A few decades ago, and I was in my 20s, I lived with a guy in New York City.
We were roommates.
He was obviously an alcoholic.
And he was on the wagon when I knew him.
But he was always telling me these amazing stories of these incredible things that happened
to him.
And he would laugh about it.
But what was most clear was that actually he was a wreck during that period.
He was miserable.
He ruined all his relationships.
He squandered all of his money.
He disappointed his parents again and again and again.
So I finally asked him, were you happy during that time?
And he said, what are you kidding me?
I was completely miserable.
I said, did you know that?
And he said, yeah, I was totally obvious to me and everybody else that I was a completely
miserable person.
I knew I was unbelievably unhappy.
And I said, so why did you keep doing it?
I thought about it.
And he said, you know, I guess I preferred to be drunk and happy.
Now, that kind of blew my mind.
But then when I thought about it a little bit more, I wondered and I still do wonder today,
how unusual is it?
Maybe a lot of people do that.
Maybe lots of people in all different walks of life with different kinds of behaviors,
sacrifice their happiness for their addictions.
Maybe I do that too.
Welcome back to How to Build a Happy Life.
I'm Arthur Brooks, Harvard professor and contributing writer at The Atlantic.
And I'm Rebecca Rashid, a producer at The Atlantic.
I know I've talked to you about this before, but I have this bad habit of using work as
an excuse for everything.
It's sort of been this habit, I guess you can call a sort of addictive behavior in the
backdrop of my life that I didn't admit or really recognize because it also had so
many positive impacts in my life.
It gave me a sense of purpose, a sense of identity, sort of answered the why am I here and
doing what I'm doing question.
So how does something like work become an addiction?
You could be talking about anything that's addictive quite frankly.
It just happens to be the strivers drug of choice, which is accomplishment, which is achievement.
If you work all night, people say good for you.
And so the result is we get more and more affirmation and we start seeing our rewards coming
through these hard struggles.
It's never quite satisfying because it's never quite enough.
And so you keep going back again and again and again, hit the lever, get the cookie, hit
the lever, get the cookie and that's a work addiction.
Probably underlying that is something even deeper, which is a success addiction.
What I'm curious about is how these things that were taught are good habits.
How do those things become as harmful as debilitating addiction or threatened to become that harmful?
And I guess I'm curious for someone like you, how has work all is played out in your
life?
I'm not immune from anything and I guess the irony is that I specialize in the science
of happiness and I fall prey to a lot of these things myself.
There's a lot of vice that we can engage in.
Almost everything that we do that's really good when we push it to the limit, when we
pat ourselves on the back, when it becomes a source of pride, when it crowds out love
relationships, virtues can become vices.
Today we want to understand how our expectations of a happy life are complicated by the disease
of addiction.
The complexities of addiction and addiction treatment can't be covered in one episode,
but we do want to identify our tendencies towards addicted behaviors and how it affects
our well-being.
The realities for those impacted by addiction are wide-ranging, but defining addictions
effects on our identities, behaviors and desires may help us parse out the divide between where
we are and where we want to be.
Thank you for joining us.
Sure, I'm happy to.
Thank you for inviting me.
And Anna sounds great.
You're good.
Your office is like a studio.
I don't know what you're doing there.
I mean, you've got these.
I don't want you teddy bears in the background or something.
I do actually.
I do.
I do with you.
But I can show you.
My name is Anna Lemke.
I'm a psychiatrist and professor at Stanford University School of Medicine and I'm the
chief of our addiction medicine, dual diagnosis clinic.
And we're recording, right?
Becca?
Okay.
You're going to show me a worse though.
This is Shakira.
This is Shakira.
And I think she's supposed to represent a therapy donkey.
Oh, yeah.
Yeah.
We're experimenting with therapy donkeys.
Anna Lemke and I sat down to discuss her work, treating patients with addiction.
Dr. Lemke specializes in dopamine, a chemical in the brain that lies behind desire and plays
an important role in our addictive behaviors.
In 2021, Dr. Lemke published the book, Dopamine Nation, Finding Balance in the Age of
Indulgence.
Now, we'll save dopamine in its complex function in the brain for another time.
But I do want to discuss the fact that many of us are at risk.
Maybe you find yourself building your life around certain substances, or devices, or just
habits that you feel like you can't live without.
She argues that many of our addictions today are not from things we would consider immediately
addictive, like drugs and alcohol, but from behaviors that are even thought of as healthy
or beneficial.
Things like exercise and work.
Things we thought were virtues.
But what you crave and what you really want are usually not the same things.
I realized that I was actually a bad psychiatrist early on in my career because I was not asking
patients about drug and alcohol use, and the reason I wasn't asking them is because I would
have had no idea how to address those problems if they had happened to say, yes, I have a problem
with that.
So it was a kind of a don't ask, don't tell policy, which by the way was completely
normative for psychiatrists at the time and is still quite a prevalent practice.
Why?
Because we don't learn a lot in medical school or even psych residency about how to screen
or intervene for substance use disorders or other addictions.
Our audience should understand that you're not confessing to be having some unusual deficit
in your training.
This is just something that psychiatrists are usually trained to treat people with mood
disorders and behavioral problems.
Yeah, I had a patient who had a bad outcome.
She was in a row over car accident.
Her brother called me and let me know.
I said, my goodness, how did it happen?
He said, well, she's been using again.
And I said, using what?
And he said, using heroin, isn't that what you've been treating her for?
And that was really the moment that I realized, oh, my goodness, I've something's gone terribly
wrong here.
I was harming my patients out of my own ignorance and neglect of this very serious problem.
So that was about 20, more than 20 years ago.
So then there was a huge kind of like, okay, I need to figure this stuff out.
And then since then, you know, I've just sort of become a person who does this work with
a lot of joy I might add because it's a great population to treat when people with addiction
get better.
The ripple effect is enormous.
I do the work with a lot of joy and I'm very grateful that I get to do it.
So to be a little bit clearer about this, I mean, obviously when people think about addiction,
they're thinking about heroin or alcohol or gambling or pornography.
But there are a lot of things that we do not was standing the fact that they're not entirely
good for us.
You know, I have a huge sweet tooth.
I mean, ever since I was a little kid, I mean, it's the, you know, a table sugar.
I still eat sugar cubes if I was like a horse or something.
And I know that that's not really good for me.
So I do it relatively moderately and I understand that I'm doing it because the benefit of the
pleasure it gives me out weighs the cost to, you know, hyping up my, you know, my insulin
response at that particular moment.
Let me ask you the most basic question of all.
What's an addiction?
So addiction is broadly defined as the continued compulsive use of a substance or a behavior
despite harm to self and or others.
The key piece is really the behaviors and whether or not they cross this threshold of impairing
function.
And that, by the way, is really the key piece for diagnosing any psychiatric disorder.
We diagnose it based on what we call phenomenology or patterns of behavior over time that are
very similar across different demographic groups, points in history.
And what we see is that despite those differences in individuals, there are very classic patterns
or manifestations of maladaptive patterns that ultimately we group in these different
buckets.
It's a frenion major depression, OCD addiction.
I always like to emphasize that there's no brain scan or blood test to date to diagnose
any mental illness, including non addiction.
Tell me about the patients who come see Dr. Annell Mckee.
What are they, what are they suffering from?
So the types of patients that I have are patients struggling with all different forms of addiction,
not just addiction to drugs and alcohol, but also to all kinds of behaviors, pornography,
gambling, shopping, digital products.
So online pornography, compulsive masturbation is a huge and growing problem.
Gaining disorder is something that we're seeing more and more of, especially among young
men, and they often also have co-occurring conditions like depression, anxiety, psychotic
disorders.
Even previously healthy and adaptive behaviors, behaviors that I think we broadly as a culture
would think of as healthy, advantageous behaviors now have become drugified such that they are
made more potent, more accessible, more novel, more ubiquitous.
And therefore they have the potential for addiction where they didn't have that before.
And I use myself as an example in reading.
I mean, I think we all of us grew up with this idea that reading is healthy and if your
kids reading a book, you know, that's got to be good.
And yet in my early 40s, I actually got addicted to romance novels.
And the Twilight Saga was my gateway drug, which is in and of itself embarrassing because
it's a vampire romance series written for teenagers, and obviously I was a middle-aged woman.
I was not the only middle-aged woman who was reading Twilight.
It was kind of a thing then.
I read it once and then I read it again and I was on my third reading and then it wasn't
quite doing for me what it had done the fourth time.
So I then explored other vampire romance novels and then I went to werewolves and necromancers
and suit savers and you name it.
And then the real kind of tipping point for me was my friend Susan, who I'm throwing
under the bus here.
So you should get a kindle.
And when I got a kindle, that was the beginning of the end because I mean, this is very
embarrassing, but you know, I was like, it was impacting my ability to function.
I was staying up later and later at night.
I was not fully present for my kids and my husband the way I really wanted to be.
And that was really the crazy thing about it.
Like the things I really care about kind of started to be compromised in a way that I wasn't
fully in control of.
Essentially what was happening was that I just, it was a fantasy escape world and I just,
the more I read, the more I just wanted to be in that world and the less I wanted to
be in the real world.
The also the less interesting the real world became to me.
So the salience and the positive and reinforcing qualities of the real world slowly began to
diminish.
And neuroscience explains this beautifully and it's really important for us to understand
it because you know, quantity and frequency matter, the more we do our drug, the more we
want to do our drug and that that's really kind of the way we get hooked.
Tell me a more typical story of perhaps one of your patients that comes in and my guess
is they're not coming in when the, you know, the elevator is now in, you know, the first
basement.
They've gone 30 down 32 floors at this point and they, when they're coming to see you,
it's pretty bad.
So typically what would addiction look like or maybe even a specific case of a patient
when they, when they get to you?
So you know, what we see here is patients, for example, maybe, you know, a middle-aged
man who has used pornography through most of his young adult life and then in the early
90s, there's the internet and then all of a sudden it's more available.
It's more graphic and then, you know, the early 2000s comes around and you know, he gets
his smartphone and now we're talking 24, 7 access, highly potent images and things start
to fall apart.
Now this person is experiencing tolerance, finding that online pornography alone is not sufficient,
starting to, for example, engage prostitutes, light as partners, spending more and more
time and resources, chasing down this particular feeling, threatening, you know, his employment
by using it, working knowing that he's doing that and yet feeling such an enormous compulsion
that he can't help himself feeling horrible about himself, enormous stigma, unable to stop
although he tries repeatedly to do that and eventually, you know, it comes to see me,
essentially feeling suicidal, feeling like, you know, I don't want to live anymore,
I can't stop this behavior.
So, so much shame, I'm so depressed, I don't even enjoy it and yet I cannot stop, you
know, will you help me?
And so, and it's the exact same narrative that we see with people who are severely addicted
to drugs, severely addicted to alcohol, which is a drug, people start out using fun or
to solve a problem.
The drug works for them initially so they return to using it over time, they escalate
their use, they build up tolerance, they need more and more, eventually it stops working
but they can't stop and then it even potentially turns on them and causes the very problem
that they're trying to solve but they still can't stop.
Exercise too has become drugified, right?
So the ways in which these machines allow us to stretch the human physical limits beyond
what we really are meant to do, the way that social media, you know, invites this
and videos comparison around sports and around exercise the way that we're constantly counting
ourselves.
So, these are like healthy, previously healthy behaviors that have now become vulnerable
to this problem of addiction.
Well, it's, isn't that encouraging, you know, but, you know, no, well, not really, I
mean, I think it's really important because this is really where we're going with this
conversation is that there are a whole bunch of areas of behavior that we've been told
since we were little kids that are really wonderful, you know, and, you know, that if you work
hard, that's always and everywhere great and if you get AIDS in school, that's always
and everywhere great and if you get promotions and raises and the admiration of others, that's
just a wonderful thing.
Do you see workaholics in your clinic?
So, typically we will not see patients who come in for workaholism as a chief complaint
because they won't identify that as their problem.
It's a little bit like you don't see very many narcissists coming in for care because it's
the people around them who are showing up for treatment, you know, not the narcissists
themselves.
But what we do see is people who come in with serious drug and alcohol problems or pornography
addiction and they also are addicted to work and the way that comes out is this kind of
work hard, play hard mentality where people push themselves so hard at work and exhaust
themselves beyond the limits of what their minds and bodies can do and then reward themselves
at the end of a very hard work day or a very hard work week or a hard work month with
the kind of a binge or overuse pattern.
And so it's this sort of seesaw, this work hard, play hard, which has become so normative
and of course the one drives the other but the overworking because we are depleted after
that instead of having that sense of being full up, you know, with the joy of a job well
done or having achieved excellence, which are all good things.
We instead come away from that work experience drained, depleted and now we're looking to
reward ourselves, right, to make up what's my compensation and the compensation is often
drug and alcohol use or some kind of addictive behavior, which then you get into this terrible
seesaw phenomenon.
Yeah, we're not, you know, another thing your mother does not brag about is that you're
so good at leisure.
I mean, she can take vacations like nobody I've ever seen.
I mean, they're, they're so relaxed.
It's unbelievable.
I mean, she really leaves the world behind and no, no, it's, you know, she's carrying
five cell phones and again, I think work has become vulnerable to the same kinds of transformations
that we see with any drug.
It's more potent, you know, in the sense that especially when you're talking about jobs
in the higher socioeconomic ladder work is made more potent by the bonuses and stock
options and the other ways in which the more you work, the more you'll potentially make,
which is not true, by the way, for, for, you know, low wage earners who are increasingly
dropping out of the workforce, we can work 24 seven because of the technology and the
phones and the devices and the internet and we're often expected to work 24 seven to be
available.
And remember, quantity and frequency matter when it comes to changing our brain and
entering, you know, addicted brain, the more of our drug we use and the more of it and
more often, we're potent.
It is the more likely we are to change our brain and become addicted to it.
And this is the other way that work has been turned into something that's potentially
very unhealthy is that the, for many of us now, the work that we do is really detached
from the meaning of the work.
So we're no longer deeply involved with the actual end product.
It's more problematic because, you know, it's highly socially acceptable.
One of the most, to me, fascinating and enduring themes in the disease of addiction is the role
of control and this wanting to have this illusion of control over our lives, drugs become
a way to do that.
And even when we get to a point where we know the drug isn't working, we're so terrified
to let go and to not be, you know, the person driving this really crazy, crazy bus down
this really, careening down this steep hill, you know, headed for no breaks, no breaks,
the inevitable crash, but at least, you know, I'm still sitting in the driver's seat.
And so this becomes really, you know, key to addiction recovery is really, really, it's
an enormous leap of faith, right?
It's asking people to give up this thing that they have used their entire lives to self-south,
to, you know, get that feeling that they need in order to feel kind of whole.
And even when it stops working, just the fear associated with having to let that go.
And then what, you know, the not knowing, well, what will that be like?
What will that existence be like for me?
I mean, the terror of the unknown is so strong.
So what do they do?
But no, no, what do they do?
What do we do?
Look, I missed a lot of my kids childhood.
Yeah.
Because I was on the wheel.
I was on this treadmill.
I was doing it too.
What, what are we?
Well, thank you for your openness and for sharing, you know, some of that regret.
That's really powerful.
And, you know, someone like you is willing to be open in that way, very, very helpful.
So thank you for that.
It's a great gift.
It's amazing to me that we have an opportunity to change our lives at any point in our lives.
I have seen people with severe lifelong addictions in their 60s, 70s and 80s get into recovery
and absolutely transform their lives for the better, transform their family and friends
lives for the better.
I'm just really beautiful, wonderful things can happen at any stage of life.
So I just, I just want to say that because I think it's never too late.
And we all make mistakes.
We all make mistakes and we all have regrets.
But you can change your life at any point in your life and you can decide to live in a
different way and to let go of that thing that you've been hanging on to.
But you thought was your life raft, but which was really, you know, your anchor.
Would you say there are probably a lot more people who are suffering from addiction than
those who are diagnosed and those that or those who even know that that's the case?
I would say that that's true in the modern age.
There is so much more access to highly potent and reinforcing drugs and behaviors.
But also just in general, it's under diagnosed because there's no infrastructure inside of
medicine or there's a limited infrastructure inside of medicine to treat addiction.
And so it's a type of thing that people generally don't want to see because there aren't a lot
of good pathways for folks.
We have pretty good treatments that we've known about for decades.
So it's not that we don't know what works.
It's that we've not built the infrastructure inside of medicine to deliver that care.
And that's not related to the lack of evidence for the treatments that's related to other
factors having to do with payment structures, stigma, doctors who treat addiction medicine
are generally not compensated for that work.
So their ways to do this is the bottom line and this is a story of hope.
Now we can get into a whole show in and of itself about what recovery looks like.
But that's traditionally about more conventional addictions.
But it sounds to me like given the fact that the primary damage that workaholism's success
addiction do is to our relationships.
And these are very fear-based addictions.
And human beings are complicated in and of themselves. You put two together and you've
just magnified the complexity.
And so many people have the experience of trying harder at relationships and not having
it worked out.
And so the drug is so much more reliable.
And what am I going to give up this thing that at least gives me some transitory relief
or escape for really a big gamble or what feels like a big gamble.
And kind of not even having the basic tools for knowing how to go about renewing and strengthening
those relationships with people in our lives.
Not to mention the fact that now so many people are addicted to the internet and their devices
and are self-suiting with strangers in various ways on the internet that those opportunities
to build intimate connections in our real lives, it has become more challenging.
This is what we get when we are willing to give up our drug.
What we get is these wonderful, quite intangible things that you can't buy and you can work
for but not in the same way and cheap among them is certainly meaningful and intimate relationships
with other people.
And I guess the last point is one that you've been making implicitly throughout which is
that none of this is going to be a problem you can solve unless you're honest.
Right.
This is one of the interesting things about, you know, I've known a lot of addicts, you've
treated a lot of addicts.
And one thing that fuels addiction always is lies to yourself, lies to others.
It's just this perpetual act of lying.
Right.
Right.
This is kind of radical honesty, this willingness to be open and truthful, not just about
how we're spending our time, what we're consuming, what drugs we're using, what we're doing
on the internet, what we're reading.
But also just about little things, why we were five minutes late for the meeting, you
know, why the keys went missing, who ate that last piece of chocolate pie.
You know, a thing little, those little lies that we tell, you know, just instinctually
to sort of hide our selfishness or our mistakes.
That's where we have to really intentionally focus and try to tell the truth.
Because when we do that, you know, we're telling a truthful autobiographical narrative
and we must do that in order to be able to know where we've been, where we are and where
we want to go.
You know, how do we make more intimate relationships?
Well, we tell the truth to the people that we care about and we stop lying to them.
That's so key.
And that becomes a huge part of recovery, right?
So when people stop using their drug, they're so terrified to be honest toward their loved
one about what they've been doing, you know, especially let's say they told their loved
one that they stopped and they really didn't and it would be nice to be able to skirt around
that and not have to tell the truth.
But if you don't go back and tell the truth and apologize and make amends, then you're
not going to be able to ultimately get to that place where you have those relationships
that are so incredibly sustaining and renewing and powerful and make the need for these drugs
so much less.
Now that you've spent the bulk of your professional career studying how some of your early behaviors
and your passion for what you did may have been a certain type of workaholism, what do
you think you would have done differently if you knew what you know now?
It's a good question, you know, in the first year of my marriage.
Now remember being on vacation, we were camping and I just couldn't handle it and I had
to go home because I needed to get back to work and those behaviors followed me.
You know, when I finally left the music business and got my doctorate and became an academic
and I just couldn't work enough.
I couldn't achieve enough.
I had to catch up with everybody my age because I went to college when I was 30 and I
finished my doctorate when I was in my mid 30s and I was years behind everybody else and
so I thought, okay, this is really just a question of catching up with everybody else.
And so I was working twice as hard as everybody else, probably.
And the result is I've published a lot of articles and thought a lot of classes.
My career went really, really well and my family life continued to suffer quite frankly.
And how many nights was I the last one to leave the office and I sacrificed the first
hour with my kids and my kids were little?
I don't remember a lot, not because I was drunk.
I don't drink.
And one of the reasons I don't drink is because I have alcoholism in my family and I know
it's too dangerous.
But here's the key thing to ask yourself, whether it's workaholism or maybe you're just
wondering if you're drinking a little bit too much is to interrogate that.
A life that's unexamined is one in which you're helpless against these ravages that come
from addictive behavior.
And then when you look in the mirror and you're quite honest with yourself, then you can
actually start to manage these things.
Here's the most encouraging thing of all.
When people understand what they're doing and are honest with themselves, they're willing
to own up to the fact that they are being managed by their desire, that they're being
managed by their cravings.
That process is the beginning of getting freedom.
That's all for this week's episode of How to Build a Happy Life.
This episode was produced by me, Rebecca Rashid, and hosted by Arthur Brooks, editing by
AC Valdez and Claudine Ebayth, fact check by Anna Alvarado.
Our engineer is Matthew Simonson.
