JRE #1708 - Anna Lembke

16-Sep-21

Joe Rogan Podcast #1708 – Anna Lembke: Topics & Summary

This podcast explores the complexities of addiction with Anna Lembke, a psychiatrist and author of “Dopamine Nation: Finding Balance in the Age of Indulgence.” The conversation covers the science of addiction, different types of addiction, the role of dopamine, and strategies for managing addictive behaviors. Provocative topics include the impact of technology on addiction, the benefits of difficult challenges, and the role of spirituality in recovery. Underlying themes explore the nature of reward systems, the evolution of our brains, and the importance of finding balance in our modern world.

Here are 20 key topics explored in the podcast, presented in a 4-point summary format:

1. Joe Rogan’s Personal Experience with Video Game Addiction

Joe Rogan recounts his own experience with an 8-hour-a-day video game addiction in his 30s, acknowledging his awareness of the problem at the time.
He describes the thrilling, but ultimately destructive, nature of the addiction and the difficulty of breaking free.
Rogan reflects on the role of his obsessive personality in fueling the addiction, emphasizing the drive to excel at whatever he engages in.
He draws parallels between his video game addiction and his friend Anthony Bourdain’s addiction to heroin, later replaced by a healthy obsession with jiu-jitsu.

2. The Science of Addiction: Nature, Nurture, and Neighborhood

Anna Lembke explains that addiction is a chronic, relapsing, and remitting disease with various risk factors, including genetics, mental health, and access to addictive substances.
She details the “nature” component, highlighting the increased risk of addiction for individuals with family histories of addiction or mental health issues, and the role of impulsive personality traits.
Lembke emphasizes the importance of “nurture,” explaining how trauma and exposure to addictive behaviors in childhood contribute to vulnerability.
She highlights the underappreciated “neighborhood” factor, which emphasizes the role of easy access to addictive substances and behaviors in shaping addiction.

3. The Dopamine Deficit State and the Pleasure-Pain Balance

Lembke explains that addiction involves a “dopamine deficit state” where individuals continue using a substance or engaging in a behavior not for pleasure, but to avoid the pain of withdrawal.
She uses the metaphor of a teeter-totter to illustrate the pleasure-pain balance, explaining that repeated use of addictive substances or behaviors tips the balance to the side of pain.
Lembke emphasizes that these neuroadaptations can persist for months or years, leading to relapses even when life circumstances improve.
She highlights the role of “neuroadaptation gremlins” in representing the brain’s response to repeated dopamine surges, leading to a chronic dopamine deficit state.

4. The Challenge of Multiple Addictions and Polypharmacy

Lembke addresses the complexity of multiple addictions, explaining how individuals may use different substances or behaviors to balance out dopamine levels, creating a “daily polypharmacy.”
She discusses the compounding effect of different addictive substances on the same dopamine pathways, highlighting the risks of this approach.
Lembke emphasizes that individuals may not perceive themselves as addicted if they only engage in a particular behavior once a week, but when combined, they may be engaging in addictive behavior daily.
She highlights the importance of recognizing the potential for this polypharmacy to worsen addiction and exacerbate negative consequences.

5. The Evolutionary Origins of Addiction: Survival and Scarcity

Lembke explores the evolutionary roots of addiction, suggesting that our brains evolved over millions of years to approach pleasure and avoid pain, driven by the need to survive in a world of scarcity.
She explains that the brain quickly brings us back to baseline after pleasurable experiences to keep us vigilant and seeking new rewards, essential for survival in a dangerous world.
Lembke argues that humanity has reached an unprecedented state of overabundance, creating a mismatch between our primitive brains and modern ecosystems, where we are bombarded by novel and potent addictive substances and behaviors.
She highlights the inherent human reward system, suggesting that our drive for the next reward stems from a need to secure food and resources in a world of scarcity, which can now be problematic in a world of abundance.

6. Recognizing Addiction: The 4 C’s of Control, Compulsion, Craving, and Consequences

Lembke emphasizes that addiction is not solely based on quantity or frequency of use, but rather on specific behaviors that demonstrate a loss of control.
She outlines the 4 C’s of addiction: control, compulsion, craving, and consequences, particularly continued use despite negative consequences.
Lembke acknowledges the complexities of diagnosing addiction, highlighting the subjective nature of consequences and the difficulty in establishing clear boundaries between passion and addiction.
She emphasizes that the diagnosis of addiction is based on the presence of these behaviors, not merely the quantity or frequency of use.

7. Societal Rewards for Addiction: Athletes and Workaholics

Lembke challenges the notion that all forms of intense focus are pathological, acknowledging that society rewards certain types of addiction, such as professional athletes and workaholics.
She emphasizes that while these individuals may experience success and recognition, it’s important to consider potential hidden consequences and the impact on their well-being.
Lembke highlights the potential for burnout, loss of identity, and negative consequences when the reward system dries up, emphasizing the need for a balanced life.
She argues that the same mental machinery underlying addiction is at play in all aspects of life, regardless of whether it is socially rewarded or considered detrimental.

8. Addiction and the Desire to Control Feelings

Lembke suggests that addiction involves controlling and changing feelings in the moment rather than tolerating them, blurring the lines between discipline and addiction.
She highlights the pervasive culture of rewarding ourselves for completing tasks or overcoming difficulties, which can lead to an unhealthy reliance on external rewards to shape our experiences.
Lembke argues that this constant drive to control our feelings prevents us from being truly present in the moment and appreciating the subtleties of our experiences.
She emphasizes that while external rewards can be beneficial in moderation, there’s a need to balance them with acceptance of uncertainty and the ability to tolerate discomfort in the moment.

9. The Benefits of Living in the Moment: Unexpected Joy and Presence

Lembke challenges the idea of expecting immediate bliss from being present in the moment, suggesting that it involves tolerating the discomfort and uncertainty of life’s experiences.
She emphasizes that the benefit of being in the moment lies in being open to unexpected and fleeting positive experiences that we might otherwise miss while chasing external rewards.
Lembke acknowledges that these experiences are unpredictable and not frequent, but their impact can be profound and enriching when we are fully present to appreciate them.
She encourages listeners to embrace the present moment and be open to the possibility of unexpected joy, even if it means tolerating discomfort and uncertainty.

10. The Role of Difficult Challenges in Personal Growth and Dopamine Release

Joe Rogan describes his own approach to life, highlighting the importance of seeking out difficult challenges and finding satisfaction in overcoming them.
He emphasizes the role of these challenges in pushing his limits, fostering discipline, and achieving a sense of accomplishment and reward.
Rogan believes that the mind requires constant challenges to stay engaged and stimulated, referencing his various addictions to games, martial arts, and stand-up comedy as examples.
He suggests that pushing oneself through difficult activities, like exercise, meditation, or creative endeavors, can create an “opponent process” where the brain releases dopamine in response to the effortful engagement, rather than relying on immediate gratification.

11. The Potential for Burnout and the Need for Novelty

Lembke acknowledges the potential for burnout when individuals constantly push themselves through difficult challenges, even if these are initially beneficial.
She suggests that individuals may need to rotate their challenges or find new areas to push their boundaries to avoid burnout and maintain engagement.
Lembke emphasizes the importance of recognizing when a particular challenge is no longer serving the individual, and the need to shift to a new area of focus to avoid stagnation and the potential for unhealthy obsession.
She emphasizes that the pursuit of difficult challenges should be balanced with other aspects of life, ensuring that the individual isn’t neglecting other areas of their well-being.

12. The Subjectivity of Pain and the Power of Interpretation

Lembke discusses the subjective nature of pain and the influence of our interpretation on how we experience it, citing the example of the construction worker who experienced intense pain from a nail that had gone between his toes.
She explains that our brains can elaborate and amplify pain signals, creating a real, but potentially exaggerated, experience of discomfort.
Lembke emphasizes the role of anxiety in exacerbating pain, highlighting the interconnectedness of our mental and physical states.
She emphasizes that while pain is a real and valid experience, it’s important to acknowledge the influence of our interpretations and the potential for our minds to shape our perception of it.

13. Innate Pain Tolerance and the Role of Graded Exposure

Lembke acknowledges that individuals are born with different pain thresholds, influenced by both genetics and life experiences.
She emphasizes that while some individuals may be naturally more sensitive to pain, others may have a higher innate tolerance.
Lembke highlights the role of graded exposure in developing pain tolerance, explaining that repeated exposure to painful stimuli can lead to neuroadaptation and a decrease in perceived pain.
She emphasizes that both innate differences and learned experiences play a role in shaping an individual’s pain tolerance.

14. The Benefits of Cold Plunges and Extreme Environments

Joe Rogan inquires about the potential for exposure to extreme environments, such as cold plunges and saunas, to build resilience in other areas of life.
Lembke confirms that these challenging experiences can indeed build resilience, both physically and psychologically, helping individuals to develop a sense of confidence and self-efficacy.
She highlights the importance of these experiences in providing a touchstone for overcoming future challenges, demonstrating that if someone can endure extreme cold, they can likely handle other difficult situations.
She acknowledges that while there may not always be a direct crossover between different types of challenges, the experience of pushing through them can provide a sense of empowerment that can be applied to other areas of life.

15. The Importance of Enriched Environments and Avoiding Overstimulation

Lembke discusses the “rat park” experiment, which demonstrated that rats living in enriched environments with opportunities for social interaction and exploration were less likely to self-administer drugs than rats living in barren cages.
However, she warns that the modern world has created a “rat amusement park” with a constant barrage of highly reinforcing substances and behaviors mediated by technology, making it difficult for even those in ideal environments to avoid addiction.
Lembke emphasizes the need for a balanced approach, combining enriched environments with intentional destimulation and strategies for managing the overabundance of addictive choices in the modern world.
She argues that even in the best environments, individuals can still be vulnerable to addiction due to the pervasive influence of technology and the availability of highly reinforcing substances and behaviors.

16. The Problem of “Rat Amusement Park” and the Mismatch Between Brain and Modern World

Lembke highlights the disconnect between our ancient brains, designed for survival in a world of scarcity, and the modern world of overabundance and technological distractions.
She argues that our brains are not equipped to handle the constant stimulation and instant gratification offered by modern technology and its addictive properties.
Lembke suggests that this mismatch has contributed to a rise in addiction across all demographics, even those who are seemingly living in ideal circumstances.
She emphasizes the importance of finding ways to mitigate this mismatch, creating environments that are both stimulating and conducive to well-being, while managing our exposure to highly reinforcing substances and behaviors.

17. The Impact of Video Games and the “World Famous” Fantasy

Lembke discusses the rise of video game addiction, particularly among young men, and the rationalizations that fuel this behavior.
She highlights the common fantasy of becoming a professional gamer, a “world famous” player, which allows individuals to justify excessive play as a pathway to success, even when it’s highly improbable.
Lembke emphasizes the role of denial and the difficulty of recognizing the true impact of video game addiction on mental health and well-being.
She stresses the importance of acknowledging the potential for addiction, even in seemingly beneficial activities, and the need to establish healthy boundaries and manage one’s engagement.

18. The “Dopamine Acronym” and Strategies for Abstinence

Lembke outlines a strategy for managing addictive behaviors, called the “Dopamine Acronym,” which involves a four-week period of abstinence followed by a process of self-reflection and planning.
She emphasizes the importance of gathering data about the individual’s addictive behavior, identifying the reasons for use, and acknowledging the negative consequences.
Lembke encourages individuals to abstain from their drug or behavior for a month, explaining that this period allows for the reset of reward pathways and the potential for a significant improvement in mood and well-being.
She acknowledges that while some individuals may require more intensive interventions, such as residential treatment, others can benefit from this outpatient approach, focusing on mindfulness, insight, and next steps for managing addictive behaviors.

19. The Appeal of Endurance Sports for Recovering Addicts

Joe Rogan highlights the attraction of endurance sports for individuals in recovery, suggesting that the physical and mental demands of these activities provide a sense of control and immersion that can be therapeutic.
He discusses the intense focus required for endurance activities, where individuals must be present in the moment and push through pain and fatigue, creating a sense of accomplishment and reward.
Rogan emphasizes that these activities can provide a healthy outlet for the drive and determination that may have previously fueled addiction, channeling it into a positive and constructive path.
He suggests that the experience of pushing through these difficult challenges can contribute to a sense of self-efficacy and resilience, helping individuals to overcome future challenges.

20. The Potential for Addiction to Exercise and the Importance of Balance

Lembke acknowledges the potential for addiction to exercise, citing animal studies that demonstrated the reinforcing properties of running wheels, even in enriched environments.
She emphasizes the need for balance and the importance of finding activities that are intrinsically rewarding and enjoyable, rather than relying solely on external rewards or a drive to push through pain.
Lembke highlights the potential for exercise to be a valuable tool for managing addiction, but cautions that it is not a guaranteed solution and can become addictive itself if not approached with mindful awareness.
She encourages individuals to approach exercise with a balanced perspective, seeking out activities that are enjoyable and sustainable, while also incorporating other aspects of a healthy lifestyle.

5 Memorable Quotes

“The things that I find that I get obsessed with that turn out to be beneficial are usually the things that enhance my life.” – Joe Rogan highlights the positive impact of his obsessions, emphasizing the importance of channeling these drives towards constructive goals.
“Being in the moment means tolerating the distress of just fully being in the moment.” – Anna Lembke challenges the expectation of immediate bliss from being present, suggesting that it requires accepting the discomfort and uncertainty of life’s experiences.
“The hard way is usually the right way.” – A patient of Anna Lembke’s captures the essence of personal growth, highlighting the value of pushing through difficulties and finding satisfaction in the effort.
“We have turned rat park into rat amusement park.” – Anna Lembke emphasizes the pervasive influence of technology and its addictive properties, suggesting that even in seemingly ideal environments, we are constantly bombarded with highly reinforcing substances and behaviors.
“There’s almost maybe a benefit recovering from addiction.” – Anna Lembke reflects on the transformative power of recovery, highlighting the increased humility, resilience, and self-awareness that can emerge from this process.