In this podcast we talk with Anna Lembke, MD about her new book Dopamine Nation: Finding Balance in the Age of Indulgence
We cover topics like:
Anna Lembke, MD is professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. A clinician scholar, she has published more than a hundred peer-reviewed papers, book chapters, and commentaries. She sits on the board of several state and national addiction-focused organizations, has testified before various committees in the United States House of Representatives and Senate, keeps an active speaking calendar, and maintains a thriving clinical practice.
In 2016, she published Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press, 2016), which was highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic (Zuger, 2018). Dr. Lembke recently appeared on the Netflix documentary The Social Dilemma, an unvarnished look at the impact of social media on our lives.
Her new book, Dopamine Nation: Finding Balance in the Age of Indulgence (Dutton/Penguin Random House, August 2021), an instant New York Times bestseller, explores how to moderate compulsive overconsumption in a dopamine-overloaded world.
In this podcast we talk with Anna Lembke, MD about her new book Dopamine Nation: Finding Balance in the Age of Indulgence
We cover topics like:
Anna Lembke, MD is professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. A clinician scholar, she has published more than a hundred peer-reviewed papers, book chapters, and commentaries. She sits on the board of several state and national addiction-focused organizations, has testified before various committees in the United States House of Representatives and Senate, keeps an active speaking calendar, and maintains a thriving clinical practice.
In 2016, she published Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press, 2016), which was highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic (Zuger, 2018). Dr. Lembke recently appeared on the Netflix documentary The Social Dilemma, an unvarnished look at the impact of social media on our lives.
Her new book, Dopamine Nation: Finding Balance in the Age of Indulgence (Dutton/Penguin Random House, August 2021), an instant New York Times bestseller, explores how to moderate compulsive overconsumption in a dopamine-overloaded world.
Addiction is essentially the loss of choice around what we consume, without being aware that we have lost that choice, and it is incredibly insidious. Welcome to the sandstone care podcast where we help teens, young adults and their families overcome the challenges that come with substance use addiction and mental health conditions. Welcome to the sandstone care podcast with me, Clint Mally, today we're talking about dopamine, the reward chemical, the thing that's in your brain every time you do something that you like, and how that plays into addiction and to our everyday lives, inside and outside of alcohol and drugs. And we have an amazing guest for you today. Her name is Dr. Ana Lemke. She is the professor of psychiatry at Stanford University School of Medicine and the chief of the Stanford Addiction Medicine dual diagnosis clinic. So she's a clinical scholar. She's published more than 100 Peer Reviewed papers, book chapters and commentaries. And she sits on the board of several national state and national addiction focused organizations. One thing that I thought was really interesting is that she was in the Netflix documentary, this social dilemma, the N varnished look at the impact of social media on our lives. And today we're going to be talking about her new book, which is dopamine nation finding balance in the age of indulgence, I read it from cover to cover, and I can't wait to get into the details. It was an instant New York Times bestseller. It explores how to moderate compulsive overconsumption in a dopamine overloaded world. Dr. Ana Lemke, thank you so much for joining us on the podcast today. Oh, my goodness, thanks for having me. I'm happy to be here. So I am going to I'm going to set the stage where we talk about the beginning of this book. And I knew that you were an amazing writer, when you titled your first chapter, the masturbation machine. And if that's not something that catches people's attention, right off the bat, then I don't know what right. And so I'm wondering if you could kind of give us a condensed version of hey, what what was this? What Why did you choose to name this chapter that, and then how that played into your focus on addiction and dopamine, even within your own life. So the chapter is called our masturbation machines. It's based on the real life story of a patient of mine who developed a very severe sex addiction, and he actually built a masturbation machine. When I first heard about that, you know, I was shocked, as really, I think most people would be. But as I came to know him, and as I reflected on it, it occurred to me that he's not all that different from the rest of us. And that in fact, our smartphones and our other digital devices, where we're getting so many of our basic needs met now, instead of turning to other people are a lot like having a masturbation machine. I also introduced there my own compulsive overconsumption of romance novels, which started with, you know, The Twilight Saga, and then progressed to 50 Shades of Grey over about a two year period, facilitated by my Kindle, which, you know, turned me into a chain reader. So just really wanting to draw parallels between kind of the way we live now. And this patient who on the face of it seems so other and so kind of shocking, but really, really just as the same as you and me. And I think that that's the thing that really, when I read that it leveled the playing field, right, when we think about people who are addicted to opiates, or to what people consider to be hard drugs, or who have an addiction that interferes with their life, right, there's so many functioning addicts out there, right. But, but an addiction that really just is not something that you would hear in the news every day, right? And then we take them we say, hey, you know, if we really kind of drill down, okay, what is addiction? How does it? How does it play out in our lives, we all kind of have these different things. And technology has been a huge piece of that, not just in the technology of the drugs that we use, right, but also the way it's allowed us to engage in to interact with our world and with a brain that hasn't quite caught up yet. So we've talked about dopamine a little bit on this podcast. But in your own words, I would love for you to tell our listeners and our and our watchers, you know, okay, what is dopamine? Why does it matter when we're thinking about technology and about addiction. So Dopamine is a neurotransmitter, we make it in our brain neurotransmitters are those molecules that bridge the gap between neurons. Neurons are the workhorse cell of the brain, which send electrical impulses around that create the emotions, thoughts, feelings that we have. But neurons actually don't touch end to end, there's a little gap between them called the synapse. And bridging that gap are these little chemicals called neurotransmitters. Dopamine is the most common neurotransmitter and the most important neurotransmitter when it comes to the experience of pleasure, motivation and reward. It's not the only neurotransmitter involved in that process. But it is the final common pathway. And the fundamental difference between things that are addictive and things that aren't is that things that are addictive, release a whole lot more dopamine and release more quickly, in a part of the brain called the reward pathway or the reward circuit. So dopamine is just super fundamental to the experience of pleasure, reward motivation, but also to the process of becoming addicted. Yeah. So when we think about technology's role, and you kind of alluded to this, when you talked about, hey, you got into romance novels, and then the Kindle happened. And the Kindle was a was a game changer, right? We might consider these technology changes as being these huge monumental shifts, one of the things that comes to mind is kind of like vaping, right? Like, especially with THC and high concentrate, like technology, making concentrates more and more available in these in these concentrated doses so that it's easier so that it's more socially acceptable, so that it's easier to conceal these addictions. So what might people not really understand when it comes to how technology plays a role in addiction? Or maybe, maybe it's our greatest enabler? What do people not not think? Their first thought when they're thinking about technology about how it enables addiction? Well, I mean, you know, there are lots of different risk factors for addiction. Not everybody has the same vulnerability to this problem, I think it's important to state that fact plainly. One of the risk factors is just inherited vulnerability. So if you have a biological parent or grandparent with, with addiction, you're more likely to become addicted yourself, even if raised outside of that addicted home. But another major risk factor that people don't really think about is access. And simply having more access to highly reinforcing highly potent drugs and behaviors puts us at risk for addiction. If you are living in an environment where drugs are readily accessible, you are more likely to become addicted. So four of the criteria that technology really enhances our quantity, potency, novelty, and access. And if you think about like digital drugs, so if you think about something like tick tock, I mean, the quantity, it's literally endless, of potency, it manages to combine dance with images with storytelling, all of which individually are reinforcing and combined together, make a very potent drug. Novelty, or variety is really key. So you know, if you are not vulnerable, let's say traditional drugs like alcohol or cannabis, there's probably something online that you are vulnerable to, right that wasn't available or didn't exist before. That was certainly true for me. And that, again, just the importance of access, you know, the the 24/7 our smartphone is essentially the equivalent of the hypodermic syringe, it's just 20 24/7 Access, which means everywhere we go wherever we are, we can, you know, look for our drug. So those things really have transformed, you know the addictiveness of the world that we live in now. And then specifically, these devices are engineered to keep us tapping and swiping and they do that in a number of different ways. You know, the bottomless balls, the alerts, enumeration is a potent factor. When we give something a number, we make it more reinforcing that releases dopamine, whether it's, you know, our rankings or the number of likes, or how many times we got retweeted. What another sort of potent source of dopamine is, is anything that's novel or new or a little bit different from the thing that we like before and the AI algorithms essentially learn us and then proffer to us what we like before but a little bit different. So then that really triggers our search and explore function, which is key for dopamine to dopamine is very sensitive to changes in the environment or new stimuli. And then we keep looking for that slightly new little, you know, treasure chest. So things like that the technology has really figured out that those are the things that that kind of keep us engaged. And so I want to kind of paint the picture for how this process works. And I love the way that within the book, there's so many great illustrations, you know, illustrations from your patients, when they're talking about the spiral of their own addiction. And one of the ways that you that you illustrate really well is when you talk about the process of addiction, and you use like little would you call them Gremlins, what would you call them? Yeah. Gremlins? Yep. Got it. And so you talk about use these Gremlins to kind of draw this visual image? So could you walk us through that? You know, just explain. What does it mean, when somebody is like, slowly falling into addictions is probably somebody who's watching or listening right now. And they're like, Yeah, you know, that's not me. But if they kind of go through this process, they're gonna see that they might be somewhere on the spectrum, and they're not really aware of it. At least, we're all somewhere on this spectrum. So could you could you kind of walk us through that? Sure. I guess I'll start by saying that it's very hard to see that we're becoming addicted. As we become addicted. Even if you have a lot of knowledge about addiction, like me, you can fall into this problem. There's a way in which these behaviors can sort of hide out in the recesses of our minds. And we are not aware that they're happening when they're happening. And essentially, what what happens in the brain as we go from recreational use, or adaptive use, to maladaptive addictive use, is that we ultimately, basically go into a dopamine deficit state. And the way to understand that is, imagine that in your brain, there's a balance, like a teeter totter in a kid's playground. And that balance represents how pleasure and pain are processed in the brain in the brain, and they work like opposite sides of a balance. It's one of the interesting interesting findings in neuroscience, in the last half century or so is that pleasure and pain are co located. So the same parts of the brain that process pleasure also process pain. When we do something pleasurable, we tip our balance aside of pleasure, we release a little bit of dopamine in the reward pathway, and we feel good. But no sooner has that happen, then our brain starts to downregulate dopamine production, and dopamine receptors, in other words down regulate dopamine transmission, not just to baseline levels, but actually below baseline level. That's called neuro adaptation. And a way to visualize that is imagine that there are these little neuro adaptation Gremlins hopping on the pain side of balance, to bring it level again, but they stay on until it's tipped an equal and opposite amount to the side of pain. And that is the after effect that come down, or that moment of wanting to watch you know, one more YouTube video. Now, if we wait long enough, the Gremlins hop off, the balance is restored, you know, and we've upregulated our dopamine firing to its baseline levels. But if we continue to consume our drug of choice over long periods of time, we essentially end up with enough Gremlins on the pain side of the balance, hopping up and down there to fill this whole room. In other words, we change our hedonic setpoint or our joy setpoint. So that we then have a balance that's tilted semi permanently to the side of pain. And why do I say somebody permanently because we can get into a state where it can take a really long time to reverse that process of neural adaptation, such that even after abstaining for several days or several weeks, or in some cases several months, those Gremlins are still hanging out on the pain side of the balance. And when they're there, we then have intense cravings to use our drug. We're experiencing the universal symptoms of withdrawal from any addictive substance which are anxiety, irritability, insomnia, depression. Now when we use our drug, we don't feel good or get high, we just essentially feel normal. And really importantly, other things are no longer interesting, right? We've narrowed our focus to this one thing. And when we're not using it, we're preoccupied by it, we have a lot of intrusive thoughts of wanting to get back to it. And this is essentially what we're all experiencing, even on a micro level with our phones, for example, right? We put our phones away, we say, I'm not going to look at that. And then you know, within five minutes, we've got our Gremlins hopping up and down on the paint, I'd say look at the phone, look at the phone, look at the phone, you know until we're either automatically or just because we can't stand it anymore reaching for the phone again. So it's that sort of thing. slippery slope that happens as the brain kind of gets into this addictive space. Dr. Lemke, it seems like all of the deck is stacked against us, like, our biology has not caught up with technology, technology is just moving so fast. And so we might feel like there's nothing we can do. We're just kind of, we're always going to be in this state in which technology is, is changing at an exponential rate. And our biology is still in this cavemen era, right? Like we're, we're, we're, we still have these, these very basic neurological functions. So you know, what hope can we have for being able to overcome all of these different ways now that we can become addicted? And how it impacts us? Yeah, well, I mean, I'm actually really hopeful. I mean, remember, this is an unprecedented problem in human history. For most of human history, people lived in a world of scarcity and ever present danger. You know, the average lifespan was 30 years. You know, the fact that we're living you know, so much longer and have so much more stuff is really an incredibly new problem. And it is a problem. But I'm optimistic that we together and individually are going to figure it out. Dopamine nation is sort of my suggestions for how to do that. And what I do is I essentially hold up people with severe addictions, who have achieved recovery as modern day Prophets for the rest of us, because if they can figure out how to live in this dopamine overloaded world, and really the rest of us can, you know, take cues from them. And what I've learned from my patients is essentially that you have to start with abstinence, right, and you have to give up that drug, and you have to give it up at least long enough for those Gremlins to hop off, and for baseline dopamine firing to be restored. Why is that because otherwise, we will not be able to enjoy other things. And we'll still be plagued by the intrusive thoughts of wanting to use and our pleasure, pain bounce will still be tipped to the side of pain, such that, you know, we're experiencing that craving that irritability, that restlessness. But once you know, we give up that drug, we really do then reset our reward pathways, other things become enjoyable. We're not plagued by intrusive thoughts and cravings. And more importantly, or at least equally important, we can look back and see true cause and effect. Because when we're chasing dopamine, it's really hard to see its true impact on our lives. And I have a lot of patients who will do the 30 day fast from their drug of choice and come back and say, Wow, I didn't really even realize I was addicted, or wow, I thought my cannabis was actually helping my anxiety. But really, it was making it worse. And I only know that after giving it up for a month, and realizing my anxiety is so much better. And I've heard that so many times, I just heard that in clinic today from a wonderful young man who gave up alcohol and was essentially using alcohol for his pernicious anxiety, but after and tried all these other medicines that he tried ketamine, and psychotherapy, and all these things, nothing worked for his anxiety, he gave up alcohol for a month, and his anxiety got, you know, so much better. So I think just recognizing that, you know, if we're unhappy in our lives, it may actually be because we're constantly trying to not be unhappy, right? We're constantly reaching for these things to take away our pain. But our brains are not wired for that. So you know, the, the result is to make us more unhappy. And then, you know, if we've been able to do that not everybody can, obviously some people and some people shouldn't people who might go into life threatening alcohol withdrawal, have seizures, they shouldn't just stop, you know, those people need, you know, professional care and a medically monitored detox. But if you can give up your drug of choice, and you're able to do it for a month, most of us will feel much better. And then we're able to, you know, with clear cognition and insight, make choices about if and how we want to reintegrate that substance back into our lives. And if we do decide to go back to try to use using in moderation, it's a matter of creating self binding strategies. So how to limit our consumption, there are lots of different ways to do it. But combined with self finding strategies, it's knowing that the best way to get our dopamine is actually to press on the pain side of the balance in small ways, as a way to trigger our body to upregulate and adopt our own endogenous production of dopamine, norepinephrine, serotonin and other feel good neurotransmitters. Yeah, can we go into a few specifics of what does it mean to actually activate that pain? That pain trigger, right? And so yes, we have this seesaw, right like this. There's this there's this imbalance, and okay, in order for us to balance because Pleasure, pleasure and pain are located in the same part of the brain. Am I getting that right? Yeah, you are. Okay. So they're located in the same part of the brain. And when we have this imbalance, one of the things we You can do is, you know, trigger this pain response. What do you mean by that? Well remember, pleasure and pain work like opposite sides of a balance. When we do something pleasurable, that balance will always want to try to level itself out again. And it does that by tilting an equal and opposite amount of the side of pain before becoming level. That's just how the balance works. That's how it restores homeostasis, there's always a price to pay. So if we do something that's painful, that the initial stimulus presses on the pain side, the way that our balance will restore a level balance, is to tilt it to the pleasure side. That means that initially painful stimuli like exercise, like ice cold water baths, like doing anything really, that's hard, or effortful is going to kick into motion, our own endogenous dopamine production, right, those Gremlins are going to hop on the pain side, until it's tilted to the side of pleasure, that means we're essentially making dopamine and making other feel good neurotransmitters and hormones. When we're doing something hard. It's like putting money in the bank for later, just to think about it in in sort of a graph, like thinking about a graph. You know, when we expose ourselves to a pleasurable stimulus, what we have is a sudden rise in dopamine levels in the brain, followed by a sudden and precipitous lowering of dopamine levels below baseline, that's craving. That's anxiety, that's restlessness, right? Until we're level again, when we do something painful, we get a very different kind of distribution, what we get is a steady rise in dopamine over the course of that painful activity, and then a leveling out and maintenance at high levels of dopamine for hours afterwards, potentially, until dopamine then goes back down to baseline levels, so we don't get that dopamine deficit state. Now, one sort of warning or caveat to that, is that an extremely potent, extremely painful stimulus, like cutting on ourselves, actually no longer works in that healthy and adaptive way, it essentially becomes equivalent to a drug. And we know that, you know, from sort of human experience of people cutting on themselves, or jumping out of airplanes, or other extremely potent, scary, painful stuff. But we also know that from interesting animal experience experiments, so for example, if you take an animal and you give it a really intense and painful foot shock, you will see the same arborization or increase in dendrites in dopamine producing neurons and the reward pathway, as you see with a single shot of cocaine. So too much pain turns it into a drug, so you don't want to do that. So, you know, it makes me think about how, when we're trying to overcome something, we tend to, we have a tendency to want to, at least for myself, I'm not going to speak for all people, but at least for myself, we have a tendency to want to kind of insulate ourselves to go into like a little cocoon of comfort, to make life as easy as possible, right? Like, within my own family, you know, if you're sick, you become royalty, like whatever you need, you know, like, whatever, show whatever food, like whatever you do, or don't want to do, okay? Like, you're sick, we, you, you are loyalty, right? And though we might not think about that, when it comes to our addictions, or trying to give up something, right? We actually do that sometimes when it comes to when we're trying to mitigate the pain that we're feeling, right? Because of not using a substance or not doing an action that's triggering all of this dopamine. But what I hear you saying and tell me if I'm on the right track with what you're saying. But what I hear you saying is that it's that pain that actually allows your body to say, Hey, listen, we're gonna need some feel good chemicals. Because because we've got some pain chemicals here. And we want equilibrium. And people are always trying to get back to equilibrium. And so you actually need to feel the pain. If you actually want to build the natural chemicals of dopamine again, so that you can restore some sort of balance. Is that what you're saying? Yeah, that's great. I love I love it. You put that really, really well. That's your body going, Whoa, you know, there's pain here. There's danger. We got to help you know, we got to help you out and we got to, you know, make these chemicals to protect you and make sure that you know, you you get well and feel better later. And the exact opposite happens when we ingest intoxicants. That's our video. Whoa, whoa, hold on. We don't need any more dopamine factories shut down, shut down the assembly line dopamine. We got too much going on here. Right. Totally. So I think I want to bring this I specifically want to talk about technology. little bit more, I love how you used the TIC tock example where you're like, hey, that's it's novel, like, there's a learning algorithm. And I feel like I'm kind of doing the devil's work sometimes because because, you know, so much of what I do is in YouTube, and with podcasting, and, and social media, and I understand these, these things, the goal of every single social media platform, the goal of every piece of technology is to keep you on the platform longer, right. And their reward the content that does that, you know, a simple example, as you know, when I'm creating a YouTube video, they want you to create an end screen that features other YouTube videos, to suggest to that person, right? To be able to keep people on there longer, right? They favor people. So when you're posting a, on a Facebook or on Instagram, instead of giving a link to a YouTube video, they prefer for you to natively upload that video, because they want don't want you to go to another platform, everyone's real selfish about their own platform, right. And so, you know, when we have these algorithms that are learning us, that are learning the things that we love, and that we don't like, and, and it really honestly makes me question like, why is this showing up in my feed? This is, this is so bizarre, right? When we think about those kinds of things, especially with technology, are you saying that all of the same things, the principles apply, when we're when we're trying to overcome addiction is like, hey, we need to replace this, we need to do a different thing. We need to do things that are triggering this, this pain thing, we need this absence, you're saying that those are kind of connected? They're essentially equivalent. Is that right? Yeah, I mean, I think the key message here is that addiction is essentially the loss of choice around what we consume, without being aware that we have lost that choice. And it is incredibly insidious. And these platforms are engineered to be addictive. And what may feel like us choosing to watch this or watch that or stay on for a certain amount of time, is very often us being manipulated by the platform itself, to keep us there by essentially hijacking our motivation and reward system. Because it it knows how it works, that people have cracked the code on that. You know, for example, the kinds of like, suggestions for what to watch next. That's a great example, that in and of itself, without even watching it, just a suggestion of something else to watch, releases a little bit of dopamine, the reward reward pathway, followed by a little dopamine deficit state, which then induces the cravings to want to click on that thing, you almost can't not click on it, right? And then you click on it. And then you know, if it's reinforcing, then you get dopamine. If it's not reinforcing, like you thought it would be, if it's clickbait, then your dopamine levels plummet even further below baseline because it was an expected reward that you don't get. And we know when we expect reward, we don't get it, dopamine levels go really low. So then we're craving even more, and then we keep looking more for something that will make up for that dopamine deficit state. So it's this incredible, vicious cycle that we can get into where we really do lose our freedom and autonomy, right? Where it's like, stop me from going nuts, please, I don't want to keep doing this. And we're not even enjoying it anymore. Right. But we're caught in. And that kind of brings things full circle. You know, one of the things that you talked about, I opened up this podcast, and I was like, hey, you know, what, what are some of the signs that someone might be feeling? Or the the pathway that someone might become addicted? And you're like, well, actually, just because you know, things, doesn't mean you can't become addicted, or that you're even aware, right? And so one of my favorite things that you did in this book, is that you use first of all, you use real stories throughout the throughout it, and you got permission from your patients, and you change their names and like, you're very candid enough. But I think the realness of the stories is one of the things that makes things so powerful within this book, that your understanding that these are real people who are struggling with real things. And the realness that vulnerability breeds vulnerability, like we're more willing to accept and to see the things within ourselves when we're looking at it through the lens of someone else also being vulnerable. Right. Yeah. And we also don't feel so alone, right? We don't feel we feel that we're not the only ones. Yeah, we don't feel misunderstood. We like there's It's like so much benefit. And the other thing that I really love about what you did with this book is that we often look at addicts as victims, which in some ways they are, right? Obviously, we look at them as people who are struggling, we look at them as people who are weak sometimes, right? You'll see that within, it's this very stigmatized thing, whether it's mental health challenges, or it's substance abuse, or addiction, or it's the dual diagnosis, as you're familiar with, right. But what you did is you flipped it on its head, right? You're like, hey, there's been a group of people who have been, who have been thinking about how to overcome addictive substances. For years. There's a lot of science, there's a lot of studies, there's a lot of stories of these people. How about we actually elevate these stories of recovery, as a means to be able to learn how that we can follow in their footsteps? You you call them profits? So you know, can you just walk me through what was that lightbulb moment, like for you? Or wasn't even alive did just seem so obvious, because at least within the literature that I've read, I don't see that being the case, you know, elevating those stories? Yeah, well, thank you. For what you just said. I mean, you've touched on a couple things that are really important to me in the book, one of them being that the stories are true stories, that I got permission from my patients to share those stories, they, by the way, been very gratified that so many people have read the book and been helped by the book that's been really meaningful for the patients who are generous enough to share their stories, but I agree with you that they're real, that they're not sort of a made up or composite stories, but these are the real deal stories of real real life people. And then also, yeah, the book is in many ways, you know, honoring those individuals, and acknowledging that we have something to learn from them. And I guess, you know, to me, it was very natural to do that, because I've learned so much from my patients. I mean, I love treating patients with addiction, and, you know, patients in recovery, just really, they're so humble. And they have this incredible, hard earned wisdom. That's really deep wisdom. It's not just wisdom for people with addiction. It's really it's like life wisdom, you know, wisdom about humility, about what is the good life? What What should we care about? How to live in this world. So it was really easy to, I guess it is in a rear reframe, you know, holding up sort of these people who are often looked down upon in society and say, No, like these people, or these people have gone on, you know, what I'm saying? So, so yeah, I was, I was really happy to, to do that. Because I feel that very strongly, you know, about my patients, and I feel, really, I've learned more from them than than they probably ever learned from me. And I want to, I want to spread that love a little bit. I'm wondering if you can share, you know, just one story, either from the book that was in the book or, you know, another story that can help, because our goal was sands don't care. We, you know, we help teens and young adults with substance abuse and mental health is the inspire and empower change, right? So many times, like, we feel no hope, right? Like, especially if we've been no, somebody who's been dealing with this for a long time. So could you share a story about change about transformation from one of your clients, one of your patients that, that might bring a little bit of hope to our listeners and watchers? Sure, I'm happy to gosh, there's so much reason for hope. One of the patients that I write about in the book is Muhammad, he was a young man, very addicted to cannabis. He was able to stop for periods of time, but he would always go back to it. The various self binding strategies that I talked about in the book never really worked for him in the long run. And that's important to acknowledge that people with more severe addictions will not be able to go back to using in moderation. And he just got to this point where he was really kind of despairing. He went out for a nature hike and play raise but he had always sort of combined hiking and smoking. So every, you know, turn in the band, he was triggered and had craving, just getting so frustrated and so discouraged, and he had his camera with him and then all of a sudden he sort of saw this beetle on a leaf and he turned the camera on to the beetle and zoomed way in and saw this amazing Kara pest or shall have the beetle and this intricate, amazing colors and textures. and got closer and closer and zoomed in further and further with his camera and realized that, you know, in order to get a good shot, he had to really he had to go down and kneel and he had to ground himself, you know, on the earth, and he had to stay very still. And he had to, you know, slow down his breathing. And it was in that moment that he had an epiphany, because in that moment, he stopped craving or thinking about cannabis. And he was transported, you know, when he forgot himself. And of course, we all want this experience of non being, you know, we need to just be out of our bodies, and out of our own heads, you know, we all need that and want that how to get that without using something addictive. And in that moment, he discovered it, right. So instead of trying to run away from himself, and his own thoughts, and the world, which is essentially what we do with intoxicants with drugs, he focused very, very deeply into the present moment, he looked closer than he had ever looked before. And all of a sudden, the world became magical, it became interesting, it held all kinds of intrigue that he hadn't noticed before. And that was really, you know, the answer for him. And I remember when he told me that, in clinical care, I was struck, just by the power of that moment. But also, I realized, that's what I had done to, you know, because with my own problems of compulsive overconsumption, where I was drifting away from my family, even getting disconnected from my work. And so, I had done something similar to him, I thought, you know, let me let me pivot and reengage. Let me reinvest in the people in my life, instead of looking for other people, let me reinvest in the job that I have, instead of thinking, I need another job. And when I did that, in a sustained way, over many days, all kinds of good things started coming to me. And the world actually became reinforcing interesting, pleasurable, rewarding. And I think that's a huge lesson of the book. Dang, it made me made me take a second, just just to think about what you're saying, you know, oftentimes, when you're doing a podcast or something, you, you know, you don't want to have this dead space. But sometimes, it's also good to just hear what you're saying. And to understand like that grounding nature, and diving deeper into the world. And losing yourself into where you're at being in the moment, allows you to also not be triggered with cravings, and, and you kind of lose yourself in that and, and then one day, you're like, Oh, my God, I actually didn't think about this. I didn't think about this for a whole day or an hour, 10 minutes. And, and that's a win. And that's, that's so amazing. And, and I think that we all know somebody who we hope that they can find recovery, whether it's from a mental health challenge, or substance abuse, and sometimes it might seem like everything's lost, right, like, like, this will never happen to them. But your story about Muhammad and, and really, just, the more I hear this, the more it becomes evident to me that there's there's no way there's no way that we should be able to, to lose hope, as someone who studied dopamine and the triggers of technology, addiction, and, and understands, understands all the ways that this can be complex and hard and difficult. Like you get it like, you know, this, like you're a smart human being who really has done a lot of research has had tons of experience. And yet you still are hopeful. Yeah, I'm so I'm hopeful. And I also I just, I just say I also struggle. So, you know, it's it's not as if sort of, like, we cracked the code, and then you're done. It's it's an ongoing struggle, right. And I think ultimately, when I think about the pleasure, pain, balance, and how to manage both pleasure and pain in our lives, I'm gonna use the analogy of a teeter totter, in a playground, but really what it is, it's almost like a, we're bouncing on a board on a ball and bouncing on a board on a ball. There's no you can't be static, right? It's a dynamic function. You have to constantly be moving, balancing, shifting your footwork, readjusting a wind comes, you got to balance in a different way. I mean, that that's really what we need to do in order to maintain balance and and stay in that place where, you know, we don't we're not falling off. It's it's a constant, dynamic, eternal reassessment in the moment. Okay, what do I what am I doing now? Okay, what do I need? Let me shift here. Let me do that. And I was I was just talking with a family therapist, and one of the things they were telling me is, you know, Hey, you've never lived another life. Like, this is a unique time with unique challenges. If you have a kid, and then you have another kid, it doesn't mean that you figured out parenting, because every day, it's the first time with your child, your second child, that's that age, and they're a whole different person. You know, there's just, there's so much complexity, and it's refreshing to, to hear like, Hey, this is hard. And it's okay. And, and it's not going to you can be hopeful, and understand that everybody struggles, and that this is closer to all of us than we think it is. And I, you know, one of the side effects, consequently, of talking with so many smart human beings about substance use and addiction, is that it's constantly making me analyze my own self, right? Like, it is just builds a lot of empathy, doesn't it? You feel like, oh, like, they're not so different than me? Or, or I have a lot in common with them. Dr. Dr. Lemke, where can people go to learn more about you? And the work that you do and all the cool stuff you're about? Hmm, well, I mean, I'm not on social media. But there's a website for the book, dopamine nation calm or on Olympia calm, which has more information, but really reading the book. You'll probably learn more about me then than anything else. Awesome. You'll find the links for all of those things in the show notes in the description box below. And I also think it's just hilarious. Yeah, not on social media. We can maybe understand why. Like, that makes a little bit of sense. Dr. Lemke, thank you so much for joining us on the podcast today. You're very welcome. It's my pleasure. listeners. Again, you can find all the links for those things in the show notes you can do this change is possible. And we will see you on the next episode. If you want to learn more about treatment options for you, your teen or young adult. Then tell us about your situation on a competent to call using the number in the show notes or live chat with us at Sam's don't care.com we'll connect you with the treatment that you need. And if we're not the right fit, we'll get you where you need to go. Be well and remember that change is possible.