August 16, 2021 • 1hr 59min
Dr. Anna Lembke: Understanding & Treating Addiction
Huberman Lab
Key Takeaways
- Dopamine is a neurotransmitter involved in reward, pleasure, and movement. It operates on a balance system where increases above baseline are experienced as pleasure, while decreases below baseline are experienced as pain or craving.
- Chronic exposure to high-dopamine substances or behaviors can lower our baseline dopamine levels over time, making it harder to experience pleasure from normal activities.
- Addiction involves a progressive narrowing of the things that bring pleasure. As addiction develops, the brain becomes less responsive to natural rewards.
- Breaking an addiction typically requires about 30 days of abstinence to reset dopamine pathways. The first two weeks are usually the hardest as the brain adjusts.
- Truth-telling and avoiding secrets are key components of addiction recovery. Being honest strengthens prefrontal cortex connections to reward circuits.
- Social media and smartphones can be highly addictive when used without intention. Setting boundaries and having phone-free times/spaces is important.
- Finding meaning through service to others, rather than pursuing individual achievement, tends to lead to more sustainable happiness and fulfillment.
Introduction
In this episode, Dr. Andrew Huberman interviews Dr. Anna Lembke, a psychiatrist and addiction expert at Stanford University. They discuss the neuroscience of addiction, focusing on how dopamine drives addictive behaviors and how to break addiction cycles. Dr. Lembke shares insights from her clinical work and new book "Dopamine Nation" on topics including:
- How dopamine creates pleasure and motivates behavior
- Why modern life makes us more prone to addiction
- The process of developing and overcoming addiction
- Social media addiction and smartphone overuse
- Finding balance and meaning in a dopamine-saturated world
Topics Discussed
The Neuroscience of Dopamine and Addiction (7:00)
Dr. Lembke explains that dopamine is a neurotransmitter involved in reward, pleasure and movement. Key points about dopamine include:
- Dopamine operates on a balance system - increases above baseline are experienced as pleasure, while decreases below baseline are experienced as pain/craving
- We have a tonic baseline level of dopamine release. It's the deviation from baseline that matters, not absolute levels.
- Chronic exposure to high-dopamine substances/behaviors can lower our baseline over time, making it harder to experience pleasure from normal activities
- This lowered baseline drives addiction as people seek more intense stimuli to achieve the same pleasure
Dr. Lembke notes: "If we expose ourselves chronically to substances or behaviors that repeatedly release large amounts of dopamine in our brain's reward pathway, we can change our tonic baseline and actually lower it over time as our brain tries to compensate."
Why Modern Life Primes Us for Addiction (18:20)
The discussion explores how aspects of modern life make us more prone to addiction:
- All our basic survival needs are easily met, leading to boredom
- We have constant access to high-dopamine stimuli (social media, porn, drugs, etc.)
- There is cultural pressure to "find your passion" and experience intense pleasure
- Many people feel a need for more "friction" or challenge in their lives
Dr. Lembke argues: "Life is hard now in this really weird way, in that we don't really have anything that we have to do. So we're all forced to make stuff up...And people really vary in their need for friction. And some people need a lot more than others. And if they don't have it, they're really, really unhappy."
The Process of Addiction and Recovery (50:05)
Dr. Lembke outlines the typical process of developing and overcoming addiction:
- Addiction involves a progressive narrowing of things that bring pleasure as the brain becomes less responsive to natural rewards
- Breaking an addiction usually requires about 30 days of abstinence to reset dopamine pathways
- The first 1-2 weeks of abstinence are usually the hardest as the brain adjusts
- By week 3-4, most people start feeling better than before they quit
- Triggers and cravings can persist long after quitting, requiring ongoing management
On the recovery process, Dr. Lembke notes: "You will feel worse before you feel better...usually in my clinical experience, you'll feel worse for two weeks. But if you can make it through those first two weeks, the sun will start to come out in week three. And by week four, most people are feeling a whole lot better than they were before they stopped using."
The Importance of Truth-Telling in Recovery (1:20:10)
Dr. Lembke emphasizes how critical honesty and avoiding secrets are in addiction recovery:
- Truth-telling helps strengthen prefrontal cortex connections to reward circuits
- Being honest creates more intimate connections with others, providing healthy dopamine
- Secrets and lies perpetuate shame, which drives addictive behavior
- Even small lies about mundane things should be avoided to build the habit of honesty
She explains: "When we tell the truth, we actually potentially strengthen our prefrontal cortical circuits and their connections to our limbic brain and our reward brain. And, of course, these are the circuits that get disconnected when we're in our addiction."
Social Media and Smartphone Addiction (1:40:20)
The discussion explores how social media and smartphones can be highly addictive:
- Social media/apps are engineered to be addictive, using variable reward schedules
- Many people use their phones unconsciously, not realizing how often they check
- Setting boundaries and having phone-free times/spaces is important
- A full 30-day "dopamine fast" from phones may be needed for severe addiction
- Even a single day without the phone can be beneficial for most people
Dr. Lembke advises: "We have to, again, put barriers in place that allow us to remain in control of our use, which means not, not too much, not too often, not too potent."
Finding Meaning and Balance (1:53:30)
The conversation concludes by discussing how to find meaning and balance in a dopamine-saturated world:
- Focus on being of service rather than individual achievement
- Take things one day at a time rather than fixating on long-term goals
- Cultivate offline connections and activities
- Align compulsions/interests with service to create sustainable fulfillment
Dr. Lembke reflects: "When we do that in a way that's authentic and paying attention and value driven, whatever our values are informed by, it is very, very interesting how those days, again, accumulate and you find, well, I guess I contributed something of value there, but I wasn't trying to do that."
Conclusion
This wide-ranging conversation between Dr. Huberman and Dr. Lembke provides deep insights into the neuroscience of addiction and how to cultivate a healthier relationship with dopamine in the modern world. Key takeaways include understanding how dopamine drives addictive behaviors, the importance of periodic "dopamine fasts", setting intentional boundaries around technology use, and finding meaning through service rather than achievement. Dr. Lembke's clinical experience and research offer valuable perspectives for anyone struggling with addiction or seeking more balance in life.
The discussion highlights how we are all susceptible to addiction given the right circumstances, and how societal factors are making addiction more prevalent. However, it also provides hope by outlining clear strategies for resetting our dopamine systems and building lives of sustainable meaning and pleasure. Overall, this episode offers an enlightening look at how our brains' reward systems shape our behavior and how we can work with rather than against our neurochemistry to live more fulfilling lives.
