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Our brain is essentially reeling in response to this fire hose of dopamine and the needs to down -regulate dopamine transmission to balance it out and get back to baseline levels.
Hi everyone, it's Rosie here, welcome back to Radio Headspace.
I'm so excited about today's conversation because we're diving into something that affects all of us – dopamine.
It's the brain chemical that drives motivation, pleasure, and reward. It can also fuel addiction, anxiety, and burnout.
And to help us make sense of all of this, I'm joined by Dr. Anna Lemke.
She's a psychiatrist, addiction specialist, and the author of Dopamine Nation – Finding Balance in the Age of Indulgence.
I'm so excited for you to hear this conversation.
So, my name is Rosie.
I'm one of the meditation teachers here at Headspace.
And I personally have been following your work for a long while.
And so I'm I'm really, when Danny told us that we got you on the show.
I was just beside myself.
I had a fangirl moment.
Oh, that's fair. So nice of you.
That makes me feel sort of like a celebrity.
To me, this is that sort of gratifying work that I feel like makes such a huge difference.
And it really creates a foundation and a landscape for even people like me that teaches the stuff that I do, it really allows us to have a good foundation as to where we need to put our energy and focus.
And I did read Dopamine Nation twice.
Love it. Love it. Thank you.
One, because I just loved it so much, and two, because it just, it's so content, it's just like the information is so good and it really took me a little bit of time to really digest everything since I'm also a neuroscience geek.
So my first question and I feel like it's a poignant question is how did you even get interested in the subject of dopamine?
Like was there an aha moment in your life when you just realized that this was something that you needed to focus on.
In fact, there was a bit of an Aha moment.
So while I was still training, I started seeing this patient nominally for depression.
And that's what she told me she wanted to work on.
And I prescribed her a little bit of an antidepressant.
And then one day out of the blue, I got a call from her brother saying that she wasn't going to make it to her appointment because she'd been in a rollover car accident.
So I was like, Oh my gosh, that's terrible.
Well, what happened?
And he said, well, she's been using again.
And I said, using using what?
He said, Well, using heroin, isn't that what you've been treating her for?
And it was this moment of just total shame, where I realized, oh my goodness, this person has been coming to me for therapy for her heroin addiction, that I had no idea that she had, because I never once asked her about drugs and alcohol, in part, because I'd never been trained in that arena.
So I had no tools. So I didn't want to ask about it because God forbid somebody actually endorsed they had a problem, I would not help them.
Anyway, it was this moment of realizing I'm actually a bad psychiatrist, and I'm hurting people because I don't know anything about addiction.
And so even though I was at the end of my training, it was the beginning really of my education in addiction, which I got by asking patients about drugs and alcohol.
And it turns out, when you ask patients, they're very eager to talk about it.
In fact, relieved to do so.
And I have wonderful colleagues who taught me a lot, I started to go to national meetings, I started to read, started to do my own research. And yeah, it's been, you know, going on 30 years now.
And let me just say, it's a very rewarding population to treat, because when people with addiction, especially severe addiction, get into recovery, not only do they get better, but it's a huge ripple effect on their families, on their friends, on the people they work with.
Yeah, I I really loved that portion of dopamine nation where you're talking about addiction and how you know it affects really the entire family, my my family was directly impacted by addiction.
And I I grew up going to AA meetings with my dad, you know, and so I saw the sort of unfortunately he's not sober anymore.
But the thing is they say it's a family disease, right.
But you've talked about this in the past and I don't know if I've read interviews that you've done but I've heard you talk about how when people go through this process of recovery how So in a way like it it's such a life -saving experience, because you see these people really change.
And I wonder if you can talk just a little bit about that, because I think it's such a powerful perspective to have on people that are struggling with addiction.
Yeah, I mean it is powerful to see it in clinical care.
People when they are in their addiction, they look so personality disordered, right?
they they meet all the criteria for narcissistic or borderline personality disorder there's huge interpersonal pathology.
Oftentimes they have significant symptoms of anxiety, depression, sometimes psychosis, sleep disturbances.
So then you know you've got a whole checklist where they're meeting criteria for all these other co -occurring psychiatric disorders then you treat their addiction and they get into recovery and they have a sustained period of abstinence or a sustained period in recovery.
Lo and behold they don't look personality disordered anymore.
They emerge from this sort of addicted self, into these really remarkable humans.
And in many cases, they also don't meet criteria for depression or bipolar or anxiety or ADHD, all of that gets better.
Now, in some instances, they also still have those co -occurring disorders.
But it's shocking to see the majority of them emerge from addiction, not meeting criteria for any of those problems. Once they get into recovery.
Would you mind defining what dopamine is?
Sure. So dopamine is a chemical that we make in our brain.
It is fundamental for our survival at the most basic level.
It's the chemical that we release when we encounter something that we we should approach and explore further.
And this is typically something that's important to our survival, like food, clothing, shelter, or something that's just novel or new in the environment, a new piece of information that we need to figure out, you know, what's going on.
Dopamine is also the chemical that becomes unbalanced, so to speak, when we experience the disease of addiction.
So the disease of addiction is characterized by these neurophysiologic changes that come about as a result of too much dopamine getting released all at once too often in a reward pathway that was evolved for just a little bit of dopamine on a rare occasion after a lot of effort to get it which is not the world that we live in now you can imagine.
Yeah I mean what happens in addiction as I've talked about is that because we're releasing a whole lot of dopamine all at once in response to these very potent stimuli whether things we ingest or our food or things we look at or things we do.
Our brain is essentially reeling in response to this fire hose of dopamine and then needs to downregulate dopamine transmission to balance it out and get back to baseline levels.
And we end up in this dopamine deficit state and that can last for a while and that's what feels so bad right because it's basically akin to a clinical depression.
We feel anxious, we feel depressed, we feel irritable.
We're constantly thinking about our drug and craving our drug.
And now we need to use not to get high or solve a problem, but just to get back up to baseline levels of dopamine firing and feel normal.
Yeah, my question to you and this was something as I was reading the book that I kept coming back to you in how, how this relates to mindfulness and meditation from my understanding and just my studying and my knowledge is there's this part the frontal lobe right that part of the brain where we can sort of instead of be in our limbic brain where we react we act more wisely when we're in the frontal lobe and you talk about in the book how we in this state of addiction we begin to experience this frontal cortical atrophy and I wonder if you could explain that and and of bridge that together with what you're
saying about being in this deficit of dopamine and and maybe how mindfulness plays a role in being able to navigate for example those four weeks of detoxing from a psychological perspective what it does is that it just allows us to be more aware of what we're feeling when we're feeling it including our ability to surf those urges or cravings and know that we can ride them out, that they're not going to last forever, that we can detach from them and observe ourselves experiencing them while they're happening in real time, so that we're not in this stage of unconscious denial or unconscious reactivity,
letting, you know, our sort of limbic brain run the show.
Yeah. What are some common dopamine traps that we fall into in our daily life that we just do without realizing it?
oh my gosh so many I would say that modern life is very oddly almost entirely arranged around our rewards one of the Duncan experiments that I sometimes engage in and sometimes invite other P other people to think about engaging in is try imagine first going through your entire day so an entire 24 -hour period without indulging in a single thing that is rewarding for you, or that you look forward to as a kind of escape from the present moment.
And I think if if we thought about that, we could all come up with a lot of things, from that first cup of caffeine in the morning to reaching for our phone or eating some sugary, fatty, salty thing or watching Netflix at the end, I mean, the list goes on and on, we really kind of bracket our day with these rewards.
And it's scary to think about not indulging in them.
And yet, if we engage in that experiment, which which I've done, a really interesting thing happens.
At least for me, what I experienced is that I'm much more able to be in the present moment.
Because instead of looking forward to that reward right now, like thinking, Okay, well, as soon as I'm done this podcast, I'm going to be able to, you know, drink my coffee.
But if there's no coffee, and there's nothing else like that at the end of this podcast, that I'm just here on this podcast with you.
And then all of a sudden, this moment becomes much richer, because I'm not projecting my psyche forward into the future, anticipating how I'm going to reward myself.
It's so powerful. I'm just thinking about, well, I've done silent retreats before so I know the power of being able to take all of those uh little pleasures out of your life all those little comforts that you just don't think about um even just sitting down on a bed and wanting to turn on the tv or reaching for your phone to just create some sort of input that's going to make you feel better right?
And it's what's interesting is the way that I've I've thought about this is like we're so desensitized to what our actual natural baseline is that when we perhaps feel a semblance of it we it's really uncomfortable.
So how do we how do we begin to find what that baseline is?
I know you've talked about sort of doing this, this what do you call it the dopamine fasting?
Yes. So maybe can we talk a little bit about the importance of dopamine fasting and, and how someone can start one?
Yeah, I mean, I just want to, I just want to sort of reiterate what you said you said we, we, when, you know, when we try to do a silent meditation retreat, or not reach for our drug of whatever it is you know we feel that something has been taken away from us well something has been taken away from us and we are literally in withdrawal and the universal symptoms of withdrawal from any addictive substance or behavior are anxiety, irritability, insomnia, dysphoria and craving so that is the first thing that we need to acknowledge embrace and expect is that we will feel withdrawal and it will be
uncomfortable but the longer we can go without reaching for our drug of choice, the more time we give our brains to reset those dopamine reward pathways, and eventually we get to this place where we are feeling good.
In fact, really good, much better than we were when we were constantly in the cycle of intoxication, withdrawal, drug seeking, intoxication, withdrawal, drug seeking.
So the dopamine fast, this is just really a way to talk about an abstinence trial or abstinence sampling, where we identify our drug of choice, and we make a commitment to stop using it for four weeks.
Why four weeks? Because again, four weeks is about the average amount of time it takes to finish the first 10 to 14 days of acute painful withdrawal, and then begin to get into that rosier part of the experiment where we're actually feeling not in withdrawal, and good.
If you don't do it long enough, you won't get the benefits.
You know, there's there's a sort of been trend for like this Silicon Valley tech bros to go into a cave for a week and then they emerge and they like look at a leaf and they get high.
I mean, you can do that it's the same phenomenon.
But most people don't have the luxury right?
They have they have jobs they have to keep going to and kids they have to take care of.
So instead, you know, identify what what's that one thing that really like once I start using it.
I just somehow can't stop.
You know, it's so pleasurable in the moment.
But then when I do step, I feel that come down right that dopamine freefall.
Then that's the thing that we make the commitment to.
And you know, as I write about in my book, for me, it was romance novels, right?
And it started innocently enough with the Twilight Saga, my gateway drug.
But over time, I was I was an addicted I mean, every moment I get I got I was reading room and then I got a Kindle.
And then I had delivered anonymously, you know, and then I was, you know, reading in between patients and the 10 minutes between patients instead of sort of taking a moment reflecting thinking about my next I would just be reading romance novels.
We went on family vacations.
I didn't want to do anything, I just wanted to read romance novels and on and on.
And so I made a commitment to get rid of my Kindle and read no romance novels for 30 days, which is what I recommend to patients.
I was astounded, absolutely astounded at how difficult it was, especially at the end of the day, putting myself to sleep because I really hadn't done that for then many years without a romance novel.
And it was super painful.
But here's the good news.
After a month of no romance novels.
I felt so much better, less anxious, less irritable, you know, slept better, less depressed, more present for my kids found my kids more interesting, again, found my patience more interesting.
Do you know what I mean?
I'm so you this kind of thing that happens where you you the salience for other pleasures or things that used to be pleasurable and they're no longer pleasurable right?
Because our focus has now narrowed on this one thing and this is the only thing that sort of has salience for us.
I loved reading that about the romance novels because I too have have been in that same position but with everything that saying it sounds like doing a dopamine fast is something that everyone has the ability to do.
For me it was I went through like a little bit of a health journey last year.
I went into early menopause and you know I was really struggling with hormones, etc., and so I found that one of My biggest sort of comfort was just scrolling on Tik Tok like that was just and I would spend hours like oh yeah hours oh yeah you know trust me i can relate.
And so one of the things that I did when you know last last June I kind of did a reset and funny enough this is sort of where you and your work came in because it really helped me right it really helped me sort of reframe and put these practices back into play and so it started with okay if I'm gonna get on tiktok I'm gonna you know I've got a treadmill so I'm like okay if I'm gonna get on tiktok I'm also gonna get on the treadmill and you know after a while I'm just like you know kind of out of breath and I'm like okay it's hard to scroll I'm like okay maybe I don't fine you know and then it's
sort of like I started to sort of take away little by little it was more of a gradual approach it wasn't necessarily like i just stopped and then it became this sort of habit where now i associated getting on the treadmill like okay i want to get on tiktok but i'm like i'm gonna go for a walk instead you know it's like i'm gonna do that first and if i do that then it's what you said the reward thing right then you can get on for 10 or 15 minutes and then after a while it just felt so much better to not be on it for hours.
Yes, yeah. I love that, I've not heard anybody describe their getting off of TikTok with, like, pairing with the treadmill and then having difficulty scrolling and then finding it was more trouble than it was worth.
But that's great, you know, and that's, you brought your own creativity to solving that problem and it's not a one -size -fits -all type of thing.
And people, I hear all kinds of creative solutions from folks.
I do wanna say, though, just to make sure we qualify this, in terms of the dopamine fast, it isn't actually appropriate for everybody or for every drug.
So for example, for individuals who are at risk of a life threatening withdrawal because they're drinking so much they might have a seizure or delirium tremens, or they're at risk of life threatening withdrawal from something like a benzodiazepine, Xanax or Klonopin or Valium.
Those folks should not do this experiment on their own.
They should, you know, go see a doctor and have medically managed detoxification again go get go get some medical help.
Yeah I'm curious what you think about or sort of your your belief or what the role of community is in breaking these addictive behaviors and being able to come to a place of finding balance?
Yeah well community is absolutely key so Addiction is a disease of isolation.
Recovery is all about human connection.
And, you know, we've known that for a long time.
A lot of times people talk about addiction as an attachment disorder.
Instead of making connections with humans, we sort of replace that human connection with our drug, which of course we have a lot more control over.
And so for, you know, for people who are vulnerable in that way, it sort of becomes their friend and lover and what have you.
um it's absolutely vital that we make human connections you know that and for people who are struggling with severe addictions we know that if you join a fellowship of other people who are also in recovery or trying to be in recovery your chances of getting recovery are much higher so i mean Alcoholics Anonymous 12 -step based mutual help group is evidence -based and and And in fact, the data show that for those with the most severe addictions, 12 step groups like Alcoholics Anonymous, Narcotics Anonymous, may actually even work better than professionally mediated treatment.
So having an integrated in your everyday life, making sure you have healthy people that you're connecting to when we think about adolescence with addiction and treatment for them, they absolutely must change their using peer group.
you cannot get into recovery as a teenager.
If you're hanging out with friends who use you've got to find new friends.
Thank you so much. I'm just again, I haven't even I'm gonna have one more question for you.
If you could believe just one have so many really but okay, I'll ask you one more question.
If there's one change you hope people will make after reading your book Dopamine Nation, what would it be and who?
And why you think it's so essential for living a healthy and balanced life today?
The one change I hope people would make is to reframe denial, discipline, and deprivation as something that's actually positive, healthy, and will ultimately bring me more joy.
And I hope that by understanding the pleasure pain balance and how dopamine works, they'll be able to have in their mind a kind of a model for what's happening in the brain as they pursue pleasure and what's happening in the brain as they open themselves up to difficult challenges and that that will then inspire them to issue these easy immediate pleasures and actually view challenge and difficulty and pain as something that they can embrace and welcome in their lives.
Doctor Lemke, thank you so so much for being on and for sharing your wisdom and your work with us.
As I said, I feel like your work has been so inspiring and so motivating and encouraging in my personal life so thank you thank you so so much and uh i'm so excited to hear what everybody thinks of this episode and for the people that are listening how could they connect with you or get more information well thank you rosie this was really fun it was a pleasure to meet you and it won't surprise you to learn that i'm not on social media because i wouldn't be able to handle it.
So there's really no place.
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