Transcript

Dr. Anna Lembke: We've got all this technology that's now taken all these behaviors, you know, whether it's moving our bodies or connecting with humans or playing games that used to be really just healthy and fun. And we've managed to turn them into drugs. 

John: Welcome to Human Science, a podcast exploring the human element behind the science that shapes our everyday lives. We're powered by Labfront, the go to tool trusted by researchers looking to automate their studies and transform real world data into health insights.

 I'm your host, John Drummond, and today we have the privilege of welcoming renowned psychiatrist and author, Dr. Anna Lembke. Dr. Lembke will take us through her journey into addiction studies, the integration of psychiatric and addiction treatments, and the powerful roles of empathy, shame, and radical honesty in recovery.

She'll also share some insights from her acclaimed books, Drug Dealer MD and Dopamine Nation, while examining how modern technology and societal forces shape addiction today. So without further ado, please welcome Dr. Anna Lembke. 

Dr. Anna Lembke: Hey, John. 

John: Thank you so much for making time for us today on the Human Science Podcast. It's an honor to get to spend a few moments with you. 

Dr. Anna Lembke: Thank you. That's very nice. I'm excited to be here. 

John: Wonderful. Well, I was hoping we could jp into it because I have so many themes and topics that I want to discuss today with you.

Early Days and Initial Perceptions of Addiction

John: I was hoping we could kind of start more from the early days, really more from the perspective of what initially drew you to study addiction and maybe if you can expand on that too, maybe how has your, your perception of addiction evolved over all these years? 

Dr. Anna Lembke: Yeah, it's a great question. I have to admit that when I was first practicing psychiatry, I'd finished medical school, finished psychiatry residency, I did not want to treat people with addiction. And that was true for a nber of reasons. 

I think I had some, you know, innate negative counter transference as we as we call it in psychiatry sort of a negative bias against people with addiction. In part because I had grown up with an alcoholic father and I had an uncle who died of alcoholism. Plus, I had a very strong notion that addiction wasn't really a disease. It was sort of a social problem combined with a willpower problem. But probably most importantly, I didn't have any training in how to help people with addiction, so I, I didn't really learn anything in medical school and very little in psychiatry.

I suppose I could have learned more in my psychiatry residency if I had sought out that information, but that wasn't something that I did. So, when I first started practicing psychiatry, I, I sort of specifically said to the folks, “Hey, don't, don't send me anyone with addiction problems.” And the truth is that, if you do that, what'll happen is you'll end up with a whole bunch of patients with addiction problems who just don't talk about it.

So what I essentially discovered was that I had lots of patients with addiction problems, but we had a kind of secret don't ask, don't tell policy. I wouldn't ask them about it, they wouldn't talk about it, and we would pretend like their main problem, or their only problem, was their bipolar disorder, or their depression, or their anxiety, or their psychotic symptoms. 

Realizing the Importance of Treating Addiction

Dr. Anna Lembke: And I really struggled in those days to get patients better because the truth of the matter is, if patients have co-occurring addictive disorders, and they have other psychiatric disorders, and you don't treat both at the same time, your patients are probably not going to get better. It's only when we integrate that treatment and target the addiction and the psychiatric disorder at the same time that we're really gonna get, get people better. So, you know, that's what I started doing really, because I realized I wasn't helping people. 

And when I started asking patients about issues related to addiction, it turned out they were more than willing to talk about it.

They were even eager to talk about it, because these were problems that they were aware of, that they were struggling with in secret and in shame and they were, just delighted and desperate to have somebody to, you know, talk about it with, even if it didn't necessarily mean that it was going to be, you know, some kind of easy solution.

And early on in my practice, when I started targeting the addiction as well as the depression, anxiety, et cetera, patients got so much better. Much, much better than when I was just sort of prescribing antidepressants or mood stabilizers or anxiolytics.

I discovered that the work is super rewarding, that the patients are incredibly likable, that when they get into recovery, they're, they're very often these really remarkable people and, yeah, it's, I just love the work and I've been doing it pretty much for the last 25 years. 

John: It's beautiful. And I, you know, I really can just relate to your level of empathy that I feel in your voice and, and thank you for sharing really that transition. It sounds like you had with even understanding your own bias and then. Still working with it and now moving past that bias is what I what I hear in that story and you know the ideas around shame and and guilt that so many who have addictions often deal with if they are obviously at a conscious level it seems so important that you know, you're you're now a safe space for them.

And something that's very meaningful and very important to me is as you grew up with addiction in your household, I did as well with my mother. And one of the moments that we really got to deeply bond. And as you say, kind of share the story of this is when we, we actually were driving together and we listened to “Drug Dealer, MD” together. And it was the first time where we had these moments of let me pause and let me share a little bit about my story coming from her perspective. And this was so beautiful and so real for me. So I just wanted to thank you first of all. 

Empathy and Addiction Treatment

John: But the question there becomes how does this role of empathy in treating patients with addicted addiction play out?

And how can we understand maybe addiction more from the empathetic side, but also holding ourselves or holding each other accountable in their recovery journey? 

Dr. Anna Lembke: Yeah, great, great question. If you don't mind, I'm really curious. Do you happen to remember what were some of the themes that came up in “Drug Dealer, MD” that that got your mom to open up a little bit?

John: Yeah. And, you know, thank you for, for double clicking into that because what I think was really eye opening to her was from the perspective of how the pharmaceutical industry worked with. The medical field and being in her generation. You never second guessed your doctors.They prescribed you something, you know, they gave you a diagnosis.

That's just what it was. And I think that's still so beautiful. And we should absolutely, you know, take that to heart. But my generation grew up with a little bit more of the healthy skepticism around. Hey, maybe I can get a second opinion. Hey, is there a holistic way to think about this? And then can I marry that with a professional opinion in the medical field?

So she was prescribed antidepressants from her doctors and there was something around, just the marketing and the, the understanding of how that system worked that her and I really began to have that those first kind of honest conversations with each other. 

Dr. Anna Lembke: Yeah, that's great because that really does capture the field as I entered it, you know, in the 1990s, where the vast majority of patients who came in for treatment for depression, anxiety, what have you, who were also struggling with an addiction would say that they were self medicating. And I think there's some validity to that. We know that people with psychiatric disorders are at increased risk of developing an addiction, and on some level it probably is an attempt to manage those psychiatric symptoms.

But what happened in the field of psychiatry is that that became, became kind of the mantra for orienting on this dual problem of addiction and other psychiatric disorders. Such that psychiatrists said to themselves and to their patients, well, I'll just treat the depression, you know with an antidepressant for example, and then the addiction will get better because I've treated the driver of the addiction but what we know both from empirical studies as well as clinical observation is that if you just treat the depression, first of all our treatments don't really work as long as people are still drinking and still using for the most part don't work. But also, even if you magically effectively treat the depression, the addiction continues. So, even if the depression is what likely triggered the addiction, once people have become addicted, they, they essentially have a new and independent problem.

And this permeates to the point where a lot of patients with addiction come in to see psychiatrists just kind of looking for the magic pill, right? Well, just give me what I need so that I feel better and then I'll stop using. But it just never really works out like that. And I think this is where you asked originally about empathy and about treating addiction and shame and I think what what's so de- shaming and generally also effective, is to explain to people that addiction is, by and large, a brain disease, which doesn't mean that you have no agency, but you certainly have mitigated agency on being able to stop it without help. And that there's probably no magic pill, either to treat the addiction or treat the co- occurring depression, or whatever the psychiatric disorder is, that it's going to be, a biopsychosocial intervention that's ultimately gonna make the difference, which is to say that there's a biological component to this disease.

And so yes, there are medications that that can help, but there's also a psychological component and there's the social environmental component, so that it's super important that we intervene at all of those levels, especially for the most severe forms of addiction. And so I think that's a way to both give people an understanding of what's happening with their disease process while also remaining empathic, non blaming, de shaming, but also not let them kind of perpetuate the self medication hypothesis and think that oh if we just get the right combination of pills all your problems including your alcoholism will go away because that that's generally not the case.

John: Yeah, absolutely, and I do remember when she understood that it was more of that biopsychosocial. 

Dr. Anna Lembke: Yeah, sometimes people call it the biopsychosocial spiritual which is actually even better formulation .

John: I love that. Yeah, once she did understand that component, I think there was more acceptance and as a theme, I wanted to explore with you that radical honesty that she had more with herself and, and I don't want to make this all about her, right?

There's, there's so many components,that go into it from, from all of the socials, you know, the societal constructs too, but there was a level of acceptance that came from when she could kind of put away the shame and talk about it more from a disease perspective. I did see there was so much more accountability from her.

And then it came a curiosity, actually, which I loved. And that all came because of your book. Obviously, you know, there was, there was many factors, but a big thing I did see was just that curiosity that came from her. That's great. So thank you. 

Dr. Anna Lembke: Yeah, that makes me, I mean, that's, you know, that absolutely makes my day.

And I, I also suspect that the fact that you all were listening to it together and that it was a shared experience probably made it also more impactful and it's wonderful that you could share that moment. 

John: Yeah. So thank you so much. And, you know, when I started finding out about your work, I, I just felt how brave and how, how incredible you are.

But I wonder here: Was there pushback from the medical community? Was there a, a breath of fresh air from a lot of your colleagues where it was, “Thank you for writing this”? Or was it a, was there maybe, you know, a little bit of a, “Why are you speaking about these things?” Are you comfortable sharing anything of that?

Dr. Anna Lembke: Yeah, sure. 

Impact of 'Drug Dealer, MD'

Dr. Anna Lembke: So, I mean, ‘Drug Dealer, MD’ came out in 2016. We were, you know, well on our way, to the American opioid, North American opioid epidemic. It was, I mean, we were full on in it. 

And of course there had been books written for the lay public on the role of the pharmaceutical industry, especially ‘Purdue Pharma’, but also many others. For example, Barry Meier's ‘Pain Killer’, which was published as early as 2001. And then following my book in 2016, there, there was ‘Dopesick’, right before my book, there was ‘Dreamland’. So, you know, there, there were really excellent books out there, but my book was the first book written by an MD, you know, somebody inside the medical establishment who was talking about this issue, the role of pharma, the role of complicit doctors in overprescribing, not just opioids, but also antidepressants, anxiolytics, stimulants, the broad problem of polypharmacy and over prescribing in general in the field of psychiatry. 

And, you know, I guess on the one hand it was brave of me to write that book, but on the other hand, I really didn't have any confidence that anybody would read the book, and was, you know, surprised when there turned out to be a fairly large audience for it.

And yes, there were, there were serious and real negative professional consequences for me, in writing that book. Fortunately, in general, my home institution, Stanford University School of Medicine was incredibly supportive and has been very supportive to this day. I feel very lucky and grateful to the deans you know, during that time in the past and currently, but I did have interactions with some colleagues that were extremely negative. I think they felt betrayed that I would write a book like that. That was really unfortunate. I have done my best to kind of repair some of those relationships, I think for the most part.

I've managed to do that, but it was unpleasant for a while. 

John: Thank you for sharing that. And I can imagine. So sending love and support your way for all of that. And you know, this leads me to kind of more of a broader theme. 

Exploring Hormesis and Radical Honesty

John: Obviously many, many people know your work with ‘Dopamine Nation’. There's this concept in your books and a theme that I really wanted to touch into. And it feels like it's a balance. I believe the word is hormesis. And it kind of reminds me of homeostasis and us just finding balance.

And is it safe to kind of say that it's us looking for stimuli that, that creates a little bit of a stress response in our system, something to the extent of us doing hard things or choosing to do hard things versus just constantly seeking pleasure and feeling good all the time.

Dr. Anna Lembke: Close. I mean, I'm not sure I would use the word stress because I think in general we think of stress as not healthy for us, especially chronic stress or severe acute stress.

But I think this is just an issue of semantics. I mean, you could use the word stress for for this branch of science. So it's a branch of science called hormesis. Hormesis is Greek for to set in motion and essentially what's being set in motion in response to noxious or painful stimuli is our body's own healing mechanism.

This is a branch of science. It's in both humans and in animals showing that when you expose an organism to mild to moderate doses of painful stimuli, for example, cold temperatures, or exercise, even, you know, in animal experiments, small amounts of radiation, what you find is that the organism becomes more resilient, i.e. healthier in response. The thought here again is that it's a hormetic response. That is the body is responding to perceived injury by upregulating feel good hormones and neurotransmitters like our endogenous, that is our self-made dopamine, norepinephrine, serotonin, our endogenous cannabinoids, our endogenous opioids, et cetera.

It's a really powerful way of sort of getting these feel good chemicals indirectly by paying for them up front, which also means that because we have to work hard to get a small amount of these chemicals, it's much less vulnerable to the problem of addiction, right? Addiction comes when with almost no effort or very little effort, we ingest something that causes a huge release of dopamine in our brain's reward pathway and other endogenous feel good neurotransmitters and hormones. And as a result, our brain has to compensate. 

By downregulating production of those neurotransmitters, not just a baseline levels, but below baseline, which puts us in this dopamine deficit state, which I think sets us up for the state of constant craving and wanting to use now– not to get high, but just to stop feeling bad. 

So that's a lot of information packed in there. But let me just give some very specific examples of hormesis. So we know that exercise is actually toxic to our cells. And yet everybody knows that exercise is good for us. And what happens When we exercise, experiments have shown that dopamine levels do not initially go up, but they gradually rise over the latter half of the exercise period.

But here's the amazing part: When exercise stops, dopamine levels remain elevated for hours afterwards before going back down to baseline levels of dopamine firing. And that's of course the runner's high or, or some equivalent, but it's just, you know, it's just a great example of how hormesis works in humans.

You know, we do this thing that causes a minor injury. It upregulates dopamine, also serotonin, norepinephrine, and then we get this buzz afterward. The same thing happens with ice cold water plunges. Dopamine levels increase gradually over the latter half of the ice cold water plunge and then remain elevated for a period afterwards before going back down.

Again, never going below baseline into that dopamine deficit state. Even something like acupuncture is thought to work through hormesis, that is to say these tiny little needles going in, causing minor, minor injuries at the site, then incite the body to release our own self made endogenous opioids at that location, thereby bringing some degree of pain relief. 

Opioid receptor blockers like naltrexone, used in very low doses, have been shown to be helpful in some chronic pain conditions. Again, probably through hormesis, that is to say, when naltrexone binds our opioid receptors, the brain then senses that net opioid levels have gone down because the receptors are no longer being bound, and as a result, upregulates endogenous opioids, which we think is the mechanism by which people get some pain relief when they take an opioid receptor blocker.

Because the opioid receptor blocker, it moves in and out of the receptor, so there's a period at which it's unbound too, and that's when these endogenous opioids bind to the receptor and give some degree of pain relief. So those are just some examples of hormesis. 

John: I love it. And the idea of hormesis there, does it stay, you know, I think about can people become addicted or overstimulated to exercise to cold plunge, or does that actually not happen in the neurochemical sense, because you can't necessarily control a reaction to freezing water. You know, you've maybe have a certain level of willpower. There might even be a certain level of enjoyment that that begins to develop, but your body still probably has a natural reaction. So I guess what I'm thinking is, can you lose the hormesis effect if you start to really enjoy these things?

I'm thinking about this from the perspective. I remember Dr. Andrew Huberman talking to David Goggins, and I don't know if you know David Goggins. He's this guy who's like, “Embrace the pain, you know, it sucks. I hate it every day therefore I do it,” but I know so many guys who love cold plunge now and so many women who love sauna. You know, they they really embrace it all. Does that have the same effects when we enjoy the pain or should we really stay like oh, no, let's not do this. 

Dr. Anna Lembke: Yeah, right. It's an interesting question: Is the subjective experience of pain changing our relationship with the pain? Certainly it will and it does, but just on a more fundamental level, you know, can people get addicted to painful activities like exercise or ice cold water plunge?

And the answer is yes, they can. So addiction is the continued compulsive use of a substance or a behavior despite harm to self and or others. And although, you know, it has, especially in previous generations, been quite rare that people would get addicted to exercise, for example, we're actually seeing more and more of that now, and especially when it's combined with calorie restriction.

So now you've got two forms of sort of hormesis right– intermittent fasting or calorie restriction combined with exercise. And frankly, anything that releases dopamine has the potential for addiction, especially depending on somebody's unique wiring, what their particular drug of choice is. We know that there are dopamine releasing neurons in the brain that actually release dopamine directly in response to painful stimuli.

So it doesn't necessarily even require the hormetic or indirect response. You know, cutting works by that mechanism too. People cut on themselves because it releases endogenous opioids, which feels good. People can get addicted to that cycle. And the intervention for, for all of those forms of painful activities is the same intervention that we would use for addiction to intoxicants, that is to say, to understand it.

As a brain disease, that's ultimately resetting baseline reward thresholds below healthy thresholds such that the individual now needs to continue the behavior, not to solve a problem or to feel pleasure or to feel good in any way. But actually to just stop feeling bad from that kind of addiction vortex and kind of the brain's attempt to compensate and return to baseline levels or what we call homeostasis.

So when we're intervening for exercise addiction, we actually have people not do that particular form of exercise for a period of time, do more modest forms of exercise that are not injurious. Same thing with calorie restriction, right? The idea would be to not focus on calories, to not have fear foods, to eat in a mindful way that allows the person to eat  healthier amounts. With cutting, same exact thing. We conceptualize cutting as an addiction. We say abstain from cutting. The longer you can go without cutting, the faster you'll get to that place where you're not craving it. Just like when people quit cigarettes or quit drinking. 

So yeah, unfortunately, it's gotten easier and easier to get addicted to things like exercise and ice cold water plunges because like everything else, we've drugified it, right? We've made it more potent, more accessible, more novel, more bountiful, Social media has turned exercise into a form of social comparison and validation. We've got all this technology that's now taken all these behaviors, you know, whether it's moving our bodies or connecting with humans or playing games that used to be really just healthy and fun and we've managed to turn them into drugs. 

John: Yeah. Wow, it's so much there too. And really it leads me to what you touched on earlier in the show. And what I'd love to hear is kind of adding in that spiritual side to that, that triangle of understanding, making it more into a square of understanding around ourselves.

And it feels mindful to me, as you said, with being mindful about how you're eating, being mindful, maybe about how you're choosing exercise or how you're approaching the world. All of this in my mind as someone who is a little more spiritual sided, this feels like the radical honesty piece that you maybe speak on and the perspective of, you know, how can I be honest about my choices in life and how I'm communicating with myself and therefore maybe how I'm showing up in the world. So thinking about all that, this radical honesty piece, is there some actionable things or tips maybe you even have for our audience to start understanding how to communicate maybe differently with themselves first?

And then how they can show up for others. 

Dr. Anna Lembke: Yeah. So radical honesty is something I learned about from my patients with severe addiction in recovery from their addiction. And what my patients taught me is that in order to maintain healthy recovery, they couldn't lie.

And it was a kind of a radical approach because it wasn't just about not lying about using their drugs. It meant they couldn't lie about even the little stuff that we tend to lie about all the time. Like, you know, why I was late for the meeting, or exaggerating a personal anecdote to make it seem more interesting, or complimenting somebody even when we really didn't think that they deserved that compliment.

And we do these lies kind of reflexively. People have actually studied this. The average adult tells one to two lies per day. So we're all kind of natural liars, but with what people with severe addiction discovered is that if they would engage in those little lies that seemed insignificant and not connected to their addiction, they would inevitably find themselves lying about the important stuff and potentially relapsing.

And I just got really intrigued by that. I thought that was so fascinating. Then began to think also about how much I lied, you know, in my own life and how prone I was to these kinds of little lies of omission or commission or flattery or exaggeration and once I started to pay attention to that, which is what, what you have to do in order to engage in radical honesty, you have to first pay attention to the lies.

I was shocked by how difficult it was to go through even a single day without one of these lies. But, you know, as you point out, this is really part of a spiritual pathway, telling the truth, that is, trying not to lie, because it's about a fundamental value. And when we embrace the value of radical honesty, I believe it changes our brains.

I believe that what happens is that we actually strengthen our prefrontal cortex, and in strengthening our prefrontal cortex, we strengthen our awareness, we improve our ability to delay gratification, we improve our ability to actually see what we're really doing, what we're consing, how we're spending our time.

When we tell true stories, true autobiographical narratives about our lives, that's not just a way to organize our past. That's also a way to create a roadmap for the future and gives us better access to better information to make better choices going forward. I found a very interesting body of work actually looking at what happens in the brain as we lie and how it engages the storytelling part of our brain again, that prefrontal cortex, which is that large gray matter area right behind our foreheads that's so important for a narrative for delayed gratification for appreciating future consequences.

And there's this great study where individuals in the laboratory were asked to engage in a die rolling task where they could win money if the die that they rolled was the same as the die number that came up on a computer screen. And not surprisingly, folks engaging in this voluntary task, which was a little bit like gambling, but where they could just say what the outcome was, people tended to lie. They tended to lie about 60 percent of the time. 

What the researchers then did was that they applied a magnet to increase electrical conductivity in the prefrontal cortex of these individuals and then had them repeated the task. And what they found is that once they stimulated the prefrontal cortex, lying went down in this die rolling task.

Which is really interesting because it suggests that, okay, if we stimulate this important prefrontal cortical matter, people are less likely to lie, which also implies that if we actively try not to lie, we might actually be strengthening our prefrontal cortex in a bottom up process through this kind of Hebbian mantra that what fires together wires together.

So I think that's what's happening. I think that's why, you know, radical honesty, the effort to not lie about even the little things, I think it probably activates this very important part of our brain that's so important for putting the brakes on appetitive desire.

John: It's so beautiful and it really makes me think of kind of your own journey and how vulnerable maybe that was for you. I think in ‘Dopamine Nation’, if I remember correctly, you wrote about, I think it's some romance novels that you had been indulging in a little bit.  And you're setting such a beautiful example in my mind of how to even bring up the understanding in our days of wow,  I just fibbed about like, you know, the timing of coming home to my wife for no reason other than, I just, I don't know how to say, like, I might be a little late.

We concoct this story that I'm not trying to hurt anyone, but why am I lying about this thing?

Dr. Anna Lembke: Yeah, yeah. I mean,  that's right. I developed this kind of minor addiction to romance novels when I got a Kindle.

I could lie about what I was reading because no one could see the cover, and you know, I pretended to be reading things other than what I was actually reading that contributed to the progression of that maladaptive behavior. Yeah, and eventually I was leading a minor form of this kind of double life, which is so classic for addiction, where on the one hand, we present ourselves as a certain type of person in the world.

And then on the other hand, we're doing these secret behaviors that we would be ashamed if others found out about it. And, you know, I would kind of at times joke that, “Oh, I'm addicted to romance novels,” but I way underestimated the negative impact that it was having on my life.

It wasn't until I was in a situation where I was teaching some psychiatry residents and we were one person short to do these kind of practical interactive exercises. So I paired up with one of the psychiatry residents and I played the patient and they said to me, you know, “Is there a behavior that you would like to change?”

I tried to think of something. I said, “Well, I think I'd like to change my late night reading habit.” And they said, as they'd been trained to do in this exercise, “Well, is there one thing that you can think of that you could change in order to move you toward that goal?” And I said, “Hmm, yeah, I think I could get rid of my Kindle.”

So I didn't share what I was reading or the extent of the problem, but it was so fascinating because the next day I kept playing that conversation over, over, over again in my mind. And even though I still read romance novels that night, far too late into the night, all of a sudden I couldn't unsee that behavior.

You know, I was like reading romance novels and seeing myself reading romance novels. And so it came into my awareness. In a way that it hadn't been there before, and what precipitated that was putting into words to another human being what I was actually doing. So I, I think that that's why, you know, when I'm training medical students and psychiatry residents, I say, how do we enter into the conversation about compulsive overconsumption or addiction?

We simply ask people what they're consuming, how much and how often. We don't need to get into, you know, the guilt or the problematic use. The very first doorway in is, “Hey, do you drink alcohol? Do you use drugs? Do you watch pornography? Do you spend a lot of time on social media? Do you play video games?” And then just kind of say, “Well, what are you consuming and how much time and how many days a week?” That alone in my experience in clinical care can lead to a huge ‘Aha’ moment where people go, “Oh my gosh I hadn't realized I was drinking that much until I actually said to you. Yeah in the last week I've had x amount of drinks.”

 So anyway, it's just one of those little things that I think can can be really practical and helpful. Just try to go through try to go through one 24 hour period and not tell a single lie. It's a lot harder than you might think.

John: It really is. Yeah, and just as you said, I mean, it started with me with just recognizing, you know, having that conversation with myself and then catching it and be like, wait, you know, kind of getting that zoom out of your own life and observe yourself moment, because that was probably just such an unconscious pattern that I even had.

And so thinking a little bit about this now, as you wrote ‘Dopamine Nation’ I think, let's see, maybe three, three, three years ago or so, maybe four years at this point.

Dr. Anna Lembke: Just about. 

John: Has there been new data or new research or new findings that have emerged or, or that you are continuing to explore, you know, no spoiler alerts for a new book potentially, but anything that's really exciting you to continue this work and this research discovery.

Dr. Anna Lembke: Oh yeah. There's so much amazing research. I mean, this is the work of my neuroscience colleagues. I'm not a neuroscientist myself. Right. But their work is so applicable to the clinical work that we do and also just really fascinating. Recently,  I've been reading more about the role of serotonin in the reward mechanism and the way that when we do something that's inherently rewarding or pleasurable, dopamine goes up and it turns out in a certain part of the nucleus accbens, which is in the reward pathway at the same time, serotonin levels go down.

So those two have this own kind of interesting opposite effect in order to create, you know, the experience of pleasure and reward or its opposite. And that's so important for learning, right? I mean, a lot of times people say, well then, okay, dope means bad. No, that's the wrong message.

Dope means not bad. It's a really important signal and without it, we wouldn't know what to approach and explore and what to avoid. It's really a fundamental survival chemical in our brains that we can be really grateful for it. Both. It lets us experience pleasure and reward. It motivates us to get up and go get the reward. It teaches us the trajectory and the change and the rewarding effect of something over time. So yeah, lots of, lots of amazing work that folks are doing. 

John: It's beautiful. 

The Role of Technology in Addiction Treatment

John: And it leads me to think about, you know, the role of, of AI and wearable tech. All of these things in my mind seem to be wonderful new ways of data collection and making ease of collection for researchers and and your colleagues. And I wonder, has there been a thought yet of how these tools can kind of better inform how we treat addiction? But on the other side of that, just being someone who loves tech, but is also wanting to be mindful about tech, is there a risk of, you know, are we oversimplifying, the complex brain processes that, maybe something's happening, but maybe we don't know how the liver is interacting right there in the sense of just something weird, it's a blind spot still with where we are. 

So are you optimistic about where we're going in terms of tech and, and wearable tech and AI, or is there a risk here?

Dr. Anna Lembke: I think it's a double edged sword, like with everything else. There's the potential to really help. And there's also the potential to make it much, much worse. I mean, one of the things that tech has allowed is that we now count ourselves, you know, our heart rates, our vagal nerve tone, our breaths. On the one hand, it gives people information that they can use to be healthier, but on the other hand, it sort of detaches them from their ability to tune into their own bodies in a way that they are very capable of doing that might inform them better than a machine connected to their body.

So I don't know. I'll be curious to see where it all goes. And I think again, there's some real positive potential for how it might be applied, but I would just ask that people detach from all the technology for at least a couple hours a day and reground themselves in their own bodies without the aid of technology in nature, with other people. I think we just don't we don't want to lose that.

John: I couldn't agree more. I think it's such an underrated process and that grounding aspect where no technology is present, where you're just with yourself, is invaluable. And I hope that that tradition continues to, with all the generations to come. 

Final Thoughts and Future Hopes

John: As we start to wrap up here, what is your maybe biggest hope for how society will think about or shift its understanding and treatment of addiction in the next decade?

Is there anything that you're really striving for personally and professionally? 

Dr. Anna Lembke: I think my main message in ‘Dopamine Nation’ a little bit and in my other talks and writing is to convey to people the extent to which we are influenced by our environment and that we live in an addictogenic world that is really conspiring against us and that this ancient wiring to reflexively approach pleasure and avoid pain which has been so critical to our survival for most of our existence is now a liability.

So we really have to think individually and collectively about how we are going to live in this world of overwhelming overabundance. And I really do think that that's going to require us to intentionally avoid intoxicants, or at least avoid using them in excess and avoid using them too often and also that we need to seek out things that are inconvenient, hard, difficult, and even potentially painful in order to bring ourselves back into balance.

John: Beautiful. Well, Dr. Lembke, thank you so much for your time and I appreciate all of your continued wisdom and insight. I hope that is authentic and is not me–as we're saying, right– not trying to over flatter right here.

Dr. Anna Lembke: No, no. I can feel your authenticity. And thank you. 

John: Looking forward to all your continued work. And do you mind just sharing where people can find more of your work? I know, as we say, any social media, anything that you would like to shout out for, for people to explore your work more?

Dr. Anna Lembke: You know, I'm not on social media

John: I love you for that by the way. 

Dr. Anna Lembke: But there's probably enough of me in my books. I think that's probably enough for folks. 

John: Well, Dr. Lembke, thank you again for everything and we'll talk to you soon. 

Dr. Anna Lembke: Sounds good. Take care.

John: Thanks for listening to Human Science. If you enjoyed this episode and you'd like to help support the podcast, please share it with others or rate and review it. All the show notes and links can be found over at labfront.com/humanscience