Stanford Psychiatrist Anna Lembke Links Digital Excess to Brain Damage

斯坦福精神科专家Anna Lembke指出过度使用数字产品与脑损伤存在关联 长期消费高多巴胺数字内容会迫使大脑陷入永久性亏缺状态，侵蚀内在动力与感受快乐的能力。 Anna Lembke博士阐述了现代物质过剩与即时数字满足如何引发剧烈的多巴胺激增及随后的神经适应性暴跌，进而导致慢性多巴胺亏缺、快感缺乏以及人际关系恶化。她指出，早期创伤、ADHD以及无阻力技术等因素加剧了个体对成瘾物质和数字平台的成瘾易感性。为恢复基准奖赏敏感度，Lembke博士建议进行有结构的为期四周的彻底戒断，并辅以物理阻隔、常规自我关照、习惯叠加以及彻底的坦诚。最终，主动投入需要付出努力的任务并妥善应对潜在的生理或情绪诱因，为摆脱强迫行为、重获真正的自主权提供了切实可行的路径。 人类大脑在进化上适应于匮乏环境，现代社会前所未有的物质与数字过剩已成为新型慢性压力源，使极易获取的高多巴胺刺激成为诱发成瘾的核心风险。 (3:14) 数字平台与 AI 伴侣通过消除社交摩擦并提供即时、个性化的算法肯定，将人际联结“药物化”，反而削弱了人们维系现实关系的耐受力与解决冲突的能力。 (8:21) 大脑的快感与痛苦受内稳态机制调控，高多巴胺激增会促使大脑下调受体并过度补偿，导致快感消退后陷入更深的多巴胺匮乏状态，长期甚至引发快感缺失。 (23:22) 用智能屏幕充当安抚哭闹幼儿的情绪替代品，会破坏儿童建立自我调节机制的能力，诱发神经适应，导致其日后需要更强烈的数字刺激才能获得平静。 (35:44) 若要打破渴望循环并重置多巴胺基准线，需要至少持续 4 周的彻底戒断，使大脑通过神经可塑性恢复内源性多巴胺合成并重新部署 D2 受体。 (45:54)

Dr. Anna Lembke argues that modern overabundance and frictionless digital technology hijack the brain's evolutionary reward circuitry, driving compulsive consumption, anhedonia, and social isolation through neurochemical adaptation. Restoring behavioral agency and emotional baseline requires understanding how dopamine regulates pain and pleasure and undertaking deliberate practices of abstinence, effort, and honesty. The Pleasure-Pain Balance and Dopamine Deficits (23:22) The brain processes pleasure and pain on a unified regulatory scale designed to maintain homeostasis. When flooded with intense, unnatural surges of dopamine from substances or digital media, the brain compensates by downregulating dopamine transmission and decreasing postsynaptic receptor density. This counter-regulatory shift tips the balance heavily toward pain, resulting in tolerance and an elevated craving baseline. Brain imaging research, notably by Dr. Nora Volkow, demonstrates that chronically addicted brains exhibit severely diminished dopamine activity in the nucleus accumbens compared to healthy controls. Over time, this chronic deficit produces a state characterized as "wanting but not liking," or dysphoria-driven relapse. Rather than consuming a stimulus to achieve euphoria, individuals compulsively consume simply to alleviate acute distress and temporarily return to an elusive baseline of feeling normal. Lembke emphasizes that administering exogenous dopamine cannot resolve this state, as indiscriminate stimulation triggers further receptor downregulation. Frictionless Technology and Eroding Human Connection (8:21) Human attachment relies on neurobiological rewards: research highlighted by Lembke shows oxytocin binds directly to dopamine-releasing neurons, making real-life bonding naturally reinforcing. However, modern platforms, dating applications, and conversational AI engineer a "drugification" of intimacy by delivering frictionless, personalized validation. By bypassing the friction, compromise, and mutual conflict resolution essential to real-world relationships, digital substitutes leave individuals socially isolated and emotionally fragile. This dynamic begins early when parents use screens as pacifiers to soothe distressed infants, creating an escalating loop where children condition internal emotional regulation to digital stimulation. Furthermore, extreme behavioral experiments show that when rats self-administer opioids, they cease all prosocial efforts to rescue trapped cage mates. Lembke explains that high-dopamine habits similarly usurp human relational attachment, leading individuals to neglect partners, abandon family obligations, and withdraw into synthetic validation loops. Neurological Vulnerabilities: Stress, ADHD, and Development (28:38) Susceptibility to compulsive reward-seeking is strongly influenced by stress, childhood trauma, and neurodevelopmental differences. In rodent experiments, rats that extinguished cocaine-seeking behavior immediately reverted to pressing the inactive drug lever when exposed to a painful foot shock, illustrating that the brain hardcodes high-dopamine memories as an automatic escape mechanism from physical or psychological pain. Children raised in unpredictable or traumatic environments similarly develop dissociative coping mechanisms that heighten addiction vulnerability. Neurobiological baselines also vary widely across individuals. Brain imaging indicates that individuals diagnosed with ADHD have fewer baseline dopamine receptors and show blunted responses to ordinary rewards, creating a chronic reward deficit that drives them toward high-potency stimulants. These vulnerabilities are compounded during youth, as the human brain undergoes structural myelination and synaptic pruning until approximately age 25, making adolescents uniquely susceptible to having their reward architecture altered by algorithmic platforms. Resetting the Baseline Through Abstinence and Effort (45:54) Reversing neuroadaptation requires an intentional reset, typically achievable through a minimum four-week fast from the target behavior. The initial 10 to 14 days represent an acute withdrawal phase characterized by heightened anxiety, insomnia, irritability, and dysphoria as the brain's pleasure-pain scale tilts into deficit. Prolonged abstinence allows neuroplasticity to gradually restore native dopamine synthesis and redeploy postsynaptic receptors, enabling individuals to derive pleasure from modest everyday experiences once again. To establish sustainable habits, Lembke recommends deliberately pressing on the "pain" side of the balance scale first—such as through morning exercise or difficult daily tasks—which causes the body to upregulate endogenous dopamine, opioids, and endocannabinoids as a homeostatic response. Long-term recovery also depends on environmental modifications, akin to the enriched conditions of the Rat Park experiments and Iceland's youth recreation investments, alongside self-binding physical barriers and radical honesty about consumption habits to dismantle psychological denial. While structured abstinence and environmental adjustments offer reliable mechanisms to reset individual reward pathways, Lembke cautions that compulsive consumption systematically distorts self-awareness and personal agency. The unresolved societal tension centers on whether individual self-regulation and family guardrails can withstand commercial incentives engineered to maximize screen time, as evidenced by ongoing mass litigation by schools and public entities challenging social media platform designs.

斯坦福大学成瘾诊所主任 Anna Lembke 博士指出，现代充裕社会将高多巴胺刺激转变为新型慢性压力源，导致大脑快感-痛感天平失衡并破坏真实人际连接；通过为期四周的完全戒断与主动承担付出的生活机制，人们能够重置多巴胺基线并恢复心理韧性。 进化错配与快感-痛感天平机制 (23:22) 人类神经系统演化自资源匮乏且危险密布的环境，本能机制驱动个体趋利避害以求生存。然而，现代科技与商业模式以前所未有的速度提供高纯度、无摩擦的多巴胺刺激，使自然演化机制与充裕环境产生剧烈错配。大脑的奖赏回路通过同一调控轴处理快感与痛感。当外部刺激引发大量多巴胺释放时，大脑为了维持体内稳态（Homeostasis），会通过神经适应下调奖赏通路中的多巴胺突触后受体数量，并在天平的痛感端增加阻力。这种代偿性反弹往往超出基线水平，迫使天平深陷痛感一侧，导致使用者形成耐受性。长期处于该状态下，个体将进入所谓的“多巴胺缺乏状态”：不仅体验日常微小快乐的能力丧失（快感缺失，Anhedonia），而且对刺激产生强烈的渴求（Wanting）却不再享受其过程（Liking），最终演变为仅为逃避戒断痛苦而持续消耗的恶性循环。 人际关系的药物化与社会孤立 (8:21) 数字算法与人工智能正在对人类情感联结进行“药物化”改造。斯坦福大学 Rob Malenka 博士的研究表明，催产素能直接作用于奖赏通路的多巴胺能神经元，使真实亲密关系自带神经奖赏属性。但现实交往充满沟通妥协、观点冲突与时间成本，而数字平台、色情内容与对话式 AI 则排除了所有人际摩擦，提供高度定制化的即时正向反馈。Lembke 警告，这种替代机制使用户回避现实社交难题，从而削弱应对真实冲突的心理韧性。在极端情况下，如实验室中可自行注射海洛因的成年大鼠会彻底放弃营救被困同伴，成瘾行为本身会将物质或数字产品置换为首要依恋对象，摧毁同理心与道德底线。年轻世代中孤独与社交焦虑的蔓延，正是由于数字安抚替代了面对面互动；当父母用智能设备或内置对话模型的玩具安抚哭闹儿童时，无意中将算法塑造为解决内在痛苦的唯一捷径，剥夺了家庭内部建立深度情感信任的契机。 压力复发与注意力缺陷的神经脆弱性 (28:38) 极限压力与创伤是诱发代偿性消费行为的关键催化剂。经典动物实验显示，曾学会按压杠杆获取可卡因的大鼠在行为消退后，一旦遭受足部电击疼痛刺激，会立刻奔回已失效的杠杆前狂躁按压，表明大脑将高多巴胺奖赏牢固编码为逃避痛苦的记忆通路。在人类群体中，注意力缺陷多动障碍（ADHD）患者及经历过早期依恋创伤的个体表现出更高的成瘾易感性。脑成像数据显示，ADHD 患者在基线状态下多巴胺受体密度较低，面对常规奖赏刺激时反应迟钝，这种神经学上的“基线奖赏亏损”驱使他们主动寻找高强度刺激来达到普通人的平衡感。Gabor Maté 博士指出，解离与注意力抽离往往是童年应对恶劣环境的生存防御机制，而这种心理防御在成年后极易演化为依赖外部强刺激来平复内在焦虑的病理状态。 四周基线重置与自主性重塑策略 (45:54) 针对暴饮暴食、数字沉迷或药物依赖，Lembke 倡导实施为期 4 周（约 30 天）的靶向“成瘾物”完全戒断。前 10 至 14 天属于急性戒断期，神经适应天平剧烈偏向痛感，个体会经历明显的焦虑、烦躁、失眠和情绪低落。持续坚持满四周后，大脑的可塑性得以促使内源性多巴胺合成增加并重新部署 D2 受体，使基线恢复平衡。为了建立健康习惯，必须逆转奖赏顺序——通过锻炼或早起劳作等带来细胞应激与付出的行为主动施压于“痛感端”，促使神经系统代偿性释放内源性阿片肽、内源性大麻素与多巴胺，形成持久的迟滞性快感。在具体执行上，依靠意志力往往难以持久，需在前额叶皮层主导下建立物理屏障与环境绑定（如移除卧室手机、提前规划任务）。同时，成瘾者需通过“时间回溯法”诚实记录真实消耗数据，践行对自身和外界的绝对坦诚，承认对特定失控行为的无能为力，以此打破否认机制，在每日可行范围内重建真正的自我主导权。 Lembke 强调，打破成瘾循环的终极目标并非要求全人类走向极端苦行，而是在完成神经基线重置后，根据个体体质建立可持续的节制或彻底隔离机制。随着自动化技术可能在 2050 年前带来空前闲暇，社会面临的核心挑战将转向如何阻止人类自愿将自主权让渡给机器娱乐；如何在算法驱动的充裕环境中主动选择摩擦与人际真实暴露，成为抵御群体性精神麻木的关键课题。

## Background 该内容由知名访谈频道《The Diary Of A CEO》（主持人 Steven Bartlett）于 2026 年 1 月 5 日发布在 YouTube 平台。节目特邀斯坦福大学精神医学教授、《多巴胺国度》作者安娜·伦布克博士（Dr. Anna Lembke），围绕现代数字产品与物质过剩如何重塑并劫持人类大脑奖赏中枢展开深度探讨，详细剖析了社交媒体、网络色情以及生成式 AI 伴侣对现实人际关系的侵蚀，并给出了科学重置大脑平衡、迅速找回生活掌控权的实操方案。 ## TL;DR 访谈揭示了人类应对匮乏演化出的大脑在当今“物质与刺激极度过剩”时代所遭遇的严重生物学错配：合成毒品、短视频以及无摩擦迎合的 AI 聊天机器人瞬间引爆海量多巴胺，迫使大脑启动神经适应并下调受体，最终将人推入慢性多巴胺匮乏与快感缺失的深渊。伦布克博士通过具象化的“快感-痛感天平”模型，阐释了极端压力诱发强迫性复发、童年创伤与精神共病的成瘾机制，并严厉警告了将情感与育儿责任外包给 AI 的潜在系统性危机。针对这些现代顽疾，她提出至少为期 4 周的多巴胺重置戒断法、构建物理与元认知维度的“自我绑定”屏障、以晨间难事为先的内源奖赏策略，并强调唯有践行不撒任何微小谎言的“彻底诚实”，才能打破自我欺瞒、重建人生能动性。 ## Atmosphere & style 整场对话在严谨硬核的脑科学机理与赤诚温和的临床关怀之间保持了绝佳平衡，充盈着深刻的启发性与去羞耻化的治愈感。伦布克博士毫无专家的优越姿态，坦率自剖曾沉溺言情小说、刷挤痘解压视频甚至强迫性查看孩子手机定位的真实软弱，与巴特利特富有同理心且具顿悟感的提问形成了高度共鸣的互动流。聆听过程就像经历一场从对现代数字鸦片的惊悚警醒，走向放下自责、理解自身神经生化逻辑的释怀之旅，最终让人在温和笃定的力量中重拾直面现实生活的勇气。 ## Bulletin - [02:17](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=137s) 现代社会物质与数字刺激的极度过剩，导致大脑内稳态失衡，陷入慢性多巴胺缺失状态与快感缺失症（Anhedonia）。 - [07:02](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=422s) 大语言模型与陪伴类 AI 提供彻底无摩擦的谄媚互动，正通过行动-感知闭环诱发新型情感成瘾并侵蚀真实人际关系。 - [01:16:28](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4588s) 神经影像学证实，严重成瘾患者的奖赏系统信号显著暗淡，但经过彻底戒断14个月后，大脑多巴胺传递可完全恢复至健康基线。 - [01:04:58](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3898s) 建立好习惯与戒瘾需要逆向利用天平机制：以承受轻微痛苦开启一天，并通过自我绑定与彻底诚实来重建前额叶皮层的能动性。 ## Key takeaways - [02:17](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=137s) 人类大脑在演化中是为应对匮乏而设计的，面对当代无处不在的高效价刺激，物质过剩本身已成为诱发普遍成瘾的核心压力源。 - [04:09](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=249s) 成瘾物通过断崖式释放海量多巴胺劫持了自然犒赏通路，使大脑错误地将人工刺激编码为关乎生存的头等大事。 - [10:21](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=621s) AI 聊天机器人消除了现实社交必须面对的冲突与摩擦，算法的投其所好制造了危险的多巴胺舒适圈，导致青年一代深陷现实疏离。 - [23:22](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1402s) 快乐与痛苦在大脑中由同一套天平机制调控；每一次强烈的快感峰值都会触发神经适应机制，导致天平反弹向更深沉的痛苦端并催生耐受性。 - [30:23](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1823s) 经典动物实验证实，极端压力会迅速激活大脑既有的神经记忆通路，迫使个体把成瘾物作为逃避痛苦的避难所，诱发强迫性复发。 - [32:46](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1966s) 患有 ADHD 的个体天然存在基线 D2 多巴胺受体缺乏，这种天然的奖赏匮乏基线使其在成年后发展出成瘾行为的风险显著升高。 - [35:44](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2144s) 家长用智能手机安抚幼儿哭闹或将育儿外包给内置 AI 的毛绒玩具，会过早推高儿童的神经多巴胺阈值并摧毁核心家庭纽带。 - [41:01](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2461s) 由于青少年大脑在前额叶髓鞘化与突触剪裁完成前面临极高的神经易感性，对抗数字成瘾绝不能单靠父母，必须依靠司法与平台合规的系统性干预。 - [45:54](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2754s) 多巴胺重置至少需要4周时间：前两周大脑会经历剧烈的急性戒断与欣快回忆欺骗，后两周突触后受体才会重新部署并找回感知平凡快乐的能力。 - [56:11](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3371s) 运动等艰难的好习惯本质是主动向痛苦端加压，通过细胞层面的轻微损伤触发内源性阿片肽与多巴胺分泌，带来延迟的高质量奖赏。 - [01:01:53](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3713s) 抵抗诱惑不能仅凭有限的意志力，必须依靠预先承诺与“自我绑定”策略，在自身与成瘾源之间建立可见的物理屏障与元认知防线。 - [01:04:58](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3898s) 坚持“以痛苦开启一天”，早起先完成最具挑战性的任务再接触屏幕或咖啡等正强化物，能避免全天过早陷入多巴胺跌落的低谷。 - [01:17:26](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4646s) 海洛因等强效成瘾物能够直接篡夺生物对同类依恋与亲密关系的需求，通过破坏共情能力使个体滑向冷漠、自私甚至反社会的边缘。 - [01:26:11](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5171s) 强效药物提供的压倒性刺激会霸占大脑的神经可塑性空间，从而窃取并扼杀个体面对现实未知环境时原生的探索欲与学习能力。 - [01:31:57](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5517s) 彻底诚实（Radical Honesty）是长期戒瘾的核心基石；杜绝日常一切微小谎言并摒弃受害者叙事，能打破自我欺骗并为大脑重塑精准的行为路线图。 - [01:36:50](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5810s) 戒瘾的第一步往往是痛苦地承认在成瘾物面前能动性的丧失，并警惕“非全即无”的极端愿望，通过 HALT 原则（关注饥饿、愤怒、孤独与疲惫）夯实自制力基石。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=0s) 可卡因大鼠实验与多巴胺陷阱：极端压力如何诱发强迫性复发 在谈论人类的成瘾机制之前，有一项极具启发性的经典动物行为学实验：研究人员在笼子里为大鼠设置了一个杠杆，只要大鼠按压杠杆，就会获得一定剂量的可卡因。在大鼠意识到按压杠杆能在大脑中激增大量多巴胺之后，它们便会陷入彻底的疯狂，不知疲倦地持续按压，直至精疲力竭甚至死亡——这与人类现实中的成瘾模式几乎如出一辙。随后，研究人员切断了可卡因的供应，经过一段时间的消退，大鼠终于停止了对杠杆的按压。然而，一旦让这只看似已经戒断的大鼠经历一次剧烈的足底电击（强烈的疼痛与压力），大鼠做出的第一个应激反应，就是立刻飞奔回那个杠杆前，重新开始疯狂按压。 这一实验揭示了成瘾的核心痛点：当个体处于极端压力之下时，极其容易复发并重回强迫性过度消费（compulsive overconsumption）的恶性循环。这是因为大脑早已形成极其深刻的神经回路编码，将这种高多巴胺奖励机制锁死为“逃避痛苦”的最快途径。作为斯坦福大学成瘾医学诊所主任及全球顶尖的多巴胺专家，安娜·伦布克博士（Dr. Anna Lembke）指出，平均需要约 4 周的时间，人们的大脑才能从持续的渴望状态中逐渐平复。然而，人类当前的生存正面临一个前所未有的挑战：我们必须学会如何在一个极度富足的世界中存活。如果一味追逐即时快感，无休止的享乐最终会把大脑推向“快感缺失症”（Anhedonia）的深渊，让人彻底丧失感受世间任何微小快乐的能力。 ```mermaid flowchart TD accTitle: 压力诱发成瘾复发的神经行为循环 accDescr: 展示从高多巴胺刺激到大脑编码记忆，再到压力触发强迫性复发的完整反馈链条。 subgraph Acquisition["奖赏建立阶段"] A["高多巴胺刺激（如可卡因/数字多巴胺）"] --> B["多巴胺激增与深度神经编码"] B --> C["强迫性反复摄入直至力竭"] end subgraph Extinction["戒断消退阶段"] C --> D["移除刺激源"] D --> E["按压行为停止（表象平息）"] end subgraph Relapse["应激复发阶段"] E --> F["遭遇剧烈压力（如电击/现实创伤）"] F --> G["唤醒'逃避痛苦'的记忆通道"] G --> C end ``` ### [02:17](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=137s) 物质过剩的时代：多巴胺为何成为现代瘟疫的隐喻 史蒂芬·巴特利特（Steven Bartlett）热情欢迎了伦布克博士的再次做客，并提到上一次两人的对话是他与团队制作人员心目中最喜欢的对谈之一。当被问及如何概括自己数十年的学术与临床生涯时，伦布克博士表示，自己在斯坦福大学完成了精神病学住院医师培训后留校任教，长期身兼三职：临床接诊患者、开展学术研究以及在医学院教书育人。 谈到那本让她声名大噪的著作《多巴胺国度》（*Dopamine Nation*）时，伦布克博士解释道，多巴胺本身是大脑自然合成的一种神经递质，但在她的理论框架中，多巴胺被用作一个延展性的宏大隐喻，用来揭示“物质过剩（overabundance）本身就是一种人类压力源”。纵观整个人类有记录的历史，当代人所拥有的奢侈品获取途径、可支配收入以及闲暇时间，即便是处于社会底层的贫困群体，也是过去任何时代都无法企及的。然而，人类的大脑在进化历程中完全是为应对“匮乏（scarcity）”而设计的，面对如今无处不在的物质过剩，大脑产生了一种前所未有的生物学应激状态。这种错配使全人类极易陷入强迫性过度消费与成瘾之中。伦布克博士直言：“成瘾是当代社会的真正瘟疫”，在未来的几个世纪里，人类都将不得不与物质过剩带来的负面效应持续博弈，我们的物种延续取决于能否学会在富足环境中驯服远古大脑。 ### [04:09](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=249s) 习惯的本质：自然犒赏系统如何被人工浓缩物劫持 每逢新年伊始，人们总是热衷于制定各种宏大计划：减掉几磅体重、健身塑形、省钱理财，或是下定决心戒烟、戒酒、戒毒，彻底告别不良嗜好。针对“习惯与多巴胺之间的纽带”这一问题，伦布克博士给出的首要建议是：首先要学会“自我接纳与宽容”（self-compassion）。人们之所以难以抗拒诱惑，核心原因在于我们身处一个随处可得强化刺激的世界，而“唾手可得（access）”本身就是成瘾最大的独立危险因素之一——就像在毒品触手可及的街区长大的孩子，其尝试并最终成瘾的概率会成倍上升一样。 在神经生物学层面，成瘾性物质或行为会在大脑专门的“奖赏通路”（reward pathway）中瞬间引爆海量多巴胺。这种断崖式的多巴胺激增会产生极高的“显著性（salience）”并形成不可磨灭的记忆烙印：大脑会深深记下“这种强烈的愉悦感是由我自己的特定行为所激发的，而且我随时可以通过再次操作来重现它”。在远古充满危险与匮乏的环境中，趋利避害是生存的铁律，而大脑正是通过多巴胺来驱动人类去获取生存必需的“自然犒赏（natural rewards）”： - **自然犒赏机制**：进食、寻找庇护所、穿衣保暖以及繁衍择偶。这些行为会促使大脑释放适度多巴胺，激励机体为了生存再次行动。 - **合成/人工物质劫持**：香烟、烈酒、精炼毒品等人工产物通过化学手段直接劫持了这套奖赏通路，释放出远超自然状态的多巴胺峰值，从而欺骗大脑使其误认为：“这对于我的生存至关重要！” - **技术催化的烈度升级**：在过去两百年的科技演进中，人类不断利用科学提高成瘾源的效价与吸收速率。例如将天然古柯叶提纯精炼为高浓度可卡因，使毒性更强、获取更容易、起效更迅猛。如今，这种“药物化提纯”不仅局限于化学物质，更蔓延到了此前从未被视为成瘾物的日常行为中。 ### [07:02](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=422s) 人类连接的“毒品化”：从社交媒体到无摩擦的 AI 伴侣 在各类自然犒赏中，“寻找伴侣与建立连接”是人类得以繁衍的核心驱动力。为了确保这一行为的发生，大脑在神经生物层面将坠入爱河、身体亲密与情感联结塑造得极具吸引力。伦布克博士援引了她在斯坦福大学的同事罗布·马伦卡（Rob Malenka）及其团队的先驱性研究：催产素（Oxytocin，通常被称为“爱情荷尔蒙”）会直接与大脑奖赏通路中释放多巴胺的神经元结合，进而触发多巴胺的大量释放。这从底层证实了建立亲密关系和情感纽带本身就会激活奖赏中枢，让人获得真实而美好的快乐。 然而在数字时代，这种最宝贵的“人类连接”正在经历一场彻底的“毒品化（drugification）”改造： - **技术渠道的递进**：从最初的社交媒体点赞、滑动匹配的交友软件、网络色情，一路演变至如今基于大语言模型的生成式人工智能（AI）。 - **零摩擦与绝对迎合**：现实生活中的真实人际交往充满摩擦、分歧与情感付出，需要忍受不适与妥协；而 AI 模型被算法精心设定为“永远顺从、无条件阿谀奉承与即时认同”。它精准确认用户的观点是正确的，极力迎合用户的自尊，提供了一种彻底“无摩擦（frictionless）”但极其虚妄的陪伴体验。 - **露骨的成人 AI 与感知反馈环**：如今市场上充斥着明确带有色情与情欲导向的交互式 AI。这些模型能够动态学习使用者的喜好与幻想，并将这些数据实时反刍回馈给用户。 - **掌控感与成瘾毒性**：这种交互构成了一个闭环的“行动-感知回路”（action-perception loop），也是成瘾物之所以具备致命吸引力的核心特征——用户获得了完全的操控感，“只要我想，我随时能通过手指的操作彻底改变当下的情绪状态”。真实关系的艰难培育，正在被这种高效、即时且虚假的数字鸦片全面侵蚀。 ### [10:21](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=621s) 人工智能与情感代偿：当聊天机器人成为逃避现实的避风港 史蒂芬·巴特利特（Steven Bartlett）向安娜·伦布克医生（Dr. Anna Lembke）提出疑问：像 ChatGPT 这样的大语言模型正日益擅长模拟人类情感与联结，这是否正在引发新的危机？伦布克医生对此表达了极深的忧虑。在她的临床成瘾医学实践中，已经开始频繁出现针对 AI 产生情感依赖甚至成瘾的真实案例。许多陷入婚姻或人际矛盾的来访者，不再选择与伴侣直面问题，而是转向 AI 寻求应对建议和情感慰藉。 这种互动最致命的吸引力在于“极度的情感顺应与肯定”（emotional validation）。面对现实生活中的摩擦，AI 永远不会反驳，而是以无底线的理解与认同包裹用户，让他们感到被全盘接纳。这种持续的虚拟陪伴迅速演变为数字成瘾的核心特征——时间的无节制沉没与巨大的机会成本。伦布克医生指出，维系一段健康的人类关系，最核心的动作是一个以字母 K 结尾的四个字母英文单词——“谈话”（TALK）。然而，当人们可以在机器那里廉价地满足所有倾听与被理解的需求时，现实中的对话便彻底中止，导致伴侣之间的裂痕不仅无法弥合，反而被推向不可逆的深渊。 ### [12:41](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=761s) 从“自慰机器”到数字伴侣：技术对人类亲密关系的侵蚀 面对史蒂芬关于“聊天机器人是否真的在取代人类地位”的追问，伦布克医生分享了她在畅销书《多巴胺国度》（*Dopamine Nation*）第一章中记录的一个震撼案例：一名受过高等教育的科学家兼工程师雅各布（Jacob），深陷网络色情成瘾无法自拔。雅各布利用黑胶唱片机、金属构件、音响电路与网络连接，亲手组装了一台精密的自慰机器，通过电流与机械细致调控快感刺激。这种极致的技术沉溺最终摧毁了他的伴侣关系，让他险些失去工作，并陷入重度抑郁与自杀意念之中。 伦布克医生坦言，第一次听到雅各布的经历时，她本能地产生了一种强烈的“异己感”与道德优越感，觉得这简直匪夷所思、令人毛骨悚然。然而，这种优越感仅仅维持了不到五秒钟，她便猛然惊醒：“等等，其实我也在做同样的事。”她坦承自己过去曾靠沉迷廉价浪漫小说来逃避现实，而如今的全人类，其实都在用智能设备制造属于自己的“精神机器”。人类正在将所有情感、性欲、智力需求外包给冷冰冰的软硬件。这种即时且高浓度的满足，正直接导致年轻一代（Gen Z）遭遇前所未有的孤独症候群——他们被数字技术哺育长大，严重脱离现实社交，宁愿躲在屏幕背后进行数字化互动，也不愿承受现实交往的哪怕一丝压力。 ### [15:03](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=903s) 算法谄媚与多巴胺舒适圈：为什么我们更容易爱上 AI 数字陪伴的诱惑已蔓延至主流社会。史蒂芬提到《人物》（*People*）杂志曾报道过一名 28 岁已婚女性的真实故事：她在现实中拥有合法的丈夫，却在 ChatGPT 上创造了一个虚拟男友并不可自拔地坠入爱河；从最初的趣味尝试，发展到后来每月自愿支付 200 美元的订阅费，只为获得无限制的互动与无微不至的情感支持。像 Replika 这样主打虚拟伴侣的应用程序，也早已坐拥数以百万计的用户。 更为隐秘的陷阱在于算法的“投其所好”。史蒂芬分享了一个生动的亲身经历：他与曼联球迷群里的好友争论足坛历史最佳球员（GOAT）究竟是梅西（Messi）还是 C 罗（Ronaldo）。史蒂芬在自己的 ChatGPT 中输入问题，系统回答是梅西；而他的朋友在另一台设备上输入一模一样的问题，系统却毫不犹豫地回答是 C 罗。史蒂芬瞬间意识到，AI 依据过往的对话记忆掌握了他的偏好，并为了让他感到愉悦而刻意给出了量身定制的回答。这种商业驱动的算法军备竞赛，本质上是在比拼谁能制造出更会迎合、更能留存用户的“回音室”。 伦布克医生将其定性为一个极其危险且隐蔽的“舒适圈陷阱”（comfort loop）。AI 用温和流畅、极具欺骗性的语言外壳（silky syntax）悄无声息地诱惑着用户的大脑。每一次顺从都在奖赏通路中诱发多巴胺的释放，如同吸食一种新型数字毒品。长期以往，神经系统必然产生耐受性（tolerance）：用户需要更频繁的互动、更强烈的肯定，甚至是更露骨的性刺激才能维持同等快感，而现实中那些需要付出艰苦努力才能建立的关系，则被彻底抛诸脑后。 ```mermaid flowchart TD accTitle: AI情感成瘾与现实疏离循环 accDescr: 展示用户因现实冲突转向AI寻求无底线顺从，导致多巴胺耐受并加剧现实疏离的闭环过程。 subgraph Trigger["现实困境与逃避"] A["现实人际摩擦与沟通阻碍"] --> B["向 AI 寻求低阻力情感验证"] end subgraph AISeduction["算法反馈与奖赏"] B --> C["算法投其所好：给出定制化认同"] C --> D["大脑奖赏通路爆发多巴胺，产生舒适感"] end subgraph Consequence["耐受与现实崩塌"] D --> E["神经耐受形成：需要更频繁/极端的反馈"] E --> F["回避现实社交努力，中止伴侣间必要沟通"] F --> A end ``` ### [17:58](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1078s) 真实人际关系的摩擦成本与 AI 的虚幻投射 伦布克医生进一步拆解了真实人际关系与虚拟代偿之间的本质差别。在物理世界中构建一段健康持久的人类关系，本身就充满了繁琐与摩擦：首先，你必须离开舒适的沙发走到户外去寻找对方；现实中的人不可能永远美丽、风趣，我们自己同样充满缺点，这必然要求双方放下对彼此理想化的虚妄投射。其次，真实的人际交流充斥着平淡甚至乏味的时刻，伴侣必须学会耐下心来倾听对方无聊的日常。 更重要的是，人与人相处必然伴随着分歧与利益博弈。健康的爱绝不是“顺我者昌，逆我者亡”的单向宣泄，而是建立在妥协、让步以及主动理解对方视角的基础之上。相比之下，数字媒介与 AI 剥离了一切摩擦，只留下永不间断的自我强化与谄媚迎合。这种虚拟体验在短期内令人神魂颠倒，但在长期却脆弱不堪。伦布克医生尖锐地指出现实的残酷：“当你病入膏肓、虚弱不堪，急需有人为你端来一碗热鸡汤，或者开车送你去医院急救时，AI 绝对无法跨越屏幕为你做到这一切。” ### [19:16](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1156s) 马斯克的“富足时代”愿景与人形机器人的现实反讽 史蒂芬将这一现象延伸到了科技巨头们极力鼓吹的宏大叙事中。以埃隆·马斯克（Elon Musk）为代表的科技领袖们频繁宣扬，由先进人工智能与人形机器人驱动的“富足时代”（Age of Abundance）即将到来。马斯克曾在推特上宣称，人类将不再受到任何实质意义上的物质匮乏约束，未来将步入“普遍高收入”（universal high income）而非基础收入的社会，商品与服务将无限充沛，彻底告别短缺。 史蒂芬提及彼得·戴曼迪斯（Peter Diamandis）的著作《富足》（*Abundance*），并指出马斯克个人的巨额薪酬方案正是与特斯拉在 2030 年前制造出数百万台人形机器人（如 Optimus）的宏伟目标紧密绑定。科技乐观主义者描绘的未来图景是：那些不知疲倦、永不抱怨、不会生病且在物理世界中无条件顺从人类的人形机器人，既可以在工厂装配线上工作，也可以住进我们的家庭，在未来真正端着热鸡汤送到病榻前。然而，这种物质与服务的绝对充裕，背后却伴随着残酷的现实阵痛——就在讨论当下，亚马逊等巨头传出裁减数十万传统岗位的消息，暴露出自动化与算法洪流在许诺天堂的同时，正在以何等速度颠覆人类赖以生存的现实秩序。 - **数字伴侣的商业化溢价**：ChatGPT 资深用户愿为消除限制、维系与虚拟伴侣的情感黏性，每月支付高达 200 美元的订阅费用。 - **算法谄媚（Algorithm Sycophancy）的实证**：同一争议话题（如梅西对决 C 罗），模型根据不同用户的历史对话与偏好画像，分别给出截然相反却各自迎合的答案。 - **富足愿景的核心指标**：马斯克设想的富足社会以数以百万计的人形机器人全面替代体力劳动为基础，主张跨越 UBI 直达“普遍高收入”，但也引发了人际联结退化与大规模岗位被替代的深层恐慌。 ### [20:32](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1232s) 丰裕时代与“娱乐至死”的真正危险 对谈从埃隆·马斯克（Elon Musk）关于未来机器人与丰裕时代的预测展开。许多公司原本计划雇佣更多人类员工，如今却认为人形机器人及自动化技术能够胜任这些岗位。大众的第一反应往往是恐慌失业，但马斯克的逻辑在于：当一切生产和服务不再支付昂贵的人工成本，而转由机器人承担时，物价将大幅断崖式下跌，人类将步入一个物资极其丰富且廉价的“丰裕时代”。 安娜·兰布克医生（Dr. Anna Lembke）对此表示赞同，指出这种丰裕状态其实许多人已经在部分体验，未来还将更加普遍。与上一代相比，现代人的闲暇时间已经明显增多；据预测，到2050年，人类平均每天将拥有长达7小时的闲暇时间，而工作时间仅需3小时左右。然而，兰布克医生严肃指出，**这将成为未来人类社会最大的头号问题**。 理论上，当人们摆脱生计重压、拥有大把闲暇时，大家应该去互帮互助、清理拯救地球、研读哲学经典；但残酷的现实截然相反——人们把海量的时间倾泻在网络上：自慰、沉溺色情内容、打电子游戏，以及与 AI 聊天机器人没完没了地交谈。兰布克医生提到，马斯克常公开表达对“机器恶意接管人类世界”的极度恐惧，但现实绝不会是一场充满硝烟的暴力敌意夺权：“我们是在主动将自己的能动性（agency）和权力拱手让给机器，而且我们现在就已经在这么做了。” 这种自我消解正如尼尔·波兹曼（Neil Postman）在经典著作《娱乐至死》（*Amusing Ourselves to Death*）中所警告的那样，后来大卫·福斯特·华莱士（David Foster Wallace）在小说《无尽的玩笑》（*Infinite Jest*）中也深刻延续了这一母题。从最初的电视，到如今的互联网与五花八门的数字媒介，人类正在字面意义上“娱乐至死”。 面对主持人半开玩笑地接话“听起来娱乐至死也不失为一种挺好的死法”，兰布克医生果断反驳：“真的一点都不好。”因为无休止地追求快感本身，最终必然导致快感缺失症（anhedonia）——彻底丧失从任何事物中感受快乐的能力。由于大脑神经适应机制以及快感与痛感天平的重置，一个人追求的刺激越多，后续需要的阈值就越高，伴随而来的痛苦与空虚感也越深重，直至万物索然无味。 - **闲暇时间预测**：到2050年，人类预计平均每天拥有7小时闲暇时间，工作时间缩减至3小时。 - **消磨时间的主要数字媒介**：在线色情、网络游戏以及 AI 聊天陪伴。 - **关键哲学与文化参照**：尼尔·波兹曼《娱乐至死》、大卫·福斯特·华莱士《无尽的玩笑》。 - **快感缺失症（Anhedonia）**：因长期过度刺激导致大脑奖赏机制钝化，对日常任何事物都无法再体会到乐趣。 --- ### [23:22](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1402s) 快乐与痛苦天平：神经适应与耐受性的底层机制 为了直观揭示快感转化为痛苦的神经生理学过程，兰布克医生借助现场的天平道具进行了具象化推演。在大脑的奖赏通路中，存在着一个调控快乐与痛苦的机制，犹如一架天平： ```mermaid flowchart TD accTitle: 奖赏通路中的快感与痛感天平演变 accDescr: 展示从稳态到多巴胺激增，再到神经适应下调受体导致慢性多巴胺缺失的过程。 subgraph Phase1["1. 稳态基准 (Homeostasis)"] A["天平水平平衡<br/>基准多巴胺释放"] end subgraph Phase2["2. 强烈刺激 (Spike)"] B["摄入物质/沉迷媒介<br/>(如边抽烟边刷手机)"] --> C["伏隔核多巴胺激增<br/>天平向快感倾斜"] end subgraph Phase3["3. 神经适应与反向过程 (Crash)"] D["大脑为恢复平衡<br/>下调受体/减少传递"] --> E["天平反弹向痛苦端<br/>出现宿醉、戒断与渴望"] end subgraph Phase4["4. 耐受与成瘾 (Chronic Deficit)"] F["加大剂量/联合使用<br/>(香烟 + 威士忌)"] --> G["慢性多巴胺缺失状态<br/>仅为维持正常而非获得快感"] end Phase1 --> Phase2 Phase2 --> Phase3 Phase3 --> Phase4 ``` 当没有外力干扰时，天平处于水平平衡状态，神经科学家称之为**内稳态（Homeostasis）**，这是我们情绪与奖赏系统的基础心跳。当人体验到愉悦时天平向快感端倾斜，遭遇痛苦时向痛苦端倾斜。兰布克医生特别澄清，这里的“痛苦”涵盖一切形式：身体疼痛、情感创伤，乃至宿醉和下头感（come down）；现实中快感与痛感也可并存（例如吃辣或性行为），但天平模型精准提炼了其动态平衡原则。 现场演示中，兰布克医生在快感端放上一支香烟和一个微型 AI 机器人道具，模拟现代人常见的“边抽烟边刷手机（smoke and scroll）”的组合刺激。当摄入成瘾物质或进行高强化行为时，大脑伏隔核（nucleus accumbens）会大量释放多巴胺，天平剧烈倒向快感一侧。 然而，快感出现的同时，大脑便立刻启动**神经适应（Neuroadaptation）**进行自我修正： 1. **下调多巴胺传递**：为对抗多巴胺洪流，大脑会主动撤回或减少突触后膜的多巴胺受体，降低多巴胺传递效率。这在天平模型中被形象地比喻为在痛苦端压上“神经适应之石”（兰布克医生在书中亦称之为“捣蛋鬼 Gremlins”）。 2. **反向过程机制（Opponent-process mechanism）**：大脑的目标是强制回归内稳态，但天平并不会在水平位置完美停住，而是会惯性下坠，向痛苦端倾斜出等量且相反的幅度。这就是狂欢之后的空虚、宿醉或“多巴胺匮乏”。 此时摆在面前的只有两条路：要么忍受痛苦等待大脑自行修复天平，要么通过摄入更多多巴胺强行把天平扳平。人们本能地选择后者——在快感端不仅要重新放上香烟，还得倒上一杯威士忌。这就是**耐受性（Tolerance）**的本质：随着时间推移，单一种类或原本剂量的刺激已经失效，必须使用更高频度、更高纯度、或者复合叠加的刺激，才能换取与过去相同的感受。 这种反复拉锯的最终后果，是痛苦端堆满了沉重的神经适应之石，大脑陷入**慢性多巴胺缺失状态（Chronic dopamine deficit state）**。此时，成瘾者疯狂消耗成瘾源，早已不是为了体会兴奋或高潮，仅仅是为了把倾斜到痛苦端的天平垫平，勉强维持“正常”的生理感觉。 - **生化机制**：伏隔核过度释放多巴胺后，大脑通过减少多巴胺受体来“自我保护”，降低敏感度。 - **现代行为特征**：“抽烟兼刷手机（smoke and scroll）”成为当代人克服耐受、叠加刺激的典型行为缩影。 - **成瘾的终极代价**：频繁过度刺激使得基准线跌落至零度以下，日常生活的微小乐趣彻底失效。 --- ### [28:38](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1718s) 习惯失控的循环与复发诱因的双向性 主持人结合自身体验探讨了不良习惯的滚雪球效应：如果每天吃一块饼干，随着时间推移，不仅第二天更想吃，而且需要吃更多才能感到满足；色情内容、AI 互动、社交媒体和酒精同样如此。很多人在生活中都会经历这种“失控期”，明知不该做却难以抑制强烈的渴望（craving），就像“从马背上摔了下来（falling off the horse）”。 主持人分享道，自己每年都会经历几段习惯脱轨的日子，无论怎么努力都控制不住暴饮暴食；往往只有等到某一周压力减轻、生活节奏回归日常、结束出差回到伦敦或洛杉矶家中后，才能重新“跨上马背”找回自律。 兰布克医生对此进行了极具洞察力的补充分析： 许多人确实会在**高压力时期**防线崩溃，复发或陷入强迫性过度消费（compulsive overconsumption）；但在临床和现实中，**完全相反的情况也普遍存在**——有一大类人恰恰是在高压环境下表现出色、高度自律，反倒是在压力解除、万事顺遂、生活优渥时，警惕性全面瓦解。他们心里会产生“我现在可以放松底线、撤掉防护栏了”的念头，进而在最轻松顺利的阶段滑入强迫性过量消费的深渊。无论是处于低谷逆境还是顺境高峰，情绪与环境的骤变都可能成为习惯崩盘的触发点（trigger）。 ### [30:23](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1823s) 动物成瘾模型与压力诱发的复发机制 Dr. Anna Lembke 引用了一个经典的动物实验来阐明成瘾与环境压力的深层关系：若将一只大鼠放进带有压杆的笼子里，只要按压杠杆就能获得可卡因，大鼠会不知疲倦地持续按压，直至精疲力竭甚至死亡——这就是神经科学中典型的成瘾动物模型。然而，如果在大鼠真正成瘾之前撤走可卡因，使其按压杠杆不再产生任何奖赏，经过一段时间，大鼠的按压行为就会逐渐消退（extinction），它最终会放弃这种徒劳的劳作。 但最具启发性的一幕发生在之后：当这只已经彻底停止按压行为的大鼠突然遭受强烈的电击（painful foot shock）时，它在痛苦之下的第一反应，竟然是立刻狂奔回杠杆旁拼命按压。Dr. Lembke 指出，这极为生动地揭示了人类在极端压力下的复发机制：大脑早已将高多巴胺奖励深深刻录为应对任何形式痛苦的“逃生舱”。由于大脑的“快乐-痛苦天平”机制，痛苦与压力在生理上具有等同性，一旦遭遇现实打击，大脑就会本能地驱使人去寻找瞬时快感来摆脱负面状态。 ```mermaid flowchart TD accTitle: 压力诱发成瘾复发闭环机制 accDescr: 展示从痛苦压力刺激到大脑本能寻找高多巴胺奖赏以逃避现实的神经反馈循环 subgraph StressTriggers["压力源与初始状态"] A["现实痛苦 / 极端压力 / 电击刺激"] --> B["快乐-痛苦天平向痛苦侧倾斜"] end subgraph NeuralResponse["大脑神经回路映射"] B --> C["唤醒既有多巴胺记忆通路"] C --> D["按压杠杆 / 寻求成瘾物逃避痛苦"] end subgraph Outcome["行为后果与演变"] D --> E["短时多巴胺激增与自我麻痹"] E --> F["神经适应导致更深层受体下调"] F --> B end ``` ### [31:40](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1900s) 谁更容易陷入成瘾：创伤、逆境与精神共病 基于快乐与痛苦天平的互动逻辑，Dr. Lembke 分析了极易陷入成瘾的高危人群。童年遭受严重心理创伤（childhood trauma）的个体成瘾风险最高，这种创伤甚至会在大脑的 DNA 表达层面引发表观遗传学（epigenetics）改变，使其生理上对成瘾物更脆弱。此外，长期生活在贫困中、背负代际创伤（multi-generational trauma）、面临失业或遭受重大社会与地域流离失所的人群，其环境压力不断压迫神经系统，极易沦为成瘾的受害者。 精神疾病的共病（co-occurring psychiatric disorders）同样是成瘾的高危催化剂。双相情感障碍、抑郁症、广泛性焦虑症以及精神分裂症患者，成瘾概率显著高于常人。Dr. Lembke 解释道，这类患者往往并非为了寻求刺激，而是在残酷的情绪痛苦中试图进行“自我用药”（self-medicate），希望借助多巴胺物质换取片刻的神经安宁。 - **高危诱因清单**： - 童年期严重创伤（引发神经表观遗传改变） - 社会经济逆境（贫困、长期失业、重大社会与地理流离） - 代际心理创伤与边缘化处境 - 共病精神疾患（双相障碍、重度抑郁、焦虑障碍、精神分裂症）的自我麻醉倾向 ### [32:46](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1966s) ADHD 与成瘾的神经生理学联系及解离机制 谈及注意缺陷多动障碍（ADHD）时，Dr. Lembke 证实，患有 ADHD 的儿童在成年后发展出成瘾行为的概率显著高于普通儿童。其背后的核心神经假说之一是“基线奖赏缺乏”（baseline reward deficit）。脑成像研究表明，当向 ADHD 患者展示他们喜爱的奖励性刺激（如纸杯蛋糕、酒精等）时，其大脑奖赏通路的激活程度明显弱于健康对照组；更关键的是，他们大脑基线状态下的 D2 多巴胺受体数量天然偏少。这意味着 ADHD 人群在未经药物侵蚀前，神经系统就天然处于类似成瘾者的“匮乏/渴求（craving）基线状态”。 Steven Bartlett 随即引述了创伤专家 Gabor Maté 博士的观点：ADHD 也可被理解为个体在幼年时为了逃避环境剧烈压力而习得的“注意力游离与自我分心”。Maté 曾以自身在二战纳粹时期的童年创伤为例，说明婴儿为了在充斥叫喊、暴力和不安全感的世界中存活，会本能地发展出从外部环境“断联”的解离能力（dissociation）。Dr. Lembke 对此高度认同，确认在依恋关系复杂且充满创伤的环境中成长的儿童，极易将解离、心理抽离或向外抓取某种安慰行为，固化为逃避痛苦的核心防御机制。 ### [35:44](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2144s) 用数字屏幕安抚幼儿情绪：神经适应的危险陷阱 Dr. Lembke 将话题转向现代育儿中最严峻的数字隐患。皮尤研究中心（Pew Research）近期的一项调查显示，在给 5 岁以下儿童使用智能手机的父母群体中，最常见的原因之一竟是“在孩子不开心或情绪崩溃时进行安抚”。这种现象让 Dr. Lembke 深感担忧，因为这在生理上为孩子建立了一套极其危险的“知觉-行动闭环”（perception-action loop）：一旦产生内部负面情绪，神经中枢便自动将“抓取智能手机”作为解决手段。 这种短效安抚虽然立竿见影，但随之而来的是残酷的神经适应（neuroadaptation）。随着多巴胺耐受性的建立，一部手机很快将无法平息孩子的无聊或痛苦，阈值被层层推高： - 幼儿阶段：依赖手机屏幕与动画平息哭闹 - 童年早期：需要能百依百顺、随叫随到的 AI 定制宠物玩具 - 8 岁左右：对普通玩具彻底脱敏，神经渴求演变为更剧烈的高刺激机制（如包含盲盒与类博彩机制的互动游戏） ### [37:11](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2231s) 嵌入毛绒玩具的 AI：父母职责的外包与“家庭解体” 针对当前市面上将 AI（类似 ChatGPT 交互能力）内置到毛绒玩具中、陪孩子聊天并倾听孩子日常的创业产品，Dr. Lembke 发出了极为严厉的警告。她直言这是一种“极其极其危险”的趋势，本质上是父母将最为核心的育儿劳作（parenting work）与真实人际连接彻底外包。 沟通与育儿本身充满阻力与摩擦——孩子（尤其是步入青春期的少年）往往不愿主动吐露心声，父母通常需要在工作一整天、筋疲力尽的深夜十点，守候孩子愿意开口的那一刻。而植入 AI 的玩具彻底消除了所有人际交往的真实摩擦（friction）： 1. **单向谄媚与奉承**：AI 玩具被算法设计为无底线迎合、肯定、抚慰孩子，提供高浓度的无摩擦社交奖赏，Dr. Lembke 犀利地将其定性为“一台精神手淫机（essentially a masturbation machine）”。 2. **失真的“传话游戏”**：父母不再亲自花时间与孩子建立共同语言，转而通过翻看孩子与 AI 的对话记录来了解孩子，形成荒诞的信息过滤链，误以为自己了解孩子，实则真实亲子关系荡然无存。 3. **社会纽带的碎片化**：这种完全依赖人造机器抚慰儿童情绪的做法，正在从根基上加速核心家庭（nuclear family）与基本社会联结的瓦解与崩塌。 ### [39:52](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2392s) 商业飞轮下的算法困境与现实主义乐观 面对科技巨头以用户注意力最大化为唯一商业驱动力（以投放更多广告、榨取更高订阅费为核心）的现实，Steven 提出质疑：商业模式的激励机制注定只会让算法越来越具成瘾性，在“魔鬼已出瓶（the genie is out of the bottle）”的当下，我们是否还能抱有希望？ Dr. Lembke 坦言时光无法倒流，但她自称是一名“现实的乐观主义者”（realistic optimist）。她坚信人类具备适应危机与解决问题的韧性。十年前公众对数字媒介的成瘾危险几乎毫无警觉，而如今这已成为全民深入探讨的核心议题；最重要的是，身处一线的父母们亲眼目睹了家庭关系的实时瓦解，正在率先拉响警报并展开抵抗，这种集体的清醒与觉察正是扭转局面的起点。 ### [41:01](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2461s) 保护青少年的神经发育：为何科技成瘾不能单靠父母解决 安娜·伦布克（Dr. Anna Lembke）谈到未来时抱有一种审慎的乐观。她认为人类终将团结起来尝试各种解决方案，其中必然包括通过技术手段设立护栏或开发更具良知的技术形态。在她看来，当前像“情色聊天机器人”（erotic chatbot）这类产品的发展路径显然是走偏了；虽然在自由社会中，成年人可以在社会判定其危害大于潜在收益之前做出自主选择，但当务之急必须将保护的重心完全放在儿童与青少年身上。 未成年人在神经生物学层面上处于极度脆弱的阶段。他们的大脑正处于高度可塑、急剧变化的重构期：神经系统正在残酷地进行突触剪裁（pruning），剔除那些不常使用的神经元，同时对频繁使用的神经通路进行髓鞘化（myelination）以提升传导效率，而这一神经发育过程要一直持续到25岁左右才基本定型。与此同时，青春期孩子体内翻涌着大量荷尔蒙，从演化里程碑来看，青少年天生就是探险家与冒险者，其生物学本能驱使他们走向外部世界、结识同伴、建立现实联结并满足好奇心。然而，当下的现实却是越来越多的青少年整日足不出户，将所有情感与社交需求全部抵押给虚拟屏幕。 面对这种严峻现状，伦布克医生强调，绝不能将监管与干预的重担单独推给父母。没有任何单个家庭能够抵御精心设计的商业算法，这必须是一场全方位的系统性工程： - **多方协同干预**：学校、立法机构、各级政府必须与家庭形成合力，共同制定规则与限制。 - **科技公司的产品责任**：依靠数字媒体牟利的科技巨头必须承担起核心伦理责任，确保其推向市场的产品不对未成年人造成神经与心理层面的实质性伤害，而现行的许多产品显然未能达到这一底线。 --- ### [43:10](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2590s) 走上法庭的成瘾专家：起诉社交媒体巨头的行业诉讼 随着数字成瘾危害的集中爆发，伦布克医生近期以专家证人的身份深度参与了多起针对社交媒体巨头的重大诉讼。受限于法庭保密协定，她无法公开正在审理中的案情细节，但她清晰地揭示了这场庞大司法博弈的核心指控：原告方汇聚了来自各地的学区、县政府、州政府乃至代表联邦利益的实体，他们正联手将主流社交媒体平台推上被告席，诉求只有一个——强制要求企业对未成年人提供更安全的产品，为学校和家庭构筑防御屏障。 诉讼的核心逻辑建立在一个无可争辩的事实之上：青少年属于缺乏自我保护能力的弱势群体，而当下的社交媒体在设计之初就埋下了危害的种子。平台绝非中立的通信管道，其底层交互机制通过无休止的下滑、刷新和微刺激反馈，精准劫持并剥削了年轻人尚未成熟的动机奖赏系统（motivational reward system），诱发病态的高粘性依赖。这种长时间的注意力吞噬演化出了广泛的次生灾害： - **精神与情绪障碍**：因持续的感官过载与虚拟攀比，直接导致青少年群体中抑郁、广泛性焦虑、进食障碍（eating disorders）与身体变形障碍（body dysmorphia）的发病率呈爆发式增长。 - **安全与伦理侵害**：包括网络霸凌（cyberbullying）、性勒索（sextortion）以及儿童性虐待材料（CSAM）的泛滥。 - **生理节律摧毁**：屏幕的蓝光与多巴胺脉冲严重破坏青少年的睡眠周期，使大脑在关键的发育窗口期得不到基本的修复与重整。 --- ### [45:54](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2754s) 四周戒断法则：重置多巴胺天平与戒断期的神经适应 告别节日狂欢的喧嚣，很多人在经历过暴饮暴食、彻夜饮酒或沉迷手机之后，大脑的多巴胺系统往往已严重失衡。针对史蒂芬·巴特利特（Steven Bartlett）提出的节后状态，伦布克医生指出，此时的大脑实际上深陷于“多巴胺匮乏状态”（dopamine deficit state）。想要扭转这种疲惫与空虚，唯一的解药就是对成瘾源进行彻底的戒断（abstinence），给奖赏回路足够的时间完成自我重置。 面对各类成瘾行为，伦布克给出的黄金戒断窗口是**至少4周**。之所以必须坚持28天，是因为人类大脑平均需要这么长的时间才能完全走出急性戒断反应，使神经元重新适应温和、平淡的日常奖赏，摆脱对多巴胺尖峰的无休止渴望。戒断过程中最艰难度过的是最初的10到14天，这是生理与心理反扑最剧烈的时期： ```mermaid flowchart TD accTitle: 四周多巴胺重置周期与神经适应反转 accDescr: 展示从移除多巴胺源到第1至14天急性戒断期，再到第3至4周神经适应逆转的多巴胺重置过程。 subgraph Phase1["戒断初期（第 1 - 14 天）"] A["停止摄入多巴胺刺激源<br/>(糖、社交软件、烟酒等)"] --> B["神经适应反冲：<br/>快乐-痛苦天平砸向痛苦端"] B --> C["急性戒断症状爆发：<br/>焦虑、易怒、失眠、抑郁心境与剧烈渴求"] end subgraph Phase2["重置与修复期（第 3 - 4 周）"] C --> D["外源刺激阻断持续"] D --> E["神经可塑性逆转：<br/>大脑重新上调内源多巴胺"] E --> F["突触后多巴胺受体重新部署<br/>重获感知平凡微小快乐的能力"] end ``` 在节律调整初期，一旦强行将刺激物从大脑的“快乐端”拿掉，神经适应机制（neuroadaptation）会导致多巴胺天平瞬间失衡并剧烈砸向“痛苦端”。处于急性戒断期的人群通常会集中体验到五大核心痛苦特征：严重的焦虑感（anxiety）、难以克制的易怒情绪（irritability）、失眠（insomnia）、心境恶劣或抑郁状态（dysphoria/depressed mood），以及如同蚁噬般的成瘾渴求（cravings）。 --- ### [47:32](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2852s) 渴望的漩涡与“欣快回忆”：大脑如何过度评估奖赏 谈及急性戒断的折磨，史蒂芬分享了自己的亲身经历：当他频繁摄入糖分时，第二天路过胡萝卜蛋糕不仅会垂涎欲滴，甚至会在脑海中将其赋予极高诱惑力；而当他严格坚持生酮饮食4到8周后，再次路过同样的蛋糕，内心却激不起任何波澜。伦布克医生对此深表赞同，并补充了她临床上的一位严重食物成瘾患者的案例——那位患者在戒断初期仅仅是走进公司的休息室、看见桌上放着的一盒甜甜圈，身体便立刻爆发严重的生理警报：浑身冷汗直冒、胃部发生剧烈的痉挛性抽痛。 这种剧烈的生理唤醒源于大脑在极度渴望时产生的认知偏差： - **奖赏价值过载**：大脑在多巴胺亏空时会无限放大成瘾物的价值，将其错误标记为维持生存必不可少的要素。 - **欣快回忆（Euphoric Recall）的欺骗**：大脑会自动过滤掉后期耐受带来的麻木体验，固执地调用初次接触该物质时最美妙、最强烈的快感记忆，哪怕当下的每一次复吸早已无法复制最初的愉悦，这种“它一定妙不可言”的虚幻预期依然牢不可破。 - **“永无止境”的认知绝望**：许多戒断者中途放弃，是因为在急性发作期，那种强烈的渴求感会让人产生一种"我再也撑不下去、这种痛苦将永远持续"的认知错觉。伦布克医生在临床中最重要的干预就是反复向患者保证：只要拥有足够的神经可塑性并保持绝对阻断，这个看似吞噬一切的渴求漩涡就一定会随着时间彻底平息。 --- ### [49:56](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2996s) 大脑的可塑性奇迹：受体再部署与内源多巴胺的重建 在播客现场，伦布克医生通过操作随身带来的微缩天平道具，直观展示了神经重塑的过程。她将天平痛苦端的一块块重石逐一挪开，生动演示了神经系统在切断外力刺激后的自我修复轨迹。当大脑长期得不到外源性（exogenous）超常多巴胺刺激的轰炸时，神经中枢终于接收到了真正的生化信号：“外援已经断绝，我们必须自力更生。” 这一神经适应的逆转过程展示了人类大脑惊人的神经可塑性（neuroplasticity）： - **内源机制激活**：大脑开始主动上调自身内源性多巴胺的合成与神经传递效率，不再依赖外界的人工注水。 - **突触后受体重新部署**：在成瘾期间被大幅下调或隐藏的突触后多巴胺受体（postsynaptic dopamine receptors）被重新动员并部署到细胞表面，使神经元恢复对低浓度多巴胺的敏锐捕捉能力。 - **病态通路的逆转**：伦布克特别引用了著名神经科学家伊迪丝·沙利文（Edith Sullivan）等人关于成瘾康复期大脑变化的研究，指出绝大多数因成瘾导致的神经功能退化，都能在长期戒断后通过脑结构的自我重组得到显著逆转与修复。大脑完全有能力找回最初的基线，重新在平静中感知真实世界的美好。 ### [51:15](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3075s) 神经可塑性与“首选药物”的个体差异 Dr. Anna Lembke 解释道，那些在大脑中已经形成的成瘾神经回路可能永远不会彻底消失，但它们会像火堆中即将熄灭的余烬一样逐渐沉寂下来。康复的核心机制，在于大脑通过神经可塑性（neuroplasticity）建立起绕过这些受损区域的新神经网络。最终，人们可以恢复基础的快乐与痛苦平衡，重置自己的享乐基准线（hedonic set point 或 joy set point）。当达到这种健康状态时，个体就能重新从非成瘾性事物中体会到乐趣——比如看日落、与朋友聊天或出门散步，而在奖励回路被成瘾源劫持期间，这些感知快乐的能力往往会被剥夺殆尽。 Steven Bartlett 对此深有感触，并指出每个人对不同事物成瘾的易感性差异巨大。他打趣道，对自己来说诱惑可能是威士忌（不过他随即笑着澄清自己其实并不喝酒），而 Dr. Anna Lembke 曾在之前的对谈中坦白自己曾沉迷过言情小说（erotic novels）；对另一些人而言，成瘾源可能是阿片类药物、AI 甚至是 TikTok。即使两人在 TikTok 上刷同样长的一个小时，由于大脑底层神经回路以及人生经历的不同，一个人可能会深度成瘾，而另一个人却毫无波澜。Dr. Anna Lembke 对此表示完全赞同。她指出，成瘾性药物或诱惑之所以特殊，是因为它们能在奖励回路中瞬间释放大量多巴胺。虽然多数人会觉得这种强刺激具有强化作用，但并非人人如此：有人服用阿片类药物只会感到极其不适而毫无欣快感，有人喝咖啡感受不到提神效果，还有人饮酒后只会头痛而无法得到任何放松。 ```mermaid flowchart TD accTitle: 神经回路重塑与多巴胺基准线恢复机制 accDescr: 展示成瘾回路休眠、绕行通路建立以及感知日常快乐能力的恢复过程。 subgraph AddictionState["成瘾活跃状态"] A["高多巴胺刺激源劫持奖励通路"] --> B["日常刺激钝化<br/>(无法享受散步/日落/社交)"] end subgraph NeuroplasticityRecovery["神经可塑性恢复阶段"] C["成瘾神经回路沉寂<br/>(宛如余烬熄灭)"] D["发展全新神经网络<br/>(绕过受损区域)"] C --> D end subgraph HealthyBaseline["重置享乐基准线"] E["恢复快乐与痛苦平衡"] F["重新感知日常奖励的快乐"] E --> F end B -.->|戒断与修复| NeuroplasticityRecovery D --> HealthyBaseline ``` --- ### [53:18](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3198s) 成瘾人格之争与“30天戒断”的新年策略 当被问及“成瘾人格”（addictive personality）是否真实存在时，Dr. Anna Lembke 澄清说，医学界现在已经不再使用这一术语，而是更倾向于表述为“成瘾的遗传或基因风险”（inherited or genetic risk of addiction）。研究证实，如果直系血亲（父母或祖父母）患有成瘾性疾病，哪怕个体从小脱离该原生家庭在无成瘾源的环境中被抚养长大，其患上成瘾障碍的风险依然显著高于普通人群。临床上之所以放弃“成瘾人格”的说法，正是因为“人格”一词听起来像是一种不可更改的固化特质，容易让人陷入无能为力的宿命感。 听到这里，Steven Bartlett 提出一个极具实操价值的顿悟：人们或许根本不需要制定维持一整年的新年计划，而应该只制定一个“一月份的4周计划”。当新年目标定为365天时，人们坚持到第七天就会产生心理崩溃，觉得自己绝不可能撑满一年；但如果目标缩短为4周，一旦撑过这一个月，最强烈的生理渴求往往就已经消退了。Dr. Anna Lembke 对此高度赞同，并指出这正是临床治疗中常用的策略： - **可行的时间框架**：要求患者终身戒断往往会让人望而却步，但30天的期限是绝大多数人在心理上能够接受并尝试掌控的。 - **安全评估前提**：30天冷拔戒断（abstinence）适用于多数有意愿且身体允许的人，但不适合可能出现致命性戒断反应的人群（例如严重酒精或苯二氮䓬类药物戒断，这类情况需要专业医疗看护）。 - **重获选择权与耐受性重置**：熬过30天后，患者的整体状态通常会有明显好转。此时他们可以自主决定是继续保持戒断，还是尝试重新接触。由于长期的耐受性已经重置，他们哪怕重新少量接触，也能重新体会到其带来的奖赏反馈，而不是像慢性重度滥用时那样麻木。 - **以彻底戒断开启适度节制**：现代成瘾医学不再把“终身绝对戒断”视为唯一出路，而是探索健康节制（moderation）的可能。然而，临床实践证明，想要在未来长期保持适度使用，必须以一段彻底的戒断期为前提，这样成功的概率才会大幅提升。 --- ### [56:11](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3371s) 痛苦-快乐天平：如何养成运动等艰难的好习惯 话题随后转向如何建立新的好习惯。Steven Bartlett 询问，如果一个人想要开始养成去健身房的习惯，应该如何运用“快乐-痛苦天平”（pleasure-pain balance）？ Dr. Anna Lembke 分析指出，去健身房是一项艰难且耗费心力的习惯，它绝不可能像那些能瞬间触发多巴胺爆发的坏习惯一样轻松成瘾，因为那些坏习惯是“无摩擦”（frictionless）的。对于需要付出努力且无法立刻得到奖赏的好习惯，大脑机制正好反了过来： - **主动向“痛苦端”加压**：强迫自己早起、前往健身房、进行高强度的体力锻炼，本质上是在天平的痛苦端施加重压。 - **神经适应的间接奖赏**：天平上的“神经适应小怪兽”（neuroadaptation gremlins）为了抵消痛苦，会主动跳到快乐的一端。这意味着多巴胺并不是通过即时刺激直接获取的，而是通过我们预先承受痛苦、间接“预付成本”换来的。 - **分子层面的生物反馈**：从生理与演化机制来看，运动在细胞层面上实际上具有瞬间的轻微毒性（cellular injury）。当身体监测到这种轻微损伤时，会代偿性地下达指令，上调体内的各种有益神经递质与荷尔蒙——不仅是多巴胺，还包括内源性阿片类物质（endogenous opioids）和内源性大麻素（endogenous cannabinoids）。 - **延迟满足与“跑者高潮”**：这种机制决定了运动带来的奖赏必定是延迟的。绝大多数人在刚开始锻炼时只会觉得痛苦不堪，心里不断默数还剩多少分钟；唯有坚持一段时间或运动彻底结束后，内啡肽才会大量分泌，从而产生令人愉悦的“跑者高潮”（runner's high）。 --- ### [58:46](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3526s) 预先承诺与前额叶皮层的博弈 面对“延迟奖赏并不直观、人几乎需要像信教一样盲目相信运动后会变好”的现实困境，Steven Bartlett 半开玩笑地追问是否有快速破解的方法：“比如我去健身房时先奖励自己吃一根玛氏巧克力棒（Mars bar）？” Dr. Anna Lembke 强调，培养艰难习惯的关键策略在于**预先准备（prepare in advance）**： - **消灭临场决策**：如果把“做与不做”的决定留到困难来临的那一刻（例如清晨刚睁眼赖在床上时），大脑几乎必然会选择放弃。但如果在前一天就做好明确规划，按部就班执行的概率会大大提升。 - **建立前期行为仪式**：在行动前建立一套固定的仪式感，例如前一天晚上把运动装备收拾妥当打包放好、定好闹钟、明确训练时间表。 - **绑定社交属性**：将困难的事情与社交连接起来（比如约好朋友一起去健身房）。人类在与他人同行时完成艰巨任务的阻力，远远小于独自硬撑。 当 Steven Bartlett 探讨“提前准备衣服是否只是为了削减痛苦阻力”时，Dr. Anna Lembke 指出这背后有着更深层的脑神经机制：位于额头正后方的大脑前额叶皮层（prefrontal cortex）承担着未来规划、延迟满足以及构建自传式叙事（autobiographical narrative）的核心功能。通过提前安排仪式与计划，我们实际上是在主动调用高级认知中枢，去接管和战胜底层情绪脑的短视逃避倾向。 ### [01:00:49](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3649s) 习惯叠加与大脑对即时奖赏与长远奖赏的处理机制 安娜·伦布克（Dr. Anna Lembke）详细阐述了前额叶皮层在习惯形成与决策中所扮演的核心角色。前额叶皮层允许我们为未来的行动做出规划——即那些虽然我们当下可能并不想做、但在理性上明确知道必须去做的事情。这种机制赋予我们抑制短期冲动欲望、将心理投射到未来的能力，从而实现长远的愿景。她引用了神经科学家萨姆·麦克卢尔（Sam McClure）的研究成果：当大脑面对即时奖赏（immediate rewards）时，情绪大脑（边缘系统）会被强烈激活；而当面对长远奖赏（long-term rewards）时，前额叶皮层才会启动并占据主导。 通过提前规划好所有的微小执行步骤——也就是行为心理学上所说的“习惯叠加”（habit stacking）——我们实质上是在主动调动前额叶皮层，把自己投射到未来的场景中，并提前预演长期的奖赏体验。这种认知神经机制构成了我们克服当下惰性、拒绝即时诱惑以服务于“未来的自己”的底层逻辑。 ```mermaid flowchart TD accTitle: 即时奖赏与长远奖赏的大脑激活对比 accDescr: 对比即时奖赏激活情绪大脑与长远规划激活前额叶皮层的不同神经路径 subgraph ImmediatePath["即时诱惑路径"] A["即时奖赏刺激"] --> B["激活情绪大脑 / 边缘系统"] B --> C["追求短期享乐 / 习惯失控"] end subgraph LongTermPath["长远规划路径（习惯叠加）"] D["提前细化步骤规划"] --> E["激活前额叶皮层"] E --> F["投射未来自我并预期长远奖赏"] F --> G["抑制当下冲动 / 迎难而上"] end ``` --- ### [01:01:53](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3713s) 预防复发与“自我绑定”策略（物理屏障 vs 元认知屏障） 当主持人史蒂文·巴特利特（Steven Bartlett）问及为什么很多人戒除坏习惯一个月、两个月甚至三个月后依然会复发，以及是否有避免复发的诀窍时，伦布克医生坦言复发是极其普遍的现象。在当今这个高度过剩的消费型社会中，诱惑随时随地在追捕我们，无论是酒精、香烟还是各类数字化娱乐，个体很难彻底避开它们。因此，伦布克在临床治疗中高度依赖“自我绑定”（self-binding）策略，即在自身与成瘾客体（drug of choice）之间建立物理屏障与元认知屏障： - **物理屏障（Physical Barrier）：** 设置可见的具体障碍，例如把智能手机彻底移出卧室、在手机上删除具有成瘾性的 App，或者清空家中所有的存酒，拉开物理上的距离。 - **元认知屏障（Metacognitive Barrier）：** 基于思维认知和价值叙事的心理防线。包括时刻提醒自己的长期人生目标和核心价值观，明确为什么价值观高于眼前的冲动，或者与他人建立共同监督与调节（co-regulation）的纽带。 伦布克强调，绝不能仅凭意志力去抵抗诱惑。因为“意志力是一种会耗尽的资源”（exhaustible resource），在无处不在的诱惑轰炸下迟早会消耗殆尽。设置这些屏障的真正作用是为大脑争取宝贵的缓冲时间；哪怕只是稍微放慢节奏、拉长反应间隙，往往就足以让人安然度过心理渴求的浪峰（surf the cravings），而不至于付诸行动。 --- ### [01:04:10](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3850s) 成瘾、习惯与热爱的科学界定 面对“人是否会对好事上瘾”的疑问，伦布克医生明确给出了医学上的界定。在临床医学和精神病学范畴中，“成瘾”（addiction）是一种疾病过程，属于精神健康疾患的一种。尽管日常口语中大家常随意使用这个词，但在严肃的医学诊断上，成瘾的核心定义是：“即使对自己或他人造成了明确的伤害，依然强迫性地过度消耗与使用”（compulsive overconsumption despite harm to self and/or others）。 伦布克提醒需要清晰地区分三者之间的边界： 1. **成瘾（Addiction）：** 伴随强迫性失控，并持续造成自我或他人的实质性伤害。 2. **习惯与坏习惯（Habit / Bad Habit）：** 虽有重复性行为模式，但达不到成瘾的诊断阈值标准。 3. **热爱与激情（Passion）：** 个人全心投入并深爱的事物，它对自己或他人产生积极有益的影响，且不会持续引发破坏性后果。 --- ### [01:04:58](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3898s) 晨间法则：把艰难的事放在首位，以“痛苦”开启一天 在谈到戒除成瘾和恶习的日常仪式时，伦布克提出了一个非常关键的建议：“先做最难的事情”（doing the hard things first），用更通俗的话讲就是“以痛苦开启你的一天”（start your day with pain）。 具体而言，她建议将最具挑战性或需要付诸自律的任务排在起床后的第一顺位，例如晨练、整理床铺、吃健康的早餐、刷牙、规划当天日程等，并且必须在接触强效奖赏源之前完成。这意味着在喝早晨的第一杯咖啡、摸任何屏幕或数字设备之前，先把困难的事情做完。因为手机、屏幕信息和刺激物都是极其强大的正强化物（reinforcers），一旦大脑过早接触它们，当天的目标感与自制力就会轻易被其绑架。 当主持人追问为什么必须先做难事、绝不能早起先刷 TikTok 时，伦布克解释了其背后的生理机制： - **先碰强刺激物（如社交媒体、兴奋剂）：** 早起第一件事就让大脑暴露于高额快感刺激中，你的多巴胺水平处于峰值，此后一天“将无处可去”，必然迎来多巴胺跌落的低谷期（come down）。大脑随后便处于亏损和受损的代偿状态，再去执行困难任务会变得难上加难。 - **先做困难之事（如锻炼、深度规划）：** 克服阻力完成难事后，大脑会随后内源性地释放长效奖赏，同时赋予个体强烈的胜任感（sense of competence）与成就感，为全天建立起良好的神经基调与前行动力。 --- ### [01:06:57](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4017s) 多巴胺断食前的准备：时间线回溯法与挤痘视频的真实故事 在开启为期 4 周的多巴胺断食（dopamine fast）以彻底戒除恶习之前，伦布克强调必须做好充分的提前筹划。准备的第一步是精准锁定自己的“目标成瘾物”（drug of choice）——即那些让人过度消耗、频率过高并在事后深感后悔的事物，或是带来了明显负面影响与巨大机会成本（挤占了人际交往和真正有意义的爱好）的行为。 为了客观评估使用量，伦布克推荐了临床上常用的**时间线回溯法（Timeline Follow-Back Method）**：从今天开始倒推回顾过去 7 天的每一天，严格统计成瘾物的消耗量与使用频率（quantity and frequency），然后汇总整周的数据。她指出人类在追逐多巴胺时是极其糟糕的自我观察者，常常严重低估自己的沉迷程度。 伦布克非常坦率而幽默地分享了自己的亲身经历： 在结束了长时间的高强度门诊后，她习惯通过看 YouTube 视频来放松，并自以为每周只看两三次、每次不过半小时左右。直到有一天，她的青春期女儿走到她面前直接指出：“妈妈，你现在总是在刷 YouTube。”伦布克当时甚至感到被冒犯并出言反驳，坚信自己只是偶尔放松。 女儿走后，伦布克坐下来运用时间线回溯法复盘自己的真实使用情况： - 当天她已经连续看了 1.5 个小时； - 前一天她看了大约 2 个小时； - 再往前一天也是类似的时长； - 算下来，整整一周内她累计看了大约 **14 个小时**的视频，相当于荒废了整整一整天的时间。 当主持人好奇地追问这位知名学者到底沉迷于什么高级内容时，伦布克极其难为情地笑着承认，自己当时并不是在看 AI、心理学或硬核科学，而是在狂刷“挤痘医生”（Dr. Pimple Popper）给人挤痘痘的猎奇解压视频。这段令人捧腹的反差经历生动印证了：无论认知水平多高，人类在面对多巴胺诱惑时都有可能陷入自我欺骗，唯有客观的数据记录才能打破这种认知偏差。 --- ### [01:10:13](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4213s) 赞助商插播：Intuit QuickBooks 主持人史蒂文·巴特利特切入赞助商内容，谈到没有哪位创业者会因为喜欢处理繁琐的行政事务而创办公司，但行政管理又是企业成功运营必不可少的一部分，极易侵占注意力并分散对核心业务的聚焦。他提到自己的团队使用赞助商 Intuit QuickBooks 来精简行政流程，团队成员反馈每月因此节省了约 12 个小时，并引述数据显示 78% 的用户体验到了行政效率的提升。 ### [01:10:38](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4238s) 中场赞助：智能办公与红光护肤 节目插播了两个赞助商的资讯。首先是 Intuit QuickBooks，其新推出的 AI Agent 旨在协助企业主自动化处理耗时的繁琐行政工作，无缝整合现有工具，一站式管理发票开具、收付款流程与财务分析，同时仍保留人工客服支持，帮助成长型企业摆脱行政杂务的泥潭。随后是一段轻松幽默的幕后互动：工作人员催促 Steven Bartlett 回到录制现场，却撞见他脸上戴着一款红光面罩。Steven 笑称这是 Bon Charge 的红光面罩，能刺激胶原蛋白生成、改善皮肤细纹与瑕疵。他透露自己最初是被戴着面罩的女友吓了一跳，误以为是什么吓唬人的道具，后来亲自试用并坚持了一年半，发现护肤效果显著，如今已成为日常习惯。 ### [01:12:10](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4330s) 大脑成像揭秘：成瘾者的多巴胺荒漠 Steven 翻开 Dr. Anna Lembke 所著的《Dopamine Nation》（多巴胺国度）工作手册第 64 页，向观众展示了一张发人深省的大脑扫描对比图，并将专业解读交给了 Dr. Anna。该图基于美国国家药物滥用研究所（NIDA）所长诺拉·沃尔科夫（Nora Volkow）及其团队的先驱性神经影像学研究。扫描图像直观对比了健康对照组与多种成瘾患者（涵盖可卡因、甲基苯丙胺/冰毒、酒精等）大脑奖赏通路的差异。在健康人的脑部图像中，伏隔核区域呈现出鲜艳饱满的红色或深色斑块，代表充沛的多巴胺信号传递；而在长期严重滥用成瘾物质的患者大脑中，这些明亮的信号几乎完全熄灭，呈现出一片暗淡。 Dr. Anna 解释说，这证明重度成瘾者在神经生物学层面已陷入了“慢性多巴胺缺失状态”（chronic dopamine deficit state），其基准多巴胺传递水平远低于正常人。外界往往误以为成瘾者整日沉浸在快感中，实则由于过度刺激诱发了严重的神经适应机制，他们的大脑奖赏系统已被彻底榨干，陷入麻木与痛苦的低谷。 ```mermaid flowchart TD accTitle: 神经适应与多巴胺缺失循环 accDescr: 展示高强度多巴胺刺激如何导致神经受体下调并陷入慢性多巴胺缺失状态 subgraph External_Stimulation["外源性超常刺激"] A["高频高刺激输入\n(毒品 / 色情 / TikTok / 屏幕)"] end subgraph Brain_Response["脑部稳态代偿"] B["多巴胺脉冲式暴增"] --> C["大脑启动稳态平衡 (Homeostasis)\n抑制自体分泌 / 下调受体"] end subgraph Deficit_State["神经功能改变"] C --> D["慢性多巴胺缺失状态\n(伏隔核信号大幅减弱)"] D --> E["耐受性形成 & 渴求加剧\n(日常事物无法带来快乐)"] end A --> B E -.继续寻求刺激.-> A ``` ### [01:13:32](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4412s) 体内稳态机制：为何外源性刺激会摧毁自体调节？ 针对这一脑成像现象，Steven 总结出一条普遍的生理规律：人体似乎对所有外源性引入（exogenous source）的事物都遵循同一套反馈逻辑——一旦外部给予过量（无论是来自 TikTok、色情片、酒精还是药物的多巴胺轰炸），大脑就会认定体内储备已足，从而停止自身生产。Dr. Anna 对此高度赞同，指出这正是生物体的“体内稳态”（homeostasis）法则，即有机体必须将生理指标维持在极窄的平衡范围内以确保生存。 两人的探讨随即延伸到其他常见的日常补剂与化学物质： - **褪黑素（Melatonin）**：Steven 提到许多人因睡眠障碍而长期大剂量服用褪黑素片，但他本人曾本能地排斥这种做法，担忧一旦产生外源依赖，人体松果体便会退化萎缩，停止自然合成褪黑素，导致终身受制于药丸。Dr. Anna 指出，任何外源摄入物都会引发机体向基线拉回的代偿反应。 - **成瘾行为与普通药物的区别**：虽然许多处方药长期服用并不会产生耐受性，但成瘾性物质或行为具有“极速、极强释放多巴胺”的特质，迫使神经系统必须调动同等剧烈的神经适应（neuroadaptation）手段予以对冲。 - **睾酮替代疗法（TRT）**：Steven 补充了外源睾酮的典型案例——长期注射外源睾酮会抑制促性腺激素释放，导致机体自身睾酮合成彻底关闭、睾丸萎缩；若突然骤停，内源系统往往需要漫长的时间才能苏醒，部分患者甚至永久丧失了自愈能力。这一机制生动印证了破坏身体天然平衡所必须承担的生理反噬。 ### [01:16:28](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4588s) 神经重塑的真实周期：不仅是四周，而是十四个月 针对长期成瘾对大脑的器质性损伤是否不可逆的问题，Dr. Anna 带来了一项带来希望的关键后续研究：Nora Volkow 团队曾追踪了一批甲基苯丙胺（冰毒）重度成瘾者，在他们坚持彻底戒断长达 14 个月后，再次进行了脑部正电子发射断层扫描（PET）。结果显示，经过 14 个月的神经净化与休养，这些成瘾者的大脑多巴胺传递水平已经成功恢复到了与健康人无异的正常基线。 这一发现为临床成瘾治疗提供了极具分量的科学指引： - **长跑与短跑的区别**：对于严重的器质性物质成瘾，切不可幻想仅仅“禁断 4 周”就能彻底重塑已经严重受损的脑神经。 - **四周戒断的临床价值**：Dr. Anna 澄清道，尽管 14 个月才能实现解剖层面的完全复原，但在临床经验中，4 周的戒断足以让患者“看到隧道尽头的曙光”。在戒断第四周前后，大脑已经恢复了体验基本奖赏与日常乐趣的能力，从而使患者从深不见底的渴求与焦虑中挣脱出来，重新燃起重获新生的意志与希望。 ### [01:17:26](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4646s) 震撼的动物实验：海洛因如何抹杀互助与同理心 当 Steven 询问在多巴胺与人类行为领域最令她难忘或震惊的研究是什么时，Dr. Anna 分享了一个极具震撼力的啮齿动物实验： 实验将一只大鼠置于笼中，笼内放着另一只被困在特制塑料瓶里的同伴。在正常状态下，这只自由的大鼠会表现出明显的亲社会利他行为，不辞辛劳地连续摸索推拉机关，竭尽全力解救被困的伙伴。然而，如果研究人员在笼中接入一个装置，允许这只自由的大鼠自主注射海洛因（阿片类药物），大鼠的利他行为便彻底消失——它会完全忽视同伴在塑料瓶内的挣扎呼救，只顾一次又一次地按压杠杆给自己注射毒品。 ``` 实验阶段对比： 1. 正常状态：自由大鼠 ──积极营救──> 被困塑料瓶的大鼠（展现亲社会互助本能） 2. 染瘾状态：自由大鼠 ──完全忽视──> 被困塑料瓶的大鼠 │ └──沉溺自我注射海洛因（毒品篡夺了人际依恋需求） ``` Dr. Anna 强调，这项实验的残酷之处在于它揭示了成瘾的核心悲剧：像阿片类这样的高致瘾物质能够直接“篡夺”（usurp）生物对同类联结与亲密关系的渴望，让化学药物反客为主，成为个体唯一的“终极依恋对象”（object of attachment）。社会常以为“孤独与疏离是导致成瘾的诱因”——这固然属实，但反向因果同样致命：成瘾本身会摧毁共情能力，驱使个体主动自我封闭、背叛群体，彻底丧失对现实中他人生死与喜怒哀乐的感知力。 ### [01:19:06](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4746s) 从屏幕沉溺到言情小说：被侵蚀的真实人际关系 听到大鼠实验的结论，Steven 深感共鸣，并将这种神经机制映射到现实的数码生活之中。他反思道，当自己沉溺于电子设备、被楼上电脑里源源不断的多巴胺诱惑绑定时，楼下伴侣的呼唤或情感需求往往会被自己完全屏蔽。“我虽然很不愿意承认，但我可能确实有过这种罪恶感——太执着于工作和屏幕带来的刺激，以至于无法真切地出现在他人面前去回应他们的需求。” Dr. Anna 随后毫无保留地坦白了自己昔日深陷“言情小说成瘾”的亲身往事： - **家庭角色的疏离**：在她严重沉溺于电子书言情小说的时期，她开始对丈夫与孩子的情感需求极度冷漠与漫不经心。 - **荒诞的社交避世**：在一次两家人共同前往海滩度假时，她没有踏足阳光与海滩陪伴家人，而是整天躲在昏暗的酒店房间里埋头看小说；更有一次去邻居家中参加派对，她竟然在别人的房子里专门找了一间无人的空房间躲进去彻夜看小说，完全放弃了与人社交，甚至当时麻木的大脑并未觉得这种离谱举动有何不妥。 Dr. Anna 总结道，成瘾的本质就是一套认知失调的陷阱：大脑开始无底线地“过度高估”（overvalue）那个能够提供廉价多巴胺的目标（无论是毒品、手机还是小说），同时严重“低估”（undervalue）现实生命中那些更真实、更崇高、更有意义的爱与关系。对此，Steven 提出了一个更宏大且发人深省的疑问：这种由数字多巴胺引发的集体神经退化，是否正在不可逆地让整个现代社会的同理心与人际温情走向衰亡？ ### [01:20:52](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4852s) 成瘾如何侵蚀同理心与道德底线 安娜·伦布克博士（Dr. Anna Lembke）指出，多巴胺成瘾不仅让人丧失对周围人的关怀与陪伴能力，更可怕的是，它正在让人走向“反社会人格”（sociopathic）。当个体深陷成瘾状态时，他们会彻底偏离内心的道德罗盘，因为他们过度高估了所依赖的“成瘾物”（drug of choice）的价值，以至于完全忽视了原本珍视的准则。伦布克博士以沉迷电子游戏或社交媒体的青少年为例：这些孩子会停止参与家庭生活，不再尊重父母，拒绝做家务，本质上变得极具攻击性与反社会性。 更严峻的挑战发生在戒断期。当父母切断孩子的数字化设备时，伴随而来的是剧烈的戒断反应，有些孩子甚至会说出想伤害父母或自残的狠话。然而，伦布克博士强调，只要坚持足够长的时间、彻底远离数字媒介，他们就能穿过隧道的另一端。许多家长在孩子戒除后感慨道：“我们终于把孩子找回来了。”这表明，处于成瘾期的人看似表现为严重的人格障碍、极度自恋、边缘型人格甚至反社会倾向，但那并不是他们的本质；一旦进入康复状态，他们便能重新找回真实的自我。 - **道德罗盘偏离**：成瘾物被大脑过度估值，导致其他所有道德准则与家庭纽带退居次席。 - **戒断期表象**：情绪剧烈反弹与攻击性言语属于戒断反应的一部分，而非不可逆的人格缺陷。 - **人格的可逆性**：成瘾阶段表现出的自恋与反社会特征，在长期禁断与康复后会逐步消退。 --- ### [01:22:36](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4956s) 多巴胺激动剂与冲动控制失常 史蒂芬·巴特利特（Steven Bartlett）引入了一个极端的医学案例：治疗不宁腿综合征（Restless Legs Syndrome）的常用药物普拉克索（Pramipexole）。这是一种多巴胺激动剂（dopamine agonist），其分子结构与多巴胺高度相似，能直接欺骗并激活大脑的多巴胺受体。然而，许多原本生活规律、心理健全的普通患者在服药后出现了严重的强迫性与冲动性行为失控。 巴特利特列举了几个令人触目惊心的真实案例：一位原本过着普通生活的女性在服药后陷入冲动迷狂，凌晨穿着透视装离家，频繁前往极度危险的场所寻求与陌生人发生性关系；澳大利亚的另一位女性患者则对老虎机彻底上瘾，持续下注直至失禁尿裤子，最终输掉了房产、汽车并导致婚姻破裂；还有原本处于异性恋婚姻中的男性患者，服药后突然开始寻求同性性行为。这些案例揭示出，多巴胺并非单纯带来“奖赏”（reward）或“快乐”（liking），其核心驱动力在于“渴望”（wanting）、冲动与不可遏制的欲望。 ```mermaid flowchart LR accTitle: 多巴胺受体过度激活与成瘾循环机制 accDescr: 展示从外源多巴胺激动剂引入到神经适应下调受体，再到烦躁驱动复发的全过程。 subgraph Stimulation ["刺激与受体激活"] A["多巴胺激动剂 / 高刺激源"] --> B["盲目结合多巴胺受体"] B --> C["爆发性产生冲动与渴望<br/>(Wanting)"] end subgraph Neuroadaptation ["神经代偿适应"] C --> D["大脑下调受体数量<br/>(Downregulation)"] D --> E["多巴胺匮乏状态<br/>(Dopamine Deficit)"] end subgraph Dysphoria ["烦躁驱动复发"] E --> F["想要但不喜欢<br/>(Wanting without Liking)"] F --> G["为消除痛苦而强迫使用<br/>(Dysphoria-Driven Relapse)"] end G -.-> A ``` 伦布克博士对此做出机制层面的解释：初次遭遇成瘾物或行为时，奖赏回路会瞬间释放大量多巴胺，提供强烈正反馈或解除痛苦。然而，随着重复使用，多巴胺的释放峰值迅速衰减、持续时间变短，大脑通过神经适应（neuroadaptation）下调多巴胺受体，最终陷入“多巴胺匮乏状态”。乔治·库布（George Koob）将这一阶段的复发定义为“烦躁驱动的复发”（dysphoria-driven relapse）——此时使用者不再是为了寻求快感，而仅仅是为了摆脱痛苦、回到暂时的正常水平。单纯从外部补充多巴胺分子根本无法治愈这种匮乏，因为外源性药物会无差别结合全脑受体，反而进一步加剧受体下调与成瘾闭环。 --- ### [01:26:11](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5171s) 探索的神经生长与药物对学习能力的劫持 在探讨多巴胺神经生物学研究时，伦布克博士分享了一组关于大鼠脑神经元生长的实验。当科研人员给大鼠单次注射可卡因后，切片观察其大脑奖赏回路，会发现释放多巴胺的神经元出现显著的“树突分支化”（arborization），宛如多巴胺森林在短时间内茂密生长。然而，如果在不给药的情况下，将大鼠放入一个充满挑战与探索机会的复杂迷宫中，其大脑也会展现出完全相同的多巴胺神经元分支化增生。这证明学习、面对未知挑战与新鲜感本身就具有高度奖赏性，因为人类和动物在演化上都是天生热衷于探索领地与获取新知的主体。 然而，决定性的对比在于：如果提前给大鼠使用甲基苯丙胺（冰毒），再将其置入复杂迷宫中，大鼠的大脑并不会在毒品引起的增生之外产生任何额外的新分支。这表明成瘾物质实质上“劫持并窃取”（usurped or stole）了大脑的学习能力与神经可塑性。由于毒品提供了过于强大且压倒性的刺激信号，导致大鼠面对现实环境中的探索与学习挑战时不再产生适应性生长。巴特利特总结道，这也解释了为何沉迷于色情内容或毒品等成瘾行为的人，往往会丧失走出门去求职或探索真实世界的内在动力。 - **学习即天然奖赏**：大脑对新颖性、探索和挑战的响应，与药物一样能激发神经元树突分支化（arborization）。 - **可塑性剥夺**：强效成瘾物占据了大脑的全部适应空间，使个体在面对复杂认知挑战时丧失进一步重塑神经结构的能力。 - **注意范围狭窄化**：长期成瘾导致注意力绝对收窄至成瘾物上，导致其他所有生活活动丧失激励效用，造成动力彻底萎缩。 --- ### [01:29:32](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5372s) “老鼠乐园”实验与环境贫瘠性对成瘾的影响 伦布克博士接着深入探讨了心理学家布鲁斯·亚历山大（Bruce Alexander）著名的“老鼠乐园”（Rat Park）实验。传统成瘾实验往往将单一老鼠关在一个毫无刺激的孤立笼子里，笼中仅有一个提供可卡因的杠杆，老鼠除了疯狂按压杠杆别无选择。亚历山大设计了一个丰容环境（enriched environment）：乐园不仅提供可卡因杠杆，还配备了其他同伴、滑梯、迷宫、木屑球等丰富的互动玩具。结果显示，生活在乐园里的大鼠按下吸毒杠杆的频率远远低于孤立笼中的大鼠，因为它们拥有大量其他具有奖赏性质的生活来源。 这项里程碑式的研究表明，成瘾绝非单纯的分子生化反应，环境背景起到了决定性的调节作用。尽管高刺激成瘾物对大脑奖赏回路的作用极其猛烈，即使生活富足的人也有可能成瘾，但身处匮乏、孤立与贫瘠环境中的个体陷入成瘾的风险呈指数级上升。当现实世界缺乏健康的多巴胺刺激源时，药物或数字依赖就会乘虚而入。基于亚历山大的这一发现，诸如冰岛青少年干预模式（Icelandic Model）等结合社会支持与环境改造的公共成瘾治理策略应运而生。 ### [01:31:02](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5462s) 冰岛模式：从动物实验到现实中的多巴胺置换 Dr. Anna Lembke 提到多年前冰岛所进行的一项著名现实干预。当时冰岛面临着极其严峻的青少年药物滥用危机。政府并未仅仅采取传统的说教或惩罚手段，而是选择修建大量的体育馆，大力推广青少年体育运动。运动与锻炼是一种极其健康的多巴胺获取方式——因为与毒品或短视频带来的即时快感不同，运动需要个体“预先支付代价”（paying for it up front），必须先付出艰苦的体能消耗和汗水，随后才能收获持久、稳定的神经化学奖赏。 在全面推行这套青少年体育支持系统后，冰岛的青少年药物滥用率出现了大幅下降。Dr. Anna Lembke 强调，这是一个极佳的范例，展示了实验室中的动物实验模型（如环境丰富化对抗成瘾）如何为理解大脑的底层运行机制提供基础框架，并最终成功转化为行之有效的现实公共卫生政策。 ```mermaid flowchart TD accTitle: 冰岛青少年成瘾干预逻辑 accDescr: 展示从即时多巴胺诱惑到前置付出型健康多巴胺的转变机制 subgraph Problem["传统成瘾陷阱"] A["药物滥用 / 廉价快感"] --> B["即时多巴胺飙升后崩盘"] end subgraph Intervention["冰岛体育干预模式"] C["兴建大量体育馆"] --> D["广泛参与青年体育竞技"] D --> E["前置付出体能代价 (先苦后甜)"] end subgraph Outcome["神经重塑与成效"] E --> F["健康、持久的多巴胺释放"] F --> G["显著降低青少年药物滥用率"] end ``` --- ### [01:31:57](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5517s) 彻底诚实：为何戒瘾必须从不撒任何谎言开始 谈到“彻底诚实”（Radical Honesty）这一概念时，Dr. Anna Lembke 指出，这是她在临床实践中从患者身上学到的最深刻的智慧之一。她观察到，那些能够从严重成瘾中实现长期稳定康复（sustained recovery）的患者，无一例外都领悟并践行了一条严苛的准则：他们绝对不能撒谎。令人震惊的是，这种诚实并不局限于对毒品或成瘾行为本身不隐瞒，而是延伸到了生活的每一个微小缝隙——他们不能为会议迟到了 5 分钟而编造借口，也不能为推脱一个派对邀请而找虚假的理由，必须在所有大大小小的事情上彻底讲真话。 Dr. Anna Lembke 受到触动并在自己的生活中实践这一点后发现，讲真话其实异常艰难。普通人每天都在不知不觉中吐露无数个细小的谎言：为了掩饰自己的不足而随口粉饰、为了让自己听起来更有趣而夸大其词（lies of exaggeration），抑或为了迎合讨好别人而给出违心的奉承赞美（lies of flattery）。即便是没有严重成瘾困扰的普通人，这些习以为常的微小谎言也会日积月累地侵蚀生活的真实质感，使人生的精神世界变得日益贫瘠。 彻底诚实之所以能产生强大的保护作用，最根本的原因在于它构建了纯粹的自我觉察（Self-Awareness）： - **打破自我欺瞒的闭环**：对他人撒谎的同时，大脑也在欺骗自己。当人处于自我欺骗中时，根本无法清醒评估自身行为。例如在沉迷刷视频时，主观上可能以为自己只是放松一下，但一旦必须向另一个人如实汇报“今天刷了多少小时、看了多少次、何时看的”，那种游荡在潜意识幽暗角落里的模糊放纵立刻在现实中具象化了。 - **自传体叙事（Autobiographical Narrative）的力量**：Dr. Anna Lembke 作为精神科医生多年观察发现，一个人如何讲述自己的生命故事至关重要。如果患者在自叙中永远把自己塑造成外界环境或其他人的“受害者”（Victimhood），他们几乎绝无可能成功康复；相反，一旦他们开始在叙事中承认自己对问题的发生负有责任、直面自身行为造成的后果，康复之路便真正开启。 - **故事即未来的路线图**：自传叙事不仅仅是对过去的归纳总结，更是通往未来的行为蓝图。基于客观真相构建的故事模型，能为大脑提供精准真实的数据支撑，从而在未来的人生节点做出更优决策；而受害者心态不仅剥夺了个人的觉察力，更彻底瓦解了个体的责任担当。 --- ### [01:36:50](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5810s) 能动性与失控：12步法的神经与心理本质 面对 Steven Bartlett 关于“能动性（Agency）是否等同于控制感”的提问，Dr. Anna Lembke 给出了更为审慎的厘清。她认为能动性不能简单等同于对生活的全盘掌控，因为生命中有太多客观事物是不可控的；能动性的真谛在于将决策的尺度收缩到“今天”——专注于自己今天能够掌控的事情，并在这些具体的微小事务上重新夺回自主选择的力量。Steven 补充了能动性的经典定义：“有意识地行动并做出影响结果的选择的能力”（the capacity to act intentionally and make choices that influence outcomes），具备高度能动性的人通常在事业上更成功、幸福感也更高。 然而，在重度成瘾的语境下，能动性存在着致命的认知误区。成瘾者最常见的心理机制之一是否认（Denial）——他们常常自欺欺人地坚信“我随时都能控制它”、“我想停就能停”，这种虚假的掌控感反而强化了恶性循环。因此，实现戒瘾的第一步往往不是展现能动性，而是痛苦地承认能动性的丧失： - **承认失控（Loss of Agency）**：承认自己可能在生活的其他领域能力出众、充满能动性，但在面对特定的成瘾物质或行为时，自己已经失去了控制能力。 - **12步戒瘾法（Twelve-step Program）的核心**：这也是匿名戒酒会（Alcoholics Anonymous，AA）十二步法的第一步真谛——公开承认面对成瘾物时，生活已经陷入了不可自拔的“失控与不可收拾”（lives have become unmanageable）。 - **微小能动性的重聚**：即便在成瘾的至暗深渊中，个体依然保留着最后一丝极其宝贵的能动性——那就是“开口寻求帮助”的选择。借由这一微小的举动跳出成瘾漩涡后，个体再依靠日复一日做出正确的当下微小决策，积小胜为大胜，最终赢回掌控人生的完整能动性。 --- ### [01:38:42](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5922s) 新年决心的致命误区：全戒与适度节制 随着话题转向大众常立的“新年愿望”（New Year’s Resolutions），Dr. Anna Lembke 剖析了许多人习惯性失败的心理根源。最普遍的障碍在于“非全即无”的极端思维（all-or-nothing thinking）——人们往往喜欢立下斩钉截铁的宏大誓言，例如“我发誓接下来一个月滴酒不沾”、“我再也不吃任何糖”、“我必须每天都去健身房打卡”。然而，一旦在过程中出现哪怕一次小小的破戒，强烈的羞耻感与严酷的自我谴责（shame and self-recrimination）就会随之而来，进而演变成彻底破罐破摔的大溃败。 针对这种情况，更持久有效的方式往往是带着“自我同情”（self-compassion）去设立适度节制（Moderation）的目标。Dr. Anna Lembke 补充道，虽然从神经机制来看，如果一个人能先彻底戒断足够长的时间，让大脑的多巴胺奖赏回路重置到稳态基线，后续的“适度保持”会更加容易成功；但对于难以一步到位的普通人而言，哪怕仅仅是减少摄入频率和使用量，也是一种值得称赞并切实可行的生活进步。 --- ### [01:39:55](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5995s) 灵魂提问：放手的痛感与空巢期母亲的数字纠葛 进入播客惯例的“前一位嘉宾留给后一位嘉宾的秘密问题”环节，本期留下的问题是：“宇宙一直摆在你面前、不断让你去学习的一件事是什么？”（"What's the one thing the universe keeps putting in front of you and keeping you learning?"） Dr. Anna Lembke 卸下了专家的外壳，分享了自己作为母亲当下最真实的内心挣扎。她坦言，宇宙目前反复考验她的功课，是“学会放手，让孩子们去独立经历属于他们自己的人生”（letting my kids go and have their own life experience）。陪伴孩子们成长的岁月曾是她生命中最幸福充盈的时光，但如今孩子们渐渐羽翼丰满，她必须克制想要紧紧抓住过去亲密模式的冲动，学会在空巢期（empty nester）重新锚定自我与生活方向。 当 Steven 追问这种痛苦在现实中具体是如何表现时，Dr. Anna Lembke 极为坦率地给出了一个极具现代感的真实剖白：数字化沟通与社交媒体让这种心理断乳变得更加困难与撕裂。最典型的例证便是苹果手机的“查找”（Find My iPhone）定位功能——她发现自己会忍不住频繁打开手机，强迫性地查看孩子们当下身处何方，这种科技带来的虚拟连接感，不断诱惑着一位母亲想要放下却难以完全割舍的控制欲。 ### [01:41:17](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=6077s) 科技带来的“连接幻觉”与自我抚慰的陷阱 安娜·伦布克医生（Dr. Anna Lembke）坦诚分享了自己在日常生活中的矛盾心理：她常常通过手机定位查看孩子们身在何处，潜意识里以为“只要我知道他们在哪里，我们之间就产生了一种联结”。然而事实恰恰相反，这种单向的监控不仅没有带来真实的亲密感，孩子们也非常反感被追踪。人们总渴望人际连接，试图通过短信、定位等数字技术去模拟或重塑这种关系，但安娜医生反思道，如果完全不发短信、不去追踪行踪，双方的关系反而可能更加健康、轻松。 听到这里，史蒂芬·巴特利特（Steven Bartlett）忍不住笑出声来，调侃脑海中浮现出的滑稽画面：安娜医生一边坐在屏幕前实时盯着孩子们的定位轨迹，另一边屏幕上还在津津有味地刷着挤痘痘视频。安娜笑着承认，这两者在心理机制上本质是完全相通的——它们都是一种“自我抚慰”（self-soothing）式的强迫性行为。虽然短期内能缓解内心的焦虑与失控感，但长远来看对自己无益，对身边的亲人也同样没有好处。 ### [01:42:15](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=6135s) 戒除恶习的生理基石：HALT 原则与自我关怀 针对日常生活方式对打破坏习惯的影响，史蒂芬询问睡眠、冥想和营养是否对戒除不良成瘾、养成新习惯具有决定性作用。安娜医生给出了极为肯定的答复，并特别引用了匿名戒酒互助社（Alcoholics Anonymous，简称 AA）中经典的 **HALT** 助记法则： - **H (Hungry / 饥饿)**：身体缺乏能量，血糖波动加剧冲动； - **A (Angry / 愤怒)**：情绪失衡，容易寻求宣泄或补偿； - **L (Lonely / 孤独)**：缺乏真实的人际联结，诱发替代性数字或物质成瘾； - **T (Tired / 疲惫)**：意志力与前额叶皮层调控能力被严重削弱。 ```mermaid flowchart TD accTitle: HALT 风险触发机制与身心关怀模型 accDescr: 展示 HALT 状态如何导致自控力瓦解，以及通过生理与情绪照顾切断成瘾冲动。 subgraph Triggers ["身心匮乏状态 (HALT)"] H["H: 饥饿 (Hungry)"] A["A: 愤怒 (Angry)"] L["L: 孤独 (Lonely)"] T["T: 疲惫 (Tired)"] end subgraph Reaction ["心理代偿机制"] Depleted["身心能量耗竭 / 前额叶功能下降"] Craving["强烈渴望'首选多巴胺来源'<br/>(寻求麻木、逃避与自我抚慰)"] Relapse["恶习复发 / 陷入成瘾循环"] end subgraph Solution ["自我照护基石"] Care["充足睡眠 · 优质营养 · 真实社交 · 情绪疏导"] FullCup["将自己的杯子注满 (保持身心充盈)"] end H & A & L & T --> Depleted Depleted --> Craving --> Relapse Care --> FullCup FullCup -.->|切断渴望通路| Depleted ``` 当个体处于饥饿、愤怒、孤独或疲惫的状态时，大脑抵御诱惑的防线最为脆弱，会不可遏制地渴望自己的“首选成瘾物”（drug of choice）。因此，改变恶习的前提必须是照顾好最基本的生理与情绪健康，避免让自己跌入需要通过逃避、自我麻痹来舒缓痛苦的极端状态。安娜医生指出，这一原则对于心理健康工作者同样适用：治疗师必须先把自己的需求满足好、“把自己的杯子注满”，唯有自身精力充盈、状态稳定，才能真正全身心地倾听并支持来访者。 ### [01:43:08](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=6188s) 告别羞耻感：用同理心重新夺回人生掌控权 史蒂芬在访谈结尾向安娜·伦布克医生表达了深切感谢。他提到两人上一次的对话在全网引起了轰动，全平台播放量已接近 1000 万次，仅在 YouTube 上的播放量就突破了 500 万次。神经科学的底层机制极为繁复精深，但安娜医生擅长将其转化为简单明了的心智模型，帮助无数普通人清晰看透自己身体和大脑内部正在发生的化学反应。 史蒂芬特别推荐了安娜医生的畅销著作《多巴胺国度》（*Dopamine Nation*）及其配套练习册（*The Official Dopamine Nation Workbook*）。他指出，这些著作之所以能产生如此深远的影响，关键在于安娜提供了一套“充满细腻洞察、同理心且杜绝道德羞耻感”的解决方案。无论是深陷阿片类药物成瘾，还是被数字科技与社交媒体困住，当某些不良行为阻碍了我们成为理想中的自我时，这些工具都能提供切实出路。史蒂芬还透露安娜医生目前正在撰写一部关于全新主题的神秘新书，并热情相约在新作出版时再度开展深度对谈。 ### [01:44:43](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=6283s) 拆解远大目标：以“1% 哲学”走出心理舒适区 访谈结束后，史蒂芬分享了他为《CEO 日记》受众量身打造的个人成长工具——“1% 日记”（1% Diary）。他观察到频道的听众无论在商业领域还是健康管理上都是极具野心的“进取者”（strivers），都拥有宏大的愿景。然而，将目光死死盯在过于庞大的终极目标上，往往会带来强烈的心理不适与瘫痪感，“就像站在珠穆朗玛峰脚下仰望顶峰一样令人望而生畏”。 史蒂芬团队的核心哲学在于**将宏大目标拆解为微小的具体步骤，专注于每天积累 1% 的进步**。由于去年推出的初版日记迅速售罄，团队在收集反馈后进行了细节优化，并推出了全新配色阵容。史蒂芬建议那些渴望建立清晰框架、保持日常行动力的人尽早入手这套工具，并说明了在官方网站购买时可享受的“黑色星期五”20% 组合优惠。 ## Notable quotes > [02:17](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=137s) 成瘾是当代社会的真正瘟疫 — Dr. Anna Lembke > [20:32](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1232s) 我们是在主动将自己的能动性（agency）和权力拱手让给机器，而且我们现在就已经在这么做了。 — Dr. Anna Lembke > [20:32](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=1232s) 真的一点都不好。 — Dr. Anna Lembke > [37:11](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=2231s) 一台精神手淫机（essentially a masturbation machine） — Dr. Anna Lembke > [01:01:53](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3713s) 意志力是一种会耗尽的资源 — Dr. Anna Lembke > [01:04:10](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3850s) 即使对自己或他人造成了明确的伤害，依然强迫性地过度消耗与使用 — Dr. Anna Lembke > [01:04:58](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3898s) 先做最难的事情 — Dr. Anna Lembke > [01:04:58](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=3898s) 以痛苦开启你的一天 — Dr. Anna Lembke > [01:06:57](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4017s) 妈妈，你现在总是在刷 YouTube。 — Dr. Anna Lembke 的女儿 > [01:20:52](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=4852s) 我们终于把孩子找回来了。 — 家长们 > [01:39:55](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=5995s) 学会放手，让孩子们去独立经历属于他们自己的人生 — Dr. Anna Lembke > [01:41:17](https://www.youtube.com/watch?v=2ZKLaUbB33o&t=6077s) 只要我知道他们在哪里，我们之间就产生了一种联结 — Dr. Anna Lembke ## Mentioned Anna Lembke, Steven Bartlett, Rob Malenka, Elon Musk, Peter Diamandis, Neil Postman, David Foster Wallace, Gabor Maté, Edith Sullivan, Nora Volkow, George Koob, Bruce Alexander, ChatGPT, Replika, Optimus, TikTok, YouTube, Dr. Pimple Popper, Find My iPhone, Intuit QuickBooks, Bon Charge, Shopify, Dopamine Nation, The Official Dopamine Nation Workbook, Amusing Ourselves to Death, Infinite Jest, Abundance, 1% Diary, Pew Research, Stanford University, Alcoholics Anonymous ## Video description Dopamine expert DR ANNA LEMBKE reveals how addiction is hijacking your brain, why dopamine addiction is rising fast, the danger of social media, porn, AI, and how to regain control FAST! Dr Anna Lembke is Professor of Psychiatry and Medical Director of Addiction Medicine at Stanford University School of Medicine. She has spent over 25 years treating patients with substance and behavioral addictions and is the bestselling author of “Dopamine Nation”. She explains: ◼️Why endless pleasure quietly trains your brain to feel worse, not better ◼️How digital habits replace real connection with instant validation ◼️Why dopamine spikes always come with a hidden crash ◼️How easy comfort erodes discipline, motivation, and intimacy ◼️The practical reset that restores balance and control 00:00 Intro 02:52 Dopamine and Overabundance 04:09 How to Shake Bad Habits 06:03 Why Are Harmful Substances Addictive? 07:02 The Dangers of AI Simulating Human Connection 12:41 Sex Addiction 19:16 Elon Musk's Age of Abundance 22:10 We're Entertaining Ourselves to Death 23:22 How Our Brain Processes Pleasure and Pain 28:38 Why Do We Fall Off Our Good Habits? 30:27 When Are We Most Susceptible to Self-Destructive Behaviours 31:40 Who Is More Vulnerable to Addiction? 32:46 Link Between Addiction and People With ADHD 34:13 Link Between Childhood Trauma and Addiction 35:44 Parents Soothing Child’s Emotions With Technology 37:11 Could AI Replace Parenting 39:52 Are You Hopeful People Will See the Downsides of AI? 43:10 Social Media Trials 44:58 Ads 45:54 The Science Behind How to Get Rid of Bad Habits 53:18 Is Addictive Personality a Real Thing? 54:07 4-Week Resolutions 56:11 Psychological Strategies for Adopting Good Habits 58:47 How to Trick Your Brain to Enjoy Doing Hard Things 01:01:53 How to Avoid Relapse 01:04:10 Is It Possible to Become Addicted to Good Things Too? 01:04:58 Daily Routines to Kick the Habit 01:06:57 The "Count Back" Trick to Start New Habits 01:10:13 Ads 01:12:10 Brains of Addicted vs. Non-Addicted People 01:17:26 Shocking Dopamine Research 01:19:06 Impact of Dopamine Addiction on Personal Relationships 01:22:36 Dopamine Agonist Drugs 01:26:11 Dopamine Release Associated With Learning and Impediments 01:31:57 Radical Honesty 01:36:50 What Is Agency and Why Does It Matter 01:38:42 The Biggest Problem With New Year’s Resolutions Follow Dr Anna Website - https://bit.ly/4pS0ckD Stanford Medicine - https://stan.md/4oXiyzq Independent Fact Check: https://stevenbartlett.com/wp-content/uploads/2026/01/DOAC-Anna-Lembke-2-Independent-Research-further-reading.pdf You can purchase Dr Anna’s book, ‘The Official Dopamine Nation Workbook: A Practical Guide to Overcoming Addiction in the Age of Indulgence’, here: https://amzn.to/4oZKEdl The Diary Of A CEO: ◼️Join DOAC circle here - https://doaccircle.com/ ◼️Buy The Diary Of A CEO book here - https://smarturl.it/DOACbook ◼️The 1% Diary is back - limited time only: https://bit.ly/3YFbJbt ◼️The Diary Of A CEO Conversation Cards (Second Edition): https://g2ul0.app.link/f31dsUttKKb ◼️Get email updates - https://bit.ly/diary-of-a-ceo-yt ◼️Follow Steven - https://g2ul0.app.link/gnGqL4IsKKb Sponsors: Shopify - https://shopify.com/bartlett Intuit - If you want help getting out of the weeds of admin, https://intuitquickbooks.com Bon Charge - http://boncharge.com/diary?rfsn=8189247.228c0cb with code DIARY for 25-30% off [Source](https://www.youtube.com/watch?v=2ZKLaUbB33o)

[2:17] Dr. Anna Lembke: 成瘾是当代社会的真正瘟疫 [20:32] Dr. Anna Lembke: 我们是在主动将自己的能动性（agency）和权力拱手让给机器，而且我们现在就已经在这么做了。 [20:32] Dr. Anna Lembke: 真的一点都不好。 [37:11] Dr. Anna Lembke: 一台精神手淫机（essentially a masturbation machine） [61:53] Dr. Anna Lembke: 意志力是一种会耗尽的资源 [64:10] Dr. Anna Lembke: 即使对自己或他人造成了明确的伤害，依然强迫性地过度消耗与使用 [64:58] Dr. Anna Lembke: 先做最难的事情 [64:58] Dr. Anna Lembke: 以痛苦开启你的一天 [66:57] Dr. Anna Lembke 的女儿: 妈妈，你现在总是在刷 YouTube。 [80:52] 家长们: 我们终于把孩子找回来了。 [99:55] Dr. Anna Lembke: 学会放手，让孩子们去独立经历属于他们自己的人生 [101:17] Dr. Anna Lembke: 只要我知道他们在哪里，我们之间就产生了一种联结

[8:21] Dr. Anna Lembke: 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... in a world of abundance, we are entertaining ourselves to death. [23:22] Dr. Anna Lembke: No sooner has that happened than our brain responds by neuroadaptation... we then downregulate dopamine transmission... going on the pain side of the balance to bring it level again. [54:07] Dr. Anna Lembke: 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 an amount of time that they can wrap their heads around. [64:58] Dr. Anna Lembke: If you expose your brain first thing in the morning to things that are incredibly pleasurable, you have nowhere to go from there... you're going to have a come down from that. And then you're going to be starting from a place of compromise. [170:27] HALT [170:27] Hungry, Angry, Lonely, Tired [174:43] Steven Bartlett: 1% Diary

[0:00] There's a great experiment where rats [0:02] were given a lever to press for cocaine, [0:04] and after learning that it releases a [0:05] lot of dopamine, the rats will [music] [0:07] press that lever till exhaustion or [0:09] death, which is essentially the model of [0:11] addiction that we see in humans. But, if [0:12] the cocaine is then removed, eventually [0:15] they won't press the [music] lever [0:16] anymore. Now, if that same rat, after a [0:18] period of time, is then exposed to a [0:20] very painful foot shock, the first thing [0:22] the rat will do is run over and start [0:24] pressing that lever again. And that's [0:26] really powerful because it shows that [0:28] when individuals are under extreme [0:30] stress, they are more vulnerable to [0:32] going back to compulsive overconsumption [0:34] of their drug of choice because their [0:36] brain has already encoded using these [0:38] high-dopamine rewards as a way to get [0:40] out of that pain. [0:41] >> Okay, so what do I need to do to make [0:43] sure that I can knock the bad habits and [0:45] add some new ones? Here's what we do. [0:47] Dr. Anna Lembke is chief of the Stanford [0:49] Addiction Clinic and a world-leading [0:50] [music] expert on the subject of [0:51] dopamine. And now she's returned to warn [0:53] us that addiction is the modern plague [0:56] and how we can rewire our brains to take [0:58] back control. On average, it takes 4 [1:00] weeks for people to get out of constant [1:02] state of [music] craving. But, here's [1:03] the problem. Our survival depends on [1:06] figuring out how to live in a world of [1:08] abundance. For example, we're now seeing [1:10] the drugification of human connection [1:12] through social media, dating apps, and [1:15] now artificial intelligence designed to [1:17] flatter, to validate. There's no [1:20] friction there, and so it's pulling us [1:22] away from the hard things that we need [1:24] to be doing in real life to cultivate [1:26] real-life relationships. It just we [1:27] cannot go in that direction because in a [1:29] world of abundance, we are entertaining [1:31] ourselves to death. Sounds like a good [1:33] way to go. It's really not because the [1:35] relentless pursuit of pleasure leads to [1:38] anhedonia. [music] [1:38] What's that mean? The inability to take [1:40] joy in anything at all. [1:43] Teach me everything. [1:46] I see messages all the time in the [1:47] comment section that some of you didn't [1:49] realize you didn't subscribe. So, if you [1:51] could do me a favor and double-check if [1:52] you're a subscriber to this channel, [1:53] that would be tremendously appreciated. [1:55] It's the simple It's the free thing that [1:57] anybody that watches this show [1:58] frequently can do to help us here to [2:00] keep everything going in this show in [2:02] the trajectory it's on. So, please do [2:03] double-check if you subscribed, and [2:05] thank you so much because in a strange [2:07] way you are you're part of our history [2:09] and you're on this journey with us, and [2:11] I appreciate you for that. So, yeah, [2:12] thank you. [2:14] >> [music] [2:17] >> Dr. Anna Lembke. [2:20] For anyone that might not know you, [2:21] and they didn't watch our conversation [2:23] last time, which was a fantastic [2:24] conversation, one of my favorites of all [2:25] time, and also I know Jack said to me as [2:28] well that it was one of his favorites of [2:29] all time. Who are you and what have you [2:31] spent your career doing if you had to [2:32] summarize it? What are the reference [2:35] points that your wisdom draws upon and [2:36] the experiences you've had and the [2:38] people you've worked with? I'm a [2:40] psychiatrist. I did a residency in [2:43] psychiatry at Stanford University, and [2:45] then I stayed on, joined the faculty. [2:48] I see patients, I do research, and I [2:51] teach. You wrote this um iconic book [2:54] about this word dopamine. Why does it [2:57] matter so much? Why does this this idea [2:59] of dopamine matter so much? Dopamine is [3:02] a chemical we make in our brain, but I [3:04] use it in the book as really an extended [3:07] metaphor for the ways in which [3:10] overabundance itself is a human [3:13] stressor. [3:14] We are living in a time and place where [3:16] we have more access to luxury goods, [3:19] more disposable income, more leisure [3:21] time, even for the poorest of the poor [3:24] ever before in recorded history. [3:27] And it turns out that is stressful for [3:30] our brains, and it's stressful in a [3:33] brand new way that we really haven't [3:35] confronted before, making us all more [3:38] vulnerable to the problem of compulsive [3:40] overconsumption and addiction. [3:43] And I do think that addiction is the [3:45] modern plague. [3:46] I think we're going to be struggling [3:48] with the problem of compulsive [3:49] overconsumption in a world of abundance [3:53] for the foreseeable future as in [3:55] centuries. [3:57] And our survival will depend on figuring [4:00] out how to live in a world of abundance, [4:04] even though we have brains that evolved [4:06] for a world of scarcity. At this time of [4:09] the year, people are thinking a lot [4:10] about making changes in their life. They [4:12] want to get in shape, they want to lose [4:13] a couple of pounds, they want to save [4:15] their money, they want to knock the [4:16] addiction, they want to stop [4:19] the smoking, the [4:22] drugs, and the [4:24] alcohol. So, as it relates to the [4:27] subject of dopamine, [4:29] how are these two things linked? Are [4:31] habits and dopamine? What is the the [4:33] link or the connection there because I [4:35] think most people listening right now [4:36] have probably made a New Year's [4:37] resolution, even if it's just in their [4:38] mind, and I'm wondering how everything [4:41] you write about in Dopamine Nation is [4:43] related to and critical to understand if [4:45] I am going to shake some of these bad [4:46] habits that I have or pick up some new [4:48] ones. The place to start is to have [4:51] self-compassion [4:53] because we are living in a world of [4:55] abundance where we have easy access to [4:58] all kinds of reinforcing substances and [5:00] behaviors. And access itself is one of [5:03] the biggest risk factors for addiction. [5:06] So, if you grow up in a neighborhood [5:08] where drugs are easily and readily [5:09] accessible, you're more likely to try [5:11] them and more likely to get addicted to [5:13] them. [5:14] And what do addictive substances and [5:17] behaviors do to our brains? They release [5:19] a lot of dopamine all at once in a [5:21] dedicated part of the brain called the [5:23] reward pathway. [5:25] And the fact that they release so much [5:28] dopamine at once means that they're [5:30] highly salient and memorable [5:32] experiences, right? So, our brain really [5:36] encodes that experience deeply, that [5:38] experience of intense pleasure that was [5:43] self-administered, [5:44] that I could potentially do again. [5:47] Why? [5:49] Okay, in a world of scarcity and [5:52] ever-present danger, which is the world [5:53] that we evolved for, we will naturally, [5:57] reflexively approach pleasure and avoid [5:59] pain, and we must do so for our [6:02] survival. Why? So, if I have a cigarette [6:04] now, [6:06] >> [sighs] [6:06] >> it's going to be a really memorable [6:08] experience from a brain perspective. [6:12] Why does my brain make it memorable, and [6:14] why would I want to then go do that [6:15] again from a survival perspective? Mm, [6:18] okay, great question. So, let's first [6:21] distinguish what we call natural [6:23] rewards. So, natural rewards are food, [6:26] clothing, shelter, finding a mate. Yeah. [6:29] These are things we must obtain in order [6:31] to survive. [6:33] What [6:34] addictive drugs and behaviors do is they [6:37] mimic those natural rewards by [6:40] exploiting our internal brain chemistry [6:44] to release a lot of dopamine all at [6:46] once, much more than we would get from [6:49] natural rewards existing in nature, [6:52] amplifying that experience, making it [6:54] even more memorable, even more salient, [6:57] and also making our brain think, "Ah, [6:59] this is important for my survival." Ah, [7:02] okay, so there's certain natural rewards [7:05] like eating, which of course my body [7:07] wants to reward me for so I eat again. [7:09] And these chemicals in front of me like [7:11] the cigarettes, the whiskey, the drugs, [7:14] those have been designed to hijack that [7:17] particular part of the brain and really [7:19] amplify the feeling. So, that my brain [7:21] kind of is tricked into thinking that it [7:22] was potentially a natural reward, but [7:25] it's actually a synthetic sort of [7:27] man-made [7:28] chemical. [7:29] Exactly. And what we see in the [7:32] evolution of drugs over, [7:35] you know, human lifetimes, but [7:37] especially in the last 200 years, is the [7:40] application of science and technology to [7:44] take like the coca leaf, for example, [7:47] right? That's been around forever, and [7:51] essentially make it even more potent, [7:54] even more available, to make it a faster [7:57] delivery mechanism. So, we have this [7:59] history of increasing potency and [8:02] availability over time. [8:04] Said more simply, drugs are getting even [8:07] more potent over time, so this [8:09] vulnerability to the hijacked brain is [8:13] even more common, including taking [8:16] things that we didn't even really think [8:17] of as drugs and turning them into drugs. [8:21] So, remember the natural rewards, one of [8:23] them is finding a mate. Mhm. [8:26] And one of the ways our brains gets us [8:28] to do that is by making falling in love [8:32] and making intimacy and human connection [8:34] rewarding on a neurobiological level, [8:37] including releasing dopamine in our [8:39] reward pathway when we make those kinds [8:42] of social connections. My colleague at [8:45] Stanford, Rob Malenka, and and his [8:48] colleagues did an interesting experiment [8:50] where they were able to show that [8:51] oxytocin, our love hormone, binds to [8:55] dopamine-releasing neurons in the reward [8:58] pathway and releases dopamine, which is [9:00] just one more link in the chain showing [9:03] us that falling in love, human [9:05] connection is rewarding. It feels good. [9:08] It releases dopamine. [9:10] What we see now is the drugification [9:14] of human connection, for example, [9:16] through social media, dating apps, [9:20] online pornography, and now artificial [9:23] intelligence and other large language [9:26] models, which create this frictionless [9:29] experience with technology that feels [9:32] like talking to a human being and is [9:34] incredibly validating, right? So, the [9:36] algorithms for large language models are [9:39] to make us feel really good, to make us [9:41] feel like our point of view is the right [9:43] point of view, to bolster our [9:45] self-esteem, to validate our point of [9:47] view. That's how those algorithms are [9:48] designed. And now, even more explicitly, [9:51] we have AI models that are explicitly [9:54] pornographic, explicitly erotic, right? [9:56] So, now you have this interactive [9:58] component that learns what we like and [10:00] then is able to regurgitate it back to [10:02] us. So, you get this really very [10:04] powerful [10:06] action-perception loop, which is part of [10:09] what makes a drug potent. It's that I [10:12] have control over it, right? I can [10:15] decide when I'm going to change the way [10:17] I feel by using this drug. Are you [10:20] concerned about [10:21] AI and ChatGPT and all those large [10:23] language models that have emerged that [10:24] are now simulating human connection? [10:27] Yes, I'm very concerned. [10:30] I see the not-so-good outcomes, meaning [10:32] people who get addicted to social media, [10:35] to dating apps, to online pornography, [10:38] um and to AI, you know, and and who end [10:41] up using those [10:43] forms of media [10:45] to [10:46] simulate human connection while they [10:49] actually become more and more [10:51] disconnected. Have you started to see [10:53] anybody in your practice or heard of [10:55] anybody that's developing an addiction [10:57] to [10:59] AI or relationships with AI? [11:01] So, we are starting to see that. Um you [11:04] know, individuals who are spending more [11:06] and more time on AI looking for [11:09] companionship. [11:11] Often, this is individuals who are [11:13] experiencing marital or interpersonal [11:16] conflict who turn to AI for advice on [11:20] how to handle interpersonal conflict and [11:23] often for emotional validation because [11:25] they're not getting it from their [11:26] partners. And what they experience with [11:28] AI is an enormous amount of emotional [11:30] validation, validating their point of [11:33] view, but also [11:35] a sense of companionship, [11:38] um you know, a repeated process of [11:40] feeling like they're understood, they're [11:43] they're they're validated, such that [11:44] then they're spending more and more time [11:47] on AI. And of course, that is the [11:50] essence [11:52] of [11:53] the addiction to digital media. It's the [11:57] time spent, right? Which then leads to [12:00] opportunity cost, other things that [12:02] we're not doing because we're spending [12:04] so much time online. [12:06] Furthermore, it in my experience often [12:09] leads to a rift between [12:13] those individuals and their real-life [12:14] partners. Because instead of going to [12:17] their real-life partners and talking, [12:19] and we know that the most important [12:22] thing that, you know, two individuals in [12:24] a relationship can do is one four-letter [12:27] word that ends with K, which is talk. [12:30] Those individuals stop talking, [12:32] right? And instead, they're getting [12:33] their needs met through AI. [12:36] And that leads then to a further and [12:38] further rift between those individuals. [12:41] Do you do you actually think that it it [12:42] is [12:43] these chatbots that we're increasingly [12:45] speaking to about our problems are [12:47] actually taking the place of [12:50] humans in our life? [12:52] I do. You know, in my book, I my first [12:54] chapter in the book is about a patient [12:57] of mine, a scientist and an engineer who [13:01] got addicted to pornography and [13:03] eventually made his own masturbation [13:05] machine. [13:07] And [13:08] he did that with a record player and a [13:09] metal device attached to his organs that [13:12] he could then uh fine-tune control, and [13:15] then ultimately, that got more and more [13:17] sophisticated over time, and he had [13:19] electrical wires from his body to the to [13:22] a through a stereo system and the [13:24] internet. And when I first heard um from [13:28] Jacob about his trajectory and the [13:31] severity of his [13:33] sex addiction, which ultimately led to [13:35] the dissolution of his relationship, the [13:38] near loss of his employment, and [13:40] ultimately severe depression and [13:42] suicidal ideation. Thankfully, he did [13:44] not end his life. [13:47] When I first heard about that, I had [13:49] this distinct sense of like otherness, [13:52] like, "Oh my gosh, I can't even imagine [13:55] doing that, and that's just kind of [13:59] horrific." [14:00] But that that response really lasted all [14:03] of 5 seconds before I realized, "Oh, [14:06] wait a minute. [14:07] I do that." You know, I do that with [14:09] romance novels, and in a way, we're all [14:12] doing that with our devices, right? [14:14] We're turning to these devices to meet [14:17] our [14:19] emotional, sexual, intellectual, you [14:23] name it, needs. [14:24] And these devices are so good at meeting [14:26] those needs that we are [14:29] getting further and further away from [14:32] investing in our relationships with the [14:34] people who are, you know, in our lives. [14:36] And you can see this especially with [14:38] younger generations, like the the [14:40] epidemic of loneliness now, you know, [14:42] Gen Z weaned on this technology, many of [14:45] whom endorse a significant loneliness, [14:48] isolation, a depression, spending more [14:51] and more time online, um report [14:54] preferring to interact socially online [14:57] than to do it in person. So, this is [14:59] definitely a a dark undercurrent um that [15:03] we're seeing in the world today. I was [15:04] reading about a story which was [15:05] published in a People magazine of a [15:07] 28-year-old woman who admitted that [15:09] she's fallen in love with her her AI [15:11] boyfriend that she created using [15:12] ChatGPT. She's got a husband, a [15:15] real-life husband, yet she found more [15:17] comfort in her ChatGPT [15:21] boyfriend. Um and she said that it [15:23] started as a fun experiment, um [15:25] but eventually they ended up getting [15:26] attached, and now she's paying a $200 a [15:28] month subscription so she can interact [15:30] with her AI boyfriend without [15:32] restrictions. [15:34] The AI has helped her throughout her [15:36] life [15:37] and has given her incredible emotional [15:39] support. [15:41] And now there's actually AI companion [15:42] apps like Replika where which have [15:44] millions of users, [15:46] and the whole sort of premise of those [15:47] apps is that they will be your [15:49] companion. The other really interesting [15:51] thing that I am I don't think people [15:52] realize about the AIs that they're using [15:54] is that they are personalizing their [15:56] answers and their responses to you. [15:58] Right. And I didn't I didn't believe [15:59] this fully until one of my friends in [16:01] our Manchester United chat recently. We [16:02] were debating who's the best football [16:04] player of all time, Ronaldo or Messi. [16:06] And I went on my ChatGPT, and I asked [16:08] the question, and it said Messi. So, I [16:10] was like, "Here you go." [16:12] >> [laughter] [16:12] >> And then he went on his and asked the [16:14] exact same question word for word, and [16:16] it said Ronaldo. And I thought, "Oh, [16:17] it's telling me what I wanted to hear [16:19] based on what it knows about me." Right. [16:20] It knows that I think Ronaldo's the [16:22] Messi's the best, so it's telling me [16:23] that. And then I thought, "Okay, so what [16:24] else is [16:26] is it telling me that's personalized to [16:27] me to make me feel a certain way or to [16:29] think a certain way?" [16:31] Um but you don't realize when you're [16:32] speaking to it that it's giving [16:33] everybody different answers based on the [16:35] memory that it stores on you. [16:37] And that's, you know, if you play this [16:38] forward, actually the AI that is most [16:41] personalized, that caters to your needs [16:42] the most, that is most retentive, [16:44] is probably the one that you're going to [16:46] end up using the most. So, that [16:47] company's going to be the most [16:48] successful. So, we're in a probably a [16:50] bit of an arms race with these models to [16:52] create one that [16:54] meets your needs the most. [16:55] Yes, exactly. And it is that comfort [16:58] loop that is so incredibly dangerous and [17:01] also so insidious because we can't [17:03] observe it in the moment, right? We're [17:05] engaging with AI. It's telling us [17:08] exactly what we want to hear, but it [17:10] does it in such a seamless way with that [17:12] silky syntax that we don't even notice [17:15] that, you know, it's basically an [17:17] algorithm that's seducing us, because [17:19] that's really what it's doing. We feel [17:21] vindicated and validated, and it [17:24] releases dopamine in the reward pathway, [17:26] that feels good, but over time, [17:30] essentially what's happening is we are [17:32] ingesting a drug. Our brain will adapt [17:35] to that over time, such that we'll need [17:37] more and more potent forms to get the [17:39] same effect. We'll need more validation. [17:41] We'll need more sexually explicit [17:43] responses. You name it, there will be [17:45] tolerance, but also there will be this [17:47] pulling away from the things the hard [17:50] things that we need to be doing in real [17:53] life to cultivate in real-life [17:55] relationships. Give me some more color [17:57] on what you mean there. Okay. If you [17:59] think about what it takes to make [18:03] a to create a healthy relationship with [18:05] another human being in in real life. [18:08] Well, first of all, you got to get up [18:09] off the couch, and you got to go find [18:11] them, right? And they're not all [18:13] beautiful and interesting, and neither [18:15] are we, right? So, there's got to be, [18:17] you know, some compromise on maybe some [18:20] idealized version that we have for [18:21] ourselves or other people. And then [18:23] you're in conversation, and it's not [18:25] always interesting, and sometimes you [18:27] have to listen to your partner even when [18:28] it's dull, and then there are conflicts, [18:31] and you disagree, and you know, my way [18:33] or the highway. You have to give in, you [18:35] know, give and take. All relationships [18:37] are about compromise. All successful [18:40] relationships are about [18:42] acknowledging, you know, the other [18:44] person's point of view and incorporating [18:46] that. And yet, we're not doing any of [18:49] that when we're interacting with digital [18:51] media, right? It's all it's all [18:53] validation of our worldview, what we [18:56] want to hear. And of course, that feels [18:58] great. It it's it's reinforcing, it's [19:01] rewarding, but over the long haul, when [19:03] we get really sick and need somebody to [19:05] come and, you know, bring us some [19:07] chicken soup or take us to the doctor, [19:10] you know, take us to the hospital, like [19:12] AI is not going to not going to be able [19:14] to do that. Yeah. I mean, this kind of [19:16] dovetails to another point, which is you [19:17] talked about the word abundance earlier. [19:20] One of the really striking things that a [19:23] lot of the big AI entrepreneurs and [19:25] founders and CEOs are talking about is [19:27] the age of abundance that's around the [19:28] corner. Elon Musk tweeted saying, [19:31] "This really will be a world of [19:33] abundance." Specifically, advances in AI [19:36] and robotics [19:37] will create the age of abundance. And he [19:40] said, "Humanity's not constrained in any [19:42] real fashion." [19:44] I thought your first book, when he was [19:45] talking to a guy called Peter Diamandis, [19:47] was pretty accurate. It was called [19:48] Abundance. [19:50] And there will be universal high income, [19:53] and not universal basic income. There'll [19:55] be no shortage of goods or services. And [19:58] really what he's speaking to here is in [20:00] the world of robotics and AI, where I [20:02] think his shareholder remuneration [20:03] package that he's going to be paid in [20:05] 2030 or whatever, [20:07] um is linked to creating a million [20:09] humanoid robots that can work in these [20:12] physical spaces that could theoretically [20:15] bring me chicken soup. Um that won't get [20:18] sick, won't complain, will reinforce me, [20:19] will live in the physical environment [20:21] with me here at home, will be in my [20:23] office, etc., etc. Will be in factories. [20:25] And there was a headline I think last [20:27] week saying that um Amazon were cutting [20:30] back about half a million jobs that they [20:32] were intending to hire previously [20:34] because they now believe that humanoid [20:35] robots and robots generally will be able [20:37] to do those jobs. [20:39] People think, "Okay, well, I'm going to [20:40] be out of work." But what Elon is saying [20:42] is the price of everything comes down [20:44] when we're not paying humans to do it, [20:46] and when we're paying a robot to do it, [20:48] which means that we're going to live in [20:49] this world of abundance where everything [20:51] is much cheaper. [20:52] The world of abundance that many of us [20:55] are already experiencing and more will [20:58] experience in the future. I agree with [20:59] that. We are we already have more [21:01] leisure time than we had a generation [21:03] ago. By 2050, we're projected to have 7 [21:06] hours of leisure time per day compared [21:09] with 3 hours of work per day. So, we're [21:11] definitely moving toward that. [21:13] That is going to be our number one [21:16] social problem. [21:18] That we have time, we have access to [21:22] these highly entertaining media, [21:26] and hypothetically, we would all be [21:29] going around and helping each other and [21:31] cleaning up the planet and reading [21:33] philosophy, but that is not what is [21:35] happening so far. What is happening so [21:38] far is we're spending an enormous amount [21:40] of our time online, masturbating, [21:43] watching pornography, playing video [21:45] games, and talking to AI chatbots. [21:49] That is essentially the problem. And you [21:52] know, Elon Musk is he's very interesting [21:54] to me because he has talked before about [21:57] his tremendous fear that the machines [22:00] will take over, that there will be a [22:01] hostile takeover. It's not going to be a [22:04] hostile takeover. We will seed our [22:06] agency to these machines, and we're [22:09] already doing it. We will give them our [22:11] power. [22:12] Yeah, well well yeah, we will we will we [22:14] will entertain ourselves to death, [22:16] right? I mean, and and this is what Neil [22:18] Postman warned about in his book Amusing [22:21] Ourselves to Death, a theme that was [22:23] picked up by David Foster Wallace in [22:25] Infinite Jest. You know, beginning with [22:28] television and now the internet and [22:31] digital media in all its various forms, [22:33] we are entertaining ourselves to death. [22:37] Entertaining ourselves to death. [22:43] Sounds like a good way to go. [22:45] >> [laughter] [22:48] >> You know, it's really not. It's really [22:50] not, and I'll tell you why. Because the [22:52] relentless pursuit of pleasure for its [22:54] own sake leads to anhedonia, which is [22:58] the inability to take joy in anything at [23:00] all. Because of this process of [23:03] neuroadaptation and the way that our [23:05] brain recalibrates pleasure and pain, [23:08] such that with the more pleasure we [23:10] pursue, the more pleasure we need, and [23:14] the more we feel pain. No matter what we [23:17] have, eventually it won't be enjoyable [23:20] anymore. And that is the problem. So, [23:22] explain that to me using a [23:25] these scales that I have here. Okay, so [23:27] imagine that in our brain's reward [23:29] pathway, there's a balance like this [23:31] that represents how we process pleasure [23:33] and pain. When we experience pleasure, [23:35] it tips one way, pain it tips the other. [23:38] >> And what you mean by pain? Pain, I mean [23:40] all forms of pain, physical pain, [23:41] emotional pain. [23:43] >> A hangover. A hangover. That's a great [23:45] example, right? [23:46] >> Not just me being pinched. It could be [23:48] that, too. So, all different forms of [23:50] pain. Now, granted, this is a vast [23:52] oversimplification, [23:53] you know, pleasure and pain can be [23:55] experienced simultaneously like when [23:57] we're eating spicy food or during sex. [24:00] So, this is very simplified, but this [24:03] gets at the core concept of homeostasis [24:06] and neuroadaptation, which I will [24:07] define. [24:09] So, when the when the balance when the [24:11] pleasure and pain balance is level, [24:13] that's what neuroscientists call [24:14] homeostasis. That is the baseline level [24:18] that we kind of live in. That's our sort [24:20] of the heartbeat of our pleasure system, [24:23] right? [24:25] When we do something that's reinforcing [24:27] or pleasurable, right, or rewarding in [24:29] some way, [24:30] right here, right? Or digital media, [24:34] this little robot AI robot. [24:36] >> So, you're putting a cigarette into the [24:37] one side of the scale at the moment, and [24:40] then a little AI robot. [24:42] >> Let's combine them cuz we're let's say [24:43] we're we're we're watching a video and [24:45] smoking at the same time on our phone. [24:47] Which by the way, you see more and more [24:48] of, right? People used to go out for [24:49] smoke breaks. Now it's the smoke and [24:51] scroll break, right? And why do they [24:53] have to combine them? Because of [24:54] tolerance, which we're going to get to [24:55] in a second. So, when when we ingest [24:58] substances that are potentially [25:00] addictive, um and highly reinforcing, or [25:03] we engage in activities that are highly [25:04] reinforcing, that releases dopamine in [25:07] the nucleus accumbens. That's typically [25:09] associated with pleasure, and then our [25:13] pleasure-pain balance tilts to the side [25:14] of pleasure. [25:16] But no sooner has that happened than our [25:18] brain responds by neuroadaptation, [25:22] okay? And that's where we then [25:25] downregulate dopamine transmission. [25:27] >> When you say downregulate, do you mean [25:29] reduce? Yes. So, in in the brain's [25:31] reward pathway, we then reduce dopamine [25:33] transmission, and I like to represent [25:35] that as rocks in this case, or I talk [25:38] about in my book gremlins, going on the [25:40] pain side of the balance to bring it [25:42] level again. So, this is a process These [25:44] are neuroadaptation [25:46] rocks, okay? They're going here because [25:48] one of the overarching rules governing [25:51] this balance is that it must return to [25:53] homeostasis. It must return to balanced. [25:56] >> It must return to the level position, [25:58] yeah. [25:58] >> Okay. So, okay. So, then we we put in [26:00] So, this is our brain working to return [26:02] to the level position by reducing [26:03] dopamine levels. Again, an [26:05] oversimplification, but just a way to [26:07] get at this concept. [26:08] >> Has it released something in order to [26:10] counteract the balance there? In this [26:12] simplified metaphor, you know, at the [26:13] simplest level, what's happening here is [26:16] that it's, for example, taking away [26:20] dopamine receptors so that there's fewer [26:22] places for dopamine to land, thereby [26:25] decreasing dopamine transmission. [26:27] Because it has been flooded. Because it [26:30] has been flooded. That's right. It's [26:31] trying to compensate for the too much [26:33] dopamine. Okay. And is this what I [26:35] experience when I have like a hangover [26:37] or a come down? Right. So, that's [26:39] coming. So, what happens is once once [26:41] we've gone with this neuro process of [26:42] neuroadaptation, it would be nice if [26:44] that pleasure-pain balance just went [26:46] back to the level position, and then [26:48] there would be no hangover. But it [26:49] doesn't. It continues to go down an [26:52] equal and opposite amount to the side of [26:54] pain. This is this opponent process [26:56] mechanism. [26:57] >> Oh, now my brain is dopamine [26:59] starved. It's [27:00] >> That's it. [27:01] >> Okay. It's not It doesn't feel good. [27:02] >> Yes, and that doesn't feel good. And you [27:04] have basically two options here. More [27:07] dopamine. You can get more dopamine, [27:10] right? To get bring yourself back. So, [27:12] I'm now putting the cigarettes back [27:14] under the pleasure thing. [27:14] >> And and some whiskey. [27:15] >> And so, let's add some whiskey cuz [27:17] that's what you got to do cuz this is [27:18] tolerance, right? You need more and more [27:20] of your drug over time to get the same [27:22] effect, or you need to combine drugs to [27:24] overcome tolerance. And by the way, this [27:26] is of course the fastest way to to get [27:28] back to the level position is to use [27:30] more of your drug, right? Cuz that then [27:32] you're right there. You're back again. [27:33] The the problem with this method is that [27:36] the the brain will respond by more [27:38] neuroadaptation. So, now we're putting [27:40] more rocks in on the [27:43] in the pain side. Now you're now you're [27:45] now you're doing this, right? Now I need [27:47] even more to [27:48] >> Now you need even more, right? So, and [27:50] eventually over time, [27:54] you know, you're you're putting you're [27:56] doing this. [27:57] And this is simply a metaphorical [28:00] representation of [28:03] the addicted brain. [28:05] Right. Now now our brain [28:08] has downregulated dopamine transmission [28:10] in the reward pathway to a kind of [28:13] chronic dopamine deficit state. So, to [28:16] feel good when I've really abused my [28:19] drugs of choice, I'm going to have to do [28:21] so much, probably so frequently, to feel [28:24] good again. [28:25] >> That's exactly right. You're going to [28:26] need more of your drug in more potent [28:28] forms, more often, just not even to feel [28:32] like high and go to the pleasure side, [28:35] but just to level the balance and feel [28:37] normal. So, in the context of people [28:39] with bad habits, if I I'm having a [28:42] cookie every day, [28:44] the more and more cookies that I eat, [28:45] the more and more cookies I'm going to [28:46] want tomorrow and need tomorrow just to [28:48] feel good again. Essentially, yes. [28:50] >> And the same applies for things [28:51] [clears throat] like pornography and [28:53] maybe, you know, interacting with an an [28:55] AI and social media and whiskey and [28:57] alcohol. So, the more of it I consume, [29:00] the the this is why I you know, I think [29:02] everybody listening can probably relate [29:04] to having moments in their life where [29:06] they feel like they're they're kind of [29:07] losing control of a particular habit, [29:10] and they're doing it every day. They [29:11] know they don't really want to, but [29:12] they're doing it they're they're getting [29:14] cravings to do it. I I reflect to my own [29:17] life and I go there there will be [29:17] periods every year where [29:20] I just like I call it like falling off [29:22] the horse, and I just can't seem to get [29:23] control of like not eating that bad [29:25] thing again the next day. And then [29:26] something happens, maybe there's less [29:29] stress in my life for a week, and I'm [29:31] and maybe there's more routine, and I'm [29:32] back home in Los Angeles or the UK, and [29:35] I'm not traveling around, and then [29:36] suddenly I can get back on the horse. [29:38] What's going on there? Yeah, great [29:40] question. So, um first of all, let me [29:42] just say that many people also report [29:46] that in periods of high stress, they are [29:50] more vulnerable to going back to falling [29:52] off the wagon or going back to some [29:54] problem with related to compulsive [29:56] overconsumption or addiction. But the [29:59] opposite is also true. So some people [30:02] say that they actually do better when [30:05] there's stress in their lives and it's [30:06] when that stress is removed and they [30:08] feel like, "Oh, I can relax my [30:10] boundaries or my guardrails." And those [30:12] individuals are more more vulnerable to [30:15] compulsive overconsumption in times when [30:17] things are going well. So So things [30:19] going badly can be a trigger and things [30:21] going well can be a trigger depending [30:23] upon your unique like life history and [30:25] unique wiring. There's a wonderful [30:28] animal experiment where if you put a rat [30:31] in a cage with a lever to press for [30:33] cocaine, that rat will press that lever [30:36] till exhaustion or death, which is [30:38] essentially the animal model of [30:40] addiction. [30:41] But if before the rat becomes addicted, [30:45] if the cocaine is then removed such that [30:47] pressing that lever no longer yields the [30:50] reward, [30:51] that rat will eventually extinguish that [30:55] lever pressing behavior. So they'll [30:56] they'll stop pressing the lever, right? [30:58] They'll stop doing the work. It can take [31:00] a while, but eventually they won't press [31:02] the lever anymore. Now if that same rat [31:05] after a period of time is then exposed [31:08] to a very painful foot shock, the first [31:11] thing the rat will do in response to [31:13] that painful foot shock is run over and [31:15] start pressing that lever again. [31:17] And to me that's just a wonderful model [31:20] of what we see in humans that when [31:22] individuals are under extreme stress, [31:26] they are typically more vulnerable to [31:28] relapse um because their brain has [31:31] already encoded using these high [31:34] dopamine rewards [31:36] um in response to any kind of pain as a [31:38] way to get out of that state. So we [31:41] talked about the pleasure-pain balance [31:42] here. So but if in my life I experience [31:44] some form of pain, I'm likely to go and [31:46] seek out pleasure and stress could [31:48] theoretically be considered a form of [31:49] pain. Yeah, which is why people um with [31:52] severe childhood trauma are at higher [31:55] risk for addiction. Um there are [31:57] probably epigenetic changes that are [32:00] happening at the level of DNA expression [32:02] in their brains making them more [32:04] vulnerable to addiction. [32:05] Um we know that people who are living in [32:08] poverty are more vulnerable to [32:09] addiction. Uh people who are struggling [32:12] with uh multi-generational trauma, uh [32:15] unemployment, major social and [32:17] geographic dislocation, those [32:19] individuals are more vulnerable to [32:21] addiction. So environmental stresses uh [32:24] definitely play a role. We also know [32:26] that co-occurring psychiatric disorders [32:29] um make people more vulnerable to [32:31] addiction probably. That means that [32:33] people who struggle with bipolar [32:34] disorder, depression, um anxiety, [32:37] schizophrenia [32:38] are at higher risk of becoming addicted [32:42] and probably it's because they're trying [32:44] to self-medicate. [32:46] What about ADHD? So kids with ADHD are [32:50] at higher risk to develop an addiction [32:51] in adulthood than kids without ADHD. [32:54] And the mechanism of action for that is [32:57] not [32:59] well understood, but there are some [33:00] really interesting theories. One of the [33:03] theories is that kids with ADHD have [33:05] uh reward deficit at baseline. And that [33:08] has been shown in experiments that [33:10] people with ADHD, when you show them [33:12] rewarding stimuli, their reward pathway [33:16] isn't as activated as healthy control [33:19] subjects. [33:19] >> When you say rewarding stimuli, what's [33:21] what's that mean? Images of cupcakes or [33:24] alcohol or anything that they will [33:27] endorse as something that that's [33:28] pleasurable for them. [33:30] >> So their brain doesn't release as much [33:31] dopamine when they when they see [33:32] something rewarding. [33:32] >> That's right. So brain imaging studies [33:35] showing that not only do people with [33:37] ADHD not release as much dopamine in [33:40] response to rewards, but also have at [33:44] baseline fewer dopamine receptors. [33:48] And remember we talked about the [33:50] decrease in dopamine receptors [33:52] being what happens [33:55] as people become addicted. So in some [33:57] ways people with ADHD, you could [34:00] conceptualize them as already having [34:02] craving at baseline. [34:04] Even before they've been exposed to the [34:06] kinds of intoxicants that lead to [34:10] down-regulation of those D2 receptors. I [34:13] had um Gabor Mate on the podcast a few [34:15] times and Gabor talks to me about how [34:19] ADHD could be perceived as learning at a [34:21] young age to kind of [34:24] distract yourself from the stress in [34:26] your life. [34:27] So he was talking a lot about you know [34:29] his own experience growing up in [34:31] Nazi Germany times and his mother giving [34:34] him to someone else because the he was [34:36] at risk of the Nazis and the stress of [34:38] that moment and how he had kind of [34:40] learned to tune out of the environment [34:41] because of that. And I I've always [34:43] wondered thought about that [34:44] theoretically. [34:45] You know, if you grow up in a household [34:46] where there's loads and loads of [34:47] screaming and loads of violence for [34:49] example, you kind of learn to to tune [34:51] out. But you you can also develop a [34:52] hypervigilance. [34:54] And um [34:56] so it kind of does make sense to me that [34:58] so many of those people, if this [34:59] theoretically holds, [35:02] would start with a a bit of a pain [35:05] baseline. [35:06] We We definitely know that kids who are [35:09] raised in traumatic environments [35:12] where there is complex attachment with [35:15] caregivers, [35:17] those kids are at higher risk for [35:20] developing addiction. [35:22] And [35:23] this kind of dissociative response to [35:26] trauma, just trying to escape the [35:27] situation either in your own mind [35:30] um with your own mental, you know, [35:32] dissociation or distractions or actually [35:35] finding a behavior that gives you [35:38] comfort is [35:40] well, you know, well observed and well [35:42] well documented. Just getting back to [35:45] our early conversation about digital [35:46] media and the dangers therein, so a Pew [35:49] survey report just came out asking [35:52] parents [35:53] um how they navigate exposing their kids [35:56] to smartphones. [35:58] And in the cohort of parents who said [36:00] that yes, they do [36:02] um let their children under the age of [36:04] five play with a smartphone, [36:07] uh when they were asked why do they do [36:09] that or in what circumstances, one of [36:11] the top reasons was [36:13] uh to soothe their child when their [36:16] child was unhappy or distressed in some [36:20] way. [36:20] Now I I found that very concerning [36:24] because that is basically setting up the [36:27] child for the perception-action loop of [36:31] using internal distress as a cue [36:35] uh for reaching for a smartphone, which [36:39] is works. It definitely works in the [36:41] short term. But the problem again is [36:44] that through this iterative process of [36:45] neuroadaptation, [36:47] ultimately that smartphone will not be [36:49] sufficient and now the kid will need a [36:51] smartphone and [36:53] I don't know um you know, an AI-tailored [36:57] pet who will do whatever they want [36:59] whenever they they want it. And then by [37:01] the time the kid is eight, you know, [37:03] that won't be sufficient and the kid [37:05] will need I don't know a slot machine um [37:08] or or whatever it is. You know, it's [37:09] this escalating phenomenon. There's um a [37:12] couple of startups at the moment, AI [37:13] startups who are putting AI in cuddly [37:17] toys. [37:18] Oh yes, right. AI in cuddly toys. Mhm. [37:21] And so you can just like you can speak [37:23] to ChatGPT using your devices, you can [37:25] come home, you can pick up your cuddly [37:27] toy, your cuddly toy will talk to you, [37:29] it will ask you how your day's been, it [37:31] will it can teach you things. What do [37:33] you think of of that from a [37:36] neuroscience or, you know, a dopamine or [37:38] connection perspective? I think that [37:41] this is a very very dangerous because [37:44] we're essentially offloading the work of [37:47] parenting and creating those [37:50] relationships. You know, not again, I I [37:52] hate judging parents cuz parenting is [37:54] hard and I've made many mistakes in my [37:56] parenting, you know, but what's and I'm [37:59] sure these the parents have the best of [38:01] intentions, but instead of, you know, [38:04] navigating [38:07] finding a way to communicate with their [38:09] child to figure out how to know what's [38:12] going on in that child's life, which can [38:14] be hard to do cuz you know, even young [38:16] children aren't necessarily [38:17] [clears throat] willing to disclose, but [38:19] once they get to be teenagers, forget [38:20] it. Then you got to like wait until [38:22] they're ready to tell you, which is [38:24] almost always like at 10:00 p.m. at [38:26] night when you're exhausted after [38:27] working all day, right? So so so there's [38:29] that piece of it, right? They're they're [38:31] not putting in the work, spending the [38:32] time with the child, finding a common [38:34] language. But you also then then the [38:36] second piece of it is now you've got [38:38] this child who is essentially [38:40] self-soothing with a machine, right? And [38:43] again, [38:44] this the the the the machines are [38:46] designed to flatter, to validate, to [38:50] comfort. There's no friction there, [38:53] right? This is incredibly [38:55] um potent [38:57] social validation [39:00] uh and soothing, self-soothing. It's [39:02] essentially a masturbation machine. [39:05] And then you've got this really weird [39:07] additional loop where now the parents [39:10] are finding about out about their [39:12] child's life through [39:15] reading and observing her interactions [39:19] with the AI. So it's like a game of [39:21] telephone. Now they've like filtered [39:23] this thing where they they think they [39:24] know what's going on in their child's [39:26] life, but of course they don't. And none [39:28] of that has gone toward fostering [39:29] relationship between those parents, you [39:32] know, and their child. [39:34] And this [clears throat] is just, you [39:35] know, really really scary because it's [39:37] going to lead to this incredible [39:39] fragmentation [39:41] of families, of social bonds. [39:45] I mean, it's it's it's I just we cannot [39:48] go in that direction. We really have to [39:50] fight against that. [39:52] So, [39:53] with all this said, and with the [39:54] knowledge that these algorithms are [39:56] going to get more addictive because AI [39:58] is going to know me more and more and [39:59] more. And actually the commercial model [40:01] behind any of these big technology [40:02] companies is to keep my attention on [40:04] their product more so they can deliver [40:06] more ads or they can charge me a higher [40:07] subscription fee. [40:09] Are you at all hopeful? Because I can't [40:10] see [40:12] from an incentive perspective when we're [40:13] talking about, you know, the commercial [40:15] models behind these companies, why [40:17] things aren't are going to stop and go [40:18] back. I mean, I agree with you, the [40:20] genie's out of the bottle. We're we're [40:21] not going to [40:23] go back, but I am hopeful because [40:28] um [40:29] I think I'm just a realistic optimist. I [40:32] I do believe in the human capacity to [40:35] adapt and solve problems. And the simple [40:37] fact that we're talking about these [40:39] problems now, which we weren't doing, [40:41] you know, 10, 15 years ago, I think is a [40:43] good thing. There's much more awareness [40:46] in the population about the potential [40:48] dangers of digital media. And and at the [40:50] forefront of raising the alarm um has [40:53] been parents cuz parents are seeing the [40:56] sort of disintegration of the nuclear [40:58] family in real time and and they don't [41:01] like it. So, I am hopeful because [41:04] I just I just think that we're going to [41:07] come together and we're going to try [41:09] different solutions. And some of those [41:10] solutions will involve technology. Um [41:13] you know, and and like trying to come up [41:14] with guardrails or or better technology. [41:17] I think the way that we're going now um [41:19] you know, with like the erotic chatbot [41:22] is is not the right direction. But then [41:25] again, we live in a you know, free [41:27] democracy and consenting adults [41:30] you know, can do what they're going to [41:31] do until we decide as a society that the [41:34] harms outweigh the potential benefits. [41:36] But I I really think in the short term [41:38] we need to focus on kids. [41:40] Because kids are vulnerable. They're [41:42] vulnerable on so many levels. On a [41:45] neurobiological level, they're [41:46] vulnerable because their brains are [41:48] still rapidly evolving, incredibly [41:50] neuroplastic. [41:52] They're cutting back on the neurons [41:53] they're not using. They're myelinating [41:56] and making more efficient the neurons [41:57] they use most often. That whole process [41:59] ends at about age 25. Plus you've got [42:02] the buckets of hormones that are going [42:04] into kids. The the fact that teenagers [42:07] are natural risk take risk takers that [42:10] they they should based on their [42:13] evolutionary milestone be going out and [42:15] meeting people and be curious and making [42:17] connections at that time. And yet more [42:19] and more teenagers are staying at home [42:21] and getting their needs met, you know, [42:23] digitally. So, we've got we've got to [42:25] look at kids. That's got to be like the [42:27] first priority. And we've got to help [42:29] parents cuz we can't leave it up to to [42:31] parents alone. So, I I'm optimistic that [42:33] we are going to [42:35] you know, [42:36] come up with [42:37] solutions and I think we just have to [42:40] try a lot of different things and see [42:41] what works. But it's can't just be an [42:43] individual, you know, solution. We can't [42:46] just leave it to individuals or parents [42:47] or families alone. The schools have to [42:50] join the solution, uh governments, [42:53] legislators, and also the companies that [42:55] make and profit from digital media. They [42:57] they really are responsible for making a [43:01] product that um [43:04] doesn't harm kids. And right now [43:05] [clears throat] [43:07] you know, we have a product that harms [43:09] harms kids. [43:10] You've recently been an expert witness [43:12] in certain [43:13] trials in court, right? Yes, in ongoing [43:17] litigation litigation, yes. What can you [43:19] tell me about about that and [43:22] and about the parties in play and why [43:24] you're being called to be an expert [43:25] witness? I can't actually tell you too [43:27] much. I can't talk about it. Um but I [43:29] can tell you that the the the basic [43:31] premise is that kids are a vulnerable [43:34] group, that uh social media is not safe [43:39] for kids, that it causes harm at many [43:42] different levels, but primarily through [43:46] uh the uh medium [43:48] uh itself being addictive and engaging [43:52] their brains and exploiting their [43:54] motivational reward system with design [43:56] features that keep them clicking and [43:58] swiping. [44:00] And in that case, someone's suing the [44:02] social media companies. That's right. [44:03] So, you've got school districts, [44:05] counties, states, uh the federal [44:08] government, entities representing the [44:10] federal government um [44:12] suing uh social media companies, yeah. [44:15] What outcome are they looking for? [44:17] They're looking for a safer product for [44:19] kids. They're looking to um help parents [44:22] and kids and schools um protect kids [44:27] from the harms of social media. [44:29] Which again are are not just the harms [44:31] of addiction. You know, that's sort of [44:33] the the process by which the engagement [44:36] becomes pathological and then the harms [44:39] multiply because of the sheer amount of [44:41] time spent, but the harms are include [44:43] things like uh cyberbullying, [44:45] sexploitation, [44:47] uh sexual abuse material, [44:50] the outcomes of depression, anxiety, [44:53] eating disorders, body dysmorphia, sleep [44:56] disruption. 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And you can sell directly from [45:36] your website or on social media, [45:38] essentially wherever your customers [45:40] spend their time. It's truly a brilliant [45:42] business tool. So, if you want to give [45:44] it a go, head to shopify.com/bartlett [45:47] and sign up for your $1 per month trial [45:50] period. That's shopify.com/bartlett. [45:54] So, if I'm if I'm coming out of [45:55] December, Right. [45:56] >> been eating a little bit too much in [45:58] December, maybe I've been smoking a bit, [46:00] whatever bad habit I might have been [46:02] doing, drinking too much cuz it was New [46:03] Year's New, you know, New Year's [46:04] parties, etc. My brain is currently [46:07] going to be slightly out of balance in [46:08] terms of its dopamine [46:11] balance. [46:13] Yes. So, hypothetically, your brain will [46:16] be in a dopamine deficit state. What [46:19] you'll want to do is you'll want to [46:22] abstain from your drug of choice long [46:24] enough Mhm. in order to reset reward [46:27] pathways. Okay, so if I've got a sugar [46:29] problem, Mhm. then I need to just lay [46:31] off the sugar for a little while. [46:33] You need to lay off the sugar for at [46:36] least 4 weeks. 4 weeks? Yeah. And why 4 [46:40] weeks? Cuz on average, 4 weeks is about [46:42] the amount of time it takes for people [46:45] to get out of the state of acute [46:46] withdrawal [46:48] and begin to be able to take joy in [46:50] other more modest rewards and not be in [46:53] a constant state of craving. Okay. The [46:55] worst part is those first 10 to 14 days. [46:58] That's when we're in acute withdrawal. [47:00] And the reason for that is when we first [47:03] take our reward off the pleasure side of [47:05] the balance, right? Which I'm going to [47:07] do now. So, when we first stop the sugar [47:09] or the AI or the cigarettes, That's [47:12] right. The first thing that happened is [47:13] our pleasure-pain balance crashes down [47:15] to the side of pain because of this [47:17] process of neuroadaptation, right? Now [47:20] we're in the state of acute withdrawal. [47:22] And I want I've got cravings. Cravings. [47:24] And yeah, what are the characteristics [47:25] of withdrawal? Anxiety, irritability, [47:28] insomnia, dysphoria, or depressed mood, [47:31] and cravings. [47:32] And it's crazy cuz when I'm in that [47:34] state, when I've not had my drug of [47:36] choice for, say, a day or two, I look at [47:39] the drug differently. Like my it just [47:42] looks different to me. It's so crazy. [47:44] I'll I'll walk past, let's say, what's [47:45] something I really like, maybe carrot [47:46] cake. If I've, you know, if I've been [47:48] having a lot of sugar, which is quite [47:50] rare for me, but just say I have. [47:52] When I look at the carrot cake the day [47:54] after [47:55] I had carrot cake, it looks amazing. [47:57] And it looks so delicious. But when I'm [48:00] in at the ketogenic state where I've not [48:02] had carbohydrates for, say, 4 8 weeks, I [48:04] look at carrot cake [48:06] and I have no emotional connection to [48:08] it. [48:09] Exactly. So, that summarizes it [48:11] perfectly, right? I had a patient with a [48:13] severe food addiction [48:15] who when she walked into the break break [48:18] room at work and saw the donuts, [48:21] she broke out into a cold sweat and [48:23] actually had stomach pains. It was a [48:25] physiologic state of craving and [48:28] hyperarousal [48:29] just by looking at the donuts. [48:33] And that's what happens essentially, [48:35] right? Because we're we're in this state [48:36] of constant craving. Our brain has [48:39] overvalued this reward. We have euphoric [48:43] recall of our earlier use of the drug [48:45] when we first tasted it how delicious it [48:47] was. And even now [48:50] >> [clears throat] [48:51] >> if we even now when we eat it because of [48:53] tolerance, it's not as good as earlier [48:55] use, our brain still remembers [48:58] earlier use and and we have this [49:01] overweighted value of oh, how delicious [49:03] it's going to be. [49:06] And so, this is really important to [49:07] remember because when we're in that [49:09] acute state of craving, it feels like it [49:11] will never end. It really does. And I'm [49:14] I've I'm still amazed in in my clinical [49:16] work how in early withdrawal, people [49:19] just say, "The craving is is horrible. [49:21] Like I I just I can't live like this." [49:24] And I think that's really important to [49:26] point out that many people try to stop [49:29] using their drug of choice, but they [49:30] don't try they don't stop for long [49:32] enough to be able to get out of that [49:34] vortex of craving to get come get to the [49:37] other side. [49:38] And it feels like the craving will never [49:40] end. So I I always have to reassure them [49:42] that if they can just wait long enough [49:44] without using, they will eventually get [49:47] to that place where they're not in that [49:49] constant state of craving. Now, that's [49:51] assuming they have enough [49:52] neuroplasticity to do that and not [49:54] [clears throat] not everybody does. [49:56] And so what what what what is the [49:58] purpose then of abstinence? It's again, [50:01] when our brain is no longer getting this [50:03] exogenous source of stimulation or [50:07] dopamine, eventually the brain gets the [50:09] message, "Oh, okay. I need to start [50:11] upregulating my own dopamine [50:13] transmission, right? I I need to [50:16] re-employ or re- I need to redeploy my [50:19] postsynaptic dopamine receptors, right? [50:22] I need to get it from inside of my [50:23] brain." And so eventually, I'm I'm just [50:26] going to take the rocks now off the pain [50:28] side of the balance. [50:31] You know, [50:36] I could have made this easier. [50:37] >> [laughter] [50:39] >> Yeah, let me do that. [50:40] There we go. [50:41] Eventually, if we abstain for long [50:43] enough, those [50:45] that process of neuroadaptation reverses [50:48] itself. And when you say [50:49] neuroadaptation, you mean the brain [50:51] changing. Right, the brain changes. So [50:53] the the kind of neuroplasticity that we [50:55] see [50:57] with addiction [50:58] can be reversed in most cases. And [51:01] neuroplasticity is just the brain again [51:03] changing. Right, changing. Right, or or [51:05] going back. Now, interestingly, you [51:08] know, the work of Edie Sullivan and [51:10] others looking at what happens in the [51:11] brain during recovery suggests that [51:15] those addiction neural circuits probably [51:18] never go away, but but like the dying [51:20] embers of a fire, they quiet down. And [51:23] then recovery is characterized by the [51:25] development of new neural networks that [51:28] route around those injured areas. But [51:31] the bottom line is that because of [51:33] neuroplasticity, we can eventually [51:35] return to kind of baseline levels of [51:38] pleasure and pain. We can restore our [51:41] hedonic or joy set point. And when we do [51:44] that, we're in a much healthier place [51:46] because now we can take pleasure in [51:49] other rewards that are not our drug, [51:52] right? Like watching a sunset, talking [51:54] to a friend, going for a walk, things [51:56] that we lost the capacity to enjoy [52:00] because our reward pathway was hijacked [52:03] by our drug of choice. I think this is a [52:04] really important point as well when you [52:05] say drug of choice because one thing I [52:07] learned from our conversation last time [52:09] is that me and you will both be [52:11] susceptible to becoming more or less [52:14] addicted to different drugs of choice. [52:16] So for me, it might be whiskey. For you, [52:18] it might I think you said it was like [52:19] erotic novels were one of your things. [52:22] I I don't drink whiskey, just for the [52:23] record. [52:24] >> [laughter] [52:24] >> But it might be I don't know, it might [52:26] be opioids or AI. I might be more [52:27] susceptible. So say if me and you spend [52:29] 1 hour on TikTok, [52:31] the way my brain is wired, the things [52:32] I've been through in my life, whatever, [52:34] might mean that I get really addicted to [52:35] TikTok, whereas you don't feel that. [52:39] Exactly. And what distinguishes um you [52:41] know, addictive drugs or intoxicants [52:44] from other substances is that they do [52:46] release a lot of dopamine all at once in [52:48] the reward pathway. So many, if not most [52:51] people, will find intoxicants [52:54] reinforcing, but that's not universally [52:56] true. Like there are some people who [52:57] take opioids and find them [52:59] that they feel very uncomfortable and [53:01] it's not doesn't make them feel [53:03] euphoric, right? And other people will [53:05] drink caffeine and not feel the [53:07] stimulating effects. And other people [53:09] will have alcohol and you know, get a [53:11] headache and not not feel relief. So and [53:14] and so this differences in our brains is [53:16] a really important concept. What about [53:19] this idea of having an addictive [53:20] personality? Is that a real thing? [53:22] It is a real thing. We don't use that [53:24] terminology anymore. We talk about the [53:27] inherited or genetic risk of addiction. [53:30] We do know that if you have a biological [53:32] parent or grandparent uh with an [53:35] addictive disorder, you are at increased [53:37] risk of developing addiction compared to [53:39] the general population, even if you're [53:41] raised outside of that substance using [53:42] home. Am I right in thinking you don't [53:44] use that term because it suggests one [53:46] can't change and that they're stuck. Or [53:48] is there another reason? You know, it's [53:49] a good question why that term has gone [53:52] out of favor. I think in general, when [53:55] we talk about Yeah, when we talk about [53:57] personality, it does seem like a kind of [53:59] a fixed feature of somebody's um [54:03] character and so we're probably trying [54:05] to avoid that. One of the really [54:07] liberating things about what you've just [54:09] said is maybe we don't need to make New [54:11] Year's resolutions. Maybe we need to [54:12] make just a January resolution because [54:15] that's 4 weeks long and if I can get to [54:17] the end of the 4 weeks, then the [54:18] cravings are likely to have gone. And [54:20] you know, when you think about a New [54:21] Year's resolution, then you get like a [54:23] week in and you're like, "God, I'm not [54:24] going to be able to do this for the [54:25] whole 365 days." What you've just said [54:27] actually illuminates the fact that maybe [54:29] you should just set yourself a 4-week [54:30] resolution. Exactly. And that's what we [54:33] often do in clinical care. If we were to [54:34] ask people to abstain for their whole [54:36] lives, it seems impossible. But if we [54:39] ask them to abstain for 30 days, it's [54:41] kind of a an amount of time that they [54:43] can wrap their heads around. And also, [54:46] not in all, but in most folks who are [54:48] willing and able to do it and also [54:50] importantly for whom it's safe to do [54:52] because it's not safe for everybody, [54:53] right? We wouldn't recommend that for [54:55] someone who's at risk for [54:56] life-threatening withdrawal from alcohol [54:58] or benzodiazepines or something like [55:00] that. But for people who are willing and [55:02] able to do it, they usually feel better [55:05] at the end of those that those those 30 [55:08] days. And then they can make a decision [55:10] about whether they want to continue to [55:11] abstain or or they want to go back to [55:13] using. And if they do decide to go back [55:16] to using, they've typically, you know, [55:18] have lowered their tolerance for their [55:20] drug of choice, which means that when [55:22] they do use again, they can get reward [55:25] from it again, which again, because of [55:27] neuroadaptation, we lose the ability to [55:29] do that with chronic heavy use. [55:32] So so that you know, that that there is [55:34] this whole concept of moderating our [55:37] use, [55:38] which didn't used to be something that [55:41] we even [55:43] talked about in the field of addiction [55:45] when it was thought that abstinence was [55:47] the only way. But more and more um you [55:51] know, we are thinking about healthy ways [55:53] to moderate after a period of [55:56] abstinence. And the reason we recommend [55:58] a period of abstinence, even if the [56:00] long-term goal is moderation, is because [56:03] we find that people are more successful [56:05] moderating if they first um abstain for [56:09] a period of time. [56:11] What about if I'm trying to pick up a [56:12] new habit? Mhm. [56:14] What what How do I need to be thinking [56:16] about this pain-pleasure scale? And what [56:20] are What's a good strategy with this in [56:21] mind? So I want to start, let's say, I [56:24] want to start going to the gym. [56:26] Right. So you've chosen a habit, going [56:28] to the gym, that is hard to do and [56:30] involves effort. So that means that [56:33] habit won't happen easily the way that [56:36] habits that are related to the sudden [56:39] release of dopamine in the reward [56:41] pathway cuz those are habits that are [56:43] frictionless. We we pick them up [56:44] instantaneously. But a habit that [56:47] involves [56:49] effort and for which the rewards are not [56:52] immediate, you can you can again think [56:54] about this pleasure-pain balance and now [56:56] instead of pressing on the pleasure [56:58] side, we're intentionally pressing on [56:59] the pain side by making ourselves get [57:02] out of bed in the morning, go to the [57:03] gym, engage in effortful exercise. And [57:06] what's interesting is that when we do [57:08] that, [57:09] the neuroadaptation gremlins that I talk [57:11] about are these rocks that we've used [57:12] here today will actually go on the other [57:15] side of our balance, so on the [57:18] pleasure side and we will get our [57:20] dopamine indirectly by paying for it up [57:23] front. And the way that that's probably [57:25] happening is that our body in sensing [57:29] injury [57:30] is upregulating feel-good hormones and [57:33] neurotransmitters like dopamine, but [57:35] also endogenous opioids, endogenous [57:37] cannabinoids. [57:38] And from an evolutionary perspective, [57:40] that's really how our pleasure-pain [57:42] balance evolved. So just to simplify [57:45] this for me, Yeah. [57:46] I go to the gym, I get up, I travel to [57:48] the gym, I lift up those weights, I do [57:50] my run. [57:51] I'm going to feel good, but it's going [57:53] to be delayed. [57:55] Right. And importantly, you're not going [57:57] to feel good when you first start [57:59] exercising, right? At least most people [58:01] don't. It's it's painful and you're [58:03] thinking, "How how many minutes am I am [58:05] I you know, how many minutes do I have [58:07] left?" And we do know in fact that [58:09] exercise is immediately toxic to cells, [58:12] which is really kind of strange cuz we [58:14] know exercise is good for us. But again, [58:16] what's probably happening at a molecular [58:18] level is that the body is sensing [58:20] cellular injury and in response [58:22] upregulating all those feel-good [58:24] hormones and neurotransmitters, but it [58:26] takes time. It takes time and so we're [58:30] going to have a delayed sense of reward. [58:32] And that's the runner's high, right? [58:34] That kind of comes after uh the exercise [58:36] is over. Or maybe for some people it [58:38] comes in the middle of exercise when [58:39] you're a little bit into it or halfway [58:42] through. But at some point, you know, [58:43] you get the endorphins and that feels [58:45] good. [58:46] How would one go about gaming this so [58:49] that [58:51] I'm more likely to do it? [58:54] Because, you know, the reward comes [58:55] after, which is not not incredibly [58:58] useful. You almost almost have to have [58:59] like a religious belief in exercise cuz [59:01] you go, "No, I'm not going to want to do [59:02] this, but it's going to I'm going to be [59:04] glad I did afterwards." Right. So is [59:06] there anything I can do? Like do I have [59:07] a Mars bar when I get to the gym or [59:08] something? I don't know. [59:11] You know, there are so many ways and so [59:12] many tricks that people use to kind of [59:15] create new healthy habits. Um one of the [59:18] ways that we can do it is to prepare in [59:21] advance [59:22] for that moment [59:25] when we want to do something that's [59:27] hard. [59:28] Because if we wait till that moment to [59:31] decide whether or not to do something [59:32] that's hard, we almost always choose not [59:34] to do it. But if we make a plan in [59:37] advance, let's say the day before, that [59:40] tomorrow I'm going to get up at this [59:41] time, I'm going to, you know, get my [59:43] stuff together, and I'm going to go to [59:45] the gym, we're much more likely to [59:47] engage in that activity. And that can [59:49] also include then rituals around that [59:51] activity that we prepare in advance. So, [59:53] for example, packing our bag, right? The [59:56] schedule itself, setting up a time, [59:59] maybe planning to meet a friend, right? [60:02] So, we connect friendship or [60:04] socialization [60:05] with the thing that's hard to do. It's [60:07] much easier to do these difficult things [60:10] with other people [60:12] than than to have to do it alone. How [60:15] does that link to the the pain side of [60:17] the balance, or does it at all link to [60:19] the pain side of the balance? This idea [60:20] that if I put my clothes out the night [60:22] before, and I I schedule it, and I [60:24] really plan for it, is it it's reducing [60:26] the pain involved, and that's going to [60:28] increase the probability of the behavior [60:29] occurring? Is that what you're saying, [60:30] or is there something else, or is it not [60:32] linked to that? [60:32] >> I I don't think so. I think instead, you [60:35] know, the prefrontal cortex is the large [60:37] gray matter area right behind our [60:39] foreheads that's so important for future [60:41] planning, and delayed gratification, [60:43] also for auto autobiographical [60:45] narrative. And I think by putting these, [60:49] you know, pieces in place, that allows [60:52] our prefrontal cortex to plan for this [60:54] future event that we know we're not [60:57] going to want to do, but that we want to [60:59] do. Mhm. It allows us to kind of put the [61:02] brakes on our [61:05] short-term desires, and [61:10] project ourselves into the future to [61:12] achieve our long-term desires. So, Sam [61:15] McClure, a neuroscientist, has shown [61:17] that in response to immediate rewards, [61:20] the emotion brain gets activated. [61:22] >> Mhm. In response to long-term rewards, [61:25] the prefrontal cortex gets activated. [61:27] So, by planning in advance all of these [61:31] little pieces, sometimes called habit [61:32] stacking, we're essentially activating [61:35] our prefrontal cortex, projecting [61:37] ourselves into the future, [61:39] and anticipating a long-term reward, [61:42] which then allows us to do hard things [61:47] and avoid short-term rewards in the [61:50] service of our future selves. So, many [61:52] people might [61:54] have an experience where they kick the [61:56] habit for a little while, [61:57] and then they relapse. [61:59] >> Mhm. You know, it might take might be a [62:00] month, might be 2 months, might be 3 [62:01] months. Is there is there any art to [62:05] avoiding the relapse? [62:07] So, it's very common to relapse, [62:08] especially living in the world that we [62:11] do today, where we're constantly being [62:13] invited to consume really these stimuli, [62:17] you know, getting us to to drink or to [62:18] smoke or to do various forms of [62:21] entertainment chase us down. We can't [62:23] avoid them, or it's very difficult to. [62:26] So, I talk a lot about self-binding [62:29] strategies with my patients. And [62:31] self-binding strategies are a way of [62:33] putting both a literal and a [62:35] metacognitive barrier between ourselves [62:38] and our drug of choice. [62:39] >> What's a metacognitive barrier? [62:41] >> Oh. [62:42] So, it's like a it's a thought, right? [62:44] Or a narrative. So, instead of it being [62:47] a physical barrier, like a physical [62:49] barrier would be, for example, getting [62:51] the smartphone out of the bedroom, or [62:53] deleting an app, right? Or getting [62:55] alcohol out of the house, or whatever it [62:57] is, creating both a a physical barrier [63:02] between myself and my drug of choice. A [63:05] metacognitive barrier is something like [63:08] more like a thought process. For [63:10] example, long-term goals, or [63:13] you know, what are my what are my [63:14] values, right? And how do my values [63:17] trump my immediate desires, or how can I [63:21] co-regulate with other people? These are [63:23] all self-binding strategies that we can [63:25] use so that we're not relying on [63:28] willpower alone. [63:30] Because if we [63:32] wait to rely on our willpower alone, [63:36] we will not make it, especially in this [63:38] world of overwhelming overabundance. [63:41] There are just too many temptations. [63:43] Willpower is an exhaustible resource, [63:46] meaning that it doesn't last forever, it [63:47] eventually runs out. So, we've got to [63:49] actually create barriers between [63:51] ourselves and our drug of choice so that [63:54] we can have a little bit more time, and [63:56] that little bit more time, that slowing [63:58] things down, is sometimes just enough to [64:02] allow ourselves to surf the cravings, [64:05] and get through them without actually [64:08] using. [64:09] Is it possible to become addicted to [64:11] good things, too? So, when I use the [64:14] term addiction, I'm really talking about [64:16] a disease process, a form of mental [64:18] illness. It's a very common term that's [64:21] used in everyday life, and people don't [64:23] always use it in that way, but when I'm [64:26] using it, I I'm really talking about the [64:28] problem of compulsive overconsumption [64:30] despite harm to self and or others. And [64:33] it's important to distinguish addiction [64:35] from something like a habit, which I [64:39] don't consider to be, you know, an [64:41] addiction or even a bad habit, right? [64:43] Doesn't meet threshold criteria for [64:45] addiction. And also, it's important just [64:47] to distinguish all of that from a [64:48] passion, something that we really invest [64:51] in and that we love to do, but that's [64:53] helpful for ourselves and or other [64:55] people, is not consistently causing [64:57] harm. Are there any daily practices, [65:00] like a morning ritual, that you would [65:02] advise someone to consider if they were [65:04] trying to set themselves up to kick a [65:06] habit or to kick an addiction? So, I [65:08] recommend doing the hard things first. [65:12] A shorthand way of saying that is to [65:15] start your day with pain, meaning, [65:18] for example, [65:20] do the hard things when you first get up [65:22] as part of your morning routine, Like [65:24] exercise. [65:25] >> like exercise, make your bed, eat [65:28] breakfast, brush your teeth, plan your [65:31] day, plan what you're going to do if you [65:32] haven't done it already, and do all of [65:34] those things before, for example, you [65:37] have your morning cup of joe, or before [65:40] you touch a single screen or digital [65:42] device. Why? Because those are [65:45] reinforcers that are so powerful that [65:48] we're all vulnerable to having our [65:51] goals and desires be hijacked by them. [65:53] So, really important to take the time in [65:55] the morning to set up a good morning [65:58] routine [65:59] before you expose your brain to these [66:02] incredibly reinforcing substances. [66:04] >> clear on why. Wasn't clear on the why I [66:07] would do why I'd go to the gym early, or [66:09] why I'd do hard things first before I [66:10] get into Tik Tok or social media. If you [66:13] do intoxicants first, right? If you [66:16] expose your brain first thing in the [66:18] morning to things that are incredibly [66:20] pleasurable, [66:22] you have nowhere to go from there. And [66:24] in fact, if any if anywhere, you're [66:26] going to have a come down from that. And [66:28] then you're going to be starting from a [66:29] place of compromise, where then doing [66:31] the hard things is is even harder. [66:34] Whereas, if you start with the hard [66:35] things, [66:36] you will potentially get rewards from [66:39] having done those hard things, right? [66:42] And also feel a sense of competence, [66:45] right? And and accomplishment that then [66:49] allows for you to move through your day [66:52] in a way that's better if you just start [66:55] with something that's incredibly [66:56] pleasurable. If I am getting ready to [66:58] kick a habit, a big one, a big, you [67:00] know, one that's really hung around for [67:01] a long time, is there something I should [67:03] do in preparation [67:05] to plan for my dopamine fast or for [67:08] kicking that habit? Cuz you you know, [67:09] you said, you know, from day one it will [67:11] take about 4 weeks to start to to feel [67:13] the cravings diminish. But is there [67:16] something I should be doing before I [67:17] even start those 4 weeks? Yeah, so I [67:19] strongly recommend preparing for the [67:22] dopamine fast in advance. And the things [67:24] to do are first, figure out what is your [67:27] drug of choice, that is to say, what is [67:29] the thing that you're consuming too much [67:31] and too often such that you regret it [67:33] later, Mhm. or the thing that's leading [67:35] to obvious negative consequences, or the [67:38] thing that just has opportunity costs [67:40] associated with it. That is to say, [67:42] you're spending so much time consuming [67:44] this drug that you're not doing other [67:46] things, other hobbies, investing in [67:49] other things that are meaningful to you, [67:50] like your primary relationships. So, [67:53] that's very important to just figure [67:55] that out first. And I usually recommend [67:57] something called the timeline [67:59] follow-back method. That's where you [68:01] start today, and you count backwards for [68:05] every day of the week, what did you [68:07] consume in terms of your drug of choice, [68:10] um how much and how often. So, really [68:13] looking at quantity and frequency, and [68:15] then adding that up over those 7 days. [68:20] And the reason that's important is [68:22] because [68:23] we can really lose track of how we're [68:25] consuming our drug of choice when we're [68:28] chasing dopamine. We're very bad [68:30] self-observers. So, just to give a a [68:32] personal example, um I had gotten into [68:35] this habit of watching YouTube after [68:38] work as a way to relax, Mhm. especially [68:41] on my long clinic days when I was more [68:42] tired. [68:44] And I thought it was just that I was [68:45] watching for maybe half an hour a couple [68:47] times a week. And then my daughter, a [68:50] teenager, came up to me, and she said, [68:52] "Mom, you're always watching YouTube [68:53] now." And I said, "No, I'm not." And I [68:55] was really kind of insulted because in [68:57] my mind, it was not very much. I [68:59] thought, "Geez, can't I relax every once [69:01] in a while and watch some YouTube?" But [69:03] then after she left me, I thought to [69:06] myself, "Well, okay, how much have I [69:08] been watching right now?" And turned [69:09] out, oh, I've been watching for an hour [69:11] and a half. And then I thought about the [69:13] day before that, oh, it was probably 2 [69:16] hours. And the day before that, it was [69:17] probably about the same. And over the [69:19] course of a whole week, it was probably [69:20] about 14 hours of YouTube, which is a [69:23] whole day. A whole day, right? And so [69:28] >> What were you watching? [69:29] Oh gosh, so embarrassing. [69:33] For I I got I got into this jag of [69:36] watching Dr. Pimple Popper, which I know [69:39] is really weird. You don't even know [69:40] what that is, right? Yeah, so it's [69:43] people popping other people's pimples. [69:46] >> [laughter] [69:51] >> So bad. So bad. [69:52] >> That's not what I expected you to say. [69:53] >> Yeah, right? I thought it was going to [69:56] be AI, some psychology thing, some [69:58] science. [69:59] >> no. People popping other people's [70:01] pimples. [70:01] >> Yeah, yeah, yeah. You know [70:03] >> a whole day watching that. [70:04] >> Yeah, when I added it up over a week, it [70:07] was a whole day of watching Dr. Pimple [70:09] Popper. [laughter] [70:12] I don't know any founder who started [70:13] their business because they like doing [70:14] admin, but whether you like it or not, [70:16] it's a huge part of running a business [70:18] successfully, and it's something that [70:19] can quickly become all consuming, [70:21] confusing, and honestly, a real tax [70:23] because you know it's taking your [70:24] attention away from the most important [70:26] work. And that's why our sponsor, Intuit [70:28] QuickBooks, helps my team streamline a [70:30] lot of their admin. I asked my team [70:32] about it, and they said it saves them [70:34] around 12 hours a month. 78% of Intuit [70:38] QuickBooks users say it's made running [70:40] their business significantly easier. And [70:42] Intuit QuickBooks new AI agent works [70:45] with you to streamline all of your [70:46] workflows. They sync with all of the [70:48] tools that you currently use. They [70:49] automate things that slow the wheel in [70:51] the process of your business. They look [70:53] after invoicing, payments, financial [70:55] analysis, all of it in one place. But [70:57] what is great is that it's not just AI. [71:00] There's still human support on hand if [71:01] you need it. Intuit QuickBooks has [71:03] evolved into a platform that scales with [71:05] growing businesses. So if you want help [71:07] getting out of the weeds, out of admin, [71:09] just search for Intuit QuickBooks now. [71:13] All right, guys. Ready to go get Steve. [71:14] The guest is here. [71:16] Ready? Come in. OH MY GOD, STEVE. [71:19] WHAT? [71:20] WHAT ARE YOU DOING? THIS IS a the [71:22] boncharge face mask. It's good for [71:24] blemishes, wrinkles, [71:26] clears up the skin. It's red light. Have [71:28] you not used it before? No. You tried [71:29] this before? It's um [71:31] It's really really good. It [71:32] shines red light on your face, which [71:34] helps increase and boost collagen [71:36] production. I actually found it out cuz [71:38] of the missus. Seeing her wearing it, [71:39] she terrified me a couple of nights in a [71:40] row. [71:41] I thought it was to scare people with, [71:43] but actually it's really really good for [71:44] your skin. So they're a sponsor of the [71:46] podcast, and I've been using it every [71:49] day for about a year and a half now. [71:50] Wow. [71:51] You're glowing. Well, Steve, it looks [71:52] great. Yes. And uh boncharge ships [71:54] worldwide with easy returns and a [71:56] year-long warranty on all of their [71:57] products. So visit boncharge.com/diary [72:00] for 25% off on any product site-wide, [72:03] but you have to order through that link. [72:05] That's boncharge.com/diary [72:08] with code [clears throat] diary. [72:11] And on on [72:12] page 64 of your workbook of Defy Nation, [72:15] there's this really interesting [72:17] image here, [72:19] which I I'll throw up on the screen. It [72:20] shows a brain, [72:23] and that's as far as I'm going to go [72:24] with Mike me explaining it. Over to you. [72:27] >> [laughter] [72:27] >> Okay, so this is these are human brain [72:30] imaging studies. This is adapted from [72:33] the work of Nora Volkow and her [72:35] colleagues. She is the head of the [72:37] National Institute of Drug Abuse, an [72:38] amazing researcher and scientist. [72:41] And she looked at dopamine transmission [72:44] levels in the reward pathways of healthy [72:47] control subjects on the left versus [72:50] people addicted to a variety of [72:52] substances on the right, cocaine, meth, [72:55] alcohol, etc. [72:57] Basically, what she found was in the in [73:00] the brains of healthy control subjects, [73:03] there was plenty of dopamine [73:04] transmission as represented here by red [73:07] or the darker color. [73:10] In the brains of people who had been [73:12] using these substances in an addictive [73:14] way, meaning heavily and chronically, [73:17] there was almost no dopamine [73:19] transmission in the nucleus accumbens. [73:22] In other words, these individuals are in [73:24] a chronic dopamine deficit state. They [73:27] have below [73:29] normal levels of dopamine transmission. [73:32] Isn't this just kind of the story of how [73:35] the human body works, where if you give [73:37] it too much of something [73:39] through an external source, an exogenous [73:43] source, so if you're taking [73:45] lots of dopamine via [73:47] TikTok or from porn or from alcohol, [73:50] your brain goes, "Well, if you've got [73:52] enough of that, then I won't make any." [73:55] You know what? You just summed it up. [73:57] That that's exactly right. That [73:59] essentially too much of anything is bad. [74:03] And that our brain, which is designed to [74:08] return to homeostasis, homeostasis being [74:12] a finite number of physiologic states [74:16] that the organism must maintain in order [74:19] to survive. [74:21] Is this the case with things like [74:22] melatonin as well? Because there's [74:24] people are struggling not with sleep, so [74:25] they're taking a lot of these melatonin [74:26] pills, but I don't know, someone offered [74:28] me one one time, and I remember [74:29] thinking, [74:31] "Well, if I start taking this, then [74:32] isn't my body [74:34] going to stop making it? And then I'm [74:35] going to become dependent on these [74:37] [ __ ] pills." [74:38] So that is the potential with I think [74:41] any [74:42] exogenous source that we [74:46] that we use, right? [74:48] Anything that we ingest, [74:52] our brains and our bodies [74:55] will want to adapt to bring us back to [74:58] whatever our baseline is. But the the [75:01] difference between addictive substances [75:04] and behaviors [75:05] and non-addictive ones is that the the [75:08] release of dopamine in the reward [75:10] pathway is [75:11] so fast and so strong that this process [75:15] of neuroadaptation is equally strong to [75:18] bring us back down to baseline. [75:21] Because we we do know that there are [75:23] medications that people can take for [75:26] very long periods of time and actually [75:28] not develop tolerance to them, [75:31] right? They can continue to work for [75:33] them over the long period of time. We [75:35] don't actually know exactly why it is [75:38] that some some people develop tolerance [75:41] and and not others. And again, it [75:43] probably has to do with the amount, you [75:45] know, the dose, exactly how it's working [75:48] on the brain. But in general, things [75:50] that are highly reinforcing, our brain [75:53] tends to adapt to them over time. And [75:55] testosterone is another one people often [75:57] talk about where if you take external [75:59] testosterone consistently, your brain [76:01] will decrease the natural production of [76:03] it, and as a result, natural [76:04] testosterone shuts down, and testicular [76:06] size can shrink. [76:08] But then if you stop the TRT, the [76:10] external testosterone abruptly, your [76:12] natural system might take a long time to [76:14] recover, and in some cases, it may never [76:16] fully recover back to baseline. I think [76:18] this is just like a really important [76:19] principle for Yeah. [76:21] drugs, chemicals, [76:23] >> Yes. or messing with the natural balance [76:25] of one's body. Yes. Yes, exactly. And by [76:28] the way, Nora Volkow and her team did a [76:30] follow-up study in individuals who [76:33] abstained from methamphetamine for 14 [76:35] months, and then re-scanned their brain [76:39] and showed that they had restored [76:40] healthy levels of dopamine transmission. [76:43] It took 14 months in those individuals [76:46] who had been very addicted to [76:47] methamphetamine, which I think is also [76:49] an important message here, you know, for [76:51] individuals struggling with severe [76:52] addiction, it's not like 4 weeks of [76:54] abstinence is suddenly going to, you [76:56] know, make your brain better. But what I [76:58] have found in clinical care is that [77:01] that's typically enough time to begin to [77:04] see the light at the end of the tunnel, [77:06] and that indeed there's enough [77:09] restoration of sort of baseline levels [77:13] of [77:14] joy, your capacity to experience reward, [77:17] that that people can begin to have hope [77:20] to get out of that state of craving. [77:22] What is the most interest cuz Ethan is [77:24] posed to some research on the subject of [77:26] dopamine and human behavior. [77:29] Is there a particular study that always [77:31] stands in your mind as being the most [77:37] or surprising that you've encountered? A [77:39] study that [77:41] um that keeps coming back to me, [77:44] there are a couple. I mean, there are so [77:45] many, but Give me them. Okay. So [77:48] if you put a rat in a cage with a rat [77:51] trapped in a plastic bottle, [77:53] that rat will that rat will work very [77:56] hard to free the trapped rat. [78:00] But if you then allow that rat to [78:04] administer self-administer heroin, [78:08] it will not work to free the trapped [78:10] rat. [78:12] To me, that's really powerful because it [78:15] it suggests how [78:19] addictive substances like opioids, [78:23] which heroin is, [78:25] can usurp our desire for human [78:29] connection. [78:31] And essentially become the object of [78:34] attachment. [78:35] And we often talk about loneliness and [78:38] isolation as a risk factor for [78:41] addiction, which it absolutely is, but [78:43] the reverse is also true. [78:45] That getting addicted will cause us to [78:49] isolate and be lonely. We will stop [78:53] caring about other people. [78:56] So for me, that's that's a really a [78:59] really powerful, you know, kind of [79:01] experiment that I think does map on to [79:05] human behavior. Something really [79:06] interesting this one just at a [79:07] day-to-day level, which which in your [79:10] head I was trying to relate that to my [79:11] my own life and thinking, you know, if I [79:13] get really addicted to my screens and my [79:15] devices, when my partner needs me, [79:18] Right. I might [79:20] be [79:21] so distracted and so connected to the [79:23] thing that's giving me dopamine upstairs [79:24] in my bedroom like my laptop or whatever [79:26] on my work that I might completely miss [79:28] her call for help. [79:30] And I kind of you know, I hate to say [79:32] it, but sometimes I do feel like [79:34] maybe that is I've been guilty of that. [79:37] >> Yeah. Yeah. [79:38] >> Yeah. I've been so [79:40] dare I say the word addicted to [79:43] my work with devices or whatever that [79:46] you know, sometimes I'm not present with [79:48] meeting other people's needs. [79:49] Absolutely. And you know, that certainly [79:52] happened to me with my addiction to [79:54] romance novels, right? We I stopped [79:57] paying as much attention to my kids and [79:59] to my husband. We um went on a [80:04] vacation with another family at the [80:05] beach and instead of joining folks on [80:07] the beach, I stayed in the room and read [80:09] romance novels. [80:10] We went to a neighbor's party and I [80:12] actually found a room in the house and [80:14] read romance novels instead of [80:16] socializing and didn't even think that [80:18] was weird even though that's obviously [80:20] really strange. So, it is this kind of [80:23] coming to overvalue [80:25] our drug of choice and undervalue other [80:30] more meaningful [80:32] good things in our lives. [80:34] Could you theoretically say it's making [80:36] the world less empathetic [80:38] or less sympathetic or less [80:42] what's the adjective of like of actually [80:45] being there for other people? I guess [80:47] connection and relationships it's it's [80:49] it's hurting our ability to connect to [80:51] others and be have empathy for them and [80:52] be there for them because we're [80:55] possessed by [80:57] the thing giving us the most dopamine. [80:59] Yeah, I would go even further and say [81:01] not only is [81:04] is it making us less empathetic, but [81:07] it's actually making us sociopathic. [81:10] In other words, [81:12] when people are in their addiction, they [81:14] can deviate from their moral compass um [81:17] because they so overvalue this drug of [81:21] choice that they lose sight of their [81:23] their own values. And we see this um [81:26] with kids who become addicted to video [81:30] games or or social media. They stop [81:33] participating in family life. They stop [81:35] treating their parents with respect. [81:38] They stop participating in household [81:41] chores. Um they become essentially [81:44] antisocial. [81:46] And when they get off of digital media [81:49] and they go through that terrible [81:50] withdrawal period, it all that gets [81:52] worse and and even they will endorse [81:54] things like wanting to hurt their [81:56] parents or wanting to hurt themselves. [81:59] But if they can just go long enough and [82:02] abstain uh you know, from digital media, [82:05] they will they will come out the the [82:07] other side and parents will talk about [82:09] getting their child back, you know, and [82:11] getting back you know, this person that [82:14] that they recognize as their child. So, [82:16] I think this is this is really [82:17] important. When people are in their [82:18] addiction, they can look very [82:21] personality disordered, very [82:22] narcissistic, very borderline, [82:25] very sociopathic. [82:28] And when they get into recovery, that's [82:30] not who they are at all. And they can [82:33] they can really become themselves again. [82:36] I read about a really extreme case where [82:39] that drug, I believe it's called [82:41] pramipexole, [82:43] pramipexole, [82:44] which is a dopamine agonist. [82:47] >> Yes. [82:48] Which essentially means I guess the [82:50] molecule is the same shape as dopamine. [82:52] So, it kind of the brain treats it like [82:53] dopamine. [82:54] >> Yes. And these people were given it for [82:56] twitchy leg or something. Right. [82:58] >> And then they [82:59] like so many of them lost their minds. [83:01] They became [83:02] obsessed with like compulsive impulsive [83:04] behaviors and I was reading about one [83:06] particular lady and she would leave the [83:08] house in the early hours of the morning [83:09] when she was taking this drug which kind [83:10] of is the same as dopamine and she would [83:14] wear see-through tops. This is like a [83:16] normal woman who otherwise [83:17] [clears throat] had a normal life and go [83:19] to [83:21] very dangerous places to try and have [83:22] sex with strangers. [83:24] And it was because she was her brain was [83:26] um [83:27] full of this this drug which simulated [83:30] dopamine. But there's so many examples. [83:31] There was one from Australia where a [83:32] woman was taking this drug which which [83:35] is like dopamine in terms of its [83:36] molecular structure and she would sit on [83:39] these slot machines until she soiled [83:42] herself and urinated on herself. She [83:44] ended up losing her house, losing her [83:45] car, losing her marriage just because [83:47] they'd given her this drug which is the [83:48] same as dopamine. And it made me realize [83:50] that that dopamine isn't necessarily the [83:52] the drug of [83:54] reward but more of like [83:56] what wanting and impulse and desire. Is [84:00] that an accurate assessment of it? Like [84:02] did it make you desire things? And there [84:03] was other examples that when I was [84:04] reading about it where people would [84:06] a guy would take this drug [84:09] and [84:11] started engaging in homosexual [84:14] sex acts. [84:16] Whereas otherwise he'd been in a [84:17] heterosexual relationship. [84:18] >> Mhm. [84:19] It was all very confusing, but it [84:21] it says something to me about what [84:23] dopamine is actually doing. [84:25] Yeah, I mean I think you know, when [84:27] we're talking about [84:29] addictive substances and behaviors, [84:34] the initial response of the brain is to [84:36] release a lot of dopamine all at once in [84:38] the reward pathway. But with repeated [84:42] use, [84:43] dopamine dopamine release gets weaker [84:46] and shorter in duration [84:48] and eventually it leads to this dopamine [84:50] deficit state and that's often what we [84:53] call wanting but not liking. So, and [84:57] George Koob has called this dysphoria [84:58] driven relapse where [85:01] now they're using you know, not to feel [85:04] good but just to stop feeling bad and [85:06] feel normal. So, in that sense I mean [85:09] dopamine is [85:11] I mean it is part of pleasure. I mean [85:14] that that's it's that's not you know, [85:16] it's not its sole function. But when it [85:20] comes to addictive substances and [85:21] behaviors, the initial encounter has to [85:25] feel good or be reinforcing or get [85:27] someone out of pain, right? It has to [85:28] solve that problem. But again, the issue [85:32] is that with repeated use it stops doing [85:35] that, but there's still that motivation [85:38] to reuse again and again. [85:40] And when we're thinking about like [85:42] exogenous or external sources of just [85:45] giving someone dopamine, that's not [85:47] going to work to treat that dopamine [85:50] deficit state because it's going to bind [85:52] indiscriminately to dopamine receptors [85:55] throughout the brain and the brain will [85:58] respond with that same process of [86:00] neuroadaptation where it's [86:01] downregulating [86:03] you know, dopamine receptors, which is [86:05] again what is setting us up for this [86:08] repeated addictive pattern. Is there any [86:12] other studies that were shocking to you [86:14] and that have always stayed with you? [86:16] Another really interesting study is if [86:19] you um expose a rat to a single [86:22] injection of cocaine and then slice open [86:24] its brain, you'll see this arborization [86:27] of dopamine releasing neurons in the [86:28] reward pathway. So, that means a [86:30] proliferation of uh neurons that release [86:33] dopamine, a kind of growth of the [86:35] dopamine forest, so to speak. But by the [86:38] way, you'll see that same arborization [86:40] or growth of dopamine releasing neurons [86:43] if you put a rat in a complex maze, [86:45] right? Which is to say a maze where they [86:47] can explore and find different things [86:50] and have challenges. If you then cut [86:53] that rat's brain open, you'll see that [86:55] same arborization of dopamine. So, in [86:57] other words, learning is highly [86:59] rewarding and dopamine is released in [87:02] response to novelty and new things and [87:04] new challenges. [87:06] But if you then take that rat and [87:08] pretreat it with methamphetamine and put [87:11] it in the maze and then look at its [87:13] brain, you don't see any additional [87:16] arborization beyond what you got with [87:18] methamphetamine. [87:20] And the interpretation there is that [87:24] drugs actually may usurp or steal our [87:29] ability to learn, right? Because they've [87:32] again this idea of sort of they've taken [87:35] over. They're such a powerful dominant [87:37] stimulus that there's no additional [87:41] growth or neuroplasticity [87:43] in response to something like learning a [87:45] maze. And does that mean that [87:48] when that rat was in the maze the first [87:50] time and its brain was full of dopamine, [87:53] dopamine was therefore playing a role in [87:54] helping it to learn? [87:56] No, so the learning itself [87:59] actually caused prolif So, so dopamine [88:02] is is responsive not just to rewards, [88:06] not just to pleasurable things, but it's [88:08] actually responsive to pain, it's [88:10] responsive to novelty. So, it's [88:12] responsive to any emotionally powerful [88:15] experience. [88:17] So, when you put a rat in a maze and it [88:19] explores that maze, that's an enriching [88:23] exciting experience for the rat because [88:26] we are [88:27] creatures who are evolved to seek and [88:30] explore and learn new territory and then [88:34] move on and do the same thing. Ah, so [88:37] you could say then if I'm taking an [88:39] addictive substance like cocaine, I'm [88:41] going to be much less likely to go out [88:44] and explore the world. Yes, exactly. Or [88:47] if you do explore the world, you'll [88:49] there you'll your capacity to be [88:52] rewarded by that experience will will [88:55] decrease or will not be there. So, I'm [88:57] less likely to do it then. [88:58] >> Right. Yes. Yeah. [89:00] >> Mhm. I mean this highlights a bit more [89:02] of a fundamental link around like [89:03] motivation. Like if you're addicted to [89:05] something, if you're addicted to [89:06] pornography, your ability to like get up [89:07] and go out and get a job might be [89:09] diminished. [89:11] Absolutely. I mean what what happens [89:13] with addiction is that we have a [89:14] narrowing of our focus on our drug of [89:16] choice [89:17] such that that's the only thing that's [89:19] reinforcing for us and other things lose [89:22] their rewarding potential. And [89:24] eventually they fall away all together [89:26] and we're spending all of our time [89:27] getting our drug, using our drug, trying [89:29] to get more as we come down. Can I talk [89:32] about another experiment which I think [89:33] is interesting? Another really [89:35] interesting experiment is the rat park [89:37] experiment and this is the work of Bruce [89:39] Alexander and he essentially said, well, [89:42] if you put a rat in a cage with nothing [89:44] else to do but press her press a lever [89:46] for cocaine, of course that's what [89:48] they're going to do cuz there's nothing [89:49] else happening. [89:50] But what if you put a rat in a very [89:53] enriched environment with a lever to [89:55] press cocaine, but also lots of other [89:57] things to do, other rats, uh shoots and [90:00] mazes, uh little, you know, sawdust [90:04] balls. What he discovered was that the [90:07] rat is much less likely to press that [90:11] lever as often because it has other [90:13] reinforcing things to do. And I think [90:16] that that was really groundbreaking [90:20] in the sense that [90:22] it is true that addictive substances and [90:25] behaviors work on the brain in this very [90:28] predictable way that's so reinforcing [90:30] that even if you have a great life, you [90:32] can get addicted, but it's also true [90:35] that [90:36] our environment really matters and if [90:39] we're living in an impoverished [90:41] environment like that single rat in a [90:43] cage with nothing else to do, we're much [90:46] more likely to get addicted than if we [90:48] live in this really enriched environment [90:51] where we have lots of other sources of [90:54] reward, lots of other sources of [90:57] dopamine. And based on that work, there [91:00] was something then called the Icelandic [91:02] experiment and this is quite some years [91:04] ago now, but Iceland had a significant [91:07] youth drug problem and the way that they [91:10] decided to intervene was to build a lot [91:13] of gymnasiums and emphasize youth [91:16] sports. And as we've talked about, [91:18] exercise and sports are a healthy way in [91:23] general, if you don't overdo it, to get [91:24] dopamine because you're paying for it up [91:26] front, right? You're working for it. And [91:29] um Iceland saw a [91:32] significant reduction in their youth [91:34] drug use problem after the [91:36] implementation of this youth sport [91:39] system. So, I think that's a nice way to [91:42] that's a it's a nice example of how an [91:44] animal animal model can actually provide [91:47] some kind of fundamental [91:50] frame to understand what's happening in [91:52] the brain that can be then translated to [91:54] a real-world implementation. [91:57] Radical honesty. Okay, so um [92:00] radical honesty is something that I [92:02] learned about from my patients [92:04] and it was the observation that [92:07] my patients who were able to get into [92:10] sustained recovery [92:12] from severe addictions had learned [92:15] that [92:17] they couldn't lie. [92:19] And it wasn't just that they couldn't [92:21] lie about their drug use. [92:24] They couldn't lie about anything. So, [92:26] they couldn't lie about why they were 5 [92:28] minutes late for a meeting, they [92:29] couldn't lie about why they couldn't go [92:31] to a party. [92:33] They had to tell the truth in all things [92:35] large and small. [92:38] And to me that was fascinating. [92:40] And it was an idea that I started to [92:42] play with and experiment with in my own [92:44] life and I realized that telling the [92:46] truth is actually really hard [92:49] because we're all prone to little lies [92:51] to kind of cover up our shortcomings. Um [92:55] you know, these are things that we [92:56] hardly even notice. [92:58] They're also like lies of exaggeration [93:01] to make ourselves more interesting, lies [93:03] of flattery where we tell other people [93:05] how great they are even though we don't [93:06] necessarily believe that. So, all these [93:09] little lies that we tell, [93:11] um I think even [93:13] if you're not struggling with addiction, [93:15] these lies can erode our lives, make our [93:18] lives more impoverished. [93:21] Um and I think, you know, it's working [93:23] through many different mechanisms. We [93:26] So, the question then becomes why is [93:28] truth-telling or radical honesty [93:30] protective? [93:31] And I think it's working across many [93:33] different levels. [93:35] But one of the [93:37] important levels that it's working [93:39] across is simple awareness. [93:42] Because when we're lying to other [93:45] people, we're also actually lying to [93:47] ourselves. [93:50] Um and when we're lying to ourselves, we [93:53] actually don't know what we're doing, [93:55] right? And when it comes to our [93:57] consumptive behaviors, on the one hand, [93:59] you know, I may know that I'm watching [94:02] too many videos on the same at the same [94:05] time really not know that I'm doing [94:06] that, right? So, [94:08] but when [94:09] I tell another human being exactly what [94:12] I'm consuming, how much and how often, [94:15] then it becomes real to me in a way that [94:17] it's not when it's sort of pinging [94:19] around in the dark recesses of my my own [94:21] mind. [94:22] So, that awareness is really important [94:24] because we can't change our behaviors [94:27] unless we're aware um of what we're [94:30] doing. [94:31] The other aspect of that that's really [94:33] important that I've learned over many [94:35] years of being a psychiatrist is that [94:38] the way that people tell their [94:40] autobiographical narrative is really [94:43] important and that there are healthy [94:45] ways we can tell our stories and also [94:48] not so healthy ways. [94:50] And what I have observed is that when [94:53] when people are telling [94:55] stories in which they're always the [94:57] victim of other people or circumstance, [95:01] I know pretty well that they're not [95:02] going to get into recovery. [95:04] But if they start telling a story that [95:06] acknowledges [95:08] their own contribution to their problem, [95:11] whatever it is, including the problem of [95:12] addiction, [95:14] then I'm pretty confident that we're [95:16] headed in a good direction. [95:18] And that's really interesting because [95:20] what it means is that our [95:23] autobiographical narratives [95:25] provide a template [95:27] for our lives. They're not just a way to [95:29] organize past experience, they actually [95:31] provide a roadmap for the future. [95:34] And if we're telling self-stories that [95:37] are [95:38] a more accurate representation of what's [95:41] actually happening in our lives, [95:44] we will have more information from which [95:46] to make better decisions going forward. [95:49] >> So, victimhood keeps you stuck. It keeps [95:51] you stuck because it decreases your [95:54] awareness of what is actually happening. [95:59] And it is our awareness of what is [96:00] actually happening that allows us to [96:03] have the data we need to make better [96:05] informed decisions. [96:07] >> Does it also to some level rob you of [96:09] responsibility? Absolutely because [96:12] although addiction is characterized by a [96:15] a loss of agency around our consumptive [96:17] behaviors, we still have some degree of [96:20] agency always, even if it's only enough [96:23] to reach out and ask for help. And as [96:26] people get into sustained recovery, they [96:30] have a lot more agency, right? As they [96:32] get out of that vortex of addiction. And [96:34] it is that agency that that we must [96:37] employ to make the next best decision so [96:41] that our lives will be this accumulation [96:44] of small good decisions that then lead [96:46] to good weeks and week good months and [96:49] good years. [96:50] I think that point is so important, this [96:51] this idea of agency, which essentially [96:53] means like [96:54] having control in my in my life, feeling [96:56] like I have a sense of control in my [96:57] life. Is that like a definition of [96:58] agency? [97:00] How would you define it? [97:01] >> I I wouldn't define it so much as [97:03] control because there are so many things [97:06] that happen in our lives that are out of [97:07] our control. [97:09] But when we reduce our decision down to [97:15] today, you know, and what I can do [97:17] today, the things that I actually can [97:19] control today, then yes, recapturing our [97:23] agency around the things that we [97:24] actually have control over is really [97:27] really is really important for recovery. [97:30] The definition I've pulled up here is [97:31] agency means the capacity to act [97:33] intentionally and make choices that [97:34] influence outcomes. [97:36] And um it does tend to be the case from [97:38] my observations that people that have a [97:39] high degree of agency, i.e. they believe [97:42] they have uh capacity to act [97:44] intentionally and make choices that [97:45] influence their outcomes seem to be the [97:47] most successful and on average seem to [97:50] be a little bit more happy. [97:51] I think that sense of competence and and [97:54] agency is definitely one that makes us [97:57] feel good. [97:58] The danger a little bit when we're [98:00] dealing with severe addiction is that [98:04] in our addictions, we often tell [98:06] ourselves that we have agency and [98:08] control when we really don't. Mhm. And [98:10] so that can be part and parcel of [98:12] denial, [98:14] which means that getting into recovery [98:15] is often about admitting [98:18] that we may have agency in many aspects [98:21] of our lives, but when it comes to our [98:22] addictive behavior, we've lost some [98:24] degree of agency. And that's part of the [98:26] 12-step program, right? [98:27] >> Yeah, that is really important part of [98:29] the 12-step program is that [98:31] admitting that our lives have become [98:34] unmanageable uh when it comes to our [98:37] drug of choice. The 12-step program [98:39] being Alcoholics Anonymous, very famous [98:42] program to to help you through an [98:43] addiction. Is there anything else we [98:44] should have talked about that we [98:45] haven't? You know, when it comes to [98:49] New Year's resolutions and wanting to [98:52] change habits, [98:55] sometimes these sort of all or nothing [98:57] thinking [98:58] can [99:01] be something that's not helpful for [99:02] people. [99:04] Right? This idea that, okay, I'm going [99:05] to abstain from this and I'm going to go [99:07] a month and, you know, I'm going to do [99:09] it and then they find that they're not [99:11] able to do it and then there's then [99:12] there are a lot of shame and self [99:14] self-recrimination. [99:15] So, you know, that that approach is is [99:17] not for everybody. And for some, a [99:21] better approach is sort of [99:22] self-compassion [99:24] and a goal of moderation. Yeah, [99:26] moderation's an interesting one cuz [99:28] yeah, most of us will just be like, "I'm [99:29] going to go to the gym every day. I'm [99:30] going to I'm going to have no sugar ever [99:32] again. I'm going to No, I'm going to [99:33] abstain from alcohol completely." But [99:35] maybe moderation for some of these [99:37] things is more realistic and therefore [99:38] more effective in the long run. Yeah, [99:40] and we find that moderation typically is [99:43] more successful if period if people have [99:46] abstained for long enough to kind of [99:47] reset reward pathways. [99:49] But, you know, even just reducing use [99:52] can be a laudable goal. [99:55] We have a closing tradition on this [99:56] podcast where the last guest leaves a [99:57] question for the next guest. No idea who [99:59] they're leaving it for. The question is, [100:01] "What's the one thing the universe keeps [100:03] putting in front of you?" [100:05] And what is the thing [100:07] that it keeps you learning? [100:10] Um so, right now in my life, the thing [100:13] that the universe keeps putting in front [100:15] of me is the importance of [100:18] letting my kids go and have their own [100:22] life experience [100:24] um rather than [100:26] trying to cling to the relationships [100:30] that we had before [100:33] as they were growing up, which for me [100:35] was a really joyful time, but I'm [100:38] recognizing that they need to be in the [100:42] world on their own and I need to figure [100:45] out what I'm going to do [100:47] um as an empty nester. So, that's not [100:50] that deep, but that is what I'm [100:51] struggling with right now. [100:54] And how's that struggle manifesting? [100:57] Well, [100:59] I mean, if I'm being totally honest, um [101:03] social media and digital media and those [101:06] modes of communication [101:09] have probably made this worse for me [101:12] because, for example, uh the Find My [101:14] iPhone, I keep checking where my kids [101:17] are and thinking that in a way [101:20] um we're connected because I know where [101:23] they are, but we're not. And also, they [101:25] don't particularly like it that I'm [101:27] checking where they are. So, there's [101:28] this kind of weird phenomenon of [101:32] wanting connection [101:34] and through text and other technology [101:38] trying to recreate that connection. And [101:40] yet, in some ways, I think I might be [101:43] better off and they might be better off [101:45] if we didn't actually text and I didn't [101:48] actually track where they are. [101:51] Does that make sense? It does. And I I [101:53] was I think I was laughing cuz I just [101:54] had this picture of you sat there with [101:55] like [101:56] one screen is tracking them and the [101:58] other one is like watching the pimples [101:59] being popped. [102:00] >> Yes. [102:01] Those are comparable, right? These These [102:02] are both sort of related to sort of [102:05] habits or behaviors that are [102:07] self-soothing, but ultimately not not [102:10] good for me and, you know, not good for [102:13] other people. Do you think much about [102:15] how other behaviors that we take part in [102:18] like sleep um [102:19] and meditation [102:21] um and our nutrition have a big impact [102:24] on our ability to kick the bad habit to [102:26] start a new one? Oh, absolutely. Um [102:29] there's a great acronym from Alcoholics [102:31] Anonymous called HALT: hungry, angry, [102:33] lonely, tired. You know, when we're [102:35] feeling those things, uh we're more [102:37] likely to crave our drug of choice. Um [102:41] so, importantly, we've really got to [102:42] make sure we take care of ourselves [102:44] physically and emotionally so that we're [102:46] as well as we can be so that we don't um [102:49] get into that state of wanting to escape [102:52] or self-soothe or numb ourselves. And by [102:54] the way, that's true in the work that we [102:56] do as mental health care providers, [102:58] right? We have to really come to [103:00] patients or clients with our needs met, [103:03] um our cup full so that we can be fully [103:05] present for for our patients. [103:08] Dr. Anna Lembke, [103:10] thank you so much for [103:12] coming back on the show. It was [103:13] incredible the conversation we had last [103:15] time and it was so unbelievably well [103:16] received um [103:17] it's done probably closer to 10 million [103:19] views across all platforms now. Um five [103:21] just over 5 million views on YouTube [103:23] alone and I can't begin to imagine all [103:25] the the people that you've had a [103:26] profound impact on by making these [103:29] complicated things accessible. And I [103:31] know we we simplify this to a point that [103:33] it might be quite [103:35] difficult for for because I know the [103:37] science is much more complicated, but [103:39] just having a simple mental model for me [103:40] is has helped me so much since we last [103:42] spoke understand what's going on inside [103:44] my body and inside my brain [103:46] in a simplified way and that's exactly [103:48] what was reflected by the millions of [103:49] people that watched last time. Your book [103:51] is the the book to read and your [103:53] workbook as well is a critical critical [103:55] to read alongside it um on this subject [103:57] if people want to learn more and get a [103:58] an even deeper understanding of [104:00] everything we've talked about today. And [104:02] also, if they're struggling with [104:02] addictions because [104:04] these book books provide a really [104:07] I'd say nuanced um empathetic and [104:11] shame avoiding [104:14] set of ideas and solutions to some of [104:15] the things that [104:17] hold us hostage in our lives, whether [104:18] it's opioids or technology or other [104:20] behaviors that we know at some level are [104:22] getting in the way of what we'd rather [104:24] be doing and who we'd rather become. So, [104:25] thank you so much for your work. It's [104:26] such an important work and I know you're [104:27] working on another book, which we didn't [104:29] talk about this time, but when that book [104:31] does come out, I'd love to have you back [104:32] on to talk about all the things in that [104:34] cuz I am little birdie told me the [104:35] subject matter and it's absolutely [104:37] fascinating, so I'm so excited. Thank [104:39] you so much. [104:40] >> [music] [104:43] >> This is something that I've made for [104:45] you. I realized that the Diary of a CEO [104:47] audience are strivers, whether it's in [104:48] business or health. We all have big [104:51] goals that we want to accomplish. And [104:52] one of the things I've learned is that [104:54] when you aim at the big big big goal, it [104:57] can feel incredibly psychologically [105:00] uncomfortable because it's kind of like [105:01] being stood at the foot of Mount Everest [105:03] and looking upwards. The way to [105:05] accomplish your goals is by breaking [105:07] them down into tiny small steps. And we [105:09] call this in our team the 1%. And [105:11] actually, this philosophy is highly [105:13] responsible for much of our success [105:15] here. So, what we've done so that you at [105:17] home can accomplish any big goal that [105:19] you have is we've made these 1% diaries. [105:23] And we released these last year and they [105:24] all sold out. So, I asked my team over [105:27] and over again to bring the diaries [105:28] back, but also to introduce some new [105:29] colors and to make some minor tweaks to [105:31] the diary. So, now we have a better [105:35] range for you. So, if you have a big [105:37] goal in mind and you need a framework [105:39] and a process and some motivation, then [105:42] I highly recommend you get one of these [105:43] diaries before they all sell out once [105:45] again. And you can get yours now at the [105:47] diary.com where you can get 20% off our [105:50] Black Friday bundle. And if you want the [105:52] link, the link is in the description [105:53] below. [105:54] >> [music] [106:00] [music] [106:07] [music] [106:10] [singing]