Published August 2021 on YouTube

Dr. Anna Lembke: Understanding & Treating Addiction | Huberman Lab Podcast #33

1. Dr. Anna Lembke, Addiction Expert

Dr. Anna Lemke, a psychiatrist and addiction specialist, discusses the common biological underpinnings of addiction and the path to treatment and recovery. She shares insights into the struggle of addiction through engaging patient stories and science, making it accessible to anyone. Her new book, Dopamine Nation, provides further insight into addiction and ways to treat various types of addiction.+

2. Science and Health Optimization

Science and Performance:Andrew discusses the science behind Roca glasses and how they were designed for performance, with lightweight frames and lenses that allow for clear vision in different lighting conditions. He also talks about the importance of regular blood work and how Inside Tracker can help individuals better understand their body and reach their health goals.+
Health Optimization:Andrew discusses the importance of optimizing health and introduces two tools that can help listeners achieve their goals: Inside Tracker, a dashboard that directs lifestyle factors, nutrition, exercise, and supplementation, and Headspace, a meditation app that can improve mental and physical health. He shares personal experiences and insights on how to maintain a consistent meditation practice. Listeners can try both tools with special offers provided in the episode.+

3. Dopamine, Happiness & Impulsivity

The Power of Dopamine:Anna explains that dopamine is a neurotransmitter that bridges the gap between two neurons and is intimately associated with the experience of reward. She also discusses how chronic exposure to substances or behaviors that repeatedly release large amounts of dopamine can change our tonic baseline and actually lower it over time as our brain tries to compensate for all of that dopamine, which is more really than we were designed to experience.+
Dopamine and Addiction:Anna and Andrew discuss the relationship between dopamine levels and addiction vulnerability. They explore how impulsivity affects addiction risk and how different temperaments can impact joy and addiction susceptibility.+
Impulsivity and Mental Illness:Anna explains that impulsivity is not always bad and can be advantageous in certain scenarios. She also shares her belief that what we now conceptualize as mental illness are actually traits that in another ecosystem might be very advantageous.+

4. What Is Pleasure?

Anna and Andrew discuss the complexity of pleasure and how it relates to addiction. While pleasure can be associated with seeking a high or euphoria, it can also be a way to escape pain. Addiction often stems from the desire to avoid the pain of withdrawal or the consequences of drug use.+

5. Finding Balance

Finding Balance:Anna Lembke discusses how the lack of friction in modern life can lead to addiction and mental illness, as some people need more stimulation than others. She argues that the word "balance" can be aversive for those seeking supernormal experiences, and that the online narrative often promotes a lack of balance.+
Passion and Hard Work:Andrew and Anna discuss the misconceptions surrounding finding one's passion and how hard work and skill acquisition can lead to a sense of purpose. They reference Cal Newport's work and the importance of deep work and removing oneself from technology.+

6. Pleasure-Pain Balance

Anna explains how pleasure and pain are co-located in the brain and work like a balance. Addiction releases a lot of dopamine in the brain's reward pathway, but beneath our awareness, pleasure is reduced by increasing pain. Understanding this balance can give people a way to master their behavior and disengage from addictive substances or behaviors.+

7. Dopamine Deficits, Anhedonia

Anna explains how indulging in high reward behaviors or substances can lead to a dopamine deficit state, which is akin to clinical depression. Chronic use can reset our dopamine threshold, making nothing enjoyable and leading to anxiety, irritability, insomnia, dysphoria, and mental preoccupation with using again or getting the drug.+

8. Are All Addictions the Same?

Addiction Mechanisms:Andrew and Anna discuss the generalizability of addiction mechanisms in the brain, explaining how addiction to any substance or behavior follows the same addictive process. They also touch on the concept of cross addiction and how severe addiction to one substance or behavior makes an individual more vulnerable to addiction to any substance or behavior.+
Pleasure Expansion:Andrew and Anna discuss the concept of addiction as a progressive narrowing of pleasure and offer a contrasting view of enlightenment as a progressive expansion of pleasure. They explore the idea of deriving pleasure from many things and question if it reflects a healthily tuned dopamine system.+

9. Wisdom in Recovery

Anna Lembke discusses how people in recovery from addiction have a hard-won wisdom that we can all benefit from, particularly in terms of adaptive ways to get dopamine. She emphasizes the importance of flexibility in finding a resilient balance and learning to live with things being a little boring a lot of the time. Boredom is an important and necessary experience that can lead to creative initiative and help us consider our priorities and values.+

10. Passion and Immediate Things

Finding Your Passion:Anna and Andrew discuss the misguided idea of finding your passion and instead suggest looking around at the work that needs to be done. They emphasize the importance of doing the job simply and honorably one day at a time with humility, which is a key insight from people in recovery.+
Cultivating Reward Pathways:Andrew and Anna discuss the importance of cultivating a relationship with our brain's action and reward circuits, starting with small tasks like taking out the trash. Anna shares her experience with patients who struggle with addiction to video games and how resetting their reward pathways can lead to a newfound enjoyment in other areas of life.+
Immediate Things:Andrew and Anna discuss the importance of tending to immediate things and how it can lead to super performance. They mention the Seal teams and people in recovery from addiction as examples of individuals who focus on their immediate environment and take it one day at a time.+

11. How to Break an Addiction

Breaking Addiction:Anna Lembke explains that it takes 30 days for the brain to reset reward pathways and regenerate dopamine transmission to become unaddicted. During the first ten days, it's expected to feel worse before feeling better. The progressive narrowing of pleasure eventually expands.+
Overcoming Addiction:Anna Lembke discusses how most people will feel worse for two weeks when trying to overcome addiction, but if they can make it through those first two weeks, the sun will start to come out in week three. By week four, most people are feeling a whole lot better than they were before they stopped using their substance. Andrew Huberman and Anna Lembke also talk about how addiction treatment is not for everybody, but it's amazing how many people with really severe addictions are willing and able to do it.+

12. Relapse, Craving & Triggers

Addiction and Hopelessness:Andrew Huberman and Anna Lembke discuss addiction and the repeated relapse of individuals despite being sober for a while. They question whether there are people who just can't quit their substance use or addictive behavior and whether it's hopeless. Anna Lembke conceptualizes addiction as a brain disease and explains how the balance of dopamine deficit state and pain can be tipped to the side of pain for some people, making it difficult for them to restore homeostasis.+
Addiction Empathy:Anna and Andrew discuss the importance of empathy in understanding addiction and how severe addiction can affect an individual's balance and homeostasis. Anna uses the analogy of an itch that can't be scratched to explain the constant pull of addiction for those with severe cases.+
Dopamine and Relapse:Anna and Andrew discuss how addiction is not a choice, but rather an unconscious mechanism driven by dopamine. They explore the concept of relapse and how it can happen even during a great stretch of life due to the dopamine associated with a win.+
Triggers and Dopamine:Anna and Andrew discuss how triggers associated with drug use release dopamine, which leads to a deficit state that drives motivation to get the drug. They also talk about how dopamine is involved in the desire for more giving, the sense of reward, but also movement.+

13. Addiction Community Dynamics

Andrew and Anna discuss the possibility of becoming addicted to sobriety and how the addiction community can become a source of dopamine hits for those in recovery. They also touch on the intensity of the intimacy that people with addiction temperament crave and how it can be disruptive for relationships but ultimately better than being intoxicated.+

14. Are We All Wired for Addiction?

Andrew and Anna discuss addiction mechanisms and how addiction can manifest in different aspects of life, including work and pursuit of knowledge. They also touch on the importance of balance and the role of dopamine in addiction.+

15. Bizarre Addiction

Anna Lembke shares a story about a patient who had a severe addiction to water. Despite being in recovery from alcohol addiction, the patient would intentionally overdose on water to escape her own head. This underscores the generalizability of addiction circuits in the brain.+

16. Recovered Addicts Are Heroes

Anna Lembke describes the incredible courage and discipline it takes to overcome addiction and praises her patients as heroes. Despite the constant temptation and bombardment of addictive opportunities in today's world, these individuals find a way to recover and offer valuable wisdom to others.+

17. Truth in Recovery

Truth Telling:Anna discusses how truth telling is central to recovery, not just about drug use, but in all aspects of life. She explores the neuroscience behind why truth telling is important for leading a balanced life and how it is a key component in addiction recovery.+
The Power of Truth:Anna explains the neuroscience behind how telling the truth can strengthen our prefrontal cortical circuits and connections to our limbic brain and reward brain. She also discusses how being honest and open with people creates intimate connections and releases dopamine, which is important for those who need intensity in their human connections.+
Truth Telling:Andrew and Anna discuss the importance of truth telling in addiction recovery, including reporting everything accurately, what to withhold, and making amends for past behavior. The act of apologizing for past lies and harm is cathartic and renewing, allowing individuals to shed their past and begin again.+
Truth and Shame:Anna and Andrew discuss the importance of truth-telling and feeling appropriate shame for past actions. They explore the neuroscience behind these concepts and the value of acknowledging one's wrongdoings in the recovery process.+

18. Psychedelics for Addiction

Treating Addiction:Andrew and Anna discuss the use of drugs like Ibogaine, ayahuasca, and MDMA to treat addiction. While skeptical, Anna acknowledges that small clinical studies have shown success in using psychedelics to help people overcome addiction to alcohol and other drugs.+
MDMA Psychotherapy:Anna and Andrew discuss the potential benefits and limitations of using MDMA-assisted psychotherapy for addiction and trauma. While it may not be a one-size-fits-all solution, it has shown promise in allowing individuals to view their lives from a different perspective and make positive changes.+
Psychedelic Misconceptions:Anna and Andrew discuss the unintended consequences of the popular narrative surrounding the use of psychedelics. They emphasize the importance of controlled settings and clinical care when using these drugs for mental health conditions, as opposed to the misconception that they are safe for anyone to take.+

19. Social Media Addiction

Social Media Addiction:Anna and Andrew discuss the addictiveness of social media and how it is engineered to be a drug. They emphasize the importance of using social media with intention and planning, and being aware of individual propensities for addiction. They also touch on the government's failure to regulate texting and driving as a cautionary tale.+
Managing Smartphone Use:Anna and Andrew discuss the challenges of managing smartphone use and offer insights on how to make it a tool that is good for us and not harmful. They suggest putting barriers in place to control use, such as allocating a specific time for free reign use or limiting daily use to a set amount of time. They also discuss how smartphones have become like a security blanket for some people.+
Phone Addiction:Andrew and Anna discuss the addictive nature of phones and how it has made us regress to infantile behavior. Andrew shares his personal experience with phone addiction and how he takes breaks from it. Anna recommends a 30-day break for severe addiction but suggests that even a single day can be challenging and sufficient for most people.+
Disconnecting for Creativity:Anna Lembke and Andrew Huberman discuss the challenges of social media and how it diverts our attention from real life interactions. They emphasize the importance of creating intentional spaces to disconnect from technology and preserve offline ways of connecting with others. They also discuss the benefits of neutral time and the importance of sustaining thoughts for creativity.+

20. Narcissism

Andrew and Anna discuss the concept of healthy narcissism and how it differs from the narcissistic culture we live in, fueled by social media. They explore how this preoccupation with individual achievement and self-worth contributes to personal shame and the brain's natural corrective mechanism of self-loathing.+

21. Goal Seeking, Success & Surprise

Pursuing Success:Andrew and Anna discuss the pressure that comes with achieving success and how the pursuit of a specific prize can be unsatisfying. They talk about the constant need to keep climbing and how dopamine can create mirages of success.+
Finding Meaningful Success:Anna and Andrew discuss the importance of focusing on the process of daily life and finding ways to be of service to others, rather than solely focusing on achieving success. They explore how aligning one's compulsions with a greater good can lead to meaningful success.+

22. Reciprocity

Andrew and Anna discuss the benefits of giving and how it can positively impact one's life. They also touch on the science behind pleasure and pain and how it relates to dopamine. Anna's book on addiction is recommended and discussed.+

23. Closing Comments, Resources

Andrew talks with Dr. Anna about addiction and the role of dopamine in it. They discuss her new book "Dopamine Nation: Finding Balance in the Age of Indulgence" and how it sheds light on the topic.+