S5E6 Open Source Health Behavioral Addictions in the Age of Infinite Dopamine

In this episode of Open Source Health, Tripp and Marcus dive deep into the under recognized world of behavioral addictions. From gambling and pornography to TikTok and Tinder, they explore how frictionless access to dopamine-driven behaviors is rewiring our brains — and what that means for mental health, public policy, and clinical practice.

Chapters:

Tech troubles and dopamine casinos (00:00)
Is gambling addiction real? (01:30)
Sex addiction, the DSM, and insurance gaps (03:00)
Behavioral addiction vs business: Intermittent reinforcement (05:00)
Crypto, options trading, and the normalization of risk (06:30)
Porn, dating apps, and frictionless intimacy (09:00)
Impulse control, parenting, and hedonic competitors (13:00)
From obesity to tech overuse: The friction thesis (15:00)
What’s next: Recognizing process addictions (17:00)
A call for deeper public awareness and structural change (21:00)

Visit aimwellbeing.com to learn more about how we are personally working on these issues.

Find us on the web:

• Advaita Integrated Medicine
• Green Hill Recovery

Transcript

Tripp Johnson (00:00.463)
All right. Well, welcome back to the next episode of the open source health that we are trying to record in person and struggling mightily with tech issues. We're not tech guys. man. I don't think I could end up with a tech addiction after this fumbling around. You definitely could. You're required for it. Just not for this. It's not audio tech.

Well, we had we talked about like men's therapy last week and then we saw that Scott Galloway, his Saturday podcast was about pornography. Yeah. And it got me thinking, I actually asked Dr. O'Connor and Dan and Liz were talking about cases together and I was asking if they were seeing much gambling and pornography, people coming in complaining of that. And we have a little bit on the

pornography but not on the gambling. surprised me. Yeah. I was just at a conference and got asked a lot about gambling. We actually just had someone pop up today that wanted to know if we could help them with gambling. Which I find is like...

It's just, it's a weird one, right? Cause like there's not a lot of great treatment options or anything for it. You've had a couple of interesting personal, I guess like friends or friends that have struggled with it way that I think is pretty interesting. Yeah. And I think, I guess the, where I'd want to jump in is just, it's not recognizing the DSM, right? Like you can't, you can't like actually get gambling treatment covered by insurance. Right.

If you're complaining of it as gambling, if you're using it as anxiety, depression, like you could probably kind of sneak in gambling treatment because that's the cause of your anxiety or depression. Yeah. But like we don't recognize any sort of gambling disorder do we right now? I don't, I mean, I don't think so, but it's the same thing with like sex addiction. Sex addiction is not really recognized. And I think that one makes a little more sense to me, right? Because sex addiction can be this really

Tripp Johnson (02:11.244)
difficult to define sort of amorphous, it's probably like rare than some people would like to acknowledge. But then it's also probably one of those that when you see it, you see it. It's like, what else are we going to call that thing? I think gambling though is one of those that seems like there's got to be a way clearer line for that. Because what's actually got to happen? Is it appropriate of process, even if it's pornography and masturbation, there's some biological

very clear primal biological drive for it. Whereas gambling addiction is more of a tertiary reinforcement. I get the argument. I guess I just find both so hard to actually understand personally that I have a hard time thinking. Basically, I don't understand either, but I can understand eating disorder.

Right. Or even like just a general tech addiction. Yeah. To, you know, Facebook, Instagram, Tik Tok more than I can either gambling or like the true sex addiction piece. What I'm curious about though, from you and I want to be careful because I don't want to run the risk of doing that thing where you take like normative behavior and then you pathologize it. Right. But I'm curious.

If you were to take gambling addiction and think of it through a strict behaviorless lens and think of it strictly as intermittent reinforcement.

think I had a hard time seeing how starting a company and all the ups and downs you've had and we've had going through this cycle. There's an element of that that is maybe at a very basic biological, if you look at it just in terms of pure reinforcement, this intermittent reinforcement, that it has some quality to it. I granted, you can not model things out and do, it's not as much of a game of chance, but...

Tripp Johnson (04:19.241)
But I wonder if there's, you don't, that doesn't help you tap into that and understand that at all? Well, I mean, maybe I just don't understand gambling. I don't understand thinking you're going to win in gambling. Right. it's literally the house is built to beat you. So I just, I don't want to play a game designed to lose without cheating. Yeah. So, I mean, I totally get like being aggressive and being risky and having some impulse control issues.

I just can't see how I would want to gamble. It's wild because I have nothing about it. We agree on that. at the same time, when I look at the macroeconomic landscape, I'm very concerned about gambling and tech addiction. It's terrifying. Because I think it's going to be super pervasive.

And I think there's gambling stuff. I mean, we talked about some last week, you people who are now, you can do options trading from your phone, from your Robinhood account. Like people are really screwing us to their lives. The crypto stuff. Yeah. I mean, crypto is all just gambling. Yeah. There's no, I mean, I don't have the in-depth understanding of crypto, but it's largely, you just playing the game. It's like the, what's the, you remember prices, right? Yeah. You have the little guy going up to the top. You have to, uh,

you laying in all that sort of stuff and you just have to pull the trigger before he goes over the edge and you're looking to get as close as you can. So basically what crypto looks like, they're like meme pulling stuff. But you were just at a conference and a lot of people were talking about it. Yeah, mean, was a lot of requests that we could do or address anything that's primary gambling. Yeah. And this goes back to you, you've made a point before and like we've talked about this where the

The that's terrifying about gambling is like, you don't know it's a problem until you're gone. You've wrecked your life. Until you've destroyed your life. With like everything else, can, you don't see a lot of them, but they're all there with you, right? Yeah. You can do that forever. Your threshold for life may be a lot lower, your quality of life may be a lot lower, but there's ways that people hide their substances for years, right? But you eventually start to see it.

Tripp Johnson (06:43.557)
Like you start to see this stuff come out and instead of interventions and things can happen but gambling you're like in it and then it becomes a and then by the time you're really in it and it becomes clear that it's a problem you're so far gone. Life's through. Yeah so like if I'm trying to think through this in terms of like I would venture to say these technology and gambling and maybe that all fall to me that actually all falls under technology.

We're not gambling. One of the things we've done from that behavioral perspective is we've reduced the friction to gamble. We've reduced the friction to engage in sexual acts with our friends or computers. We have these devices where we can just go to the dopamine casino anytime we want. If I could do anything right now, positioning, looking at the future, it would be

develop resources for gambling and technology addictions because basically everyone's probably going to struggle with this at some level. I mean, we're lots of people. Yeah. I'll go to my hotel room tonight and I'll sit down on TikTok and we'll probably fall asleep way too late, right? Or something. But the frictionless piece is what's interesting, right? So I'm going to take it back to the question I asked earlier. I asked if

you could see parallels with the way that you engaged in a business, right? Yeah. And so there's gambling, there's risk, granted there's modeling and all this stuff, but that was a very friction full process, right? And so it requires a lot of planning, a lot of strategy, a lot of engagement, but the reward is much bigger. But if you could approximate some of the payoff of that with much less friction,

but still taking on all the same risks. That's sort of the, maybe that is the parallel with gambling. And I think about the same thing with like sex and pornography, right? Going out to a bar, sitting down, looking, searching and acquiring sex, your success rate on that's gonna be much, much lower, right? Like trying to have sex at a bar or whatever, pick someone up is much, much lower. Versus pornography, right? Like you can pull up porn.

Tripp Johnson (09:05.666)
And like, I'm a sex-political guy. Whatever you're saying is like, I'm not, I don't want to do this like weird, like, I'm talking in terms of pure utility, right? Yeah. You can fuck a chicken if you want. Right, Yeah. Bok bok, baby. Yeah. He doesn't bother me, he doesn't hurt anyone. Yeah, yeah. Assuming he's a dead chicken. Yeah, well, a chicken might like it. Who does? But what becomes interesting about that is now we're actually talking about like a survival level piece.

And I think Galileo is just someone who speaks to this stuff so well. Men, out of just pure evolutionary perspective, men that aren't partnered tend to fare worse in so many different ways. Women fare worse in so many ways. Society fails worse in so many ways. I think one of the real downfalls of some of the climate change narratives and stuff like that is we've been pushing this

hard hard hard thing of population control and scarcity mindset and that sort of stuff. I don't know how you would trace that that actually was affecting birth rates, but we're at pretty quickly hitting an inflection point around birth rates. There's probably a million infinite number of reasons for that that are coalescing in a mosaic effect.

If population dips a little certain level, it becomes under doing, then you have an aging population that can't be supported by a much smaller proportion, younger population. You mean like our current social security system? Big up, exactly. Just like that. I mean, I'm not as, I guess I'm not as interested in like the replacement rate stuff. And sometimes I think these are just macro economic things that economists throw around. But what I think what actually struck me is really interesting.

As we talked about a Zembeck in the past, is everything we're talking about now from the addiction piece outside of substance use addiction are all things that there used to be a lot of friction to get it. And there's a biological imperative to receive them. So as we've removed the friction now that there's abundant food and a lot of it is triggered to

Tripp Johnson (11:24.415)
are designed to make us crave it and not be satiated. Now we have an obesity epidemic. It was hard to find a mate and you had to go out there in the real world and now all of a sudden it went to Tinder and Bumble and your dating apps and you had that bifurcation where 80 % of women are going after 10 % of men.

Tripp Johnson (11:53.235)
But I mean, so the thing is, do think the, maybe that's not exactly the topic that we're focusing on, the niche topic in this that we're focusing on right now. But I do find the population piece really disturbing, especially if it is something where people aren't going out and securing sexual partners and because the drive to do so isn't getting so intense that you would actually leave the comfort of your, you know, this hedonic cocoon that we call our couch.

And so you don't end up going out, you don't meet people, there's all that sort of... It could have all these like secondary and then third order sort of effects. And I don't know how you connect that stuff. Maybe it's there, maybe it's not. But regardless, like there's a lot of things to get lost in that, right? Like all the skills you have to develop to acquire sex should do that sort of stuff. Or acquire a romantic partner or a relationship. There's a lot...

that has growth and potential and things that have to happen for that to come together, right? Well, I think like this, yeah. And I'm with you on all of that. I'm sure I feel like the well, mean, countries that have, you know, aging populations do have economic troubles, but I've never seen the the goal of anything for national economic gain like GDP. Japan's GDP is down. Right. Like does it like they have less people? Sure. Their GDP is down. Like maybe it's up.

Based on the number of words. When I hear it or when I hear Elon Musk having 97 kids and talking about how we need to have more kids, but we're also in an economy now where it's... I saw the new Birkin bag is a third kid. It's like you have to be... It is now a status symbol in some communities to be able to afford three kids. I thought that was funny.

But yeah, I guess, yeah, I'm just, I'm fascinated. Like I would like to be ready for gambling. Like I know, I feel like very confident if we could do gambling, technology, pornography, bring that all up and have treatment around that. I mean, there's just a huge need for it. And I just, I wonder what we can do to clear the way to do that.

Tripp Johnson (14:17.083)
Because it's just not recognized, right? Like again, like we've done this before, not even it's becoming more common, but it's been years where we've heard, well, can you take a primary process addiction? And I guess I just wonder like the difference between substance use addiction, not even like neurologically, is it, you know, like same treatment protocols you think? Like what do you think would be different? I don't know, But I just had this memory pop up where I was thinking,

of parallel sort of thing, right? Like when I first started my clinical career, someone had asked me if like cannabis addiction was a thing. Yeah, for a pussy. Yeah. But by the time I was like getting less out of direct clinical work, was like, I'm seeing exactly what I would call like it. And it has all the same sort of catastrophic fallout, like psycho, know, all this.

calamity of stuff coming together. In years past when someone asked me what about sex addiction, most of the time I didn't see something that made me think that this was like rape, it was always co-morbid. Someone's doing too much, too much blow, too much drinking, whatever, it's just like sex, right? If they have a hypersexual person, I don't know if this is a disorder or what.

But like we're sort of seeing, like again, it's the concentration of it. I think the frictionless access to it is actually to creating a lot of something, right? Something's going off. Something's going off. And I think it's going to be, I would just implore anyone.

some sort of regulating body. Like we need, we probably just need to get these things added to the DSM is the first step. Like I don't know what it is, but we've got to like recognize that because the technology piece is really terrifying to me. Because like I can't imagine with my current impulse control, like you said, like I have to like, where I feel like it's interesting for me is like, have to like leave my phone in places if I don't want to use it. Like if I'm at home with the kids, like

Tripp Johnson (16:31.948)
My wife's so much better about it than I am. But I've got to put my phone away, or I'm just going to be like, I'd like to check this. I'd like to check that. And thankfully, I grew up at a time where that wasn't the norm. But now, if you've got a smartphone, you've got everything right there. And at least remembering a time before is helpful. So I think about this.

Right? Like what you're describing is you've ultimately found something more purposeful being a dad. So you now have these obligations that are pulling at it. And so I think it's something similar with like substance use recovery is that you ultimately have to find something that's a hedonic competitor for it. The problem is it's always going to be tough to find something that's a hedonic competitor that has as much privacy to it. Right? Yeah.

If you can just pull your phone up and look at any number of porn sexual stuff, it's so easy to do. But it's never going to be as gratifying as being in a long-term relationship or creating stability or going out and having a sexual relationship with someone. That's more satisfying. If you get into that, it starts to compete with that in some sort of way.

at least the meditate against it right like you're obviously not done with that yeah no i mean to absolutely but i guess like where where i'm interested in is like we've got this meme of the twenty-year-old guy in his parents basement playing video games jerking off right vey dang like and maybe you know placing some little bats yeah but that meme is like real yeah

like you know because we are and where to me it's a pseudo flow thing that i'm very concerned with that we're approximating the right thing better and better and that's making work basically we have a cheaper frictionless alternative to the real thing yes and and that she were frictionless alternative doesn't come with any of the other positive externalities like you said like if you have to go to the bar and trying

Tripp Johnson (18:52.894)
pick up a chick or a dude or a person, then you can develop social skills. You are in community. There's a lot of other stuff happening. At the worst, you're going to fun night. Yeah, mean like, theoretically. Maybe too much. Yeah, mean that fun night can be a problem too.

But like there were positive externalities, right? And then even when we talk about it, like I think even the substance use piece, like the scarier part of substance use disorders now are the isolation that come with right? Like the thing you don't want to do for an IV user is use alone. Right? Like use with people. If you're fadin', like we can bring you back. And same thing, with, and I think that's like the piece with the wheat that...

is different now, right? Like it's just, if you just have to like go out and like buy some crappy weed and like, you know, figure out how to roll it or smoke it out of an apple or something, pick out the seeds and stems and like, now you're getting like, I'm just going to go to the store and get 98 % THC and I'm just going to rip this and be in my little, on the couch. But now I got door to asher. It's terrible.

Yeah, I mean that frictionless nature of it and I get the problem is that like all of this it's the combination to me of like biology and capitalism to some extent and and we can't we can't like just Societally, what are you gonna do because it is easy like these are these trade-offs kind of make sense, right? you know what I was thinking about just now was the Donald Hoffman is he's a scientist he does it

research on consciousness and one of the things he talked about is humans like we've not actually evolved for detecting reality, we've evolved to like recognize patterns. Just because there's a million different reasons for that and that would take us down a rabbit hole. But the problem with that is it largely works for us as a species, right? Like on the aggregate, if we're selecting from patterns, more often than not, we're going to get it right enough that it serves us as survival.

Tripp Johnson (21:09.797)
But the problem is there's times when there's pattern recognition are poor approximations that align with survival. I was thinking about, uses one of the biological examples he uses of this was there was some sort of beetle or something in Australia and there was this like, they had to ban brown bottles. And the reason they had to ban them was because the beetle would mistake it for its partner and just start breeding with it until it died.

And so the species of these beetles was dying off and they were sort of important for the ecosystem. so something, we're just animals. And so the problem is we're just breeding with our phones or whatever and it's a poor approximation of what we actually need. And the correlation is probably similar with back to your obesity epidemic. Now we have this access to food that at the risk of sounding

You know, like I've got a R.F.K. brain worm. Like, there's a reason that it's probably better to eat whole foods and yada yada yada and less processed foods. But the reason is not because you're, you know, whatever it's the whatever R.F.K. would say. But the reason to do it is because those things tend to have be packaged in a way that's we're going to be attracted to because all of our pattern recognition faculties are pulled towards that.

It's a poor approximation for what would be actually neat. Well, in the past, in the foraging days, the sugary, fatty foods were treats you needed. You looked for them, you had to find them. The rest of the time you're eating fibrous greens. I find it really interesting. Again, we're not evolved. The Scott Galloway quote that I always use is that...

Paleolithic brains, medieval institutions and godlike technology. And our brains aren't caught up at all. And so now we've got this technology that like we're just not like capable of wielding it effectively. And I think it's, I'm generally someone that's like, I'm sort of always skeptical sometimes in like top-down approaches because I

Tripp Johnson (23:32.91)
I come from this sort of Lindo Berry school of thought that locality of knowledge breeds better solutions. When you understand the location and the specific place that you're in, then the solutions for that are going to be tailored to that. That's my baseline. And yet, I don't think that

lies in this situation, but I'm not sure what the answer is. And I don't know how you regulate or control for these things or what that looks like. and that's the, but like, that's where, you know, technology is now near pervasive than any other system. And that's because of the internet. Yeah. And, and it's never going back in the box. So now we have to grapple with because yeah, like sure. And then not on the window, Barry's school of thought, but

I'm also even just from the pick yourself up by your bootstraps mentality where it's like if you don't want to be on your phone, put your phone down. And if you can't do that, put it in another room. If you can't do that, then get a flip phone. I'm literally considering a flip phone because I'm like, I bet it would be better for me in a lot of ways. But I'm not going to do that right now.

That was one of the things that was interesting to me coming out of the hurricane. I'm going to have this, there was this one spot that I could go to that had 5G coverage, right? So could get there, I could send messages out in the morning, coordinate stuff. I would go, anytime I had to leave there, I had about a two tenths of a mile, three tenths of a mile or something away from that spot before my fall would go dead again. And every time that I went, there was this like profound.

like isolation, detox, like brief respite that I would notice happening in myself or not respite, which is like panic, right? Yeah. And then after acclimating to that for like five to 10 minutes, it was back to like, well, I just can't do it. then it would be this profound equanimity. Yeah. over me. You know, in some way the paradox of that whole experience. I'd come back and I'd have all these messages. Oh my God, are you okay? You okay? And then I get like

Tripp Johnson (25:44.619)
three minutes away from where I had a signal and it's like, I'm better than I've been in years. Well, I think that's the count. mean, really just with the whole flourishing project, the personal flourishing project is at some level about impulse control in today's society because to eat healthy foods does not fulfill all of the dopamine centers in the brain the same way a salad and tofu does for me.

It's not gonna it's just not gonna work the same I Just lost my train of thought to that's But like they so impulse control like it's anything with the exercise like you don't like it, right? But it's not actually that enjoyable like even like even when you but you have learned to Get that you know like that time between the you know the activity in the real board there, you know, it runs like small

is longer and you have to be able to manage that. I've encouraged people and myself, I do this, sometimes do this energy audit, which is largely a proxy for a happiness audit to some extent. The interesting thing is your overall level of happiness is higher when you're doing all of these things that do not immediately bring you gratification. It's a counterintuitive lesson and I don't think most people learn it.

ever potentially. And if you do learn it, you kind of have to keep relearning it because you're always going to pick up, there's always going to be that shiny object, the thing that pulls you for your immediate attention and you have to reorient to what really matters. And so there's so much, like we talked about last week on the community side, there is friction and being in the community, there are all of these things that can't go wrong and you have to be willing to endure all of that to get the benefit.

And now, like in the past, there was no opting out of society. There was no opting out of the quote real world. But now that hedonic cocoon is as close as your vape and your cell phone and your parents basement. And that's different than it has been. Yeah. I think you sort of do something kind of interesting. Were you trying to host friends and people at least once a week at the house? Yeah. What was what was driving up for you?

Tripp Johnson (28:17.088)
I've always liked how Dr. Book invites people over from his team. People talk about it after and you're like, man, that means something, bring people together. For me, I just genuinely enjoy it.

Tripp Johnson (28:38.499)
It's and I think like I've got to go out of my way. Otherwise I'm stuck in like there's too much to do. Like I'm already late getting home. Like there's, you know, like it's a little bit of a burden and everything else. I, gosh, I was reading something. it was probably the Oliver Berkman. And it really is like there's so much to this friction piece. Like, and when you talked about like risk in terms of like business and everything else, you know,

What was initially going through my head was the obstacle is the way like, I will be successful with this because I will continue to, you know, treat the obstacle as the way knowing that a lot of people aren't willing to do that. Yeah. And so like, I know that if you just keep working at something like we've talked about, you just do a shot and go like, you can actually get pretty good at it. Most people just aren't don't have that impulse control.

to fumble through all of the learning until you achieve some level of mastery where it becomes enjoyable. And that's what I encourage. One of the things that I think is so important about participating in sports or having a real interest young is I have said, I got a buddy who's the CEO of a furniture company, and I did all his math homework. And I did so much.

like math and work in high school so he didn't have to take college level classes. And then he was the captain of the tennis team at Chapel Hill and he shot up the ranks like from being a salesperson to being a CEO in like eight years. And like I think that part of that is like you just learned how to master something and you learned the determination and you learned that there is a process and if I keep working it I'm probably going to get better and better.

But now you don't have to do that so much. Any hobby in the past had a lot of friction to get to that baseline level of mastery. Take guitar. Anything we do without phones is hard to some extent. You have to feel foolish, have to fumble, have to suck at it. That can be a really distressing thing.

Tripp Johnson (30:53.624)
But we're removing friction everywhere. So like everything we want to be on demand and that cycle makes sense. then when you look like what's the purpose of anything in life? Yeah. Yeah. Just get hurry up to the next thing. And so yeah, this friction piece, think is super important. Yeah. But I don't know how you like our society is literally wired against it. Like we are cruising towards like, you know, very or well in circumstances. Yeah.

The friction piece is interesting too. I'm thinking about this terms of a slightly different bend on the diet, on the food stuff, like what we consume. I'm thinking in terms of diet, like diet culture. You and I are both big fans of the guy, Lane Norton. One of the things I love about him is that he's researcher, he's an all-natural power lifter and all that sort of stuff. One of the things I love about the guy is he hammers home how much junk science there is out there.

It's the most boring answer but it's like, yes, calories in, calories out. You're not going to hijack that system no matter what any package or something someone's trying to sell you. Essentially the hook and the giant red flag on any diet is like are they telling you there's something frictionless? It's usually going to be like, we're going to be intermittent fasting, you're going to change your gut, biome, blah, blah, blah, blah. It's just a proxy for calories in, calories out.

or they're going try sell you this special diet if you just eat this, just do this. But the idea, ultimately I think it all creates more friction in your life. And it's the same thing with like horror or gambling or whatever. There's some frictionless entry point into a feeling state that you're trying to apply that ultimately will create more friction in your life. You can get to the same brain tingles

without with a lot less effort. the problem is it's going to create a lot of friction in the back. And so I think it's like these diets and it's like, cool. Yeah, you can do keto if you want, but you really want to eat a piece of fucking bread. Yeah, OK. I think I just came to terms with like gambling and sex pornography addiction. I just don't get it. I still don't get it. But here's what I get. OK, I just think those aren't as good as using drugs. Yeah.

Tripp Johnson (33:18.311)
Yeah, yeah, yeah. It's like, well, you know, you've got to learn to get to the gym because if you don't get to the gym, then your knees hurt and this hurts and your body breaks down. But like you can shortcut everything with like, you know, cocaine and heroin. Yeah, yeah, yeah. So I get that. The rewards from sex and scrolling, know, scrolling, TikTok, Instagram, gambling. it seems like, just, you know.

Go shoot death. So you're just like, is an intermediate step. Maybe just skip to the pure pleasure piece. I don't need pizza. I don't need like low calorie. Just lupin' Oh man. Well, yeah. We'll have to pick this topic back up, but I gotta run. Yeah. All right. All right. Cool.