Addiction Explained, Rises & Falls in Dopamine | Dr. Andrew Huberman
00:00:00.000 | [silence]
00:00:02.660 | Let's just think about addiction,
00:00:04.540 | because in biology and in psychology, frankly,
00:00:08.780 | it really often pays to think about the extremes first
00:00:12.180 | and then work our way towards more typical circumstances.
00:00:15.060 | And with that said,
00:00:16.100 | addiction, unfortunately, is very common nowadays.
00:00:18.580 | I just heard a statistic, in fact,
00:00:20.060 | that there is an 80, 80% increase
00:00:24.700 | in alcohol use disorder among women in the last 30 years.
00:00:28.380 | I talked a little bit about this
00:00:29.540 | in the episode that I did about alcohol and health.
00:00:33.020 | Again, I want to be very clear.
00:00:33.940 | I'm not somebody that is completely against alcohol
00:00:36.540 | for adults, provided they're not alcoholics.
00:00:39.200 | Turns out two drinks a week, probably fine health-wise.
00:00:42.520 | Zero would be better, if we're honest.
00:00:45.120 | Zero is better than any alcohol.
00:00:47.340 | But two drinks a week is probably fine.
00:00:49.180 | Past two drinks, you start running into problems.
00:00:51.580 | And yet many, many people out there, male and female alike,
00:00:56.100 | suffer from alcohol use disorder, also called alcoholism.
00:01:00.780 | The same is also true for things like methamphetamine
00:01:03.920 | or cocaine or other types of substance addictions.
00:01:08.020 | And the same is also true for a lot of behavioral
00:01:11.300 | or what are sometimes called process addictions,
00:01:13.520 | things like sex addiction or video game addiction
00:01:16.340 | or any type of behavior that, frankly,
00:01:20.140 | is leveraging the dopamine system,
00:01:22.780 | but that engages this progressive narrowing
00:01:25.780 | of the things that bring someone pleasure,
00:01:27.780 | such that nothing else is really salient.
00:01:30.220 | Nothing else is really pulling them in
00:01:32.500 | in the way that their video games or sex
00:01:35.360 | or pornography or alcohol, pick your substance
00:01:39.300 | or behavior that you see out there, or hopefully not,
00:01:43.760 | but that you might suffer from an addiction to.
00:01:46.260 | So what's happening in addiction?
00:01:48.340 | Well, addiction involves dopamine, among other things,
00:01:51.720 | often, the opioid system, et cetera.
00:01:54.380 | But if we were to think about what's the stimulus
00:01:57.440 | in an addiction and what's the peak in dopamine,
00:02:01.460 | and then what happens after that peak,
00:02:04.420 | it all becomes very clear as to why addiction happens
00:02:07.940 | and why it's so pernicious.
00:02:10.260 | So for instance, let's take cocaine.
00:02:12.160 | Cocaine causes dramatic increases in dopamine
00:02:15.820 | very, very fast.
00:02:17.340 | So if somebody craves cocaine, what are they craving?
00:02:21.380 | They're craving that dopamine peak.
00:02:22.900 | They're craving the increased level of alertness.
00:02:26.300 | They're craving a number of things associated
00:02:29.060 | with the feeling of being under the influence of the drug,
00:02:32.660 | but the stimulus for it simply becomes that line of cocaine,
00:02:36.700 | or in the case of crack,
00:02:37.780 | that crack rock that they're going to smoke,
00:02:40.580 | and God forbid, they're mainlining it.
00:02:42.100 | You know, they're shooting into a vein.
00:02:44.100 | What happens is they snort, smoke, or inject cocaine,
00:02:49.260 | and dopamine levels almost immediately
00:02:52.220 | go up, up, up, up, up, up to a very high peak, okay?
00:02:55.340 | So the time gap between the stimulus and the dopamine
00:02:59.220 | is very, very short, so short, in fact,
00:03:02.820 | that there's really no other contingencies in between
00:03:06.160 | that the mesocortical system has to learn.
00:03:09.620 | In fact, what does the system quote-unquote learn?
00:03:12.740 | It learns cocaine equals massive amounts of dopamine
00:03:17.740 | equals feeling euphoric and energetic, et cetera,
00:03:20.980 | and in doing that, it reinforces the whole circuit
00:03:25.500 | so that that short, we can even say hyper short contingency,
00:03:30.500 | is really what the system wants,
00:03:33.180 | so much so that longer contingencies of, say,
00:03:37.400 | putting in the hard work of, you know,
00:03:40.220 | generating a fitness program
00:03:41.700 | or a professional program for yourself
00:03:43.660 | or a education program, which takes not just many days,
00:03:47.820 | but many weeks and years,
00:03:49.260 | well, none of that is going to lead to peaks in dopamine
00:03:51.820 | that are as high as the peak in dopamine
00:03:54.260 | associated with cocaine.
00:03:55.980 | So that tells us something critical.
00:03:58.340 | It is both the duration between desire and effect,
00:04:03.340 | and when I say effect, I mean the rewarding properties
00:04:05.900 | of dopamine that are experienced, that's important,
00:04:08.220 | so very short gaps teach the system
00:04:11.140 | to expect and want short gaps,
00:04:14.540 | makes it very hard to pursue things that take longer.
00:04:17.900 | So when we say it's the short,
00:04:20.580 | or in this case, hyper short distance
00:04:23.380 | or time between the stimulus and the dopamine,
00:04:26.220 | what we're really talking about,
00:04:27.440 | if we were to plot this out on a board
00:04:29.780 | or on a piece of paper,
00:04:30.860 | is the steepness of the rise of that peak.
00:04:33.500 | It's very, very steep.
00:04:34.940 | The peak in dopamine is coming up very fast
00:04:37.680 | after the desire.
00:04:40.840 | And in addition to that, and this is very important,
00:04:44.040 | the higher the peak in dopamine
00:04:45.900 | and the faster the rise to that peak,
00:04:49.060 | the further below baseline the dopamine drops
00:04:52.520 | after the drug wears off.
00:04:54.840 | Okay, so in the case of cocaine,
00:04:56.140 | it's a very fast and very large rise in dopamine
00:04:59.720 | followed by a steep drop
00:05:03.120 | and very deep trough in dopamine below baseline.
00:05:06.760 | You say, okay, so there's pleasure,
00:05:09.440 | then there's lack of pleasure.
00:05:11.240 | Ah, but it's worse than that
00:05:13.640 | because it's not just lack of pleasure.
00:05:16.020 | If you recall what we talked about a little bit earlier,
00:05:18.360 | that drop below baseline triggers the desire
00:05:22.620 | and the pursuit for what?
00:05:24.560 | For more.
00:05:26.000 | And so this sets in motion a vicious loop
00:05:28.260 | where people start pursuing peaks in dopamine
00:05:30.940 | that can come very fast without much effort.
00:05:33.760 | And that's one of the ways
00:05:35.340 | in which addictions start to take hold.
00:05:38.240 | Now, there's a simple way to think about this
00:05:40.440 | and to remember if you want to avoid this whole thing.
00:05:43.240 | I mean, the first one is obvious.
00:05:44.720 | Don't do cocaine, don't try it, don't use it.
00:05:46.640 | Certainly don't get addicted to it.
00:05:48.920 | Those are all sort of one in the same, frankly.
00:05:50.320 | I don't know many people that,
00:05:52.480 | despite opinions to the contrary,
00:05:55.040 | that use cocaine recreationally,
00:05:57.220 | that don't at some point run into either a financial,
00:05:59.760 | psychological, physical, or some other problem.
00:06:03.480 | The other thing that's absolutely critical to keep in mind,
00:06:05.840 | and this was discussed in my colleague,
00:06:07.900 | Dr. Anna Lemke's book, "Dopamine Nation,"
00:06:10.560 | and on this podcast.
00:06:11.640 | Excellent book, by the way.
00:06:12.600 | I highly recommend it if you haven't read it already.
00:06:14.680 | It's a fascinating exploration into dopamine
00:06:17.860 | as it relates to addiction,
00:06:19.040 | not just drug addiction, but other types of addiction.
00:06:21.760 | Again, the name of that book is "Dopamine Nation."
00:06:23.440 | We'll provide a link to it in the show note captions.
00:06:26.000 | The other thing that happens
00:06:28.460 | after those big, fast increases in dopamine
00:06:32.120 | caused by things like cocaine
00:06:33.920 | is afterwards, when it quickly drops below baseline,
00:06:38.140 | it takes a much longer time
00:06:41.240 | to get back to the original baseline
00:06:43.960 | than it did prior to using the drug.
00:06:46.680 | And worse still is that the peaks in dopamine
00:06:50.920 | that are created from more consumption of cocaine
00:06:54.760 | leads to progressively lower peaks
00:06:57.600 | and deeper troughs below baseline.
00:07:01.420 | So the whole system is shifting away from pleasure
00:07:03.800 | and more to pain and the desire for pursuit of the drug.
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