Essentials: Understanding & Treating Addiction

00:00:00.000 | Welcome to Huberman Lab Essentials,

00:00:02.320 | where we revisit past episodes

00:00:04.080 | for the most potent and actionable science-based tools

00:00:07.260 | for mental health, physical health, and performance.

00:00:10.040 | And now for my discussion with Dr. Anna Lemke.

00:00:15.040 | I and many listeners of this podcast

00:00:18.640 | are obsessed with dopamine.

00:00:21.540 | What is dopamine?

00:00:23.080 | And what are maybe some things about dopamine

00:00:26.180 | that most people don't know?

00:00:27.860 | And probably that I don't know either.

00:00:30.840 | So dopamine is a neurotransmitter,

00:00:33.020 | and neurotransmitters are those molecules

00:00:35.120 | that bridge the gap between two neurons.

00:00:38.100 | So they essentially allow one neuron,

00:00:40.840 | the presynaptic neuron,

00:00:42.120 | to communicate with the postsynaptic neuron.

00:00:44.640 | Dopamine is intimately associated

00:00:48.980 | with the experience of reward,

00:00:50.980 | but also with movement,

00:00:52.700 | which I think is really interesting

00:00:54.100 | because movement and reward are linked, right?

00:00:56.440 | If you think about, you know, early humans,

00:01:00.180 | you had to move in order to go seek out the water

00:01:04.460 | or the meat or whatever it was.

00:01:06.960 | So dopamine is this really powerful,

00:01:10.820 | important molecule in the brain

00:01:13.820 | that helps us experience pleasure.

00:01:17.640 | It's not the only neurotransmitter involved in pleasure,

00:01:20.420 | but it's a really, really important one.

00:01:22.600 | And if you want to think about something

00:01:25.700 | that most people don't know about dopamine,

00:01:27.520 | which I think is really interesting,

00:01:29.000 | is that we are always releasing dopamine

00:01:32.020 | at a kind of tonic baseline rate.

00:01:34.860 | And it's really the deviation from that baseline

00:01:38.260 | rather than like hits of dopamine in a vacuum

00:01:41.260 | that make a difference.

00:01:42.120 | So when we experience pleasure,

00:01:44.100 | our dopamine release goes above baseline.

00:01:47.140 | And likewise, dopamine can go below that tonic baseline.

00:01:51.080 | And then we experience a kind of pain.

00:01:53.800 | Interesting.

00:01:54.680 | So is it fair to say that one's baseline levels of dopamine,

00:01:59.140 | how frequently we are releasing dopamine

00:02:01.620 | in the absence of some, I don't know,

00:02:04.920 | drug or food or experience,

00:02:06.800 | just sitting, being,

00:02:08.700 | is that associated with how happy somebody is,

00:02:12.620 | their kind of baseline of happiness

00:02:13.900 | or level of depression?

00:02:15.680 | There is evidence that shows

00:02:17.900 | that people who are depressed

00:02:20.500 | may indeed have lower tonic levels of dopamine.

00:02:25.260 | So that's a really reasonable thought.

00:02:28.140 | And there is some evidence to suggest

00:02:30.180 | that that may be true.

00:02:31.440 | The other thing that we know

00:02:33.120 | is that if we expose ourselves chronically

00:02:37.260 | to substances or behaviors

00:02:40.100 | that repeatedly release large amounts of dopamine

00:02:44.180 | in our brain's reward pathway,

00:02:45.980 | that we can change our tonic baseline

00:02:49.120 | and actually lower it over time

00:02:51.120 | as our brain tries to compensate

00:02:53.240 | for all of that dopamine,

00:02:55.180 | which is more really than we were designed to experience.

00:02:59.740 | Interesting.

00:03:00.640 | And is it the case

00:03:03.040 | that our baseline levels of dopamine

00:03:04.860 | are set by our genetics,

00:03:06.520 | by our heredity?

00:03:07.920 | Well, I think, you know,

00:03:09.400 | if you think about sort of, you know,

00:03:11.280 | the early stages of development in infancy,

00:03:13.300 | certainly that is true.

00:03:14.920 | You're kind of, you know,

00:03:16.300 | born with probably whatever is your baseline level,

00:03:19.300 | but obviously your experiences

00:03:21.120 | can have a huge impact

00:03:23.240 | on where your dopamine level ultimately settles out.

00:03:28.580 | Do you think that's a set in terms of our parents

00:03:33.160 | and obviously nature and nurture interact,

00:03:36.480 | but is dopamine at the core of our temperament?

00:03:40.440 | I don't really think we know the answer to that,

00:03:43.740 | but I will say that

00:03:45.260 | people are definitely born with different temperaments,

00:03:49.740 | and those temperaments do affect

00:03:52.880 | their ability to experience joy.

00:03:55.620 | And, you know, we've known that for a long time

00:03:58.720 | and we describe that in many different ways.

00:04:00.940 | One of the ways that we describe that in the modern era

00:04:03.500 | is to use psychiatric nomenclature,

00:04:05.920 | like this person has a dysthymic temperament

00:04:08.460 | or, you know,

00:04:09.300 | this person has chronic major depressive disorder.

00:04:12.080 | In terms of looking specifically

00:04:14.980 | at who's vulnerable to addiction,

00:04:17.920 | that's an interesting sort of mixed bag

00:04:20.500 | because when you look at the research

00:04:22.940 | on risk factors for addictions

00:04:24.920 | or what kind of temperament of a person

00:04:27.700 | makes them more vulnerable to addiction,

00:04:29.360 | you see some interesting findings.

00:04:31.980 | First, you see that people who are more impulsive,

00:04:34.140 | who have a thought to do something

00:04:35.620 | and just do it impulsively,

00:04:37.560 | are people who are more vulnerable to addiction.

00:04:40.400 | What we now conceptualize in our current ecosystem

00:04:44.500 | as mental illness

00:04:47.000 | are actually traits that in another ecosystem

00:04:51.760 | might be very advantageous.

00:04:53.820 | They're just not advantageous right now

00:04:56.740 | because of the world that we live in.

00:04:58.720 | And I think, you know,

00:05:00.500 | impulsivity is potentially one of those, right?

00:05:03.360 | Because we live in this world

00:05:04.940 | that's such a sensory rich environment, right?

00:05:07.560 | That we're being bombarded

00:05:09.860 | with all of these opportunities,

00:05:11.380 | these sensory opportunities,

00:05:12.960 | and we have to constantly check ourselves.

00:05:14.980 | And so impulsivity is something that right now

00:05:18.460 | can be a difficult trait,

00:05:20.960 | but isn't in and of itself a bad thing.

00:05:23.940 | In a previous conversation we had,

00:05:25.720 | you said something that really rung in my mind,

00:05:27.340 | which is that many people who become addicted to things

00:05:30.980 | have this feeling that normal life

00:05:33.740 | isn't interesting enough.

00:05:35.700 | Maybe you could just tell us a little bit about your experience

00:05:39.080 | with this association,

00:05:40.880 | if it really exists,

00:05:41.960 | between people's sense of the normalcy

00:05:44.920 | or maybe even how boring life can be

00:05:47.340 | and their tendency to become addicts of some sort.

00:05:50.600 | I think that life for humans has always been hard,

00:05:55.620 | but I think that now it's harder in unprecedented ways.

00:06:01.280 | And I think that the way that life is really hard now

00:06:05.520 | is that it actually is really boring.

00:06:07.620 | All of our survival needs are met.

00:06:10.140 | We don't even have to leave our homes

00:06:12.060 | to meet every single physical need.

00:06:14.440 | You know, as long as you're of a certain level

00:06:16.980 | of financial well-being,

00:06:18.960 | which frankly, you know,

00:06:21.060 | we talk so much about, you know, the income gap,

00:06:24.120 | and certainly there is this enormous gap

00:06:25.940 | between rich and poor,

00:06:26.780 | but that gap is smaller than it's ever been

00:06:29.540 | in like the history of humans.

00:06:31.460 | We don't really have anything that we have to do.

00:06:34.740 | So we're all forced to make stuff up,

00:06:38.300 | you know, whether it's being a scientist

00:06:40.920 | or being a doctor or being an Olympic athlete

00:06:45.980 | or, you know, climbing Mount Everest.

00:06:49.140 | And people really vary in their need for friction.

00:06:54.140 | And some people need a lot more than others.

00:06:56.840 | And if they don't have it,

00:06:58.220 | they're really, really unhappy.

00:07:00.000 | And I do think that a lot of the people

00:07:02.360 | that I see with addiction

00:07:04.000 | and other forms of mental illness

00:07:05.600 | are people who need more friction.

00:07:08.900 | Like they're unhappy,

00:07:11.040 | not necessarily because there's something wrong

00:07:13.600 | with their brain,

00:07:14.280 | but because their brain is not suited to this world.

00:07:17.520 | Let's talk about the pleasure-pain balance

00:07:20.540 | and addiction.

00:07:21.520 | And I've heard you use this seesaw

00:07:23.920 | or balance scale analogy before.

00:07:27.180 | And I think it's a wonderful one.

00:07:28.560 | Yeah.

00:07:29.580 | So to me, one of the most significant findings

00:07:31.780 | in neuroscience in the last 75 years

00:07:33.980 | is that pleasure and pain are co-located,

00:07:36.740 | which means the same parts of the brain

00:07:38.740 | that process pleasure also process pain.

00:07:41.560 | And they work like a balance.

00:07:43.360 | So when we feel pleasure,

00:07:44.820 | our balance tips one way.

00:07:46.320 | When we feel pain,

00:07:47.140 | it tips in the opposite direction.

00:07:49.040 | And one of the overriding rules

00:07:51.560 | governing this balance

00:07:52.580 | is that it wants to stay level.

00:07:54.140 | So it doesn't want to remain tipped very long

00:07:56.020 | to pleasure or to pain.

00:07:57.380 | And with any deviation from neutrality,

00:08:00.040 | the brain will work very hard

00:08:01.560 | to restore a level balance

00:08:03.140 | or what scientists call homeostasis.

00:08:05.780 | And the way the brain does that

00:08:07.920 | is with any stimulus to one side,

00:08:10.560 | there will be a tip

00:08:12.140 | in equal and opposite amount

00:08:13.940 | to the other side.

00:08:15.260 | It's like they have

00:08:15.860 | principal laws of physics.

00:08:17.280 | Yes, right, right.

00:08:18.760 | So like I like to watch YouTube videos.

00:08:20.840 | When I watch YouTube videos

00:08:22.160 | of American Idol,

00:08:23.120 | you know,

00:08:23.920 | it tips to the side of pleasure.

00:08:25.240 | And then when I stop watching it,

00:08:27.920 | I have a come down, right,

00:08:29.940 | which is a tip to the equal

00:08:31.700 | and opposite amount

00:08:32.540 | on the other side.

00:08:34.260 | And that's that moment

00:08:35.160 | of wanting to watch

00:08:36.080 | one more YouTube video, right?

00:08:37.580 | It's not something

00:08:38.340 | that consciously happens

00:08:39.840 | or that we're aware of

00:08:41.340 | unless we really begin

00:08:43.040 | to pay attention.

00:08:44.640 | And of course,

00:08:45.240 | one way to combat that

00:08:46.700 | is to do it more, right?

00:08:48.500 | And more and more and more.

00:08:49.720 | So I think that is really

00:08:51.800 | what I want people

00:08:52.800 | to tune into

00:08:53.660 | and get an awareness around

00:08:55.620 | because once you tune into it,

00:08:57.000 | you can see it a lot.

00:08:58.080 | And if you, you know,

00:08:59.320 | keep the model

00:08:59.980 | of the balance in mind,

00:09:00.960 | I think it gives people

00:09:02.840 | kind of a way

00:09:04.560 | to imagine

00:09:05.680 | what they're experiencing

00:09:07.800 | on a neurobiological level

00:09:09.540 | and understand it.

00:09:10.960 | and in that understanding,

00:09:12.460 | get some mastery over it,

00:09:14.040 | which is really

00:09:14.580 | what this is all about.

00:09:15.700 | Because ultimately,

00:09:16.860 | we do need to disengage, right?

00:09:19.380 | We can't live in that space

00:09:22.080 | all the time, right?

00:09:23.480 | We have other things

00:09:24.420 | we need to do.

00:09:25.240 | And there are also

00:09:26.320 | serious consequences

00:09:27.660 | that come with

00:09:28.740 | trying to repeat

00:09:30.060 | and continue that experience

00:09:32.520 | or that feeling.

00:09:33.240 | Yeah, so if I understand

00:09:34.720 | this correctly,

00:09:35.360 | when we find something

00:09:37.240 | that we enjoy

00:09:39.200 | that feels pleasurable,

00:09:40.480 | social media,

00:09:41.940 | food, sex,

00:09:43.400 | gambling,

00:09:44.660 | whatever happens to be,

00:09:45.800 | there's some dopamine release

00:09:47.500 | when we engage

00:09:48.160 | in that behavior.

00:09:48.860 | And then what you're telling me

00:09:51.180 | is that very quickly

00:09:52.420 | and beneath

00:09:53.920 | my conscious awareness,

00:09:54.980 | there's a tilting back

00:09:57.560 | of the scale

00:09:58.260 | where pleasure is reduced

00:10:00.280 | by way of increasing pain.

00:10:02.340 | Right.

00:10:03.000 | And I've heard you say before

00:10:04.260 | that the pain mechanism

00:10:07.520 | has some competitive advantages

00:10:10.800 | over the pleasure mechanism

00:10:12.900 | such that it doesn't just

00:10:14.320 | bring the scale back to level.

00:10:15.640 | It actually brings pain

00:10:17.380 | higher than pleasure.

00:10:19.000 | What happens right after

00:10:21.120 | I do something

00:10:21.720 | that is really pleasurable

00:10:22.920 | and releases a lot of dopamine

00:10:23.900 | is, again,

00:10:24.660 | my brain is going to

00:10:25.860 | immediately compensate

00:10:27.000 | by down-regulating

00:10:28.620 | my own dopamine receptors,

00:10:29.660 | my own dopamine transmission

00:10:30.840 | to compensate for that.

00:10:32.600 | Okay.

00:10:32.960 | And that's that come down

00:10:35.640 | or the hangover

00:10:36.500 | or that after effect,

00:10:37.420 | that moment of wanting

00:10:38.180 | to do it more.

00:10:38.760 | Now, if I just wait

00:10:40.620 | for that feeling to pass,

00:10:42.420 | then my dopamine

00:10:43.700 | will re-regulate itself

00:10:44.760 | and I'll go back

00:10:45.240 | to whatever my chronic baseline is.

00:10:46.760 | But if I don't wait,

00:10:47.960 | and here's really the key,

00:10:48.920 | if I keep indulging

00:10:49.840 | again and again and again,

00:10:51.400 | ultimately,

00:10:52.380 | I have so much

00:10:54.860 | on the pain side,

00:10:56.480 | right,

00:10:56.960 | that I've essentially

00:10:57.700 | reset my brain

00:10:59.220 | to what we call

00:11:00.460 | like an anhedonic

00:11:01.760 | or lacking in joy

00:11:03.200 | type of state,

00:11:04.500 | which is a dopamine

00:11:05.800 | deficit state.

00:11:07.040 | So that's really

00:11:07.760 | the way in which

00:11:09.460 | pain can become

00:11:11.040 | the main driver

00:11:11.780 | is because I've indulged

00:11:13.420 | so much in these

00:11:14.380 | high-reward behaviors

00:11:15.500 | or substances

00:11:16.580 | that my brain

00:11:17.900 | has had to compensate

00:11:18.960 | by way down-regulating

00:11:20.800 | my own dopamine

00:11:21.620 | such that

00:11:22.440 | even when I'm not

00:11:23.580 | doing that drug,

00:11:25.020 | I'm in a dopamine

00:11:26.040 | deficit state

00:11:26.700 | which is akin

00:11:27.220 | to a clinical depression.

00:11:28.340 | I have anxiety,

00:11:29.520 | irritability,

00:11:30.180 | insomnia, dysphoria,

00:11:31.160 | and a lot of mental

00:11:32.320 | preoccupation

00:11:33.080 | with using again

00:11:34.100 | or getting the drug.

00:11:35.040 | So in general,

00:11:36.240 | what we want

00:11:37.000 | is some kind

00:11:38.340 | of flexibility

00:11:39.540 | in that balance

00:11:40.940 | and the ability

00:11:41.620 | to easily

00:11:42.700 | reassert homeostasis.

00:11:44.080 | We don't want

00:11:44.600 | to break our balance,

00:11:45.720 | which is possible

00:11:46.900 | if we overindulge

00:11:48.260 | for enough period

00:11:49.140 | of time

00:11:49.540 | and end up

00:11:50.460 | with a balance

00:11:51.000 | tipped to the side

00:11:51.900 | of pain,

00:11:52.300 | this dopamine

00:11:52.860 | deficit state

00:11:53.580 | we've been talking about.

00:11:54.800 | We want a flexible,

00:11:56.380 | resilient balance,

00:11:57.960 | right,

00:11:58.280 | which can be sensitive

00:11:59.540 | to things going on

00:12:00.580 | in the environment,

00:12:01.200 | which can experience

00:12:02.280 | pleasure and approach,

00:12:04.040 | which can experience

00:12:05.300 | pain and recoil,

00:12:06.720 | right,

00:12:07.260 | this is all adaptive

00:12:08.280 | and healthy

00:12:08.940 | and necessary

00:12:09.680 | and good.

00:12:10.460 | We would never want

00:12:11.560 | a balance

00:12:12.000 | that doesn't tilt.

00:12:13.180 | Right.

00:12:13.600 | That would be a disaster.

00:12:14.640 | Right.

00:12:14.900 | We wouldn't be human.

00:12:15.800 | And we wouldn't want that.

00:12:17.220 | It would be really,

00:12:17.700 | really boring.

00:12:18.380 | On the other hand,

00:12:19.700 | what people in recovery

00:12:20.780 | from addiction

00:12:21.520 | talk about is

00:12:22.820 | to some extent

00:12:24.080 | having to learn

00:12:25.140 | to live with

00:12:26.120 | things being a little boring

00:12:28.440 | a lot of the time,

00:12:29.760 | right?

00:12:30.120 | So trying to avoid

00:12:31.920 | some of this intensity

00:12:33.180 | and thrill-seeking

00:12:34.700 | and escapism

00:12:36.140 | that really is

00:12:36.780 | at the core

00:12:37.440 | of addictive tendencies.

00:12:38.680 | So along those lines,

00:12:40.840 | I've heard you say

00:12:42.020 | that in order to reset

00:12:43.460 | the dopamine system,

00:12:44.600 | essentially in order

00:12:46.560 | to break an addictive

00:12:47.600 | pattern,

00:12:48.560 | 30 days

00:12:49.880 | of zero interaction

00:12:52.360 | with that substance,

00:12:53.620 | that person,

00:12:54.460 | et cetera.

00:12:55.220 | Right.

00:12:55.640 | Is that correct?

00:12:56.280 | Yeah.

00:12:57.040 | And 30 days

00:12:58.240 | is in my clinical experience

00:12:59.780 | the average amount

00:13:00.640 | of time it takes

00:13:01.680 | for the brain

00:13:02.140 | to reset,

00:13:02.740 | reward pathways,

00:13:03.680 | for dopamine transmission

00:13:04.940 | to regenerate itself.

00:13:06.560 | by depriving ourselves

00:13:08.100 | of this high dopamine,

00:13:09.700 | high reward substance

00:13:11.440 | or behavior,

00:13:12.180 | we allow our brains

00:13:13.560 | to regenerate

00:13:14.320 | its own dopamine

00:13:14.980 | for the balance

00:13:15.840 | to really equilibrate

00:13:16.620 | and then we're in a place

00:13:18.080 | where we can sort of

00:13:19.080 | enjoy other things.

00:13:20.540 | So I'd like to

00:13:21.740 | dissect out

00:13:22.760 | that 30 days

00:13:23.520 | a little more

00:13:24.080 | finally.

00:13:25.300 | So days 1 through 10

00:13:26.700 | I would imagine

00:13:27.860 | will be very uncomfortable.

00:13:29.300 | Yes.

00:13:29.800 | Anxiety,

00:13:30.720 | trouble sleeping,

00:13:31.840 | physical agitation

00:13:34.140 | and to the point

00:13:34.800 | where,

00:13:35.120 | you know,

00:13:36.420 | maybe impulsive,

00:13:37.620 | angry.

00:13:38.300 | Should one expect

00:13:40.100 | all of that?

00:13:40.740 | Should the...

00:13:41.180 | Yeah.

00:13:41.460 | So what I say

00:13:42.520 | to patients

00:13:43.080 | and it's a really important

00:13:44.500 | piece of this intervention

00:13:46.020 | is that you will feel worse

00:13:47.700 | before you feel better.

00:13:49.020 | For how long?

00:13:49.940 | Yeah.

00:13:50.260 | This is probably

00:13:50.740 | the first question

00:13:51.440 | they ask, right?

00:13:52.260 | And I say usually

00:13:53.520 | in my clinical experience

00:13:55.060 | you'll feel worse

00:13:56.520 | for two weeks

00:13:57.320 | but if you can make it

00:13:58.500 | through those first two weeks

00:13:59.800 | the sun will start

00:14:01.220 | to come out

00:14:01.920 | in week three

00:14:02.740 | and by week four

00:14:03.840 | most people are feeling

00:14:05.400 | a whole lot better

00:14:06.600 | than they were

00:14:07.260 | before they stopped

00:14:08.280 | using their substance.

00:14:09.160 | So it's a hard thing

00:14:10.440 | like you have to sign up

00:14:11.540 | for it.

00:14:12.020 | Then days 21 through 30

00:14:14.600 | dopamine is starting

00:14:16.020 | to be released

00:14:16.640 | in response to

00:14:17.600 | the taste of a really

00:14:18.860 | good cup of coffee

00:14:19.880 | for instance.

00:14:20.480 | Yes, exactly.

00:14:21.440 | whereas before

00:14:22.220 | it was only to

00:14:23.400 | insert

00:14:24.820 | you know

00:14:25.400 | addictive behavior.

00:14:26.080 | Right.

00:14:26.360 | One thing I've seen

00:14:27.260 | over and over again

00:14:28.360 | sadly

00:14:29.080 | often in the same individuals

00:14:30.700 | is

00:14:31.200 | they get sober

00:14:33.440 | from whatever

00:14:34.940 | they're doing great

00:14:36.900 | and then

00:14:38.080 | all of a sudden

00:14:38.860 | you get this call

00:14:40.020 | so and so's

00:14:41.180 | back in jail

00:14:43.080 | so and so's

00:14:44.080 | wife is gonna leave him

00:14:45.220 | because he

00:14:45.980 | drank two bottles

00:14:47.460 | of wine

00:14:48.440 | and took a Xanax

00:14:49.480 | at 7am

00:14:50.360 | crashed his truck

00:14:51.840 | into a pole

00:14:52.460 | it's got two beautiful kids

00:14:53.600 | like how

00:14:54.340 | did this happen

00:14:56.160 | again

00:14:56.640 | to the point

00:14:57.520 | where by the fourth

00:14:58.420 | and fifth time

00:14:59.180 | people are just

00:15:00.620 | done

00:15:01.780 | and so what I'd like

00:15:03.140 | to talk about

00:15:03.740 | in this context

00:15:04.460 | is what sorts

00:15:05.760 | of things

00:15:06.320 | help

00:15:07.060 | other people

00:15:08.360 | that we know

00:15:08.880 | that are addicted

00:15:09.520 | what really helps

00:15:10.940 | and

00:15:11.840 | are there

00:15:12.880 | certain people

00:15:13.640 | for whom

00:15:14.420 | it's hopeless

00:15:15.940 | yeah

00:15:16.580 | so there

00:15:17.240 | there are people

00:15:18.440 | who will die

00:15:19.720 | of their disease

00:15:20.680 | of addiction

00:15:21.180 | you know

00:15:21.660 | and I think

00:15:22.020 | conceptualizing it

00:15:23.040 | as a disease

00:15:23.720 | is a helpful frame

00:15:25.420 | there are other frames

00:15:26.760 | that we could use

00:15:27.880 | but I do think

00:15:28.620 | given the

00:15:29.900 | brain physiologic

00:15:31.540 | changes

00:15:32.060 | that occur

00:15:32.780 | with sustained

00:15:34.480 | heavy drug use

00:15:36.100 | and what we know

00:15:37.480 | happens to the brain

00:15:38.600 | it is really

00:15:40.420 | reasonable

00:15:41.180 | to think of it

00:15:42.000 | as a brain disease

00:15:43.000 | and for me

00:15:45.220 | the real window

00:15:47.200 | of let's say

00:15:48.320 | being able to access

00:15:49.740 | my compassion

00:15:50.660 | around people

00:15:52.080 | who are repeat

00:15:53.080 | relapsers

00:15:53.760 | even when their life

00:15:54.660 | is so much better

00:15:55.500 | when they're in recovery

00:15:56.600 | yeah it's like

00:15:57.120 | it's like a no brainer

00:15:58.020 | right

00:15:58.280 | is to conceptualize

00:16:00.840 | this balance

00:16:01.540 | and the dopamine

00:16:02.200 | deficit state

00:16:02.980 | and a balance

00:16:03.580 | tilted to the side

00:16:04.780 | of pain

00:16:05.260 | and to imagine

00:16:06.800 | that for some

00:16:08.100 | people

00:16:08.580 | after a month

00:16:10.240 | or six months

00:16:11.200 | or maybe even

00:16:11.900 | six years

00:16:12.680 | their balance

00:16:13.780 | is still

00:16:14.800 | tipped to the side

00:16:15.880 | of pain

00:16:16.280 | that on some level

00:16:17.220 | that balance

00:16:18.200 | has lost

00:16:18.960 | its resilience

00:16:20.080 | and its ability

00:16:21.040 | to restore homeostasis

00:16:22.700 | it's almost like

00:16:23.200 | the hinge on that

00:16:23.980 | balance is messed up

00:16:25.060 | exactly

00:16:25.440 | imagine that

00:16:27.060 | you had an itch

00:16:28.420 | somewhere on your body

00:16:29.620 | okay

00:16:30.020 | I mean we've all

00:16:30.600 | had that

00:16:31.020 | like you know

00:16:31.620 | whatever the source

00:16:32.920 | you know

00:16:33.640 | if you really focus

00:16:34.700 | you could go for

00:16:35.920 | a pretty good

00:16:37.200 | amount of time

00:16:37.860 | not scratching

00:16:38.600 | it

00:16:38.900 | but the moment

00:16:40.340 | you stopped

00:16:41.020 | focusing on

00:16:42.040 | not scratching

00:16:42.860 | it

00:16:43.160 | you would scratch

00:16:44.360 | it

00:16:44.500 | and maybe

00:16:44.860 | you would do

00:16:45.260 | it while you

00:16:45.720 | were asleep

00:16:46.300 | right

00:16:46.720 | and that is

00:16:48.780 | what happens

00:16:50.020 | to people

00:16:50.640 | with severe

00:16:51.740 | addiction

00:16:52.380 | that balance

00:16:53.640 | is essentially

00:16:54.420 | broken

00:16:55.100 | homeostasis

00:16:56.100 | does not

00:16:56.720 | get restored

00:16:57.320 | despite

00:16:57.900 | sustained abstinence

00:16:59.640 | they're living

00:17:00.540 | with that

00:17:01.520 | constant

00:17:02.380 | specter

00:17:03.220 | of that pull

00:17:04.120 | it never

00:17:05.180 | goes away

00:17:05.880 | so let me say

00:17:06.540 | there are lots

00:17:07.040 | of people

00:17:07.320 | with addiction

00:17:07.700 | for whom

00:17:08.040 | that does

00:17:08.480 | go away

00:17:08.940 | and it goes

00:17:09.340 | away at four

00:17:09.940 | weeks

00:17:10.260 | for many

00:17:10.700 | of them

00:17:10.980 | but in

00:17:11.700 | severe cases

00:17:12.640 | that's always

00:17:14.020 | there

00:17:14.720 | and it's

00:17:15.200 | lingering

00:17:15.660 | and it's

00:17:16.820 | the moment

00:17:17.320 | when they're

00:17:17.740 | not focusing

00:17:18.760 | on not

00:17:19.360 | using

00:17:19.780 | it's like

00:17:20.520 | a reflex

00:17:21.040 | they fall

00:17:21.920 | back into it

00:17:22.680 | it's not

00:17:23.240 | purposeful

00:17:23.900 | it's not

00:17:24.560 | because they

00:17:25.060 | want to get

00:17:25.520 | high

00:17:25.940 | it's not

00:17:26.600 | because they

00:17:27.060 | value using

00:17:27.700 | drugs more

00:17:28.200 | than they do

00:17:28.640 | their family

00:17:29.360 | none of that

00:17:30.360 | it's that

00:17:30.860 | really

00:17:31.580 | they

00:17:32.000 | cannot

00:17:34.100 | not

00:17:34.920 | do it

00:17:35.500 | when given

00:17:36.060 | the opportunity

00:17:37.320 | and that moment

00:17:38.440 | when they're

00:17:38.860 | not thinking

00:17:39.300 | about it

00:17:39.840 | does that

00:17:40.320 | make sense

00:17:40.680 | that's a great

00:17:41.240 | description

00:17:41.700 | and actually

00:17:42.280 | in that description

00:17:43.280 | I can feel

00:17:44.560 | a bit

00:17:45.100 | of empathy

00:17:45.680 | because

00:17:46.460 | the way

00:17:47.420 | you describe

00:17:47.860 | scratching an

00:17:48.460 | itch in your

00:17:48.860 | sleep

00:17:49.300 | yeah

00:17:49.820 | you know

00:17:50.380 | I've done

00:17:51.120 | that with

00:17:51.420 | mosquito bites

00:17:52.020 | in summer

00:17:52.420 | you're scratching

00:17:53.000 | you wake up

00:17:54.020 | scratching that

00:17:54.800 | mosquito bite

00:17:56.460 | and I also

00:17:58.340 | have to

00:17:59.700 | admit that

00:18:00.660 | I've experienced

00:18:02.220 | not feeling

00:18:03.280 | like I want

00:18:03.760 | to pick up

00:18:04.140 | my phone

00:18:04.580 | because it's

00:18:05.000 | so rewarding

00:18:05.660 | but just

00:18:06.280 | finding myself

00:18:07.240 | doing it

00:18:07.800 | yes of course

00:18:08.620 | like I'm not

00:18:09.060 | going to use

00:18:09.480 | this thing

00:18:09.720 | I'm not

00:18:09.960 | going to use

00:18:10.240 | this thing

00:18:10.620 | and then

00:18:11.440 | just finding

00:18:11.980 | myself

00:18:12.340 | doing it

00:18:12.680 | like what

00:18:13.020 | am I doing

00:18:13.440 | here

00:18:13.660 | sort of

00:18:14.480 | the how

00:18:14.960 | did I

00:18:15.260 | get back

00:18:15.660 | here again

00:18:16.240 | and I

00:18:17.420 | know enough

00:18:18.280 | about brain

00:18:19.000 | function

00:18:19.360 | to understand

00:18:20.320 | that we

00:18:20.740 | have

00:18:21.120 | circuits

00:18:22.040 | that

00:18:22.540 | generate

00:18:23.560 | deliberate

00:18:23.960 | behavior

00:18:24.420 | and we

00:18:24.700 | have circuits

00:18:25.080 | that generate

00:18:25.580 | reflexive

00:18:26.100 | behavior

00:18:26.420 | and one

00:18:26.980 | of the

00:18:27.420 | goals

00:18:28.040 | of the

00:18:28.380 | nervous

00:18:28.640 | system

00:18:29.040 | is to

00:18:29.740 | make

00:18:30.160 | the

00:18:30.580 | deliberate

00:18:30.900 | stuff

00:18:31.280 | reflexive

00:18:31.980 | so you

00:18:32.380 | don't have

00:18:32.660 | to make

00:18:32.880 | the decision

00:18:33.340 | because

00:18:33.600 | decision

00:18:33.980 | making

00:18:34.280 | is a

00:18:34.640 | very costly

00:18:35.700 | thing

00:18:36.440 | to do

00:18:36.760 | decision

00:18:37.440 | making

00:18:37.740 | of any

00:18:38.100 | kind

00:18:38.360 | why is

00:18:39.540 | it then

00:18:39.900 | that people

00:18:40.520 | will relapse

00:18:41.800 | not just

00:18:42.400 | after getting

00:18:43.240 | fired from

00:18:43.680 | a job

00:18:44.100 | or their

00:18:44.400 | spouse

00:18:44.700 | leaving

00:18:44.980 | them

00:18:45.120 | but when

00:18:45.460 | things

00:18:45.780 | are going

00:18:46.280 | really

00:18:46.740 | well

00:18:47.140 | is it

00:18:47.560 | this

00:18:47.820 | unconscious

00:18:48.760 | mechanism

00:18:49.580 | because I've

00:18:50.200 | seen this

00:18:50.520 | before

00:18:50.940 | is

00:18:51.440 | they have

00:18:52.560 | a great

00:18:52.860 | win

00:18:53.140 | I have

00:18:53.360 | a friend

00:18:53.700 | who's

00:18:53.980 | a

00:18:54.160 | really

00:18:55.020 | impressive

00:18:55.500 | creative

00:18:56.100 | I don't

00:18:57.120 | want to reveal

00:18:57.600 | any more

00:18:58.020 | than that

00:18:58.460 | but

00:18:58.700 | and relapsed

00:19:00.700 | upon getting

00:19:01.880 | another

00:19:02.460 | really

00:19:03.240 | terrific

00:19:03.820 | opportunity

00:19:04.460 | to create

00:19:05.080 | for the

00:19:05.460 | entire

00:19:05.820 | world

00:19:06.240 | and I was

00:19:07.200 | like

00:19:07.320 | how can

00:19:07.740 | that

00:19:07.900 | happen

00:19:08.240 | but now

00:19:08.880 | I'm

00:19:09.040 | beginning

00:19:09.220 | to wonder

00:19:09.600 | was it

00:19:10.020 | the dopamine

00:19:10.500 | associated

00:19:11.060 | with that

00:19:11.520 | win

00:19:11.800 | that

00:19:12.620 | opened

00:19:13.440 | the spigot

00:19:13.980 | on this

00:19:14.280 | dopamine

00:19:14.620 | system

00:19:15.080 | because

00:19:16.280 | it

00:19:17.540 | happened

00:19:17.920 | in a

00:19:18.220 | phase

00:19:18.520 | of a

00:19:19.160 | really

00:19:19.660 | great

00:19:20.120 | stretch

00:19:20.580 | of life

00:19:21.300 | yeah

00:19:21.780 | triggers

00:19:22.380 | are things

00:19:22.900 | that

00:19:23.400 | make us

00:19:24.300 | want to

00:19:25.120 | go back

00:19:25.680 | to using

00:19:26.140 | our drug

00:19:26.720 | and the

00:19:27.400 | key thing

00:19:27.800 | about

00:19:28.040 | triggers

00:19:28.440 | whatever

00:19:28.720 | they are

00:19:29.160 | is they

00:19:29.560 | also

00:19:30.240 | release

00:19:30.800 | a little

00:19:31.320 | bit

00:19:31.580 | of

00:19:31.760 | dopamine

00:19:32.180 | right

00:19:32.860 | so just

00:19:33.400 | thinking

00:19:34.000 | about

00:19:34.660 | whatever

00:19:36.220 | the

00:19:36.480 | trigger

00:19:36.760 | is

00:19:37.140 | that

00:19:37.320 | we

00:19:37.480 | associate

00:19:37.860 | with

00:19:38.160 | drug

00:19:38.420 | use

00:19:38.840 | or

00:19:39.240 | just

00:19:39.460 | thinking

00:19:39.780 | about

00:19:40.100 | drug

00:19:40.400 | use

00:19:40.800 | can

00:19:41.340 | already

00:19:41.980 | release

00:19:42.420 | this

00:19:42.620 | anticipatory

00:19:43.440 | dopamine

00:19:43.800 | this little

00:19:44.380 | mini spike

00:19:45.020 | but here's

00:19:45.520 | the part

00:19:45.840 | that I think

00:19:46.280 | is really

00:19:46.600 | fascinating

00:19:47.120 | that mini

00:19:48.240 | spike

00:19:48.640 | is followed

00:19:49.140 | by a

00:19:49.520 | mini

00:19:50.000 | deficit

00:19:50.560 | state

00:19:51.020 | so it

00:19:51.380 | goes

00:19:51.600 | up

00:19:51.920 | and then

00:19:52.420 | it

00:19:52.520 | doesn't

00:19:52.780 | go back

00:19:53.140 | down

00:19:53.320 | to

00:19:53.400 | baseline

00:19:53.600 | it

00:19:53.740 | goes

00:19:53.960 | below

00:19:54.620 | baseline

00:19:55.360 | tonic

00:19:55.800 | levels

00:19:56.160 | and that's

00:19:57.020 | craving

00:19:57.380 | right

00:19:57.940 | so that

00:19:59.220 | anticipation

00:20:00.000 | is

00:20:01.180 | immediately

00:20:01.740 | followed

00:20:02.300 | by

00:20:02.860 | wanting

00:20:04.320 | the

00:20:04.640 | drug

00:20:04.960 | and it's

00:20:05.400 | that

00:20:05.580 | dopamine

00:20:05.960 | deficit

00:20:06.320 | state

00:20:06.700 | that

00:20:06.960 | drives

00:20:07.980 | the

00:20:08.360 | motivation

00:20:09.020 | to go

00:20:09.780 | and get

00:20:10.200 | the

00:20:10.400 | drug

00:20:10.620 | so many

00:20:10.920 | people

00:20:11.140 | talk about

00:20:11.540 | dopamine

00:20:11.840 | is not

00:20:12.160 | really about

00:20:12.680 | pleasure

00:20:13.100 | but about

00:20:13.940 | wanting

00:20:14.620 | and about

00:20:15.120 | motivation

00:20:15.720 | and so

00:20:16.720 | it is

00:20:17.080 | that

00:20:17.280 | deficit

00:20:17.800 | state

00:20:18.260 | that then

00:20:18.740 | drives

00:20:19.320 | the

00:20:19.480 | locomotion

00:20:20.000 | to get

00:20:20.520 | it

00:20:20.660 | and earlier

00:20:21.320 | your

00:20:21.620 | description

00:20:22.040 | of

00:20:22.240 | dopamine

00:20:22.560 | being

00:20:22.840 | involved

00:20:23.220 | in the

00:20:23.520 | desire

00:20:23.900 | for more

00:20:24.480 | giving

00:20:25.120 | the sense

00:20:25.480 | of reward

00:20:25.820 | but also

00:20:26.200 | movement

00:20:26.860 | right

00:20:27.460 | I have

00:20:27.800 | to assume

00:20:28.220 | that those

00:20:28.580 | things are

00:20:28.940 | braided

00:20:29.240 | together

00:20:29.600 | in our

00:20:29.980 | nervous

00:20:30.260 | system

00:20:30.620 | for the

00:20:31.160 | specific

00:20:31.500 | intention

00:20:31.900 | of when

00:20:32.280 | you feel

00:20:32.660 | something

00:20:33.120 | good

00:20:34.060 | then you

00:20:34.820 | feel the

00:20:35.100 | pain

00:20:35.660 | maybe you

00:20:36.480 | don't

00:20:36.640 | notice

00:20:36.960 | it

00:20:37.140 | and then

00:20:37.480 | the next

00:20:37.760 | thing

00:20:37.880 | you know

00:20:38.080 | you're

00:20:38.360 | pursuing

00:20:38.720 | more

00:20:39.180 | of the

00:20:39.480 | thing

00:20:39.840 | that

00:20:40.040 | can

00:20:40.200 | deliver

00:20:40.440 | pleasure

00:20:40.740 | you use

00:20:40.900 | the word

00:20:41.160 | braided

00:20:41.420 | together

00:20:41.720 | that's

00:20:42.040 | beautiful

00:20:42.360 | there are

00:20:42.940 | people

00:20:43.260 | for whom

00:20:43.900 | bad

00:20:44.580 | life

00:20:44.980 | experiences

00:20:45.740 | loss

00:20:46.540 | you know

00:20:47.220 | in any

00:20:47.740 | form

00:20:48.300 | stress

00:20:48.980 | in many

00:20:49.520 | different

00:20:49.800 | forms

00:20:50.140 | that's

00:20:50.840 | a trigger

00:20:51.140 | but there

00:20:51.600 | are

00:20:51.900 | absolutely

00:20:52.520 | people

00:20:53.240 | for whom

00:20:53.800 | the trigger

00:20:54.900 | is things

00:20:55.600 | going well

00:20:56.460 | and the

00:20:57.380 | things going

00:20:57.960 | well

00:20:58.420 | can be like

00:20:59.300 | the reward

00:20:59.840 | of the things

00:21:00.140 | going well

00:21:00.540 | but very

00:21:00.980 | often

00:21:01.420 | what it

00:21:02.120 | is

00:21:02.460 | is the

00:21:02.880 | removal

00:21:03.320 | of the

00:21:03.860 | hypervigilant

00:21:04.720 | state

00:21:05.260 | that's

00:21:05.960 | required

00:21:06.480 | to keep

00:21:07.260 | their use

00:21:07.860 | in check

00:21:08.340 | so it's

00:21:08.720 | this sense

00:21:09.200 | of

00:21:09.420 | I want

00:21:10.360 | to celebrate

00:21:10.900 | you know

00:21:11.520 | or I want

00:21:12.180 | to

00:21:12.260 | this reward

00:21:13.280 | happened

00:21:13.660 | I want

00:21:14.240 | to put

00:21:14.700 | more

00:21:15.080 | reward

00:21:15.620 | on there

00:21:16.180 | and it's

00:21:17.000 | really

00:21:17.420 | really

00:21:17.680 | fascinating

00:21:18.120 | because

00:21:18.520 | when people

00:21:19.300 | come to

00:21:19.780 | that

00:21:19.980 | realization

00:21:20.720 | about

00:21:21.480 | themselves

00:21:22.040 | that

00:21:22.680 | they're

00:21:22.880 | most

00:21:23.420 | vulnerable

00:21:24.020 | when

00:21:24.680 | things

00:21:24.980 | are

00:21:25.100 | going

00:21:25.360 | well

00:21:25.940 | that's

00:21:27.360 | really

00:21:27.660 | a valuable

00:21:28.300 | insight

00:21:28.720 | because

00:21:28.980 | then they

00:21:29.240 | can put

00:21:29.560 | some

00:21:29.820 | things

00:21:30.320 | in place

00:21:30.800 | or barriers

00:21:31.240 | in place

00:21:31.720 | or go

00:21:31.980 | to more

00:21:32.340 | meetings

00:21:33.040 | or whatever

00:21:33.460 | it is

00:21:33.820 | that they

00:21:34.220 | do

00:21:34.620 | to protect

00:21:35.640 | themselves

00:21:36.220 | I wanted

00:21:37.540 | to just

00:21:38.620 | touch on

00:21:39.120 | something

00:21:39.840 | that you

00:21:40.280 | mentioned

00:21:40.620 | which is

00:21:41.080 | the shame

00:21:41.780 | I heard

00:21:42.880 | you say

00:21:43.480 | in an

00:21:44.340 | interview

00:21:44.600 | with

00:21:44.900 | somebody

00:21:45.320 | else

00:21:45.540 | recently

00:21:45.960 | that

00:21:46.860 | truth

00:21:48.240 | telling

00:21:48.640 | and secrets

00:21:49.780 | are sort

00:21:51.060 | of at the

00:21:51.400 | core

00:21:51.760 | of recovery

00:21:52.660 | and

00:21:53.960 | tell us

00:21:55.480 | more about

00:21:55.920 | that

00:21:56.280 | yeah

00:21:57.160 | so one

00:21:57.680 | of the

00:21:57.920 | things

00:21:58.140 | that I

00:21:58.540 | found

00:21:59.020 | really

00:21:59.580 | fascinating

00:22:00.540 | about

00:22:00.940 | working

00:22:01.400 | with people

00:22:01.840 | in recovery

00:22:02.420 | was how

00:22:03.060 | telling the

00:22:04.300 | truth

00:22:04.700 | even about

00:22:05.340 | the merest

00:22:06.060 | detail

00:22:06.540 | of their

00:22:06.900 | lives

00:22:07.360 | was central

00:22:08.320 | to their

00:22:08.680 | recovery

00:22:09.140 | it's not

00:22:09.920 | even just

00:22:10.480 | not lying

00:22:11.140 | about using

00:22:11.700 | drugs

00:22:12.040 | I have to

00:22:12.920 | not lie

00:22:13.420 | about

00:22:13.720 | anything

00:22:14.240 | I can't

00:22:15.200 | lie about

00:22:15.740 | why I was

00:22:16.280 | late to

00:22:16.680 | work this

00:22:17.080 | morning

00:22:17.240 | which we

00:22:17.540 | all do

00:22:17.980 | oh I hit

00:22:18.580 | traffic

00:22:18.900 | no I

00:22:19.260 | didn't

00:22:19.400 | hit

00:22:19.560 | traffic

00:22:19.880 | I wanted

00:22:20.240 | to spend

00:22:20.580 | two more

00:22:20.980 | minutes

00:22:21.260 | reading the

00:22:21.900 | paper

00:22:22.140 | and drinking

00:22:22.480 | my coffee

00:22:23.140 | right

00:22:23.460 | so people

00:22:24.500 | with addiction

00:22:24.980 | will get

00:22:25.280 | into you know

00:22:25.940 | the lying

00:22:26.440 | habit

00:22:26.720 | where they're

00:22:27.060 | lying about

00:22:27.580 | random stuff

00:22:28.220 | because they're

00:22:28.660 | sort of in

00:22:29.120 | the habit

00:22:29.520 | of lying

00:22:30.080 | and how

00:22:31.180 | recovery

00:22:31.660 | is really

00:22:32.240 | about

00:22:32.840 | telling the

00:22:33.280 | truth

00:22:33.540 | and there's

00:22:34.080 | really

00:22:34.360 | interesting

00:22:34.860 | neuroscience

00:22:35.340 | behind it

00:22:36.480 | that suggests

00:22:37.500 | that when we

00:22:38.340 | tell the

00:22:38.940 | truth

00:22:39.480 | we actually

00:22:40.480 | potentially

00:22:41.140 | strengthen our

00:22:42.420 | prefrontal

00:22:43.060 | cortical circuits

00:22:44.260 | and their

00:22:45.360 | connections to

00:22:46.200 | our limbic

00:22:46.740 | brain and

00:22:47.160 | our reward

00:22:47.740 | brain

00:22:48.060 | and of course

00:22:48.840 | these are the

00:22:49.320 | circuits that

00:22:49.860 | get disconnected

00:22:50.560 | when we're in

00:22:51.040 | our addiction

00:22:51.540 | right

00:22:52.120 | our balance

00:22:53.020 | in our

00:22:53.400 | reward

00:22:53.700 | pathway

00:22:54.060 | our limbic

00:22:54.560 | brain

00:22:54.800 | our emotion

00:22:55.280 | brain

00:22:55.500 | is doing

00:22:55.800 | one thing

00:22:56.340 | and our

00:22:57.140 | cortical circuits

00:22:57.920 | are completely

00:22:58.580 | disengaged

00:22:59.300 | from that

00:22:59.680 | ignoring

00:23:00.140 | what's

00:23:00.440 | happening

00:23:00.680 | which is

00:23:01.040 | easy to

00:23:01.480 | do

00:23:01.660 | because

00:23:01.900 | it's

00:23:02.100 | reflexive

00:23:02.680 | we don't

00:23:03.120 | need to

00:23:03.680 | think about

00:23:04.280 | that balance

00:23:04.960 | for the

00:23:05.220 | balance

00:23:05.520 | to be

00:23:05.780 | happening

00:23:06.140 | but we

00:23:07.420 | have to

00:23:07.900 | re-engage

00:23:08.540 | those circuits

00:23:09.280 | anticipate

00:23:09.940 | future

00:23:10.440 | consequences

00:23:11.100 | think through

00:23:12.280 | the drink

00:23:12.840 | you know

00:23:13.260 | not just

00:23:14.020 | how am I

00:23:14.400 | going to

00:23:14.620 | feel

00:23:14.880 | now

00:23:15.360 | if I

00:23:15.820 | use

00:23:16.260 | but how

00:23:16.640 | am I

00:23:16.780 | going to

00:23:16.900 | feel

00:23:17.040 | tomorrow

00:23:17.520 | or six

00:23:18.060 | months

00:23:18.320 | from now

00:23:18.720 | and that

00:23:19.520 | telling

00:23:19.920 | the truth

00:23:20.500 | is in

00:23:20.860 | fact a

00:23:21.280 | way

00:23:21.560 | to do

00:23:22.340 | that

00:23:22.660 | to make

00:23:23.160 | these

00:23:23.440 | connections

00:23:23.980 | stronger

00:23:24.600 | and there

00:23:24.880 | I talk

00:23:25.240 | about some

00:23:25.620 | studies in

00:23:26.040 | my book

00:23:26.320 | that

00:23:26.540 | kind of

00:23:27.480 | indirectly

00:23:28.000 | show that

00:23:28.760 | so I

00:23:29.340 | find that

00:23:29.720 | really

00:23:29.900 | fascinating

00:23:30.280 | plus

00:23:30.840 | just that

00:23:32.280 | like being

00:23:32.760 | open and

00:23:33.260 | honest with

00:23:33.700 | people

00:23:34.120 | really does

00:23:35.520 | create very

00:23:36.860 | intimate

00:23:37.460 | connections

00:23:38.460 | and those

00:23:39.440 | intimate

00:23:39.780 | connections

00:23:40.420 | create

00:23:41.200 | dopamine

00:23:41.560 | you think

00:23:42.340 | people are

00:23:42.740 | going to run

00:23:43.080 | away from

00:23:43.520 | you if you

00:23:43.960 | tell them

00:23:44.300 | about all

00:23:44.720 | like your

00:23:45.100 | weird

00:23:45.380 | neuroses

00:23:45.720 | but really

00:23:46.180 | they don't

00:23:47.080 | what they're

00:23:47.480 | like is

00:23:47.740 | oh thank

00:23:48.040 | god

00:23:48.320 | I'm not

00:23:48.960 | the only

00:23:49.260 | one

00:23:49.660 | right

00:23:50.080 | I love

00:23:50.740 | that there's

00:23:51.080 | neuroscience

00:23:51.580 | being done

00:23:52.520 | on truth

00:23:53.080 | telling

00:23:53.400 | and the

00:23:53.920 | value

00:23:54.280 | of truth

00:23:54.640 | telling

00:23:54.840 | I think

00:23:55.560 | I hope

00:23:56.020 | they'll

00:23:56.480 | continue

00:23:56.820 | to do

00:23:57.060 | more

00:23:57.260 | work

00:23:57.420 | I want

00:23:58.720 | to ask

00:23:58.980 | you about

00:23:59.500 | using drugs

00:24:00.880 | to treat

00:24:01.580 | drug addiction

00:24:02.200 | this is a

00:24:03.520 | vast area

00:24:04.460 | right

00:24:04.840 | different

00:24:05.180 | chemistries

00:24:05.700 | for different

00:24:06.120 | drugs

00:24:06.560 | and different

00:24:07.200 | purposes

00:24:07.560 | but the

00:24:08.060 | rationale

00:24:08.980 | as I

00:24:09.580 | understand

00:24:10.000 | it

00:24:10.480 | is

00:24:11.320 | take

00:24:12.160 | people

00:24:12.500 | who are

00:24:12.960 | in a

00:24:13.560 | pattern

00:24:13.980 | of

00:24:14.180 | addiction

00:24:14.540 | launch

00:24:16.300 | them

00:24:16.520 | into

00:24:16.900 | a

00:24:17.300 | experience

00:24:18.540 | that's

00:24:19.460 | also

00:24:19.720 | chemical

00:24:20.200 | and

00:24:20.580 | extreme

00:24:21.120 | often

00:24:21.660 | of

00:24:22.020 | the

00:24:22.280 | extreme

00:24:23.080 | serotonin

00:24:23.940 | and or

00:24:24.900 | extreme

00:24:25.280 | dopamine

00:24:25.780 | type

00:24:26.240 | so

00:24:26.480 | MDMA

00:24:27.020 | ecstasy

00:24:27.520 | for instance

00:24:27.900 | tons

00:24:28.360 | of serotonin

00:24:29.100 | dumped

00:24:29.420 | tons

00:24:30.060 | of dopamine

00:24:30.700 | dumped

00:24:31.020 | how

00:24:31.800 | neurotoxic

00:24:32.520 | if neurotoxic

00:24:33.400 | debatable

00:24:33.920 | et cetera

00:24:34.280 | et cetera

00:24:34.560 | not

00:24:34.860 | a topic

00:24:35.720 | for now

00:24:36.140 | but a lot

00:24:37.600 | and then

00:24:38.780 | somehow

00:24:39.220 | that extreme

00:24:40.180 | experience

00:24:40.840 | wrapped

00:24:41.360 | inside

00:24:41.840 | of a

00:24:42.360 | supported

00:24:43.600 | network

00:24:44.220 | in there

00:24:44.640 | whether or

00:24:45.080 | not

00:24:45.300 | there's

00:24:45.680 | just

00:24:45.820 | someone

00:24:46.080 | there

00:24:46.460 | or

00:24:46.660 | whether

00:24:46.800 | or

00:24:46.940 | not

00:24:47.000 | they're

00:24:47.200 | actively

00:24:47.560 | working

00:24:47.900 | through

00:24:48.140 | something

00:24:48.460 | with

00:24:48.660 | the

00:24:49.140 | patient

00:24:49.460 | is supposed

00:24:50.580 | to eject

00:24:51.360 | the person

00:24:52.980 | into a

00:24:53.720 | life

00:24:54.020 | where

00:24:54.440 | drug

00:24:55.480 | use

00:24:56.060 | isn't

00:24:56.880 | as much

00:24:58.140 | of interest

00:24:58.660 | this

00:24:59.300 | violates

00:24:59.780 | everything

00:25:00.360 | we've talked

00:25:00.980 | about in

00:25:01.360 | terms of

00:25:01.700 | dopamine

00:25:02.000 | biology

00:25:02.560 | it would

00:25:03.680 | if this

00:25:04.580 | arrangement

00:25:05.300 | is the way

00:25:06.060 | I described

00:25:06.480 | it

00:25:06.840 | cause

00:25:08.680 | more

00:25:09.140 | addiction

00:25:09.460 | is anything

00:25:10.100 | but a

00:25:10.520 | dopamine

00:25:10.860 | fast

00:25:11.260 | it's a

00:25:11.600 | dopamine

00:25:11.920 | feast

00:25:12.560 | so

00:25:14.040 | we hear

00:25:15.100 | about

00:25:15.420 | successful

00:25:15.980 | transitions

00:25:16.940 | through

00:25:17.260 | this

00:25:17.540 | at least

00:25:17.940 | anecdotally

00:25:18.860 | and may

00:25:19.200 | maybe

00:25:20.040 | say

00:25:20.740 | what

00:25:21.320 | is

00:25:21.980 | going

00:25:22.300 | on

00:25:22.760 | what

00:25:24.440 | is

00:25:24.640 | going

00:25:24.880 | on

00:25:25.200 | doesn't

00:25:25.580 | make

00:25:25.720 | any

00:25:25.960 | sense

00:25:26.240 | to me

00:25:26.680 | yeah

00:25:27.420 | so

00:25:28.160 | I think

00:25:28.700 | it's

00:25:29.060 | good

00:25:29.280 | that

00:25:29.500 | you're

00:25:29.720 | skeptical

00:25:30.220 | I think

00:25:31.140 | we all

00:25:31.540 | should

00:25:31.780 | be

00:25:31.980 | skeptical

00:25:32.480 | having

00:25:33.520 | said

00:25:33.900 | that

00:25:34.420 | there

00:25:35.580 | are

00:25:36.000 | clinical

00:25:36.520 | studies

00:25:37.220 | showing

00:25:38.080 | you know

00:25:39.600 | and these

00:25:39.800 | are small

00:25:40.200 | studies

00:25:40.620 | and they're

00:25:40.960 | short

00:25:41.200 | duration

00:25:41.680 | small

00:25:42.380 | number

00:25:42.720 | of

00:25:42.960 | subjects

00:25:43.600 | but

00:25:44.480 | you know

00:25:44.760 | taking

00:25:45.020 | people

00:25:45.320 | for example

00:25:45.780 | who are

00:25:46.360 | addicted

00:25:47.160 | to

00:25:47.380 | alcohol

00:25:47.760 | and then

00:25:48.840 | having

00:25:49.340 | them

00:25:49.600 | have

00:25:49.980 | this

00:25:50.460 | let's

00:25:50.980 | say

00:25:51.100 | psychedelic

00:25:51.680 | experience

00:25:52.140 | in a

00:25:52.940 | very

00:25:53.320 | controlled

00:25:53.940 | setting

00:25:54.480 | so

00:25:54.680 | either

00:25:54.860 | typically

00:25:55.320 | it's

00:25:55.580 | a

00:25:55.720 | high

00:25:55.920 | dose

00:25:56.120 | psilocybin

00:25:56.700 | or

00:25:56.920 | three

00:25:57.460 | dose

00:25:57.860 | as I

00:25:58.440 | saw it

00:25:58.820 | for the

00:25:59.160 | MAP

00:25:59.380 | study

00:25:59.700 | of

00:25:59.940 | MDMA

00:26:00.880 | of

00:26:01.480 | ecstasy

00:26:01.940 | those

00:26:02.260 | are

00:26:02.360 | sort

00:26:02.540 | of

00:26:02.620 | the

00:26:02.740 | seem

00:26:03.100 | to be

00:26:03.340 | the

00:26:03.480 | kind

00:26:03.760 | of

00:26:03.880 | bread

00:26:05.060 | and

00:26:05.240 | butter

00:26:05.440 | of

00:26:05.680 | this

00:26:05.880 | kind

00:26:06.160 | of

00:26:06.300 | work

00:26:06.460 | but

00:26:07.000 | the

00:26:07.160 | thing

00:26:07.440 | to

00:26:07.660 | really

00:26:07.920 | keep

00:26:08.220 | in

00:26:08.400 | mind

00:26:08.700 | is

00:26:09.000 | that

00:26:09.320 | this

00:26:09.680 | is

00:26:09.920 | completely

00:26:10.720 | interwoven

00:26:11.720 | with

00:26:12.580 | regular

00:26:13.300 | psychotherapy

00:26:14.240 | and that

00:26:15.120 | these are

00:26:15.480 | highly

00:26:15.980 | selected

00:26:16.660 | individuals

00:26:17.420 | and

00:26:17.840 | clinical

00:26:18.200 | trials

00:26:18.620 | right

00:26:18.880 | right

00:26:19.100 | when it

00:26:21.820 | works

00:26:22.380 | it's

00:26:23.020 | a

00:26:23.320 | transformational

00:26:24.280 | experience

00:26:24.900 | because

00:26:25.320 | it

00:26:26.460 | gives

00:26:26.900 | the

00:26:27.480 | person

00:26:27.880 | another

00:26:28.620 | lens

00:26:29.660 | to view

00:26:30.480 | their

00:26:30.680 | lives

00:26:31.200 | which

00:26:32.800 | I

00:26:33.200 | think

00:26:33.560 | for

00:26:34.200 | some

00:26:34.480 | people

00:26:34.800 | is

00:26:35.080 | positive

00:26:35.520 | and

00:26:35.720 | powerful

00:26:36.140 | because

00:26:37.000 | they

00:26:37.200 | can

00:26:37.380 | come back

00:26:37.820 | from that

00:26:38.120 | and be

00:26:38.360 | like

00:26:38.640 | oh my

00:26:39.580 | gosh

00:26:40.020 | I

00:26:40.640 | care

00:26:41.260 | about

00:26:41.880 | my

00:26:42.120 | family

00:26:42.560 | and I

00:26:43.400 | don't

00:26:44.060 | I want

00:26:44.520 | X Y

00:26:44.980 | or Z

00:26:45.240 | for them

00:26:45.620 | and I

00:26:45.860 | realize

00:26:46.140 | that my

00:26:46.520 | continuing

00:26:46.920 | to drink

00:26:47.400 | is not

00:26:47.840 | going to

00:26:48.720 | achieve that

00:26:50.100 | so it's

00:26:51.160 | almost like

00:26:51.780 | a spiritual

00:26:52.560 | or values

00:26:53.800 | based

00:26:54.300 | so I think

00:26:55.260 | it can be

00:26:56.000 | very powerful

00:26:56.500 | but having

00:26:57.180 | said that

00:26:57.720 | I truly

00:26:58.760 | am quite

00:26:59.260 | skeptical

00:26:59.780 | because

00:27:00.920 | you know

00:27:02.100 | addiction

00:27:02.500 | is a

00:27:02.940 | chronic

00:27:03.280 | relapsing

00:27:03.920 | and remitting

00:27:04.300 | problem

00:27:04.760 | it's hard

00:27:05.200 | for me

00:27:05.420 | to imagine

00:27:05.800 | that there's

00:27:06.640 | something that

00:27:07.240 | works very

00:27:07.940 | quickly short

00:27:08.660 | term

00:27:09.020 | that's going

00:27:09.780 | to work

00:27:10.200 | for a

00:27:11.380 | disease

00:27:11.740 | that's

00:27:12.140 | really

00:27:12.440 | long

00:27:12.820 | lasting

00:27:13.380 | yeah

00:27:13.860 | the two

00:27:14.220 | addicts

00:27:14.660 | I know

00:27:15.000 | that did

00:27:15.760 | MDMA

00:27:16.320 | assisted

00:27:17.440 | psychotherapy

00:27:18.140 | as part

00:27:18.520 | of this

00:27:19.620 | thing

00:27:20.160 | both got

00:27:20.660 | worse

00:27:21.140 | yeah

00:27:21.760 | but the

00:27:23.360 | people I

00:27:23.740 | know

00:27:23.960 | who had

00:27:24.660 | severe

00:27:25.160 | trauma

00:27:25.700 | who did

00:27:26.860 | this

00:27:27.180 | who took

00:27:27.640 | this

00:27:27.820 | approach

00:27:28.220 | seem to

00:27:29.120 | be doing

00:27:29.460 | better

00:27:29.820 | okay

00:27:30.180 | and so

00:27:31.120 | I

00:27:31.400 | I think

00:27:32.920 | that

00:27:33.120 | the

00:27:33.820 | discussion

00:27:34.260 | as we

00:27:34.740 | hear it

00:27:35.020 | now

00:27:35.260 | is just

00:27:35.540 | sort of

00:27:35.840 | psychedelics

00:27:36.600 | which is

00:27:37.220 | a huge

00:27:37.580 | category

00:27:38.120 | that includes

00:27:38.900 | many different

00:27:39.680 | drugs and

00:27:40.400 | compounds

00:27:40.820 | with different

00:27:41.160 | effects

00:27:41.440 | and we

00:27:42.980 | hear about

00:27:43.520 | trauma and

00:27:44.100 | addiction

00:27:44.500 | lumped

00:27:45.080 | together

00:27:45.500 | and I

00:27:46.380 | think it's

00:27:46.740 | going to be

00:27:47.020 | important

00:27:47.700 | for people

00:27:48.580 | to know

00:27:49.460 | that this

00:27:50.500 | is definitely

00:27:51.060 | not a

00:27:52.580 | one-size-fits-all

00:27:53.680 | kind of thing

00:27:55.040 | but it sounds

00:27:55.680 | like it may

00:27:56.180 | have some

00:27:56.600 | utility under

00:27:57.440 | certain conditions

00:27:58.460 | yeah I think

00:27:59.380 | so I think

00:28:00.220 | we I'm trying

00:28:01.120 | to be very

00:28:01.560 | open-minded

00:28:02.180 | about its

00:28:02.780 | potential utility

00:28:03.760 | for certain

00:28:04.520 | individuals

00:28:05.020 | but I can tell

00:28:06.320 | you in my

00:28:06.760 | clinical work

00:28:07.400 | what is a

00:28:08.000 | very concerning

00:28:08.920 | unintended

00:28:10.040 | consequence of

00:28:11.220 | this narrative

00:28:12.080 | is I have a

00:28:13.440 | lot of people

00:28:14.100 | who are looking

00:28:14.960 | for some kind

00:28:15.560 | of spiritual

00:28:16.080 | awakening

00:28:16.520 | who on

00:28:17.140 | their own

00:28:17.800 | not in the

00:28:18.560 | context of any

00:28:19.340 | kind of

00:28:19.700 | therapeutic

00:28:20.220 | psychological

00:28:21.120 | work

00:28:21.520 | you know

00:28:22.080 | microdose

00:28:23.080 | or want

00:28:24.120 | to try

00:28:24.680 | you know

00:28:25.000 | psilocybin

00:28:25.740 | or MDMA

00:28:26.660 | with a friend

00:28:27.920 | or wherever

00:28:28.520 | so they can

00:28:28.940 | have this

00:28:29.340 | you know

00:28:29.620 | spiritual

00:28:30.120 | experience

00:28:30.700 | that they

00:28:30.940 | can figure

00:28:31.320 | out their

00:28:31.660 | lives

00:28:31.940 | that's a

00:28:33.000 | disaster

00:28:33.480 | and almost

00:28:34.580 | never works

00:28:35.560 | out well

00:28:36.080 | and I can

00:28:36.580 | just tell you

00:28:37.120 | that the

00:28:37.500 | downstream

00:28:38.180 | effect for

00:28:39.580 | the average

00:28:40.340 | person

00:28:40.940 | is that

00:28:41.900 | they've

00:28:42.280 | misconstrued

00:28:43.580 | the data

00:28:44.420 | on the use

00:28:45.900 | of psychedelics

00:28:46.840 | for mental

00:28:47.460 | health

00:28:47.700 | conditions

00:28:48.180 | to this

00:28:49.820 | idea that

00:28:50.500 | they're safe

00:28:51.400 | or that

00:28:51.740 | anybody can

00:28:52.300 | take them

00:28:52.640 | in any

00:28:52.900 | circumstance

00:28:53.360 | and have

00:28:54.020 | this kind

00:28:54.800 | of awakening

00:28:55.340 | and that

00:28:56.660 | that's not

00:28:57.120 | what the

00:28:57.400 | data show

00:28:58.260 | right

00:28:58.520 | the data

00:28:58.880 | are these

00:28:59.240 | highly

00:28:59.860 | controlled

00:29:00.480 | settings

00:29:01.120 | there are

00:29:02.120 | a couple

00:29:02.440 | other things

00:29:03.080 | I just want

00:29:03.500 | to touch

00:29:03.980 | on

00:29:04.360 | but they

00:29:05.960 | all relate

00:29:06.460 | to social

00:29:06.960 | media

00:29:07.300 | okay

00:29:07.780 | I have

00:29:08.560 | to imagine

00:29:08.980 | that we

00:29:09.760 | need to

00:29:10.260 | regulate

00:29:10.760 | not

00:29:11.380 | necessarily

00:29:12.080 | eliminate

00:29:12.740 | this

00:29:13.500 | behavior

00:29:13.960 | how

00:29:14.520 | addicting

00:29:15.040 | is it

00:29:15.720 | and

00:29:16.320 | what

00:29:17.400 | is

00:29:18.020 | healthy

00:29:18.480 | social

00:29:18.960 | media

00:29:19.240 | behavior

00:29:19.720 | the

00:29:20.380 | first

00:29:21.020 | message

00:29:22.380 | I would

00:29:22.800 | want to

00:29:23.080 | get across

00:29:23.560 | about social

00:29:24.140 | media

00:29:24.420 | is that

00:29:24.900 | it

00:29:25.140 | really

00:29:25.560 | is a

00:29:26.260 | drug

00:29:26.560 | and it's

00:29:27.300 | engineered

00:29:27.640 | to be

00:29:28.020 | a drug

00:29:28.400 | which

00:29:28.900 | doesn't

00:29:29.460 | mean

00:29:29.740 | that

00:29:30.060 | we

00:29:30.380 | can't

00:29:30.840 | use

00:29:31.200 | it

00:29:31.520 | but

00:29:32.100 | we

00:29:32.280 | need

00:29:32.500 | to

00:29:32.640 | be

00:29:32.780 | very

00:29:33.020 | thoughtful

00:29:33.520 | about

00:29:33.860 | the

00:29:34.020 | way

00:29:34.180 | we

00:29:34.620 | use

00:29:35.120 | it

00:29:35.240 | and

00:29:35.500 | so

00:29:35.680 | that

00:29:35.900 | means

00:29:36.360 | with

00:29:36.880 | intention

00:29:37.440 | and

00:29:37.800 | in

00:29:37.980 | advance

00:29:38.640 | planning

00:29:39.600 | our

00:29:40.080 | use

00:29:40.580 | right

00:29:41.220 | and

00:29:41.460 | trying

00:29:41.780 | to

00:29:42.020 | use

00:29:42.280 | it

00:29:42.680 | as

00:29:43.180 | a

00:29:43.600 | really

00:29:44.300 | awesome

00:29:45.000 | tool

00:29:45.780 | to

00:29:46.360 | potentially

00:29:46.880 | connect

00:29:47.540 | with

00:29:47.760 | other

00:29:48.000 | people

00:29:48.500 | and

00:29:49.160 | not

00:29:49.480 | to

00:29:49.720 | be

00:29:49.980 | used

00:29:50.560 | by

00:29:51.020 | it

00:29:51.320 | or

00:29:52.000 | get

00:29:52.300 | lost

00:29:52.780 | in

00:29:53.000 | it

00:29:53.180 | we

00:29:53.580 | do

00:29:53.880 | need

00:29:54.160 | to

00:29:54.360 | figure

00:29:54.660 | out

00:29:55.100 | you

00:29:55.300 | know

00:29:55.460 | how

00:29:55.880 | to

00:29:56.440 | make

00:29:57.300 | this

00:29:57.720 | tool

00:29:58.760 | something

00:29:59.540 | that's

00:30:00.420 | you know

00:30:00.660 | going to

00:30:00.860 | be good

00:30:01.200 | for us

00:30:01.640 | and not

00:30:02.160 | ultimately

00:30:02.580 | harmful

00:30:03.120 | as

00:30:03.680 | more

00:30:04.100 | and more

00:30:04.420 | of us

00:30:04.900 | are

00:30:05.040 | spending

00:30:05.360 | more

00:30:05.700 | and more

00:30:05.920 | time

00:30:06.220 | on

00:30:06.400 | social

00:30:06.700 | media

00:30:07.040 | we're

00:30:07.780 | divesting

00:30:08.540 | our

00:30:08.980 | libidness

00:30:09.680 | energies

00:30:10.220 | etc

00:30:10.860 | from

00:30:11.760 | real

00:30:12.200 | life

00:30:12.440 | interactions

00:30:13.000 | so I

00:30:13.660 | think

00:30:13.920 | our

00:30:14.160 | collective

00:30:14.720 | challenge

00:30:15.760 | and it

00:30:16.500 | should be

00:30:16.860 | our

00:30:17.240 | mission

00:30:17.860 | is to

00:30:18.780 | make sure

00:30:19.500 | that we

00:30:20.460 | are

00:30:20.680 | preserving

00:30:21.300 | and

00:30:21.820 | maintaining

00:30:22.320 | offline

00:30:23.720 | ways to

00:30:24.900 | connect

00:30:25.300 | with each

00:30:25.840 | other

00:30:26.140 | so this

00:30:26.640 | is the

00:30:26.980 | key

00:30:27.200 | you have

00:30:27.620 | to

00:30:27.840 | with

00:30:28.260 | intention

00:30:28.820 | prior to

00:30:29.980 | being in

00:30:30.400 | that

00:30:30.580 | situation

00:30:31.140 | think

00:30:31.880 | think

00:30:31.900 | of

00:30:32.220 | literal

00:30:32.880 | physical

00:30:33.460 | and

00:30:33.720 | metacognitive

00:30:34.360 | barriers

00:30:34.900 | that you

00:30:35.260 | can put

00:30:35.640 | between

00:30:36.000 | yourself

00:30:36.480 | and your

00:30:37.620 | phone

00:30:38.200 | or whatever

00:30:38.660 | your drug

00:30:39.440 | is

00:30:39.740 | to create

00:30:40.580 | these

00:30:41.060 | intentional

00:30:41.860 | spaces

00:30:42.440 | where you're

00:30:42.820 | not

00:30:43.080 | constantly

00:30:43.960 | interrupting

00:30:45.080 | yourself

00:30:45.580 | essentially

00:30:46.060 | and distracting

00:30:46.760 | yourself

00:30:47.120 | because I

00:30:47.460 | really do

00:30:47.840 | think

00:30:48.160 | we're

00:30:48.480 | losing

00:30:48.820 | the ability

00:30:49.460 | to have

00:30:50.080 | a sustained

00:30:51.040 | thought

00:30:51.760 | right

00:30:52.400 | I mean

00:30:52.620 | we get

00:30:53.080 | so far

00:30:53.780 | and then

00:30:54.320 | then you

00:30:55.240 | get to

00:30:55.520 | that point

00:30:56.020 | in the

00:30:56.440 | thought

00:30:56.760 | where

00:30:57.180 | it's a

00:30:58.280 | little bit

00:30:58.600 | hard to

00:30:59.120 | know what's

00:30:59.500 | coming

00:30:59.720 | next

00:31:00.140 | and it's

00:31:00.660 | very easy

00:31:01.400 | to

00:31:01.800 | check your

00:31:02.920 | phone

00:31:03.240 | or check

00:31:03.900 | your email

00:31:04.320 | or look

00:31:05.420 | something up

00:31:05.960 | on you

00:31:06.580 | know the

00:31:06.820 | internet

00:31:07.160 | and then

00:31:08.540 | you never

00:31:09.100 | get that

00:31:09.660 | opportunity

00:31:10.240 | to finish

00:31:11.560 | that thought

00:31:12.200 | which is

00:31:12.520 | really the

00:31:13.040 | source of

00:31:13.660 | creative energy

00:31:14.500 | and an

00:31:15.220 | original thought

00:31:16.100 | right

00:31:16.340 | you're not

00:31:16.580 | just reacting

00:31:17.300 | to

00:31:17.760 | right

00:31:18.140 | and something

00:31:18.700 | that could

00:31:19.100 | contribute

00:31:19.460 | to the

00:31:19.820 | world

00:31:20.060 | I know

00:31:20.720 | a number

00:31:21.020 | of people

00:31:21.260 | are going

00:31:21.460 | to have

00:31:21.700 | questions

00:31:22.260 | and want

00:31:22.560 | to get

00:31:22.760 | in contact

00:31:23.240 | with you

00:31:23.800 | you are

00:31:24.240 | not on

00:31:24.780 | social media

00:31:25.440 | that's

00:31:26.280 | correct

00:31:26.680 | yes

00:31:26.980 | you are

00:31:27.360 | true to

00:31:27.780 | your

00:31:28.000 | you are

00:31:28.280 | true to

00:31:28.920 | your

00:31:29.200 | ideology

00:31:30.000 | that is

00:31:30.440 | that's

00:31:30.800 | great

00:31:31.060 | thank you

00:31:31.820 | so much

00:31:32.420 | for sharing

00:31:33.160 | this information

00:31:33.880 | and I

00:31:34.980 | know I

00:31:35.300 | learned a

00:31:35.680 | ton

00:31:35.900 | and I

00:31:36.600 | know

00:31:36.740 | everyone

00:31:37.040 | else

00:31:37.280 | is going

00:31:37.560 | to learn

00:31:38.100 | a lot

00:31:38.460 | more

00:31:38.700 | about

00:31:38.960 | addiction

00:31:39.320 | and

00:31:39.920 | the

00:31:40.560 | good

00:31:40.720 | side

00:31:40.960 | of

00:31:41.100 | dopamine

00:31:41.460 | that's

00:31:42.020 | right

00:31:42.300 | thank you

00:31:43.320 | for having

00:31:43.680 | me

00:31:43.880 | it's been

00:31:44.340 | really

00:31:44.700 | really great

00:31:45.160 | to talk

00:31:45.500 | with you

00:31:45.800 | you

00:31:47.860 | you

Essentials: Understanding & Treating Addiction | Dr. Anna Lembke

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