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

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there's a very famous experiment in

which rats were engineered to have no

dopamine and the scientists discovered

that if they put food in the rat's mouth

the rat would eat but if you put the

food even a body length away the rat

will starve to death which tells us that

dopamine is fundamental to get the

things that we need for our basic

survival now every time we're doing

something that's pleasurable from sugar

to video games work pornography social

media that will affect dopamine and the

more dopamine that's released the more

likely that drug or behavior is to be

addictive but also the genetic risk of

addiction is about 50 to 60% so if you

have a biological parent or grandparent

with addiction you are more likely to

develop that addiction we have to keep

it in balance in order to stay healthy

Dr Anna lmy is Professor of Psychiatry

at Stanford chief of the Stanford

addiction clinic and a world leading

expert on the subject of doping she will

tell you how this one powerful chemical

is controlling your life and what to do

about it one of the most important

findings in Neuroscience in the past 75

years is that the same parts of the

brain that process pleasure also process

pain and the balance wants to remain

level the problem is that we

automatically seek out pleasure and

avoid pain and we're exposed to all

kinds of Pleasures that we have in the

modern world and our brains are reeling

in response to try to compensate now I

need more of my drug and more potent

forms to get the same effect which then

leads to addiction and that's what

happened to me when I got addicted to

romance novels take me into that phase

of your life I was out of control and I

needed to restore a level balance and

take the advice I give my patients and

the Diary of a CEO is independently fact

checked for any studies or science

mentioned in this episode please check

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much I've sat here for the last 20

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episode Dr Anna

lmy you wrote one of the most iconic

well-known books about dopamine which

propelled the subject matter of dopamine

into the public

Consciousness but I guess the most

important question I should ask you

is why does dopamine matter ah good

question good good place to start I mean

dopamine matters because it

fundamental to our survival right so

it's the chemical that we make in our

brain that tells us this is something we

should approach explore investigate so

it's it's really almost the survival

chemical so what is dopamine if you had

to explain it to a 10-year-old how would

you go about explaining it so dopamine

is a chemical that we make in our brain

um it has many different functions but

one of its most important functions is

that it helps us experience pleasure

reward and

motivation um it may be even more

important for the motivation to do

things than it is for the pleasure

itself so for example there's a very

famous experiment in which rats were

engineered to have no dopamine in the

brain's reward pathway and the

scientists discovered that if they put

food in the rat's mouth the rat would

eat the food would seem to get some

pleasure from the food if you can deter

that from watching a rat eat which I

think they felt like they could uh but

if you put the food even a body length

away the rat will starve to death the

idea being that without dopamine we're

not motivated to seek out the things

that we need for our basic survival

that's crazy so you get a rat you put

the food an inch from its mouth and it

will starve to death because it doesn't

have dopamine the dopamine required to

just reach out and eat yeah essentially

maybe it's not an inch maybe it's a

little more than an inch but the idea

being that dopamine is necessary to be

motivated to do the work to get the

thing that we need and having an

understanding of dopamine how might that

improve my life having a basic

understanding of how dopamine Works how

we process Pleasure and Pain and also

what happens with dopamine as we go from

adaptive recreational use to Mal

adaptive addictive use is something that

is really useful especially for those of

us living in the modern world where now

we're exposed to so many reinforcing

substances and behaviors that we've all

become vulnerable to the problem of

addiction and what are the biggest

misconceptions of on the subject of

dopamine because it's kind of thrown

around in society I see it in my group

chats people saying I need more dopamine

or whatever or you know that person just

craves dopamine what what are the

biggest misconceptions you've come

across the main miscon conception is

that somehow we can get addicted to

dopamine we're not getting addicted to

dopamine itself dopamine is neither good

nor bad it's a signal to tell us whether

or not something that we're doing is

potentially useful for our survival and

also it's related to what we predicted

about how rewarding or pleasurable

something would be and so it's really um

you know I sort of sometimes I joke it's

like the um reward theory of relativity

DOP mean is in the sense that Pleasure

and Pain really are truly relative to

one another and so dopamine gives us

information about where we are in that

relativity scale between Pleasure and

Pain and when you say relative you mean

I mean it's it's quite fitting for

anyone that can't see we have a a set of

scales on the table and scales are

relative to each other because if you

pour in one end the other end goes up

and if you pour in the other end the

other end goes up and this end goes down

and when you say relative that's what

you're describing right yes that's what

that's what I'm describing yes okay and

what activities that I do every day have

an impact on my

dopamine well probably almost everything

you know in some ways um I mean every

time we are doing something that's

pleasurable reinforcing rewarding that

will affect dope mean it's it's really

the primary signal that lets us know

that this thing is potentially important

for our survival as I mentioned um but

you know even um aversive stimuli can

trigger dopamine what's oh something

that's painful or not pleasurable

dopamine gets involved in in that um

equation anything that's novel or new is

something that triggers our dopamine in

in our reward pathway dopamine is

fundamental for movement so not just

pleasure and reward but also movement so

for example Parkinson's disease which is

a disease related to stiffness and

Tremor is caused by a depletion of

dopamine in a part of the brain called

the substantia and as dopamine

gets depleted in that part of the brain

people lose the ability to move their

bodies and it's probably no coincidence

that the same neurotransmitter that is

so important for pleasure reward

motivation is also really important for

movement because most organisms have to

to locomote toward the object of their

desire we want that thing we have to

exert effort right we have to put in the

work to go get it but in the world today

we really don't have to do that right we

can swipe right we can swipe left and

all of a sudden it magically appears at

the touch of a finger and that's very

confusing for our brains because that's

not how we evolved we really evolved for

for having to do quite a bit of upfront

work for a tiny little bit of reward

I just want to before we move on talk

about this point you said because I

think it's quite foundational to

everything we're going to talk about

about dopamine being relative to pain

and I have this set of scales in front

of me and here I have some chemicals

that are likely to produce dopamine in

my brain I believe right so alcohol I

have some rum I have some whiskey I have

some vodka and can you explain to me

using this rum whiskey and vodka how

dopamine is relative to pain and what

going on in my brain sure okay I'll

slide this over to you oh

okay so one of the most exciting

findings in Neuroscience in the past 75

years is that Pleasure and Pain are

collocated in the brain so the same

parts of the brain that process pleasure

also process pain and in a very simple

reductionist kind of way they work like

opposite sides of a balance so imagine

that deep in your brain's reward pathway

which is is another exciting Discovery

right that there's this dedicated reward

pathway of the brain that consists

broadly speaking of the prefrontal CeX

which is this large gray matter area

right behind our foreheads that's so

important for future planning for

delayed gratification for appreciating

future consequences you might think of

it as like the brakes on the car if

we're going to analogize to to a to an

engine and then deep you know in the

brain we've got what we call the limic

areas or the emotion brain and there you

have the nucleus accumbens and the

vental tegmental area that are rich in

dopamine releasing neurons right and

they act like the accelerator on the car

so when you've got a healthy functioning

brain you've got enough accelerator but

not too much right so enough dop Meine

being released but not too much and

youve got a healthy prefrontal cortex

putting the brakes on that dopamine

release when people um become addicted

there's either a problem with the brakes

the prefrontal cortex or the accelerator

the nucleus accumbens and vental

tegmental area or both right what we're

finding is that there's actually a

disconnect so there are large neuronal

circuits and Pathways between those deep

lyic structures and the prefrontal

cortex that literally get severed or

disconnected when people become addicted

as we think about Pleasure and Pain

being collocated in the same parts of

the brain working like opposite sides of the

the

balance in order to understand what

happens in the addicted brain is to

appreciate that there are fundamental

rules governing this balance and one of

the most important rules is is that the

balance wants to remain level it does

not want to be tilted very long to the

side of either pleasure or pain and in

fact what our brain does is first tilt

an equal and opposite amount to whatever

the initial stimulus is so I'm going to

try to illustrate that here so let's say our

our

initial stimulus is alcohol now alcohol

Works through its own chemical pathway

it works on our endogenous opioid system

the opioids that we make we have

receptors for opioids in our brains it

works on our endogenous Gaba system

which is our calming

neurotransmitter and at the end of the

day it releases dopamine in the reward

pathway so any potentially addictive

substance will release dopamine in the

reward pathway the more that's released

and the faster that's released in a

given individual the more likely that

substance is to be

addictive now another important concept

here is what we call drug of choice

which is to say what releases a lot of

dopamine in your brain may not release a

lot of dopamine in my brain and vice

versa right which is this idea that

people have predictions to different

kinds of drugs and by the way people can

get addicted to behaviors too I should

emphasize that when you say drug of

choice you mean the brain has a

particular sensitivity to that drug in

terms of dopamine yes okay the more

dopamine that's released the faster that

it's released the more likely that drug

is to be addictive for a given

individual so you're holding some

whiskey there I'm holding some whiskey

there could be a brain that is very

sensitive to Whiskey and there could be

a different brain that you could pull

all the whiskey and you like and the

dopamine response is sort of limited

exactly okay and for many of my patients

who become addicted to alcohol they will

tell you that from the first moment they

had alcohol they knew they were either

in trouble or had met their best friend

or some combination it was a very potent

experience for them all right so let's

let's go ahead and put this on the

pleasure side of the

balance dopamine is being released but

no sooner has that happened then my

brain will work very hard to restore a

level balance and by the way a level

balance is what neuroscientists call

homeostasis okay and one of the

overarching physiologic drives for all

living organisms is to return to

homeostasis homeostasis is that

parameter of what's often called called

affordances or states of being that are

adaptive and healthy for the organism

for example like we have a certain

homeostasis of body temperature and if

we go much too much beyond that either

too high or too low we will disintegrate

and die right so homeostasis is that

that states of being that are compatible

with existence

and and potentially advantageous too

sort of Baseline level that's right yeah

Baseline level and by the way we're

always releasing dopamine at a kind of

tonic Baseline level in our brains I

sometimes think of it as the heartbeat

of the brain so what's happened here for

people that can't see is you've poured a

little bit of whiskey into one end of

the scale the pleasure side of the scale

and the other side of the scale has

risen because now there's whiskey um in

the the pleasure side which I guess is

released dopamine exactly so now now we'

released dopamine in the reward pathway

okay because the pain side went up does

that mean there's now less pain in the

brain well I think you know again this

is a metaphor it's an oversimplification

the idea here is just when we press on

the pleasure side we're releasing

dopamine in the reward pathway and

experiencing pleasure okay okay but no

sooner has that happened then our brain

will try to compensate or adapt to

increased dopamine firing by down

regulating dopamine transmission for

example by involuting post synaptic

dopamine receptors that mean okay okay

so our brain is a bunch of wires you

know um that conduct these electrical

signals and and these long spindly cells

are called neurons and the thing about

neurons is that they don't actually

touch end to end there's a little Gap or

space between them and that Gap is

called the synapse and that Gap or

synapse is bridged by what we call

neurotransmitters and dopamine is one of

those neurotransmitters okay and when

the pre synaptic neuron pulses and

releases dopamine it crosses the synapse

and binds to a receptor on the post

synaptic neuron which either continues

or aborts that electrical signal does

that make sense yes okay so one of the

ways that our brain can decrease the

effects of dopamine decrease dopamine

transmission is by involuting or taking

inside the neuron the post synaptic

receptor that way when dopamine is

released it has nowhere to bind oh okay

so it's like removing the docking

station exactly very good it's removing

the docking station so essentially

getting back to our scale we've we've

you know ingested alcohol we've

increased dopamine firing in the reward

pathway but remember our pleasure pain

balance wants to return to the level

position level with the ground

homeostasis so it's going to decrease

dopamine transmission by for example

involuting those post synaptic dopamine

receptors but one thing about the brain

in its process of trying to get back to

homeostasis and again I like to think of

this neuro adaptation process as these

Gremlins hopping on the pain side of the

balance to bring it level again you

don't have Gremlins here you have these

little rocks but let's go ahead and put

a rock on the pain side of the balance

and the these rocks are are friends

right their job is to level the balance

because remember we got to go back to

homeostasis I'm going to put a rock on

and you're going to see oh my gosh it

overshot right it now I've got it

pressed down on the the pain side of the

balance but that's exactly what happens

in our brains in this process of neuro

adaptation those Gremlins hopping on the

pain side of the balance don't get off

as soon as the balance is level they

stay on until we're tilted and equal an

opposite amount so is that what a

hangover is or a cown as they would say

when people take drugs they say I have a

come down exactly that's exactly what it

is that's the hangover the come down the

Blue Monday or on a much smaller scale

just that moment of craving right that

moment of wanting to have one more shot

right why does it overshoot why can't it

just perfectly hit homeostasis such a

great question because then we'd feel

fine yeah why did Mother Nature do that

to us so cruel right yeah okay I'm going

to tell you an evolutionary just so

story what we mean by that is we don't

really know why you know this mechanism

exists but from an evolutionary

perspective if you're living in a world

of scarcity and everpresent danger this

is the perfect mechanism to make sure

that we're never satisfied with what we

have that we're always wanting more it's

made us the ultimate

Seekers okay because immediately after

getting something I'm now feeling a lack

of pleasure and I'm at a deficit you

know on the pain side of the scale which

means that I'm going to go seeking out

more dopamine and in a world where

everything is quite scarce that could

mean going on another 4-Hour hunt the

next day to go killer gazelle or

something perfect you got yeah you got

it interesting yeah okay so that's going

to motivate me because this get so Jesus

people that have hangovers don't seem very

very

motivated right so now that's a so why

is that right it's because alcohol is a

product of human

engineering that releases so much

dopamine all at once in the reward

pathway that our brains are reeling to

compensate right we we really weren't

evolved for this much pleasure with this

much easy access as you said yourself we

were really evolved for to have to do

quite a lot of work upfront and to be

hungry and to be lonely and to be tired

and then get a little bit of reward that

would then bring us back up to

homostasis so really we were evolved to

be pressing on the pain side of the

balance in our effort to find pleasure

and then when we find it that little bit

of food or clothing or shelter or a mate

would bring us back to the level

position does that makes sense yeah so

you're you're telling me essentially

that we're all wired to be addicted

because if this is how our brain works

in a world it's designed to seek out

more dopamine but the problem we have

now is we have all the synthetic

dopamine effectively like this so

synthetic chemicals and synthetic things

and you know an Internet that is wiring

us to give us so much dopamine so easily

that that means that our brains are

effectively like mismatched to the world

that we live in and therefore wired to

be addicted yeah I think you actually

said that I found a quote you said in an

interview where you said we all wired to

be addicted and if you're not addicted

yet it's right around the corner right

coming to a website near you yes I I

guess I would I would qualify that a

little bit by saying we're wired for

survival in a world of scarcity that's

not the world live in now we live in a

world of overwhelming overabundance and

so there is a mismatch between this

ancient wiring that has us relentlessly

pursuing pleasure in order to survive

and a world that's so infused with

pleasure and so many rewarding stimuli

that now we're overwhelming our reward

system and our brains are reeling in

response to try to compensate so what

happens to this scale then in such a

world where I can get a big hit of

dopamine all the time using some of

these synthetic things or the internet

or pornography or whatever else what's

going on with this scale over and over

again okay great so let me get there let

me first say though that remember after

we do something that's highly

pleasurable our brain compensates with

neuro adaptation tilting an equal and

opposite amount to the side of pain and

then restoring our balance back to the

level position right or what we call

homeostasis so this doesn't last forever

right it's to pleasure then it's to pain

then it's back to the level position but

if we continue to consume our drug of

choice over days to weeks to months to

years and we add in a whole bunch of

other drugs and now we're consuming you

know pornography and smoking pot and

eating um donuts and you know you name

it all at the same time then essentially

what happens is those Gremlins on the

pain side of the balance end up camped

out there for anyone that see she put

all of the Rocks into the pain side to

represent All Of The Addictive behaviors

that this individual has now taken on

right and now we've entered addicted

brain by which I mean that we've changed

our honic or Joy set point to the side

of pain now we need more and more of our

drug in more potent forms not to get

high and feel good but just to level the

balance feel normal and this is not

going to be enough to level the balance

I would have to like keep filling this

much more than this container can hold

and that would be in Pursuit really of

just trying to level that balance so

that we can feel normal and when we're

not using we're walking around with a

balance tilted toward the side of pain

experiencing the universal symptoms of

withdrawal from any addictive substance

or behavior which are anxiety

irritability insomnia depression and crav

crav

so if I managed to get enough vodka

whiskey rum and pour it into the

pleasure side of the scale now that all

the rocks are in the pain side of the

scale I managed to outweigh

it it would it would what would then

happen more rocks more rocks would be

added yes more so momentarily yeah I

would maybe be in a little bit of

pleasure yes but then my brain would

remove those docking stations again

remove more of them and more rocks would

go in and I'd slam

down on the pain side again which means

I need more alcohol to try and get up to

pleasure SL okay so really you want to

you want to like dopamine fast you need

you need to just balance this and this

is so difficult because of the world we

live in it's almost it's it's it's funny

enough because this little scales

experiment um analogy here has given me

a huge amount of empathy for people that

are addicts oh gosh I'm so glad you said

that because I think that is the key to

empathy for the disease of addiction as

well as for people with the disease

having empathy for themselves is

recognizing that on some level it it's

it's out of their control right because

when we are tilted to the side of pain

the overwhelming drive to restore a

level balance or restore homeostasis as

quickly as possible overwhelms any other

rational thought about the consequences

of my drug use right it's just like get

back to the level position because if I

do that I'll at least feel temporarily better

better

one of the things this analogy also

highlights for me is that people who are

addicted aren't trying to self harm

right and this is kind of the prevailing

narrative that if you're like why would

you do that to yourself right whereas

when I look at this analogy I go

actually what they're trying to do is

to deal with pain and we're all trying

to find ways to deal with our pain and

but in this analogy what ultimately

happens and I guess is what's happening

with addicts is the way they're choosing

to deal with their pain is becoming

self-destructive and that's creating

more pain right and it's this vicious

downward cycle yes and I think that sort

of reframing of what's going on there is

really critical because again it begets

more empathy absolutely I agree with you

and and I think you know we this this

metaphor it makes an assumption that we

all start with a pleasure pain balance

that's level with the ground but

actually that's probably not true right

some people at Baseline may actually be

more depressed or more anxious or may

have had life experiences that sets them

up for a kind of chronic stress reaction

and we know that people with

co-occurring psychiatric disorders for

example are at increased risk of

developing addiction probably because

they're reaching for that substance to

self medicate their psychiatric problem

the the issue with that is that it's not

medicinal right it's not healing

although in the short term substances

can help with those kinds of feelings

feelings of psychological and physical

pain over time because of the way the

brain adapts as we've

discussed substances and other addictive

behaviors just make psychiatric problems

worse right as we drive ourselves

further into the the kind of uh you know

the pain side of the balance so is this

why trauma often leads to addictive

behaviors because the trauma has caused

a a pain a stress and we're searching

for ways to

medicate that pain or stress yeah to

numb ourselves to not be present in our

reality and have to deal with what's

going on there is dopamine what role is

dopamine playing in it's all the same dopamine

dopamine

originally was to help us find those

things that we need to survive food

clothing shelter a mate we call those

Natural Rewards but

today that same reward pathway that

relies on dopamine has been hijacked by

all of these

artificial rewards that our brain

confuses as necessary for survival which

is why people with severe addiction will

be willing to lose you know not

consciously but unconsciously their

loved ones their homes their jobs

everything they have in pursuit of their

drug of choice it's because their brain

has been hijacked and they now confuse

the drug as necessary for survival the

other thing about drugs is that they're

incredibly potent they release a lot of

dopamine all at once which again is

confusing for our brain Natural Rewards

require upfront effort where we do a lot

of work and then we get a little bit of

dopamine and that's what our brains

evolved for I mean I can that makes

sense in my own life when I'm most

stressed or most challenged by something

professionally is when I I immediately

notice that my diet goes out the window

I start eating things that are bad I

actually stop going to the gym as much

um and it's it be can form a bit of a

downward spiral can't it I guess as

we've kind of seen from the dopamine

scale um can I can I get back to that

your question though about trauma and

stress so um there's a very series

there's a very interesting series of

experiments in rodents mice and rats

where they first of all rodents very

easily get addicted to cocaine they will

press a lever for cocaine until

exhaustion or death but if that cocaine

is then taken away that behavior will

extinguish which means that the mice

will eventually just stop pressing the

lever right because they're not getting

any cocaine totally makes sense and then

they'll go off and do something else in

the cage but if they're then exposed to

a very painful foot shock right so a

very extreme physical pain which you

could equate to a serious life stressor

the first thing the rat will do is run

cocaine which tells us that once our

brain has discovered a drug that

releases a lot of dopamine in our reward

pathway even after we stop using that

drug if we are exposed to an extreme

stressor our brain will tell us

immediately go and do that thing that

gives us a lot of dopamine because you

are under stress and I need to be

relieved of stress does that make sense

makes perfect sense yeah so if you

especially so if you discover your drug

of choice when you're younger and it's

food or it's pornography or if it's I

don't know anything that really made you

feel good for a moment a moment of

pleasure that will always become in the

case of these rodent

experiments the thing you run back to

when life gets hard right and we see

that again and again in people in

sustained recovery from addtion that

when they are under stress that is a

trigger potentially for them to relapse

so they have to be really thoughtful in

their lives for number one trying to

avoid stressful situations and and by

the way stress can come in many

different forms there's a great acronym

in in alcoholic synonymous called halt

hungry angry lonely tired those kinds of

stressors everyday stressors which we

all experience hungry angry lonely tired

can trigger us to want to use so people

in recovery have to be really thoughtful

about not getting too hungry not getting

too angry not getting too lonely and not

getting too tired at the end of this

conversation I want to go through all of

the sort of practical solutions that

someone struggling with an addiction to

social media pornography food whatever

it might be um Can Implement to try and

shift that cycle that they might be

going through especially when they're

halting hungry angry lonely or tired how

often have you worked with addicts have

you spent much time working with addicts

directly oh my gosh yeah so that's the

bulk of my career is working uh with

people with all different kinds of

addictions me an example of the most

obscure the most I had a patient who was

addicted to

water I know hard hard to imagine you

have to though understand her narrative

so she had a very severe alcohol

addiction she got into recovery from

that addiction and gave up alcohol but

she discovered that by drinking copious

amounts of water she could become

hyponic meaning that she could lower the

sodium levels in her bloodstream which

would then lead her to become delirious

and so in her desire to just be checked

out she would do that she would she

would drink a large amounts of water

she's doing okay no sadly she's not um

she she ended up taking her own life so

gosh in that situation was there was

there a root cause of that behavior

pattern further Upstream some kind of

trauma or experience that had set this

sort of cascade cascading set of issues

off yeah you know I'm just speaking

broadly um for for some patients with

severe addiction trauma is a huge Factor

um especially severe Early Childhood

trauma but there are also many folks we see

see

who have kind of great parents and have

had happy childhoods and have great

social networks and and work that they

enjoy and yet they still become addicted

and that's because we again we are wired

to consume as much as possible of

whatever releases dopamine in our brains

to have survived Evolution to this date

and yet we're living in this world where

we have access to so many drug aied

substances and behaviors that we've all

become vulnerable to this problem and

the reason I highlight this is because

one of the things that I think has

happened in the field of addiction

medicine that maybe isn't the best is

that often times patients themselves as

well as their providers are digging

really deep to find the trauma or the

reason that someone has become addicted

and I think that that's important to do

in some cases but in in other other

cases it can lead to kind of

manufacturing trauma where there really

isn't any furthermore I would say that

when a person is in the throws of their

addiction they're not going to be able

to really do the complex emotional

processing of their trauma while they're

still using their drug of choice that

they really need to get out of that

Vortex of addiction and get into some

degree of recovery before you would even

want to go tackle some of those early

traumatic experiences how many people do

you think are struggling with some form of

addiction well if you think of addiction

as a spectrum disorder right there's

mild moderate and severe um and there's

I would even say a kind of a pre-

addiction state where we're all sort of

dabbling in compulsive overc consumption

I would say the vast majority of us like

90 probably

95% have some degree of compulsive over

consumption and you know if and when it

tips over into what we would call

addiction there's not a brain scan or a

blood test to assess that it's not like

you know switching a light a light

switch and it's like oh yeah now you

have addiction um it's not like that

it's you know it's a gradual often a

gradual and Insidious thing and we don't

in fact have a biological measurement of

addiction we Bas it on what we call

phenomenology which is patterns of

behavior that re repeat themselves

across time and broadly speaking the

definition of addiction is the continued

compulsive use of a substance or a

behavior despite harm to self and or

others and so you know that harm can be

very subtle um or not right and it can

be a judgment call interesting because

we do throw the word Addiction around a

lot in society but but really the most

important part of that is to understand

if it's harming yourself or someone else

the behavior pattern yes that's right

and to also recognize that we're not

very good judges of that when we're

chasing dopamine okay so we sometimes

justify behaviors we have as being not

harmful and it's fine and it's not

impacting me at all and what do you mean

exactly and we don't we're not very good

at seeing true cause and effect honestly

when it comes to these behaviors which

is why often times people won't really

see the harm until they've stopped using

for a period of time in your book

dopamine Nation you talk about an

addiction that you had yes and it was

really surprising to me because I would

never have thought that being obsessed

with erotic

novels could be classified as an addiction

what happened what was the behavior take

me into that that phase of your life so

I was in my early 40s um my kids were no

longer little um I got a lot of my

self-worth and identity from being a mom

and my kids were sort of entering

adolescence they were doing fine but

they didn't need me as much um so I had

kind of a grief reaction you know in

response to that was trying to figure

out you know how to navigate this next

phase of my life I'd always been a

reader and in particular a reader of

novels um in my own way that was how as

a child I self soothed was to escape

into uh the Fantasy Life of novels um

but I never had what what I would call a

problem with it and then one day I heard

another mother at school said that she

was reading this great book it was

called Twilight it was about these

vampires and she was going on and on

about it and I read it and I I can't

tell you what it was but it was just

like the the the key in my particular it

was completely

transporting it just released a lot of

dope mean is all I can imagine in my

brains reward pathway and so I read the

whole series and then I read the series

again and I read it again and of course

by the third or fourth time it wasn't as

you know reinforcing and I thought to

myself I wonder if there are any more

vampire romance novels and then for me

the real Tipping Point was I got an

e-reader I got a Kindle because what

happened was I I even before I got the

Kindle I started reading you know novels

that I would say I would be slightly

embarrassed to admit that I was reading

like kind of bodice Ripper novels as

time went on I I needed more and more

like graphic kinds of descriptions in

order to find it pleasurable and and by

the way that's classic for the addiction

narrative right where you start out with

a little bit and it goes a long way and

then over time you build up tolerance

that's neuro adaptation the Gremlins

pressing down on the pain side of

balance now I need more of my drug in

more potent forms to get the same effect

gradually over time I started um reading

you know more and more sort of graphic

erotic sexualized versions of this novel

and I would I was embarrassed so I would

hide that I was reading them and that

gets into the whole double life of

addiction where now we're lying about

our use we're we're using our drug over

here but pretending like we're not so my

kids or my husband would walk in the

room and I would be you know hiding

behind another book one book behind

another book so it looked like I was

reading something you know I don't know more

sophisticated and then the Tipping Point

for me came really when I got a Kindle

or an e-reader and then my reading was

totally Anonymous I could read these

books anywhere any time no one knew what

I was reading and as soon as I finished

one um I could read another one and I

almost overnight became a chain reader

like literally when I was n doing

something else that I had to do I was

reading romance novels one after another

after another um which meant I was you

know less present for my kids less

present for my husband I would often

stay up till 2: 3 4 in the morning on a

week night reading romance novels have

to get up two hours later go to work

exhausted not able to be present for my

patience not enjoying my work gradually

getting more depressed more irritable

more anxious more insomnia we went on on

a a family vacation with an family

friends of ours everybody together at

this beach house all the kids playing I

was like hiding in a room reading

romance novels so and this is exactly

what happens with addiction is that our

Focus Narrows and the things that we

used to enjoy are no longer pleasurable

only this one thing has salience for us

we plan our whole whole day around

getting it using it hiding our use um

and that's what happened to me

it's so interesting because I was as you

were talking about that I was thinking

about all the behaviors that I have that

are maybe isolating me or you know I

just even things like spending a lot of

time on the internet just watching video

after video after video on YouTube or um

those kinds of things or just like

spending tons of time in my WhatsApp

group chat talking like roasting my

friends about nothing right how do you

know if like this is it's cuz on end of

the spectrum I could say okay well

that's harming my relationship with

people in the real world but

it's helping making me feel good and

it's you know maybe helping me in

another department because I'm learning

more about vampires or you know like so

like you know because there's there

might be net harm somewhere else but

then an upside over here which and then

I start rationalizing this Behavior like

how' you just distinguish between these

behaviors and know what's bad and what's

good you know what it's really hard um

these digital devices are powerful tools

but also very potent drugs there's no

doubt that digital media lights up the

same reward pathway as drugs and alcohol

these devices and platforms were

designed to be addictive that is to keep

us scrolling and tapping long beyond

what we plan for or what we want or even

what's pleasurable I think we can all

relate to using this

medium to a point where we don't even

like it anymore and yet have difficulty

getting ourselves off of it that really

speaks to the inherently reinforcing and

cognitively adherent nature of this

medium it is a drug and so you know if

and when and how we're crossing into addictive

addictive

use I think we need to be very Vig

about whether that's happened in our

lives and one of the ways to do that is

actually to try cutting out that

particular digital medium that website

or that behavior for a period of time

long enough to experience withdrawal

potentially reset reward Pathways and

then re-evaluate because when we're in

the behavior as you yourself noted it's

very easy to rationalize oh I need to do

this for work oh I need need to do this

to stay in touch with my friends oh I'm

learning so much from this right and all

of that may have been true initially but

may not be that true anymore and what I

often point to is the subtler signs of

addiction which are things like

depression anxiety in attention insomnia

restlessness these can be early signals

for our consumption entering into that

addiction range but us not realizing it

because again we don't see cause and

effect which is why doing an experiment

like I did with my romance novels you

know following in the footsteps of my

patients and taking the advice I give

them and I gave my romance novels up for

30 days right just to see like okay I

think this is a problematic Behavior can

I give it up how will I feel and the

very first day that I the very first 24

hours hours that I did not read any

romance novel any novel at all I was

astounded at my level of anxiety

restlessness and utter insomnia I had

completely unlearned the art of putting

myself to sleep without this digital

narrative and that lasted a good 10 to

14 days completely mapping on with the

amount of time it takes typically to get

out of acute withdrawal that is to say

for those neuro adapt PA Gremlins to hop

off the pain side of the balance and for

homeostasis to to begin to be re

restored um but by the time I got to

weeks three and four I felt not just

better than I had in the first two weeks

but actually better than I had felt in a

really long time I enjoyed my kids more

I was more present for them I enjoyed my

husband more my work seemed salian again

I had started to think oh maybe I should

do something else you know maybe maybe I

you know this work I've been doing it a

long long time I don't it's not that

interesting anymore all of a sudden it

was interesting again right so you see

the relativity of that honic pathway and

how when we're doing that behavior or

substance that's so reinforcing that

everything else loses its salience we

can really

misidentify what is causing our

irritability anxiety insomnia until we

stop that substance for long enough to

see its impact on our lives how is it

making you feel because I think a lot of

a lot of people can't understand how you

could get addicted to a book I'm sure

some people understand that but but for

me it's not something I've ever become

addicted to so how how did it feel was

it like exciting is it arousing is it

somewhere in

between I mean I think that romance

novels are essentially socially

sanctioned pornography for women okay

and the medium is narrative and if

you're a person for whom narrative is a

powerful drug as it is for me a story a

narrative a fiction um very potent since

I was a child then you know it was a

natural that that that would be the

thing that I would get addicted to and

basically just like we've hacked and

bioengineered everything to make it more

potent I mean people there's a formula

for writing romance novels like if you

take a physical copy if you go to a

store and you pick up a romance novel

and you literally physically open it to

2third of the way through you will get

to the climactic scene pun intended

right it's it's like it's

engineered I mean I got to a point where

I wouldn't even read it read after I

wouldn't finish the book I would go on

to the next book just to get to the

climax part and then you'd move yeah and

I wouldn't even read the danum ma or

like what happens to the characters I

didn't care you didn't care about no and

also I didn't I got to point where I

didn't care about the quality of the

writing or the depth of the car it

didn't matter it was it was the drug it

was that moment I was looking for and

you know there are a lot of free books

on Amazon some some of which are high

quality and some of which are not but

like you know any good drug dealer knows

free samples that's the way you hook

people I would search for these free

samples and that's part of it too like

the searching for the drug so the

Working The Upfront work you do for the

drug is part of the drug right it's all

that you know the machinations and the

hiding and the this and the that that

gets to be part of like all of the

rituals surrounding it as you were

talking as well I thought about work and

work addiction yes because you earlier

used the term excessive consumption and

when I think about work even my work I

Think Jesus I excessively consume work I

start so many bloody businesses and

invest in so many things and if you look

to that behavior objectively if you're

like an alien looking down at me you'd

go this guy's got a problem do

you know what I mean you think you think

know I feel for you and it's funny cuz

in society we then those people are

reinforced we clap that's right we clap

we got this guy's not sleeping he's

working 18 hours a day clap clap clap

give him a trophy an award name a thing

after him or her or right you know um

and it's just really interesting that

that that addiction of work and you tell

me if it is it can be an addiction it's

certainly in the scale of one end being

sort of consumption excessive

consumption in the other hand being

addiction it's on there somewhere people

can get addicted to work

and part of the reason is that we've

drug aied work right when when I say

drug aied what do I mean we've made it

more potent and this is true for all all

these drugs we've made them more potent

more novel more Bountiful meaning

there's more of it and more accessible

so if we if we break that down with work

how is work more potent well certain

types of work are more reinforcing not

all types of work so for example Works

work White Collar work is often now

associated with stock options and

bonuses right um there's often like a

social media aspect to it or maybe even

a Fame aspect or as you point out those

are our cultural Heroes right so you get

all this you know agulation for being a

workaholic and that also because we're

such social creatures right and human

connection stimulates dope mean that

that also makes work more of a potent

drug personal brand right so you're

LinkedIn oh my God this person got a

promotion we all clap we the likes the

comments you're amazing the agulation

the a as you said the awards the

trophies and then you've got um the fact

the fact of novelty so once we've

exposed our brains enough times to a

certain drug as I said we develop

tolerance right and then we need more

potent forms or novel forms one of the

ways we overcome tolerance is by taking

our drug and then changing it slightly

like adding a little new molecule on

this chemical right or on the Internet

you know when we're searching videos we

want something similar to what we liked

before but just a little bit different

and that's what the algorithm does

automatically right it offers oh you

should check this out oh how about this

oh check that out right and that engages

our treasure seeking function we're

looking for that that novel thing but

that's not too novel right it has to be

in our category of things we like and I

think for work we have that too like

there are so many ways now that people

can engage in their work and it's not

all bad that it's novel but you know

certain types of work it makes it very

enticing then you have quantity

right I mean work never ends there's

like no natural stopping point for work

you know you do a line of cocaine you

run out of money you run out of cocaine

you're done right but that's not true

for work everywhere anytime and then

that gets to

accessibility one of the biggest risk

factors for addiction to any drug or

behavior is simple access we know that

if you grow up in a neighborhood where

drugs are sold on a street corner you're

more likely to try them more likely to

get addicted if you live in a world

where you have access to work

24/7 you're more likely to expose your

brain to more work and more likely to

get addicted to work again especially if

it's got all those other reinforcing

qualities this is probably in part why

people quit their

jobs you mean if they just get

overwhelmed or it's it's partially why

people can never quit but I think it's

important to make a distinction between

work that's reinforcing in those ways

and then work that's completely not

reinforcing yeah

alienating mind-numbing work in which

the the actual task is separated from

the meaning of a task I mean they quit

their jobs either in search of more

dopamine so if I'm working in a job

where I don't know maybe it once gave me

dopamine and now it's become monotonous

and the same right I I need to quit to

go find but there's novelty for you

that's right yeah and that's true people

many people change jobs every two to

three years I I recently read that the

the average life of a business now is

like 15 years whereas you know 50 years

ago it was 50 years and there's all this

turnover all this churn chasing novelty

also you know I I do want to emphasize

that people who are in work that's not

like intrinsically rewarding but is the

opposite kind of soul sucking that's

also a risk factor for addiction because

people just wait till the end of the day

till they can go home and then use a

drug to numb themselves from the stress

of work so it's it's plausible that

people who are in lower pleasure jobs

are more likely to be overweight or

addicted or dependent on alcohol yeah or

simply opt out of the workforce as many

young men are doing now in the United

States and what we know from data that's

been collected is many of them are

playing video games right they've just

completely opted out of the workforce I

guess this in part explains why there's

a drinking culture that's associated

with people who are potentially lower

class um because they're doing um potentially

potentially

less pleasurable work

and they're therefore they if we think

about the scale that they would then end

up in the pub after work you know maybe

that's partially true but even people

doing like doctors and lawyers they're

are oh okay yeah equal rates of

alcoholism among those groups I think

what's happening there though is that

the nature of the work is just so

stressful whether it's white collar or

blue collar that there's this kind of

work hard play hard right I'm going to

work all day and at the end of the day

I'm going to reward myself so now you've

got a pleasure pain balance that's going

pleasure pain pleasure pain and and

remember the biological definition of

stress is any deviation from

neutrality so that every time our brain

has to work to restore a level balance

we're actually triggering our stress

response triggering our own adrenaline

it's stressful to have to restore the

balance from those extremes of Pleasure

and Pain I read in um your book you were

talking about how different behaviors

and sort of chemicals and substances

have different impacts and I was on page

50 of dopamin nation in a study of mice

sex increases the release of dopamine by

100% And amphetamines which is like

drugs right hardcore drugs increases it

by 1,000% by this accounting one hit of

a meth pipe is equal to 10 orgasms yes

it's interesting to think about that the

different behaviors we have and how

they'll have a bigger impact on our

dopamine is there like any in an in in

typical order of things that are like

extremely dopamine inducing and things

that aren't what's it like the top and

bottom of the list but in your view you

know I really think that it depends on

the person and we've got to look at drug

of choice right I mean potent drugs like

methamphetamine like opioids like

alcohol like nicotine like cannabis um

are are going to be very reinforcing for

many people but not for all people and

most people do have their one drug that

they sort of prefer above all others so

although generally speaking intoxicants

release a lot of dopamine in the reward

pathway um I think every person is going

to be different and also we we don't

really have good ways of measuring

absolute values of dopamine in human

beings right we can do that in rats but

we can't really do that in humans it's

it's relative values I've got this um

picture here which shows what looks like

brain scans in uh normal person but then

in someone who's addicted to different

substances I'll put this on the screen

and I'll link it below in the

description for anyone that needs it and

wants to see it but it effectively shows

the impact that like cocaine has on the

brain meth um alcohol and heroin what is

what is going on here so the red in this

image represents dopamine transmission

okay so how much dope mean is being

released from the pr synaptic neuron

Crossing that synapse binding to

receptors on the Sy aptic neuron how

much dopamine is kind of swirling around

in the reward pathway part of the brain

and what this image shows is that on the

left hand side in healthy control

subjects who do not have addiction

there's plenty of red right so there's

plenty of dopamine Transmission in the

reward pathway specifically here in the

nucleus accumbens but if you look at the

right hand column you'll see that in

these individuals who have been using

cocaine meth amphetamine alcohol and

heroin in addictive ways there's almost

no red which means there's decreased or

below normal levels of dopamine

transmission they are in a chronic

dopamine deficit

State this is evidence of the brain

trying to

compensate for too much dopamine being

triggered by down regulating its own

dopamine production and transmission not

just to Baseline but below

Baseline and importantly these

individuals who are addicted to these

substances these brain scans were done

two weeks after they stopped

using oh wow yeah which tells us that

this dop dopamine deficit State persists

for some period of Time how long well it

depends on the person but we know at

least from this experiment that the

first two weeks are this persistent

dopamine deficit state which is

consistent with acute withdrawal right

people feel when they first stop their

drug of choice they feel terrible right

they experience all of the symptoms of

physical withdrawal that correspond with

that particular drug they were using

usually the opposite of what the drug

did plus the universal symptoms of

withdrawal from any addictive substance

or behavior anxiety irritability

insomnia depression and craving now if

they can get through the first 10 to 14

days what we see clinically is those

acute withdrawal symptoms slowly start

to get better and we think that that is

mapping on to regenerating dopamine

Transmission in the reward pathway and

if they can make it to a month that's

usually the point for for on average in

based on clinical experience when people

really can start to get out of that

constant state of craving for their drug

of choice and begin to see some light at

the end of the tunnel for what their

lives might look like if they can

maintain abstinence from their drug and

we can't just inject or drink dopamine I

mean I guess that would be like drinking

alcohol we can't just artificially mess

with the the balances to try and restore

the dopamine levels in an addict can we

can't just add a little bit of dopamine

yeah it's it's a great question because

we have some natural experiments that

suggest what what might happen if we do

that so as I mentioned before people

with Parkinson's have depletion of DOP

mean in the substan That's What

Causes That that motor disease the

treatment for it is to give L Doopa

which is a dopamine precursor if I were

to give you a spoonful of dopamine it

would do absolutely nothing because it

doesn't cross into the bra the brain it

doesn't cross the blood brain barrier

but I could give you lopa which is a

precursor chemical that would cross your

blood brain barrier and get turned into

dopamine and then diffusely bind

dopamine receptors in your brain in the

reward pathway but also in the movement

Pathways when we give patients with Parkinson's dopamine in this form that

Parkinson's dopamine in this form that can temporarily improve their movements

can temporarily improve their movements but in about one in four Parkinson's

but in about one in four Parkinson's patients they will develop a denovo

patients they will develop a denovo addictive disorder shopping addiction

addictive disorder shopping addiction sex addiction other types of addiction

sex addiction other types of addiction because we have the same problem we are

because we have the same problem we are stimulating

stimulating the reward pathway with dopamine that is

the reward pathway with dopamine that is ingested exogenously from the

ingested exogenously from the outside and our brain reads that as oh

outside and our brain reads that as oh boy got to compensate by downregulating

boy got to compensate by downregulating dopamine transmission to below Baseline

dopamine transmission to below Baseline which then puts us in that addiction

which then puts us in that addiction Vortex does that make sense it does so

Vortex does that make sense it does so we have to I mean it tells me that we

we have to I mean it tells me that we have to live lives in a certain sense of

have to live lives in a certain sense of we have to live our lives in a certain

we have to live our lives in a certain sort of

sort of homeostasis and

homeostasis and it's so easy not to in the world we live

it's so easy not to in the world we live in it's like it's like impossible to

in it's like it's like impossible to live in a perfect homeostasis balance in

live in a perfect homeostasis balance in the world we live in right even more

the world we live in right even more than having to try to live within this

than having to try to live within this sort of narrow range of homeostasis in

sort of narrow range of homeostasis in the world we live in today we probably

the world we live in today we probably have to intentionally do things that are

have to intentionally do things that are painful do things that are hard pleasure

painful do things that are hard pleasure pain balance like we learn that when we

pain balance like we learn that when we press on the pleasure side of the

press on the pleasure side of the balance like with alcohol or pornography

balance like with alcohol or pornography or romance novels or cannabis or

or romance novels or cannabis or whatever it is right no sooner does that

whatever it is right no sooner does that happen than our brain adapts by those

happen than our brain adapts by those neuro adaptation Gremlins hopping on the

neuro adaptation Gremlins hopping on the pain side of the balance to bring it

pain side of the balance to bring it level again but they like it on the

level again but they like it on the balance so they don't get off right when

balance so they don't get off right when it's level they stay on until we're

it's level they stay on until we're tilted an equal an opposite amount to

tilted an equal an opposite amount to the side of pain that's the come down

the side of pain that's the come down the hangover Etc but it turns out the

the hangover Etc but it turns out the opposite is also true if we

opposite is also true if we intentionally press on the pain side of

intentionally press on the pain side of the balance for example with exercise or

the balance for example with exercise or an ice cold water bath or intermittent

an ice cold water bath or intermittent fasting those Gremlins will hop on the

fasting those Gremlins will hop on the pleasure side of the balance and we will

pleasure side of the balance and we will get our dopamine indirectly by paying

get our dopamine indirectly by paying for it up front and there are studies in

for it up front and there are studies in humans showing that when humans expose

humans showing that when humans expose themselves to exercise for

themselves to exercise for example dopamine levels gradually rise

example dopamine levels gradually rise over the latter half of the exercise and

over the latter half of the exercise and then when the exercise stops dopamine

then when the exercise stops dopamine levels will remain elevated for hours

levels will remain elevated for hours after afterwards before going back down

after afterwards before going back down to the Baseline level position without

to the Baseline level position without ever going into that dopamine deficit

ever going into that dopamine deficit state so it's a great way to get our

state so it's a great way to get our dopamine in directly because it's much

dopamine in directly because it's much less vulnerable to that compulsive

less vulnerable to that compulsive craving phenomenon of overuse so you're

craving phenomenon of overuse so you're not going to get an exercise come down

not going to get an exercise come down you can butc and people can get addicted

you can butc and people can get addicted to exercise right but typically it's

to exercise right but typically it's it's very unusual because The Upfront

it's very unusual because The Upfront cost

cost to to do the work and endure the pain of

to to do the work and endure the pain of exercise in the first place mitigates

exercise in the first place mitigates our vulnerability to an exercise

our vulnerability to an exercise addiction and in general H okay CU it's

addiction and in general H okay CU it's so hard to do that it's going to be it's

so hard to do that it's going to be it's not like pulling a lever on a slot

not like pulling a lever on a slot machine or clicking on a porn website is

machine or clicking on a porn website is difficult yes okay so fighting for the

difficult yes okay so fighting for the dopamine

dopamine is insulates us against the chance of an

is insulates us against the chance of an addiction having to really fight hard

addiction having to really fight hard for it okay yeah and this kind of

for it okay yeah and this kind of explains I guess in part why

explains I guess in part why I pulled out some stats ahead of our

I pulled out some stats ahead of our conversation today that from 1996 to

conversation today that from 1996 to 2008 participation in ultramarathons has

2008 participation in ultramarathons has increased by

1,676 the ice bath Market is expected to rise from 350 million in 2024 to to

rise from 350 million in 2024 to to nearly half a billion by 2030 the number

nearly half a billion by 2030 the number of people taking part in obstacle course

of people taking part in obstacle course races like tough mut or hrock etc etc

races like tough mut or hrock etc etc has increased by almost 7x from 2010 to

has increased by almost 7x from 2010 to 2017 it seems like in society there's

2017 it seems like in society there's this counter movement towards people

this counter movement towards people seeking out hard dopamine chasing pain

seeking out hard dopamine chasing pain yeah those are amazing I didn't know

yeah those are amazing I didn't know that those are amazing numbers um you

that those are amazing numbers um you know in general there's a part of me

know in general there's a part of me that wants to say well that's a good

that wants to say well that's a good thing um but there there's another part

thing um but there there's another part of me that's wary also because we're so

of me that's wary also because we're so good at drug aying everything that we do

good at drug aying everything that we do that there's a way in which these types

that there's a way in which these types of behaviors can also be drug aied right

of behaviors can also be drug aied right made more potent with all of the

made more potent with all of the technology the way that we count

technology the way that we count ourselves the leaderboards the social

ourselves the leaderboards the social comparisons all of that takes this thing

comparisons all of that takes this thing which is really in its natural state

which is really in its natural state kind of impervious to addiction like you

kind of impervious to addiction like you just typically wouldn't get addicted to

just typically wouldn't get addicted to these types of painful physical

these types of painful physical activities you would do what you needed

activities you would do what you needed to do for survival but we've managed to

to do for survival but we've managed to make them addictive in all these

make them addictive in all these different ways I still think it's a

different ways I still think it's a better way to get your dopamine like I

better way to get your dopamine like I really encourage exercise we always talk

really encourage exercise we always talk about movement as medicine and in

about movement as medicine and in general our our life is so convenient so

general our our life is so convenient so easy so passive so sedentary that I'm

easy so passive so sedentary that I'm telling patients all the time you know

telling patients all the time you know get up off the couch move your body walk

get up off the couch move your body walk around the block I think that's the

around the block I think that's the bigger obstacle right now is just

bigger obstacle right now is just getting people to move but I do think we

getting people to move but I do think we need to be wary of not going too far in

need to be wary of not going too far in the direction of like the ultra Ultra

the direction of like the ultra Ultra Ultra whatever it is so what is a better

Ultra whatever it is so what is a better way to live if we're trying to optimize

way to live if we're trying to optimize happiness and to keep our dopamine in

happiness and to keep our dopamine in balance and not have the crashes Etc and

balance and not have the crashes Etc and come downs and hangover what is a

come downs and hangover what is a optimal way to live our lives do we have

optimal way to live our lives do we have to look back at our caveman ancestors

to look back at our caveman ancestors and live like them I think that part of

and live like them I think that part of the problem is that we've

the problem is that we've organized Our Lives now around

organized Our Lives now around rewards almost everything that we do is

rewards almost everything that we do is predicated on the Feelgood moment we'll

predicated on the Feelgood moment we'll have at the end of it and because of

have at the end of it and because of that that we

that that we are missing out on the

are missing out on the process we're projecting our psyche

process we're projecting our psyche forward into the future toward the

forward into the future toward the reward and not able to really be here in

reward and not able to really be here in the moment okay this is going to be

the moment okay this is going to be sound weird I'm going to give you a

sound weird I'm going to give you a weird example so driving over here today

weird example so driving over here today I found I was nervous for this interview

I found I was nervous for this interview and in a way looking forward to it but

and in a way looking forward to it but in a way wanting it to be over right and

in a way wanting it to be over right and and in seeing that in myself I thought

and in seeing that in myself I thought that's so sad like that's that's so sad

that's so sad like that's that's so sad that we live our lives that way myself

that we live our lives that way myself included always this weird blend of

included always this weird blend of wanting whatever we're doing to be over

wanting whatever we're doing to be over so that in a way we can just go hide and

so that in a way we can just go hide and do whatever that self- steem thing is

do whatever that self- steem thing is that we do where we're safe and we're

that we do where we're safe and we're like you know stimulating ourselves in

like you know stimulating ourselves in some way and then I thought well what if

some way and then I thought well what if I knew that I was going to die right

I knew that I was going to die right after this going come off really weird

after this going come off really weird now but what if I knew that I was

now but what if I knew that I was actually going to die right after our

actually going to die right after our conversation today

conversation today that totally changes my perspective

that totally changes my perspective doesn't it because this time you and I

doesn't it because this time you and I have that's all I got it's over for me

have that's all I got it's over for me when this so this this conversation is

when this so this this conversation is it I really better be right here right

it I really better be right here right now and really taking joy in whatever

now and really taking joy in whatever you and I can find together and and I

you and I can find together and and I think the more we can do that the better

think the more we can do that the better what's happening there you're removing

what's happening there you're removing the thought of the outcome the rewards

the thought of the outcome the rewards the potential you know failure or

the potential you know failure or whatever and you're focusing on just

whatever and you're focusing on just being present and in doing so what is

being present and in doing so what is happening it's a great question and I've

happening it's a great question and I've actually given this quite a lot of

actually given this quite a lot of thought because I remember when I was in

thought because I remember when I was in college and I you know met some like Zen

college and I you know met some like Zen people and they were like be here now be

people and they were like be here now be here now and I thought well whenever I'm

here now and I thought well whenever I'm here now I'm miserable like I I I don't

here now I'm miserable like I I I don't like me and I don't like being in the

like me and I don't like being in the world I I don't want to be here now I

world I I don't want to be here now I want to be somewhere else so I didn't

want to be somewhere else so I didn't really understand what they were getting

really understand what they were getting at

at it really took me you know till I had

it really took me you know till I had lived quite a lot of life and had some

lived quite a lot of life and had some you know some significant experiences

you know some significant experiences and given it some thought that I

and given it some thought that I realized oh be here now means be here

realized oh be here now means be here now and be

now and be uncomfortable and be okay with being

uncomfortable and be okay with being uncomfortable and being okay with not

uncomfortable and being okay with not being able to

being able to control my pleasure or my pain or my

control my pleasure or my pain or my comfort level but just being open to

comfort level but just being open to whatever comes and I think that's a

whatever comes and I think that's a really a key shift

really a key shift that I'm not trying to control my

that I'm not trying to control my experience in the moment and that it's

experience in the moment and that it's okay to be unhappy or Restless or

okay to be unhappy or Restless or uncomfortable and not trying to run away

uncomfortable and not trying to run away from that but just really turn and face

from that but just really turn and face it and embrace the discomfort which I

it and embrace the discomfort which I also think is quite Universal I don't

also think is quite Universal I don't think I'm I'm alone in that and then the

think I'm I'm alone in that and then the key piece about not not anticipating the

key piece about not not anticipating the reward is helps me be in the moment

reward is helps me be in the moment right because I'm not just waiting for

right because I'm not just waiting for the good thing to come after I'm saying

the good thing to come after I'm saying to myself imagine there's nothing good

to myself imagine there's nothing good coming after nothing at all right

coming after nothing at all right there's just there aren't rewards this

there's just there aren't rewards this is it and then also being able to say

is it and then also being able to say and it's okay if in the moment like it's

and it's okay if in the moment like it's not great like I I can Embrace that you

not great like I I can Embrace that you know I can be unhappy or Restless or

know I can be unhappy or Restless or anxious or whatever it is and then when

anxious or whatever it is and then when I do that you know I feel like there's a

I do that you know I feel like there's a funny funny thing that happens and all

funny funny thing that happens and all the sudden I I'm not as anxious right

the sudden I I'm not as anxious right and I am present and it there is some

and I am present and it there is some Joy there interesting so when you allow

Joy there interesting so when you allow yourself to deal with being

yourself to deal with being uncomfortable in the moment it turns out

uncomfortable in the moment it turns out you it removes the thing that was making

you it removes the thing that was making you uncomfortable in the moment which is

you uncomfortable in the moment which is like the avoidance or the worry or

like the avoidance or the worry or overthinking whatever else yeah I I

overthinking whatever else yeah I I think we have this and it's fed by

think we have this and it's fed by modern culture this kind of expectancy

modern culture this kind of expectancy that really we should be happy all the

that really we should be happy all the time and if you know if we've arranged

time and if you know if we've arranged things appropriately for our lives and

things appropriately for our lives and if we've done our work and you know

if we've done our work and you know aimed true then we should just be like

aimed true then we should just be like life is great and I don't believe that

life is great and I don't believe that anymore I think that you know I mean

anymore I think that you know I mean like Buddha said life is suffering but I

like Buddha said life is suffering but I really think that

really think that fundamentally like it's uncomfortable to

fundamentally like it's uncomfortable to be

be alive and that it's a kind of a constant

alive and that it's a kind of a constant state of restlessness and discomfort if

state of restlessness and discomfort if we're being really honest and and tuning

we're being really honest and and tuning in when I really let myself see that and

in when I really let myself see that and feel that all of a sudden I'm I'm freed

feel that all of a sudden I'm I'm freed from from some of

that what has caused your anxiety throughout your life in the moment you

throughout your life in the moment you you referenced earlier that some things

you referenced earlier that some things have happened that have led you to

have happened that have led you to understand this better and understand

understand this better and understand yourself better what is what am I

yourself better what is what am I missing from this jsaw puzzle yeah well

missing from this jsaw puzzle yeah well you're you're good you could have been a

you're you're good you could have been a psychiatrist oh really yeah it's always

psychiatrist oh really yeah it's always time this doesn't work out there's still

time this doesn't work out there's still time right it's not too late you get a

time right it's not too late you get a new profession yay um I think you know

new profession yay um I think you know for me the the big Turning Point um was

for me the the big Turning Point um was that we lost our we lost a child and um

that we lost our we lost a child and um in the immediate aftermath of our

in the immediate aftermath of our child's death I was just determined to

child's death I was just determined to like sort of undo the experience

like sort of undo the experience and um you know get enough Psychotherapy

and um you know get enough Psychotherapy and enough whatever whatever it took to

and enough whatever whatever it took to sort of not feel that pain and it wasn't

sort of not feel that pain and it wasn't until I really just said oh like I'm

until I really just said oh like I'm going to feel this pain for the rest of

going to feel this pain for the rest of my life it's never going away that

my life it's never going away that suddenly I felt some relief from that

suddenly I felt some relief from that pain and that was a real window for

pain and that was a real window for me so interesting that the

me so interesting that the it's

it's acceptance yeah and and you know and and

acceptance yeah and and you know and and I think you know one of the reasons I

I think you know one of the reasons I love treating patients with addiction is

love treating patients with addiction is because I really relate to that hitting

because I really relate to that hitting bottom moment you know that moment when

bottom moment you know that moment when it's like you just have the feeling that

it's like you just have the feeling that like everything I try to do to manage

like everything I try to do to manage this Behavior or to make my life better

this Behavior or to make my life better only makes it worse I felt like I had a

only makes it worse I felt like I had a very similar

very similar experience um and that it was only when

experience um and that it was only when I kind of realized oh I yeah I I can't

I kind of realized oh I yeah I I can't run from this I cannot run this pain uh

run from this I cannot run this pain uh that I I begin to have some the

that I I begin to have some the beginnings of relief from that

beginnings of relief from that experience I can't outrun this

experience I can't outrun this pain it's all natural sort of

pain it's all natural sort of disposition to try and outrun pain isn't

disposition to try and outrun pain isn't it that's the irony right we're really

it that's the irony right we're really wired to outrun the pain we are like we

wired to outrun the pain we are like we reflexively seek out pleasure and avoid

reflexively seek out pleasure and avoid pain and yet that's the very thing thing

pain and yet that's the very thing thing that doesn't get us to where we want to

that doesn't get us to where we want to go but we do now live in a world where

go but we do now live in a world where it's very easy to outrun the pain yes

it's very easy to outrun the pain yes this is a lion that's chasing me this

this is a lion that's chasing me this could be a bad email and then I open up

could be a bad email and then I open up a tab and start Doom scrolling or open

a tab and start Doom scrolling or open up a tab and start watching video

up a tab and start watching video playing video games or pornography or

playing video games or pornography or whatever yeah that's exactly right there

whatever yeah that's exactly right there are so many ways that we can now

are so many ways that we can now distract ourselves from you know our own

distract ourselves from you know our own suffering or our own

suffering or our own awareness and where do you find yourself

awareness and where do you find yourself now with dealing with that grief and the

now with dealing with that grief and the pain as we sit here yeah I mean I I feel

pain as we sit here yeah I mean I I feel like in many ways it's been a real gift

like in many ways it's been a real gift in my life you know it's really informed

in my life you know it's really informed my life in in ways that um I mean I I've

my life in in ways that um I mean I I've learned things from that experience that

learned things from that experience that I think it would have been almost

I think it would have been almost impossible for me to learn otherwise you

impossible for me to learn otherwise you deal with a lot of people that are in a

deal with a lot of people that are in a state of

state of suffering

suffering I imagine that's a

I imagine that's a weight because I um even hearing the

weight because I um even hearing the story of the lady that passed away after

story of the lady that passed away after that water addiction it was like a it

that water addiction it was like a it was like a weight on my shoulders just

was like a weight on my shoulders just to hear it

to hear it so if your profession puts you right at

so if your profession puts you right at the heart of this type of suffering how

the heart of this type of suffering how do

do you manage that to to hold that

you manage that to to hold that weight a couple things um first of all a

weight a couple things um first of all a lot of people get better and when people

lot of people get better and when people with addiction get better

with addiction get better it's so much better that it's incredibly

it's so much better that it's incredibly rewarding to see and they're amazing

rewarding to see and they're amazing people Absolut like the most tenacious

people Absolut like the most tenacious talented people you'll ever meet and

talented people you'll ever meet and when they get better it impacts so many

when they get better it impacts so many other people right their friends their

other people right their friends their family the people they work with so it's

family the people they work with so it's very rewarding work and and not at all

very rewarding work and and not at all burdensome of course you know for

burdensome of course you know for patients who don't don't get better or

patients who don't don't get better or patients who die it's a terrible feeling

patients who die it's a terrible feeling and there is a sense of um

and there is a sense of um responsibility and and guilt even when I

responsibility and and guilt even when I feel like there was nothing that I could

feel like there was nothing that I could have done otherwise um you know I carry

have done otherwise um you know I carry those losses with me so it's hard is

those losses with me so it's hard is there any particular cases that have

there any particular cases that have stayed with you the most I mean every

stayed with you the most I mean every patient I've had who's died while under

patient I've had who's died while under my care those are incredibly painful um

my care those are incredibly painful um and I will never you know those are sort

and I will never you know those are sort of a those people will be with me as a

of a those people will be with me as a part of me for all of my life young and

part of me for all of my life young and old yeah young and old yeah it's

old yeah young and old yeah it's especially tragic to you to lose young

especially tragic to you to lose young people and it always feels like their

people and it always feels like their second gu ing like oh if only I had done

second gu ing like oh if only I had done that or if only we had intervened here

that or if only we had intervened here but I just think that's the nature of

but I just think that's the nature of death we we can't get away from the

death we we can't get away from the feelings of guilt around it no matter

feelings of guilt around it no matter who we are and no matter the

who we are and no matter the circumstances how young can addiction

circumstances how young can addiction and the consequences of

and the consequences of addiction ruin someone's life like how

addiction ruin someone's life like how young can someone be when their life is

young can someone be when their life is ruined from from the work you've done

ruined from from the work you've done and the the patients you've worked with

and the the patients you've worked with and what are those addictions typically

and what are those addictions typically that seem to be most um susceptible to

that seem to be most um susceptible to those that are young

those that are young well I mean you know some some kids

well I mean you know some some kids start with drugs and alcohol you know

start with drugs and alcohol you know five six seven eight five six yeah I

five six seven eight five six yeah I mean it's you know some some some kids

mean it's you know some some some kids use with their parents or their

use with their parents or their caregivers they're exposed very early if

caregivers they're exposed very early if we seriously conceptualize digital media

we seriously conceptualize digital media as a drug I mean then we've got you know

as a drug I mean then we've got you know even younger cohorts starting with that

even younger cohorts starting with that and we do know that kids can get

and we do know that kids can get addicted to digital media

addicted to digital media and as a result um die from that I mean

and as a result um die from that I mean there was just this tragic case of a

there was just this tragic case of a young man who essentially got addicted

young man who essentially got addicted to a chat box I think he was 14 not my

to a chat box I think he was 14 not my patient it was written up um in the New

patient it was written up um in the New York Times in the Wall Street Journal

York Times in the Wall Street Journal and he fell in love with this chat box

and he fell in love with this chat box started to isolate wasn't spending time

started to isolate wasn't spending time with his family or friends and then

with his family or friends and then eventually took his own life purportedly

eventually took his own life purportedly so he could join this imaginary person

what's the youngest patient you've ever seen the youngest I've seen is probably

seen the youngest I've seen is probably around 15 14 15 and they had an

around 15 14 15 and they had an addiction yeah usually cannabis alcohol

addiction yeah usually cannabis alcohol nicotine can you get addicted to

nicotine can you get addicted to cannabis oh yeah oh my gosh cannabis is

cannabis oh yeah oh my gosh cannabis is very addictive really oh yeah

very addictive really oh yeah yeah harmful very harmful the target

yeah harmful very harmful the target organ that it damages the most is the

organ that it damages the most is the brain um it's harmful in many ways I

brain um it's harmful in many ways I mean it number one it demotivates people

mean it number one it demotivates people often and so they can have the feeling

often and so they can have the feeling that they're getting stuff done or that

that they're getting stuff done or that they're creative when in fact they're

they're creative when in fact they're not doing

not doing anything um it most people smoke it and

anything um it most people smoke it and so it can be damaging to the lungs and

so it can be damaging to the lungs and and other other organs um a lot of

and other other organs um a lot of people say that well cannabis isn't

people say that well cannabis isn't addictive because I don't have this

addictive because I don't have this standard withdrawal phenomenon when I

standard withdrawal phenomenon when I stop like I don't have the shakes or

stop like I don't have the shakes or anything like that but keep in mind the

anything like that but keep in mind the universal symptoms of addiction are

universal symptoms of addiction are psychological symptoms anxiety

psychological symptoms anxiety irritability depression insomnia craving

irritability depression insomnia craving and people have that in Spades when they

and people have that in Spades when they try to stop using cannabis plus we often

try to stop using cannabis plus we often see something called the hyperemesis

see something called the hyperemesis syndrome so cannabis can help with

syndrome so cannabis can help with nausea and vomiting it can help decrease

nausea and vomiting it can help decrease the feeling of wanting to vomit but

the feeling of wanting to vomit but again as the brain continues to be

again as the brain continues to be exposed to it there's this process of

exposed to it there's this process of neuro adaptation it stops working and it

neuro adaptation it stops working and it can even turn on them and do the

can even turn on them and do the opposite So eventually people can

opposite So eventually people can actually have a cyclical vomiting

actually have a cyclical vomiting syndrome as a result of cannabis so

syndrome as a result of cannabis so they'll show up in the emergency room

they'll show up in the emergency room and say I can't stop I can't stop

and say I can't stop I can't stop vomiting and the reason is because of

vomiting and the reason is because of the Cannabis that they maybe initially

the Cannabis that they maybe initially started uh to stop feelings of

started uh to stop feelings of nausea on page 40 of dopamine Nation you

nausea on page 40 of dopamine Nation you say we've lost the ability to tolerate

say we've lost the ability to tolerate even minor forms of discomfort yeah and

even minor forms of discomfort yeah and as I was reading through this section of

as I was reading through this section of your book I was thinking it sounds like

your book I was thinking it sounds like we've gone a little bit soft in society

we've gone a little bit soft in society um we've reset our pleasure pain

um we've reset our pleasure pain threshold to the side of pain that even

threshold to the side of pain that even the slightest thing feels like trauma to

the slightest thing feels like trauma to us even things that objectively speaking

us even things that objectively speaking a generation or two ago would not have

a generation or two ago would not have been considered traumatic are now trauma

been considered traumatic are now trauma we live in a bit of a trauma Society uh

we live in a bit of a trauma Society uh one that doesn't appear to be very

one that doesn't appear to be very resilient and the only measure of that

resilient and the only measure of that that I have is if I think about the work

that I have is if I think about the work that my grandfather had to do versus the

that my grandfather had to do versus the work that you know people maybe in my

work that you know people maybe in my generation do in complain about and seem

generation do in complain about and seem to be like objectively suffering over

to be like objectively suffering over and stressed about it seems like there's

and stressed about it seems like there's been a shift in our threshold our

been a shift in our threshold our tolerance levels can this be explained

tolerance levels can this be explained through dopamine what's going on here

through dopamine what's going on here and do you believe that's true have we

and do you believe that's true have we gone a bit soft I would say succinctly

gone a bit soft I would say succinctly yes I do believe we have gone a bit soft

yes I do believe we have gone a bit soft but I don't think it's a moral problem

but I don't think it's a moral problem or a character problem I actually think

or a character problem I actually think it's a physiological problem based on

it's a physiological problem based on the fact that we're insulated from Pain

the fact that we're insulated from Pain and we're exposed to all kinds of

and we're exposed to all kinds of Pleasures so I really think that we have

Pleasures so I really think that we have individually and collectively reset our

individually and collectively reset our reward Pathways to the side of pain

reward Pathways to the side of pain meaning that the Gremlins have now

meaning that the Gremlins have now accumulated on the pain side we've

accumulated on the pain side we've tipped ourselves to the side of pain

tipped ourselves to the side of pain because we've had so much pleasure

because we've had so much pleasure because we've had so much pleasure yes

because we've had so much pleasure yes thanks for having me clarify so that you

thanks for having me clarify so that you now we need more and more pleasure to

now we need more and more pleasure to feel any pleasure at all and the

feel any pleasure at all and the slightest little pain and we're you know

slightest little pain and we're you know experiencing excruciating pain you add

experiencing excruciating pain you add to that the fact that we have a culture

to that the fact that we have a culture that tells us we should never be in pain

that tells us we should never be in pain and that if we are something's wrong

and that if we are something's wrong with our life or something's wrong with

with our life or something's wrong with our wife or something's wrong with our

our wife or something's wrong with our job and so now you've got you know a

job and so now you've got you know a whole generation of folks who feels

whole generation of folks who feels like they're experiencing more pain

like they're experiencing more pain because they're literally don't do not

because they're literally don't do not have the mental calluses to tolerate

have the mental calluses to tolerate pain and now they're being told and if

pain and now they're being told and if you have any pain at all you must have

you have any pain at all you must have you know something wrong with your brain

you know something wrong with your brain go see a doctor go take a pill and I

go see a doctor go take a pill and I think this is really uh this is not a

think this is really uh this is not a direction we want to keep going in

direction we want to keep going in we have a mental health culture where we

we have a mental health culture where we assume most things are mental health

assume most things are mental health illness um in page 186 of your book you

illness um in page 186 of your book you say I've become convinced that the way

say I've become convinced that the way we tell our personal stories is a marker

we tell our personal stories is a marker and predictor of mental health now if

and predictor of mental health now if you live in a society where everything

you live in a society where everything has a label and it's a it's a disease or

has a label and it's a it's a disease or an illness or you know I I don't feel

an illness or you know I I don't feel good today so I've got this disorder and

good today so I've got this disorder and therefore I need this

therefore I need this medication I guess there's two questions

medication I guess there's two questions is my assessment of this situation

is my assessment of this situation correct and

correct and be is this a bad place to be in a

be is this a bad place to be in a society where we think everything every

society where we think everything every feeling we have every you know we think

feeling we have every you know we think everything that makes us different is a

everything that makes us different is a deficiency let me let me start let me

deficiency let me let me start let me let me answer this by talking a little

let me answer this by talking a little bit about the role of language and

bit about the role of language and narrative because I think this is very

narrative because I think this is very fascinating and you know as a

fascinating and you know as a psychiatrist and a therapist that is my

psychiatrist and a therapist that is my bread and butter right is is narrative

bread and butter right is is narrative how people tell their stories by by

how people tell their stories by by giving language to our experience

giving language to our experience we gain awareness of our conceptual

we gain awareness of our conceptual models of the world okay okay and what I

models of the world okay okay and what I have learned over time is that the way

have learned over time is that the way people tell their stories is a window

people tell their stories is a window into their model of the world and that

into their model of the world and that there are healthy narratives and not so

there are healthy narratives and not so healthy narratives and in general in my

healthy narratives and in general in my clinical experience when people come

clinical experience when people come into the room and they tell their life

into the room and they tell their life story in such a way that they're always

story in such a way that they're always the victim of other people and

the victim of other people and Circumstance in the world those are

Circumstance in the world those are people who are number one not doing well

people who are number one not doing well and number two not going to do well

and number two not going to do well going forward unless they change that

going forward unless they change that narrative to acknowledge what they've

narrative to acknowledge what they've contributed to the problem and the

contributed to the problem and the reason for that is because the way that

reason for that is because the way that we narrate Our Lives is not just a way

we narrate Our Lives is not just a way to understand our past it actually is

to understand our past it actually is our road map for the future so if I see

our road map for the future so if I see myself as a victim and that's my

myself as a victim and that's my narrative I will literally create

narrative I will literally create victimhood for myself going forward I

victimhood for myself going forward I will literally change my sensed

will literally change my sensed experience so that whatever happens I'll

experience so that whatever happens I'll make sure I end up as a victim when

make sure I end up as a victim when people with severe addiction get into

people with severe addiction get into recovery one of the most palpable

recovery one of the most palpable changes that I see is the way that they

changes that I see is the way that they narrate their lives they go from in

narrate their lives they go from in addiction talking about their lives as

addiction talking about their lives as if it's always everybody else's fault to

if it's always everybody else's fault to in recovery talking about their lives in

in recovery talking about their lives in a way that says oh you know what I could

a way that says oh you know what I could have done better here or you know what

have done better here or you know what that's something that I keep doing that

that's something that I keep doing that really messes with my life that I want

really messes with my life that I want to change and I'm going to figure out

to change and I'm going to figure out how to change that why is it so hard to

how to change that why is it so hard to take responsibility in such a way great

take responsibility in such a way great question we just hate to do it because

question we just hate to do it because when we do it we feel shame and shame is

when we do it we feel shame and shame is an incredible painful emotion it's like

an incredible painful emotion it's like a gut punch of an emotion that is

a gut punch of an emotion that is associated with fear of Abandonment fear

associated with fear of Abandonment fear of being shunn by our tribe we'd much

of being shunn by our tribe we'd much rather paper that shame over with anger

rather paper that shame over with anger and resentment toward others it's it's

and resentment toward others it's it's interesting

interesting because there'll be a different groups

because there'll be a different groups of people listening to this now there'll

of people listening to this now there'll be the high responsibility group that

be the high responsibility group that just love and revel and taking

just love and revel and taking responsibility because they think taking

responsibility because they think taking responsibility means that they are

responsibility means that they are strong it means that I'm so strong I can

strong it means that I'm so strong I can take the blame and withstand it and it's

take the blame and withstand it and it's funny cuz the more I've learned to take

funny cuz the more I've learned to take responsibility for things in certain

responsibility for things in certain areas of my life The more I've become

areas of my life The more I've become proud of myself and the more I think I'm

proud of myself and the more I think I'm strong and I'm like oh look at me I can

strong and I'm like oh look at me I can take responsibility for anything and it

take responsibility for anything and it doesn't and then if you go down this

doesn't and then if you go down this spectrum you'll eventually get to the

spectrum you'll eventually get to the end of the spectrum where you've got

end of the spectrum where you've got people who even as they heard you say

people who even as they heard you say that will feel cognitive dis they'll

that will feel cognitive dis they'll feel a sense like a little it'll

feel a sense like a little it'll irritate them it'll piss them off and

irritate them it'll piss them off and they will be the whatab about gang

they will be the whatab about gang they'll be saying yes but what about

they'll be saying yes but what about Dave he did this to me and you know

Dave he did this to me and you know they'll immed like the immediate

they'll immed like the immediate reaction would be they they're pissed

reaction would be they they're pissed off they've probably gone now they've

off they've probably gone now they've gone so we're not even talking to them

gone so we're not even talking to them anymore but if you but it's fine we can

anymore but if you but it's fine we can talk about them they're no longer here

talk about them they're no longer here but that group of people my question

but that group of people my question really is how do you speak to that group

really is how do you speak to that group of people and convince them that

of people and convince them that actually taking personal responsibility

actually taking personal responsibility is a good thing for them and if they're

is a good thing for them and if they're focused on what their core values or

focused on what their core values or their North Star is in their life then

their North Star is in their life then personal responsibility is the path

personal responsibility is the path there not blame not victimhood you know

there not blame not victimhood you know like how do you turn those people around

like how do you turn those people around great question and I have to say what I

great question and I have to say what I know about this I learned from Al

know about this I learned from Al Alcoholics Anonymous and what they do

Alcoholics Anonymous and what they do because they do something that's really

because they do something that's really incredible first of all it's necessary

incredible first of all it's necessary to validate somebody's victimhood so

to validate somebody's victimhood so this is to say you have been wrong if if

this is to say you have been wrong if if they really have been wronged to

they really have been wronged to validate that or you experience this

validate that or you experience this trauma or you were born into this crappy

trauma or you were born into this crappy situation and you were just a kid and

situation and you were just a kid and you had no choice about that and to

you had no choice about that and to really acknowledge that but then the

really acknowledge that but then the fourth step of the 12 steps of Alcoholic

fourth step of the 12 steps of Alcoholic Anonymous talks about looking at each of

Anonymous talks about looking at each of those

those situations and after writing down like

situations and after writing down like this person wronged me and exactly what

this person wronged me and exactly what they did so you know taking time to

they did so you know taking time to focus on the resentment

focus on the resentment right then only after that to say okay

right then only after that to say okay but is there

but is there anything that I did that contributed to

anything that I did that contributed to that problem is there anything at all

that problem is there anything at all that I could have done differently and

that I could have done differently and for a little kid you know born into a

for a little kid you know born into a horrific situation you there's not much

horrific situation you there's not much right that that a kid could have you

right that that a kid could have you know we don't we don't expect a child to

know we don't we don't expect a child to take responsibility but the adult who

take responsibility but the adult who was that child who continues to

was that child who continues to perpetuate some of th the harms they

perpetuate some of th the harms they experienced on other people now we're

experienced on other people now we're talking now you can begin to take

talking now you can begin to take responsibility for your actions in the

responsibility for your actions in the world so I think starting with

world so I think starting with validating you know the trauma or the

validating you know the trauma or the victimhood or the way in which we were

victimhood or the way in which we were wronged processing it so giving it

wronged processing it so giving it airtime right but not stopping there

airtime right but not stopping there which is by the way which is by the way

which is by the way which is by the way often you know in therapy certain types

often you know in therapy certain types of therapy that's often where we stop we

of therapy that's often where we stop we don't then take it that very important

don't then take it that very important next up and say but you know let's go

next up and say but you know let's go and look at that again and like is there

and look at that again and like is there anything at all that you're contributing

anything at all that you're contributing to this problem maybe it's just that you

to this problem maybe it's just that you continue to ruminate about it right that

continue to ruminate about it right that like you're ruminating on your

like you're ruminating on your resentments is in a way your happy place

resentments is in a way your happy place and maybe that's what you need to stop

and maybe that's what you need to stop doing so that form of sort of

doing so that form of sort of psychotherapy that stops there can help

psychotherapy that stops there can help keep us sick and make us sick it it it's

keep us sick and make us sick it it it's interesting because someone that's in

interesting because someone that's in that therapy room who has ruminated

that therapy room who has ruminated themselves all the way down to having a

themselves all the way down to having a low self-esteem being depressed or

low self-esteem being depressed or whatever um it appears to me that people

whatever um it appears to me that people who are at that sort of ground floor

who are at that sort of ground floor State find it hardest to take

State find it hardest to take responsibility for some reason just

responsibility for some reason just that's an observation in my life that

that's an observation in my life that the the people that I have met that are

the the people that I have met that are the worst or that struggle the most with

the worst or that struggle the most with taking responsibility are those that

taking responsibility are those that have a very low self-esteem so it's

have a very low self-esteem so it's almost this double-edged like Catch 22

almost this double-edged like Catch 22 and then I I've also P pondered whether

and then I I've also P pondered whether you know someone that never takes

you know someone that never takes responsibility is more likely to have

responsibility is more likely to have bad things happen to them make mistakes

bad things happen to them make mistakes which are then going to further hurt

which are then going to further hurt their self-esteem which are going to

their self-esteem which are going to make it even harder to take

make it even harder to take responsibility so I guess the question

responsibility so I guess the question is is there this Rel is there a

is is there this Rel is there a relationship between my current

relationship between my current self-esteem and my ability or inability

self-esteem and my ability or inability to take responsibility for a situation

to take responsibility for a situation yeah great great question it brings to

yeah great great question it brings to mind a a patient of mine who um who said

mind a a patient of mine who um who said to me that

to me that um you know that and he had very very

um you know that and he had very very low self-esteem and he said essentially

low self-esteem and he said essentially Dr ly I'm the piece of crap around which

Dr ly I'm the piece of crap around which the universe

the universe revolves meaning that he had his own

revolves meaning that he had his own brand of

brand of narcissism in which he wasn't the most

narcissism in which he wasn't the most successful person he was the most

successful person he was the most successful at being the least successful

successful at being the least successful person and that became his identity

person and that became his identity right that was sort of how he saw

right that was sort of how he saw himself and also how he saw the world

himself and also how he saw the world and it became very entrenched and it was

and it became very entrenched and it was a kind of a narcissism

a kind of a narcissism because he created then situations in

because he created then situations in order to perpetuate like I'm the worst

order to perpetuate like I'm the worst of the worst so I think the ways in

of the worst so I think the ways in which we get these sort of entrenched

which we get these sort of entrenched ideas about ourselves and the world can

ideas about ourselves and the world can really hold us back from seeing clearly

really hold us back from seeing clearly Who We Are Who other people are and what

Who We Are Who other people are and what what the possibilities are does our

what the possibilities are does our personal narrative need to be positive I

personal narrative need to be positive I mean what do I guess what do you mean by

mean what do I guess what do you mean by positive like ra I'm great almost like

positive like ra I'm great almost like have a have a positive ending because I

have a have a positive ending because I was thinking about the personal

was thinking about the personal narrative I've created in my life and my

narrative I've created in my life and my personal narrative is like kid born in

personal narrative is like kid born in Africa came to the UK little bit of

Africa came to the UK little bit of racial abuse here and there felt

racial abuse here and there felt different shame insecurity parents

different shame insecurity parents weren't around this made me independent

weren't around this made me independent the shame made me motivated and then I

the shame made me motivated and then I did this this this and it went well

did this this this and it went well that's like my personal narrative um but

that's like my personal narrative um but if my personal narrative was moved to

if my personal narrative was moved to Plymouth from Botswana in Africa a

Plymouth from Botswana in Africa a little bit of Shame little bit of pain

little bit of Shame little bit of pain parents weren't around my parents didn't

parents weren't around my parents didn't love me people don't love me right right

love me people don't love me right right if my personal narrative ended there

if my personal narrative ended there would it be you know would it be

would it be you know would it be detrimental to me ever becoming

detrimental to me ever becoming successful happy healthy I'm just

successful happy healthy I'm just wondering if because we all have a

wondering if because we all have a personal narrative we have like a story

personal narrative we have like a story if we're up on stage and someone passes

if we're up on stage and someone passes a mic to us and says tell us your story

a mic to us and says tell us your story we'll narrate this version of events um

we'll narrate this version of events um skewed towards victimhood to heroism to

skewed towards victimhood to heroism to you know yeah I mean as I said before

you know yeah I mean as I said before how we narrate Our Lives is important

how we narrate Our Lives is important right it's it's not trivial and there

right it's it's not trivial and there are healthier narratives and there are

are healthier narratives and there are not healthy narratives and and I would

not healthy narratives and and I would argue that the you know the victim

argue that the you know the victim narrative where you know perpetuates

narrative where you know perpetuates victimhood you could make the same

victimhood you could make the same argument that the the hero's journey

argument that the the hero's journey narrative perpetuates hero good having

narrative perpetuates hero good having said that if we get too stuck in any

said that if we get too stuck in any fixed Identity or any narrative I think

fixed Identity or any narrative I think that can become its own trap right and

that can become its own trap right and then we wall ourselves off feeling like

then we wall ourselves off feeling like we have to show up in a certain way or

we have to show up in a certain way or be a certain person and I wonder if you

be a certain person and I wonder if you have that experience like you know you

have that experience like you know you have this hero's journey and now you got

have this hero's journey and now you got to be this hero and I mean I could

to be this hero and I mean I could imagine that that would be burdensome at

imagine that that would be burdensome at times yeah I think it causes a lot of

times yeah I think it causes a lot of like dissonance internally what I mean

like dissonance internally what I mean like dis so when I say dissonance I mean

like dis so when I say dissonance I mean discomfort internally because people

discomfort internally because people meet a version of you that doesn't

meet a version of you that doesn't reflect the version of you that you know

reflect the version of you that you know so like that the experience you have

so like that the experience you have when you go like I go to the gym or

when you go like I go to the gym or something yes and I say this to my team

something yes and I say this to my team all the time anyone that knows me

all the time anyone that knows me personally his head me say this 50 times

personally his head me say this 50 times I will say the phrase I just don't

I will say the phrase I just don't understand what these people are talking

understand what these people are talking about like I just don't get it and I

about like I just don't get it and I said to my team the other day in the

said to my team the other day in the office I went it's almost like I think

office I went it's almost like I think they're lying to me and I said I was in

they're lying to me and I said I was in this I was in this meeting group when

this I was in this meeting group when you say you don't understand you mean

you say you don't understand you mean when they when they praise you or okay

when they when they praise you or okay yeah yeah it's so yeah unbelievable what

yeah yeah it's so yeah unbelievable what they're saying to me that it

they're saying to me that it um that it feels like you're I've not

um that it feels like you're I've not even watched the trumman show I just

even watched the trumman show I just know what it means but it feels like

know what it means but it feels like this is these people are just all lying

this is these people are just all lying to you yeah and I I was I think I was

to you yeah and I I was I think I was talking to Jack and the team the other

talking to Jack and the team the other day about going to Thailand and being so

day about going to Thailand and being so far away from home and people coming up

far away from home and people coming up to you like thousands of people we doing

to you like thousands of people we doing this meet and greet thing and saying

this meet and greet thing and saying these things to you and you and I said

these things to you and you and I said to the team I was like I think it's like

to the team I was like I think it's like it's part of my brain that's like these

it's part of my brain that's like these people are lying to me and also

people are lying to me and also um yeah you can see how it can be a

um yeah you can see how it can be a slippery slope to slide in to their

slippery slope to slide in to their Narrative of you right and you've got to

Narrative of you right and you've got to do quite a lot to just like stay at home

do quite a lot to just like stay at home what I mean by stay at home I don't mean

what I mean by stay at home I don't mean like physical location I mean like

like physical location I mean like staying grounded in like who you

staying grounded in like who you actually are right um and this goes for

actually are right um and this goes for people that obviously you know have a a

people that obviously you know have a a public platform or don't it's very easy

public platform or don't it's very easy for one person on the internet to say

for one person on the internet to say something to you and then you to start

something to you and then you to start to accept that as your narrative it's

to accept that as your narrative it's easy for your parents to tell you that

easy for your parents to tell you that you should be a doctor and then you go

you should be a doctor and then you go to university and you study to be a

to university and you study to be a doctor and you become a doctor and then

doctor and you become a doctor and then you start thinking you're a doctor and

you start thinking you're a doctor and how that can sway you away from the full

how that can sway you away from the full array of things that make you who you

array of things that make you who you are the music you know the the whatever

are the music you know the the whatever Hobbies you had yeah narratives are

Hobbies you had yeah narratives are comfortable sometimes they make us feel

comfortable sometimes they make us feel heard and understood they make us fit

heard and understood they make us fit yeah but they also are a double-edged

yeah but they also are a double-edged sword because they can take us away from

sword because they can take us away from like who we actually are yes yeah so

like who we actually are yes yeah so when I think about you know your

when I think about you know your experience of feeling like people must

experience of feeling like people must be lying to you I mean sometimes we call

be lying to you I mean sometimes we call this something like the impostor

this something like the impostor syndrome where you never thought of it

syndrome where you never thought of it like that you know it yeah projected

like that you know it yeah projected personal

personal that is is you know true in a way but

that is is you know true in a way but also doesn't capture the fullness of who

also doesn't capture the fullness of who you are or maybe is so extreme in terms

you are or maybe is so extreme in terms of um looking good that it's inevitable

of um looking good that it's inevitable that you'll feel some dissonance with

that you'll feel some dissonance with that kind of heroic figure and I think

that kind of heroic figure and I think the way to think about that and

the way to think about that and also you know um not become like

also you know um not become like cynically suspicious of people who who

cynically suspicious of people who who who praise you when they meet you is

who praise you when they meet you is just to recognize that you have become a

just to recognize that you have become a kind of Cipher or a vehicle for their

kind of Cipher or a vehicle for their projections so they've listened to you

projections so they've listened to you they've had a very positive experience

they've had a very positive experience or maybe they learned something and it

or maybe they learned something and it meant a lot in their lives and you were

meant a lot in their lives and you were the vehicle for that and so you're a

the vehicle for that and so you're a symbol for them and they're projecting

symbol for them and they're projecting positive feelings onto you and because

positive feelings onto you and because you're now integrated in their mental

you're now integrated in their mental tapestry as kind of a you know a totemic

tapestry as kind of a you know a totemic figure or a token something important Sy

figure or a token something important Sy interesting cuz part of what you just as

interesting cuz part of what you just as you were talking I was thinking you know

you were talking I was thinking you know what's interesting I don't even I'm not

what's interesting I don't even I'm not even the smart one in

even the smart one in this I'm interviewing these smart people

this I'm interviewing these smart people no and the smart people are changing

no and the smart people are changing their lives and then someone comes up to

their lives and then someone comes up to me in Thailand and says well you're

me in Thailand and says well you're wrong about that so you're obviously

wrong about that so you're obviously really smart and you also have you know

really smart and you also have you know a really high emotion quotient right

a really high emotion quotient right which is its own kind of

which is its own kind of underappreciated smarts where you read

underappreciated smarts where you read people really well and you have

people really well and you have intuitive reasoning

intuitive reasoning and I mean I don't know you but you also

and I mean I don't know you but you also seem very humble and real and so all of

seem very humble and real and so all of these things that people have a craving

these things that people have a craving for you know authenticity someone they

for you know authenticity someone they can relate to um someone familiar I mean

can relate to um someone familiar I mean keep in mind too that more and more

keep in mind too that more and more people live alone and have maybe fewer

people live alone and have maybe fewer close contacts so a person like you with

close contacts so a person like you with a regular show that they tune into to

a regular show that they tune into to regularly you become you're in their

regularly you become you're in their living room yeah you're not just some

living room yeah you're not just some distant celebrity like you are your

distant celebrity like you are your voice is there your face is there they

voice is there your face is there they feel they know you because they've seen

feel they know you because they've seen you in all these different situations

you in all these different situations and I think that's really natural and

and I think that's really natural and normal and not a bad thing so you just

normal and not a bad thing so you just have to realize when you go out into the

have to realize when you go out into the world you know you You' become a symbol

world you know you You' become a symbol for people they're projecting onto you

for people they're projecting onto you you don't have to necessarily identify

you don't have to necessarily identify with that but it's okay to let them have

with that but it's okay to let them have you know their experience through you if

you know their experience through you if that makes any sense it makes a lot of

that makes any sense it makes a lot of sense okay yeah no it makes a lot of

sense okay yeah no it makes a lot of sense I felt the same imposter syndrome

sense I felt the same imposter syndrome as you said everything there I was like

as you said everything there I was like that's um very kind of you to say but

that's um very kind of you to say but it's it's just very I think part of the

it's it's just very I think part of the dissonance comes from the fact that I

dissonance comes from the fact that I sit here in a room with you and there's

sit here in a room with you and there's only the person in this whole room we're

only the person in this whole room we're in this big Studio here in Los Angeles

in this big Studio here in Los Angeles is Jack yeah and so there's part of your

is Jack yeah and so there's part of your brain the like prehistoric brain that

brain the like prehistoric brain that thinks the three people that are aware

thinks the three people that are aware of what happened in this room are me you

of what happened in this room are me you and Jack that's it yeah and then you you

and Jack that's it yeah and then you you go to you go to Kuwait right

go to you go to Kuwait right amazing and a comes up to you in the gym

amazing and a comes up to you in the gym and goes that conversation that you had

and goes that conversation that you had about addiction right and that that's

about addiction right and that that's the dissonance like you went there yeah

the dissonance like you went there yeah but it's I don't know the preo brain

but it's I don't know the preo brain might might not be able to fully

might might not be able to fully comprehend the idea of cameras and

comprehend the idea of cameras and numbers you know people are listening at

numbers you know people are listening at the moment oh no they feel that they're

the moment oh no they feel that they're there and they and and again you you

there and they and and again you you know the guests are totally secondary

know the guests are totally secondary because they're watching because they're

because they're watching because they're identifying with you and the questions

identifying with you and the questions that you ask as you yourself said are

that you ask as you yourself said are questions that you anticipate they would

questions that you anticipate they would want to ask right you said that so you

want to ask right you said that so you are also channeling

are also channeling them when it comes to food I trust my

them when it comes to food I trust my gut and I trust Zoe a business I'm an

gut and I trust Zoe a business I'm an investor in and today's sponsor of this

investor in and today's sponsor of this podcast all the nutritionists I've

podcast all the nutritionists I've spoken to have highlighted just how

spoken to have highlighted just how misleading information is out there when

misleading information is out there when it comes to food take healthy Halos the

it comes to food take healthy Halos the claims you see on packaging that say

claims you see on packaging that say things like low sugar and nothing

things like low sugar and nothing artificial are often a sign of foods to

artificial are often a sign of foods to avoid have you ever noticed a health

avoid have you ever noticed a health claim on fresh fruit you probably get my

claim on fresh fruit you probably get my point understandably there's loads of

point understandably there's loads of distrust out there who should you turn

distrust out there who should you turn to for accurate information I use Zoe

to for accurate information I use Zoe which is backed by one of the world's

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10% off your membership that's zoe.com code Steven 10 trust your gut trust Zoe

code Steven 10 trust your gut trust Zoe on this point of how we help someone in

on this point of how we help someone in our lives who's suffering with some of

our lives who's suffering with some of the things we've talked about

the things we've talked about today what is a bad way to try and help

today what is a bad way to try and help someone because we're in our in our love

someone because we're in our in our love for them sometimes we do things which

for them sometimes we do things which even in my own experience of people that

even in my own experience of people that are struggling in my life I think

are struggling in my life I think actually I think in my pursuit of

actually I think in my pursuit of helping them I've actually hurt them in

helping them I've actually hurt them in some way yes well you know there's this

some way yes well you know there's this whole uh sort of area of the addiction

whole uh sort of area of the addiction field called

field called codependency and codependency refers to

codependency and codependency refers to the ways in which a loved one of the

the ways in which a loved one of the addicted person can actually enable or

addicted person can actually enable or make their addiction worse without

make their addiction worse without realizing it and without intending to

realizing it and without intending to and the way that essentially happens is

and the way that essentially happens is that we can well number one addiction

that we can well number one addiction can is very often a family systems

can is very often a family systems problem so the person who gets addicted

problem so the person who gets addicted their addiction affects everybody in the

their addiction affects everybody in the family and in order to cope and compens

family and in order to cope and compens say families can end up in these very

say families can end up in these very strange maladaptive places but they

strange maladaptive places but they often have difficulty seeing how to get

often have difficulty seeing how to get out of those situations or how their

out of those situations or how their behavior is harming their addicted loved

behavior is harming their addicted loved one because in a sense they themselves

one because in a sense they themselves get addicted to the addicted person and

get addicted to the addicted person and then use that addicted person to

then use that addicted person to regulate the way that they feel so for

regulate the way that they feel so for example I treat a lot of families where

example I treat a lot of families where like the adult child is deep in their

like the adult child is deep in their addiction the parents know that the

addiction the parents know that the money they're giving the child is mostly

money they're giving the child is mostly going to drugs and yet cannot bring

going to drugs and yet cannot bring themselves to stop giving the money and

themselves to stop giving the money and often they're manipulated by the child

often they're manipulated by the child the child saying well the adult child

the child saying well the adult child saying something like well if you don't

saying something like well if you don't give me money for drugs I'm going to go

give me money for drugs I'm going to go get it off the streets and it's going to

get it off the streets and it's going to be laced with fentel then I'll I'm going

be laced with fentel then I'll I'm going to die and it's going to be on your

to die and it's going to be on your hands so this kind of like emotional

hands so this kind of like emotional hostage taking but even when it's not

hostage taking but even when it's not that blatant what can happen is just

that blatant what can happen is just this very

this very fascinating very twisted and meshed

fascinating very twisted and meshed relationship between the addicted person

relationship between the addicted person and the codependent person where again

and the codependent person where again having the person engage in their

having the person engage in their Addiction in a way is a predictable

Addiction in a way is a predictable scenario for the codependent person so

scenario for the codependent person so even though they may say on the face of

even though they may say on the face of it they want this person to stop their

it they want this person to stop their Addiction on another another level they

Addiction on another another level they really don't they get to be the Martyr

really don't they get to be the Martyr they get to be the Savior or they even

they get to be the Savior or they even just get

just get to

to predict what that person is doing based

predict what that person is doing based on their use I've had experiences in my

on their use I've had experiences in my life and this is why I really wanted to

life and this is why I really wanted to ask this question where I thought I was

ask this question where I thought I was helping someone yeah and then the minute

helping someone yeah and then the minute I withdrew the help and basically

I withdrew the help and basically completely gave up the person got better

completely gave up the person got better yes but for six seven eight years this

yes but for six seven eight years this person struggled and the minute I

person struggled and the minute I stopped helping they got better I was

stopped helping they got better I was like so I I I said to my partner before

like so I I I said to my partner before when I was talking about this I was like

when I was talking about this I was like it's possible to prop someone up in

it's possible to prop someone up in their like compulsive behavior and not

their like compulsive behavior and not realize you're doing it in fact there's

realize you're doing it in fact there's three examples which me and my friends

three examples which me and my friends are aware of and one of my friends talks

are aware of and one of my friends talks openly about this where I was propping

openly about this where I was propping him up yeah I was letting him stay at my

him up yeah I was letting him stay at my house I was providing for him while he

house I was providing for him while he was in his struggles the minute I had a

was in his struggles the minute I had a difficult conversation with him when he

difficult conversation with him when he was I think I was 25 years old and he

was I think I was 25 years old and he was 30 and I said you got to go you got

was 30 and I said you got to go you got to go you got to get out of my house he

to go you got to get out of my house he went back moved in with his parents in

went back moved in with his parents in his childhood room he built up his whole

his childhood room he built up his whole life again he's out of the compulsive

life again he's out of the compulsive behaviors he's very successful very rich

behaviors he's very successful very rich living abroad now I was like God if I

living abroad now I was like God if I hadn't have pushed him out my like

hadn't have pushed him out my like basement he probably would still be

basement he probably would still be there I thought I was doing him a favor

there I thought I was doing him a favor and there's another really poent example

and there's another really poent example to me quite recently where someone who

to me quite recently where someone who I've known for many many many years um

I've known for many many many years um minute I said to them listen and this

minute I said to them listen and this sounds really harsh right because I

sounds really harsh right because I tried paying for their therapy tried

tried paying for their therapy tried paying for everything for this person

paying for everything for this person and eventually I got to the point where

and eventually I got to the point where I said honestly I tried don't talk to me

I said honestly I tried don't talk to me about this anymore yeah stop talking to

about this anymore yeah stop talking to me about it just don't message me about

me about it just don't message me about it don't talk to me about it anymore

it don't talk to me about it anymore they got better yep yeah it's really F

they got better yep yeah it's really F so so there um Kai Erikson wrote this

so so there um Kai Erikson wrote this book on deviants where he studied

book on deviants where he studied Puritan societies and found that no

Puritan societies and found that no matter what group of humans you looked

matter what group of humans you looked at there was always there were always

at there was always there were always going to be people who were on the

going to be people who were on the margins of the society he he use the

margins of the society he he use the word deviant his point being

word deviant his point being that groups of

that groups of humans we just have these roles and we

humans we just have these roles and we have these hierarchies and there's

have these hierarchies and there's always somebody on top and always

always somebody on top and always somebody below and when when we're

somebody below and when when we're occupying a certain Niche or when we

occupying a certain Niche or when we stop occupying it we make room for

stop occupying it we make room for somebody else so when you stop being the

somebody else so when you stop being the hero and the Savior that person had room

hero and the Savior that person had room to stop being the sick victim

to stop being the sick victim interesting yeah and my last question on

interesting yeah and my last question on this then is how do you approach that

this then is how do you approach that conversation with that person because so

conversation with that person because so often it's approached through

often it's approached through frustration or shame or blame um what's

frustration or shame or blame um what's the best way to approach someone who's

the best way to approach someone who's struggling with a behavior to express

struggling with a behavior to express that your concerned and to I don't know

that your concerned and to I don't know offer your help if that's a good thing I

offer your help if that's a good thing I think we can always try to find our

think we can always try to find our empathy for them without

empathy for them without necessarily um doing things that would

necessarily um doing things that would perpetuate or enable that behavior and

perpetuate or enable that behavior and we need to recognize that for many

we need to recognize that for many people with severe addiction the the the

people with severe addiction the the the only thing that will get them into

only thing that will get them into recovery is real life

recovery is real life consequences real life negative

consequences real life negative consequences and that our trying to

consequences and that our trying to protect them from that is not protecting

protect them from that is not protecting them at all we've got to let them hit

them at all we've got to let them hit the rock bottom I mean this is a hard

the rock bottom I mean this is a hard one because you have a lot of families

one because you have a lot of families now dealing with children who are

now dealing with children who are severely addicted to opioids for whom

severely addicted to opioids for whom you know being out on the streets might

you know being out on the streets might really result in their death so this is

really result in their death so this is not for every situation but I can tell

not for every situation but I can tell you in my clinical experience after 25

you in my clinical experience after 25 plus

plus years the majority of people with severe

years the majority of people with severe addiction who get into recovery get into

addiction who get into recovery get into recovery as the result

recovery as the result of a real life negative consequences

of a real life negative consequences lost their job lost their partner ended

lost their job lost their partner ended up in jail what whatever it was until

up in jail what whatever it was until there are those significant consequences

there are those significant consequences for some people they just won't be able

for some people they just won't be able to have the motivation to make a change

to have the motivation to make a change guys back to a quote I had a long time

guys back to a quote I had a long time ago some 10 years ago that said change

ago some 10 years ago that said change happens when the pain of staying the

happens when the pain of staying the same becomes greater than than the pain

same becomes greater than than the pain of making a change there you go that's a

of making a change there you go that's a good one I want to talk about digital

good one I want to talk about digital drugs one of the subjects that's been

drugs one of the subjects that's been recurring theme on this podcast inspired

recurring theme on this podcast inspired initially I think it was mentioned in an

initially I think it was mentioned in an episode we had but then it was um such a

episode we had but then it was um such a huge amount of the feedback we got in

huge amount of the feedback we got in the comment section that I thought we

the comment section that I thought we need to talk about this more because

need to talk about this more because clearly there's a lot of people

clearly there's a lot of people suffering we also then used a tool um

suffering we also then used a tool um which looks at what people are Googling

which looks at what people are Googling in searching a lot and one of the most

in searching a lot and one of the most popular searches around the subject

popular searches around the subject matter of addiction is pornography

matter of addiction is pornography addiction yeah it's actually it was

addiction yeah it's actually it was number number one and four in the The

number number one and four in the The Search tool that we used and the phrases

Search tool that we used and the phrases people are using are how to stop

people are using are how to stop pornograph addiction how to help someone

pornograph addiction how to help someone with pornography addiction how to rewire

with pornography addiction how to rewire my brain which are sort of all sort of

my brain which are sort of all sort of correlated themes so pornography

correlated themes so pornography addiction something you see a lot oh my

addiction something you see a lot oh my gosh I have to create a little bit of a

gosh I have to create a little bit of a space actually before I ask this

space actually before I ask this question because I did a porn debate on

question because I did a porn debate on the show and I got a very long voice

the show and I got a very long voice note from a good friend of mine who said

note from a good friend of mine who said just watch the porn debate there was two

just watch the porn debate there was two women there and a guy and me stevenh um

women there and a guy and me stevenh um but I just wish someone had mentioned

but I just wish someone had mentioned that women get addicted to addicted to

that women get addicted to addicted to porn too yeah and then on the episode

porn too yeah and then on the episode one of the top three comments on the

one of the top three comments on the episode is I'm a woman um it wasn't

episode is I'm a woman um it wasn't mentioned but I also have a pornography

mentioned but I also have a pornography addiction and you've also kind of echoed

addiction and you've also kind of echoed that with the erotic like novels that

that with the erotic like novels that you you mentioned romantic novels so

you you mentioned romantic novels so pornography addiction do you see that

pornography addiction do you see that often and I guess critically how does

often and I guess critically how does one go about overcoming that and how do

one go about overcoming that and how do you know it's a pornography addiction I

you know it's a pornography addiction I guess it goes back to the point of harm

guess it goes back to the point of harm but yeah yes yeah so um I do think that

but yeah yes yeah so um I do think that pornography addiction is

pornography addiction is one of the biggest addictions and the

one of the biggest addictions and the most silent and the most shameful

most silent and the most shameful addictions that we have now in the

addictions that we have now in the modern

modern world um we will not infrequently have a

world um we will not infrequently have a patient come in to the clinic who claims

patient come in to the clinic who claims to have other problems and it's not

to have other problems and it's not until visit three or four that they

until visit three or four that they finally fess up I'm really here for a

finally fess up I'm really here for a pornography

pornography addiction there's so much shame around

addiction there's so much shame around it it's so incredibly shameful for

it it's so incredibly shameful for people to admit that they are spending

people to admit that they are spending their time looking at these images often

their time looking at these images often associated with compulsive

associated with compulsive masturbation some people their addiction

masturbation some people their addiction manifests by actually pursuing Partners

manifests by actually pursuing Partners so dating apps are highly addictive and

so dating apps are highly addictive and and meetups all of this is related to

and meetups all of this is related to sex an orgasm which releases dopamine in

sex an orgasm which releases dopamine in the reward pathway but it's not just the

the reward pathway but it's not just the moment of orgasm it's all of the rituals

moment of orgasm it's all of the rituals and the buildup and the searching um

and the buildup and the searching um that's related to it women can get

that's related to it women can get addicted to pornography as well as men

addicted to pornography as well as men although I would say that men outnumber

although I would say that men outnumber women um probably you know in my

women um probably you know in my clinical experience um I don't know 10

clinical experience um I don't know 10 to one women however are much more

to one women however are much more vulnerable to love addiction which is

vulnerable to love addiction which is also real right uh the pathological

also real right uh the pathological compulsive falling in love with Partners

compulsive falling in love with Partners um and then getting into these

um and then getting into these relationships that are really dramatic

relationships that are really dramatic and not healthy and then falling out of

and not healthy and then falling out of love and then pursuing doing another

love and then pursuing doing another love partner so the these addictions are

love partner so the these addictions are real um they are very harmful for people

real um they are very harmful for people who get addicted ultimately they're not

who get addicted ultimately they're not even about sex they're about human

even about sex they're about human attachment and the desire for human

attachment and the desire for human attachment and also just as a way to

attachment and also just as a way to self- soothe and Escape our own everyday

self- soothe and Escape our own everyday suffering

suffering and I'm particularly concerned about

and I'm particularly concerned about girls and boys who now have access to

girls and boys who now have access to all kinds of sexual images that would

all kinds of sexual images that would not have been possible for them to get

not have been possible for them to get access to a generation or two ago and

access to a generation or two ago and now you know a child with five with an

now you know a child with five with an iPad can accidentally end up um on a

iPad can accidentally end up um on a site that has very graphic uh sexual

site that has very graphic uh sexual images and videos so what's the harm of

images and videos so what's the harm of pornography watching

pornography watching pornography well there's a lot lot of

pornography well there's a lot lot of potential harms one of the harms

potential harms one of the harms especially if combined with you know

especially if combined with you know compulsive masturbation is that just

compulsive masturbation is that just simply addictive which means that the

simply addictive which means that the more people do it the more they want to

more people do it the more they want to do it then they have the come down where

do it then they have the come down where they don't feel good and then pretty

they don't feel good and then pretty soon it becomes like a a compulsive

soon it becomes like a a compulsive repetitive Loop where they're spending

repetitive Loop where they're spending large amounts of their day uh engaging

large amounts of their day uh engaging in this activity and that that in itself

in this activity and that that in itself is highly

is highly debilitating but other harms um I think

debilitating but other harms um I think that are significant are it really does

that are significant are it really does change a person's conceptualization of

change a person's conceptualization of what sex is is and what sex is for and I

what sex is is and what sex is for and I don't want to get into the whole thing

don't want to get into the whole thing of like you know sex is exercise or sex

of like you know sex is exercise or sex is recreational fun compared with sex

is recreational fun compared with sex you know as something that's maybe more

you know as something that's maybe more sacred because I I I I'm not here to

sacred because I I I I'm not here to judge any of that except to say that if

judge any of that except to say that if a main pathway for a young person to

a main pathway for a young person to learn about sex is through watching

learn about sex is through watching pornography that's going to give them a

pornography that's going to give them a very distorted view of what you know

very distorted view of what you know real sex uh is like not to mention what

real sex uh is like not to mention what relationships are like right and how sex

relationships are like right and how sex um becomes a part of um an intimate

um becomes a part of um an intimate relationship I've heard a few people say

relationship I've heard a few people say that pornography lowers our motivation

that pornography lowers our motivation to go out there in the world and to

to go out there in the world and to pursue getting a job and getting a

pursue getting a job and getting a career and going to the gym etc etc and

career and going to the gym etc etc and through the lens of what we've talked

through the lens of what we've talked about today where dopamine was this

about today where dopamine was this motivating force for those rats to just

motivating force for those rats to just reach out and eat the food if you remove

reach out and eat the food if you remove the dopamine from the rat's and it

the dopamine from the rat's and it wouldn't even eat food in front of it

wouldn't even eat food in front of it and it will starve to death when we

and it will starve to death when we think about men you said roughly in your

think about men you said roughly in your practice about 90% of the people that

practice about 90% of the people that come in with a pornography addiction of

come in with a pornography addiction of men this all kind of overlaps to create

men this all kind of overlaps to create this picture that in the modern world

this picture that in the modern world when we think about why more men are

when we think about why more men are lonely why they're more often in their

lonely why they're more often in their basements playing video games now or

basements playing video games now or watching pornography than ever before

watching pornography than ever before why they're having less sex and having

why they're having less sex and having sex later um why they're struggling to

sex later um why they're struggling to form Rel

form Rel relationships um why less men are

relationships um why less men are potentially in college at the moment um

potentially in college at the moment um maybe some of the answers are in the

maybe some of the answers are in the fact of just like how men are wired

fact of just like how men are wired because if they've thinking this through

because if they've thinking this through if men are more likely to have a

if men are more likely to have a disposition to these kinds of behaviors

disposition to these kinds of behaviors then these kinds of behaviors are more

then these kinds of behaviors are more likely to impact and demotivate and

likely to impact and demotivate and destabilize men is that all like rough

destabilize men is that all like rough broadly accurate I absolutely agree

broadly accurate I absolutely agree which is why I've talked about the

which is why I've talked about the smartphone as a masturbation machine

smartphone as a masturbation machine essentially these devices have become

essentially these devices have become the way that we meet our physical

the way that we meet our physical emotional sexual intellectual needs and

emotional sexual intellectual needs and taken to the extreme that would mean

taken to the extreme that would mean that we're no longer relying on other

that we're no longer relying on other people to meet those needs we're meeting

people to meet those needs we're meeting the needs ourselves with with this

the needs ourselves with with this technology and with the devices and I

technology and with the devices and I don't think that's a future that anybody

don't think that's a future that anybody wants taken to the extreme right because

wants taken to the extreme right because we are social creatures we need to

we are social creatures we need to connect with each other human connection

connect with each other human connection is vital to a thriving life and survival

is vital to a thriving life and survival in general so yes I have a lot of

in general so yes I have a lot of concerns that that pornography is now

concerns that that pornography is now replacing intimacy with people in real

replacing intimacy with people in real life or disrupting our expectations of

life or disrupting our expectations of intimacy with people in real life when

intimacy with people in real life when you say expectations do you mean like

you say expectations do you mean like hard work we have to do to create and

hard work we have to do to create and find intimacy that too and also just

find intimacy that too and also just expectations around sex

expectations around sex a lot of folks that I work with with sex

a lot of folks that I work with with sex addiction as they try to give up

addiction as they try to give up pornography compulsive masturbation or

pornography compulsive masturbation or whatever they Define as their uh sexual

whatever they Define as their uh sexual adct sexually addictive

adct sexually addictive behaviors what they find is that they

behaviors what they find is that they almost go in the opposite direction and

almost go in the opposite direction and they kind of have zero interest in sex

they kind of have zero interest in sex or they just don't have interest in sex

or they just don't have interest in sex with their real life partner or they

with their real life partner or they can't enjoy sex with their real life

can't enjoy sex with their real life partner you know which all kind of makes

partner you know which all kind of makes sense right when you hijack the reward

sense right when you hijack the reward pathway with this incredibly potent

pathway with this incredibly potent version of sex you come back down to

version of sex you come back down to earth with your actual partner who's got

earth with your actual partner who's got his or her own needs and you know aging

his or her own needs and you know aging bodies or whatever it is um it's hard

bodies or whatever it is um it's hard to experience pleasure in that realm in

to experience pleasure in that realm in an attempt to offer people out there now

an attempt to offer people out there now that are struggling with some kind of

that are struggling with some kind of form of compulsive Behavior or addiction

form of compulsive Behavior or addiction a pathway to turn this around what is

a pathway to turn this around what is step one in your book I talk I've read

step one in your book I talk I've read all these incredible ideas is around the

all these incredible ideas is around the wisdom we can learn from addicts I

wisdom we can learn from addicts I learned about dopamine fasting and I

learned about dopamine fasting and I also learned about radical honesty in

also learned about radical honesty in the role that that plays what is the

the role that that plays what is the process so someone listening to this

process so someone listening to this right now they're struggling with one of

right now they're struggling with one of these addictions they've got a

these addictions they've got a pornography addiction they're addicted

pornography addiction they're addicted to gaming maybe it's food maybe it's

to gaming maybe it's food maybe it's erotic novels maybe they're on they

erotic novels maybe they're on they Twilight the reading Twilight at the

Twilight the reading Twilight at the moment what what do you say to that

moment what what do you say to that person at the step one

person at the step one is step one is really just acknowledging

is step one is really just acknowledging the behavior that it's problematic and

the behavior that it's problematic and that it might require some changing in

that it might require some changing in our lives um um the next step is being

our lives um um the next step is being honest with ourselves and maybe another

honest with ourselves and maybe another person about why we do the behavior what

person about why we do the behavior what we get out of it what's positive uh step

we get out of it what's positive uh step three would be honestly making a list of

three would be honestly making a list of all of the problems with the behavior

all of the problems with the behavior how is it interfering with my goals and

how is it interfering with my goals and as we talked about my values what do

as we talked about my values what do other people say to me about how it's

other people say to me about how it's problematic is one of the problems

problematic is one of the problems potentially that it's just not working

potentially that it's just not working anymore the way that it used to right

anymore the way that it used to right I'm developing tolerance I need more to

I'm developing tolerance I need more to get the same effect it's doing the

get the same effect it's doing the opposite of what I want it to do and

opposite of what I want it to do and after we've done all that really done a

after we've done all that really done a really honest self

really honest self assessment about the

assessment about the behavior I recommend a 30-day dopamine

behavior I recommend a 30-day dopamine fast now we're not really fasting from

fast now we're not really fasting from dopamine right because we're not really

dopamine right because we're not really ingesting dop me what we're doing a fast

ingesting dop me what we're doing a fast from is whatever that substance or

from is whatever that substance or behavior is that is causing these kinds

behavior is that is causing these kinds of problems potentially maybe we aren't

of problems potentially maybe we aren't even really sure but we think it might

even really sure but we think it might be give it up for 30 days why 30 days

be give it up for 30 days why 30 days well we know that two weeks is not

well we know that two weeks is not enough right we know that from this

enough right we know that from this Imaging study right that people are

Imaging study right that people are still in that dopamine deficit state two

still in that dopamine deficit state two weeks after stopping but 30 days based

weeks after stopping but 30 days based on clinical experience not just mine but

on clinical experience not just mine but that of many other people who do this

that of many other people who do this work that no for most people no matter

work that no for most people no matter the drug and no matter sort of the

the drug and no matter sort of the severity and chronicity once they get to

severity and chronicity once they get to about 30 days they begin to feel better

about 30 days they begin to feel better they begin to come out of of that tunnel

they begin to come out of of that tunnel of constant craving they begin to be

of constant craving they begin to be able to imagine a life in which they

able to imagine a life in which they would um you know not necessarily have

would um you know not necessarily have to rely on this substance or on this

to rely on this substance or on this Behavior what I always tell folks when

Behavior what I always tell folks when they're preparing for the dopamine fast

they're preparing for the dopamine fast is just remember you will feel worse

is just remember you will feel worse before you feel better but that is

before you feel better but that is withdrawal mediated suffering once you

withdrawal mediated suffering once you get through those first 14 days you'll

get through those first 14 days you'll begin to feel better and potentially by

begin to feel better and potentially by 30 days you'll feel much better than you

30 days you'll feel much better than you have in a really long time now this is

have in a really long time now this is not to say that 30 days of fasting is

not to say that 30 days of fasting is going to cure your addiction not at all

going to cure your addiction not at all um but it's the beginning it's the

um but it's the beginning it's the beginning of being able to see causality

beginning of being able to see causality getting some insight it's an experiment

getting some insight it's an experiment right our lives are one big experiment

right our lives are one big experiment what better way to understand the

what better way to understand the variables in our lives than to change

variables in our lives than to change one thing one variable and see what

one thing one variable and see what happens do we then need to you talk

happens do we then need to you talk about this concept of

about this concept of self-binding yes self-binding right what

self-binding yes self-binding right what role not PL what this self-binding is a

role not PL what this self-binding is a way of acknowledging that if we rely on

way of acknowledging that if we rely on Willpower alone we will not be

Willpower alone we will not be successful especially living in this

successful especially living in this drug aied world and what we need to do

drug aied world and what we need to do is anticipate desire before we're in the

is anticipate desire before we're in the throws of Desire by creating both

throws of Desire by creating both literal and metacognitive or thought you

literal and metacognitive or thought you know gunan experiment like barriers

know gunan experiment like barriers between ourselves and our drug of choice

between ourselves and our drug of choice so these barriers can be actual physical

so these barriers can be actual physical barriers like putting our

barriers like putting our device into a kitchen safe and locking

device into a kitchen safe and locking it up over the night or leaving it

it up over the night or leaving it outside of our bedroom or getting the

outside of our bedroom or getting the potato chips the alcohol the Cannabis

potato chips the alcohol the Cannabis out of the house deleting our contact

out of the house deleting our contact drug dealers information and telling our

drug dealers information and telling our drug dealer don't call me and I won't

drug dealer don't call me and I won't call you um because these are all cues

call you um because these are all cues these are all cues that's right and the

these are all cues that's right and the cues can be physical things so someone I

cues can be physical things so someone I see can cues cues can also be basically

see can cues cues can also be basically an emotion you talked about halt hungry

an emotion you talked about halt hungry angry tired I eat well during the day

angry tired I eat well during the day like now as I leave here there'll be a

like now as I leave here there'll be a salad I reckon in the in the Green Room

salad I reckon in the in the Green Room over there for me and the only time

over there for me and the only time where I'm susceptible to not eating well

where I'm susceptible to not eating well is if it's late and so when you said the

is if it's late and so when you said the hungry angry lonely tide thing that is

hungry angry lonely tide thing that is probably the state that I'm in sometimes

probably the state that I'm in sometimes when I get home certainly hungry

when I get home certainly hungry certainly tired probably a little bit

certainly tired probably a little bit lonely as well but certainly those two

lonely as well but certainly those two things and that seems to be when I'm

things and that seems to be when I'm most susceptible to making a regrettable

most susceptible to making a regrettable decision as it relates to my dopamine

decision as it relates to my dopamine I've also wondered if if dopamine is

I've also wondered if if dopamine is responsible for what people almost call

responsible for what people almost call like the sugar Cravings that we have so

like the sugar Cravings that we have so what I've observed is in previous years

what I've observed is in previous years of my life when when I was eating lots

of my life when when I was eating lots of sugar I would then go into about like

of sugar I would then go into about like a two week cycle of like binging the

a two week cycle of like binging the sugar and right now I'm in like a really

sugar and right now I'm in like a really great cycle of with my food where I have

great cycle of with my food where I have no cravings for the sugar I'm I'm in a

no cravings for the sugar I'm I'm in a staying in a hotel here in La there's a

staying in a hotel here in La there's a mini bar in the room with Oreos and

mini bar in the room with Oreos and gummy all these chocolates and all these

gummy all these chocolates and all these things and I haven't touched them

things and I haven't touched them because for some reason in this like

because for some reason in this like couple of weeks of my life or whatever I

couple of weeks of my life or whatever I just don't have the Cravings anymore but

just don't have the Cravings anymore but I kind of suspect that if I start eating

I kind of suspect that if I start eating them yes then the next four weeks will

them yes then the next four weeks will be a car crash yes why does this happen

be a car crash yes why does this happen yeah it's so fascinating and and I think

yeah it's so fascinating and and I think this is sort of a universal experience

this is sort of a universal experience so first of all sugar is addictive it

so first of all sugar is addictive it lights up the same reward pathway as

lights up the same reward pathway as drugs and alcohol clear dopamine release

drugs and alcohol clear dopamine release in the nucleus bins part of the reward

in the nucleus bins part of the reward pathway in response to sugar and when we

pathway in response to sugar and when we quit sugar we have a come down right we

quit sugar we have a come down right we go into withdrawal and it's manifested

go into withdrawal and it's manifested in all the different ways that we've

in all the different ways that we've talked about and it lasts for about two

talked about and it lasts for about two weeks and one of the most Salient

weeks and one of the most Salient symptoms is intense craving for sugar

symptoms is intense craving for sugar and it's so amazing how intense it is

and it's so amazing how intense it is but if we can get through that period

but if we can get through that period and get out of that Vortex of addictive

and get out of that Vortex of addictive craving the craving gradually gets

craving the craving gradually gets better and then eventually goes away

better and then eventually goes away which is by the way very paradoxical

which is by the way very paradoxical because whatever our drug is when we

because whatever our drug is when we first stop it we have intense cravings

first stop it we have intense cravings and we have the feeling that the

and we have the feeling that the Cravings will only get worse with time

Cravings will only get worse with time even though we logically may have

even though we logically may have experienced otherwise by giving it up

experienced otherwise by giving it up before we have the feeling this is going

before we have the feeling this is going to last forever it never does right with

to last forever it never does right with time the craving goes away and once we

time the craving goes away and once we are in that Arena where we're not

are in that Arena where we're not constantly craving we might have

constantly craving we might have something that triggers the craving

something that triggers the craving right but like stress but generally

right but like stress but generally we're not dealing with a craving if we

we're not dealing with a craving if we were then to reexpose our brains to a

were then to reexpose our brains to a little bit of sugar immediately back in

little bit of sugar immediately back in the vortex of craving and there's an

the vortex of craving and there's an experiment I love that illustrates this

experiment I love that illustrates this it's an experiment in rats where rats

it's an experiment in rats where rats were injected with cocaine the same

were injected with cocaine the same amount of cocaine every day for seven

amount of cocaine every day for seven days and over the course of those seven

days and over the course of those seven days the rats went from kind of hiding

days the rats went from kind of hiding in the shadows of the cage to

in the shadows of the cage to progressively running a little bit more

progressively running a little bit more and a little bit more and by day seven

and a little bit more and by day seven they were in a running frenzy right as

they were in a running frenzy right as measured by these beams of light that

measured by these beams of light that they were

they were crossing then there was no more cocaine

crossing then there was no more cocaine injected after seven days and no cocaine

injected after seven days and no cocaine or any addictive substance administered

or any addictive substance administered to the rats for a year which is a rat

to the rats for a year which is a rat lifetime a really long time that would

lifetime a really long time that would make you think oh you know that there's

make you think oh you know that there's no more cocaine in the system no none of

no more cocaine in the system no none of that and then the rats were injected

that and then the rats were injected with a single dose of cocaine and

with a single dose of cocaine and immediately they were plunged back into

immediately they were plunged back into that running frenzy that you saw on day

that running frenzy that you saw on day seven really important information

seven really important information because it tells us that there's some

because it tells us that there's some kind of permanent latent

kind of permanent latent echo in our brains once we've been

echo in our brains once we've been exposed to and especially if we become

exposed to and especially if we become addicted to a particular substance such

addicted to a particular substance such that even with sustained abstinence on

that even with sustained abstinence on the order of years and decades if we are

the order of years and decades if we are reexposed to that drug we can

reexposed to that drug we can immediately be plunged into the depths

immediately be plunged into the depths of our addiction there's no ramp up

of our addiction there's no ramp up period that happens and of course we see

period that happens and of course we see this all the time you know people with

this all the time you know people with alcohol addiction who are then exposed

alcohol addiction who are then exposed to alcohol and right back to their Max

to alcohol and right back to their Max use or even exposed to something like

use or even exposed to something like opioids and alcohol also works on our

opioids and alcohol also works on our endogenous opioid system so there's some

endogenous opioid system so there's some homology or similarity between alcohol

homology or similarity between alcohol and opioids and then immediately being

and opioids and then immediately being plunged into opioid addiction which then

plunged into opioid addiction which then leads them back to their alcohol whole

leads them back to their alcohol whole addiction it made me think about

addiction it made me think about children it made me think about children

children it made me think about children because if I'm a 5-year-old and I'm

because if I'm a 5-year-old and I'm binging on sugar yeah this sets me up

binging on sugar yeah this sets me up for a life where I'm going to be I mean

for a life where I'm going to be I mean based on the analogy I just the

based on the analogy I just the experiment I just had based on the

experiment I just had based on the experiment I just heard there it sets me

experiment I just heard there it sets me up for a life where I'm going to so

up for a life where I'm going to so easily slip right back into that

easily slip right back into that addiction for sugar um and also I know

addiction for sugar um and also I know that the brain isn't fully developed

that the brain isn't fully developed when we're children so maybe the effect

when we're children so maybe the effect is even more um lasting

significant is any of that true yeah it's all true which is why a big focus

it's all true which is why a big focus of the addiction medicine field is

of the addiction medicine field is prevention and trying to make sure that

prevention and trying to make sure that we protect kids brains from the harms of

we protect kids brains from the harms of these addictive substances and behaviors

these addictive substances and behaviors like what from sugar to digital media

like what from sugar to digital media video games pornography social media or

video games pornography social media or any other drug you know nicotine so many

any other drug you know nicotine so many kids are vaping now you know taking 50

kids are vaping now you know taking 50 plus Puffs a day

plus Puffs a day on their nicotine Vape cannabis alcohol

on their nicotine Vape cannabis alcohol what's going on in the brain if we if a

what's going on in the brain if we if a kid is exposed to those things so

kid is exposed to those things so essentially at age five we have more

essentially at age five we have more neurons and neuronal

neurons and neuronal connections than we have in the rest of

connections than we have in the rest of our adult lives about 50% more neuronal

our adult lives about 50% more neuronal connections than we'll have it as adults

connections than we'll have it as adults which is what makes us such good

which is what makes us such good Learners when we're kids kids can just

Learners when we're kids kids can just absorb anything because they're sort of

absorb anything because they're sort of like these Tod potent sponges with all

like these Tod potent sponges with all these neurons and all these neuronal

these neurons and all these neuronal connections but we age through

connections but we age through adolescence to about age 25 we cut back

adolescence to about age 25 we cut back or what's called

or what's called prune the neural circuits that we don't

prune the neural circuits that we don't use and we myelinate or make more

use and we myelinate or make more efficient the neural circuits that we

efficient the neural circuits that we use most often such that by age 25 we

use most often such that by age 25 we are left with the neurological

are left with the neurological scaffolding that will serve us for the

scaffolding that will serve us for the rest of our adult lives that means that

rest of our adult lives that means that if we're engaging in addictive

if we're engaging in addictive maladaptive coping at a young age we're

maladaptive coping at a young age we're elaborating a neural circuitry based on

elaborating a neural circuitry based on that maladaptive coping which is going

that maladaptive coping which is going to set us up for addiction in adulthood

to set us up for addiction in adulthood I always like to emphasize though that

I always like to emphasize though that because the Child and Adolescent brain

because the Child and Adolescent brain is so plastic or Tod potent or so

is so plastic or Tod potent or so changeable that's also a very hopeful

changeable that's also a very hopeful message it means that even a young

message it means that even a young person exposed at a young age to an

person exposed at a young age to an addictive substance if we can get in

addictive substance if we can get in there early enough while their brain is

there early enough while their brain is still plastic enough we can rewire them

still plastic enough we can rewire them whereas when I treat people in their 70s

whereas when I treat people in their 70s and ' 80s

and ' 80s who have been you know smoking pot their

who have been you know smoking pot their whole lives or drinking

whole lives or drinking alcohol mainly it was manageable now all

alcohol mainly it was manageable now all of a sudden they retire they're in their

of a sudden they retire they're in their 60s all this time the pot's a lot more

60s all this time the pot's a lot more potent they can develop these full-blown

potent they can develop these full-blown addictive disorders late in life and

addictive disorders late in life and it's very hard to treat them because

it's very hard to treat them because they've lost a lot of that plasticity

they've lost a lot of that plasticity that would allow them to regenerate new

that would allow them to regenerate new neural Pathways once they

neural Pathways once they abstain what is the most important thing

abstain what is the most important thing that we didn't talk about that we should

that we didn't talk about that we should have as it relates to dopamine oh my God

have as it relates to dopamine oh my God we talked about so much I I don't even

we talked about so much I I don't even know it seems like it was a lot of stuff

know it seems like it was a lot of stuff I guess based on the questions you're

I guess based on the questions you're exposed to from the general public is

exposed to from the general public is there anything that we missed that

there anything that we missed that someone at home right now is going to be

someone at home right now is going to be screaming at the screen um talk about

screaming at the screen um talk about yeah well I mean I guess I would

yeah well I mean I guess I would emphasize that when I talk about the

emphasize that when I talk about the dopamine fasting it's an early

dopamine fasting it's an early intervention it's not an intervention

intervention it's not an intervention that I would recommend for someone who

that I would recommend for someone who had repeatedly tried to quit on their

had repeatedly tried to quit on their own and been unable to you know clearly

own and been unable to you know clearly that would be an exercise and futility

that would be an exercise and futility that person should go and get

that person should go and get professional help maybe they need to go

professional help maybe they need to go to a residential treatment center I also

to a residential treatment center I also wouldn't recommend dopamine fasting or

wouldn't recommend dopamine fasting or just quitting your drug of choice if

just quitting your drug of choice if you're at risk for a lifethreatening

you're at risk for a lifethreatening withdrawal so we can have

withdrawal so we can have life-threatening withdrawal from alcohol

life-threatening withdrawal from alcohol and benzo isipin like clopin Xanax

and benzo isipin like clopin Xanax adaman again in those cases go see a

adaman again in those cases go see a professional get help with a medical

professional get help with a medical detoxification before you try to you

detoxification before you try to you know sustain absence for a period of

know sustain absence for a period of time so you know I would blanket the

time so you know I would blanket the whole thing with like the caveat go see

whole thing with like the caveat go see your addiction you go see the addiction

your addiction you go see the addiction medicine specialist near you thank you

medicine specialist near you thank you so much you're wel it's been so

so much you're wel it's been so unbelievably um

unbelievably um thought-provoking for for me in so many

thought-provoking for for me in so many ways I thought I knew what dopamine was

ways I thought I knew what dopamine was I thought I had covered all the ground

I thought I had covered all the ground there was to cover on these subjects of

there was to cover on these subjects of sort of compulsive behaviors but I was

sort of compulsive behaviors but I was so unbelievably wrong and it wasn't

so unbelievably wrong and it wasn't until I got into your book and started

until I got into your book and started reading through your work that I was

reading through your work that I was like oh my God most people have a clue

like oh my God most people have a clue about dopamine and the role it plays on

about dopamine and the role it plays on us and this scale analogy is

us and this scale analogy is particularly memorable because that

particularly memorable because that helps me to Think Through um many of the

helps me to Think Through um many of the behaviors that I have in my life that

behaviors that I have in my life that I've either struggled with or become

I've either struggled with or become quite stubborn in various ways but also

quite stubborn in various ways but also has turned a couple of lights on to some

has turned a couple of lights on to some of the things I said about like my sugar

of the things I said about like my sugar um eating sugar and um even like going

um eating sugar and um even like going to the gym and why like my motivation

to the gym and why like my motivation can seem to fluctuate with the gym

can seem to fluctuate with the gym sometimes it's so unbelievably important

sometimes it's so unbelievably important because this little neurotransmitter

because this little neurotransmitter seems to control so much of our lives um

seems to control so much of our lives um and we never taught anything about it so

and we never taught anything about it so we become these kind of puppets and the

we become these kind of puppets and the puppet master is this this brain which

puppet master is this this brain which is firing off all of these

is firing off all of these neurotransmitters that are determining

neurotransmitters that are determining who we are who we become and also who we

who we are who we become and also who we don't become um thank you so so so much

don't become um thank you so so so much I I know you were nervous coming here

I I know you were nervous coming here today but I have to tell you you are

today but I have to tell you you are very brilliant you're exceptionally

very brilliant you're exceptionally brilliant in so many ways you you that's

brilliant in so many ways you you that's why I said you should start a podcast

why I said you should start a podcast because you're really Built For This

because you're really Built For This medium thank you you have a a certain

medium thank you you have a a certain warmth and empathy to you while while

warmth and empathy to you while while also being incredibly smart and

also being incredibly smart and accessible in the way that you

accessible in the way that you communicate so please carry on because I

communicate so please carry on because I I don't think although you overcame that

I don't think although you overcame that the difficulty of those nerves I think

the difficulty of those nerves I think there's so many hundreds of thousands

there's so many hundreds of thousands and millions of people listening now

and millions of people listening now that are so thankful that you did oh

that are so thankful that you did oh like really thankful that you did and if

like really thankful that you did and if youve just nudged their life a little

youve just nudged their life a little bit in a better Direction that's that's

bit in a better Direction that's that's worthwhile so thank you um we have a

worthwhile so thank you um we have a closing tradition on this podcast where

closing tradition on this podcast where the last guest leaves a question for the

the last guest leaves a question for the next guest without knowing who they're

next guest without knowing who they're going to be leaving it for what is the

going to be leaving it for what is the most recent piece of information that

most recent piece of information that changed your

life I think the most recent piece of information that was very impactful for

information that was very impactful for me was the

me was the realization

realization that we are probably going to

that we are probably going to be cybernetically enhanced in the

be cybernetically enhanced in the future and interfacing with technology

future and interfacing with technology in a way that's completely

seamless and that this is inevitable we're going to become cyborgs or at

we're going to become cyborgs or at least we're going to be surrounded by

least we're going to be surrounded by the technology in a way that's

the technology in a way that's invisible um and it's going it's going

invisible um and it's going it's going to be just completely integrated into

to be just completely integrated into our lives whether we'll it'll actually

our lives whether we'll it'll actually be under the skin I think it will be um

be under the skin I think it will be um but I can see in that so much potential

but I can see in that so much potential good and promise and and so much that's

good and promise and and so much that's really terrifying especially when I

really terrifying especially when I think about the way it's going to change

think about the way it's going to change us as humans and my big fear about it is

us as humans and my big fear about it is that we will become more and more

that we will become more and more isolated and that we'll end up sort of

isolated and that we'll end up sort of in these little cubicles of our own

in these little cubicles of our own making scattered alone all across you

making scattered alone all across you know planet Earth I I hope it doesn't

know planet Earth I I hope it doesn't lead to that but that's that's my word

it's interesting when we become connected to the internet and we truly

connected to the internet and we truly interface with the internet we really

interface with the internet we really don't need to use our physical being

don't need to use our physical being anymore because we can experience all

anymore because we can experience all the joy and adventure and travel

the joy and adventure and travel digitally and that's I mean it just

digitally and that's I mean it just messes with the incentive structures

messes with the incentive structures like we've talked about with dopamine

like we've talked about with dopamine yeah changes our ability to to get up

yeah changes our ability to to get up and go and to do

and go and to do things I mean that's a lovely hopeful

things I mean that's a lovely hopeful ending for

us thank you so much yeah thanks for the opportunity to you

yeah thanks for the opportunity to you know teach people about this information

know teach people about this information I hope it's helpful for people super

I hope it's helpful for people super helpful and I'm going to link both of

helpful and I'm going to link both of these books below I've got the dopamine

these books below I've got the dopamine Nation book which was the original I

Nation book which was the original I believe yes um and then following That

believe yes um and then following That You released dopamine Nation workbook

You released dopamine Nation workbook which is a practical guide to find

which is a practical guide to find balance in an age of indulgence I highly

balance in an age of indulgence I highly recommend everybody reads these I'm

recommend everybody reads these I'm going to go and reread them on my

going to go and reread them on my journey home back to London tonight so I

journey home back to London tonight so I really really appreciate you read these

really really appreciate you read these books and honestly everyone needs to go

books and honestly everyone needs to go read these books I'm sure they will so

read these books I'm sure they will so thank you than you so much thank you so

thank you than you so much thank you so much do you know that 80% of New Year's

much do you know that 80% of New Year's resolutions fail by February it's

resolutions fail by February it's because we focus too much on the end

because we focus too much on the end goal and we forget the small daily

goal and we forget the small daily actions that actually move us forward

actions that actually move us forward those actions that are easy to do are

those actions that are easy to do are also easy not to do in life it's easy to

also easy not to do in life it's easy to save a dollar so it's also easy not to

save a dollar so it's also easy not to making one small Improvement each day

making one small Improvement each day one tiny step in the right direction has

one tiny step in the right direction has a big difference over time and that is

a big difference over time and that is the 1% mindset which is why we created

the 1% mindset which is why we created the 1% diary a 90day journal designed to

the 1% diary a 90day journal designed to help you stay consistent and focus on

help you stay consistent and focus on the small wins and make real progress

the small wins and make real progress over time it also gives you access to

over time it also gives you access to the 1% Community a space where you can

the 1% Community a space where you can stay accountable motivated inspired

stay accountable motivated inspired along with many others on the same

along with many others on the same Journey we launched the 1% diary in

Journey we launched the 1% diary in November and it sold out so now we're

November and it sold out so now we're doing a second drop join the wait list

doing a second drop join the wait list at the diary.com and you'll be the first

at the diary.com and you'll be the first to know as soon as it's back in stock

to know as soon as it's back in stock I'll put the link below

I'll put the link below [Music]

[Music] ah

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

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