Dopamine Expert: How TikTok Is Physically Rewiring Your Brain (Permanent Damage?)

There's a great experiment where rats. were given a lever to press for cocaine, and after learning that it releases a. lot of dopamine, the rats will [music]. press that lever till exhaustion or. death, which is essentially the model of. addiction that we see in humans. But, if. the cocaine is then removed, eventually. they won't press the [music] lever. anymore. Now, if that same rat, after a. period of time, is then exposed to a. very painful foot shock, the first thing. the rat will do is run over and start. pressing that lever again. And that's. really powerful because it shows that. when individuals are under extreme.

stress, they are more vulnerable to. going back to compulsive overconsumption. of their drug of choice because their. brain has already encoded using these. high-dopamine rewards as a way to get. out of that pain. >> Okay, so what do I need to do to make. sure that I can knock the bad habits and. add some new ones? Here's what we do. Dr. Anna Lembke is chief of the Stanford. Addiction Clinic and a world-leading. [music] expert on the subject of. dopamine. And now she's returned to warn. us that addiction is the modern plague. and how we can rewire our brains to take. back control. On average, it takes 4.

weeks for people to get out of constant. state of [music] craving. But, here's. the problem. Our survival depends on. figuring out how to live in a world of. abundance. For example, we're now seeing. the drugification of human connection. through social media, dating apps, and. now artificial intelligence designed to. flatter, to validate. There's no. friction there, and so it's pulling us. away from the hard things that we need. to be doing in real life to cultivate. real-life relationships. It just we. cannot go in that direction because in a. world of abundance, we are entertaining.

ourselves to death. Sounds like a good. way to go. It's really not because the. relentless pursuit of pleasure leads to. anhedonia. [music]. What's that mean? The inability to take. joy in anything at all. Teach me everything. I see messages all the time in the. comment section that some of you didn't. realize you didn't subscribe. So, if you. could do me a favor and double-check if. you're a subscriber to this channel, that would be tremendously appreciated. It's the simple It's the free thing that. anybody that watches this show. frequently can do to help us here to.

keep everything going in this show in. the trajectory it's on. So, please do. double-check if you subscribed, and. thank you so much because in a strange. way you are you're part of our history. and you're on this journey with us, and. I appreciate you for that. So, yeah, thank you. >> [music]. >> Dr. Anna Lembke. For anyone that might not know you, and they didn't watch our conversation. last time, which was a fantastic. conversation, one of my favorites of all. time, and also I know Jack said to me as. well that it was one of his favorites of. all time. Who are you and what have you.

spent your career doing if you had to. summarize it? What are the reference. points that your wisdom draws upon and. the experiences you've had and the. people you've worked with? I'm a. psychiatrist. I did a residency in. psychiatry at Stanford University, and. then I stayed on, joined the faculty. I see patients, I do research, and I. teach. You wrote this um iconic book. about this word dopamine. Why does it. matter so much? Why does this this idea. of dopamine matter so much? Dopamine is.

a chemical we make in our brain, but I. use it in the book as really an extended. metaphor for the ways in which. overabundance itself is a human. stressor. We are living in a time and place where. we have more access to luxury goods, more disposable income, more leisure. time, even for the poorest of the poor. ever before in recorded history. And it turns out that is stressful for.

our brains, and it's stressful in a. brand new way that we really haven't. confronted before, making us all more. vulnerable to the problem of compulsive. overconsumption and addiction. And I do think that addiction is the. modern plague. I think we're going to be struggling. with the problem of compulsive. overconsumption in a world of abundance. for the foreseeable future as in. centuries. And our survival will depend on figuring.

out how to live in a world of abundance, even though we have brains that evolved. for a world of scarcity. At this time of. the year, people are thinking a lot. about making changes in their life. They. want to get in shape, they want to lose. a couple of pounds, they want to save. their money, they want to knock the. addiction, they want to stop. the smoking, the. drugs, and the. alcohol. So, as it relates to the. subject of dopamine, how are these two things linked? Are.

habits and dopamine? What is the the. link or the connection there because I. think most people listening right now. have probably made a New Year's. resolution, even if it's just in their. mind, and I'm wondering how everything. you write about in Dopamine Nation is. related to and critical to understand if. I am going to shake some of these bad. habits that I have or pick up some new. ones. The place to start is to have. self-compassion. because we are living in a world of. abundance where we have easy access to. all kinds of reinforcing substances and.

behaviors. And access itself is one of. the biggest risk factors for addiction. So, if you grow up in a neighborhood. where drugs are easily and readily. accessible, you're more likely to try. them and more likely to get addicted to. them. And what do addictive substances and. behaviors do to our brains? They release. a lot of dopamine all at once in a. dedicated part of the brain called the. reward pathway. And the fact that they release so much. dopamine at once means that they're.

highly salient and memorable. experiences, right? So, our brain really. encodes that experience deeply, that. experience of intense pleasure that was. self-administered, that I could potentially do again. Why? Okay, in a world of scarcity and. ever-present danger, which is the world. that we evolved for, we will naturally, reflexively approach pleasure and avoid. pain, and we must do so for our.

survival. Why? So, if I have a cigarette. now, >> [sighs]. >> it's going to be a really memorable. experience from a brain perspective. Why does my brain make it memorable, and. why would I want to then go do that. again from a survival perspective? Mm, okay, great question. So, let's first. distinguish what we call natural. rewards. So, natural rewards are food, clothing, shelter, finding a mate. Yeah. These are things we must obtain in order.

to survive. What. addictive drugs and behaviors do is they. mimic those natural rewards by. exploiting our internal brain chemistry. to release a lot of dopamine all at. once, much more than we would get from. natural rewards existing in nature, amplifying that experience, making it. even more memorable, even more salient, and also making our brain think, "Ah, this is important for my survival." Ah,

okay, so there's certain natural rewards. like eating, which of course my body. wants to reward me for so I eat again. And these chemicals in front of me like. the cigarettes, the whiskey, the drugs, those have been designed to hijack that. particular part of the brain and really. amplify the feeling. So, that my brain. kind of is tricked into thinking that it. was potentially a natural reward, but. it's actually a synthetic sort of. man-made. chemical. Exactly. And what we see in the.

evolution of drugs over, you know, human lifetimes, but. especially in the last 200 years, is the. application of science and technology to. take like the coca leaf, for example, right? That's been around forever, and. essentially make it even more potent, even more available, to make it a faster. delivery mechanism. So, we have this. history of increasing potency and.

availability over time. Said more simply, drugs are getting even. more potent over time, so this. vulnerability to the hijacked brain is. even more common, including taking. things that we didn't even really think. of as drugs and turning them into drugs. So, remember the natural rewards, one of. them is finding a mate. Mhm. And one of the ways our brains gets us. to do that is by making falling in love.

and making intimacy and human connection. rewarding on a neurobiological level, including releasing dopamine in our. reward pathway when we make those kinds. of social connections. My colleague at. Stanford, Rob Malenka, and and his. colleagues did an interesting experiment. where they were able to show that. oxytocin, our love hormone, binds to. dopamine-releasing neurons in the reward. pathway and releases dopamine, which is.

just one more link in the chain showing. us that falling in love, human. connection is rewarding. It feels good. It releases dopamine. What we see now is the drugification. of human connection, for example, through social media, dating apps, online pornography, and now artificial. intelligence and other large language. models, which create this frictionless. experience with technology that feels.

like talking to a human being and is. incredibly validating, right? So, the. algorithms for large language models are. to make us feel really good, to make us. feel like our point of view is the right. point of view, to bolster our. self-esteem, to validate our point of. view. That's how those algorithms are. designed. And now, even more explicitly, we have AI models that are explicitly. pornographic, explicitly erotic, right? So, now you have this interactive. component that learns what we like and.

then is able to regurgitate it back to. us. So, you get this really very. powerful. action-perception loop, which is part of. what makes a drug potent. It's that I. have control over it, right? I can. decide when I'm going to change the way. I feel by using this drug. Are you. concerned about. AI and ChatGPT and all those large. language models that have emerged that. are now simulating human connection? Yes, I'm very concerned.

I see the not-so-good outcomes, meaning. people who get addicted to social media, to dating apps, to online pornography, um and to AI, you know, and and who end. up using those. forms of media. to. simulate human connection while they. actually become more and more. disconnected. Have you started to see. anybody in your practice or heard of. anybody that's developing an addiction. to. AI or relationships with AI?

So, we are starting to see that. Um you. know, individuals who are spending more. and more time on AI looking for. companionship. Often, this is individuals who are. experiencing marital or interpersonal. conflict who turn to AI for advice on. how to handle interpersonal conflict and. often for emotional validation because. they're not getting it from their. partners. And what they experience with. AI is an enormous amount of emotional.

validation, validating their point of. view, but also. a sense of companionship, um you know, a repeated process of. feeling like they're understood, they're. they're they're validated, such that. then they're spending more and more time. on AI. And of course, that is the. essence. of. the addiction to digital media. It's the. time spent, right? Which then leads to.

opportunity cost, other things that. we're not doing because we're spending. so much time online. Furthermore, it in my experience often. leads to a rift between. those individuals and their real-life. partners. Because instead of going to. their real-life partners and talking, and we know that the most important. thing that, you know, two individuals in. a relationship can do is one four-letter. word that ends with K, which is talk.

Those individuals stop talking, right? And instead, they're getting. their needs met through AI. And that leads then to a further and. further rift between those individuals. Do you do you actually think that it it. is. these chatbots that we're increasingly. speaking to about our problems are. actually taking the place of. humans in our life? I do. You know, in my book, I my first. chapter in the book is about a patient. of mine, a scientist and an engineer who.

got addicted to pornography and. eventually made his own masturbation. machine. And. he did that with a record player and a. metal device attached to his organs that. he could then uh fine-tune control, and. then ultimately, that got more and more. sophisticated over time, and he had. electrical wires from his body to the to. a through a stereo system and the. internet. And when I first heard um from. Jacob about his trajectory and the.

severity of his. sex addiction, which ultimately led to. the dissolution of his relationship, the. near loss of his employment, and. ultimately severe depression and. suicidal ideation. Thankfully, he did. not end his life. When I first heard about that, I had. this distinct sense of like otherness, like, "Oh my gosh, I can't even imagine. doing that, and that's just kind of. horrific.".

But that that response really lasted all. of 5 seconds before I realized, "Oh, wait a minute. I do that." You know, I do that with. romance novels, and in a way, we're all. doing that with our devices, right? We're turning to these devices to meet. our. emotional, sexual, intellectual, you. name it, needs. And these devices are so good at meeting. those needs that we are. getting further and further away from.

investing in our relationships with the. people who are, you know, in our lives. And you can see this especially with. younger generations, like the the. epidemic of loneliness now, you know, Gen Z weaned on this technology, many of. whom endorse a significant loneliness, isolation, a depression, spending more. and more time online, um report. preferring to interact socially online. than to do it in person. So, this is. definitely a a dark undercurrent um that.

we're seeing in the world today. I was. reading about a story which was. published in a People magazine of a. 28-year-old woman who admitted that. she's fallen in love with her her AI. boyfriend that she created using. ChatGPT. She's got a husband, a. real-life husband, yet she found more. comfort in her ChatGPT. boyfriend. Um and she said that it. started as a fun experiment, um. but eventually they ended up getting. attached, and now she's paying a $200 a. month subscription so she can interact.

with her AI boyfriend without. restrictions. The AI has helped her throughout her. life. and has given her incredible emotional. support. And now there's actually AI companion. apps like Replika where which have. millions of users, and the whole sort of premise of those. apps is that they will be your. companion. The other really interesting. thing that I am I don't think people. realize about the AIs that they're using. is that they are personalizing their. answers and their responses to you. Right. And I didn't I didn't believe. this fully until one of my friends in.

our Manchester United chat recently. We. were debating who's the best football. player of all time, Ronaldo or Messi. And I went on my ChatGPT, and I asked. the question, and it said Messi. So, I. was like, "Here you go.". >> [laughter]. >> And then he went on his and asked the. exact same question word for word, and. it said Ronaldo. And I thought, "Oh, it's telling me what I wanted to hear. based on what it knows about me." Right. It knows that I think Ronaldo's the. Messi's the best, so it's telling me. that. And then I thought, "Okay, so what. else is. is it telling me that's personalized to. me to make me feel a certain way or to. think a certain way?".

Um but you don't realize when you're. speaking to it that it's giving. everybody different answers based on the. memory that it stores on you. And that's, you know, if you play this. forward, actually the AI that is most. personalized, that caters to your needs. the most, that is most retentive, is probably the one that you're going to. end up using the most. So, that. company's going to be the most. successful. So, we're in a probably a. bit of an arms race with these models to. create one that. meets your needs the most. Yes, exactly. And it is that comfort. loop that is so incredibly dangerous and.

also so insidious because we can't. observe it in the moment, right? We're. engaging with AI. It's telling us. exactly what we want to hear, but it. does it in such a seamless way with that. silky syntax that we don't even notice. that, you know, it's basically an. algorithm that's seducing us, because. that's really what it's doing. We feel. vindicated and validated, and it. releases dopamine in the reward pathway, that feels good, but over time,

essentially what's happening is we are. ingesting a drug. Our brain will adapt. to that over time, such that we'll need. more and more potent forms to get the. same effect. We'll need more validation. We'll need more sexually explicit. responses. You name it, there will be. tolerance, but also there will be this. pulling away from the things the hard. things that we need to be doing in real. life to cultivate in real-life. relationships. Give me some more color. on what you mean there. Okay. If you. think about what it takes to make.

a to create a healthy relationship with. another human being in in real life. Well, first of all, you got to get up. off the couch, and you got to go find. them, right? And they're not all. beautiful and interesting, and neither. are we, right? So, there's got to be, you know, some compromise on maybe some. idealized version that we have for. ourselves or other people. And then. you're in conversation, and it's not. always interesting, and sometimes you. have to listen to your partner even when. it's dull, and then there are conflicts,

and you disagree, and you know, my way. or the highway. You have to give in, you. know, give and take. All relationships. are about compromise. All successful. relationships are about. acknowledging, you know, the other. person's point of view and incorporating. that. And yet, we're not doing any of. that when we're interacting with digital. media, right? It's all it's all. validation of our worldview, what we. want to hear. And of course, that feels. great. It it's it's reinforcing, it's.

rewarding, but over the long haul, when. we get really sick and need somebody to. come and, you know, bring us some. chicken soup or take us to the doctor, you know, take us to the hospital, like. AI is not going to not going to be able. to do that. Yeah. I mean, this kind of. dovetails to another point, which is you. talked about the word abundance earlier. One of the really striking things that a. lot of the big AI entrepreneurs and. founders and CEOs are talking about is. the age of abundance that's around the. corner. Elon Musk tweeted saying,

"This really will be a world of. abundance." Specifically, advances in AI. and robotics. will create the age of abundance. And he. said, "Humanity's not constrained in any. real fashion.". I thought your first book, when he was. talking to a guy called Peter Diamandis, was pretty accurate. It was called. Abundance. And there will be universal high income, and not universal basic income. There'll. be no shortage of goods or services. And. really what he's speaking to here is in.

the world of robotics and AI, where I. think his shareholder remuneration. package that he's going to be paid in. 2030 or whatever, um is linked to creating a million. humanoid robots that can work in these. physical spaces that could theoretically. bring me chicken soup. Um that won't get. sick, won't complain, will reinforce me, will live in the physical environment. with me here at home, will be in my. office, etc., etc. Will be in factories. And there was a headline I think last. week saying that um Amazon were cutting.

back about half a million jobs that they. were intending to hire previously. because they now believe that humanoid. robots and robots generally will be able. to do those jobs. People think, "Okay, well, I'm going to. be out of work." But what Elon is saying. is the price of everything comes down. when we're not paying humans to do it, and when we're paying a robot to do it, which means that we're going to live in. this world of abundance where everything. is much cheaper. The world of abundance that many of us. are already experiencing and more will. experience in the future. I agree with. that. We are we already have more.

leisure time than we had a generation. ago. By 2050, we're projected to have 7. hours of leisure time per day compared. with 3 hours of work per day. So, we're. definitely moving toward that. That is going to be our number one. social problem. That we have time, we have access to. these highly entertaining media, and hypothetically, we would all be. going around and helping each other and.

cleaning up the planet and reading. philosophy, but that is not what is. happening so far. What is happening so. far is we're spending an enormous amount. of our time online, masturbating, watching pornography, playing video. games, and talking to AI chatbots. That is essentially the problem. And you. know, Elon Musk is he's very interesting. to me because he has talked before about. his tremendous fear that the machines.

will take over, that there will be a. hostile takeover. It's not going to be a. hostile takeover. We will seed our. agency to these machines, and we're. already doing it. We will give them our. power. Yeah, well well yeah, we will we will we. will entertain ourselves to death, right? I mean, and and this is what Neil. Postman warned about in his book Amusing. Ourselves to Death, a theme that was. picked up by David Foster Wallace in. Infinite Jest. You know, beginning with. television and now the internet and.

digital media in all its various forms, we are entertaining ourselves to death. Entertaining ourselves to death. Sounds like a good way to go. >> [laughter]. >> You know, it's really not. It's really. not, and I'll tell you why. Because the. relentless pursuit of pleasure for its. own sake leads to anhedonia, which is. the inability to take joy in anything at.

all. Because of this process of. neuroadaptation and the way that our. brain recalibrates pleasure and pain, such that with the more pleasure we. pursue, the more pleasure we need, and. the more we feel pain. No matter what we. have, eventually it won't be enjoyable. anymore. And that is the problem. So, explain that to me using a. these scales that I have here. Okay, so. imagine that in our brain's reward. pathway, there's a balance like this.

that represents how we process pleasure. and pain. When we experience pleasure, it tips one way, pain it tips the other. >> And what you mean by pain? Pain, I mean. all forms of pain, physical pain, emotional pain. >> A hangover. A hangover. That's a great. example, right? >> Not just me being pinched. It could be. that, too. So, all different forms of. pain. Now, granted, this is a vast. oversimplification, you know, pleasure and pain can be. experienced simultaneously like when. we're eating spicy food or during sex.

So, this is very simplified, but this. gets at the core concept of homeostasis. and neuroadaptation, which I will. define. So, when the when the balance when the. pleasure and pain balance is level, that's what neuroscientists call. homeostasis. That is the baseline level. that we kind of live in. That's our sort. of the heartbeat of our pleasure system, right? When we do something that's reinforcing. or pleasurable, right, or rewarding in. some way,

right here, right? Or digital media, this little robot AI robot. >> So, you're putting a cigarette into the. one side of the scale at the moment, and. then a little AI robot. >> Let's combine them cuz we're let's say. we're we're we're watching a video and. smoking at the same time on our phone. Which by the way, you see more and more. of, right? People used to go out for. smoke breaks. Now it's the smoke and. scroll break, right? And why do they. have to combine them? Because of. tolerance, which we're going to get to. in a second. So, when when we ingest. substances that are potentially.

addictive, um and highly reinforcing, or. we engage in activities that are highly. reinforcing, that releases dopamine in. the nucleus accumbens. That's typically. associated with pleasure, and then our. pleasure-pain balance tilts to the side. of pleasure. But no sooner has that happened than our. brain responds by neuroadaptation, okay? And that's where we then. downregulate dopamine transmission. >> When you say downregulate, do you mean. reduce? Yes. So, in in the brain's.

reward pathway, we then reduce dopamine. transmission, and I like to represent. that as rocks in this case, or I talk. about in my book gremlins, going on the. pain side of the balance to bring it. level again. So, this is a process These. are neuroadaptation. rocks, okay? They're going here because. one of the overarching rules governing. this balance is that it must return to. homeostasis. It must return to balanced. >> It must return to the level position, yeah. >> Okay. So, okay. So, then we we put in.

So, this is our brain working to return. to the level position by reducing. dopamine levels. Again, an. oversimplification, but just a way to. get at this concept. >> Has it released something in order to. counteract the balance there? In this. simplified metaphor, you know, at the. simplest level, what's happening here is. that it's, for example, taking away. dopamine receptors so that there's fewer. places for dopamine to land, thereby. decreasing dopamine transmission. Because it has been flooded. Because it.

has been flooded. That's right. It's. trying to compensate for the too much. dopamine. Okay. And is this what I. experience when I have like a hangover. or a come down? Right. So, that's. coming. So, what happens is once once. we've gone with this neuro process of. neuroadaptation, it would be nice if. that pleasure-pain balance just went. back to the level position, and then. there would be no hangover. But it. doesn't. It continues to go down an. equal and opposite amount to the side of. pain. This is this opponent process. mechanism. >> Oh, now my brain is dopamine. starved. It's.

>> That's it. >> Okay. It's not It doesn't feel good. >> Yes, and that doesn't feel good. And you. have basically two options here. More. dopamine. You can get more dopamine, right? To get bring yourself back. So, I'm now putting the cigarettes back. under the pleasure thing. >> And and some whiskey. >> And so, let's add some whiskey cuz. that's what you got to do cuz this is. tolerance, right? You need more and more. of your drug over time to get the same. effect, or you need to combine drugs to. overcome tolerance. And by the way, this. is of course the fastest way to to get. back to the level position is to use.

more of your drug, right? Cuz that then. you're right there. You're back again. The the problem with this method is that. the the brain will respond by more. neuroadaptation. So, now we're putting. more rocks in on the. in the pain side. Now you're now you're. now you're doing this, right? Now I need. even more to. >> Now you need even more, right? So, and. eventually over time, you know, you're you're putting you're. doing this. And this is simply a metaphorical.

representation of. the addicted brain. Right. Now now our brain. has downregulated dopamine transmission. in the reward pathway to a kind of. chronic dopamine deficit state. So, to. feel good when I've really abused my. drugs of choice, I'm going to have to do. so much, probably so frequently, to feel. good again. >> That's exactly right. You're going to. need more of your drug in more potent. forms, more often, just not even to feel.

like high and go to the pleasure side, but just to level the balance and feel. normal. So, in the context of people. with bad habits, if I I'm having a. cookie every day, the more and more cookies that I eat, the more and more cookies I'm going to. want tomorrow and need tomorrow just to. feel good again. Essentially, yes. >> And the same applies for things. [clears throat] like pornography and. maybe, you know, interacting with an an. AI and social media and whiskey and. alcohol. So, the more of it I consume,

the the this is why I you know, I think. everybody listening can probably relate. to having moments in their life where. they feel like they're they're kind of. losing control of a particular habit, and they're doing it every day. They. know they don't really want to, but. they're doing it they're they're getting. cravings to do it. I I reflect to my own. life and I go there there will be. periods every year where. I just like I call it like falling off. the horse, and I just can't seem to get. control of like not eating that bad. thing again the next day. And then. something happens, maybe there's less. stress in my life for a week, and I'm.

and maybe there's more routine, and I'm. back home in Los Angeles or the UK, and. I'm not traveling around, and then. suddenly I can get back on the horse. What's going on there? Yeah, great. question. So, um first of all, let me. just say that many people also report. that in periods of high stress, they are. more vulnerable to going back to falling. off the wagon or going back to some. problem with related to compulsive. overconsumption or addiction. But the. opposite is also true. So some people.

say that they actually do better when. there's stress in their lives and it's. when that stress is removed and they. feel like, "Oh, I can relax my. boundaries or my guardrails." And those. individuals are more more vulnerable to. compulsive overconsumption in times when. things are going well. So So things. going badly can be a trigger and things. going well can be a trigger depending. upon your unique like life history and. unique wiring. There's a wonderful. animal experiment where if you put a rat.

in a cage with a lever to press for. cocaine, that rat will press that lever. till exhaustion or death, which is. essentially the animal model of. addiction. But if before the rat becomes addicted, if the cocaine is then removed such that. pressing that lever no longer yields the. reward, that rat will eventually extinguish that. lever pressing behavior. So they'll. they'll stop pressing the lever, right? They'll stop doing the work. It can take.

a while, but eventually they won't press. the lever anymore. Now if that same rat. after a period of time is then exposed. to a very painful foot shock, the first. thing the rat will do in response to. that painful foot shock is run over and. start pressing that lever again. And to me that's just a wonderful model. of what we see in humans that when. individuals are under extreme stress, they are typically more vulnerable to. relapse um because their brain has.

already encoded using these high. dopamine rewards. um in response to any kind of pain as a. way to get out of that state. So we. talked about the pleasure-pain balance. here. So but if in my life I experience. some form of pain, I'm likely to go and. seek out pleasure and stress could. theoretically be considered a form of. pain. Yeah, which is why people um with. severe childhood trauma are at higher. risk for addiction. Um there are. probably epigenetic changes that are.

happening at the level of DNA expression. in their brains making them more. vulnerable to addiction. Um we know that people who are living in. poverty are more vulnerable to. addiction. Uh people who are struggling. with uh multi-generational trauma, uh. unemployment, major social and. geographic dislocation, those. individuals are more vulnerable to. addiction. So environmental stresses uh. definitely play a role. We also know. that co-occurring psychiatric disorders. um make people more vulnerable to.

addiction probably. That means that. people who struggle with bipolar. disorder, depression, um anxiety, schizophrenia. are at higher risk of becoming addicted. and probably it's because they're trying. to self-medicate. What about ADHD? So kids with ADHD are. at higher risk to develop an addiction. in adulthood than kids without ADHD. And the mechanism of action for that is. not. well understood, but there are some.

really interesting theories. One of the. theories is that kids with ADHD have. uh reward deficit at baseline. And that. has been shown in experiments that. people with ADHD, when you show them. rewarding stimuli, their reward pathway. isn't as activated as healthy control. subjects. >> When you say rewarding stimuli, what's. what's that mean? Images of cupcakes or. alcohol or anything that they will. endorse as something that that's. pleasurable for them.

>> So their brain doesn't release as much. dopamine when they when they see. something rewarding. >> That's right. So brain imaging studies. showing that not only do people with. ADHD not release as much dopamine in. response to rewards, but also have at. baseline fewer dopamine receptors. And remember we talked about the. decrease in dopamine receptors. being what happens. as people become addicted. So in some. ways people with ADHD, you could.

conceptualize them as already having. craving at baseline. Even before they've been exposed to the. kinds of intoxicants that lead to. down-regulation of those D2 receptors. I. had um Gabor Mate on the podcast a few. times and Gabor talks to me about how. ADHD could be perceived as learning at a. young age to kind of. distract yourself from the stress in. your life. So he was talking a lot about you know. his own experience growing up in.

Nazi Germany times and his mother giving. him to someone else because the he was. at risk of the Nazis and the stress of. that moment and how he had kind of. learned to tune out of the environment. because of that. And I I've always. wondered thought about that. theoretically. You know, if you grow up in a household. where there's loads and loads of. screaming and loads of violence for. example, you kind of learn to to tune. out. But you you can also develop a. hypervigilance. And um. so it kind of does make sense to me that. so many of those people, if this. theoretically holds,

would start with a a bit of a pain. baseline. We We definitely know that kids who are. raised in traumatic environments. where there is complex attachment with. caregivers, those kids are at higher risk for. developing addiction. And. this kind of dissociative response to. trauma, just trying to escape the. situation either in your own mind.

um with your own mental, you know, dissociation or distractions or actually. finding a behavior that gives you. comfort is. well, you know, well observed and well. well documented. Just getting back to. our early conversation about digital. media and the dangers therein, so a Pew. survey report just came out asking. parents. um how they navigate exposing their kids. to smartphones. And in the cohort of parents who said.

that yes, they do. um let their children under the age of. five play with a smartphone, uh when they were asked why do they do. that or in what circumstances, one of. the top reasons was. uh to soothe their child when their. child was unhappy or distressed in some. way. Now I I found that very concerning. because that is basically setting up the. child for the perception-action loop of.

using internal distress as a cue. uh for reaching for a smartphone, which. is works. It definitely works in the. short term. But the problem again is. that through this iterative process of. neuroadaptation, ultimately that smartphone will not be. sufficient and now the kid will need a. smartphone and. I don't know um you know, an AI-tailored. pet who will do whatever they want. whenever they they want it. And then by.

the time the kid is eight, you know, that won't be sufficient and the kid. will need I don't know a slot machine um. or or whatever it is. You know, it's. this escalating phenomenon. There's um a. couple of startups at the moment, AI. startups who are putting AI in cuddly. toys. Oh yes, right. AI in cuddly toys. Mhm. And so you can just like you can speak. to ChatGPT using your devices, you can. come home, you can pick up your cuddly. toy, your cuddly toy will talk to you, it will ask you how your day's been, it.

will it can teach you things. What do. you think of of that from a. neuroscience or, you know, a dopamine or. connection perspective? I think that. this is a very very dangerous because. we're essentially offloading the work of. parenting and creating those. relationships. You know, not again, I I. hate judging parents cuz parenting is. hard and I've made many mistakes in my. parenting, you know, but what's and I'm. sure these the parents have the best of.

intentions, but instead of, you know, navigating. finding a way to communicate with their. child to figure out how to know what's. going on in that child's life, which can. be hard to do cuz you know, even young. children aren't necessarily. [clears throat] willing to disclose, but. once they get to be teenagers, forget. it. Then you got to like wait until. they're ready to tell you, which is. almost always like at 10:00 p.m. at. night when you're exhausted after. working all day, right? So so so there's. that piece of it, right? They're they're.

not putting in the work, spending the. time with the child, finding a common. language. But you also then then the. second piece of it is now you've got. this child who is essentially. self-soothing with a machine, right? And. again, this the the the the machines are. designed to flatter, to validate, to. comfort. There's no friction there, right? This is incredibly. um potent. social validation.

uh and soothing, self-soothing. It's. essentially a masturbation machine. And then you've got this really weird. additional loop where now the parents. are finding about out about their. child's life through. reading and observing her interactions. with the AI. So it's like a game of. telephone. Now they've like filtered. this thing where they they think they. know what's going on in their child's. life, but of course they don't. And none. of that has gone toward fostering. relationship between those parents, you.

know, and their child. And this [clears throat] is just, you. know, really really scary because it's. going to lead to this incredible. fragmentation. of families, of social bonds. I mean, it's it's it's I just we cannot. go in that direction. We really have to. fight against that. So, with all this said, and with the. knowledge that these algorithms are. going to get more addictive because AI. is going to know me more and more and. more. And actually the commercial model.

behind any of these big technology. companies is to keep my attention on. their product more so they can deliver. more ads or they can charge me a higher. subscription fee. Are you at all hopeful? Because I can't. see. from an incentive perspective when we're. talking about, you know, the commercial. models behind these companies, why. things aren't are going to stop and go. back. I mean, I agree with you, the. genie's out of the bottle. We're we're. not going to. go back, but I am hopeful because. um. I think I'm just a realistic optimist. I.

I do believe in the human capacity to. adapt and solve problems. And the simple. fact that we're talking about these. problems now, which we weren't doing, you know, 10, 15 years ago, I think is a. good thing. There's much more awareness. in the population about the potential. dangers of digital media. And and at the. forefront of raising the alarm um has. been parents cuz parents are seeing the. sort of disintegration of the nuclear. family in real time and and they don't.

like it. So, I am hopeful because. I just I just think that we're going to. come together and we're going to try. different solutions. And some of those. solutions will involve technology. Um. you know, and and like trying to come up. with guardrails or or better technology. I think the way that we're going now um. you know, with like the erotic chatbot. is is not the right direction. But then. again, we live in a you know, free. democracy and consenting adults.

you know, can do what they're going to. do until we decide as a society that the. harms outweigh the potential benefits. But I I really think in the short term. we need to focus on kids. Because kids are vulnerable. They're. vulnerable on so many levels. On a. neurobiological level, they're. vulnerable because their brains are. still rapidly evolving, incredibly. neuroplastic. They're cutting back on the neurons. they're not using. They're myelinating. and making more efficient the neurons. they use most often. That whole process. ends at about age 25. Plus you've got.

the buckets of hormones that are going. into kids. The the fact that teenagers. are natural risk take risk takers that. they they should based on their. evolutionary milestone be going out and. meeting people and be curious and making. connections at that time. And yet more. and more teenagers are staying at home. and getting their needs met, you know, digitally. So, we've got we've got to. look at kids. That's got to be like the. first priority. And we've got to help. parents cuz we can't leave it up to to.

parents alone. So, I I'm optimistic that. we are going to. you know, come up with. solutions and I think we just have to. try a lot of different things and see. what works. But it's can't just be an. individual, you know, solution. We can't. just leave it to individuals or parents. or families alone. The schools have to. join the solution, uh governments, legislators, and also the companies that. make and profit from digital media. They. they really are responsible for making a.

product that um. doesn't harm kids. And right now. [clears throat]. you know, we have a product that harms. harms kids. You've recently been an expert witness. in certain. trials in court, right? Yes, in ongoing. litigation litigation, yes. What can you. tell me about about that and. and about the parties in play and why. you're being called to be an expert. witness? I can't actually tell you too. much. I can't talk about it. Um but I. can tell you that the the the basic.

premise is that kids are a vulnerable. group, that uh social media is not safe. for kids, that it causes harm at many. different levels, but primarily through. uh the uh medium. uh itself being addictive and engaging. their brains and exploiting their. motivational reward system with design. features that keep them clicking and. swiping.

And in that case, someone's suing the. social media companies. That's right. So, you've got school districts, counties, states, uh the federal. government, entities representing the. federal government um. suing uh social media companies, yeah. What outcome are they looking for? They're looking for a safer product for. kids. They're looking to um help parents. and kids and schools um protect kids. from the harms of social media. Which again are are not just the harms.

of addiction. You know, that's sort of. the the process by which the engagement. becomes pathological and then the harms. multiply because of the sheer amount of. time spent, but the harms are include. things like uh cyberbullying, sexploitation, uh sexual abuse material, the outcomes of depression, anxiety, eating disorders, body dysmorphia, sleep. disruption. The world of business looks entirely.

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whatever bad habit I might have been. doing, drinking too much cuz it was New. Year's New, you know, New Year's. parties, etc. My brain is currently. going to be slightly out of balance in. terms of its dopamine. balance. Yes. So, hypothetically, your brain will. be in a dopamine deficit state. What. you'll want to do is you'll want to. abstain from your drug of choice long. enough Mhm. in order to reset reward. pathways. Okay, so if I've got a sugar. problem, Mhm. then I need to just lay.

off the sugar for a little while. You need to lay off the sugar for at. least 4 weeks. 4 weeks? Yeah. And why 4. weeks? Cuz on average, 4 weeks is about. the amount of time it takes for people. to get out of the state of acute. withdrawal. and begin to be able to take joy in. other more modest rewards and not be in. a constant state of craving. Okay. The. worst part is those first 10 to 14 days. That's when we're in acute withdrawal.

And the reason for that is when we first. take our reward off the pleasure side of. the balance, right? Which I'm going to. do now. So, when we first stop the sugar. or the AI or the cigarettes, That's. right. The first thing that happened is. our pleasure-pain balance crashes down. to the side of pain because of this. process of neuroadaptation, right? Now. we're in the state of acute withdrawal. And I want I've got cravings. Cravings. And yeah, what are the characteristics. of withdrawal? Anxiety, irritability, insomnia, dysphoria, or depressed mood,

and cravings. And it's crazy cuz when I'm in that. state, when I've not had my drug of. choice for, say, a day or two, I look at. the drug differently. Like my it just. looks different to me. It's so crazy. I'll I'll walk past, let's say, what's. something I really like, maybe carrot. cake. If I've, you know, if I've been. having a lot of sugar, which is quite. rare for me, but just say I have. When I look at the carrot cake the day. after. I had carrot cake, it looks amazing. And it looks so delicious. But when I'm.

in at the ketogenic state where I've not. had carbohydrates for, say, 4 8 weeks, I. look at carrot cake. and I have no emotional connection to. it. Exactly. So, that summarizes it. perfectly, right? I had a patient with a. severe food addiction. who when she walked into the break break. room at work and saw the donuts, she broke out into a cold sweat and. actually had stomach pains. It was a. physiologic state of craving and. hyperarousal. just by looking at the donuts.

And that's what happens essentially, right? Because we're we're in this state. of constant craving. Our brain has. overvalued this reward. We have euphoric. recall of our earlier use of the drug. when we first tasted it how delicious it. was. And even now. >> [clears throat]. >> if we even now when we eat it because of. tolerance, it's not as good as earlier. use, our brain still remembers. earlier use and and we have this.

overweighted value of oh, how delicious. it's going to be. And so, this is really important to. remember because when we're in that. acute state of craving, it feels like it. will never end. It really does. And I'm. I've I'm still amazed in in my clinical. work how in early withdrawal, people. just say, "The craving is is horrible. Like I I just I can't live like this.". And I think that's really important to. point out that many people try to stop. using their drug of choice, but they.

don't try they don't stop for long. enough to be able to get out of that. vortex of craving to get come get to the. other side. And it feels like the craving will never. end. So I I always have to reassure them. that if they can just wait long enough. without using, they will eventually get. to that place where they're not in that. constant state of craving. Now, that's. assuming they have enough. neuroplasticity to do that and not. [clears throat] not everybody does. And so what what what what is the. purpose then of abstinence? It's again,

when our brain is no longer getting this. exogenous source of stimulation or. dopamine, eventually the brain gets the. message, "Oh, okay. I need to start. upregulating my own dopamine. transmission, right? I I need to. re-employ or re- I need to redeploy my. postsynaptic dopamine receptors, right? I need to get it from inside of my. brain." And so eventually, I'm I'm just. going to take the rocks now off the pain. side of the balance.

You know, I could have made this easier. >> [laughter]. >> Yeah, let me do that. There we go. Eventually, if we abstain for long. enough, those. that process of neuroadaptation reverses. itself. And when you say. neuroadaptation, you mean the brain. changing. Right, the brain changes. So. the the kind of neuroplasticity that we. see. with addiction. can be reversed in most cases. And.

neuroplasticity is just the brain again. changing. Right, changing. Right, or or. going back. Now, interestingly, you. know, the work of Edie Sullivan and. others looking at what happens in the. brain during recovery suggests that. those addiction neural circuits probably. never go away, but but like the dying. embers of a fire, they quiet down. And. then recovery is characterized by the. development of new neural networks that. route around those injured areas. But.

the bottom line is that because of. neuroplasticity, we can eventually. return to kind of baseline levels of. pleasure and pain. We can restore our. hedonic or joy set point. And when we do. that, we're in a much healthier place. because now we can take pleasure in. other rewards that are not our drug, right? Like watching a sunset, talking. to a friend, going for a walk, things. that we lost the capacity to enjoy.

because our reward pathway was hijacked. by our drug of choice. I think this is a. really important point as well when you. say drug of choice because one thing I. learned from our conversation last time. is that me and you will both be. susceptible to becoming more or less. addicted to different drugs of choice. So for me, it might be whiskey. For you, it might I think you said it was like. erotic novels were one of your things. I I don't drink whiskey, just for the. record. >> [laughter]. >> But it might be I don't know, it might. be opioids or AI. I might be more. susceptible. So say if me and you spend. 1 hour on TikTok,

the way my brain is wired, the things. I've been through in my life, whatever, might mean that I get really addicted to. TikTok, whereas you don't feel that. Exactly. And what distinguishes um you. know, addictive drugs or intoxicants. from other substances is that they do. release a lot of dopamine all at once in. the reward pathway. So many, if not most. people, will find intoxicants. reinforcing, but that's not universally. true. Like there are some people who. take opioids and find them. that they feel very uncomfortable and.

it's not doesn't make them feel. euphoric, right? And other people will. drink caffeine and not feel the. stimulating effects. And other people. will have alcohol and you know, get a. headache and not not feel relief. So and. and so this differences in our brains is. a really important concept. What about. this idea of having an addictive. personality? Is that a real thing? It is a real thing. We don't use that. terminology anymore. We talk about the. inherited or genetic risk of addiction.

We do know that if you have a biological. parent or grandparent uh with an. addictive disorder, you are at increased. risk of developing addiction compared to. the general population, even if you're. raised outside of that substance using. home. Am I right in thinking you don't. use that term because it suggests one. can't change and that they're stuck. Or. is there another reason? You know, it's. a good question why that term has gone. out of favor. I think in general, when. we talk about Yeah, when we talk about. personality, it does seem like a kind of. a fixed feature of somebody's um.

character and so we're probably trying. to avoid that. One of the really. liberating things about what you've just. said is maybe we don't need to make New. Year's resolutions. Maybe we need to. make just a January resolution because. that's 4 weeks long and if I can get to. the end of the 4 weeks, then the. cravings are likely to have gone. And. you know, when you think about a New. Year's resolution, then you get like a. week in and you're like, "God, I'm not. going to be able to do this for the. whole 365 days." What you've just said. actually illuminates the fact that maybe. you should just set yourself a 4-week.

resolution. Exactly. And that's what we. often do in clinical care. If we were to. ask people to abstain for their whole. lives, it seems impossible. But if we. ask them to abstain for 30 days, it's. kind of a an amount of time that they. can wrap their heads around. And also, not in all, but in most folks who are. willing and able to do it and also. importantly for whom it's safe to do. because it's not safe for everybody, right? We wouldn't recommend that for. someone who's at risk for. life-threatening withdrawal from alcohol. or benzodiazepines or something like.

that. But for people who are willing and. able to do it, they usually feel better. at the end of those that those those 30. days. And then they can make a decision. about whether they want to continue to. abstain or or they want to go back to. using. And if they do decide to go back. to using, they've typically, you know, have lowered their tolerance for their. drug of choice, which means that when. they do use again, they can get reward. from it again, which again, because of. neuroadaptation, we lose the ability to. do that with chronic heavy use.

So so that you know, that that there is. this whole concept of moderating our. use, which didn't used to be something that. we even. talked about in the field of addiction. when it was thought that abstinence was. the only way. But more and more um you. know, we are thinking about healthy ways. to moderate after a period of. abstinence. And the reason we recommend. a period of abstinence, even if the.

long-term goal is moderation, is because. we find that people are more successful. moderating if they first um abstain for. a period of time. What about if I'm trying to pick up a. new habit? Mhm. What what How do I need to be thinking. about this pain-pleasure scale? And what. are What's a good strategy with this in. mind? So I want to start, let's say, I. want to start going to the gym. Right. So you've chosen a habit, going. to the gym, that is hard to do and.

involves effort. So that means that. habit won't happen easily the way that. habits that are related to the sudden. release of dopamine in the reward. pathway cuz those are habits that are. frictionless. We we pick them up. instantaneously. But a habit that. involves. effort and for which the rewards are not. immediate, you can you can again think. about this pleasure-pain balance and now. instead of pressing on the pleasure. side, we're intentionally pressing on. the pain side by making ourselves get.

out of bed in the morning, go to the. gym, engage in effortful exercise. And. what's interesting is that when we do. that, the neuroadaptation gremlins that I talk. about are these rocks that we've used. here today will actually go on the other. side of our balance, so on the. pleasure side and we will get our. dopamine indirectly by paying for it up. front. And the way that that's probably. happening is that our body in sensing. injury.

is upregulating feel-good hormones and. neurotransmitters like dopamine, but. also endogenous opioids, endogenous. cannabinoids. And from an evolutionary perspective, that's really how our pleasure-pain. balance evolved. So just to simplify. this for me, Yeah. I go to the gym, I get up, I travel to. the gym, I lift up those weights, I do. my run. I'm going to feel good, but it's going. to be delayed. Right. And importantly, you're not going. to feel good when you first start. exercising, right? At least most people.

don't. It's it's painful and you're. thinking, "How how many minutes am I am. I you know, how many minutes do I have. left?" And we do know in fact that. exercise is immediately toxic to cells, which is really kind of strange cuz we. know exercise is good for us. But again, what's probably happening at a molecular. level is that the body is sensing. cellular injury and in response. upregulating all those feel-good. hormones and neurotransmitters, but it. takes time. It takes time and so we're.

going to have a delayed sense of reward. And that's the runner's high, right? That kind of comes after uh the exercise. is over. Or maybe for some people it. comes in the middle of exercise when. you're a little bit into it or halfway. through. But at some point, you know, you get the endorphins and that feels. good. How would one go about gaming this so. that. I'm more likely to do it? Because, you know, the reward comes. after, which is not not incredibly. useful. You almost almost have to have. like a religious belief in exercise cuz.

you go, "No, I'm not going to want to do. this, but it's going to I'm going to be. glad I did afterwards." Right. So is. there anything I can do? Like do I have. a Mars bar when I get to the gym or. something? I don't know. You know, there are so many ways and so. many tricks that people use to kind of. create new healthy habits. Um one of the. ways that we can do it is to prepare in. advance. for that moment. when we want to do something that's. hard. Because if we wait till that moment to.

decide whether or not to do something. that's hard, we almost always choose not. to do it. But if we make a plan in. advance, let's say the day before, that. tomorrow I'm going to get up at this. time, I'm going to, you know, get my. stuff together, and I'm going to go to. the gym, we're much more likely to. engage in that activity. And that can. also include then rituals around that. activity that we prepare in advance. So, for example, packing our bag, right? The. schedule itself, setting up a time, maybe planning to meet a friend, right?

So, we connect friendship or. socialization. with the thing that's hard to do. It's. much easier to do these difficult things. with other people. than than to have to do it alone. How. does that link to the the pain side of. the balance, or does it at all link to. the pain side of the balance? This idea. that if I put my clothes out the night. before, and I I schedule it, and I. really plan for it, is it it's reducing. the pain involved, and that's going to. increase the probability of the behavior. occurring? Is that what you're saying,

or is there something else, or is it not. linked to that? >> I I don't think so. I think instead, you. know, the prefrontal cortex is the large. gray matter area right behind our. foreheads that's so important for future. planning, and delayed gratification, also for auto autobiographical. narrative. And I think by putting these, you know, pieces in place, that allows. our prefrontal cortex to plan for this. future event that we know we're not. going to want to do, but that we want to. do. Mhm. It allows us to kind of put the.

brakes on our. short-term desires, and. project ourselves into the future to. achieve our long-term desires. So, Sam. McClure, a neuroscientist, has shown. that in response to immediate rewards, the emotion brain gets activated. >> Mhm. In response to long-term rewards, the prefrontal cortex gets activated. So, by planning in advance all of these.

little pieces, sometimes called habit. stacking, we're essentially activating. our prefrontal cortex, projecting. ourselves into the future, and anticipating a long-term reward, which then allows us to do hard things. and avoid short-term rewards in the. service of our future selves. So, many. people might. have an experience where they kick the. habit for a little while, and then they relapse. >> Mhm. You know, it might take might be a.

month, might be 2 months, might be 3. months. Is there is there any art to. avoiding the relapse? So, it's very common to relapse, especially living in the world that we. do today, where we're constantly being. invited to consume really these stimuli, you know, getting us to to drink or to. smoke or to do various forms of. entertainment chase us down. We can't. avoid them, or it's very difficult to. So, I talk a lot about self-binding. strategies with my patients. And.

self-binding strategies are a way of. putting both a literal and a. metacognitive barrier between ourselves. and our drug of choice. >> What's a metacognitive barrier? >> Oh. So, it's like a it's a thought, right? Or a narrative. So, instead of it being. a physical barrier, like a physical. barrier would be, for example, getting. the smartphone out of the bedroom, or. deleting an app, right? Or getting. alcohol out of the house, or whatever it. is, creating both a a physical barrier.

between myself and my drug of choice. A. metacognitive barrier is something like. more like a thought process. For. example, long-term goals, or. you know, what are my what are my. values, right? And how do my values. trump my immediate desires, or how can I. co-regulate with other people? These are. all self-binding strategies that we can. use so that we're not relying on. willpower alone.

Because if we. wait to rely on our willpower alone, we will not make it, especially in this. world of overwhelming overabundance. There are just too many temptations. Willpower is an exhaustible resource, meaning that it doesn't last forever, it. eventually runs out. So, we've got to. actually create barriers between. ourselves and our drug of choice so that. we can have a little bit more time, and. that little bit more time, that slowing. things down, is sometimes just enough to.

allow ourselves to surf the cravings, and get through them without actually. using. Is it possible to become addicted to. good things, too? So, when I use the. term addiction, I'm really talking about. a disease process, a form of mental. illness. It's a very common term that's. used in everyday life, and people don't. always use it in that way, but when I'm. using it, I I'm really talking about the. problem of compulsive overconsumption.

despite harm to self and or others. And. it's important to distinguish addiction. from something like a habit, which I. don't consider to be, you know, an. addiction or even a bad habit, right? Doesn't meet threshold criteria for. addiction. And also, it's important just. to distinguish all of that from a. passion, something that we really invest. in and that we love to do, but that's. helpful for ourselves and or other. people, is not consistently causing. harm. Are there any daily practices,

like a morning ritual, that you would. advise someone to consider if they were. trying to set themselves up to kick a. habit or to kick an addiction? So, I. recommend doing the hard things first. A shorthand way of saying that is to. start your day with pain, meaning, for example, do the hard things when you first get up. as part of your morning routine, Like. exercise. >> like exercise, make your bed, eat. breakfast, brush your teeth, plan your.

day, plan what you're going to do if you. haven't done it already, and do all of. those things before, for example, you. have your morning cup of joe, or before. you touch a single screen or digital. device. Why? Because those are. reinforcers that are so powerful that. we're all vulnerable to having our. goals and desires be hijacked by them. So, really important to take the time in. the morning to set up a good morning. routine. before you expose your brain to these.

incredibly reinforcing substances. >> clear on why. Wasn't clear on the why I. would do why I'd go to the gym early, or. why I'd do hard things first before I. get into Tik Tok or social media. If you. do intoxicants first, right? If you. expose your brain first thing in the. morning to things that are incredibly. pleasurable, you have nowhere to go from there. And. in fact, if any if anywhere, you're. going to have a come down from that. And. then you're going to be starting from a. place of compromise, where then doing.

the hard things is is even harder. Whereas, if you start with the hard. things, you will potentially get rewards from. having done those hard things, right? And also feel a sense of competence, right? And and accomplishment that then. allows for you to move through your day. in a way that's better if you just start. with something that's incredibly. pleasurable. If I am getting ready to. kick a habit, a big one, a big, you.

know, one that's really hung around for. a long time, is there something I should. do in preparation. to plan for my dopamine fast or for. kicking that habit? Cuz you you know, you said, you know, from day one it will. take about 4 weeks to start to to feel. the cravings diminish. But is there. something I should be doing before I. even start those 4 weeks? Yeah, so I. strongly recommend preparing for the. dopamine fast in advance. And the things. to do are first, figure out what is your. drug of choice, that is to say, what is. the thing that you're consuming too much.

and too often such that you regret it. later, Mhm. or the thing that's leading. to obvious negative consequences, or the. thing that just has opportunity costs. associated with it. That is to say, you're spending so much time consuming. this drug that you're not doing other. things, other hobbies, investing in. other things that are meaningful to you, like your primary relationships. So, that's very important to just figure. that out first. And I usually recommend. something called the timeline. follow-back method. That's where you.

start today, and you count backwards for. every day of the week, what did you. consume in terms of your drug of choice, um how much and how often. So, really. looking at quantity and frequency, and. then adding that up over those 7 days. And the reason that's important is. because. we can really lose track of how we're. consuming our drug of choice when we're. chasing dopamine. We're very bad.

self-observers. So, just to give a a. personal example, um I had gotten into. this habit of watching YouTube after. work as a way to relax, Mhm. especially. on my long clinic days when I was more. tired. And I thought it was just that I was. watching for maybe half an hour a couple. times a week. And then my daughter, a. teenager, came up to me, and she said, "Mom, you're always watching YouTube. now." And I said, "No, I'm not." And I. was really kind of insulted because in. my mind, it was not very much. I. thought, "Geez, can't I relax every once.

in a while and watch some YouTube?" But. then after she left me, I thought to. myself, "Well, okay, how much have I. been watching right now?" And turned. out, oh, I've been watching for an hour. and a half. And then I thought about the. day before that, oh, it was probably 2. hours. And the day before that, it was. probably about the same. And over the. course of a whole week, it was probably. about 14 hours of YouTube, which is a. whole day. A whole day, right? And so. >> What were you watching? Oh gosh, so embarrassing.

For I I got I got into this jag of. watching Dr. Pimple Popper, which I know. is really weird. You don't even know. what that is, right? Yeah, so it's. people popping other people's pimples. >> [laughter]. >> So bad. So bad. >> That's not what I expected you to say. >> Yeah, right? I thought it was going to. be AI, some psychology thing, some. science. >> no. People popping other people's.

pimples. >> Yeah, yeah, yeah. You know. >> a whole day watching that. >> Yeah, when I added it up over a week, it. was a whole day of watching Dr. Pimple. Popper. [laughter]. I don't know any founder who started. their business because they like doing. admin, but whether you like it or not, it's a huge part of running a business. successfully, and it's something that. can quickly become all consuming, confusing, and honestly, a real tax. because you know it's taking your. attention away from the most important. work. And that's why our sponsor, Intuit. QuickBooks, helps my team streamline a.

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for 25% off on any product site-wide, but you have to order through that link. That's boncharge.com/diary. with code [clears throat] diary. And on on. page 64 of your workbook of Defy Nation, there's this really interesting. image here, which I I'll throw up on the screen. It. shows a brain, and that's as far as I'm going to go. with Mike me explaining it. Over to you. >> [laughter]. >> Okay, so this is these are human brain.

imaging studies. This is adapted from. the work of Nora Volkow and her. colleagues. She is the head of the. National Institute of Drug Abuse, an. amazing researcher and scientist. And she looked at dopamine transmission. levels in the reward pathways of healthy. control subjects on the left versus. people addicted to a variety of. substances on the right, cocaine, meth, alcohol, etc. Basically, what she found was in the in.

the brains of healthy control subjects, there was plenty of dopamine. transmission as represented here by red. or the darker color. In the brains of people who had been. using these substances in an addictive. way, meaning heavily and chronically, there was almost no dopamine. transmission in the nucleus accumbens. In other words, these individuals are in. a chronic dopamine deficit state. They. have below. normal levels of dopamine transmission.

Isn't this just kind of the story of how. the human body works, where if you give. it too much of something. through an external source, an exogenous. source, so if you're taking. lots of dopamine via. TikTok or from porn or from alcohol, your brain goes, "Well, if you've got. enough of that, then I won't make any.". You know what? You just summed it up. That that's exactly right. That. essentially too much of anything is bad.

And that our brain, which is designed to. return to homeostasis, homeostasis being. a finite number of physiologic states. that the organism must maintain in order. to survive. Is this the case with things like. melatonin as well? Because there's. people are struggling not with sleep, so. they're taking a lot of these melatonin. pills, but I don't know, someone offered. me one one time, and I remember. thinking,

"Well, if I start taking this, then. isn't my body. going to stop making it? And then I'm. going to become dependent on these. [ __ ] pills.". So that is the potential with I think. any. exogenous source that we. that we use, right? Anything that we ingest, our brains and our bodies. will want to adapt to bring us back to. whatever our baseline is. But the the.

difference between addictive substances. and behaviors. and non-addictive ones is that the the. release of dopamine in the reward. pathway is. so fast and so strong that this process. of neuroadaptation is equally strong to. bring us back down to baseline. Because we we do know that there are. medications that people can take for. very long periods of time and actually. not develop tolerance to them,

right? They can continue to work for. them over the long period of time. We. don't actually know exactly why it is. that some some people develop tolerance. and and not others. And again, it. probably has to do with the amount, you. know, the dose, exactly how it's working. on the brain. But in general, things. that are highly reinforcing, our brain. tends to adapt to them over time. And. testosterone is another one people often. talk about where if you take external. testosterone consistently, your brain.

will decrease the natural production of. it, and as a result, natural. testosterone shuts down, and testicular. size can shrink. But then if you stop the TRT, the. external testosterone abruptly, your. natural system might take a long time to. recover, and in some cases, it may never. fully recover back to baseline. I think. this is just like a really important. principle for Yeah. drugs, chemicals, >> Yes. or messing with the natural balance. of one's body. Yes. Yes, exactly. And by. the way, Nora Volkow and her team did a.

follow-up study in individuals who. abstained from methamphetamine for 14. months, and then re-scanned their brain. and showed that they had restored. healthy levels of dopamine transmission. It took 14 months in those individuals. who had been very addicted to. methamphetamine, which I think is also. an important message here, you know, for. individuals struggling with severe. addiction, it's not like 4 weeks of. abstinence is suddenly going to, you. know, make your brain better. But what I. have found in clinical care is that.

that's typically enough time to begin to. see the light at the end of the tunnel, and that indeed there's enough. restoration of sort of baseline levels. of. joy, your capacity to experience reward, that that people can begin to have hope. to get out of that state of craving. What is the most interest cuz Ethan is. posed to some research on the subject of. dopamine and human behavior. Is there a particular study that always.

stands in your mind as being the most. or surprising that you've encountered? A. study that. um that keeps coming back to me, there are a couple. I mean, there are so. many, but Give me them. Okay. So. if you put a rat in a cage with a rat. trapped in a plastic bottle, that rat will that rat will work very. hard to free the trapped rat.

But if you then allow that rat to. administer self-administer heroin, it will not work to free the trapped. rat. To me, that's really powerful because it. it suggests how. addictive substances like opioids, which heroin is, can usurp our desire for human. connection.

And essentially become the object of. attachment. And we often talk about loneliness and. isolation as a risk factor for. addiction, which it absolutely is, but. the reverse is also true. That getting addicted will cause us to. isolate and be lonely. We will stop. caring about other people. So for me, that's that's a really a. really powerful, you know, kind of.

experiment that I think does map on to. human behavior. Something really. interesting this one just at a. day-to-day level, which which in your. head I was trying to relate that to my. my own life and thinking, you know, if I. get really addicted to my screens and my. devices, when my partner needs me, Right. I might. be. so distracted and so connected to the. thing that's giving me dopamine upstairs. in my bedroom like my laptop or whatever. on my work that I might completely miss. her call for help.

And I kind of you know, I hate to say. it, but sometimes I do feel like. maybe that is I've been guilty of that. >> Yeah. Yeah. >> Yeah. I've been so. dare I say the word addicted to. my work with devices or whatever that. you know, sometimes I'm not present with. meeting other people's needs. Absolutely. And you know, that certainly. happened to me with my addiction to. romance novels, right? We I stopped. paying as much attention to my kids and. to my husband. We um went on a.

vacation with another family at the. beach and instead of joining folks on. the beach, I stayed in the room and read. romance novels. We went to a neighbor's party and I. actually found a room in the house and. read romance novels instead of. socializing and didn't even think that. was weird even though that's obviously. really strange. So, it is this kind of. coming to overvalue. our drug of choice and undervalue other.

more meaningful. good things in our lives. Could you theoretically say it's making. the world less empathetic. or less sympathetic or less. what's the adjective of like of actually. being there for other people? I guess. connection and relationships it's it's. it's hurting our ability to connect to. others and be have empathy for them and. be there for them because we're. possessed by. the thing giving us the most dopamine. Yeah, I would go even further and say.

not only is. is it making us less empathetic, but. it's actually making us sociopathic. In other words, when people are in their addiction, they. can deviate from their moral compass um. because they so overvalue this drug of. choice that they lose sight of their. their own values. And we see this um. with kids who become addicted to video.

games or or social media. They stop. participating in family life. They stop. treating their parents with respect. They stop participating in household. chores. Um they become essentially. antisocial. And when they get off of digital media. and they go through that terrible. withdrawal period, it all that gets. worse and and even they will endorse. things like wanting to hurt their. parents or wanting to hurt themselves. But if they can just go long enough and.

abstain uh you know, from digital media, they will they will come out the the. other side and parents will talk about. getting their child back, you know, and. getting back you know, this person that. that they recognize as their child. So, I think this is this is really. important. When people are in their. addiction, they can look very. personality disordered, very. narcissistic, very borderline, very sociopathic. And when they get into recovery, that's.

not who they are at all. And they can. they can really become themselves again. I read about a really extreme case where. that drug, I believe it's called. pramipexole, pramipexole, which is a dopamine agonist. >> Yes. Which essentially means I guess the. molecule is the same shape as dopamine. So, it kind of the brain treats it like. dopamine. >> Yes. And these people were given it for. twitchy leg or something. Right. >> And then they. like so many of them lost their minds.

They became. obsessed with like compulsive impulsive. behaviors and I was reading about one. particular lady and she would leave the. house in the early hours of the morning. when she was taking this drug which kind. of is the same as dopamine and she would. wear see-through tops. This is like a. normal woman who otherwise. [clears throat] had a normal life and go. to. very dangerous places to try and have. sex with strangers. And it was because she was her brain was. um. full of this this drug which simulated.

dopamine. But there's so many examples. There was one from Australia where a. woman was taking this drug which which. is like dopamine in terms of its. molecular structure and she would sit on. these slot machines until she soiled. herself and urinated on herself. She. ended up losing her house, losing her. car, losing her marriage just because. they'd given her this drug which is the. same as dopamine. And it made me realize. that that dopamine isn't necessarily the. the drug of. reward but more of like. what wanting and impulse and desire. Is.

that an accurate assessment of it? Like. did it make you desire things? And there. was other examples that when I was. reading about it where people would. a guy would take this drug. and. started engaging in homosexual. sex acts. Whereas otherwise he'd been in a. heterosexual relationship. >> Mhm. It was all very confusing, but it. it says something to me about what. dopamine is actually doing. Yeah, I mean I think you know, when. we're talking about. addictive substances and behaviors,

the initial response of the brain is to. release a lot of dopamine all at once in. the reward pathway. But with repeated. use, dopamine dopamine release gets weaker. and shorter in duration. and eventually it leads to this dopamine. deficit state and that's often what we. call wanting but not liking. So, and. George Koob has called this dysphoria. driven relapse where.

now they're using you know, not to feel. good but just to stop feeling bad and. feel normal. So, in that sense I mean. dopamine is. I mean it is part of pleasure. I mean. that that's it's that's not you know, it's not its sole function. But when it. comes to addictive substances and. behaviors, the initial encounter has to. feel good or be reinforcing or get. someone out of pain, right? It has to. solve that problem. But again, the issue.

is that with repeated use it stops doing. that, but there's still that motivation. to reuse again and again. And when we're thinking about like. exogenous or external sources of just. giving someone dopamine, that's not. going to work to treat that dopamine. deficit state because it's going to bind. indiscriminately to dopamine receptors. throughout the brain and the brain will. respond with that same process of.

neuroadaptation where it's. downregulating. you know, dopamine receptors, which is. again what is setting us up for this. repeated addictive pattern. Is there any. other studies that were shocking to you. and that have always stayed with you? Another really interesting study is if. you um expose a rat to a single. injection of cocaine and then slice open. its brain, you'll see this arborization. of dopamine releasing neurons in the. reward pathway. So, that means a.

proliferation of uh neurons that release. dopamine, a kind of growth of the. dopamine forest, so to speak. But by the. way, you'll see that same arborization. or growth of dopamine releasing neurons. if you put a rat in a complex maze, right? Which is to say a maze where they. can explore and find different things. and have challenges. If you then cut. that rat's brain open, you'll see that. same arborization of dopamine. So, in. other words, learning is highly. rewarding and dopamine is released in.

response to novelty and new things and. new challenges. But if you then take that rat and. pretreat it with methamphetamine and put. it in the maze and then look at its. brain, you don't see any additional. arborization beyond what you got with. methamphetamine. And the interpretation there is that. drugs actually may usurp or steal our. ability to learn, right? Because they've.

again this idea of sort of they've taken. over. They're such a powerful dominant. stimulus that there's no additional. growth or neuroplasticity. in response to something like learning a. maze. And does that mean that. when that rat was in the maze the first. time and its brain was full of dopamine, dopamine was therefore playing a role in. helping it to learn? No, so the learning itself. actually caused prolif So, so dopamine.

is is responsive not just to rewards, not just to pleasurable things, but it's. actually responsive to pain, it's. responsive to novelty. So, it's. responsive to any emotionally powerful. experience. So, when you put a rat in a maze and it. explores that maze, that's an enriching. exciting experience for the rat because. we are. creatures who are evolved to seek and.

explore and learn new territory and then. move on and do the same thing. Ah, so. you could say then if I'm taking an. addictive substance like cocaine, I'm. going to be much less likely to go out. and explore the world. Yes, exactly. Or. if you do explore the world, you'll. there you'll your capacity to be. rewarded by that experience will will. decrease or will not be there. So, I'm. less likely to do it then. >> Right. Yes. Yeah.

>> Mhm. I mean this highlights a bit more. of a fundamental link around like. motivation. Like if you're addicted to. something, if you're addicted to. pornography, your ability to like get up. and go out and get a job might be. diminished. Absolutely. I mean what what happens. with addiction is that we have a. narrowing of our focus on our drug of. choice. such that that's the only thing that's. reinforcing for us and other things lose. their rewarding potential. And. eventually they fall away all together. and we're spending all of our time. getting our drug, using our drug, trying. to get more as we come down. Can I talk.

about another experiment which I think. is interesting? Another really. interesting experiment is the rat park. experiment and this is the work of Bruce. Alexander and he essentially said, well, if you put a rat in a cage with nothing. else to do but press her press a lever. for cocaine, of course that's what. they're going to do cuz there's nothing. else happening. But what if you put a rat in a very. enriched environment with a lever to. press cocaine, but also lots of other. things to do, other rats, uh shoots and.

mazes, uh little, you know, sawdust. balls. What he discovered was that the. rat is much less likely to press that. lever as often because it has other. reinforcing things to do. And I think. that that was really groundbreaking. in the sense that. it is true that addictive substances and. behaviors work on the brain in this very. predictable way that's so reinforcing.

that even if you have a great life, you. can get addicted, but it's also true. that. our environment really matters and if. we're living in an impoverished. environment like that single rat in a. cage with nothing else to do, we're much. more likely to get addicted than if we. live in this really enriched environment. where we have lots of other sources of. reward, lots of other sources of. dopamine. And based on that work, there.

was something then called the Icelandic. experiment and this is quite some years. ago now, but Iceland had a significant. youth drug problem and the way that they. decided to intervene was to build a lot. of gymnasiums and emphasize youth. sports. And as we've talked about, exercise and sports are a healthy way in. general, if you don't overdo it, to get. dopamine because you're paying for it up. front, right? You're working for it. And. um Iceland saw a.

significant reduction in their youth. drug use problem after the. implementation of this youth sport. system. So, I think that's a nice way to. that's a it's a nice example of how an. animal animal model can actually provide. some kind of fundamental. frame to understand what's happening in. the brain that can be then translated to. a real-world implementation. Radical honesty. Okay, so um.

radical honesty is something that I. learned about from my patients. and it was the observation that. my patients who were able to get into. sustained recovery. from severe addictions had learned. that. they couldn't lie. And it wasn't just that they couldn't. lie about their drug use. They couldn't lie about anything. So, they couldn't lie about why they were 5. minutes late for a meeting, they. couldn't lie about why they couldn't go.

to a party. They had to tell the truth in all things. large and small. And to me that was fascinating. And it was an idea that I started to. play with and experiment with in my own. life and I realized that telling the. truth is actually really hard. because we're all prone to little lies. to kind of cover up our shortcomings. Um. you know, these are things that we. hardly even notice. They're also like lies of exaggeration.

to make ourselves more interesting, lies. of flattery where we tell other people. how great they are even though we don't. necessarily believe that. So, all these. little lies that we tell, um I think even. if you're not struggling with addiction, these lies can erode our lives, make our. lives more impoverished. Um and I think, you know, it's working. through many different mechanisms. We. So, the question then becomes why is. truth-telling or radical honesty.

protective? And I think it's working across many. different levels. But one of the. important levels that it's working. across is simple awareness. Because when we're lying to other. people, we're also actually lying to. ourselves. Um and when we're lying to ourselves, we. actually don't know what we're doing, right? And when it comes to our. consumptive behaviors, on the one hand, you know, I may know that I'm watching.

too many videos on the same at the same. time really not know that I'm doing. that, right? So, but when. I tell another human being exactly what. I'm consuming, how much and how often, then it becomes real to me in a way that. it's not when it's sort of pinging. around in the dark recesses of my my own. mind. So, that awareness is really important. because we can't change our behaviors. unless we're aware um of what we're.

doing. The other aspect of that that's really. important that I've learned over many. years of being a psychiatrist is that. the way that people tell their. autobiographical narrative is really. important and that there are healthy. ways we can tell our stories and also. not so healthy ways. And what I have observed is that when. when people are telling. stories in which they're always the. victim of other people or circumstance,

I know pretty well that they're not. going to get into recovery. But if they start telling a story that. acknowledges. their own contribution to their problem, whatever it is, including the problem of. addiction, then I'm pretty confident that we're. headed in a good direction. And that's really interesting because. what it means is that our. autobiographical narratives. provide a template. for our lives. They're not just a way to. organize past experience, they actually.

provide a roadmap for the future. And if we're telling self-stories that. are. a more accurate representation of what's. actually happening in our lives, we will have more information from which. to make better decisions going forward. >> So, victimhood keeps you stuck. It keeps. you stuck because it decreases your. awareness of what is actually happening. And it is our awareness of what is.

actually happening that allows us to. have the data we need to make better. informed decisions. >> Does it also to some level rob you of. responsibility? Absolutely because. although addiction is characterized by a. a loss of agency around our consumptive. behaviors, we still have some degree of. agency always, even if it's only enough. to reach out and ask for help. And as. people get into sustained recovery, they.

have a lot more agency, right? As they. get out of that vortex of addiction. And. it is that agency that that we must. employ to make the next best decision so. that our lives will be this accumulation. of small good decisions that then lead. to good weeks and week good months and. good years. I think that point is so important, this. this idea of agency, which essentially. means like. having control in my in my life, feeling. like I have a sense of control in my. life. Is that like a definition of. agency?

How would you define it? >> I I wouldn't define it so much as. control because there are so many things. that happen in our lives that are out of. our control. But when we reduce our decision down to. today, you know, and what I can do. today, the things that I actually can. control today, then yes, recapturing our. agency around the things that we. actually have control over is really. really is really important for recovery.

The definition I've pulled up here is. agency means the capacity to act. intentionally and make choices that. influence outcomes. And um it does tend to be the case from. my observations that people that have a. high degree of agency, i.e. they believe. they have uh capacity to act. intentionally and make choices that. influence their outcomes seem to be the. most successful and on average seem to. be a little bit more happy. I think that sense of competence and and. agency is definitely one that makes us. feel good. The danger a little bit when we're.

dealing with severe addiction is that. in our addictions, we often tell. ourselves that we have agency and. control when we really don't. Mhm. And. so that can be part and parcel of. denial, which means that getting into recovery. is often about admitting. that we may have agency in many aspects. of our lives, but when it comes to our. addictive behavior, we've lost some. degree of agency. And that's part of the. 12-step program, right? >> Yeah, that is really important part of. the 12-step program is that.

admitting that our lives have become. unmanageable uh when it comes to our. drug of choice. The 12-step program. being Alcoholics Anonymous, very famous. program to to help you through an. addiction. Is there anything else we. should have talked about that we. haven't? You know, when it comes to. New Year's resolutions and wanting to. change habits, sometimes these sort of all or nothing. thinking. can.

be something that's not helpful for. people. Right? This idea that, okay, I'm going. to abstain from this and I'm going to go. a month and, you know, I'm going to do. it and then they find that they're not. able to do it and then there's then. there are a lot of shame and self. self-recrimination. So, you know, that that approach is is. not for everybody. And for some, a. better approach is sort of. self-compassion. and a goal of moderation. Yeah, moderation's an interesting one cuz. yeah, most of us will just be like, "I'm. going to go to the gym every day. I'm.

going to I'm going to have no sugar ever. again. I'm going to No, I'm going to. abstain from alcohol completely." But. maybe moderation for some of these. things is more realistic and therefore. more effective in the long run. Yeah, and we find that moderation typically is. more successful if period if people have. abstained for long enough to kind of. reset reward pathways. But, you know, even just reducing use. can be a laudable goal. We have a closing tradition on this. podcast where the last guest leaves a. question for the next guest. No idea who. they're leaving it for. The question is,

"What's the one thing the universe keeps. putting in front of you?". And what is the thing. that it keeps you learning? Um so, right now in my life, the thing. that the universe keeps putting in front. of me is the importance of. letting my kids go and have their own. life experience. um rather than. trying to cling to the relationships.

that we had before. as they were growing up, which for me. was a really joyful time, but I'm. recognizing that they need to be in the. world on their own and I need to figure. out what I'm going to do. um as an empty nester. So, that's not. that deep, but that is what I'm. struggling with right now. And how's that struggle manifesting? Well, I mean, if I'm being totally honest, um.

social media and digital media and those. modes of communication. have probably made this worse for me. because, for example, uh the Find My. iPhone, I keep checking where my kids. are and thinking that in a way. um we're connected because I know where. they are, but we're not. And also, they. don't particularly like it that I'm. checking where they are. So, there's. this kind of weird phenomenon of.

wanting connection. and through text and other technology. trying to recreate that connection. And. yet, in some ways, I think I might be. better off and they might be better off. if we didn't actually text and I didn't. actually track where they are. Does that make sense? It does. And I I. was I think I was laughing cuz I just. had this picture of you sat there with. like. one screen is tracking them and the. other one is like watching the pimples. being popped.

>> Yes. Those are comparable, right? These These. are both sort of related to sort of. habits or behaviors that are. self-soothing, but ultimately not not. good for me and, you know, not good for. other people. Do you think much about. how other behaviors that we take part in. like sleep um. and meditation. um and our nutrition have a big impact. on our ability to kick the bad habit to. start a new one? Oh, absolutely. Um. there's a great acronym from Alcoholics.

Anonymous called HALT: hungry, angry, lonely, tired. You know, when we're. feeling those things, uh we're more. likely to crave our drug of choice. Um. so, importantly, we've really got to. make sure we take care of ourselves. physically and emotionally so that we're. as well as we can be so that we don't um. get into that state of wanting to escape. or self-soothe or numb ourselves. And by. the way, that's true in the work that we. do as mental health care providers, right? We have to really come to.

patients or clients with our needs met, um our cup full so that we can be fully. present for for our patients. Dr. Anna Lembke, thank you so much for. coming back on the show. It was. incredible the conversation we had last. time and it was so unbelievably well. received um. it's done probably closer to 10 million. views across all platforms now. Um five. just over 5 million views on YouTube. alone and I can't begin to imagine all. the the people that you've had a. profound impact on by making these. complicated things accessible. And I.

know we we simplify this to a point that. it might be quite. difficult for for because I know the. science is much more complicated, but. just having a simple mental model for me. is has helped me so much since we last. spoke understand what's going on inside. my body and inside my brain. in a simplified way and that's exactly. what was reflected by the millions of. people that watched last time. Your book. is the the book to read and your. workbook as well is a critical critical. to read alongside it um on this subject. if people want to learn more and get a. an even deeper understanding of.

everything we've talked about today. And. also, if they're struggling with. addictions because. these book books provide a really. I'd say nuanced um empathetic and. shame avoiding. set of ideas and solutions to some of. the things that. hold us hostage in our lives, whether. it's opioids or technology or other. behaviors that we know at some level are. getting in the way of what we'd rather. be doing and who we'd rather become. So, thank you so much for your work. It's. such an important work and I know you're. working on another book, which we didn't. talk about this time, but when that book.

does come out, I'd love to have you back. on to talk about all the things in that. cuz I am little birdie told me the. subject matter and it's absolutely. fascinating, so I'm so excited. Thank. you so much. >> [music]. >> This is something that I've made for. you. I realized that the Diary of a CEO. audience are strivers, whether it's in. business or health. We all have big. goals that we want to accomplish. And. one of the things I've learned is that. when you aim at the big big big goal, it. can feel incredibly psychologically.

uncomfortable because it's kind of like. being stood at the foot of Mount Everest. and looking upwards. The way to. accomplish your goals is by breaking. them down into tiny small steps. And we. call this in our team the 1%. And. actually, this philosophy is highly. responsible for much of our success. here. So, what we've done so that you at. home can accomplish any big goal that. you have is we've made these 1% diaries. And we released these last year and they. all sold out. So, I asked my team over. and over again to bring the diaries. back, but also to introduce some new. colors and to make some minor tweaks to.

the diary. So, now we have a better. range for you. So, if you have a big. goal in mind and you need a framework. and a process and some motivation, then. I highly recommend you get one of these. diaries before they all sell out once. again. And you can get yours now at the. diary.com where you can get 20% off our. Black Friday bundle. And if you want the. link, the link is in the description. below. >> [music].

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