictive
1:52:35behaviors what they find is that they
1:52:37almost go in the opposite direction and
1:52:39they kind of have zero interest in sex
1:52:42or they just don't have interest in sex
1:52:45with their real life partner or they
1:52:46can't enjoy sex with their real life
1:52:48partner you know which all kind of makes
1:52:50sense right when you hijack the reward
1:52:53pathway with this incredibly potent
1:52:55version of sex you come back down to
1:52:57earth with your actual partner who's got
1:52:59his or her own needs and you know aging
1:53:02bodies or whatever it is um it's hard
1:53:07to experience pleasure in that realm in
1:53:11an attempt to offer people out there now
1:53:13that are struggling with some kind of
1:53:14form of compulsive Behavior or addiction
1:53:17a pathway to turn this around what is
1:53:19step one in your book I talk I've read
1:53:21all these incredible ideas is around the
1:53:23wisdom we can learn from addicts I
1:53:24learned about dopamine fasting and I
1:53:27also learned about radical honesty in
1:53:28the role that that plays what is the
1:53:30process so someone listening to this
1:53:31right now they're struggling with one of
1:53:32these addictions they've got a
1:53:33pornography addiction they're addicted
1:53:34to gaming maybe it's food maybe it's
1:53:36erotic novels maybe they're on they
1:53:38Twilight the reading Twilight at the
1:53:39moment what what do you say to that
1:53:41person at the step one
1:53:43is step one is really just acknowledging
1:53:46the behavior that it's problematic and
1:53:49that it might require some changing in
1:53:51our lives um um the next step is being
1:53:54honest with ourselves and maybe another
1:53:56person about why we do the behavior what
1:53:58we get out of it what's positive uh step
1:54:02three would be honestly making a list of
1:54:05all of the problems with the behavior
1:54:06how is it interfering with my goals and
1:54:09as we talked about my values what do
1:54:11other people say to me about how it's
1:54:13problematic is one of the problems
1:54:15potentially that it's just not working
1:54:17anymore the way that it used to right
1:54:19I'm developing tolerance I need more to
1:54:21get the same effect it's doing the
1:54:23opposite of what I want it to do and
1:54:25after we've done all that really done a
1:54:27really honest self
1:54:30assessment about the
1:54:32behavior I recommend a 30-day dopamine
1:54:35fast now we're not really fasting from
1:54:37dopamine right because we're not really
1:54:39ingesting dop me what we're doing a fast
1:54:41from is whatever that substance or
1:54:43behavior is that is causing these kinds
1:54:46of problems potentially maybe we aren't
1:54:48even really sure but we think it might
1:54:50be give it up for 30 days why 30 days
1:54:53well we know that two weeks is not
1:54:55enough right we know that from this
1:54:57Imaging study right that people are
1:54:59still in that dopamine deficit state two
1:55:02weeks after stopping but 30 days based
1:55:05on clinical experience not just mine but
1:55:08that of many other people who do this
1:55:09work that no for most people no matter
1:55:12the drug and no matter sort of the
1:55:14severity and chronicity once they get to
1:55:17about 30 days they begin to feel better
1:55:21they begin to come out of of that tunnel
1:55:23of constant craving they begin to be
1:55:25able to imagine a life in which they
1:55:29would um you know not necessarily have
1:55:32to rely on this substance or on this
1:55:34Behavior what I always tell folks when
1:55:37they're preparing for the dopamine fast
1:55:39is just remember you will feel worse
1:55:41before you feel better but that is
1:55:43withdrawal mediated suffering once you
1:55:46get through those first 14 days you'll
1:55:48begin to feel better and potentially by
1:55:5030 days you'll feel much better than you
1:55:52have in a really long time now this is
1:55:54not to say that 30 days of fasting is
1:55:56going to cure your addiction not at all
1:55:58um but it's the beginning it's the
1:56:00beginning of being able to see causality
1:56:02getting some insight it's an experiment
1:56:05right our lives are one big experiment
1:56:08what better way to understand the
1:56:10variables in our lives than to change
1:56:12one thing one variable and see what
1:56:14happens do we then need to you talk
1:56:16about this concept of
1:56:18self-binding yes self-binding right what
1:56:21role not PL what this self-binding is a
1:56:25way of acknowledging that if we rely on
1:56:27Willpower alone we will not be
1:56:29successful especially living in this
1:56:31drug aied world and what we need to do
1:56:34is anticipate desire before we're in the
1:56:37throws of Desire by creating both
1:56:40literal and metacognitive or thought you
1:56:43know gunan experiment like barriers
1:56:46between ourselves and our drug of choice
1:56:48so these barriers can be actual physical
1:56:50barriers like putting our
1:56:52device into a kitchen safe and locking
1:56:55it up over the night or leaving it
1:56:57outside of our bedroom or getting the
1:56:59potato chips the alcohol the Cannabis
1:57:01out of the house deleting our contact
1:57:04drug dealers information and telling our
1:57:06drug dealer don't call me and I won't
1:57:08call you um because these are all cues
1:57:11these are all cues that's right and the
1:57:14cues can be physical things so someone I
1:57:16see can cues cues can also be basically
1:57:19an emotion you talked about halt hungry
1:57:21angry tired I eat well during the day
1:57:25like now as I leave here there'll be a
1:57:27salad I reckon in the in the Green Room
1:57:29over there for me and the only time
1:57:31where I'm susceptible to not eating well
1:57:33is if it's late and so when you said the
1:57:36hungry angry lonely tide thing that is
1:57:39probably the state that I'm in sometimes
1:57:41when I get home certainly hungry
1:57:44certainly tired probably a little bit
1:57:47lonely as well but certainly those two
1:57:49things and that seems to be when I'm
1:57:50most susceptible to making a regrettable
1:57:51decision as it relates to my dopamine
1:57:53I've also wondered if if dopamine is
1:57:56responsible for what people almost call
1:57:58like the sugar Cravings that we have so
1:58:01what I've observed is in previous years
1:58:03of my life when when I was eating lots
1:58:05of sugar I would then go into about like
1:58:08a two week cycle of like binging the
1:58:10sugar and right now I'm in like a really
1:58:12great cycle of with my food where I have
1:58:14no cravings for the sugar I'm I'm in a
1:58:16staying in a hotel here in La there's a
1:58:17mini bar in the room with Oreos and
1:58:19gummy all these chocolates and all these
1:58:21things and I haven't touched them
1:58:23because for some reason in this like
1:58:26couple of weeks of my life or whatever I
1:58:28just don't have the Cravings anymore but
1:58:29I kind of suspect that if I start eating
1:58:32them yes then the next four weeks will
1:58:35be a car crash yes why does this happen
1:58:38yeah it's so fascinating and and I think
1:58:40this is sort of a universal experience
1:58:42so first of all sugar is addictive it
1:58:46lights up the same reward pathway as
1:58:48drugs and alcohol clear dopamine release
1:58:51in the nucleus bins part of the reward
1:58:53pathway in response to sugar and when we
1:58:56quit sugar we have a come down right we
1:58:59go into withdrawal and it's manifested
1:59:01in all the different ways that we've
1:59:03talked about and it lasts for about two
1:59:05weeks and one of the most Salient
1:59:06symptoms is intense craving for sugar
1:59:09and it's so amazing how intense it is
1:59:12but if we can get through that period
1:59:14and get out of that Vortex of addictive
1:59:17craving the craving gradually gets
1:59:19better and then eventually goes away
1:59:21which is by the way very paradoxical
1:59:23because whatever our drug is when we
1:59:26first stop it we have intense cravings
1:59:29and we have the feeling that the
1:59:30Cravings will only get worse with time
1:59:34even though we logically may have
1:59:36experienced otherwise by giving it up
1:59:38before we have the feeling this is going
1:59:40to last forever it never does right with
1:59:44time the craving goes away and once we
1:59:47are in that Arena where we're not
1:59:50constantly craving we might have
1:59:52something that triggers the craving
1:59:53right but like stress but generally
1:59:56we're not dealing with a craving if we
1:59:58were then to reexpose our brains to a
2:00:00little bit of sugar immediately back in
2:00:03the vortex of craving and there's an
2:00:05experiment I love that illustrates this
2:00:07it's an experiment in rats where rats
2:00:10were injected with cocaine the same
2:00:13amount of cocaine every day for seven
2:00:16days and over the course of those seven
2:00:19days the rats went from kind of hiding
2:00:21in the shadows of the cage to
2:00:23progressively running a little bit more
2:00:25and a little bit more and by day seven
2:00:27they were in a running frenzy right as
2:00:29measured by these beams of light that
2:00:31they were
2:00:32crossing then there was no more cocaine
2:00:35injected after seven days and no cocaine
2:00:38or any addictive substance administered
2:00:40to the rats for a year which is a rat
2:00:42lifetime a really long time that would
2:00:45make you think oh you know that there's
2:00:47no more cocaine in the system no none of
2:00:50that and then the rats were injected
2:00:53with a single dose of cocaine and
2:00:54immediately they were plunged back into
2:00:56that running frenzy that you saw on day
2:00:59seven really important information
2:01:02because it tells us that there's some
2:01:04kind of permanent latent
2:01:07echo in our brains once we've been
2:01:10exposed to and especially if we become
2:01:12addicted to a particular substance such
2:01:15that even with sustained abstinence on
2:01:17the order of years and decades if we are
2:01:20reexposed to that drug we can
2:01:22immediately be plunged into the depths
2:01:25of our addiction there's no ramp up
2:01:27period that happens and of course we see
2:01:29this all the time you know people with
2:01:31alcohol addiction who are then exposed
2:01:34to alcohol and right back to their Max
2:01:36use or even exposed to something like
2:01:39opioids and alcohol also works on our
2:01:42endogenous opioid system so there's some
2:01:44homology or similarity between alcohol
2:01:46and opioids and then immediately being
2:01:49plunged into opioid addiction which then
2:01:50leads them back to their alcohol whole
2:01:52addiction it made me think about
2:01:54children it made me think about children
2:01:56because if I'm a 5-year-old and I'm
2:01:59binging on sugar yeah this sets me up
2:02:02for a life where I'm going to be I mean
2:02:04based on the analogy I just the
2:02:06experiment I just had based on the
2:02:07experiment I just heard there it sets me
2:02:09up for a life where I'm going to so
2:02:11easily slip right back into that
2:02:13addiction for sugar um and also I know
2:02:16that the brain isn't fully developed
2:02:17when we're children so maybe the effect
2:02:19is even more um lasting
2:02:24significant is any of that true yeah
2:02:26it's all true which is why a big focus
2:02:28of the addiction medicine field is
2:02:30prevention and trying to make sure that
2:02:34we protect kids brains from the harms of
2:02:36these addictive substances and behaviors
2:02:39like what from sugar to digital media
2:02:43video games pornography social media or
2:02:46any other drug you know nicotine so many
2:02:48kids are vaping now you know taking 50
2:02:50plus Puffs a day
2:02:52on their nicotine Vape cannabis alcohol
2:02:55what's going on in the brain if we if a
2:02:57kid is exposed to those things so
2:03:00essentially at age five we have more
2:03:03neurons and neuronal
2:03:04connections than we have in the rest of
2:03:07our adult lives about 50% more neuronal
2:03:09connections than we'll have it as adults
2:03:11which is what makes us such good
2:03:12Learners when we're kids kids can just
2:03:14absorb anything because they're sort of
2:03:16like these Tod potent sponges with all
2:03:18these neurons and all these neuronal
2:03:20connections but we age through
2:03:23adolescence to about age 25 we cut back
2:03:26or what's called
2:03:28prune the neural circuits that we don't
2:03:31use and we myelinate or make more
2:03:33efficient the neural circuits that we
2:03:35use most often such that by age 25 we
2:03:38are left with the neurological
2:03:40scaffolding that will serve us for the
2:03:42rest of our adult lives that means that
2:03:44if we're engaging in addictive
2:03:46maladaptive coping at a young age we're
2:03:49elaborating a neural circuitry based on
2:03:52that maladaptive coping which is going
2:03:54to set us up for addiction in adulthood
2:03:57I always like to emphasize though that
2:04:00because the Child and Adolescent brain
2:04:02is so plastic or Tod potent or so
2:04:05changeable that's also a very hopeful
2:04:07message it means that even a young
2:04:09person exposed at a young age to an
2:04:11addictive substance if we can get in
2:04:13there early enough while their brain is
2:04:15still plastic enough we can rewire them
2:04:18whereas when I treat people in their 70s
2:04:21and ' 80s
2:04:22who have been you know smoking pot their
2:04:24whole lives or drinking
2:04:25alcohol mainly it was manageable now all
2:04:28of a sudden they retire they're in their
2:04:3060s all this time the pot's a lot more
2:04:32potent they can develop these full-blown
2:04:35addictive disorders late in life and
2:04:37it's very hard to treat them because
2:04:40they've lost a lot of that plasticity
2:04:42that would allow them to regenerate new
2:04:44neural Pathways once they
2:04:48abstain what is the most important thing
2:04:50that we didn't talk about that we should
2:04:52have as it relates to dopamine oh my God
2:04:55we talked about so much I I don't even
2:04:56know it seems like it was a lot of stuff
2:05:00I guess based on the questions you're
2:05:01exposed to from the general public is
2:05:04there anything that we missed that
2:05:06someone at home right now is going to be
2:05:07screaming at the screen um talk about
2:05:11yeah well I mean I guess I would
2:05:12emphasize that when I talk about the
2:05:15dopamine fasting it's an early
2:05:17intervention it's not an intervention
2:05:19that I would recommend for someone who
2:05:20had repeatedly tried to quit on their
2:05:22own and been unable to you know clearly
2:05:24that would be an exercise and futility
2:05:26that person should go and get
2:05:27professional help maybe they need to go
2:05:29to a residential treatment center I also
2:05:32wouldn't recommend dopamine fasting or
2:05:34just quitting your drug of choice if
2:05:35you're at risk for a lifethreatening
2:05:37withdrawal so we can have
2:05:39life-threatening withdrawal from alcohol
2:05:41and benzo isipin like clopin Xanax
2:05:44adaman again in those cases go see a
2:05:47professional get help with a medical
2:05:49detoxification before you try to you
2:05:52know sustain absence for a period of
2:05:54time so you know I would blanket the
2:05:57whole thing with like the caveat go see
2:05:58your addiction you go see the addiction
2:06:00medicine specialist near you thank you
2:06:03so much you're wel it's been so
2:06:04unbelievably um
2:06:06thought-provoking for for me in so many
2:06:08ways I thought I knew what dopamine was
2:06:10I thought I had covered all the ground
2:06:12there was to cover on these subjects of
2:06:13sort of compulsive behaviors but I was
2:06:15so unbelievably wrong and it wasn't
2:06:17until I got into your book and started
2:06:19reading through your work that I was
2:06:20like oh my God most people have a clue
2:06:22about dopamine and the role it plays on
2:06:24us and this scale analogy is
2:06:26particularly memorable because that
2:06:28helps me to Think Through um many of the
2:06:31behaviors that I have in my life that
2:06:32I've either struggled with or become
2:06:33quite stubborn in various ways but also
2:06:35has turned a couple of lights on to some
2:06:38of the things I said about like my sugar
2:06:40um eating sugar and um even like going
2:06:42to the gym and why like my motivation
2:06:44can seem to fluctuate with the gym
2:06:46sometimes it's so unbelievably important
2:06:48because this little neurotransmitter
2:06:50seems to control so much of our lives um
2:06:53and we never taught anything about it so
2:06:55we become these kind of puppets and the
2:06:57puppet master is this this brain which
2:06:59is firing off all of these
2:07:00neurotransmitters that are determining
2:07:02who we are who we become and also who we
2:07:04don't become um thank you so so so much
2:07:07I I know you were nervous coming here
2:07:09today but I have to tell you you are
2:07:10very brilliant you're exceptionally
2:07:12brilliant in so many ways you you that's
2:07:14why I said you should start a podcast
2:07:15because you're really Built For This
2:07:17medium thank you you have a a certain
2:07:19warmth and empathy to you while while
2:07:21also being incredibly smart and
2:07:22accessible in the way that you
2:07:24communicate so please carry on because I
2:07:27I don't think although you overcame that
2:07:29the difficulty of those nerves I think
2:07:31there's so many hundreds of thousands
2:07:33and millions of people listening now
2:07:34that are so thankful that you did oh
2:07:36like really thankful that you did and if
2:07:38youve just nudged their life a little
2:07:39bit in a better Direction that's that's
2:07:41worthwhile so thank you um we have a
2:07:44closing tradition on this podcast where
2:07:45the last guest leaves a question for the
2:07:48next guest without knowing who they're
2:07:49going to be leaving it for what is the
2:07:51most recent piece of information that
2:07:54changed your
2:07:58life I think the most recent piece of
2:08:02information that was very impactful for
2:08:04me was the
2:08:07realization
2:08:10that we are probably going to
2:08:13be cybernetically enhanced in the
2:08:17future and interfacing with technology
2:08:21in a way that's completely
2:08:26seamless and that this is inevitable
2:08:29we're going to become cyborgs or at
2:08:31least we're going to be surrounded by
2:08:34the technology in a way that's
2:08:37invisible um and it's going it's going
2:08:40to be just completely integrated into
2:08:44our lives whether we'll it'll actually
2:08:45be under the skin I think it will be um
2:08:50but I can see in that so much potential
2:08:54good and promise and and so much that's
2:08:57really terrifying especially when I
2:08:59think about the way it's going to change
2:09:01us as humans and my big fear about it is
2:09:04that we will become more and more
2:09:07isolated and that we'll end up sort of
2:09:10in these little cubicles of our own
2:09:12making scattered alone all across you
2:09:16know planet Earth I I hope it doesn't
2:09:19lead to that but that's that's my word
2:09:23it's interesting when we become
2:09:25connected to the internet and we truly
2:09:26interface with the internet we really
2:09:28don't need to use our physical being
2:09:30anymore because we can experience all
2:09:31the joy and adventure and travel
2:09:34digitally and that's I mean it just
2:09:36messes with the incentive structures
2:09:38like we've talked about with dopamine
2:09:40yeah changes our ability to to get up
2:09:42and go and to do
2:09:44things I mean that's a lovely hopeful
2:09:46ending for
2:09:49us thank you so much
2:09:52yeah thanks for the opportunity to you
2:09:54know teach people about this information
2:09:56I hope it's helpful for people super
2:09:57helpful and I'm going to link both of
2:09:58these books below I've got the dopamine
2:10:00Nation book which was the original I
2:10:02believe yes um and then following That
2:10:04You released dopamine Nation workbook
2:10:06which is a practical guide to find
2:10:07balance in an age of indulgence I highly
2:10:10recommend everybody reads these I'm
2:10:13going to go and reread them on my
2:10:14journey home back to London tonight so I
2:10:16really really appreciate you read these
2:10:18books and honestly everyone needs to go
2:10:19read these books I'm sure they will so
2:10:21thank you than you so much thank you so
2:10:22much do you know that 80% of New Year's
2:10:25resolutions fail by February it's
2:10:27because we focus too much on the end
2:10:29goal and we forget the small daily
2:10:31actions that actually move us forward
2:10:33those actions that are easy to do are
2:10:34also easy not to do in life it's easy to
2:10:36save a dollar so it's also easy not to
2:10:38making one small Improvement each day
2:10:41one tiny step in the right direction has
2:10:43a big difference over time and that is
2:10:45the 1% mindset which is why we created
2:10:48the 1% diary a 90day journal designed to
2:10:51help you stay consistent and focus on
2:10:53the small wins and make real progress
2:10:55over time it also gives you access to
2:10:57the 1% Community a space where you can
2:10:59stay accountable motivated inspired
2:11:01along with many others on the same
2:11:03Journey we launched the 1% diary in
2:11:05November and it sold out so now we're
2:11:07doing a second drop join the wait list
2:11:10at the diary.com and you'll be the first
2:11:12to know as soon as it's back in stock
2:11:13I'll put the link below
2:11:15[Music]
2:11:21ah
2:11:25[Music]
2:11:35[Music]

About this transcript

This page contains the full transcript of Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Doing To Your Brain! by The Diary Of A CEO, generated from the public captions YouTube serves with the video. The transcript has 23,452 words across 3,350 segments, with the original timestamps preserved so you can click any line to jump to that moment in the embedded player.

What you can do with it

Use the transcript to take notes, quote the speaker, build a study guide, generate a summary with ChatGPT or Claude via the YouTube Summary tool, or export it as a timed subtitle file with YouTube to SRT. You can also re-open it in the transcriber to translate the transcript into 100+ languages.

Free YouTube transcript tool

YouTube2Text is a free YouTube transcript generator — no signup, no daily limit. Paste any YouTube link and get the full transcript instantly, with timestamps, click-to-jump, translation to 100+ languages, AI prompts for ChatGPT, Claude, and Gemini, and exports to TXT, SRT, VTT, or Markdown.