Dr. Anna Lembke, author Of ‘Dopamine Nation’ on addiction, the pain/pleasure balance, and a counterintuitive, drug-free way to find homeostasis
Host: Brenda Zane, brenda@brendazane.com
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Guest: Dr. Anna Lembke, MD
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episode transcript
SPEAKERS
Brenda Zane, Dr. Lembke
Brenda
Am I ever excited for today's episode. I know you do a ton of reading like me and for a bit.
Now I have had Dopamine Nation on my list of must-read books. So I finally did read it and I immediately said, holy cow, I have to get Dr. Anna Lemke on the podcast. It's one of those where you read it. And you just know, she also wrote the book Drug Dealer MD, which I've only skimmed, but it is one that will give you a lot of great background information on where the opioid epidemic stemmed from and how pain doctors played a role in that. But in reading Dopamine Nation, it struck me how much science there is behind addiction and our behavior in general. It's not just an emotional thing where we get pulled one direction or another, because we feel something random.
There is so much chemical action happening in our bodies. And if you can understand a little bit more about that, it makes it easier to understand and be a little more empathetic about how somebody might choose to use substances in the first place. And also why they can't just stop. If you don't know of Dr. Lembke, she is one of the world's leading authorities on the neuroscience of addiction. You might've seen her in a Netflix documentary, the social dilemma, which by the way, is a must, must watch for anybody who owns a smart. She is a professor of psychiatry at Stanford University, School of Medicine and Chief of the Stanford Addiction Medicine, Dual Diagnosis Clinic.
She has published more than a hundred peer-reviewed papers, book, chapters and commentaries sits on the board of several state and national addiction. Focused organizations has testified before various committees and the house of representatives. Keeps an active speaking calendar maintains a thriving clinical practice, no big deal.
You know, she's just one of those people. And an incredibly personable and thoughtful human being also because I got to speak with her for a few minutes before we recorded. And she is a gem. This is an important and impactful conversation that I got to have. With Dr. Lemke about the role of dopamine in addiction and what that means for young people.
She also helps us understand what's going on in the brain and the body when somebody uses substances. Why that wreaks havoc on her body's desire. To always come back to homeostasis and so much more that I don't want to take up your time with because we're going to get into it. The book is awesome. I would recommend getting it in print versus the audio version only because she has these great drawings in it that really help you understand this pain-pleasure balance in an easy way.
So that would be my reco. I feel in very good company today because Dr. Lemke has been on the human lab podcast. NPRs fresh air, the rich roll podcast. One of my all-time favorites, pretty much all the big ones. So settle in, lace up your shoes, grab a dog, whatever you do, and listening to this very informative and thoughtful conversation.
Well, it's so good to have you here, Dr. Lembke. I am so thrilled to have read your book and to have you on to chat a little bit about this very confusing and confounding, subject of substance abuse and young people. So I can't wait to pick your brain a little bit, so thanks for joining me.
[00:05:25] Dr. Anna Lembke: Oh, well thank you for inviting me. I'm so happy to be here and I'm so moved by, you know, your, your personal story. So thanks for sharing that with. Yes. Thank you. Sometimes I tell people and I'm like, wow, did that. How did I live through that? You know, because you just do it, especially as moms. I think we just have this superpower that somehow gets us through these periods of time.
[00:05:48] Brenda: And then you look back and I hear this in our community all the time, moms are like, Wow. I gave my Mo my, my daughter Narcan last night and got her to the ER, and then I'm home. When I'm at work this morning, it was like, how did I do that? Right. I know. It's like, well, we can endure when we must endure it.
Right. It's always incredible. It is. And how we keep going. I mean, in the moment, it, it does just feel like that, like just hanging on and just trying to keep, keep going one day at a time. But. Yeah, we, we do endure for the sake of our kids. That's for sure. We do. And it's really interesting when I came across your book.
And I think I heard you on a couple of podcasts, dopamine nation. I had never really, I mean, I, I always hear dopamine kind of front around and the yearbook is about so much more than, than just over me. I love the title, first of all. And I thought, huh, that's really interesting. I thought it was going to be more of like a science book and I was so glad it wasn't because I'm terrible at science, but what made you decide, wow, I need to write a whole book about this, you know, as a physician and everything that you do, there's so much you could write about. I know you have other books as well, but kind of what prompted this one.
[00:07:03] Dr. Anna Lembke: Yeah, well, you know, I've been practicing psychiatry for gosh, going on 25 years here. And I primarily treat patients with all different types of substance use problems and other addictions. And I just felt like I've learned a couple things over the years about how to get through to folks and.
Maybe I could share those ideas more broadly to be of service, essentially, to people struggling with these types of problems. So this, that was the main motivator. Also, I will say that, you know, the advances in the neuroscience of addiction, how we process pleasure and pain, all of that. Really fascinating.
And I think really useful for people struggling with addiction and the people who love them, because it does help understand why people do the things that they do, you know, when they're in the throws of their disease. So I wanted to share that. And then there are some bigger ideas in domain nation, which is essentially that we're all now vulnerable to the problem of addiction.
Even people who. Previously might've been immune to this problem. And the reason is because we're living in this dopamine overloaded world where everything has become drug-ified, where these drugs now exist, you know, in digital form and hunt us down. It's not even like we have to go looking for them. So I wanted to talk about that problem and how, in fact, I see people.
In recovery from addiction as modern-day phrophets for all of us, because if they can figure out how to live in this dopamine saturated world, and then so can the rest of you.
[00:08:47] Brenda: Right. Yeah. Now I love how you kind of position that, where we can learn so much. And I have the benefit of being able to learn from my son and everything that he's been through.
But I think it's, if you're still in the thick of it, you don't have that beautiful hindsight yet you can learn a lot because man, it takes so much strain and so much determination. And I love. A lot of the concepts that you share, and we won't have time to go into all of them, but first of all, just kind of to level set on dopamine and its role and connection in addiction, and then how that's relevant for adolescents and young adults.
And I don't know if it's different or not, it might not be, but maybe you can just sort of lay the groundwork for that. And then we'll dive into a couple other things.
[00:09:34] Dr. Anna Lembke: Okay. Great. Yeah. So, I mean, dopamine is a chemical that we make in our brain. If you were to eat dopamine, it would have no effect on you because it doesn't cross the blood-brain barrier.
You could eat a dopamine precursor like L-DOPA is use to treat Parkinson's disease, and that would cross the blood-brain barrier. But in essence, the way to think of dopamine is it's a chemical that's made in the brain. Neurotransmitter neurotransmitters are the molecules that bridge the gap between neurons neurons are the workhorse cell of the brain that creates the electrical circuits that create our emotions.
Thoughts, you name it and. Neurotransmitters are the molecules that bridge that space between neurons because neurons don't actually touch. And so there are lots of different neurotransmitters, many, many neurotransmitters in the body, but dopamine is the most important neurotransmitter for the experience of pleasure, motivation and reward.
And it may be even more important for motivation than it is for pleasure. So for example, there's a very famous rat experiment where if you give, if you engineer a rat to not have dopamine in its brain and not have dopamine receptors and especially in the reward pathway of the brain, and if you give that rat food, it will eat the food and seem to enjoy that.
But if you put the food, even a single body lengths away, the rat will die of starvation. It won't. Get up and go and get the food. So dopamine is really important for pleasure, but also maybe even more important for the motivation to seek out the pleasurable reward. Got it. And so I know many of us have young people who are very heavy pot users, and I, I hear that that is.
Especially hard on motivation. Is that connected to dopamine? Like is the, you can tell I am not a psychiatrist. No, it's a great question. What's going on there I guess. Yeah. So, um, every intoxicant, whether it's a substance or a behavior, but especially I think with the substances, this kind of makes sense.
It mimics. The chemical our brain already makes. So when it comes to cannabis or pot, we make a version of pot in our brains and we have pot receptors. They're called receptors and script for bliss. So every single chemical, whether it's alcohol or cannabis or cocaine, they all work because they mimic something that our brain already makes that already.
We already have receptors for, except they're much. More potent and much more power. And then the downstream result of all of those chemicals is that they release dopamine in a specific part of the brain called the reward pathway. So when you, when we smoke cannabis or otherwise ingest cannabis, What it does is it binds to the cannabis receptors, which are the most numerous receptor in our brains.
And all of that ultimately leads to dopamine being released in large amounts in this specific part of the brain called the reward pathway. You know, what I talk about in the book is essentially how the brain then responds to, or compensates for that huge release of dopamine, which is at the heart of what happens as people become addicted.
[00:13:16] Brenda: Got it. That explains a lot because basically what we're doing is we're just so overloading what a normal amount of dopamine would be. Is that right? It, when we're using substances, it's just like, A hundred times, or I don't know how many times greater than what our bodies would normally produce.
[00:13:38] Dr. Anna Lembke: That is exactly right. So we're, we're, we're creating this artificially high elevation of dopamine that we really weren't evolved, uh, to experience. And with this firehose of dopamine, our brain essentially compensates by down-regulating. Our endogenous dopamine production. Um, but also like down-regulating our endogenous production of the endocannabinoid system.
Our endogenous cannabinoid system basically says, Hey, wait a minute. I'm getting all of this cannabis from this textural source. I can stop making my own. And that's where then you go into essentially an indogenous or internal. Deficit state of what, of that chemical, which in the case of cannabis you asked, why is it the steam motivational syndrome?
It's because it essentially goes into this deficit state where then people, you know, their various neurotransmitters, they're not making them. So they're, they're not motivated to do a lot of things.
[00:14:41] Brenda: Right. So we have completely just whacked out the balance of what's going on chemically in the body, which then turns into what the parents see. Like people who would be listening to this is we see our kids doing all these things, or like, why are they doing those things? Makes no sense, but it kind of does make sense. Then if you understand what's going on, chemicals.
[00:15:06] Dr. Anna Lembke: Right. Exactly. That's right. I mean, if you see what's happening in the brain as a result of ingesting these chemicals, you realize how physiologic, the whole phenomenon of addiction really is.
And how, in essence, what happens is the individual's reward and motivational system. Hijacked by the substance or that substance comes to signify for their brain cells. Something that is essential for their survival, such that they will invest all of their resources and energy and creativity into getting more of that substance.
Instead of investing it in what mother nature really meant for us to invest in, which is seeking out and obtaining natural rewards, food, clothing, shelter, finding a mate. Right.
[00:15:53] Brenda: Yeah. It's much easier and probably way more rewarding just to say, okay, I'm going to go hit this bong, then I'm going to go watch the sunset like that.
[00:16:02] Dr. Anna Lembke: That balance has been disrupted as, I guess what I'm, what I'm seeing. That's right. I mean, the sunset is literally no longer enjoyable because the system has been hijacked by a far more potent. Yeah.
[00:16:15] Brenda: You talked about this was so perfect because this is exactly what I see with the moms that I work with. Is you shared about a patient that you had had? Um, I think his name was David and he kind of epitomizes that this lifestyle of leisure and boredom. And now we don't really have to work very hard for our dopamine hits. And so I think he was taking a lot of Adderall. He was just kind of hanging around. Um, the house and there was a lot of anger and this is what so many of my moms see my moms.
I have like a hundred moms, the moms, the, my community, they see this anger and we can't figure out where this anger is coming from and this resentment and just, they won't do anything. And so he was, and you can tell me if I've got this right or not. He was really looking at kind of like, I have this mental illness when I think what you kind of unpacked eventually was that he was really overstimulated and sleep-deprived.
And so I think a lot of us are so confused because it's. Giant, like, I think one of those rubber band balls where it's like, well, what is it? And how do I know? And how do we start to untangle and tease apart? Like, what are we really treating? Is that pretty common that you see that. Yeah, that's very common because when we're chasing dopamine, it's very hard to see true cause and effect.
[00:17:41] Dr. Anna Lembke: Right. So what feels like, let's say I have many, many patients who come in who say that the reason that they use cannabis for example, is because they they're depressed or they're anxious or they can't sleep. And the. It is their medicine for that problem. What they're not able to see is that although cannabis in the very short term may make them feel less depressed, anxious, or put them to sleep in the longterm.
What it does is actually drive those symptoms. So what feels like is self-medication is actually the toxin that's creating the psychiatric problem in the first place. But it's hard to see that that's part of the, the major disconnect that happens with addiction is that, um, people can no longer appreciate that.
And again, it makes sense because again, in the immediate moment of using their drug, they do feel better, but they're not treating any kind of underlying psychiatric disorder. They're really treating withdrawal from the last dose. And when they're doing. Using they're in withdrawal and the universal symptoms of withdrawal from any addictive substance or anxiety or an ability, insomnia, depression, and craving.
So the anger and irritability that you know, that we see in people who get into. The daily use and addictive use is that they've essentially changed their hedonic set point or their pleasure-pain set point. And when they're not using, you know, they've got a balance tilted to the side of pain.
And this isn't a book where I talk about this extended metaphor of balance as a way to understand. Yes. I love the teeter-totter. I love it because it's just so understandable to the common person who's reading it and trying to understand this. Maybe you can talk a little bit about that. I wish, I guess the only downside of podcasts is you can't show somebody something, right.
[00:19:30] Brenda: So you'll have to get the book, but there's a really great, um, teeter-totter analogy. And maybe you can just talk to that briefly, because I think it was really helpful for me to, to understand what was actually going on.
[00:19:43] Dr. Anna Lembke: Yeah. So one of the most interesting findings in neuroscience in the past 75 years or so is.
Pleasure and pain are processing the same parts of the brain and they work like opposite sides of a balance. So if you imagine that in your brain, there's like a, teeter-totter like in a kid's playground, but essentially a FIM of beam on a central fulcrum. And that represents how we process pleasure and pain.
When we experience pleasure. One way. And when we experience pain, it tips the opposite way. And there are several overarching rules governing this balance. And the first is that the balance wants to remain level and that our brains will work very hard to restore a level balance after any deviation from neutral.
So, for example, you know, if we smoke pot, we get the release of dopamine that reward neurotransmitter in a specific circuit of the brain called the reward pathway and the balance tilts to the side of pleasure. But again, no sooner has that happened. Then our brains will work to restore a level balance.
And here's the key, the way that the brain restores a level balance is first by tipping, an equal and opposite amount to whatever the initial stimulus was. So if we do something. Immediately pleasurable what'll happen is our brains will. Tip to the site of pain before going back to the level position.
And I often imagine this as these neuro adaptation gremlins hopping on the pain side of the balance to bring it level again, but they like it on the balance, so they don't hop off. They stay on until it's tilted. An equal and opposite amount to the site of pain and that's the come down or the aftereffect or the hangover.
And then they hop off and it goes to the level position. And this is really, really important for understanding what happens in the brain as we become addicted, that the fundamental way that the brain restores a level balance or what neuroscientists call homeostasis is first by tipping, an equal and opposite amount to the side of pain.
Because the other rule of the balances that with repeated exposures to the same or similar stimulus, the initial response to the pleasure side gets weaker and shorter, but that after response to pain gets stronger and longer. In other words, those gremlins start to multiply, get bigger, get stronger. And eventually you end up with, you know, hundreds of grads.
Uh, on the pain side of the balance and they're essentially camped out there and they're not going anywhere fast. Right. And that's the addicted brain people who relapse even weeks and months after they've stopped using often do so because they're not walking around with a level balance. They're walking around with gremlins, still camped out on the pain side of their balance.
And that means that they have to use not to get high or feel good, but just to level a balance and feel. And when they're not using, they're experiencing again, the universal symptoms of withdrawal from any addictive substance, which are anxiety, ability, insomnia, depression, and craving. Now, the idea is that with enough abstinence and with enough brain plasticity, Eventually those gremlins will hop off the pain side of the balance and homeostasis will be restored, but honestly, in some people it can take months to even years for that to happen.
And there may be some people for whom it doesn't ever completely happen, right. That they've potentially permanently. Um, broken that balance, but I like to be optimistic and many clinical experience. Most people with enough abstinence can eventually get back to homeostasis or a level balance, which is really, really important because it allows the, it allows them to then take joy in other things, but also equally important.
It allows them to get true insight and look back and see the true impact of their drugs. On their lives and on their brains, which they're not able to do, uh, when they're in the midst of it. Right. So that, that's interesting. I was going to ask that if it does eventually rebalance itself, or do you have to sort of do extra work?
[00:23:57] Brenda: I'm over here, like raising my arms. Like everybody can see me, but do you have to do extra work and, and double down on the pleasure side then to like a year to get that back up? Cause I'm imagining if it is kind of like those gremlins are like, we're not going anywhere. We're just going to sit here on the pain side.
How is the best way then to start to rebalance that, especially if you're a teenager and you're not even working with a fully developed.
[00:24:26] Dr. Anna Lembke: Yeah, so great question. So here's the problem. If you replace one drug with another highly pleasurable substance, there's the danger of cross addiction because all drugs work on the same final, common pathway and release dopamine.
So. Yes, the impulse is to say, okay, well, what else can I put on the pleasure side of the balance to counteract those gremlins? But in fact, what I tell patients is that there's nothing that goes on the pleasure side of the balance. That number one will work as well as their drug of choice. And number two, that won't put them at risk for cross addiction to that other substance.
So instead of paradoxically, the better intervention. Is to put more weight on the pain side of the balance.
[00:25:15] Brenda: That's so interesting. I know now I'm dying to hear that. Right.
[00:25:20] Dr. Anna Lembke: So first let me explain what happens. So it's the science of hormesis. Hormesis is Greek for, to set in motion and basically it's the science of how mild to moderate painful stimuli actually caused the upregulation of.
Production of our own feel-good hormones like dopamine and norepinephrine and serotonin and et cetera. So it's very paradoxical, but number one, just abstaining from your drug of choice. Eventually those gremlins will hop off. But what to do in the meantime is actually to do things that are. And do things that are painful and by doing so what you will do is encourage those neuro adaptation gremlins to hop on the pleasure side of the balance in order to counteract the weight that you're putting on the pain side.
That makes sense. Yep. And we have lots of science to support this. So for example, Exercise is the classic example. Everybody knows about the runner's high. How does it work? It's essentially the science of hormesis. When we do things that are painful and hard and exercise is in fact, noxious to two cells, it's toxic to cells, but what it does is it tells the cells, oh boy, there's an injury here, a minor injury.
So I need to start making more dopamine in order to counteract this injury. Or if you visualize it with the best. Those gremlins say, oh goodness. There's weight on the pain side. Now I got need to go over and hop on the pleasure side in order to bring it level again. But remember first I'm going to tip an equal and opposite amount to the side.
Pleasure. So now you've got a way to encourage those gremlins, not just to hop off the pain side, which you do by abstaining for long enough for them to get the message that they can hop. But also in fact, by intentionally doing things that are hard so that they hop on the pleasure side beyond exercise, what are examples?
So ice cold water baths have been shown to slowly increase dopamine levels and keep them elevated for hours. Afterwards, as I said, all different forms of exercise do that. They slowly increase over the course of exercise and remain elevated for hours afterwards, but there are also many other types of.
Hard things that people can do, uh, that, that have this effect, um, all kinds of martial arts, do this things like centering prayer or meditation, do this, doing things that are psychologically or intellectually challenging, do this. Although when people are in their addiction, the first thing I recommend is actually some kind of embody.
Painful thing or some kind of mind body work. So I think getting back into our bodies and being physical is really important. So I typically will prescribe exercise or prescribe ice, cold water prescribed martial arts prescribed, you know, Tai-Chi yoga, anything that my patients can do to exert themselves in a physical or embodied way, um, is a really great way to, um, help them.
Manage the symptoms of withdrawal, um, reduce their likelihood of re relapse and potentially find another healthier source of dopamine.
[00:28:32] Brenda: That makes a ton of sense. And that's why I think you see so many people in recovery. And CrossFit or doing, you know, the really hard workouts at the gym or rock climbing. I'm imagining that that's probably what's going on. Even if they don't know it, they just know they feel good when they're doing that.
[00:28:51] Dr. Anna Lembke: Yeah. And I think the key is to find something that requires this kind of physical exertion, also the mental concentration on intense mental concentration that can also get people in that flow. That is also a great source of dopamine. And I always like to say, can you, can you take it too far? Do my patients tend to want to do that.
Absolutely. Can you get addicted to exercise? You can. And it's not like, like for example, self cutting would not be what we're talking about here. Right? Right. Why do, why do people cut on themselves? Because in the short-term it works, it tells the body there's an injury and there's the immediate release of our endogenous opioids.
The opioids that our brain makes get relief in the system and people it's a psychological relief and it's a little bit of a high, but you try to cut yourself a second time and you have essentially depleted. I mean, and all those opiods and it doesn't work. So tolerance builds up very, very quickly to extreme forms of physical pain.
So those you want to avoid, but more mild to moderate doses effectively work by causing the pleasure pain balance to kind of reset itself to the side of pleasure, rather than the side of. Right. Okay. So interesting. But that makes a ton of sense now. And if you're listening, when you read the book, you'll see the photo of the little drawings, which are amazing.
And they're so helpful because they're very simple.
[00:30:10] Brenda: So I love that you mentioned abstinence and that is one word that parents kind of, at least I know I did just rolled my eyes at like, oh right. I'm going to get my 17 year old to abstain from smoking pot. But you had a really interesting dialogue in the book that you share.
I think it was you talking with a patient, but I was thinking in my mind like, oh, this is actually something that a parent could do where you're kind of running through. I think maybe it's a bit of a motivational interviewing dialogue, but could you share that? Because I think that that would be actually not unrealistic.
[00:30:47] Dr. Anna Lembke: You as a parent with, if you have a child who's I was using and you're trying to get them to give their brain a break for a few weeks. Yeah. So I use a couple of different strategies. I'll just talk about two of them. One of them is that if you get your child or your young person to contemplate their use in the broader narrative timeframe of their entire lives, sometimes.
Forcing them or, or encouraging them. I should say to look at their life in the long-term can be a helpful way to get them to shift their frame. And so in this dialogue, I had a patient who came in, she will want to help for anxiety and depression. She was smoking pot heavily every day. She said that was her medicine.
It was the only thing that worked for anchored anxiety and depression. Can I suggested to her that although I could appreciate that, it felt like it was helping in the short term that it was probably harming or in fact, causing her symptoms in the longterm. And then I explained to her about the pleasure pain balance and how that works in the gremlins.
So, and neuroscience, I find really speaks to young people and they're like, oh yeah, neuroscience. Okay. And so I explained that to her, but even after explaining that, and I asked her to abstain then from cannabis as an experiment, Just to see if maybe her anxiety, depression got better if she abstained for a month and let those gremlins hop off the pain side of the balance, because in my experience, and this is supported by data too, it takes on average a month to.
Baseline dopamine reward levels and for those gremlins to hop off. So it all made sense to her, but she ultimately, still wasn't willing to try a month of abstinence as an experiment. And then I, I asked her kind of just say, well, I said to look at sort of the longer timeframe I said, okay, well, do you, do you think you still want to be smoking like this 10 years from now?
And she goes, oh no, definitely. I'm not going to be smoking everyday. Like this 10 years from now, she was a. Uh, in her late teens, early twenties instead. Okay. Well, how about five years from now? She was, no, no, I don't want to be smuggling fine. I said, okay. How about two years from now? And then she kind of paused and there was sort of like this sense of, okay.
I don't want to be smoking like this two years from now. And then this realization that, well, okay. She said, okay, doc, I guess you got me. If I don't want to be smuggled with this tier two years from now, why not try this experiment right now? So just by getting her to reflect on. I was able to get her to kind of admit that the way that she was using cannabis now was not something that she intended to do her entire life and blend by shrinking the sort of sense of her future by starting in a long time from now for a 20 year old, 10 years, and then making my way to the present day, all of a sudden she was able to say, okay, well, You know, I guess I'll give it a try, which then she ultimately did and came back a month later after abstaining and noted that her anxiety and depression were a lot.
And of course, that's a great moment. And about 80% of my patients who can stop for a month will feel a lot better. And that is absolutely key because then no longer am I in the position of having to persuade them that they should change their use. Now they're motivated themselves because they've lived it and seen how much better they feel.
So I do a lot of. So I present the neuroscience, the pleasure pain balance, the gremlins. Then I asked them to engage in an experiment. I actually call it an experiment. I explain that the promise of the experiment is that there's actually a better way to feel better because a lot of times people who use they're like, well, either I'm going to use and feel okay, or I'm going to not use in.
But I hold out this third way and I say, no, you know, there's a, there's a third alternative that, that you might want to check out. And it's a way that you could not use for long enough to feel a heck of a lot better than you feel using. But it's a leap of faith, you know, you gotta, you gotta really abstain for long enough to reset reward pathways.
And then when people do the experiment, I'm telling you about 80% of them feel a heck of a lot better. And then they're motivated to change their use. They might want to go back to using, but they definitely want to use differently. They want to use less. And now all of a sudden they have that data. You know, that that's their own experiment.
I don't need to, it's not me telling you.
[00:35:19] Brenda: Right. I love the way of, um, especially for young people. I love the way that you presented as an experiment and that you're just getting some data because that feels a lot less judgy, a lot less, you know, like you're this terrible person that you're using drugs.
Like it just, it makes it a lot more factual. And just especially if you have somebody who can explain the brain chemistry to you, right. That seems to make a lot of sense. Would it be, I mean, I guess the answer is obviously yes, but I would assume that if they are going to say, okay, doc or okay, mom, I'm going to, I'll try this experiment for two weeks.
It seems like it would then going back to your previous point, help to say, cool. Why don't you get into the gym a little bit, so that you're really doing that pressing on the pain. Side even more at the same time. Do you see that kind of gives a double benefit because if you just stop the smoking the weed and then you're sitting on the couch and not doing anything that might not get you the effect that you want or what's the story with that?
[00:36:26] Dr. Anna Lembke: Yeah. So a couple things so often I'll have patients say, well, how about if I just abstained for a week or two? And normally I dissuade them from doing that because usually that's not enough time. To reset homeostasis or for the gremlins to hop off. And if people just abstain for one or two weeks, they won't get the benefits of abstention.
Right. So I really do ask for four weeks kind of minimum for somebody who's got a serious addiction. And then I absolutely prescribed that around the time that they would normally use that they do something. Which is counterintuitive, right? Usually like, well, I'm just going to watch Netflix, like, well, why did there a lot of triggers on Netflix, right?
Or I'm just gonna watch YouTube, tons of triggers on YouTube. Um, instead, you know, the thing is to actually do something that hurts more than withdrawal hurts. And then when you're done doing it, it's like, oh, this isn't. And physiologically, it does really speed up the time for withdrawal and decrease the risk of relapse.
So it's counterintuitive, but that is what I prescribed.
[00:37:31] Brenda: That is really interesting. It makes sense. My son started getting up and hopping on a cold shower and I always thought, okay, that's really interesting. But instead of hopping up and smoking a joint, that's what he would do. And so now that's making a lot more sense why he would do.
[00:37:47] Dr. Anna Lembke: There you go, he figured it out. Yeah, he did. Yeah. That's not anything I feel like I want to do, but yeah. And I'm never going to get in a cold shower myself, but, you know, but there are other things that you probably do that press on the pain side of your balance to kind of reset your. Yes, definitely.
[00:38:04] Brenda: Well, we just have a minute, but I really loved a quote that you had, um, in the book that I just would love to get your maybe expansion on, which is the reason we're all so miserable.
Maybe because we're working so hard to avoid being miserable, just really struck me. And this kind of goes to the broader society that we live in and how. So much and everything is instant, especially for our kids. They've never had to really wait for anything. They didn't have to live through, dial up, like even know what that means.
And there was also a saying about how we are cacti in the rainforest and it just, wow. I was like, that is just so true. Um, any additional thoughts on that? I just, I think those are just some really profound statements.
[00:38:58] Dr. Anna Lembke: Yeah. Yeah. Thanks for sharing those that does get to the heart of the message in dopamine nation, which is that we really need to reframe pain.
You know, we've, we've turned pain into this thing that, um, needs to be avoided at all costs, right? It's not just dangerous in the moment. It sets us up for future pain. It leaves kind of psychic scar and damages us. I think as parents. You know, we've bought into this idea that we have to protect our kids from, from all of these painful experiences so that they have good self-esteem and that they're psychologically healthy.
And I know even I, as a, as a parent have made this mistake many times, right. Where in fact what we're doing by always swooping in and, and kind of protecting our kids from. He's painful. Emotional experiences is really depriving them of the opportunity to develop a resilient brain and develop those kinds of mental callouses that they're going to need to, you know, go out there and be successful in the world.
So a kind of a radical acceptance of the fact that life is hard and it's hard for everybody. And that, you know, if we can just, um, face that truth and allow ourselves to just sit with pain and know that we're not alone in our suffering and even intentionally seek out challenging experiences, uh, in a world where those things are generally.
Right. Right. So we have to kind of embrace, embrace the kind of modern asceticism so that we remain physiologically imbalanced, because we're not living in a balanced world. We're living in this world where everything has become drug defied from the food we eat to the information, you know, that we ingest to the very wide variety of digital drugs that we consume on and off.
[00:40:49] Brenda: Yeah, it's so true in what you were saying about parents. And I think with, you know, it's wonderful that we've had such a, sort of a big trauma move. I don't know if it's not a movement, but there's a lot of information. Let's just put it that way about trauma and our kids. And I think that can really scare parents and we're afraid to.
Kids experienced anything that might traumatize them. And I just recently did a, an episode on trauma and that it's not necessarily that bad experience it's that if kids, if our kids in particular are alone through that bad experience, that it can become trauma. So letting them struggle. Letting them have some of these experiences and work really hard for something is not traumatizing necessarily in itself.
[00:41:36] Dr. Anna Lembke: Right? It's, it's something that could actually really be a protective factor for them down the road, as they get into middle school and high school, and the drugs are going around that they're going to be a little bit better prepared for that. Yeah. And you know, my big concern with the emphasis on trauma, which is in some cases appropriate, but other cases really not, you know, you can have the perfect life and the perfect parents and the perfect job and the perfect school and still get addicted.
So what I see sometimes as we're like, you know, well-intended. Mental health care providers. They actually go looking for trauma where there is no trauma. And then they collude together with the client or the patient around this trauma narrative, which isn't really true. And that's not helpful for people.
Right. You know, then they're kind of like turning. Something that really wasn't traumatic into a trauma. So this, this is all part of the complexity of unintended consequences, and it's not like people should go out looking for trauma, but we have to also acknowledge the ways in which we've all become so much more.
Easily injured than ever before. And that it's truly physiologic, right? It's that we are so insulated from pain. And so inundated with pleasure that our physiologic step point, our pleasure pain balance has really, um, you know, tilted to the side of pain. And now the mirror pain gives us pain and we need ever more pleasure, uh, to feel anything good at all.
[00:43:03] Brenda: And that's. Yeah, well, that is a perfect way to wrap it up. And I just appreciate you being here so much. I will be obviously linking to your book and, um, resources in the show notes. So if you're listening and you want that, definitely take a look at the show notes and. Thank you immensely for being here and sharing this with listeners who are frazzled, tired, parents, just trying to figure out what's going on with their kids.
[00:43:32] Dr. Anna Lembke: So this has been incredibly helpful. It's been my pleasure. Thank you so much for inviting me. And it's really good to talk to you.
Thank you so much for listening. If you would like to go to the show notes, you can always find those@brendazane.com forward slash podcast. Each episode is listed there with full transcript, all of the resources that we mentioned as well as a place to leave comments.
If you'd like to do that, you might also want to download a free ebook. I wrote called hindsight three things. I wish I knew, and my son was addicted to drugs. It's full of the information. I wish I would've known when my son was struggling with his addiction. You can grab that at Brenda's ane.com forward slash hindsight.
Thanks again for listening and I will meet you right back here next week.
Brenda
Thank you so much for listening. If you'd like to go to the show notes, you can always find those at At Brendazane.com/podcast, each episode is listed there with a full transcript, all of the resources that we mentioned, as well as a place to leave comments if you'd like to do that. You might also want to download a free ebook I wrote called Hindsight: Three things I wish I knew when my son was addicted to drugs. It's full of the information I wish I would have known when my son was struggling with his addiction. You can grab that at Brendazane.com/hindsight. Thanks again for listening and I will meet you right back here next week.