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    About this Episode

    Are you scrolling on your phone constantly? How badly do you crave that morning cup of coffee? Are you compulsively gambling, drinking, shopping, or even reading romance novels just to fall asleep? The potential for addiction is everywhere in our society, and on this episode of The Knowledge Project psychiatrist and author Dr. Anna Lembke discusses dopamine, addictive behaviors, warning signs and treatment for addiction, and how our brains handle all that pleasure and pain in life.
     
    Dr. Lembke is professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She appeared in the 2020 Netflix documentary The Social Dilemma to discuss the addictive nature of social media, and she is the author of the 2021 New York Times bestseller Dopamine Nation: Finding Balance in the Age of Indulgence, which explores how to moderate compulsive overconsumption in a dopamine-overloaded world.

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    🔑 Key Takeaways

    • Dopamine is a crucial neurotransmitter that not only brings us pleasure but also motivates us to work towards our goals. Addiction occurs when there is a deficit of dopamine, leading to constant cravings and the desire for more of the addictive stimulus.
    • Addiction is a severe condition characterized by compulsive behavior despite negative consequences. Diagnosis is based on specific criteria, such as control and cravings, and it is important to recognize that addiction can involve both substances and behaviors. Restoration of balance is crucial in overcoming addiction.
    • Addiction is influenced by dopamine release, but varies among individuals. Different substances and behaviors affect dopamine levels differently. Abstaining from a drug of choice for a month can reset dopamine pathways and alleviate symptoms for most patients.
    • Addiction is a separate and progressive disease that requires intervention and treatment, regardless of underlying psychological problems or life circumstances. Healthcare professionals can provide more effective care by recognizing addiction as a distinct issue.
    • Treatment for addiction goes beyond understanding its origins. It involves addressing biological, psychological, and social aspects. Early warning signs include a double life and lying about drug use. Restoring homeostasis is important, but ongoing support is crucial due to the chronic nature of addiction.
    • Addiction treatment involves addressing biological, psychological, and contextual factors, including insulating oneself from triggers, medication to limit cravings, psychotherapy for meaningful connections, and social support for recovery. Radical honesty is crucial to prevent relapse.
    • Addiction is a disease that affects the brain, and individuals should not be blamed for their behavior. Healthy activities and support groups like Alcoholics Anonymous can help restore the pleasure-pain balance and overcome addiction.
    • AA's success stems from its sober social network, transformative 12-step program, de-shaming process, ritualistic aspects, and holistic approach to addressing addiction.
    • By participating in support meetings, focusing on the present, creating self-finding strategies, and avoiding socialization with others who engage in substance use, individuals can increase their likelihood of long-term recovery.
    • Healthcare providers must recognize addiction as a brain disease and create a safe space for patients to discuss their addiction. Allocating more time to delve into psychological and emotional problems can lead to better outcomes.
    • Effective recovery requires healthcare professionals to have open and honest discussions with patients, using techniques like motivational interviewing, to help them actively participate in their own healing process.
    • Sleep is not always perfect, so it is important to adjust our expectations and find contentment in the small accomplishments each day to build a fulfilling life.

    📝 Podcast Summary

    The Role of Dopamine in Pleasure, Reward, and Motivation

    Dopamine is a crucial neurotransmitter in the brain that plays a major role in pleasure, reward, and motivation. Dopamine is released in the reward circuit of the brain when we engage in reinforcing substances or behaviors. It was found that dopamine is not just related to pleasure, but also to motivation, as it drives us to work towards achieving our goals. Our brain forms lasting memories of these rewarding experiences and creates a desire to recreate them in order to experience the release of dopamine again. Addiction occurs when there is a deficit of dopamine, leading to constant cravings and motivation to engage in the addictive substance or behavior. Pleasure and pain work like opposite sides of a balance, and our brain strives to maintain a level balance. Neuroadaptation occurs when the brain downregulates dopamine receptors and production to restore balance, leading to the desire for more of the addictive stimulus. Waiting for the brain to restore homeostasis allows the gremlins on the pain side of the balance to hop off, but continued consumption leads to addiction.

    Understanding Addiction and its Diagnosis

    Addiction is a severe form of psychopathology defined by the continued compulsive use of a substance or behavior despite harm to oneself or others. To diagnose addiction, the Diagnostic and Statistical Manual of Mental Disorders is used, which includes criteria such as control, compulsions, cravings, and consequences. Quantity and frequency of substance or behavior use are not included in the criteria, although they do play a role in determining the likelihood of addiction. It is important to recognize that addiction is not limited to substances but can also involve behaviors. In today's world, where many activities have become "drugified," it can be challenging to differentiate between minor addictions and a true psychological disorder. The conversation highlights the need to restore homeostasis and find a level balance to overcome addiction.

    Understanding addiction and its impact on dopamine levels and individual variability.

    Addiction is influenced by the release and speed of dopamine in the reward circuit, but there is significant variability among individuals. Different substances or behaviors may affect dopamine levels differently for each person. Additionally, the modern world has introduced a wide range of drugs and behaviors that can be addictive, making everyone more exposed and vulnerable to addiction. When seeking out dopamine, individuals are often looking for pleasure or trying to solve a problem. Those with psychiatric disorders are at a higher risk of developing addiction as they may turn to substances to alleviate their symptoms. Tolerance to a substance is a sign of chronic dopamine deficit, but it alone does not indicate addiction. Chronic exposure to drugs can lead to a state of dysphoria, causing symptoms of depression and anxiety. Encouraging individuals to abstain from their drug of choice for a month can reset dopamine pathways and alleviate these symptoms for the majority of patients.

    Understanding and Addressing Addiction: A Complex and Universal Issue

    Addiction is a complex issue with both unique and universal characteristics. While the duration of abstinence required to reset reward pathways may vary, 30 days is generally advised as a minimum. Withdrawal symptoms are universal and include anxiety, irritability, insomnia, dysphoria, and craving. Addiction can have various entry points, such as seeking fun, self-medicating, or escaping trauma. However, once addiction takes hold, it becomes its own primary progressive disease. Treating underlying psychological problems or improving life circumstances does not spontaneously resolve addiction. It is essential to recognize addiction as a distinct and separate issue that requires intervention and treatment. By understanding this, healthcare professionals can provide more effective care for individuals struggling with addiction.

    Comprehensive Approach to Treating Addiction: Addressing the Biopsychosocial Aspects

    Addiction is a complex biopsychosocial disease that requires a comprehensive approach to treatment. Merely understanding the origins or ideology behind addiction is not enough to solve the problem. Treatment involves addressing the biological, psychological, and social aspects of the disease. One important early warning sign of addiction is the development of a double life or a lying habit, where individuals lie about their consumption and minimize the frequency and amounts of their drug use. Treatment often begins with restoring homeostasis or baseline dopamine firing through abstinence from the drug of choice. However, addiction is a chronic, relapsing, and remitting disease, and cravings can resurface even after achieving homeostasis. It's crucial to be aware of the lingering gremlins of addiction and seek ongoing support and intervention.

    Comprehensive Approach to Addiction Treatment

    Addiction treatment involves not only addressing the biological aspects but also the psychological and contextual factors. Dr. Anna Lembk explains that addiction is driven by a dopamine deficit state, which leads to cravings. Therefore, part of recovery involves insulating oneself from triggers and reminders of the drug of choice. Medications such as naltrexone can help limit the reinforcing effects of craving. Additionally, both individual and group psychotherapy can be effective in treating addiction as it helps reteach people how to form meaningful and intimate connections. The social and contextual factors, such as stress and having a sober social network, also play a significant role in recovery. Furthermore, Dr. Lembk emphasizes the importance of radical honesty, where patients are encouraged not to lie about anything, as it helps prevent relapse. Overall, addiction treatment requires a comprehensive approach that addresses various aspects of the individual's life.

    Understanding Addiction as a Disease and Breaking the Stigma

    Addiction should be understood as a disease, and individuals should not be blamed for their behavior in that state. Dr. Anna Lembk emphasizes that addiction affects the brain and disrupts the pleasure-pain balance, leading to compulsive drug-seeking behavior. She suggests various healthy activities such as exercise, mind-body work, and meditation to indirectly stimulate dopamine production and restore the pleasure-pain balance. Stress is identified as a major contributor to addiction, with modern life's constant stimulation and overabundance being significant sources of stress. Additionally, poverty, unemployment, and social dislocation create vulnerable conditions for addiction. Severe pain can trigger relapse by causing a large dopamine release, similar to drugs themselves. Finally, Alcoholics Anonymous, founded by individuals who overcame addiction, has proven successful through shared experiences and support.

    How Alcoholics Anonymous (AA) helps individuals achieve sobriety through its unique approach.

    Alcoholics Anonymous (AA) is a remarkable social movement that has helped millions of people achieve sobriety. Despite being a grassroots fellowship, AA has remained successful because it is independent of any financial, political, or external organization. The key to AA's effectiveness lies in several mechanisms. Firstly, it provides a sober social network and allows individuals to connect with others who are also striving for sobriety. Secondly, AA's 12-step program facilitates spiritual transformation, which aids in recovery. Additionally, AA leverages pro-social shame by creating a de-shaming process, making individuals realize they are not alone in their struggles. The ritualistic aspects of AA also combat feelings of isolation and foster a sense of belonging. Ultimately, AA's success can be attributed to its holistic approach in addressing addiction.

    Rituals and Strategies for Addiction Recovery

    Addiction recovery relies on certain rituals and strategies to prevent relapse. In Alcoholics Anonymous (AA), meetings serve as an important ritual that provides a space for individuals to share their stories and seek support. AA emphasizes the concept of taking it one day at a time, recognizing the power of focusing on the present and overcoming cravings and desires in the short term. Biochemically, our willpower is stronger earlier in the day, making it imperative to establish self-finding strategies and barriers between ourselves and our drug of choice. Moreover, socialization plays a role in substance abuse, as individuals may seek out others who normalize and engage in similar substance use. By understanding these dynamics and implementing effective strategies, individuals can improve their chances of achieving long-term recovery.

    The Importance of Addressing Addiction in Healthcare

    Addiction is often overlooked or misunderstood in the medical field. Dr. Anna Lembk initially had little knowledge or interest in treating addiction, viewing it as a social or moral problem rather than a brain disease. However, a personal experience with a patient opened her eyes to the importance of addressing addiction. She realized that it is the responsibility of healthcare providers to ask about drug and alcohol use and explore these issues with their patients. Creating a safe space for patients to discuss their addiction is crucial. Additionally, teaching fellows and doctors to allocate more time for patients and delve into their psychological and emotional problems, including addiction, can lead to more meaningful connections and better outcomes. It is also crucial for healthcare providers to recognize the distinction between helping patients and enabling their addiction.

    Engaging Conversations: The Key to Recovery

    In order for individuals to truly recover, it is crucial for healthcare professionals to engage in impactful conversations with patients. It is not enough for patients to simply fulfill obligations and check boxes; they must actively participate in their own recovery process. This requires healthcare professionals to have open and honest discussions about the patient's goals and how they can help them achieve those goals. Motivational interviewing is a recommended technique to move individuals from a lack of motivation to addressing their problems to becoming motivated to make a change. Additionally, this conversation highlights the personal experience of Dr. Anna Lembk, who struggled with addiction to romance novels as a coping mechanism for sleep troubles. This personal experience underscores the importance of addressing addiction and seeking help when needed.

    Adjusting Expectations and Finding Contentment in Sleep and Life

    Our expectations around sleep in the modern world are often too high. Dr. Anna Lembk explains that normal adult sleep includes intermittent awakenings throughout the night and it is normal to wake up in the middle of the night. She also highlights that exercise can be a potent sleeping pill but it is not foolproof. Furthermore, she mentions that sleep medications like ambien may improve sleep quality by making us amnestic to the awakenings, but they don't actually increase the total amount of sleep. Dr. Lembk's perspective on success reflects her focus on small daily accomplishments and the accumulation of good days. Overall, the conversation reminds us to adjust our expectations around sleep and find contentment in the achievement of small things to build a fulfilling life.

    Recent Episodes from The Knowledge Project with Shane Parrish

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    Newsletter - I share timeless insights and ideas you can use at work and home. Join over 600k others every Sunday and subscribe to Brain Food. Try it: https://fs.blog/newsletter/

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    Join our membership: https://fs.blog/membership/

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    Watch the episode on YouTube: https://www.youtube.com/c/theknowledgeproject/videos

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    My Book! Clear Thinking: Turning Ordinary Moments into Extraordinary Results is out now - https://fs.blog/clear/ 

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    Watch the episode on YouTube: https://www.youtube.com/c/theknowledgeproject/videos

    Newsletter - I share timeless insights and ideas you can use at work and home. Join over 600k others every Sunday and subscribe to Brain Food. Try it: https://fs.blog/newsletter/

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    Sponsors:

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    Watch the episode on YouTube: https://www.youtube.com/c/theknowledgeproject/videos

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    Eight Sleep: Sleep to power a whole new you. https://www.eightsleep.com/farnamstreet

     

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    (26:24) The importance of writing things no one reads

    (36:55) Davis' experiences through financial crises

    (52:31) Why Davis loves managing a mutual fund

    (55:49) Why Berkshire Hathaway operates with margin

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    (01:30:20) Lessons learned from Munger

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    #188: Bryan Johnson: Five Habits for Longer Living
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    Johnson also opens up about the constant hate he receives from people online, how he deals with it all, and what he wishes he'd known when he sold his company.

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    Watch the episode on YouTube: https://www.youtube.com/c/theknowledgeproject/videos

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    Timecodes:

    (00:00:00) Intro

    (00:03:45) On biographies

    (00:08:03) On depression and coping mechanisms

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    (00:42:06) How to turn Blueprint protocols into habits

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    (00:49:07) The downsides and lessons of making money

    (00:59:22) The five habits

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    (01:07:48) Relationship between biological health and sexual health

    (01:09:50) Hair-loss prevention

    (01:15:46) Sunscreen, plastics, and other miscellaneous impacts on aging

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    (01:22:10) On success

    Dr. Becky Kennedy: The One Thing You Can Say That Changes Everything

    Dr. Becky Kennedy: The One Thing You Can Say That Changes Everything

    Dr. Becky Kennedy shares the skills you need but didn't get taught on regulating emotions, setting boundaries, and the best sentence you can say when a partner tells you something difficult.

    While there is an obvious focus on parenting, the most surprising thing about this episode was how much of what we discussed applies to EVERY relationship in your life.

    Learn how to parent more effectively with less stress, repair after a disagreement, regulate emotions, and unlock the next level in all of your relationships. Listen and Learn

    Dubbed the “The Millennial Parenting Whisperer” by TIME Magazine, Dr. Kennedy is the #1 New York Times bestselling author of Good Inside: A Guide to Becoming the Parent You Want to Be. She also hosts “Good Inside with Dr Becky,” the top kids and family show on Apple Podcasts.

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    Tom Gayner: Invest Like The Best

    Tom Gayner: Invest Like The Best

    Tom Gayner, CEO of Markel Group, reveals the lessons he’s learned from Charlie Munger and Berkshire Hathaway, how he invests, and the specific way he thinks about opportunity cost.

    Gayner shares the difference between good debt and bad debt, where he disagrees with Munger, and why he focuses on the basics.

    This intimate conversation offers a level of insight and honesty that Tom hasn’t offered anywhere else.

    Gayner is currently the CEO of Markel Group and the Director of The Coca‑Cola Company. He also serves as chairman of the Davis Series Mutual Funds board and on the boards of Graham Holdings and Markel.

    Listen and Learn.

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    Blake Eastman: Learn to Read Anyone

    Blake Eastman: Learn to Read Anyone
    Blake Eastman has dedicated his entire life to psychology and nonverbal behavior.
     
    In 2009 he founded The Nonverbal Group, a  behavioral research and education company in New York City which conducts large scale studies on human behavior and uses a wide range of technologies to systematically deconstruct and improve human communication.
     
    Eastman dives deep into a number of subjects revolving around how we communicate with one another, including the ability to read nonverbal cues, his thoughts on big talkers vs. silent types, how we can communicate with our partners without complaining, the value of watching ourselves communicate on video, understanding the power structures and social dynamics at work, and so much more.
     
    Eastman has also served as an adjunct psychology professor at the City University of New York for six years where he taught General Psychology, Developmental Psychology, and Group Dynamics. He is also a former professional poker player and the founder of School of Cards, the first brick-and-mortar poker school in New York City.
     
    Listen and Learn

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