Anna Lembke (psychiatrist on addiction)

[0] Welcome, welcome, welcome to armchair, expert, experts on expert.

[1] I'm Dan Shepard, and I'm joined by Maximum Mouse Powerhouse.

[2] Hello, that's a ding, ding, ding, ding.

[3] We've been wanting this guest for quite a while.

[4] I'm obsessed with her book.

[5] I'm sure you've heard me talk about it, Dopamine Nation.

[6] She is the one and only Anna Lemke.

[7] Dr. Anna Lemke is a professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic.

[8] Her first book is incredible.

[9] It's called Drug Dealers, M .D., how doctors were duped.

[10] Patients got hooked and why it's so hard to stop, obviously about the opioid crisis.

[11] Her new book, I'm obsessed with.

[12] I talk about it nonstop.

[13] It's called Dopamine Nation, finding balance in the age of indulgence.

[14] She's so radical.

[15] I learned so much.

[16] Overdelivered.

[17] I had high expectations, and she blew right past them.

[18] Hard to do.

[19] I think I love her.

[20] We love her.

[21] We love you, Anna.

[22] Please enjoy Dr. Anna Lymke.

[23] Wondry Plus subscribers can listen to Armchair Expert early and ad free right now.

[24] Join Wondry Plus in the Wondry app or on Apple Podcasts.

[25] Or you can listen for free wherever you get your podcasts.

[26] He's an armchair expert.

[27] He's an option expert.

[28] Nice to meet you.

[29] I'm Dax.

[30] This is Monica.

[31] Thanks for having me. Well, I have to tell you, this isn't happened to.

[32] ton because I don't read that quickly, but occasionally I fall so in love with the book and I talk about it incessantly, which is the case of dopamine nation, and then just begging Robin Monica around the clock.

[33] So I am really, really excited to be talking to you.

[34] Oh, thank you.

[35] That's great.

[36] That makes my day.

[37] Are you at Stanford currently?

[38] Yes, I'm in my office.

[39] And usually the Wi -Fi is good, but I'm noting that there are some glitches.

[40] Hopefully it'll be all right.

[41] You would think at Stanford, the Wi -Fi would just be top -notch.

[42] And you would be wrong.

[43] We were interviewing somebody, and I said, I don't know if it's our internet connection or yours.

[44] And he said, well, I'm at MIT.

[45] Oh, it was Eric Lander.

[46] Yeah, Eric Lander.

[47] It was very funny.

[48] The Chemical Moore is the first book I read about dopamine, and it got me really, really interested in it.

[49] And whether you know this about me or not is I'm an addict, and I've been in recovery for like 18 years.

[50] I didn't know that.

[51] So that's good to know.

[52] Congratulations.

[53] Thank you.

[54] And your book, of course, is you speak so highly of us junkies.

[55] So I really appreciate it.

[56] So I think I've just opened my heart and mind to your book in general.

[57] But you've worked with addicts as a psychiatrist for many, many years, yeah?

[58] Yeah.

[59] Can I ask you a question?

[60] A million.

[61] Okay.

[62] You use the word addicts.

[63] And in the medical field, we keep being told we shouldn't use that word because it's derogatory.

[64] And we're trying to have non -stigmatizing language.

[65] And I'm wondering why you think of that, because addiction is a term that everybody understands substance use disorder is a term that most people don't know what that is, although that's what's in the DSM.

[66] And we're not even supposed to use the word abuse, like you're not supposed to say you abuse drugs because abuse is considered stigmatizing as well.

[67] Just curious, your thoughts as somebody in recovery or somebody with the disease of addiction.

[68] I think that's horseshit.

[69] Okay.

[70] On a bunch of levels.

[71] I definitely can easily see the intention behind it, right?

[72] Which is people have a hard time acknowledging that they're, quote, defective or even most people struggle with the first step.

[73] The first step is unpowerless.

[74] People have some hurdle over that, as if doing that would take away your agency as a human.

[75] But in my opinion, that is required.

[76] If you hope to beat this thing, and again, we both would agree you can't beat it.

[77] But if you hope to beat it today, minimally you have to humble yourself.

[78] Now, granted, I'm very powerful in many facets of my life.

[79] I'm talking to you, you're brilliant.

[80] If you add an opiate to this mix, now all I will want to do is pursue more and more of those opiates.

[81] If you give me alcohol, I will find cocaine in a cemetery.

[82] I don't think one can get better without that first admission of kind of powerlessness.

[83] And I actually find it comforting.

[84] I think my stigmatism was, oh, I associate addiction with the person in the gutter.

[85] And I don't think of myself that way.

[86] But if you tell me I have a condition, a medical thing, not unlike diabetes, that actually, to me, I feel less shame about that.

[87] So how do you feel about them pushing for that?

[88] Well, I find this shifting language awkward, but I try to adhere to what the medical field is doing because people that I really respect, really believe that we need to change the language.

[89] Wait, and they're saying it should be substance.

[90] What are they saying it should be?

[91] A person with addiction rather than an addict.

[92] So this is sort of a movement in general in medicine, patient -centered language.

[93] But anyway, getting away from language and getting to the first step, I absolutely 100 % agree with you that it is that giving it over to something outside yourself, acknowledging that you are powerless over this particular substance or behavior.

[94] And that humility really is at the core of not just recovery, but in my opinion, a life well lived.

[95] But it's really fascinating how so many people resist that idea and do feel that it takes away their agency, somehow feel that it makes them less than.

[96] Weak.

[97] Yeah, that people don't identify with this idea of being broken.

[98] In fact, just yesterday I was talking with somebody who said, I think AA is outdated because we try to get people in a positive, happy, upbeat way.

[99] And I'm just like, hmm, okay.

[100] And of course, in my work in general, even beyond addiction, I do think that this moment of being humbled in our lives, of recognizing that there are things over which we have no control of acknowledging that there is a power greater than ourselves, however we define it, that is at play, even if it's just the force of nature, as my husband likes to say, gravity.

[101] I will say to him, you know, you don't believe in God.

[102] He's like, what are you talking about?

[103] I believe in gravity.

[104] Like, that's not God.

[105] He goes, well, it's a mysterious force that operates everywhere that no one can explain.

[106] And I'm like, hey, you're kind of right.

[107] our recent pandemic.

[108] If someone thinks that they are all powerful, they must have concluded that even sure within their bubble, maybe they had some control, but on a global sense, no. And then all the subsequent outcomes of that.

[109] These are all things that you and I have really very little to do with.

[110] But I want to go even further with the addict thing.

[111] So I have been criticized on here, always by non -addicts when I'll call myself a junkie or another person a junkie.

[112] And I'm sympathetic to it.

[113] They don't want to see their brother as a junkie.

[114] But I love that.

[115] I got a great friend that always says, I'm Pete the Alki instead of I'm an alcoholic.

[116] Like we've passed that point where it was shameful and we live now in a period of it without shame.

[117] And in that, we can have kind of fun and levity about it.

[118] And to me, I need to be in a place that is joyful and has some levity.

[119] Because if it was just detention for the next 50 years, I wouldn't be there.

[120] Right.

[121] So you've taken a thing that you didn't want to admit, and that's highly stigmatizing identity in our society, and you've totally transparently embraced it.

[122] You can use humor, which is a very sophisticated form of defense.

[123] You know, you've made it a part of your DNA, and that's great.

[124] That means you're comfortable with it.

[125] It's also something that you're continuing to look at.

[126] So one of the things that my patients will sometimes say is, well, I just want to be past that.

[127] I just want to put that on the back burner.

[128] and what I say to them gently is that in my experience, when people just put that on the back burner, they relapse.

[129] And they can relapse in a very dissociated way.

[130] It's not like they're craving.

[131] It's not like they're planning to relapse.

[132] All of a sudden, they find themselves at Costco buying whiskey.

[133] Because if you're not paying attention to it actively and engaging your prefrontal cortex around your disease, then you're going to go back into your default mode network and you're going to just relapse without even knowing what happened.

[134] I know it's uncomfortable for people to imagine infusing it in their identity in such a way.

[135] No one was a child and said, I aimed to be an addict when I grow up.

[136] People love saying I'm an architect or I am a psychiatrist.

[137] Yeah, it's not an identity one aims at.

[138] But with our current technology, a lifetime condition, it doesn't evaporate.

[139] It doesn't seem to ever be overcome.

[140] Yeah.

[141] And I also think on another level, there's something important here, which is to say that we are living in a time of highly curated personas online and otherwise where people are projecting an identity and a life, which is not really consistent with their inner life and their struggles.

[142] And we have this sort of narcissistically achievement -oriented culture that separates us, makes us feel isolated, makes us feel less than.

[143] So I think it's very valuable when people can talk in a transparent way about the way that they are struggling in their lives without it being gratuitous or manipulative, as I talk about in the book.

[144] There are ways that it can be that, too.

[145] You know, you don't want sort of like disclosure porn going on.

[146] But on the other hand, I think very helpful for our society, for people to like show up in all of their authenticity, including their brokenness.

[147] And I really advise this to parents, too, as I talk about in the book, to kind of engage in what I call transparent parenting, where we're not just telling our kids about all the ways that we've achieved this and that and how that.

[148] And how they should follow that.

[149] We have to really talk to our kids about the ways that we continue to struggle even as old as we are and how far we are along in our lives.

[150] And I think kids really appreciate that, really resonate with that and can rise to the occasion, right, and access their own empathy and then promote intimacy through accessing their own empathy for somebody else.

[151] Well, what I like about it is you're not creating a fairy tale by which you do X and you get Y and there's permanence to it.

[152] So it's like we say in the program, we get a daily reprieve.

[153] Likewise, when you exercise, you get a daily reprieve.

[154] When you eat correctly, you get the daily, nothing's permanent.

[155] So I think the more the child's expectations are, oh no, you're a machine that needs maintenance all day, every day, whether what you put into it, how you exercise it, how you think, how you talk, who you meet with.

[156] I'm at a stage in my life.

[157] And I wonder if you are as well where it's like, I was introduced to a paradigm, which is work really hard, save enough, retire.

[158] And retirement to me has this fantasy quality where I will not be inconvenienced or bothered by anything ever again.

[159] And I, A, wonder if I would even enjoy that state.

[160] And then B, is it not just another thing of like, oh, I could do the perfect set and be built forever?

[161] Of course not.

[162] What do you think about retirement as a concept?

[163] Well, I think that concept has pervaded my entire life.

[164] It's not even retirement.

[165] It's like I can even remember as a five -year -old when we were going to get on a plane and go to Europe and I had never been to Europe.

[166] And I vividly remember the night before thinking my life is going to change.

[167] And by that, I really meant my life is going to be much, much better than this life that I have now that I don't really like all that much.

[168] And it was really this very powerful fantasy that somehow I was going to get on this airplane with my brother.

[169] We were going to visit our grandparents in Europe.

[170] And this would be a transformed experience, kind of like taking a geographic at age five.

[171] And it wasn't.

[172] And I've had that again and again and again.

[173] I'm like, how many times do you have to happen before you realize, wow, this is it.

[174] Like right here, this is all there is.

[175] Yeah.

[176] I may sit in a different room around different people, but it'll be me there.

[177] It'll be me and it'll be this life.

[178] And it will be life in general, which has moments of incredible joy and then otherwise is pretty hard.

[179] What made you get into addiction?

[180] I'm so curious about that.

[181] Yeah.

[182] So I went to Stanford Medical School and then I stayed on for a psychiatry residency.

[183] And I was very open to treating all kinds of patients except patients with addiction.

[184] Oh, wow.

[185] Didn't want to have anything to do with them for a number of reasons.

[186] Learned very little in medical school about addiction.

[187] Learned very little in my psychiatry residency about addiction, which was normative for, you know, the 1990s.

[188] And today isn't all that different.

[189] We're making headway, but we have a long way to go.

[190] And I also had what we often call negative countertransference because my father was a, I would say, you know, a high functioning alcoholic.

[191] Can I ask really quickly what part of the country you originate from?

[192] Well, we moved around a lot, but basically I mostly grew up in the Midwest outside of Chicago.

[193] Okay, I'm a Detroit person.

[194] Okay, there you go.

[195] So same general region.

[196] So what happened was that I had a patient who I had been seeing for about a year targeting her depression, and she would come into the session, and she would fall asleep mid -session, and I had prescribed her paxil.

[197] And so I was thinking, oh, my gosh, she must be one of these, like, slow metabolizers.

[198] I should write a case report about this.

[199] This is how ignorant I was.

[200] This is my wife before she met me. Right, exactly.

[201] It's so embarrassing to talk about this, but it's good for me to be out about this.

[202] So then one day, about, I don't know, nine months into treating this woman every single week for an hour session, her brother calls me and he says, she's been in a roll over car accident.

[203] I said, oh, my goodness, what happened?

[204] He said, oh, she's been using.

[205] And I said, using what?

[206] And there was this incredible pause.

[207] And he says, using heroin, isn't that what you've been treating?

[208] treating her for.

[209] Oh, my God.

[210] And I had to say, oh, my goodness, I didn't know.

[211] And you could argue that she never told me, but that's not her job.

[212] I'm the doctor.

[213] I never once asked her about drug or alcohol use.

[214] We talked about every conversation she had ever had with her mother, and I never asked her about drugs and alcohol.

[215] And that was my wake -up call.

[216] It was like, I'm a bad psychiatrist.

[217] Wow.

[218] Like, I'm going to hurt people.

[219] And that was the beginning of this transformation.

[220] Well, can I just interject and say back to your stigmatism thing.

[221] See, that's where the stigmatism is actually counterproductive, which is if we think heroin addicts are not young girls in college, I think the more people like me who say it, hopefully, it's like it's conceivable that everyone you know that you trust, that you admire could have this issue.

[222] I agree, especially now, right, when everything has become drugified, when it's not just substances, it's all this online content.

[223] I mean, I think as I talk openly, the book about, I think we're all struggling with at least minor forms of compulsive overconsumption, if not outright addictions.

[224] Okay, so you're just now hinting at the thing about your book that made my ears most open, which is the fact that you start with admission of your own, I literally click in my head, okay, I trust this person.

[225] As flawed as that might be, I'm like, this isn't someone preaching to me. This is someone who's experienced what I've experienced, and now I trust you.

[226] And again, talk about stigma.

[227] The last person we're expecting this from, in my opinion.

[228] So please tell Monica and the listeners what road you ended up on.

[229] Somewhere around age 40, I discovered romance novels.

[230] And for whatever reason, they were just not books I had ever read before.

[231] And Twilight was my gateway drug.

[232] And it just absolutely transported me. And so when I was done with the whole series, I read it again and then I read it again.

[233] And each time I read it, it was similar, but not quite the same experience.

[234] So I went from there to reading all different kinds of romance novels.

[235] And I got a Kindle.

[236] And that meant that as soon as I was done reading one, I could start reading another.

[237] And I was staying up later and later at night.

[238] And I was showing up at work exhausted.

[239] And I was reading more and more potent forms of romance novels.

[240] That is to say, erotica, combined with a behavior that we don't need to mention, but that you can infer from this.

[241] And basically, I got addicted to that.

[242] And it took hours every day.

[243] Got to the point where I remember we went on a vacation with another family and I spent most of the vacation like off by myself reading.

[244] I at one point took romance novels to work and was reading between patients and I would kind of joke about it.

[245] This was about, let's say, 18 or so months into it.

[246] I was sort of like vaguely aware that it was a problem, but not really recognizing it as a problem, which is so common with these behaviors until I sort of had this experience actually with a student that made me recognize him.

[247] But basically, yeah, I mean, I got addicted to culturally sanctioned pornography for women.

[248] There's so much in there that I relate to because they're all the same, right?

[249] So I have to imagine you had barriers, right?

[250] So it was like, you were going to read this at night.

[251] Yes.

[252] Right.

[253] And it just escalates.

[254] Virtually you're going to read it whenever the fuck you want because you've stepped over every single obstacle.

[255] You're absolutely right.

[256] And the Kindle was really the tipping point.

[257] I didn't have to go to the library.

[258] I could be totally anonymous.

[259] I could be reading in the waiting room of a doctor's office and nobody could see what I was reading.

[260] It was all that aspect, the way it got accelerated, that I could be more and more hidden about what were really not very good behaviors.

[261] It's interesting because I think it would be so easy, and I'm sure you did this, to justify why it's fine, because it is fine.

[262] It's nothing's illegal.

[263] It's all for you.

[264] I guess you could also say, like, I'm more sexually evolved than other people.

[265] who might not understand it.

[266] Like, there's all these ways that you can make this okay.

[267] So to decide it's not, I feel like, it's actually hard to do.

[268] Yeah.

[269] And I think you're bringing up a very important point about the culture wars, right?

[270] And maybe for some people, they would say it was okay.

[271] But for me, I was now consuming written words that were really not consistent with my values.

[272] It was interfering with my goal to be a good parent and a good mother.

[273] mother and a good doctor.

[274] And I was experiencing what I talk about in the book are the very subtle signs of a dopamine deficit state, which is to say that I was experiencing irritability, anxiety, depression, and lack of joy in other areas of my life, which I attribute to the hijacking of my motivational reward system, which is a very subtle, but very important point, which I think pervades our lives today, which is that we are so surrounded by so many easy pleasures, so many reinforcing drugs and behaviors, that as a result, we are bombarding our reward pathways with too much dopamine.

[275] And to compensate, our brains have to downregulate production of dopamine and dopamine transmission so that we get in this dopamine deficit state where life is no longer enjoyable, not because life is hard, but because it is too easy.

[276] So I want to break all that down.

[277] I mean, that's the meat in the fun of the book.

[278] The last thing I wanted to relate to you on before we moved to that is I had a sense of humor.

[279] And as you labeled that, the greatest defense mechanism, which was my own intellectual vanity, refused to let other people be in on a joke I wasn't in on.

[280] So when I was an addict, I would say, well, I'm an alcoholic because of my own vanity of there's no way I want these people to know something I don't or whatever.

[281] Yes.

[282] And so I would joke along with it for years.

[283] And it wasn't until I was standing in my kitchen.

[284] one day.

[285] And I go, oh, this isn't a joke.

[286] You for real cannot go a day without this.

[287] Like, I'm not in on this joke anymore.

[288] That's really powerful.

[289] Let's look at that for a second, because I do the same thing.

[290] And it's where I want to call out my character defects loud and clear before anybody else does, right?

[291] And by doing that, I make sure that I'm in control of who says I've got what kinds of problems?

[292] Because what I'm really terrified of is not being in control.

[293] That's really the ultimate terror.

[294] Yes, a thousand percent.

[295] And then for me, my biggest nightmare would be everyone in the room has realized something about me. And I was too slow to see it as like, whatever, my dyslexia baggage.

[296] Right.

[297] Yeah.

[298] Or worse yet, I've actually transgressed and harmed somebody because of some flaw that I didn't see.

[299] Yeah.

[300] Oh, God.

[301] This is so juicy.

[302] I'm just now embarrassingly endeavored in real therapy twice a week.

[303] And my gentleman has said to me, I'm prone to throw out a mitigating sentence, right?

[304] He'll say, why do you think you do blank?

[305] And I go, well, I'm sure you'll think, da, da, da.

[306] And then I give my three reasons.

[307] And he said, I just want to flag that.

[308] As I thought about it, I was like, I'm trying to head off an embarrassment that you'll have known something I didn't know.

[309] Right out front, I'm going to say, I probably don't know this.

[310] You'll know better.

[311] But I think it's X, Y, and Z. yeah, just protecting my ego the whole time.

[312] Yeah, yeah, it is.

[313] I recently had a similar exchange with my children.

[314] They're now teenagers and they're a great, sort of like a good alternative to psychotherapy because they don't pull back any punches.

[315] You know, your kids will tell you exactly what they think of you.

[316] Because I'll go on and on about how I'm bad at this or this, I tend to do this.

[317] And as I was doing it, they're like, yeah, but you know, mom, like you're always kind of blaring really loudly about all your defects.

[318] And it's kind of weird.

[319] It's sort of like, like you're not like letting anybody else tell you what's wrong with you.

[320] And the other tendency that people like us experience is that we want things to be tied up with a bow.

[321] Like we don't want there to be any loose ends.

[322] You know, we want it to be completely explained, a closed system done.

[323] And so it's this rush to judgment that we really have to resist.

[324] And the ability to tolerate that ambiguity and that openness and the not knowing.

[325] Yeah.

[326] Okay.

[327] Now, tell us what dopamine is.

[328] In doing so, if you could maybe delineate the difference between dopamine and serotonin and epinephrine, and just tell us about these chemicals that are kind of regulating our mood.

[329] Okay.

[330] So dopamine like serotonin and norapine is a neurotransmitter.

[331] Neurotransmitters are the molecules that bridge the synapse or the gap between neurons.

[332] Neurons are the workhorse cells of the brain.

[333] They're long and spindly.

[334] They work by conducting electrical signals in loops.

[335] But very interestingly, they have a little space, and that's to afford this fine -tuned control that's moderated through these neurotransmitters, these chemicals.

[336] Dopamine is essential to the experience of pleasure, motivation, and reward.

[337] It may be even more important for motivation than for pleasure itself.

[338] So there's a famous experiment where a rat was engineered to not have dopamine in its reward pathway, and it was found that the rat would eat food and seem to get pleasure from it.

[339] But if you put the food even out single body length, the way the rat would start, to death.

[340] It wasn't motivated to get up and go get the food.

[341] Dopamine, interestingly, is also intimately associated with movement.

[342] So, for example, Parkinson's disease is a disease of degeneration of a substantia nigra, where you have dopamine releasing neurons that are engaged in movement.

[343] And it's no coincidence that pleasure, motivation, reward, and movement are tied together because for most of human existence, we have had to move our bodies to go get the thing that we want.

[344] That's no longer true, of course.

[345] Now, this wasn't in your book, but this was in Chemical More.

[346] It scales up into populations who have emigrated from places.

[347] So the people who got to America where people were dopamogenically high that they would cross this ocean to an unknown place.

[348] They had inordinately high dopamine levels.

[349] And then we as a result, right?

[350] Yeah, so that's right.

[351] I mean, we are evolved over millions of years of evolution to approach pleasure and avoid pain.

[352] We do that instinctively without thought.

[353] And the way that pleasure and pain our process of the brain makes us the ultimate seekers because every pleasure is transient or temporary and is followed by pain.

[354] And I often think of people with severe addiction as like people who probably were the most likely to survive in a world of scarcity and ever -present danger.

[355] But it's a liability today.

[356] Yes, yes.

[357] Dopamine is not the only neurotransmitter involved in the experience of reward, pleasure, and motivation, but it's probably the final common pathway for all intoxicants.

[358] So, for example, psychedelics, like LSD, for example, work primarily by releasing huge amounts of serotonin.

[359] But the ultimate thing that they do are the final common pathway is to release dopamine.

[360] Alcohol is actually primarily mediated by our endogenous opioid system.

[361] Cannabis works on the anandomide receptors or our cannabis receptors.

[362] We actually make our own endogenous equivalent of a cannabis plant.

[363] And we have more cannabis receptors in our brain than any other type of receptor, which is really amazing.

[364] But again, cannabis ultimately also releases dopamine in the reward pathway.

[365] So you have these different ways that intoxicants act through different endogenous systems, but the final common pathway is to release dopamine in the reward pathway.

[366] And it's a way that neuroscientists have come to kind of measure the innately rewarding potential of a substance.

[367] I learned this through both the books, which is like if you track the dopamine when drinking.

[368] So the first two drinks, you get a large dose of dopamine because you know you have a novel or different or altered state ahead of you.

[369] Again, it's the promise of the reward.

[370] But then that dissipates after you've had to.

[371] And now you just enter intoxication, which most people find less pleasurable.

[372] Exactly.

[373] And this is really important to understand in terms of understanding what happens in the brain as people become addicted, that it's driven by the phenomenon of homeostasis and the innate biological drive to assert homeostasis.

[374] And the way that I talk about that in the book is to imagine that in your brain there's a balance like a teeter -totter and a kid's playground.

[375] And that balance represents how we process pleasure and pain.

[376] And neuroscientists have found that pleasure and are indeed co -located in the brain.

[377] So the same parts of the brain that process pleasure also process pain.

[378] So for example, for me, my drug of choice is romance novels.

[379] I read romance novel.

[380] I get a little release of dopamine in my reward pathway and the balance tips to pleasure.

[381] But no sooner has that happened, then my brain will work very hard to reassert a level balance.

[382] And it does that first by tipping an equal and opposite amount to the side of pain before going back to the level position.

[383] So that's the price we pay for pleasure.

[384] There's a cost.

[385] It's the after effect, the come down, the hangover, or even just that subtle urge to want to keep reading and not want to go into dopamine free fall.

[386] The other rule governing that balance, though, which is really how to understand how people get addicted is that with repeated exposures to the same or similar pleasure, that initial response or deviation to the pleasure side gets shorter and weaker, but that after response gets stronger and longer.

[387] And I like to imagine that is these neuroadaptation gremlins that hop on the pain side of the balance, but they like it there so they don't get off as soon as the balance is level.

[388] They stay on until it's tip an opposite amount to the side of pain.

[389] And you accumulate them with repeated exposure till now you have enough gremlins to fill this whole room when you're walking around in a dopamine deficit state.

[390] And that's the addicted brain.

[391] Once you're in that dopamine deficit state with those gremlins camped out on the pain side of the balance, you need more and more of your substance of choice to not even just get high, but just level the balance and feel normal.

[392] And when you're not using, you're walking around experiencing the universal symptoms of withdrawal from any addictive substance or behavior, which are anxiety, irritability, insomnia, depression, and craving.

[393] Yeah, so this is the brain exploding aspect of your book that I loved hearing.

[394] And I find myself repeating it to anyone who will listen, which is you have to enter this equation recognizing your body is going to balance itself.

[395] That is its primary objective.

[396] You are not going to hack that.

[397] And so I was curious, what are the chemicals released to balance the dopamine?

[398] It's a cascade of many different chemicals and hormones, but one of the main ones is cortisol.

[399] It's very clear that with any deviation from homeostasis, and by the way, a deviation from homeostasis is the biological definition of stress.

[400] So any deviation from homeostasis, we set off our endogenous adrenaline.

[401] There's a cost to us to have to do the work to reset that balance.

[402] So it's mainly driven by our HPA axis or the hypothalamic pituitary adrenaline axis.

[403] often I don't think people recognize that all the drugs we take, we're not actually getting high on the drugs, we're getting high on the chemicals that are already in our brain.

[404] The chemistry set is already there.

[405] So all we're doing is blocking the uptake or inhibiting this.

[406] So this system is so clever in that life was a ton of suffering.

[407] You were freezing for 150 ,000 years as a hunting gather.

[408] You were in a tremendous amount of pain.

[409] You were in warfare.

[410] You know, there was so much that, God bless, the brain figured out how to soften that blow and allow us to keep moving forward in very adverse conditions, right?

[411] So it's just there probably initially to help us get back up from what is insufferable environment.

[412] Right.

[413] I mean, when you think about that pleasure pain balance and the fact that for every pleasure there's a cost, it does feel like some kind of cruel joke that Mother Nature would play, right?

[414] But if you think about a world of scarcity, It's absolute genius because it means that we are the ultimate seekers, no matter what we get, no matter how pleasurable, we will immediately keep looking for more.

[415] And that is what keeps us alive.

[416] Furthermore, there's the wonderful forgiveness of pain.

[417] So when we have a stimulus that causes initial pain, those gremlins that adapt the balance, they're agnostic to whatever the initial stimulus is.

[418] So with pain, they'll hop on the pleasure side.

[419] That means when we experience injury, our body has its own built -in mechanism to protect us from pain, right?

[420] It starts to upregulate our own endogenous opioids, our own endogenous cannabinoids, all of which are pain relieving.

[421] When people cut on themselves, the reason that that feels good is it because releases a huge amount of our own endogenous opioids, the opioids that we make in our brain.

[422] The problem is that people develop tolerance very quickly to that phenomenon and stops working.

[423] But it's a graceful system in a world of scarcity and ever -present danger.

[424] It's a terrible system in a world of ubiquitous pleasure in which we're largely insulated from pain.

[425] Stay tuned for more armchair expert, if you dare.

[426] What's up, guys?

[427] It's your girl Kiki, and my podcast is back with a new season, and let me tell you, it's too good, and I'm diving into the brains of entertainment's best and brightest, okay?

[428] Every episode, I bring on a friend and have a real conversation.

[429] And I don't mean just friends, I mean the likes of Amy Poehler, Kell Mitchell, Vivica Fox, the list goes on.

[430] So follow, watch, and listen to Baby.

[431] This is Kiki Palmer on the Wondery app or wherever you get your podcast.

[432] We've all been there.

[433] Turning to the internet to self -diagnose our inexplicable pains, debilitating body aches, sudden fevers, and strange rashes.

[434] Though our minds tend to spiral to worst -case scenarios, it's usually nothing.

[435] But for an unlucky few, these unsuspecting symptoms.

[436] can start the clock ticking on a terrifying medical mystery.

[437] Like the unexplainable death of a retired firefighter, whose body was found at home by his son, except it looked like he had been cremated, or the time when an entire town started jumping from buildings and seeing tigers on their ceilings.

[438] Hey listeners, it's Mr. Ballin here, and I'm here to tell you about my podcast.

[439] It's called Mr. Ballin's Medical Mysteries.

[440] Each terrifying true story will be sure to keep you up at night.

[441] Follow Mr. Ballin's Medical Mysteries wherever you get your podcasts.

[442] Prime members can listen early and add free on Amazon Music.

[443] Am I right on this?

[444] I don't know who explained this to me, but as someone who had about with opioid addiction a couple years ago, my understanding of it is, right, you take this medicine and it blocks the receptors that would uptake the pain feeling.

[445] And that works.

[446] But then the body is so clever that it says, okay, we need to grow more pain receptor cells because clearly there's none being uptight, or whatever the past sense of uptake is.

[447] So, in fact, the opiate addict is now growing more and more pain receptors.

[448] Is this accurate?

[449] Yeah.

[450] So this is the best way to understand.

[451] This is, again, the pleasure pain balance, but think of it in the context of a person who starts out with chronic pain, right?

[452] So they start tilted out to the side of pain.

[453] They take an opioid.

[454] They get relief from that, right?

[455] But the gremlin don't care where you started.

[456] they hop on the pain side to counterbalance the opioids, and then you eventually end up even deeper in that pain hole, which is why people with chronic pain who take high -dose opioids for long periods of time will develop something called opioid -induced hyperalgesia.

[457] That is increased pain as a result of the opioid, okay?

[458] Which is why opioids are so pernicious in the treatment of pain and why this opioid epidemic is such a tragedy because it did start out with doctors prescribing lots of opioids for people with pain, hoping that it would help them, but the result has not been that.

[459] Plus, you've got addiction -related death.

[460] Now, here's what's fascinating.

[461] If you take Naltrexone, which is an opioid receptor blocker, and you give it in low doses to people with chronic pain, they will see improvements in pain.

[462] How is that happening?

[463] Essentially, as you described, because you're blocking the opioid receptor, that's the only chemical intervention you're making, your own endogenous opioids cannot bind to your opioid receptors.

[464] So your homeostatic system is getting the signal, we don't have enough opioids.

[465] What does it do?

[466] It starts to make more opioids, right?

[467] And you get pain relief then indirectly by blocking the opioid receptors and telling your body it needs to upregulate opioid production, opioid receptors.

[468] So when you talk about cutting and I guess all of it, addiction, why isn't it a generalize, like, if everyone drinks this much, then they become addicted, or if everyone cuts, then they become, you know, like, it's also variable within people and why, different levels of these neurotransmitters?

[469] Yeah, so this is a really important concept, and there's very little research on this, but basically it's called the drug of choice, which is to say the same thing that tilts your pleasure pain balance on the side of pleasure may not tilt mine, or it may not tilted as much.

[470] If you think about this from an evolutionary perspective, it makes enormous sense.

[471] You wouldn't want everybody in the tribe going for the same berry bush, right?

[472] You would want some people to be really excited about berries and other people to be really excited about Buffalo and other people to be really excited about finding a mate, right?

[473] So that together collectively, you end up with all of the things that you need because we are a hive or such social creatures and we depend on each other so much to sustain all of our needs.

[474] And so, this drug of choice concept is really, really important.

[475] Furthermore, even within, like, people preferring one drug, they can have very different reactions to that drug.

[476] For some people, opioids are sedating.

[477] And that's usually how we think of them when we imagine opium dens, but for many people addicted to opioids, they're super stimulating, kind of like a little bit of a manic buzz.

[478] It all dates back to something called the self -medication hypothesis, which was first put forward by Sander Rado in the early 1900s, he was an acolyde of Freud, who said that the reason that some people get addicted and not others is because they are self -medicating and underlying psychiatric or emotional problem.

[479] And if you could just figure out what that is, then they wouldn't use substances.

[480] By the way, what I'm leading to, just so you know, is to debunk the self -medication.

[481] I know.

[482] This is the part of the book I was sad by, to be honest.

[483] Okay, well, good.

[484] Then let's talk about it.

[485] Yeah.

[486] And then in the 1960s or 70s, Ed Concian is the one who actually then came up with this idea that people with certain psychiatric disorders will get addicted to certain types of substances versus others.

[487] But if you look at that literature, it's not true.

[488] Anxious people like stimulants.

[489] People who don't have anxiety like stimulants, right?

[490] Unfortunately, it doesn't really pan out.

[491] It suffers from what often all this stuff suffers from, which is people want one leading cause.

[492] They're so attracted to a binary.

[493] Well, we figured it out.

[494] it's this, but I think it's probably not even comprehensive enough, but I think we would go genetics is in the stew.

[495] We would go trauma, childhood adversities in the stew.

[496] And then this is the part that I don't like learning in your book.

[497] And unfortunately it might be one of the strongest components of it, but it's accessibility.

[498] Because I hate that.

[499] I want to be kind of anti -war on drugs, pro.

[500] I don't know.

[501] Let's treat the illness.

[502] But walk us through the power of accessibility.

[503] There are many risk factors for addiction.

[504] I divide them into three basic groups.

[505] nature, nurture, and neighborhood.

[506] There's certainly a heritable component.

[507] If you have a biological parent or grandparent with addiction, you're more likely to get addicted even if raised outside of that substance using home.

[508] Nurture really matters.

[509] As you mentioned, trauma, serious trauma increases the risk.

[510] But also there are some protective factors.

[511] If you have a parent who knows where you are, knows what's in your backpack, knows how you're spending your free time, you are less likely to get addicted than a parent who doesn't know those things.

[512] But then finally, neighborhood is really, really important.

[513] What we mean by neighborhood is things like social determinants of health.

[514] Unemployment is a risk factor for addiction.

[515] Poverty is a risk factor for addiction.

[516] But so is simple access to the drug.

[517] If you live in a neighborhood where that drug is sold on a street corner, you're more likely to use it.

[518] You're more likely to get addicted to it.

[519] If you go see a doctor who's free with their prescription pad, you're more likely to be exposed to opioids and benzos, and you're more likely to get addicted.

[520] And we are living in a world now with virtual, infinite.

[521] access to highly reinforcing drugs and behaviors, including drugs and behaviors that didn't exist before.

[522] And as a result, we've all become more vulnerable to this problem of addiction.

[523] For you, it was the Kindle.

[524] For me, it was romance novels and the way that romance novels and other novels have become drugified.

[525] As a reader, I can tell you that writing has changed, and I'm probably guilty of this myself, but now every chapter ends on a cliffhanger so that you can't not go to the next chapter.

[526] You can't not turn the page, right?

[527] It's like they've cracked the code.

[528] Everybody's cracked the motivational desire code and it infiltrates everything.

[529] And the four features that really make these modern drugs so addictive are quantity.

[530] So a line of cocaine probably is going to run out at some point.

[531] TikTok never runs out.

[532] You know what I mean?

[533] So you've got quantity.

[534] You've got access.

[535] The phone is essentially a 24 -7 access to these digital products, these digital drugs.

[536] You've got potency.

[537] So how do you make something more potent?

[538] You take two separate drugs and you combine them together.

[539] And we're seeing that everywhere, including in online content.

[540] You've got narrative plus music, plus beautiful faces, plus numbers, which dopamine is very sensitive to enumeration and rankings and number of likes.

[541] Oh, yes, status.

[542] Oh, yeah, all that.

[543] And then you've got novelty, even drugs that didn't exist.

[544] And those four features have essentially drugified every aspect of modern day life, whether you're shopping, whether you're investing your money, look at Robin Hood and cryptocurrency, whether you're reading, whether you're watching some kind of production, whatever it is.

[545] So yeah, I think people would have a hard time connecting the dots between cocaine, heroin, and Instagram.

[546] Could you walk us through how chemically, maybe even if you were hooked up to an fMRI machine or something, that maybe it would be indistinguishable or it would be at least similar.

[547] So there are studies showing that when people are looking at pornography or looking at video games or looking at social media, the same parts of their brain light up as when they are ingesting addictive drugs.

[548] And it's basically the reward circuit, the nucleus accumbens, the ventral segmental area, and the prefrontal cortex.

[549] They're called the reward circuit or the reward pathway.

[550] So it stimulates that very same part of the brain.

[551] Now, importantly, the vast majority of people who drink alcohol will not get addicted to alcohol.

[552] The vast majority of people who smoke pot will get addicted to pot.

[553] Most people on Instagram will not get addicted to Instagram.

[554] But for that subset of vulnerable folks for whom that turns out to be their drug of choice, it will be a potential danger zone for them.

[555] Again, I just got to say it.

[556] I love your book so much.

[557] Because if I know the mechanical reality of something, I'll stop trying to litigate for a better case.

[558] Things that are certain for me are just so helpful.

[559] Here's one I discovered long ago.

[560] I was like, okay, I learned in some other book that the chemical for pleasure is a tenth of as strong is the chemical for this fruit is poison.

[561] So if I go online and read comments about myself, I had better be damn sure that they're going to be 98 % positive because I have to acknowledge that 10 % negative will outweigh 90%.

[562] So as soon as I know that math, that becomes how I can anchor my decision to not do.

[563] It's like, oh, I'm going to lose.

[564] This is a casino.

[565] If I play this slot machine, 52 % of the time I'm going to lose.

[566] Great.

[567] I'm over it.

[568] Yeah.

[569] And I think that's a really important point.

[570] You probably don't look at the comments, right?

[571] That's how you've hacked that.

[572] By and large.

[573] Now, we'll have a racy episode.

[574] I want to check in to see if I've lost the audience.

[575] I do it.

[576] But generally I don't.

[577] That's really important, again, for young people who are so.

[578] caught up in sort of measuring themselves by whether or not people liked what they posted on Instagram or what kind of feedback they got and having them sort of do that experiment where they step away from it and see how it makes them feel.

[579] I think that's really important.

[580] Now, Jacob, one of your patients in the book, who is a sex addict will say, I feel uncomfortable labeling people that.

[581] I don't really know much.

[582] Addicted to sex.

[583] There we go.

[584] He's a sex lover.

[585] He's a unicorn in search of sex.

[586] But he creates this.

[587] masturbation machine, which is fascinating.

[588] But what I really, really saw immediately was the pattern of his life was together, and any time he had a good deal of isolation or privacy, for lack of a better term, that's when the wheels seem to come off.

[589] So I want you to elaborate on that, but I also want to interject into it as someone who majored in anthropology.

[590] I feel like this is a phenomena that is really a modern phenomenon in that people didn't have private.

[591] like this.

[592] They didn't have isolation like this.

[593] If you were isolated, you were dead.

[594] Your house was either a long house of women and a long house of men or at least a multifamily house.

[595] There wasn't really room for this.

[596] And I'm just curious what your thoughts are about this modern aspect of single family homes, multiple rooms, the amount of isolation and privacy we can all choose at any given time, how that might impact this level of chronic addiction.

[597] I think that addiction is the ultimate antisocial disease.

[598] It drives people into isolation.

[599] Certainly, it can be born of isolation.

[600] So if you lack connectivity and intimacy and those things in your life, you probably are more vulnerable to becoming addicted.

[601] But you can have the best social network, the best spouse, the best family, and you can still become addicted because I do believe addiction is its own primary progressive disease.

[602] And then you will become isolated from the people who love you.

[603] will drive you into that place.

[604] The reason I opened the book with Jacob's masturbation machine is because I was really hoping to draw a parallel between his masturbation machine and all of our masturbation machine, which is, of course, our smartphone and our other digital devices by which we can now meet so many of our needs, our emotional needs, our intellectual needs, even in some ways our physical needs, which further drives us apart because we need each other traditionally for all of those things, for emotional intimacy, for sexual intimacy, to learn things.

[605] We need each other.

[606] And yet now, you know, you can just Google stuff.

[607] And so I think it's very, very scary to see the ways in which, you know, we are splintering apart.

[608] Of course, the internet is also a wonderful source of meaningful and good connections as well.

[609] So it's not that it's all bad, but there is definitely this dark underbelly that I think we need to take a good hard look at and begin to think about what kind of relationship do we really want to have with technology?

[610] Do we really want a metaverse?

[611] Is that really where people want to ultimately spend their time?

[612] I don't know.

[613] I know.

[614] Can it come all the way out on the other end where it's like you're in your little suit and you are interacting with other people?

[615] I don't know.

[616] I'm pessimistic about it.

[617] You were in the social dilemma and I think the conclusion of that was quite right, which is it's both utopia and it's dystopia.

[618] So you do, though, have a prescriptive aspect.

[619] to this book, which is if you find yourself in this dopamine deprivation state, and I think we can all relate when you sit down at a restaurant and you happen to be by yourself, I get a visceral, like, oh, I'm uncomfortable.

[620] I got to open up my phone.

[621] I can feel it in my body.

[622] It's like now it's muscle memory.

[623] It's physiological.

[624] So how does one extract themselves from the deprivation?

[625] So I would say over the past 20 years in my practice, I've seen growing numbers of people coming in very, very unhappy.

[626] who are also spending enormous amounts of time on their phones, playing video games, looking at other online content.

[627] And I essentially frame those people as addicted to a drug, just like alcohol or cannabis.

[628] And I do a very similar intervention, which is to say, I ask them to do an experiment.

[629] And that experiment is to abstain from their drug of choice for 30 days.

[630] And why 30 days because 30 days is probably the minimum amount of time it takes for those neuroadaptation gremlins to hop off the pain side of the balance and for dopamine homeostasis to be restored.

[631] And I let them know that if they engage in that experiment, it's going to be very hard, especially in the first couple of weeks because their pleasure pain balance will tip down hard to that side of pleasure.

[632] They'll experience anxiety, insomnia, dysphoria, craving.

[633] A lot of folks will say, well, you know, how can I really be addicted?

[634] I don't have any physical withdrawal.

[635] They'll even say that with things like pot, right, or alcohol.

[636] And I'll say, really, the universal symptoms of withdrawal are not physical.

[637] They're aversive psychological states, and they're very subtle in some cases, but it's withdrawal, and it's what gets us to reach for the thing again.

[638] So I warn them that it's going to get worse before it gets better, but if they can get to 30 days without using that drug of choice, and with the example you gave, it might be a particular app on their phone, or it might be the whole device itself that they need to put away in more extreme cases.

[639] But if people can do that and come out the other side, they almost universally report feeling less depressed, less anxious, more at peace with themselves, able to be fully present.

[640] And they get out of that loop of kind of addictive craving and wanting to go back.

[641] And it's also a great moment of insight because it's only after having done that experiment that they're able to really look back and see that they were addicted.

[642] So when we're chasing dopamine, we do not see it ourselves, and we can't see true cause and effect.

[643] We feel like, oh, this just is helping my anxiety, but in fact, it's contributing to the anxiety, but you require some distance in order to get away from that.

[644] Yeah, and as someone who has gone through that in probably the most extreme fashion, both like detoxing from opiates, detoxing from drugs and alcohol, detoxing from marijuana.

[645] I guess the encouraging thing I would say is like, if you can make it through day one, you can have the optimism of, well, that was the worst one.

[646] And then tomorrow's going to be just a tiny bit less miserable.

[647] And then when you plateau, the sense of, oh, my God, I have my brain back is incredible.

[648] Because the preoccupation with our addictions, or at least my preoccupation, is so all -consuming.

[649] And even people listening to this may have something running in the back of their mind that they can't wait to check that text they heard that buzzed whatever it is you just recognizing like oh my god the racket was very loud and i didn't recognize how loud it was that is a very nice state to get to yeah so the amount of mental real estate that gets occupied by thinking about our drug is really incredible and i think again let's look at the smartphone because we can almost physically feel a place in our brains where our smartphone lives and that's always tethered in some umbilical cordway where is my phone when will i be getting to it next and so i think to be able to get to that point where you're not feeling that it's both scary and liberating at the same time but let's focus on scary first because i think it's important to acknowledge the ways in which that mental preoccupation even though it's a burden also makes us feel safe because it circums inscribes our life in a way that feels like, okay, I don't have to deal with like the abyss of what is my real purpose and meaning in life and what are we actually doing?

[650] Because I'm way too preoccupied with like the four corners of this tiny little world that I've built.

[651] And so in a way, it's horrible.

[652] But in a way, I would be so afraid to leave this cage.

[653] Yeah.

[654] If we do and we get out and we see that we can go without and then these incredible vistas open up and we're free.

[655] we all want to be free, but we're constantly putting ourselves in these cages.

[656] It's incredible.

[657] Now, often I'll be here to say that your story is very dangerous to you.

[658] It's like something that has to be regularly checked in on what story you're telling yourself.

[659] But I would argue it also has this great upside, which is, I'd be lonely without it.

[660] I get it.

[661] I feel lonely and I check in with it.

[662] And that's great.

[663] But then the story you're telling of your life, I want you to zoom out and think, okay, why am I lonely?

[664] Is there a solution to loneliness?

[665] If I didn't have, this thing, how long would I sit in loneliness before I would act and I would find something that actually got rid of the loneliness to begin with?

[666] I would maybe be calling more people.

[667] I wouldn't be sitting here alone.

[668] Whatever it is, it definitely is the solution temporarily to the feeling, but it's not a long -term solution.

[669] So when we take the long view of the narrative of our lives, what do we want to say about our lives?

[670] Really, the moment that occurred to me was when I was up at three in the morning, reading 50 Shades of Gray, and I got about halfway through, my husband was asleep.

[671] I was exhausted.

[672] I should have gone to sleep hours ago.

[673] And I was reading about butt plugs.

[674] I'm not into any of that, right?

[675] And I'm like, what?

[676] And it was the moment.

[677] It was really the moment.

[678] It's like, what am I doing?

[679] You know, and I closed the book.

[680] By the way, I had like done all these sort of rationalizations that, oh, 50 Shades of Gray.

[681] It's like a modern day pride and prejudice.

[682] like I had, you know, mapped on the characters to Elizabeth Bennett, all these weird things.

[683] And I was like, no, no, Anna, you're reading about butt plugs at three and want, put this away.

[684] Yeah.

[685] And, like, change your life.

[686] The other thing that was really important for me is, again, like the salience in other things that used to give me joy that was gone.

[687] In retrospect, I could see that it was related to this hijacking of my reward pathway.

[688] So, yeah, this long view, you know, are we acting in ways that are consistent with our values that are.

[689] consistent with how we want to live our lives.

[690] I'll never forget a patient of mine who I actually talk about in my first book who got into recovery from an opioid addiction.

[691] And he got into recovery after a year of daily smoking when he was like living with his dealer and helping his dealer sell.

[692] And for him, it was looking at time and saying, well, I've been living here and doing this for a year.

[693] So a year is kind of important and symbolic, right?

[694] And if I keep doing this, I may be doing this for the rest of my life.

[695] And I don't want to do that.

[696] So I should stop now.

[697] So it was his ability to look at himself through time and weigh that in the context of his goals and values that really allowed him to take that step to get help and get into recovery.

[698] So I use this acronym dopamine and the D of dopamine stands for data.

[699] And data is where we just like count the hours because just doing that can be revelatory.

[700] Like I'll have patients who come in and say, I don't drink very much.

[701] I'll say, okay, well, how much did you drink yesterday?

[702] It's like, I had a cocktail and I had a couple beers.

[703] Okay, that's three.

[704] Anyway, you add it up after seven days.

[705] It's like 30 drinks.

[706] It's like, yeah, you had 30 drinks this week.

[707] Like, that puts you in the one percentile.

[708] Just stopping and counting the number of hours we're spending on devices and then putting that in the context of, do I really want to spend five hours of my day for my life scrolling Instagram?

[709] And if the answer to that is no, then And that's a powerful motivator in and of itself.

[710] Okay, you were great at being kind of ahead of the curve with the opioid epidemic, and you wrote a great book, Drug Dealer, MD.

[711] That's it, yeah.

[712] I think we have two other epidemics of this variety.

[713] I'm curious what you think.

[714] I think the benzodia epidemic is going to be everything the opioid epidemic was, and maybe even more.

[715] And these would include Xanax, Valium.

[716] We could name a dozen, right?

[717] Yeah, so about five years ago, I published with co -authors of peace in the New England Journal of Medicine called Our Hidden Prescription Drug Epidemic, which is about the benzodiazepine problem.

[718] And since the late 1990s, benzodiazepine prescribing has increased in this country, not at the same rate as opioid prescribing, but a similar type of curd.

[719] It has gone down in the last five years or so, but we're still prescribing more benzos than previously.

[720] And now, of course, we have several generations of individuals who are dependent on benzos, even if they're taking just as prescribed.

[721] And of course, there's no evidence to support long -term benzodiazepine use for any medical condition.

[722] Most of the studies are about two weeks or shorter in length.

[723] Benzos have been shown to be helpful in the short term for things like anxiety and somia, but there's no evidence to support their long -term use.

[724] And yet, many, many people are prescribed them and take them for very long periods of time.

[725] They have the sensation that they're still working, but I would suggest to you that really what they're doing is medicating withdrawal from the last dose and just getting those gremlins temporarily lifted up so their balances level.

[726] They're not really treating any longer the underlying anxiety.

[727] This is like my nicotine addiction.

[728] Yeah, I don't get any buzz.

[729] I just get relief from the agitation.

[730] That's right.

[731] I interpret it as a good feeling, but it's really just the lack of a bad feeling.

[732] Exactly.

[733] Yeah.

[734] I absolutely agree with you.

[735] We have both a benzodiazepine sort of elicit misuse problem because, of course, people have normalized pill taking and think they're safe.

[736] That's made even more dangerous by the counterfeit pills that are out there now.

[737] Fentanyl, yeah.

[738] Yeah, terrible.

[739] I know all these people in my meeting have been coming in in the last four or five years with children odine from what they think is Xanax because it's fentanyl.

[740] I think maybe that's when I started going like, oh, this is clearly off the rails.

[741] There's a huge black market for it, and it's not even a Benzo anymore.

[742] This is a very, very traditional AA thing.

[743] is Suboxone.

[744] So Suboxone's regularly prescribed to people who can't get over the opioid addiction.

[745] And I see two categories for it.

[746] So one I'm a little bit in favor of.

[747] You have all these parents of these young children in Appalachia and their kids are going to die if they're not on Suboxone.

[748] You just look at the recovery rate at that age group from that drug.

[749] And I can definitely be sympathetic and go, yes, I choose alive over debt.

[750] There is then, for me, you're just on another drug.

[751] So it's like we're not ever going to address the underlying ism.

[752] We're not going to find tools for living that would alleviate the need for the medicine.

[753] So it also seems like a dead end.

[754] I'll even go on as far and say, great.

[755] So you're just afraid of death.

[756] So what if every child has installed in them some Narcams?

[757] So they can feel free to OD as much as they want.

[758] Then it self -deploys Narcum.

[759] Then your kid will always be alive.

[760] Is that a not?

[761] You know, it's in the same premise.

[762] So tell me the pros and cons of suboxone, and I think there's other ones that are similar to it.

[763] I mean, I think your first assessment around this, we're in crisis now.

[764] We've got people dying, right?

[765] If you're thinking of it like a dam that's exploding and you've got people drowning, we're not going to sit there and sort of cogitate on how we should have built the dam differently.

[766] Or teach swimming lessons as opposed to throwing out like rafts.

[767] We're just going to be trying to pull people out of the water and save lives.

[768] And so that's kind of where we are now.

[769] But also, I would suggest to you, you, again, using the analogy of the pleasure pain balance and people getting into this addicted dopamine deficit state, the idea with sustained abstinence is that with enough brain plasticity, those gremlins will hop off, homeostasis will be restored, and that person will be able to engage in a fulfilling and flourishing life just like everybody else.

[770] However, there is this hypothesis that no matter how long some people abstain, their pleasure pain balance is permanently broken and that they will not be able to reassert based on homeostasis.

[771] So essentially they're going to be walking around in this dopamine deficit state the rest of their lives.

[772] It means that they will never be able to engage in recovery work and a meaningful life because they're just constantly white -knuckling it, trying not to reach for their drug and not to relapse.

[773] So when I think about buprenorphine, what I think about is that it's a way to level the balance for people who otherwise might not be able to.

[774] And they're not really just on another drug or getting high.

[775] Now they've got a level balance.

[776] They're not feeling great.

[777] They're just feeling not in withdrawal.

[778] And now they can go to AA meetings, right?

[779] And they can get jobs and they can act in ways that are in accordance with their goals and values.

[780] Great.

[781] And this is just for fun now, which is, I don't know where I stand on this.

[782] There is part of me that thinks the benzodia epidemic, all these different things, all of us having sleep issues, am I naive and think we can curb it, or do I have to recognize the inevitability of where life on planned earth is heading, recognizing we have a 150 ,000 -year -old brain, and that my child in the first 10 minutes of being awake will have more stimuli than she would have had in a week as a hunting and gathering child.

[783] So it's like, I've stuck her in this world, and now guess what?

[784] It's hard for her to go to sleep.

[785] Right.

[786] And so then I go, well, okay, I don't think ideally I want to give my kids melatonin, but I also have to recognize the world we live in, and I need them to get sleep.

[787] It's like a sliding scale of my priorities.

[788] And so I am curious from your point of view what the future of all of this is.

[789] Do we continue to try to live in a way with our outdated brains in misery?

[790] Or do we throw in the towel in maybe surgical methods?

[791] I don't know if they remove receptors successfully at some point.

[792] I don't know if our SSRI is.

[793] inhibitors go to the next phase where they work predictably for a long time.

[794] Like, are we going to have to augment ourselves to survive in this increasingly stimuli -driven world?

[795] Are we being naive to think we'll not have to do that?

[796] I think that there's a path that's neither of the paths that you have laid out.

[797] Surprise, surprise.

[798] I think there's a path, and this is essentially what I maybe don't explicitly say in dopamine nation, which I believe, and which is actually how we've tried to raise our children and how we try to live, in which we can establish essentially barriers between ourselves and the world that we live in to create a world within a world.

[799] Because I think we have to assume that the drugification of everyday life will only continue, at least for the immediate future.

[800] So how can we live in a world like that?

[801] I think we have to not be naive and assume that Facebook is going to wake up tomorrow and say, oh, gee whiz, you know, social media is bad for teenage girls.

[802] And let's not have them do that.

[803] No, that's not going to happen.

[804] So what we need to do is create kind of these moats or these castle walls around ourselves so that we recognize that this is the world that we live in and we need to insulate ourselves from intoxicants and avoid pleasure and intentionally seek out a more ascetic life.

[805] That means we have to intentionally make life harder for ourselves in the short term to make it better in the long term.

[806] And that's why I think pressing on the pain side of the balance is the way to go because we'll get our dopamine indirectly.

[807] For example, we have raised our kids with a lot of forced marches, just like I think most people would agree that it would be cruel to not walk your dog every day.

[808] It's actually cruel to let your kid stay on the computer all day long and not get them out in fresh air and getting exercise.

[809] And what you do is if you build that into the culture of your family life, it's actually amazing.

[810] Your kids will imbide that and they will run with it because they experientially will see that they feel good when they are out and about and moving their bodies and with friends in real life.

[811] And sure, they have their devices and this and that, but they have something to compare it to.

[812] There are so many families now and young people now who don't leave their homes.

[813] They don't get out of bed.

[814] And they don't know what they're missing because they haven't had anything to compare it to.

[815] Even during COVID, my kids who have been raised with forced marches, they started a biking club and they started biking everywhere all over the Bay Area.

[816] And other kids joined them.

[817] It was like a Pied Piper phenomenon.

[818] And they biked hundreds of miles, like 16 -year -olds on their own, a bikepacking trip down to San Luis Obispo.

[819] And they had the time of their lives.

[820] And they had the world and the road to themselves because everybody else was at home.

[821] so really that's what I believe that we need to do.

[822] I'd love to see that incorporating an addiction treatment.

[823] So so much of mental health treatment, we're sitting around talking.

[824] That's good, but talking and thinking about thinking and thinking about emotions only goes so far.

[825] People need to know what to do.

[826] Yes, to act your way into thinking differently.

[827] Yes.

[828] Right.

[829] Yeah.

[830] And they need to know, okay, don't eat this.

[831] Don't do that.

[832] But do this and do that and essentially do things that are hard in the short term to feel better in the long term.

[833] Well, that's the big silver lining of your book.

[834] The last chapter, which I love and took to heart, I've tried to implement it as much as I can.

[835] I don't have the right equipment quite yet.

[836] But as you point out, when you add dopamine to the one side of the seesaw, the body is going to react with more than that share, and you're going to have an asymmetrical cost reward.

[837] It's going to cost you more ultimately than the reward first gave you.

[838] But the converse is true, which is really exciting.

[839] So cold plunges.

[840] There's a bunch of data in your book about cold plunges.

[841] If people do a cold plunge between five and ten minutes, the after effect, the heightened dopamine can last two to three hours.

[842] So if you give yourself 10 to 20 minutes of suffering, you get this asymmetrical positive thing.

[843] Now that I know this, I can't not know it.

[844] So now I try to build my day around.

[845] I have to work out.

[846] That's miserable.

[847] But I get a sustained bump for hours.

[848] If I could cold plunge in the morning, and I got the whole fan.

[849] family doing it.

[850] So now the little girls, yeah, they're getting in the cold pool and we all have to sit there and time ourselves or we listen to songs.

[851] That's easier than timing.

[852] I aim to structure my day in like four periods of suffering because I want to die a dopamine junkie.

[853] I just want to do it right.

[854] I want the cost, reward to work in my favor.

[855] So I still want to seek it.

[856] But I'm very embracing of your notion of suffering followed by sustained heightened mood.

[857] That's great.

[858] And I'm so glad you're doing it together with your kids.

[859] I really think.

[860] as a culture, we need to reframe pain.

[861] This idea that pain is dangerous, that we need to avoid pain, that we need to distract ourselves or comfort ourselves constantly, and instead say, no, you know what?

[862] We are wired for pain.

[863] That's essentially how we evolved.

[864] We live in a world that has us completely insulated from really not even just painful experiences, physical experiences, period, which is part of the appeal of drugs.

[865] It's a very physical experience, right?

[866] So we have to find a way to be re -embodied and to do things that are hard so that we can reset our dopamine reward pathways and get that kick that we want because we are creatures of desire.

[867] It's not like we're going to be able to just not have pain and not have pleasure and like hang out.

[868] No, we need that friction and that intensity, but there are good ways to get it and they're not good ways to get it.

[869] Yeah.

[870] I like even removing good or not good because there's somehow implicit a judgment.

[871] It's just do you want a 10x outcome or do you want a negative 10x outcome?

[872] That's right.

[873] Who knows what's good or bad, but you'll know from the outcome, in essence.

[874] Right.

[875] Do the experiment.

[876] That's the key and see really how you feel.

[877] Yeah.

[878] I love your book.

[879] I love talking to you.

[880] I'm so glad we got to do this.

[881] It's been so fun.

[882] We've been invited to go up to Stanford to teach.

[883] Oh, gosh.

[884] We got to cash in on that.

[885] We do.

[886] And when we do, we're going to definitely try to find you.

[887] We're going to sniff you out.

[888] Oh, yeah.

[889] That would be wonderful.

[890] Yeah.

[891] Where are you teaching?

[892] We don't know.

[893] We were invited by Nina, that.

[894] I mean, I don't know how real the invite was.

[895] It was real.

[896] It was in writing.

[897] Yeah, but she said we should come do a little lecture.

[898] A little guest lecture.

[899] Yeah, yeah, yeah.

[900] Oh, yeah, that would be great.

[901] Maybe we could have you do grand rounds or something.

[902] Well, now we're friends with Huberman, you.

[903] Yes.

[904] Nina, I mean, by God.

[905] It's just because we're obsessed with fancy schools and we want to say that we taught at a fancy school.

[906] We've created a term, in fact, unifile.

[907] We're super susceptible to that status, us little primates over here.

[908] well so much fun thanks again for giving us so much of your time and again i hope we get to see you in the 3d version oh it was my pleasure really nice talking with you and if you're ever up here in the bay area for any reason even separate from teaching here at stanford let me know and i'd love to grab coffee or something all right wonderful thank you so much you're welcome bye bye stay tuned for more armchair expert if you dare and now my favorite part of the show The Fact Check with my soulmate Monica Padman.

[909] We are wearing matching pants today.

[910] Same brand and everything.

[911] Danny Ricardo pants.

[912] Danny Rick Gear.

[913] Uh -huh.

[914] Me and teal.

[915] What would we call this color?

[916] Yeah, I would call it a teal.

[917] I resist calling it teal because I don't like the color teal, but I love this color.

[918] Turns out you do love the color teal.

[919] You know, the color teal that is always etched into my mind is what they painted the Chevrolet Cavalier in the 90s.

[920] Every rental car was this terrible teal.

[921] It's like they ordered too much of it, General Motors, and they were just plastering it on everything, and it scarred me. So it's not that teal.

[922] It's not Cavalier or Corsica teal, but it's a darker.

[923] It's a richer.

[924] It's a rich.

[925] It's bold.

[926] It's a jewel tone.

[927] Oh, my God, a jewel tone.

[928] That's what you call this.

[929] Oh, because you're in an earth town.

[930] Yeah.

[931] Terracotta Warriors.

[932] A mustard.

[933] There's an exciting update for everyone.

[934] Someone rang our gate today this morning.

[935] early in the morning and I looked in there I said, hello, can I help you?

[936] And I said, hi, I have Monica Padman's credit card.

[937] And I was like, hmm, this is interesting.

[938] Entree foo.

[939] And it was a neighbor.

[940] It was a neighbor, yeah.

[941] It was your neighbor.

[942] It's actually the house directly in between you and I. That was a pretty fun pop out.

[943] Big time.

[944] To have someone ring the gate and say they have your credit card.

[945] And my first thought was, she's been mugged by our neighbor.

[946] But I've heard it several times in AA, which is really funny, is that someone will say, like, I'm the type of alcoholic that would steal your wallet and help you look for it.

[947] Oh, right.

[948] So it would have been interesting if she had mugged you.

[949] Yep.

[950] And then wanted to be a good Samaritan and turned in your credit card she had stolen.

[951] Yes.

[952] Well, that didn't happen.

[953] Sadly.

[954] I had friends in town, and I took them to my house to see it before.

[955] Of course.

[956] You started to get wheely -nilly with your credit cards?

[957] Well, no, I thought...

[958] Are you guys chopping up lines?

[959] No. I had fuzzy pants on that had zippers.

[960] So I thought I was doing great.

[961] Everything was zipped up.

[962] But then I must have unzipped and taken out my phone and the card must have fallen out.

[963] Okay.

[964] I realized this pretty shortly after, after we left.

[965] We just walked to the street and they were calling an Uber and I was going to walk home.

[966] And I was like, oh, Oh, shit, I don't have my credit card.

[967] It's probably at my house because I walked.

[968] Your apartment?

[969] No. Like, I knew it was in my pocket zipped up.

[970] So I knew that it was just like, you know, 50 feet away, most likely.

[971] Yeah.

[972] But I decided to go ahead and cancel it.

[973] Why didn't you go look?

[974] I felt rushed.

[975] Oh.

[976] That seems like so much more trouble.

[977] Me too.

[978] I would walk like five miles.

[979] to avoid dealing with waiting for my credit card to get mailed and all that.

[980] But I felt rough.

[981] And I memorized the number and now I've got to rememorize it.

[982] Got the auto pay on so many.

[983] Oh my God, you've got to reset all of your auto pays.

[984] I forgot about that part.

[985] That part is annoying.

[986] If I had known the neighbor was going to drop it off to you by Monday morning, I wouldn't have cared.

[987] But I...

[988] Well, surely not.

[989] I was in a rush to get to the wedding festivities.

[990] Uh -huh.

[991] And it was hot out.

[992] Okay.

[993] There's another variable.

[994] And my house is a mess.

[995] Like, who knows where that thing is?

[996] It could be in that mosquito pond.

[997] It could be anywhere.

[998] Well, they found it.

[999] Yeah.

[1000] If you find my credit card in the woods, you know, you got to give me a drug test.

[1001] Why would my credit card be out in the field?

[1002] You know, you follow me?

[1003] I will.

[1004] Okay.

[1005] Oh, I have an update that I think would be fun.

[1006] Because sometimes people hear us, like, we connect with folks on the show, and then we kind of write some checks and they wonder if are asking cash them case in point the david sadaris walk it happened that was so great yes so guess who i played spades with yesterday dwayne wade no meta you did yes met in his wife Maya they came over they came over and we played spades wow and guess what we learned a thing or two okay they cheat it's like part of the way they play it's fine to cheat it's a four point penalty but you got to not just catch the person and go oh you you said you were out of clubs and you trumped it i got to be able to point to the exact book and i say you cheated we're going to flip that book it's going to expose your cheating and if i'm wrong no no harm no foul they keep rolling if i nail it they're down four points huh or four books i'm not totally clear on how the penalty worked okay but anyways because i knew this was part of their strategy i had to be all over What hand was this?

[1007] What book?

[1008] Okay, I think that's suspicious that he was out of hearts at that moment.

[1009] That's the second book they got.

[1010] Two of hearts, I got to remember.

[1011] It's another layer to pay attention to.

[1012] But it was really fun.

[1013] It was really sweet.

[1014] Yeah.

[1015] My kids thought it was quite a riot that there was somebody so much bigger than me in the house.

[1016] Yeah.

[1017] That's a cool full circle.

[1018] I had a big weekend.

[1019] I had Callie's wedding.

[1020] It was incredible.

[1021] It was everything she wanted it to be.

[1022] No snafews.

[1023] Anyone get too drunk?

[1024] Fall on anything?

[1025] Oh, good.

[1026] People did get too drunk, which was a sign of a good party.

[1027] Oh, good, good, good.

[1028] Dancing?

[1029] So much.

[1030] Booty bumping.

[1031] Oh, yeah.

[1032] Oh, my God, was it full on?

[1033] Yeah.

[1034] Because that was the crew that did all the booty bumping, right?

[1035] That's right.

[1036] And was everyone doing the same dance is from college?

[1037] Booty bumps?

[1038] We were definitely booty bumping.

[1039] Okay.

[1040] And we did kept saying that.

[1041] Like, we're back at Firehouse.

[1042] That was our big bar.

[1043] Booty bump spot.

[1044] Yes.

[1045] Okay.

[1046] And it was so fun.

[1047] That is incredible.

[1048] It's really special to get to see the full maturation of a human.

[1049] Yeah, the progression of everyone.

[1050] For us, since we all went to high school together, looking around at all the different places we are all at, it's lovely.

[1051] One of our friends couldn't stop crying.

[1052] Oh, great.

[1053] Yeah, and it was hilarious and really sweet.

[1054] Boy or girl?

[1055] Boy.

[1056] Oh, boy, good for him.

[1057] It was because he was in love with Callie and she was gone forever now?

[1058] No, he was just like so moved by everything.

[1059] I think by just all of us.

[1060] Did you love it?

[1061] Yeah, of course.

[1062] Did you get PQs?

[1063] Yeah.

[1064] Oh, good.

[1065] Well, congratulations to the bride and groom.

[1066] Callia Max forever.

[1067] Thigh guy.

[1068] She gets those thighs for life.

[1069] Oh, listen, the thigh guy won.

[1070] The best thigh one.

[1071] The best thigh one.

[1072] That's what it was.

[1073] I'm coming for you, Max, eighth of an inch at a time.

[1074] Because I'm turning on the afterburners on my thighs.

[1075] It's all I work out anymore is my thighs.

[1076] Have you showed the towels to anyone, and has there been a reveal?

[1077] Well, I just ran out of patience.

[1078] Like, Charlie was never over to work out.

[1079] Matt was never over to work out.

[1080] No one was ever over to work out.

[1081] So finally, I just sent a picture of them to Charlie.

[1082] Great.

[1083] And did he love it?

[1084] Oh, yeah, yeah, he really enjoyed it.

[1085] I think he wants to work out here more than he did.

[1086] Before it was called Dan Gaines.

[1087] It's a good, it's a good lure in.

[1088] A good hook.

[1089] If you're going to have a home gym, you might as well fucking name it.

[1090] It's a much more fun.

[1091] Might as well.

[1092] I'm going to.

[1093] Yeah, go out to Dan Gaines to the Beef House.

[1094] Hoss.

[1095] Who would mine be called in opposition to yours?

[1096] Maximum Mouse, Powerhouse.

[1097] Maximum Mouse Powerhouse.

[1098] That's pretty good.

[1099] Yeah.

[1100] It really came out quick, and that was good.

[1101] Yeah, PQ Paradise.

[1102] Maximum.

[1103] maximum mouse's powerhouse but that's confusing because i just threw gains and you can infer oh really yeah i just did a z i didn't even do an apostrophe i don't know if they do them apostrophe's in embroidery i don't know enough about embroidery as it turns out but when you see the title do you understand that it's it is dan gains as beef hoss oh actually no oh my god how would that work Dan Gaines.

[1104] Well, I thought you were just saying, like, a bunch of funny words together.

[1105] No, it's Dan Gaines.

[1106] He's a guy.

[1107] Yeah.

[1108] And that's you.

[1109] Well, yeah.

[1110] On my best day.

[1111] Dan Gaines is beef hoss.

[1112] I see.

[1113] Yeah, Dan Gaines beef hoss.

[1114] I didn't know that until now.

[1115] All right.

[1116] So I'm trying to rethink it now through your lens.

[1117] It's just a lot of words together.

[1118] It's still very funny.

[1119] Fun words.

[1120] To me, it was like, Dan Gaines is one thing.

[1121] And then beef hoss is another thing all connected.

[1122] So similar.

[1123] Similar.

[1124] You did realize that Dan's last name was game.

[1125] That's the most important thing to me. Yeah.

[1126] Oh, boy.

[1127] This was a really fun episode because Anna Lemke, addiction, dopamine nation.

[1128] Yeah, I really had a good time bonding with her over our vanity, how we make jokes to head off.

[1129] Someone else laughing at our stupidity.

[1130] Yeah, it was a real nice.

[1131] Connect.

[1132] You know, and you connect.

[1133] Yeah, and you get a z. Yeah.

[1134] Yeah, I like that.

[1135] I wouldn't mind getting her into Dan Gaines beef hoss.

[1136] She's into suffering to promote dopamine.

[1137] That's true.

[1138] And Dan Gaines is a great place to suffer.

[1139] Well, it's also black mold.

[1140] You're also hurting yourself.

[1141] Killing yourself.

[1142] Okay, so where was Wi -Fi created?

[1143] Okay.

[1144] Wi -Fi was created in the Netherlands.

[1145] Congratulations, Netherlands.

[1146] Dr. O'Sullivan and his team of engineers credit for pioneering the development of Wi -Fi technology.

[1147] Born in Australia, the engineer, he's born in Australia, received his university education at Sydney University.

[1148] O'Sullivan made his revolutionary invention while working in the Netherlands Dwingaloo Radio Observatory.

[1149] in 1977 oh that's before the internet okay so he figured it out early okay but Carnegie Mellon was the first campus wide wireless internet network oh not MIT exactly well that's an listen there's a lot of credit and there's a lot of embarrassment to go around first of all Australia well done my Netherlands well done I don't know was that something and then and then and then Carnegie Mellon well done boy oh that's what I think of you made it stuffy yeah exactly upper crust judgmental condescending we love these fancy schools but then also you do I don't I would never make a stuffy voice about it have you tried out of Wi -Fi it's campus wide don't make them feel bad for being smart that's not okay that's just as bad is making someone feel bad about being stupid.

[1150] I hope I have Beef Wellington today after the commissary.

[1151] If you get but hurt about people making fun of hillbillies.

[1152] Well, but Hillbillies is a real person.

[1153] I'm doing basically thirst in hell, but I will do a real person now.

[1154] You're doing Margaret Thatcher.

[1155] Well, this is Margaret Thatcher, which, as I was doing it, I do want to do Margaret Thatcher.

[1156] You ready?

[1157] Yes.

[1158] That's good.

[1159] Wait one more.

[1160] I didn't do it as good as I wanted to do.

[1161] Oh.

[1162] Yes.

[1163] Yes, that's Kristen's one of her impersonations.

[1164] And I think Aaron Weekly's the first to really lock on to it.

[1165] No, Kristen did it, and then Aaron started doing it.

[1166] His is much different than Kristen's, but both are great.

[1167] Oh, yes.

[1168] You're right.

[1169] That was me saying, oh, yes, you're right.

[1170] Oh, thank you.

[1171] Hers is, like, gutter roll.

[1172] Hers is a little more gutterol.

[1173] It's all about that first, and it's so, it's a mind trick because you know you're ending with yeah, and it sounds so wrong to start, yeah, with, oh, yes.

[1174] Yeah, but it's yes.

[1175] I know, well, or yeah.

[1176] You did a mixture there, which I like.

[1177] Okay, hybrid.

[1178] All right, so we found out about Wi -Fi.

[1179] That's cool.

[1180] Carnegie Mellon, congratulations.

[1181] I'm impressed by your smarts, and I would never make fun of you.

[1182] Good job, old boy.

[1183] Is that what they say?

[1184] Old boy.

[1185] That's a saying, right, for fancy people?

[1186] I don't think so.

[1187] Old boy is a British phrase.

[1188] A former male pupil of a school.

[1189] There we go.

[1190] That's really thing, yeah.

[1191] Good job.

[1192] Good job, old boy on your Wi -Fi experiment.

[1193] From now on.

[1194] So when we're out and about, you and I, getting a burger probably.

[1195] Yeah, yeah.

[1196] Oh, I'm so hungry.

[1197] I can't wait.

[1198] I'm going to get my medium rare, of course.

[1199] That's Oulu, this guy.

[1200] Megaloo!

[1201] Oh, that's a good role.

[1202] Roll reversal, you're a megalo.

[1203] But anyways, yeah, if you could throw out it, like, well, we should ask old boy how it was.

[1204] Like, if he just left the burger restaurant.

[1205] Okay.

[1206] All right.

[1207] Oh, this guy.

[1208] Oh, good.

[1209] People are coming out.

[1210] There's probably room.

[1211] Hey, old boy.

[1212] How was the burger?

[1213] Tasted like shit, man. Oh.

[1214] I just think he says man at the end of every sentence.

[1215] He seems angry.

[1216] He did not like the burger.

[1217] Oh, man. You can't make everyone happy.

[1218] There's an old boy, ding, ding, ding about an upcoming guest.

[1219] Okay, I never heard of that.

[1220] Or that.

[1221] Or that.

[1222] But, okay, great.

[1223] So that was an Easter egg.

[1224] Okay, I wanted to ask you about this.

[1225] Even though you're mean to smart Carnegie Mellon types, you were nice about this.

[1226] She was addicted to romance novels, which I found very interesting.

[1227] Fuck, yeah.

[1228] But I am impressed.

[1229] that addicts, like yourself, aren't like, that's not.

[1230] Oh, it's child's play?

[1231] That's not an addiction.

[1232] I think I would feel like, you can't say that's an addiction.

[1233] It is, it is.

[1234] Sure.

[1235] I think she's right, but.

[1236] And you've heard me saying here that I think an addiction is any time you compulsively regulate your insides with something externally with diminishing effect and diminishing power over it and loss of control.

[1237] You could fucking be, you could hump couch cushions.

[1238] Exactly, yeah.

[1239] I hope you start because I'd love, I think, I don't want it.

[1240] You don't need any more addictions in our, in our group.

[1241] Yeah.

[1242] But it would be a great one to walk through with the public.

[1243] Like, how did it start?

[1244] When was it manageable?

[1245] If I looked in your car and I saw a couch cushion on the passenger seat and I was like, where is that going?

[1246] You're like, oh, re -apultery.

[1247] I got to get it fixed.

[1248] Yeah, well.

[1249] Carnegie Mellon's double loaded, let me just say.

[1250] Okay.

[1251] Because it's not fair to Carnegie Mellon, but it has some vestigial judgment on my end about Carnegie, or Carnegie.

[1252] People say Carnegie, whatever.

[1253] Because he was a philanthropist like our man. Like, sure.

[1254] Rockefeller.

[1255] They were peers the same time.

[1256] Andrew Carnegie, he put his name on everything.

[1257] He wouldn't give you five bucks without insisting his name was on the building.

[1258] So I don't like that part of Andrew Carnegie.

[1259] and so Carnegie Mellon It's like it's got his name on it University of Chicago is Rockefeller That could be called Rockefeller University He's like I hate to point out that you named your Jim Dan Gaines Not my name Check it I'm giving credit to like some other Fucking fictitious person No We don't know who Dan Gaines is yet Oh boy Oh little boy Oh little boy Girl.

[1260] Okay.

[1261] Let's get back on track.

[1262] Sorry.

[1263] Romance novels.

[1264] So, yes, you do that often.

[1265] Your definition of addiction is regulating the inside with the outside, which I think is nice because you could be like, that's not.

[1266] That's chicken shit.

[1267] That's not real.

[1268] I got the real thing.

[1269] Yeah, I don't feel that way.

[1270] I'm not a traumaer.

[1271] But I understand why it's like something bad to at least the silver lining is it's a club.

[1272] Yep.

[1273] Yeah, it's just, it's interesting.

[1274] Oh, this is great because we were watching John Stewart's new show on Apple Plus.

[1275] Have you checked it out?

[1276] I have not yet.

[1277] I checked out the first episode of it and it's really, really great.

[1278] And it was about guns.

[1279] And he illuminated the most fascinating aspect of this that I had no idea, which is that 60 % of mass shooters have a domestic violence conviction.

[1280] And as he pointed out This should be a very unifying thing left and right Because the most dangerous call for a police officer to respond to is domestic violence That's when they get shot the very most And so there is a law that people convicted of domestic violence can't own guns But there's absolutely no system to go get the guns So it's like they can't go buy a new one but however many they had So there was two women who had been attacked and shot by their ex -husband and both paralyzed and then met each other and now started this activism and they were introduced as survivors and then the conversation came up about that term survivors it's a very interesting term so i won't speak on their thing i'll speak on mine of being molested like i would never want to be called a survivor personally i like that i was a victim in that situation but then became this larger conversation between chris and i it's like if you are feeling like you are wearing a permanent label of i'm a victim like you're powerless i can see where it's appealing and then if you're me which is like i wore a label of always in control and there was a situation where i am disappointed to myself because i wasn't in control it's more comforting to me to say no i was a victim in that moment i'm still powerful it's just all weird and then it's made me think of another thing I don't like having had a dad and a stepdad die of cancer.

[1281] I don't like the beat cancer.

[1282] This person beat cancer.

[1283] It implies that like, oh, my father didn't fight hard enough or Barton didn't fight hard enough.

[1284] It's like you get cancer and it kills yours.

[1285] It doesn't.

[1286] It's not about your fight.

[1287] It's kind of shameful to me to all the people who lost to cancer, I guess.

[1288] Yeah, it depends on how you look at.

[1289] at it, I guess.

[1290] If you have someone in your life who had cancer and survived it, you might feel differently.

[1291] You might feel like you were there through this major struggle and then they came out okay.

[1292] Yeah, but they'll go like, they're a fighter and they beat it.

[1293] And it's, I don't know.

[1294] I don't know.

[1295] It's great for them.

[1296] Yeah.

[1297] I guess what I'm saying is I found myself on the other side of one of those things where I don't love it myself.

[1298] Now, I cannot love someone.

[1299] I'm not pushing for anyone to stop.

[1300] I don't get a fuck of people.

[1301] But I'll just say that like that's one of these where I'm on the other side and I might be on the other side going, oh, gives a fuck what people say.

[1302] Right.

[1303] But I'm acknowledging to me, it's like, everyone who gets cancer fights cancer.

[1304] And everyone fights as hard as their body will allow them to.

[1305] Yeah, that it makes you feel emotional.

[1306] Yeah.

[1307] But again, I don't want people to stop saying anything that they want to say.

[1308] Yeah.

[1309] I don't care.

[1310] Say survivor, say victim.

[1311] That, yeah, that has to be about.

[1312] the person what they want what they prefer that's kind of that yeah okay ding ding ding kind of you said that you've just now endeavored into real therapy now i didn't want anyone to think that like you've been lying all this time that you've talked about therapy sure sure sure you've been in and out of therapy yeah couples therapy primarily yeah and you've done individual a little bit yeah as a result of the couples therapy right but now you're an intensive individual therapy trauma specific twice a week yeah but you're right yeah that would sound like i was lying no i wish there was a way to qualify it i guess would just be like yeah intensive i guess yeah she mentioned forced marches with her kids oh uh -huh she kept saying that and i was like what is that just a walk right well yeah i think so but it's a military term, a movement on foot by soldiers or military prisoners who must, in order to satisfy a military requirement, travel at a speed, or in adverse conditions that would normally tire them excessively.

[1313] Ooh.

[1314] That's it.

[1315] Oh, I mean, I also wrote down Interstellar.

[1316] Oh, because you went and saw it.

[1317] Because of Brian Cox and because of David Ferrier, it's his favorite movie.

[1318] He encouraged me to watch it, and then I did.

[1319] And you were sad.

[1320] Yeah.

[1321] Daddy daughter.

[1322] I told my friend who cried that he should watch Interstellar on the way home.

[1323] Oh, to really ring it out all the way.

[1324] Just to be to land dehydrated, even more so.

[1325] Exactly.

[1326] I recommend.

[1327] High recommend.

[1328] High recommend.

[1329] And if you listen to Brian Cox, a lot of that stuff makes a lot more sense.

[1330] I was glad I had had that knowledge as a foundation because I don't think I would have understood.

[1331] I already didn't understand a lot of Brian Cox's stuff, but then I definitely would have understood any of Interstellar if I hadn't had that.

[1332] I think I want to watch Interstellar now having talked to Brian Cox.

[1333] Yeah.

[1334] Because I was certainly 30 % of it.

[1335] I was like, hmm, you know, this, this is probably just science fiction.

[1336] Exactly.

[1337] Yeah.

[1338] That's what I kept thinking.

[1339] I was like, if I didn't know this was like real based in science stuff, I would think the whole thing was totally made up.

[1340] That's the thing, because I can only be so emotionally interested in sci -fi when it's real sci -fi.

[1341] Yeah.

[1342] And this is, but it's also real.

[1343] It's real.

[1344] I had to pause it a few times and stand up, walk around.

[1345] Oh, shake it out.

[1346] Go on a force march.

[1347] Poo -Poo -Poo -Poo -Poo -Ties.

[1348] That's all.

[1349] Love you.

[1350] Love you.

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