Are you scrolling on your phone constantly? How badly do you crave that morning cup of coffee? Are you compulsively gambling, drinking, shopping, or even reading romance novels just to fall asleep? The potential for addiction is everywhere in our society, and on this episode of The Knowledge Project psychiatrist and author Dr. Anna Lembke discusses dopamine, addictive behaviors, warning signs and treatment for addiction, and how our brains handle all that pleasure and pain in life.
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Dr. Lembke is professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She appeared in the 2020 Netflix documentary The Social Dilemma to discuss the addictive nature of social media, and she is the author of the 2021 New York Times bestseller Dopamine Nation: Finding Balance in the Age of Indulgence, which explores how to moderate compulsive overconsumption in a dopamine-overloaded world.
Here are a few highlights from our conversation:
Once people have started to take their drug regularly, whether or not they’ve started for fun or to solve a problem, they will eventually end up in this dopamine deficit state where they’ve changed their reward threshold.
That’s what people don’t understand. They think that people are choosing to use, but once people are addicted, their reward centers have essentially been hijacked and they’ve lost a great deal of their autonomy and their ability to choose.
Well, I do think we’re facing a unique kind of stress, an unprecedented kind of stress. And I actually think that living in a world of overabundance is its own source of stress.
So that’s very, very common where people will normalize their substance use by affiliating and hanging out with other people who use similarly and also in heavy amounts.
I think the hardest thing is to know when we’re helping patients and when we’re enabling them, because there are ways in which we as healthcare providers can enable our patients’ addiction.
So I really work on the accumulation of a lot of small things over the course of a single day because what I’ve discovered is a lot of good days add up to a pretty good life.
00:00 – Intro
01:20 – Dopamine, explained
02:17 – Dopamine and motivation
10:30 – Addiction, explained
13:46 – Pleasure, pain, and withdrawal
24:08 – Early warning signs of addiction
26:39 – Treatment for addiction
36:29 – Stress and addiction
39:40 – Why is AA so successful?
48:26 – Does the time of day impact relapse?
51:34 – Why Lembke studies addiction
54:26 – The hardest thing for fellows to learn
57:39 – Lembke’s difficulties with sleeping
01:03:05 – What success looks like for Lembke