This week on. It Starts With Attraction.
Speaker 2:Dopamine is a chemical that not just leads us to want to experience pleasure, but it may even be the chemical that's giving us the motivation to move towards experiencing pleasurable things. And in today's episode I'm speaking with Dr Anna Limpke. Dr Anna Limpke is a distinguished psychiatrist and she's also a professor of psychiatry at Stanford University's School of Medicine. She's also the author of the New York Times' best-selling book Dopamine Nation Finding Balance in the Age of Indulgence. In her book, she sheds light on the modern-day epidemic that we're experiencing of excessive dopamine-driven behaviors, and she offers insight on how to find balance and well-being in the midst of those indulgences. Today we talk about sex addiction, pornography, video games, alcohol, food, sugar all of the things Not all but we talk about several of the different intoxicants, as Dr Limpke puts it, that actually leads to this pleasure-pain cycle that dopamine is highly involved in. It's a great episode. Let's dive in.
Speaker 1:There's a process to falling in love, and it starts with attraction. Join Kimberly-Beam Homes and her special guest as they discuss how to become the most attractive you can be physically, intellectually, emotionally and spiritually or, as we refer to it, working on your pies. We'll teach you how to have better relationships and become more attractive to others and maybe, more importantly, to yourself. It starts with attraction and it starts now.
Speaker 2:Dr Limpke is so excited to have you on today. Author of Dopamine Nation, which is a New York Times bestseller. So that's I mean congratulations on a New York Times bestselling book. I know that must have felt fantastic. You spiked your dopamine a bit.
Speaker 3:Definitely. That definitely spiked my dopamine. Those unexpected rewards are the best yeah for sure, for sure.
Speaker 2:Well, what led you to want to write a book about dopamine?
Speaker 3:It was really a convergence of multiple threads in my professional and personal life in the last 20 years.
Speaker 3:The first was probably seeing more and more patients coming in with depression, anxiety, general despair, fatigue and ennui, who otherwise had really good lives good families, good social networks, access to all of the kinds of things that we would associate with a good life and who were not responding to traditional interventions like antidepressants or psychotherapy and who were consuming large amounts of substances over the course of the day, whether cannabis, alcohol or other drugs or various forms of what we call process addictions gambling, shopping, digital media and all its various forms.
Speaker 3:That coupled with the whole phenomenon of opioid overprescribing and seeing patients getting addicted to opioids prescribed by their doctor, but also a very fascinating noting that their physical pain got worse as a result of prolonged exposure to opioids. And then, of course, all the amazing neuroscientific research that's come out of the laboratories of my many wonderful colleagues and their predecessors over the past 50 to 100 years, showing that with repeated exposure to highly reinforcing substances and behaviors, we essentially change our hedonic or joy set point to the side of pain. So, putting all those things together, I felt like there was an important story to tell about how our relentless pursuit of pleasure actually leads to the inability to experience pleasure and leads to pain, and that our current mental health crisis could potentially be informed by understanding the neuroscience of pleasure and pain and the neuroscience of addiction.
Speaker 2:So do you believe that the current mental health crisis is made worse by social media, by alcohol, by those different things?
Speaker 3:There's plenty of evidence to show that, for example, over the past 20 years, drug overdoses have been steadily increasing, even separate from the opioid epidemic aside. There's also evidence to show that, despite decreasing stigma around being identified as a person with a mental illness and increasing access to a modern state of the art interventions like antidepressants, we are collectively getting more depressed, more anxious, more suicidal, less functional. So I don't think it's a stretch to look at that not just as a correlative phenomenon but actually a potentially causal one, and also to broaden our conception of what a drug is and to consider ourselves all vulnerable today to this problem of a compulsive overconsumption. That is to say, our environment is now saturated with highly reinforcing drugs and behaviors at the touch of a fingertip, and that by relentlessly exposing our brains to all of this pleasure, what we're essentially doing is effectively driving down our dopamine levels, which is, on some level, just a metaphor for making ourselves miserable.
Speaker 2:So how would you define a drug?
Speaker 3:I mean I think I probably wouldn't venture to to narrowly define it I could say that in the context that I'm using that word, what I'm talking about is anything that functions as an intoxicant and that I would define as anything that releases a lot of dopamine all at once in a dedicated part of our brain called the reward pathway. We know that intoxicants typically do that for most people not all people but we know that intoxicants do that for most people. We know from rat studies where you can actually put a probe into the brain and measure baseline levels of dopamine firing at exposure to chocolate increases dopamine firing 55% above baseline. So by that measure, on some level, chocolate is an intoxicant. Chocolate is a drug, I think. Going up from there, nicotine is 150%, cocaine 200%, amphetamines 1,000%. So essentially anything that releases a lot of dopamine all at once in our reward pathway can be conceptualized as a drug for the purposes that I'm using that term in my book.
Speaker 3:And it's clear that digital media in all its various forms causes the increased release of dopamine in our brains reward pathway. So we can infer from that that digital media functions like a drug. That's not our only point of inference. Our other point of inference is just the simple phenomenology that we're seeing a very strong correlation between increased rates of consumption of digital media correlating with increased experience of depression, anxiety and other forms of psychiatric and psychological morbidity and mortality. And I would venture to hypothesize that these are not just correlative. This is actually causal in the direction of digital media causing mental health disturbances.
Speaker 2:So you talk about this pleasure pain cycle of sorts that dopamine kind of takes us on a ride on. So for people who maybe this is their first time hearing about dopamine, although it's become more talked about in different areas, if people are saying well, what is this dopamine thing? Can you explain to us what it is and how it relates to this pleasure pain cycle that you speak of?
Speaker 3:Dopamine is a chemical that we make in our brains. It has many different functions, but one of its most important functions is that it mediates the experience of pleasure, reward and motivation. It may be even more important for motivation than it is for pleasure. We base this on a number of different data points, one of them being a very seminal experiment in rats showing that if you engineer rats to have no dopamine receptors in the reward pathway and you put food in the rat's mouth, it will eat the food and seem to get some gustatory pleasure from the food, but if you put the food even a body length away, the rat will starve to death Again, this idea being that the primary function of dopamine may actually be motivation to do the work to get the drug, rather than the experience of pleasure itself.
Speaker 3:I think that there's evidence to show that dopamine is involved in both pleasure and motivation, but not exclusively pleasure, because we can get surges of dopamine in response to aversive stimuli as well. But importantly, it's the fluctuations in dopamine over time that really determine whether or not we experience pleasure or pain from our drug of choice, which is to say that although our drug of choice may initially release a lot of dopamine in the brain's reward pathway. Over time what happens is the brain adapts to that drug by essentially down-regulating dopamine transmission and production in response to that drug. But the after effect, the come down, the hangover, that blue Monday, is actually made worse over time so that we get to a point where that drug that was initially pleasurable, with repeated use, doesn't give us much pleasure at all. And yet when we're not using, we're in a dopamine deficit state, below healthy baseline levels of dopamine firing and we're experiencing very intense craving to use, which is what drives the repeated cycle of consumption even beyond that experience being in any way pleasurable for us.
Speaker 2:You mentioned a minute ago that in opioid cases, for opioid users that prolonged use actually led to an increase in their pain. Is that related to the pleasure pain cycle that you're talking about right now?
Speaker 3:It's exactly the same phenomenon. So you know, when I use this metaphor to sort of simplify the neuroscience of a balance like a teeter-totter in a kid's playground, that represents how we process pleasure and pain. Increasing evidence shows that pleasure and pain are co-located in the brain. So the same part of the brain that process pleasure also process pain. So imagine that when we expose ourselves to something that's pleasurable we release dopamine. The balance tilts one way.
Speaker 3:But a driving force of all living organisms is to want to return that balance back to the level position, what's commonly called homeostasis. And we do that first by tilting an equal and opposite amount to the side of pain. Now again, I imagine that is these neuro-adaptation gremlins hopping on the pain side of the balance to bring it level again. But they like it there, so they stay on until it's tilted an equal and opposite amount. Over time, with repeated exposure to the same or similar stimulus, that initial deviation to pleasure gets weaker and shorter in duration, but that after response gets stronger and longer.
Speaker 3:In other words, those gremlins multiply. We get these Arnold Schwarzenegger gremlins pretty much then. We pretty much have enough gremlins to fill this whole room. Now you're in this chronic dopamine deficit state. That's the addictive brain. So what happens with people with chronic pain, or what can happen if they're exposed to high enough doses for long enough time that is, doses of opioids to treat their chronic pain is that, even though they're starting out with a balance til the side of pain because of their medical condition.
Speaker 3:When they take an opioid they do get initial relief because it restores homeostasis and they're not in pain. But this process of neuroadaptation nonetheless is at play and those gremlins multiply to return back to whatever was baseline for that individual, so that over time the opioids tend to stop working. The individual tends to need more and more to get the same effect and then they even get to a point where they have increased pain because of the neuroadaptation process in the original places of pain and also pain in areas where they never experienced pain before. And this is sometimes called opioid induced hyperalgesia. Hyper meaning more and algeasia meaning pain. So this is really just an incredible phenomenon to me and really speaks to the broader phenomenon of how this relentless pursuit of pleasure can actually lead to the absence of pleasure and its opposite and Hedonia.
Speaker 3:One fascinating data point here is that we are now trying to use naltrexone and opioid receptor blocker to treat patients with chronic pain. So on the face of it that seems paradoxical. Why would you want to block somebody's endogenous opioid receptors? That means the opioids that we naturally make can't find that opioid receptor. But what happens when you give people naltrexone and medication that's an opioid receptor blocker is you're essentially telling the body wait a minute, we don't have enough opioids. And what does the body do? It starts to upregulate its own endogenous opioid production, which then can lead to relief in pain for people with chronic pain. So I think that's fascinating and it just speaks to the ways that we, once we understand the science, might be able to intervene to upregulate in a healthy way the kinds of hormones and neurotransmitters that we need to feel good.
Speaker 2:So let me repeat back to you in a grossly oversimplified way to see if I'm understanding this correctly. So are you basically saying that we do something that makes us feel really great? It spikes that dopamine, but the reason that we go so low below that original line, is it kind of our body's way to? I guess the only way I can think of it. I have an eight-year-old daughter and when she doesn't get something she wants, it's like the temper tantrum right to try and get that thing just becomes even worse the more you say no. Is it kind of like the body's way of doing that, of saying like, hey, I want that again, so I'm just going to be worse off than before to try and get you to go get that thing I want you to get? Is that kind of what you're saying?
Speaker 3:I'm not sure you can analogize to your daughter's temper tantrums. That might be more a function of her will and her character.
Speaker 2:Very fascinating, that's for sure.
Speaker 3:And also I think we have to differentiate between initial exposure to an intoxicant.
Speaker 3:And again, I use that term broadly to encompass both substances and behaviors, because I think, for example, tiktok very short digital media that's an intoxicant. We have to distinguish between initial exposure and repeated exposure. So at baseline right we're always releasing dopamine at a baseline tonic level. If we do something that's intensely enjoyable, we temporarily increase dopamine firing above baseline. But remember there's always a drive to go back to baseline or homeostasis and the key here is that the way that our brains have evolved to restore homeostasis is first by overshooting and going into that dopamine deficit state before going back to baseline. So that's the initial condition. It's as simple as what goes up must come down, the law of homeostasis. Then you might reasonably ask well, why would Mother Nature do that? Why not just let us go to the pleasure side and then go back to baseline? Well, it's just not the way we're wired. We're wired to go into this deficit state and if you think about it from an evolutionary point of view, it makes good sense.
Speaker 3:If you are living in a world of scarcity, where you have a lot of competition for very few resources, then the people who are going to survive and the people who are willing to work very, very hard to get scant resources, and those are people who are. You know, they eat a berry and they don't feel good for eight hours. They feel good for about 10 minutes and then, or maybe one minute or 30 seconds, and then they're looking for a lot more berries. Right, those are people who are going to survive. So it's adaptive in that sense for a world of scarcity.
Speaker 3:Now, if you transpose that ancient wiring to our modern ecosystem, what you have is a maladaption or a mismatch between that ancient wiring and our modern ecosystem, where we don't have to do any work at all to get these highly reinforcing substances and behaviors. We can just sit on the couch and they come right to us through our digital delivery mechanism. So then, what happens to the brain Then? The brain is essentially having to deal with an enormous amount of stimulation, including dopamine, that it was not adapted for. So what does it do? It compensates over time by going into this dopamine deficit state, which essentially, again, is akin to a clinical depression. And now we're in this state of constant craving, experiencing the universal symptoms of withdrawal from any addictive substance or anxiety, irritability, insomnia and depression.
Speaker 2:What are you most worried about looking into right now, or even into the future, when it comes to either the types of addictions that you see people struggling with more, or the ones people are currently struggling with and those just having more people that are struggling with? I mean, when it comes to the reason you wrote the book, kind of what did you have in mind of what you were hoping to stop people from doing?
Speaker 3:The primary thing I had in mind was to alert people to the fact that we've all become vulnerable to the problem of compulsive overconsumption because of the mismatch between our ancient wiring and our modern ecosystem, which is saturated with dopamine. So when we look at the mental health crisis and rising rates of depression, anxiety, suicide, addiction of course there are many reasons for that, you know social dislocation, socioeconomic disparity, poverty, multi-generational trauma but I think one of the reasons for it that we are ignoring to our potential demise is the simple problem of overabundance and the fact that when we are constantly exposing ourselves to pleasure, we end up more miserable, plus we're guilty. We feel guilty about it Another layer of misery because we feel like we should be so happy. So, really trying to reorient on pleasure and pain by understanding the neuroscience of what drives these disbalance and then thereby encouraging people to actually insulate themselves from intoxicants, if they're going to use them in moderation and with enough time in between for the gremlins to hop off and for homeostasis to be restored, and actually to reconceptualize pain as something that is good for us and that is much needed in order for us to thrive in the world, and so wanting people to seek out painful activities, both literally physically painful but also just psychologically challenging, and to see that as an opportunity for growth and health.
Speaker 3:Now, a lot of this stuff you will find in the writings of philosophers and theologians over centuries. This is not really new ideas, but what I try to do is frame them with the latest neuroscience and also, frankly, kind of push back on some modern mental health tropes. In my profession, in psychiatry, around the drive that dominates mental health treatment, which is that, oh, our patients are unhappy. We need to take away all the stressors and actually make them more and more comfortable, and I think that that is leading to people not getting better and one of the fact what they need to do is reframe pain and to find adequate challenges in their lives so that they can have healthy brains and healthy bodies and find meaning and purpose.
Speaker 2:Hmm, how would you define the difference in an addiction versus a hobby or a social engagement? So things like video games, sex, alcohol, digital media use, phone use, things like that. At what point can a person kind of begin to self identify? Hey, this is more than just me checking my email, a normal amount. This is me. My life is being affected by it. What are the things to look for?
Speaker 3:Right. So there are no brain scans or blood tests to diagnose addiction. We diagnose addiction based on phenomenology, which is to say patterns of behaviors that observe, observable and verifiable through experience, either subjective experience or observed experience in others over time, across demographics and across countries. And the definition of addiction broadly is the continued compulsive use of a substance or behavior, despite harm to self and or others. And you'll see that for almost any definition of a mental health disorder, what is the difference between someone who's got a big personality and someone who's got a personality disorder? It's essentially whether or not they cross the threshold into harm to self and or others. Sometimes it's obvious when people have crossed that threshold, other times it's not. It's probably not a light switch in the brain that, like you're not addicted one second and then the next second you are. This is a gradual, iterative process. But quantity and frequency of use matters and the more that we expose our brains to highly reinforcing drugs and behaviors, the more that we change our brains and increase our risk of falling into actual pathological consumption. So when I use the word addiction, I'm using it to describe psychopathology, mental illness, somebody who has passed from recreational use into harmful use.
Speaker 3:Sometimes we think about the three C's control, compulsions and consequences, especially continued use despite consequences. Some softer signs to look for are just subjectively, how you feel when you're using the drug over time, noting that the drug stops doing what it used to do for you or even turns on you and does its opposite For example, using cannabis to sleep. And finding over time Cannabis actually wakes you up, makes you more suspicious, maybe even paranoid. Noting over time that other things become less enjoyable because your reward system has essentially been hijacked by this highly reinforcing substance and behaviors. Noting that you're now living not according to your values, lying, for example, about your use. Those are some soft indicators that are not in the DSM, the diagnostic and statistical manual, but I think from clinical experience and lived experience can be important to tell tale warning signs for developing addiction. Yeah.
Speaker 2:One of the things that I have heard you talk about is that there are these areas so I mean alcohol addiction people kind of know about. One that I've heard you talk about that's emerging is sex addiction and pornography. How are you seeing that affecting people, and who is it that's typically coming in for treatment? So, as we were chatting a little bit about before we started, I work in the marriage space a lot, and most of the time it's the spouse being hurt that wants the offending spouse, so to say, to change Right, which is the most frustrating place to be because you can't control that person who's engaging in this activity. And so what do you see? That typically precipitates someone personally getting to the point, especially with sex and pornography, of saying I need to make a change.
Speaker 3:We are seeing rapidly increasing numbers of typically men coming in for help with sex, pornography, masturbation, and we are seeing the most severe cases who bring themselves in. So these are individuals who have lost relationships, lost jobs, have legal consequences very, very severe forms. That then leads them to seek out getting help. But I am convinced that what we see is really just the tip of the iceberg of an enormous and growing number of individuals, especially men and boys, who are struggling with compulsive masturbation, pornography, sex addiction and really really suffering. And one of the myths about sex addiction is that it's about sex. In a lot of ways it's really not about sex. It's about maladaptive coping and using these various strategies to change the way that they feel, to deal with stress, to escape their own thoughts, to control their inner state. You can love your spouse and love your sexual contact with your spouse and still have a terrible sex addiction, because in some ways those things are orthogonal not entirely orthogonal, but very often, if you're really engaging in compulsive sexual behaviors, you're not going to bring the same pleasure to your sexual relationships with your spouse because essentially, you've answered anhedonia in law and you're losing the ability to take pleasure in other things period, not just in sex.
Speaker 3:But it's an especially difficult time for people to come forward with sex addiction, even more minor forms, because it's so woefully misunderstood and because there's so much stigma around sex addiction I would say much more so than around drug and alcohol addiction. There's so much shame around those behaviors, fear of being outed, fear of being identified as a predator having legal consequences. It's super shameful. But it's a huge and growing problem and we're seeing growing numbers of really young people, young men, coming in with this problem. But the good news is there's you know, it's treatable, there's something you can do about it. We intervene in a pretty much an identical way as we would with drugs and alcohol addiction and we work with families in a similar way. So one of the biggest things that happens in families that are struggling with the disease of addiction is the loss of trust, and that loss of trust is almost worse than the relapse or the use itself. It's the line around the behaviors.
Speaker 3:So you know, in addition to working with the individual with the addiction to try to give their drug up for a while. So try to reset, reward pathways and reevaluate. We work a lot with you know what I call radical honesty. We're trying to tell the truth, even when they're using as a way to regain the trust of their spouse or their partner, since it's that loss trust that is so eroding for the relationship.
Speaker 2:Yeah, absolutely Before something becomes an addiction, or maybe even if it's, if it would never become an addiction. But we're in that state we were talking about earlier where there's just this intoxicant that we keep going back to, keep going back to what is. So what do we do about it? If we are constantly checking our phones, email, instagram, if we are just craving, like if we're having problems? I guess the question here is does food fall under this food behavior?
Speaker 3:Yeah, so you know I have this dopamine acronym, but the core of it is essentially a dopamine fast where we identify what the problematic consumptive behavior is and we give that behavior or substance up for long enough to reset reward pathways, recognizing that we will feel worse before we feel better, right? So when you take that pleasure, that reward, off the pleasure side, those gremlins that have been accumulating on the pain side slam that pleasure pain balance, the side of pain and we're in withdrawal. And that lasts typically about 10 to 14 days and then the gremlins get the memo okay, we're not getting this substance. I can hop off the pain side of the balance. Homieostasis begins to be restored, people start to notice they feel better. So that's something you know, that I think people can do. It's a simple intervention, it's an early intervention. It may not work for people who are already severely addicted and simply not able to stop on their own, or people who are at risk for life threatening withdrawal from things like alcohol or benzodiazepines, but it can be a really good litmus test for the rest of us.
Speaker 3:And you know some people will say well, I couldn't possibly give it up for four weeks because, like I use my device, I have to be on Twitter, for example, for my job. That does make it harder, but even then, if you can't give up your device entirely, you can't give up food entirely, right, for a month. We wouldn't even recommend that. What you can do is identify what are the problematic, specific behaviors. You know, is it specifically processed food and sugars? Okay, you can give that up for a month, right. And, by the way, giving up sugar is probably one of the hardest addictions out there. I put it right up there with nicotine. Wow, really, really hard. People have intense cravings and withdrawal, and to get to 14 days is no mean feat. I've tried multiple times and I actually don't make it so really hard. If you can't, and with digital devices, it's a matter of saying, okay, maybe I'm going to delete my Instagram for a month, or maybe I want to delete my Twitter for a month, or whatever. It is really kind of singling it out to that specific problematic behavior and then just kind of doing the experiment, observing yourself, seeing how it goes and using that information to make more informed decisions going forward. If you really can't do a month, do 24 hours. I said this with digital devices because it is amazing how hard it is to just not touch a screen or any digital device for a full 24 hour cycle.
Speaker 3:You know, I think many of us will experience like intrusive thoughts of wanting to grab her, for even reaching for it, finding it's not there. If, for example, we locked it up so that we wouldn't be able to get it. We're just feeling completely at sea and disconnected and kind of panicking and anxiety, feeling anxious. So those are. You know, these are all experiments. This is a brave new world and I just think, you know, the technology is amazing but it definitely has a dark side, and so we have to look at that dark side. We can't just kind of, you know, squint our eyes and move past it. We have to really focus on it and evaluate it and make choices based on all of the information that we can gather.
Speaker 2:Yeah, I can imagine that one of the hardest things is for the person who's not quite yet addicted but knows that they have a problem to actually follow through with this dopamine detox, because they probably get a couple days in and think this doesn't feel good. And I just want to go back to what I was doing before because it wasn't really hurting anyone anyway. Right, you know, it's not like I was causing harm to myself or others. What encouragement would you give someone to kind of keep them focused and grounded and to have some of that willpower to continue through as to why this is an important thing to do?
Speaker 3:One of the things I like to do is to reframe the exercise as not depriving myself, but rather giving myself a gift. I think this is an important first place to start, because we think about oh, I'm not going to have that cookie. Oh gosh, I really want a cookie. You know, I worked hard. I want to reward myself. Everybody else is having a cookie and instead say you know what? I'm really doing myself a favor by not eating sugar or not playing this video game. I'm giving my brain an opportunity to rest, to recover, to do the experiment so that I can see if it does make a difference in my life.
Speaker 3:The other thing is to focus on what isn't working out in your life. What are the problems associated, or just even if you don't see them as associated, what are the problems in your life? And do you want to engage in an experiment, a tangible, real experiment that you can control, presumably if you're not at the point of addiction or you've lost control, which does happen, but where you can control it, and then just kind of take a look at that. You know again if you're depressed, if you're anxious, if you're not sleeping well, if you don't have enough friends, if you're bored, if you don't like your classes at school, if you don't like your job, try a dopamine vest and see what happens with your experience of this particular problem in your life, once you have eliminated these highly reinforcing substances and behaviors.
Speaker 3:And then, thirdly, I would say, do it together with somebody else. So co-regulation with other people is something that is so important. We really underestimate the power of co-regulation, for good and for bad. So engage in a dopamine vest with a friend, with a partner, with a family member. Do it as a whole family. It's so much easier because you're holding each other accountable, you're encouraging each other, and it's just so much easier than if you try to go solo, especially in a culture where we're constantly being tempted and invited to indulge.
Speaker 2:Yes, I didn't realize that when you do this dopamine detox and remove things from your life that are causing some of those more potent spikes of dopamine, that actually it's other areas of your life that could benefit from it. I always just thought it was maybe it would give me a better relationship with my phone or whatever, but you're saying no, it makes a 360 effect.
Speaker 3:Yeah, and as I talk about in the book, this happened to me personally, where I would joke that I was addicted to romance novels, but really I had developed a minor addiction to romance novels where I was constantly chain reading on my Kindle, reading at social gatherings instead of socializing, even at some point, bringing my Kindle to work and reading in the 10 minutes between patients, and I really didn't see it as a serious problem. But gradually, what happened over time is I lost the ability to take joy in things that had normally given me joy, like my children and my husband and my work, and I didn't see the connection between those things. And then I decided to experiment, as I advised my patients to do, with giving up this particular drug for a month, and it was fascinating on many levels, but the most impactful piece for me was number one how difficult it was. In the first 10 to 14 days, I really had physiologic insomnia, which I hadn't had before as part of the withdrawal phenomenon, and how much better I felt when I made it to four weeks, how much more I enjoyed the things that I used to enjoy, and then that allowed me to make that connection. What happened then was I told myself. Oh, I'll be fine to go back to reading. And then I binge read all weekend long and went to work that next Monday hungover. So then there was a realization. Oh wow, that didn't go well. I think I'm going to recommit to a longer period of absence, which I didn't do too.
Speaker 2:Yeah, I've also heard you talk about how even just the thought of engaging with the intoxicant can actually increase the dopamine in our brain and kind of gives us that initial push to want to do it. And I was thinking about that this morning, thinking last night I had finished dinner and I thought I have ice cream in the fridge or in the freezer, like I don't even I'm full, I don't even want ice cream. But once I had the thought I had to have the ice cream.
Speaker 3:Absolutely, Absolutely, yeah, and this is what we sometimes talk about as euphoric recall, where we'll and this is a common, well-described phenomenon among people with severe addiction to drugs and alcohol where they'll have the memory or their recall, the time that they used and they get this intense craving to use based on euphoric recall, and what's happening in the brain most likely is that they're getting a little spike of dopamine, so getting a little bit high Remembering use, followed by a little mini dopamine deficit state, which then creates the craving and the restlessness to use, which then sets us up to do the work, to go get it, and it's almost impossible to resist desire once we've gone through that dopamine cycle. So the key there is to try to insulate ourselves not just from the drug of choice but also reminders of the drug of choice. Now, this can be very difficult to do because you live in a family and maybe you've got ice cream there for other members of your family who are not interested in giving up ice cream. So that makes it. You can't just get ice cream out of the house, right?
Speaker 3:Or when we look at sex and pornography addiction, sometimes it's just like the fantasy life. As one patient said to me the bar is in my brain, right? So the fantasy life is part of what then keeps people in that cycle of addictive craving. So then sometimes people have to commit to giving up sexual fantasies, as well as giving up the kind of acting out behaviors which is it's like don't think of white elephants, don't think of white elephants. But some of the ways to do that is to it's a sometimes referred to as think through the drink, Don't just think of white elephants, Think about the way that white elephants stomp around your living room and destroy all the furniture. So walk yourself through the consequences so that you don't get stuck in euphoric recall. You remember the whole cycle.
Speaker 2:Yeah, I mean you said it's almost impossible to resist once that thought chain, the euphoric recall begins. But I mean what you recommend is resist it kind of replace those thoughts, work the willpower, kind of like building a muscle. I mean, is it kind of like building a muscle?
Speaker 3:Right, oh, absolutely. And also sort of mindfulness meditation practices, just observing the craving come up, crest and subside because it will subside and recognizing that you are not your feelings, you don't have to react. I mean, you are your feelings but you don't have to react to those feelings, or you can create some distance between them, which is to actually do something intentionally. That's more painful than the pain of craving. So, for example, do 20 sit-ups, go for a walk, take an ice, cold water plunge, read a complicated text. So you're kind of actually trying to jolt your brain out of that craving vortex into another state.
Speaker 2:Spiritual practices meditation, prayer can do that as well, yeah, so you talk about there being a I can't remember exactly the way you word it, but kind of an appropriate way to experience dopamine. So is the appropriate way that you expend effort for the dopamine that you receive? And what does that look like?
Speaker 3:Yeah, so I mean, I guess I probably wouldn't use the word appropriate just because the whole thing is that word.
Speaker 3:I can't remember what you used. I'm trying to find the language because it's so laden with judgment that I always need. But how can we talk about it? I think the idea is it's not even to say never use intoxicants, like never. It's not to say never go I mean you never go on YouTube and mindlessly scroll. I mean I do that all the time. But it's more to say hey, recognize the intoxicating nature of these activities, recognize the way that they can hijack our word pathway.
Speaker 3:You can get lost in them and then be really intentional about using in moderation, leaving enough time in between, doing it dopamine fast if you're already caught up in the compulsive use, so that you actually have a chance of being successful in moderation. Because people say, well, can't I just cut back? Why do I have to stop and then go back to using? Mainly because we find cutting back doesn't work. People are much more likely to be able to use in moderation if they first stop for a while, reset reward pathways and then try to go back to using in moderation.
Speaker 3:And then there is this idea that there might be more sustainable ways of getting dopamine indirectly by paying for it upfront.
Speaker 3:Which is to say we know that when we press on the pain side of the balance, the gremlins hop.
Speaker 3:I mean, when we press on the pleasure side of the balance, the gremlins hop on the pain side of the balance. If we intentionally press on the pain side of the balance, those gremlins actually switch sides and go hop on the pleasure side of the balance and we get our dopamine indirectly, without that dopamine deficit state. So again, that's things like exercise, ice, cold water immersion. We know that dopamine levels gradually increase over the latter half of those activities, remain elevated for hours afterwards before returning back to baseline position without ever going into that dopamine deficit state. So this idea that it's not, that we all, we're not, just not going to hang around with this boring level balance, that's just not human beings, right, we're strivers, but by doing things that are hard and getting our dopamine that way we're more likely to. Not entirely not entirely will we avoid addiction, because you can still get addicted to pain, but we're much less likely to fall into that compulsive vortex Define appropriate amount of time between exposure.
Speaker 2:How do you know?
Speaker 3:You know what? We don't have it defined. But I can tell you one thing to watch out for is daily use. There does seem to be something very salient about that 24-hour cycle and if we can avoid daily use and also avoid binge use. So, which is to say, try to not use every day, try to space it out with some non-using days and when you do use, be mindful of trying to use low potency and low quantities.
Speaker 3:So you don't want to get into this work hard, play hard mentality where we slam on the pain side of the balance. We work all day and then we come home and we're exhausted and then we drink a six pack of beer. That's also not good. Going this extremes again, to extend the metaphor. But you want to have a subtle pleasure pain balance. You want it to be able to respond to modest cues and powerful cues in the environment. And the way to keep that healthy balance is by doing things that are hard, getting your dopamine indirectly. And if and when you do use intoxicants, leave some time in between, probably at least today, and use in moderation.
Speaker 2:Last question I want to ask you is the dopamine mechanism the same in kids or does it fully develop at a certain age? And if it is the same in kids, how should we be mindful of our kids and exposure to sugar technology, these different things that could become a problem for them even when they're still children?
Speaker 3:What's different in kids is that throughout childhood and adolescence, we are pruning back on the neurons and the neuronal synapses that we're using least and myelinating or making more efficient the neuronal synapses that we use most. Often this process is referred to as pruning. You might imagine it as pruning the branches of a tree that you're just left with the essential branches that you need. So what that says is that this is a very important time where we're essentially creating the neurological scaffolding that will support us throughout our adult life. So if we're, at a very early age, priming our brain to be overwhelmed with surges of dopamine and to have to compensate in the way that I've talked about, that's going to be a stressed out brain which is then going to develop a lattice work to sort of perpetuate that cycle. So you want to, early on, make sure that we develop healthy coping strategies and that kids are not exposed to powerful intoxicants repeatedly.
Speaker 3:Remember I say that people often feel a kind of a sense of hopelessness, like, oh no, it's too late, I've already messed up. But you never feel that way because the other thing about kids brain is that they're very plastic, meaning that they can change and you're growing new branches and synapses all the time. So the whole period is an incredibly plastic period. It's never that's a wonderful time to intervene and to make changes, because there's enough plasticity there to get new synapses, new branches, to myelinate those, whereas when we work with patients who are in their 50s, 60s and 70s, a lot of that system has become relatively calcified. It's not impossible, but it's a lot harder.
Speaker 2:Yeah, so it's even more important in some ways for children.
Speaker 3:Yeah, yeah, the opportunity is. It's just a time of opportunity.
Speaker 2:Yes, absolutely, dr Anna Lymphke amazing conversation. Where can people find out more about you, follow your work and get your bestselling book, dopamine Nation?
Speaker 3:The book is available wherever books are sold. It's also available on Audible for people who like to listen rather than read, and I'm not on social media, but there is a website, dopamine-nationcom, to read more about the work that I've done.
Speaker 2:Thank you so much for your time. I appreciate it. You're very welcome. Thanks for inviting me.
Speaker 2:Here are my key takeaways from today's episode with Dr Lymphke. First of all, I'm just honored to be able to speak with someone as highly esteemed as Dr Lymphke and the amazing work that she's doing, especially at Stanford. And man, what a great book that she has of teaching people about dopamine and the cycle that it puts us. On my key takeaways and how it really translates to us in becoming our best versions of ourselves, talking about ourselves physically, intellectually, emotionally and spiritually. This is a topic that hits every single one of those categories Because if we get into this pleasure pain cycle with different intoxicants, like Dr Lymphke talks about, then it's going to have a negative effect on every single area of our lives because it can begin to really bring negative consequences to our personal health and our relational health. When we begin to crave an intoxicant so much that we actually begin to sacrifice connection with other people or even doing the things that are actually healthy for us, such as exercising or eating healthier foods, then that's where the negative effects and consequences of this dopamine cycle come into play. So here are my key takeaways from today. I think I've said that three times now, but here they actually are. The first one is to do a dopamine detox, so taking the process that Dr Lymphke outlined for us and identifying what is it in our lives that we really are becoming intoxicated by.
Speaker 2:And if I was going to be transparent, which I will be with all of you listeners, then I would say the probably number one thing on my mind right now is my phone, and recently sugar. We'll get to that in a minute, but definitely I mean, I am the queen at just constantly checking email, slack, instagram, email, slack, instagram all throughout the day. And I've actually implemented an app that I used on my phone, that I still use on my phone, called Opal, and it has a free version of it, which is the one I'm currently using, and you can actually block certain apps for certain hours throughout the day. So I block Instagram, facebook, all social media and Gmail and Slack for six or eight hours a day and I've thought, well, this is helping, but what ends up happening is when it automatically shuts off at 3pm, is when I just get on and then I just binge do it, or I just find my computer because it's not on my computer and I'll do it when I'm on my computer doing stuff. And so for me, I think a very good exercise that I need to participate in is taking some of those devices just off my phone completely and dedicating a day a week especially for social media. I think I could go. I know that once I start I could go a month or months without social media, but when it comes to some of the things like email or Slack, there's definitely better ways that I could engage and interact with those things, because there's just always that thought in the back of your mind like someone might need me right.
Speaker 2:Another thing I've heard Dr Limke say before is that we, as humans, crave connection and crave social connection, and so when we have this feeling that someone may have reached out to us on Instagram or liked something we did, or there could be an email of someone who needs us in our inbox, then that drive to want to check it, that dopamine spike that we're thinking about and how it could give us pleasure to feel needed and feel included and feel wanted. I mean, that's part of what starts this whole process. So for me, that's definitely one thing that I'm going to commit to do, but the other thing is sugar Y'all. I went eight years on a paleo diet and didn't eat sugar and didn't eat gluten, and then I had kids and it has been all downhill from there. Not really all downhill, but I've really noticed in the past like month or two, every day I'm just craving sugar, and so one of the key takeaways I have from that today is not necessarily trying to get all sugar out of my life, but going 24 hours without engagement with certain things. So going 24 hours without checking Instagram, I'll probably go more. Going 24 hours without eating sugar, maybe eating it just three days a week, finding a healthier way to engage with some of these intoxicants, but they're different for you.
Speaker 2:So when you think about what is it that you seemingly compulsively go back to? Once the thought comes into your head, you have to have it. Maybe it's alcohol, maybe it's some kind of drug, maybe it is pornography, maybe it is a sex addiction and maybe it's something that you're struggling with to the extent that you are harming yourself or other people, and I want to encourage you today by telling you to get help, because there's always hope. There are people out there who are experienced, such as Dr Limke and in the lab and clinic that she has out in Stanford, I can help you with this. I encourage you to make it your key takeaway today to go and make that step of getting help, because it's only going to keep hurting you and it's only going to keep hurting those who you love. Now, for those of you who are not in an addiction state, I encourage you to continue on with the dopamine detox that she outlined, talking about how, just even being aware that you're going to experience pain during this, because those gremlins are going to be really starting to try and get that seesaw to get you to do the pleasurable thing again. So be aware it's going to happen.
Speaker 2:Remove the triggers from your house. Try and proactively think of happy thoughts or more helpful thoughts that you can replace with. When you are met with that desire to go and eat the ice cream or check your Instagram or go and watch the porn, what can you do instead? Who can you bring in to help keep you accountable? And then, more than anything, how can you reframe this to realize you're giving yourself a gift, it's not something that is just being taken away from you. You're actually giving yourself a part of your life back. And then there are the religious and spiritual practices that can help us get through the pain of the detox stage of this as well Prayer, meditation, reading your Bible and then she also mentioned even doing some hard things can help you have the willpower to overcome those dopamine cravings that you might get. So taking a cold bath, going for a run, doing 20 pushups, whatever it might be, engage in some of those harder things to kind of get your mind off of it and again, it's another form of replacing your thoughts and replacing your behaviors.
Speaker 2:Overall, one of my other key takeaways for this is avoiding daily use and avoiding binge use. So avoiding the daily use of something, and sugar is such a great example of this. So it's not just not eating sugar Monday through Friday and then Saturday and Sunday you go into a sugar coma, because then that's the binge use. It's really finding a healthier way to engage with some of these intoxicants and pleasurable activities. Honestly, in many cases in our lives, but then in many other ways, these are things that some of them just in and of themselves, such as pornography or sex addiction, can just be harmful period, but then there's other ones that are more of. They can be on a line, using social media, eating sugar, drinking alcohol right.
Speaker 2:At the end of the day, either the things in our lives can control us and have a hold on us, or we can find freedom.
Speaker 2:And anytime there's something that has more control on me that I'm not able to say no to, unless that is the Holy Spirit speaking to me, that's pretty much the only thing in my life that I want to have more control over me than I can have over it, because I don't know about you, but I believe we're called to live in freedom, and when there are things out there that are trying to take away our freedom and trying to pull us in to negative behaviors, and things that are going to hurt ourselves or others, or just things that kind of chip away slowly over time, at our body being treated the way that it should be, such as the things that we choose to eat and the things we choose to do to our body, when those things continue to tell us the lie that this is what's going to make you happy, that's where we get in trouble.
Speaker 2:True self-worth, I believe even true happiness it comes from the love and engagement that we have from our family, the love that we believe that God has for us, and that's all based in the research. It comes from the character traits that we have and the morals that we have as individuals and some of these other intoxicant things. They're not all bad, but when they begin to try and tell us that our worth is found in it, that's when we need to change our relationship with it. Share this with someone who you believe would find benefit. I always love and appreciate when you find the episodes helpful and that you share them with other people and, as always, it's amazing when you leave a review. It helps us to reach even more people in the whole podcast algorithm. Wherever you listen to podcasts, I would be forever grateful.