Dr. Anna Lembke: Understanding & Treating Addiction | Huberman Lab Podcast #33

Andrew Huberman・2 minutes read

The Huberman Lab podcast delves deep into the science behind addiction, discussing topics like dopamine, pleasure-pain balance, impulsivity, and recovery methods, offering valuable insights on managing addiction and finding balance in life through various approaches. Dr. Lembke's expertise sheds light on addiction's biological and psychological aspects, advocating for understanding and addressing addiction vulnerabilities through targeted interventions and a comprehensive approach to recovery.

Insights

Dopamine plays a crucial role in addiction, with both low and high levels impacting pleasure and pain, influenced by genetic disposition and early experiences.
Impulsivity, linked to the startle reflex, is a risk factor for addiction, but can be advantageous in certain scenarios, contributing to vulnerability and identifying individuals for targeted interventions.
Understanding the balance between pleasure and pain, driven by dopamine release, is key to gaining mastery over addictive behaviors and disengaging from high-reward activities.
Recovery from addiction involves a 30-day abstention period to reset dopamine pathways, with the brain regenerating transmission and individuals experiencing positive changes over time.
Relapse risks are constant in addiction recovery, with triggers during positive moments driving cravings and motivating drug-seeking behavior, necessitating ongoing vigilance and protective strategies.

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Summary

00:00

"Addiction, Dopamine, and Impulsivity Explained"

The Huberman Lab podcast discusses science and science-based tools for everyday life, hosted by Andrew Huberman, a professor of neurobiology and ophthalmology at Stanford School of Medicine.
Dr. Anna Lembke, a psychiatrist and chief of the Addiction Medicine Dual Diagnosis Clinic at Stanford University School of Medicine, treats patients with various addictions.
Dr. Lembke's upcoming book, "Dopamine Nation, Finding Balance in the Age of Indulgence," delves into addiction and its treatment, set to release on August 24th, 2021.
Dopamine is a neurotransmitter associated with reward and movement, released above or below baseline levels to signify pleasure or pain.
Lower tonic levels of dopamine may be linked to depression, while chronic exposure to substances or behaviors altering dopamine release can impact baseline levels.
Genetic disposition and early experiences can influence baseline dopamine levels, affecting temperament and vulnerability to addiction.
Impulsivity, the difficulty in delaying actions after a thought or desire arises, is a risk factor for addiction.
Impulsivity is linked to the startle reflex, where immediate reactions may differ from intended responses.
Understanding impulsivity and its connection to addiction can aid in identifying vulnerable individuals and implementing targeted interventions.
Dr. Lembke's insights shed light on the biological and psychological aspects of addiction, offering a comprehensive approach to understanding and treating various forms of addiction.

13:18

"Balancing Pleasure and Pain in Addiction"

Some people have a heightened startle reflex related to anxiety, not impulsivity.
Impulsivity can be advantageous in certain scenarios, like intimate interactions or fight or flight situations.
Mental illness traits may have been advantageous in different ecosystems.
Life now can be boring due to all survival needs being met, leading to people seeking friction.
People with addiction may initially seek pleasure but often use substances to escape suffering.
Pleasure is not just about seeking highs but also about escaping pain.
The brain works to maintain a balance between pleasure and pain, seeking homeostasis.
Indulging in pleasurable activities can lead to a desire for more, driven by a subconscious awareness of impending pain.
Developing awareness of the pleasure-pain balance can help individuals gain mastery over addictive behaviors.
Understanding the neurobiological aspects of pleasure and pain can aid in disengaging from addictive behaviors.

27:42

"Balancing Pleasure and Pain for Happiness"

Pleasureful activities like social media, food, sex, or gambling trigger dopamine release in the brain.
Engaging in pleasurable behaviors leads to a decrease in pleasure and an increase in pain below conscious awareness.
Addictive substances or behaviors release high levels of dopamine, unlike less stimulating activities like eating broccoli.
After intense pleasure, the brain compensates by reducing dopamine receptors, leading to a dopamine-deficit state.
Chronic indulgence in high-reward behaviors can reset dopamine thresholds, causing anhedonia and depression-like symptoms.
Addiction can extend beyond substances to behaviors like gambling, sex, work, or relationships, all driven by similar brain circuitry.
Recovery from severe addiction offers wisdom on balancing pleasure and pain, advocating for adaptive ways to regulate dopamine levels.
Flexibility in pleasure-pain balance is crucial, avoiding extremes that lead to a dopamine-deficit state.
Boredom, often avoided in modern society, is a necessary experience that can prompt reflection on values and priorities.
Finding passion involves embracing boredom, allowing for creative initiative and a deeper understanding of personal values and goals.

40:51

"Focus on Work, Reset Rewards, Build Better"

Stop looking for your passion and focus on the work that needs to be done around you.
The work that needs to be done doesn't have to be grandiose; it can be as simple as taking out the garbage or helping a neighbor.
People in recovery realize the importance of focusing on the work that needs to be done in the moment.
Abstaining from high dopamine activities like video games can help reset reward pathways and lead to finding enjoyment in other activities.
SEAL team members have a sense of duty towards immediate tasks and constantly look for ways to contribute in their environment.
Taking things one day at a time is crucial for building a better life and experiencing pleasure and reward.
It takes about 30 days for the brain to reset reward pathways and regenerate dopamine transmission after abstaining from addictive substances or behaviors.
The first 10 days of abstaining can be uncomfortable, with symptoms like anxiety, trouble sleeping, and physical agitation.
Patients may feel worse before feeling better, but by week four of abstaining, most people start to feel significantly better.
The intervention of abstaining for 30 days may not be suitable for everyone with severe addictions, but many are willing and able to successfully complete the challenge and experience a better life.

54:09

Navigating Addiction Recovery: Vigilance Amid Positive Moments

Days 21 through 30 mark a period where individuals undergoing addiction treatment start feeling better, with the emergence of positive changes supported by the release of dopamine in response to pleasurable experiences like enjoying a good cup of coffee.
People in recovery from addiction often face relapses, even when their lives seem to be going well, due to triggers that release dopamine, creating a deficit state that drives cravings and motivates drug-seeking behavior.
Triggers for relapse can be both negative experiences like stress or loss, as well as positive events that remove the hypervigilant state individuals maintain to control their substance use.
Understanding that vulnerability to relapse can occur during positive moments is crucial for individuals in recovery to implement protective measures or seek support to prevent setbacks.
A key aspect of addiction is the imbalance in dopamine levels, where anticipation of pleasure leads to a deficit state that fuels the desire for more, emphasizing the role of dopamine in motivation rather than just pleasure.
Severe addiction can disrupt the brain's balance, making it challenging for individuals to resist drug use even when they consciously want to stay abstinent, akin to reflexive behavior like scratching an itch unconsciously.
The analogy of always being a fixed distance from a ditch, shared by a friend in long-term recovery, highlights the perpetual need for vigilance in managing addiction, offering a sense of peace through acceptance of this ongoing reality.
The intricate interplay of dopamine in addiction involves a cycle of anticipation, deficit, and craving, where triggers can lead individuals to seek drugs not solely for pleasure but also to alleviate the dopamine deficit state.
Recognizing the constant risk of relapse, especially during positive moments, can empower individuals in recovery to maintain vigilance and implement strategies to safeguard against potential setbacks.
The journey of addiction recovery is likened to driving a road where awareness of the ditch's proximity necessitates constant vigilance, highlighting the importance of understanding and accepting the ongoing challenges of managing addiction.

01:07:07

Addiction Recovery Communities: Supportive, Cult-like, Beneficial

12-step communities create supportive environments for individuals struggling with addiction.
There is a question raised about whether individuals can become addicted to the addiction recovery community.
Some individuals with addiction tendencies seek intense experiences and highs and lows.
Meetings within addiction recovery communities can provide a dopamine hit for some individuals.
Participation in recovery communities, like Alcoholics Anonymous, can be likened to a cult but is beneficial for individuals seeking sobriety.
Oxytocin, linked to dopamine release, plays a role in the bonding experienced in recovery communities.
The enthusiasm for meetings in recovery communities can be compared to other intense experiences people seek.
Addiction to recovery can be disruptive but is preferable to substance addiction.
The speaker relates their own work addiction to the enthusiasm seen in addiction recovery communities.
Recovery from addiction requires immense courage, discipline, and fortitude, with individuals facing constant urges and temptations in a society filled with addictive opportunities.

01:19:45

"Truth-telling in Recovery Strengthens Brain Connections"

Recovery involves truth-telling about all aspects of one's life, not just drug use, to strengthen prefrontal cortical circuits and connections to the limbic and reward brain.
Telling the truth is crucial in recovery to re-engage circuits, anticipate consequences, and create intimate connections that release dopamine.
Being open and honest with others fosters intense and rewarding human connections, essential for dopamine release.
Making amends for past wrongs and lies is a significant part of recovery, allowing individuals to shed past sins and start anew.
The 12-step program emphasizes admitting past harm and making apologies as a cathartic and renewing process.
Truth-telling is vital for everyone, not just addicts, to strengthen prefrontal cortex-dopamine system connections and prevent addiction.
Neuroscience research on truth-telling's importance is an emerging and exciting area of study.
Using drugs like ibogaine, Ayahuasca, and MDMA in addiction treatment aims to provide extreme experiences to reduce interest in drug use, despite contradicting dopamine biology.
The rationale behind using extreme chemical experiences in addiction treatment is to disrupt addictive patterns and create a life less focused on drug use.
Despite the potential neurotoxicity and contradicting dopamine biology, some individuals have successfully transitioned away from addiction through these methods.

01:32:39

Psychedelic therapy and social media addiction.

Clinical studies show small, short-term trials with addicted individuals undergoing controlled psychedelic experiences.
High-dose psilocybin or MDMA are common in these studies, integrated with psychotherapy.
The approach offers a condensed, transformative experience, providing a broader perspective on life.
Results vary, with some experiencing positive shifts in values and behaviors.
Concerns arise regarding the long-term efficacy for chronic addiction.
Mixed outcomes observed, with some addicts worsening and trauma survivors benefiting.
Not a one-size-fits-all solution, emphasizing the need for individualized approaches.
Social media is likened to a drug, engineered for addiction, requiring intentional and controlled use.
Addiction tendencies vary among individuals, necessitating thoughtful and moderate engagement.
Strategies for regulating social media use include setting time limits and being conscious of unconscious habits.

01:46:10

Phone detox enhances real-life connections and success.

Immature phone behavior is likened to acting like a baby, supported by neuroscience.
A 30-day phone detox is recommended for severe addiction, but a single day may suffice for mild addiction.
Creating intentional spaces away from the phone is crucial to avoid constant interruptions and distractions.
Social media usage can lead to a decrease in real-life interactions, emphasizing the importance of offline connections.
Young people are exploring ways to disconnect from technology together to combat FOMO.
Exercising without the phone can enhance enjoyment and focus during activities like dog walks.
The pressure to constantly achieve more can lead to dissatisfaction despite accomplishments.
Success is often more satisfying when it aligns with serving a greater good rather than personal recognition.
Accumulating success through authentic, value-driven actions can lead to meaningful contributions without aiming for recognition.
Aligning personal compulsions with serving humanity or the planet can lead to reciprocal support from the world.

01:58:35

"Dr. Anna Lembke on Generosity and Social Media"

The speaker invited Dr. Anna Lembke to their podcast after reading her book, "Dopamine Nation, Finding Balance in the Age of Indulgence," which they found incredible and loved.
Dr. Lembke discussed the importance of generosity and giving without expecting immediate returns, emphasizing the positive impact it can have on one's life in the long run.
Dr. Lembke explained her decision to avoid social media due to its addictive nature, highlighting the intimacy and personal connection readers can experience through her book.

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