Comedian Joe Rogan opens up about his long battle with video game addiction, and how he managed to get clean after trying to quit for years. He also discusses the science behind addiction and how it can affect the way we think about our mental health and the impact it can have on our relationships with friends, family, work, and the rest of the world. Joe also talks about how he was able to break his addiction to video games, and why he thinks we should all try to break our addictions to video game and other forms of media that keep us addicted to them, like video games and other media that distract us from our day-to-day lives and keep us from doing the things we need to do to improve them. The Joe Rogans Experience is a podcast by day, a comedy podcast by night, all day, all the time, by night. It's a show about what it's like to be a comedian, a writer, a podcaster, a nerd, a geek, and a human being who loves to play video games. It's called the "Joe Rogan Experience" and it's hosted by the comedian, actor, writer, and podcaster J.J.R. Rogan. And it's one of the funniest things I've ever done, and I think you should listen to it. If you're interested in learning more about addiction and mental health, check it out! Thanks for listening to this episode, and share it on your social media accounts! Tweet me and let me know what you thought of it! and what you think of it was your favorite part of the show! Timestamps: or your thoughts on this episode? Tweet Meghan McElroy: or what you'd like to see me talk about it in a future episode about addiction or how it's affected your life, or how you're dealing with it in the next episode of this podcast? or any other podcast you're struggling with addiction and/or how you think it's affecting your life in general, and what kind of thing you're going to try to do about it? I'd love to hear your thoughts or your story or thoughts on it in any of the things you've heard about it tweet me in the comments section! or in a new episode of the podcast :) <3 - Timestamp: 8:00 -
00:00:52.000I was playing this online video game called Quake.
00:00:55.000And what it is, is you play online and you are in this 3D environment.
00:01:04.000And you hear, like, sounds in 3D, and the graphics are amazing, and you're running around shooting at people, and they're shooting at you, and it's really exciting.
00:01:14.000It's very thrilling, but it's not real life, and it'll eat your whole life away.
00:02:15.000So usually, as we become addicted to something, we don't see it until there's some sort of threshold where maybe we have a bad consequence, or someone else makes a comment, or just something happens so that we start to look at our behavior in a different way.
00:02:33.000So I guess I'm wondering with your video game addiction, What was it for you?
00:02:37.000Do you remember what the tipping point was where you said, I have to stop doing this?
00:03:17.000Because I have this obsession with getting really good.
00:03:22.000Whatever I get into, it becomes too much of my life.
00:03:27.000I was watching this documentary recently about my late friend Anthony Bourdain and in the documentary they were talking about how he used to be addicted to heroin and then later on it actually became a healthy thing.
00:03:46.000But it was like this addiction where he talked about it constantly and all the people that were working with him were laughing about how he never stopped talking about it.
00:04:20.000We just use the idea of the disease model.
00:04:23.000So we say that somebody has the disease of addiction.
00:04:28.000It's a chronic relapsing and remitting problem.
00:04:32.000People come to it with different degrees of vulnerability, and the risk for it can essentially be summarized as nature, nurture, and neighborhood.
00:04:41.000And just to briefly describe that, If you have a biological parent or grandparent with addiction, you are at increased risk compared to the general population of getting addicted yourself.
00:04:52.000If you have a co-occurring mental illness, you are at increased risk of getting addicted.
00:04:57.000If you have certain character traits, like you're more impulsive, you have a hard time putting a break between the idea to do something and actually doing it.
00:05:06.000You're at increased risk for addiction.
00:05:09.000So that's kind of all in the sort of nature risk category.
00:05:15.000So if you grow up in an environment where you experience a whole lot of trauma, you are at increased risk for becoming addicted.
00:05:23.000If you grew up in an environment where your caretakers model using drugs and alcohol or other addictive substances or behaviors as a coping strategy, you are at increased risk of becoming addicted or even if they just implicitly condone it.
00:05:38.000And then that brings us to the whole neighborhood idea.
00:05:42.000And this, I think, is a really under-recognized aspect of our risk for addiction, which is just simple access.
00:05:49.000So if you live in an environment where you have more access to highly reinforcing drugs and behaviors, you're more likely to try them.
00:06:00.000Especially with the increasing potency, variety, and novelty of drugs today, you're at increased risk of becoming addicted.
00:06:07.000So if you go see a doctor who's more free with their prescription pad, you're exposed to opioids or benzos, you're more likely to get addicted.
00:06:14.000If you grow up in a culture where people are playing a lot of video games, you're more likely to try them, more likely to get addicted.
00:06:21.000And neighborhood are the risk factors.
00:06:24.000But again, people bring different degrees of vulnerability to this problem of addiction.
00:06:29.000And some people are more vulnerable than others.
00:06:32.000And you may indeed be in that category where you're just somebody who, you know, once you find something that's reinforcing for you, you just go and you just want to do it again and again and again.
00:06:44.000When you say reinforcing, what do you mean by that?
00:06:47.000I mean that it's rewarding in some way.
00:06:55.000Now the thing about addiction and the way that it changes our brains is that that thing that initially is pleasurable and has us engaging in approach behaviors If we continue to consume that substance or engage in that behavior,
00:07:11.000it ultimately actually puts us in a dopamine deficit state such that we want to continue to do that behavior, not to feel good, but just to stop feeling bad.
00:07:22.000And that's kind of one of the fundamental things about the disease of addiction.
00:07:57.000The initial rush that you get from the first uses of it, you're always chasing that, but really what you're doing later on in life is just trying to not be sick.
00:08:08.000Not having it in your body makes you feel terrible.
00:08:12.000So interesting, that term, chasing the dragon, it comes in part from, as you describe, like the elusiveness of trying to recreate that initial high, which with continued use becomes harder and harder.
00:08:24.000But it also literally comes from when heroin is inhaled.
00:08:29.000So if you put it on a piece of tin foil and you light it underneath, you get this kind of smoke.
00:08:33.000Then that plume looks like a dragon's tail.
00:08:36.000So it's got a couple of different meanings.
00:08:38.000But yes, I mean, what you're saying is exactly right.
00:08:41.000And the way that I describe this to patients and describe it to medical students is imagine that in your brain there's a balance, kind of like a teeter-totter in a kid's playground.
00:08:52.000And one of the most interesting findings in neuroscience in the past 75 years is that pleasure and pain are co-located.
00:08:59.000Which means the same parts of our brain that process pleasure also process pain and they work like opposite sides of a balance.
00:09:06.000So when we do something that's rewarding or reinforcing or pleasurable, our balance tips slightly to the side of pleasure.
00:09:14.000We get a little release of dopamine, the pleasure neurotransmitter in that part of our brain, our reward pathway, and we feel good.
00:09:20.000But the thing about that balance is that it wants to remain level, and the brain will work very hard to restore a level balance, or what's called homeostasis.
00:09:31.000And it does that by tipping the brain an equal and opposite amount to the side of pain.
00:09:36.000So again, the way the balance restores homeostasis is to tip to the opposite side.
00:09:42.000That's the come down after using that moment of wanting to do it again, the hangover.
00:09:47.000If we wait long enough, that feeling passes and balance is restored.
00:09:51.000But if we don't wait and we continue to use our drug again and again, We end up with a balance that's essentially weighted to the side of pain.
00:10:01.000And I imagine that like these little neuroadaptation gremlins hopping on the pain side of the balance.
00:10:08.000But the point is that with repeated use, we get enough gremlins on the pain side of the balance to fill this whole room.
00:10:14.000And then we're essentially working from a dopamine deficit state.
00:10:18.000We've down-regulated our own dopamine levels.
00:10:20.000We've downregulated our own dopamine transmission, and those gremlins like it on the balance, so they don't get off after the hangover is over or the acute withdrawal.
00:10:29.000They can persist there for weeks to months to years, which is why people with addiction...
00:10:35.000Even when their lives have become so much better, we'll relapse because they're not walking around with a level pleasure pain balance.
00:10:43.000They're walking around with a balance tipped to the side of pain.
00:10:48.000They're experiencing the universal symptoms of withdrawal from any addictive substance or behavior, anxiety, irritability, insomnia, dysphoria, and intrusive thoughts of wanting to use their drug again.
00:11:01.000Now, with enough time elapsed, and again, in people with severe addiction, it can take months to years, those neuroadaptation gremlins will hop off.
00:11:10.000We will regenerate our own dopamine and our own dopamine receptors, and our level balance or homeostasis will be restored.
00:11:17.000Is it scientific to call them gremlins?
00:12:09.000But then once I knew there was no temptation, like we never went, maybe one time again, One time we did it, we went back and played again after like a year of not playing.
00:12:20.000We played a couple times when the Doom guys came.
00:12:41.000Just a nice way to think of the neuroscience and a nice way to teach it is to imagine this balance that gets tipped to one side or the other and the little gremlins which represent neuroadaptation hop on one side or the other as the opponent process mechanism to try to restore homeostasis.
00:13:04.000Okay, so the gremlins represent neuroadaptation.
00:13:09.000It's the way that our brain, it's our innate re-regulating mechanism to restore a level balance.
00:13:16.000So if we ingest a substance or engage in a behavior that causes a very large release of dopamine in the brain's reward pathway, Our brains will immediately respond to that by down-regulating our own dopamine production and our own dopamine transmission.
00:13:35.000They will put us into a dopamine deficit state.
00:13:38.000So it's not that we just go back to a level balance or homeostasis.
00:13:45.000Okay, so if you think about dopamine firing, we're always firing at a tonic level, a baseline rate of dopamine.
00:13:51.000And dopamine goes up or down depending upon what we're doing.
00:13:57.000And it is what really governs our approach and avoidance behavior.
00:14:01.000But every time we have a big surge of dopamine upwards, there's a price to pay for that.
00:14:08.000And it is that dopamine levels then go below baseline to compensate for that before bringing dopamine back to our baseline tonic levels.
00:14:18.000And if you repeat that behavior again and again, the initial response to the stimulus gets weaker and shorter, and the after response, the dopamine deficit state, gets stronger and longer until you've essentially put yourself in a chronic dopamine deficit state.
00:14:36.000Where you're always chasing the dragon.
00:15:53.000So, I mean, you know, these evolutionary stories are sort of just-so stories, but I think we can speculate and tell them.
00:16:00.000I mean, we evolved over millions of years to approach pleasure and avoid pain, and it is what has kept us alive in a world of scarcity and ever-present danger, right?
00:16:10.000I mean, if we, so when, like, we travel across the desert and we find some water, woohoo, you know, dopamine, that's good.
00:16:17.000But if we stayed in that, you know, euphoric celebratory state, we really wouldn't be aware of the fact that night's coming or there's a predator that's going to get us.
00:16:26.000So our brains have evolved to very quickly bring us back down to baseline, again by going below baseline, and that keeps us sort of ever vigilant, ever seeking new and greater rewards, which is exactly what we need in order to survive in a dangerous world and in a world where we don't have the kind of abundance that we're talking about now.
00:16:49.000And, you know, one of the things that I think has happened is that humanity has reached this really unprecedented state in which our primitive brains are completely mismatched for our modern ecosystem, which is an ecosystem of incredible overabundance and quantity,
00:17:07.000potency, and variety of these novel drugs.
00:17:10.000So we're designed for essentially like a hunter-gatherer life.
00:17:15.000That's how the human body is designed.
00:17:18.000And I'm sure a lot of those obsessive and dopamine reward system, the release comes from this idea of finding food.
00:17:28.000The idea of figuring out how to survive and feed the family.
00:17:33.000When you're successful on a fishing trip and you come back with food, everybody's happy.
00:17:38.000Like that kind of thing makes people strive to be obsessed with success in that particular area in hunting.
00:18:00.000And one of the things that I think about people with addiction in our modern times is that, you know, First of all, addiction is endemic in the population.
00:18:11.000Since the beginning of human history, you can find accounts of people getting addicted to intoxicants.
00:18:18.000What is new today is the increasing numbers of people with minor addictions and just the increasing numbers of people with addictions all across the board.
00:18:26.000But one of the ways that I think about people with addiction is that There are people who thousands of years ago probably would have been highly adapted to the environment because they would have been our seekers.
00:18:41.000They would have been the people who were always pushing the envelope.
00:18:45.000But in the modern world, it can really be a curse to have that kind of temperament and that kind of physiology.
00:18:54.000Because, you know, modern life is everything sort of, you know, we've got everything we need.
00:18:59.000We don't have to do anything to survive.
00:19:01.000We don't even have to really do anything to, you know, we don't have to get off the couch even just to eat.
00:19:06.000So it can be very challenging to have that chemical makeup in this modern environment.
00:19:12.000Now, what's the best method for recognizing whether or not you have an addiction or whether you're just an enthusiast?
00:19:24.000Like, if you're, whatever, if it's a sport or, you know, whatever, it's maybe a gambling thing.
00:19:31.000Like, how does one know when it's a real problem?
00:19:35.000And how much recreation can you have without it being addictive?
00:19:42.000So great question, and I think the answer is going to be different for every person.
00:19:50.000In general, when we are diagnosing addiction in clinical care, it's not based on quantity or frequency per se, although daily users tend to be people that we are concerned about.
00:20:04.000But the diagnosis of addiction is really based on behaviors and can be briefly summarized as the four C's.
00:20:11.000Control, compulsion, craving, and consequences, especially continued use despite consequences.
00:20:19.000So, like, what if you're, like, I have friends that are addicted to golf and they just can't wait to go play golf.
00:20:34.000Okay, so this actually comes up a lot in clinical care.
00:20:39.000Like, to what extent is it my problem, and to what extent do I have to change my life?
00:20:44.000And I always say to patients, you know, that is a great question, and not one that I can answer for you, but maybe together we can find the answer.
00:20:53.000Because the truth is, sometimes it is a question of needing to change your life, right?
00:20:58.000And I wouldn't presume to necessarily know, especially with cases on the border.
00:21:08.000I mean, there are some cases where like, okay, you don't need to be a psychiatrist to diagnose that this person has addiction.
00:21:14.000It seems open to interpretation in the world of what you would call extreme winners, like the Michael Jordans of the world, the people that are just absolutely, completely obsessed with winning.
00:21:24.000That seems like you could kind of call that an addiction, but then they are the most celebrated people in all of the world.
00:21:32.000So you're tapping into something that is really important to talk about, which is that our society rewards certain types of addictions and not others.
00:21:42.000We certainly reward professional athletes who have become obsessively focused.
00:22:07.000But what I think is important is to recognize that the same mental machinery that approach and avoid behavior mediated by dopamine that is at play when we become addicted to something can be at play really in all different aspects of our lives,
00:22:30.000You're just saying the same mechanism is in place, whether it is extremely beneficial, like you are, Michael Jordan, or whether extremely detrimental, like you're a person who's addicted to crack, or you're a gambling addict who keeps blowing all their family's money.
00:22:47.000You're on the same human neurological pathway.
00:23:14.000I mean, just using the example, again, of athletes, I feel like there are more and more there are athletes who are in different ways kind of questioning their lifestyle or the things that they have to do.
00:23:29.000I think it's always good to look at the pros and cons.
00:23:31.000Basically, there's never the light without the dark.
00:23:35.000It's really that dialectic that comes into play really in all aspects of our lives, which I think we need to talk about and think about.
00:23:45.000We celebrate the people that are extreme winners.
00:23:49.000We celebrate the people that are absolutely completely obsessed with performance, and they have everything dialed in, including their calories, their macronutrients, the amount of sleep they have, the amount of recovery that they seek out, how they do it.
00:24:08.000But they have a massive reward for that, right?
00:24:10.000The massive reward is the glory of being a Michael Jordan or being a Mike Tyson or being a Sugar Ray Leonard or whoever it is at the peak of their performance when they're on top of the world.
00:24:22.000There's a great deal of benefit to having what many would just call extreme discipline.
00:24:34.000Well, what we hear very little about is when that road comes to an end and that escalating glory and reward dries up and what those people's lives are like after that.
00:24:46.000And my sense is that unless they've worked very hard to cultivate other aspects of their personality, when that dopamine trail dries up because...
00:25:00.000Then they have to contend with the come down, the dopamine deficit state, not to mention all of the other aspects related to loss of identity.
00:25:11.000Who am I if I'm not this person who's winning?
00:25:15.000We know that, but we don't hear about those athletes after that.
00:25:19.000The other thing I would say that you point out in that description, which I think is also key to the process of becoming addicted, is the ways in which addiction is also about controlling and changing the way we feel in the moment rather than tolerating the feelings or the uncertainty of what's next and just letting it wash over us.
00:25:43.000So a really key important aspect of what you call discipline, which I think in some contexts might be addiction, is wanting to control what we're feeling when we feel it.
00:25:57.000And I think this is also deeply embedded into modern life and modern culture.
00:26:01.000Explain that, wanting to control what we're feeling and when we feel it, and that's what separates discipline from addiction?
00:26:08.000No, I think there's overlap there, so let me go back.
00:26:11.000So, part of what drives the phenomenon of addiction is that people control what they feel when they feel it.
00:26:23.000So, for example, In this moment, let's say I'm struggling, right?
00:26:30.000But I feel like, oh, I can get through this because when this is over...
00:26:34.000I'm not saying I'm struggling, but I mean if I were...
00:26:37.000Because when this is over, I'm going to reward myself with X, Y, and Z. So like if you go running and then afterwards you can have a slice of pizza.
00:26:45.000So it's the way that we bracket our endeavors with rewards.
00:26:50.000And this is just like deeply embedded into our culture.
00:26:54.000And the control aspect is a big part of the addictive aspect, because I'm now going to control the way I feel when I feel it, which is a very different way of living if you were to eliminate...
00:27:11.000If you were to think, I'm not going to do anything to reward myself today.
00:27:16.000I'm just going to get through the day.
00:27:20.000It totally changes the arc of our experience in the moment.
00:27:26.000But is there a bad thing with rewarding yourself for doing something that's difficult but that's ultimately beneficial, like getting a run-in?
00:27:35.000Like, say if you're going to run five miles.
00:29:31.000There's a better, harder solution that is about not using rewards as a way to shape time, but instead letting our experience unfold with uncertainty and embracing that uncertainty.
00:29:51.000I don't know if I'm communicating this, but you can let me know if it makes no sense.
00:30:20.000Well, first of all, let me just say that for a long time, when I would hear people say, you know, be in the moment, and I would try to do that, I thought I was doing it wrong because I thought if I could just be in the moment, I would experience some sort of bliss, and I never did.
00:30:37.000But what I eventually realized is that being in the moment means tolerating the distress of just fully being in the moment.
00:30:50.000And that's all the harder to tolerate because we have all these rewards that are waiting for us and we'd rather go there.
00:30:57.000So being in the moment is tolerating the distress of being in the moment?
00:31:03.000What's the benefit of being in the moment?
00:31:08.000The benefit of being in the moment, for me, once I acknowledge that I'm not necessarily going to feel good, is that I can really be present and then open to positive experiences that are not of my own making.
00:32:14.000So, you know, you could be baseline temperament just a happier person than I am, which is perfectly possible, because I do think we come into life with sort of different degrees of happiness, and I'm probably a little bit on the unhappiness side of things.
00:33:05.000I seek out very, very difficult things to do, and in getting better at those very difficult things, I believe that you're challenging your human potential, and that you're trying to figure out how to master your emotions,
00:33:23.000your discipline, your focus, and I think there's great reward in that.
00:33:28.000I think there's great reward in discipline.
00:33:31.000There's great reward in sticking to a difficult schedule, particularly physically, that's hard to stick to, like a physical workout schedule or a meditation schedule,
00:34:42.000So, I mean, what you're describing is something that I actually recommend to patients who are trying to get into recovery from addiction to things like drugs, alcohol, or other highly reinforcing things like games or pornography.
00:34:57.000If we think about the pleasure-pain balance again, what I actually recommend they do, in addition to abstaining from their drug of choice, is to actually intentionally press So how does one step intentionally onto the pain side?
00:35:24.000By doing the very kinds of things that you talk about, effortful engagement in daily practices that are not easy.
00:35:32.000So you've really figured it out in terms of you need a certain amount of friction in your life.
00:36:19.000But I guess where my mind goes, thinking about you and your experience...
00:36:26.000I mean, certainly we can get addicted to pain, right?
00:36:29.000And we can push too hard on that side of it and take that too far.
00:36:34.000I mean, it sounds like what you do is you do that for a while with one activity on the pain side, and then you switch to another one, so there's just that little bit of novelty to stretch yourself again.
00:36:44.000But I guess I wonder, is there a point at which you kind of get burned out on all of that?
00:37:09.000Okay, so this is still working for you.
00:37:11.000I just find things that are difficult.
00:37:14.000My problem, I do have issues with obsessive things, like games.
00:37:21.000I still play pool, which I find, I think there's a mental reward and there's benefit to the focus that I get from The geometry of pool and the calculations of the maneuvers and how to move the ball around,
00:39:53.000But it was a thing where, like, multiple post office workers were, like, going on rampages to the point where there's games called Going Postal, like a video game.
00:40:03.000And I was always wondering, like, is that because that's not challenging?
00:40:09.000What is it about it that makes people so frustrated or that builds up this angst or this anger or, you know...
00:40:19.000But then some people love a job like that where they just show up and they talk to their friends at work and they have a coffee break and they have a great time and they feel completely satisfied by that.
00:40:32.000Maybe they go home and they watch a little TV or they watch a game.
00:40:35.000Maybe they'll play little video games before they go to sleep and they can have a happy life like that, at least allegedly.
00:40:44.000So, is it that you have to find the balance for your own personality, your own personal biological makeup, your own life experiences, and all the levels of neurotransmitters you have in your brain as opposed to other people?
00:41:03.000It's like finding your own personal balance?
00:41:05.000Yeah, I mean, you know, addiction is called a biopsychosocial disease.
00:41:11.000And it's a really great construct because it speaks to the fact that there's a biological component, you know, your sort of innate biochemistry.
00:41:22.000There's a psychological component, the way that you problem solve or, you know, have insight or not into your behaviors.
00:41:30.000And then there's the social component.
00:41:40.000Has had opportunities and also has made the most of those opportunities, but there are lots of people who probably don't have those types of choices and opportunities, so then they need to figure out, you know, people who, I mean, I don't know what it's like to work in a post office,
00:41:56.000but, I mean, it might be very interesting.
00:42:00.000I do think that there are ways you can make it interesting by, again, trying to be more present and focus on it.
00:42:07.000But what can happen in a lot of jobs that, like, lack the same level of fascination is that people kind of get through that and then reward themselves at the end of that day.
00:42:22.000So, you know, again, speaking to kind of the difficulty of modern life for many people, I mean, you have what appears to be a really interesting job, and you've made—I mean, I gather you're a self-made person,
00:42:54.000And so how do they make a life worth living even within that context?
00:42:59.000Also, I just want to emphasize again that you've tapped into something that I think I think it's really, really important in that you realize that the best way to get your dopamine is through the opponent process mechanism.
00:43:11.000So instead of getting it by ingesting something that immediately releases dopamine in your brain's reward pathway, you do hard things by pressing on the pain side of the balance.
00:43:23.000Which then triggers your own endogenous opponent process or reregulating mechanism to create dopamine in response to that, which is potentially a more enduring source of dopamine, less likely to lead to tolerance and addiction.
00:43:38.000I don't necessarily know that I would agree that it's a pain side of things, though.
00:43:43.000Because I think a lot of it is the way you approach things.
00:44:07.000This is, broadly speaking, not just physical pain.
00:44:09.000We're talking about emotional effort, creativity, cognitive complexity, things that take effort on a daily basis where the reward is delayed.
00:44:20.000It's also really true that the pleasure-pain balance is an oversimplification and that we can experience pain and pleasure simultaneously, for example, when we're eating spicy food.
00:44:33.000It's also true that the meaning that we give to our suffering can absolutely change that experience.
00:44:38.000So there's a Very famous experiment done by Dr. Beecher, who interviewed World War II soldiers right after they had, you know, on the battle lines, right after they had received these grotesque injuries,
00:44:57.000And he found that approximately two-thirds of them had no pain in the immediate aftermath of their injury.
00:45:03.000And through his research, he concluded that the reason for that was, number one, they realized they were still alive and happy to be so.
00:45:09.000And number two, they realized they were probably going home.
00:45:12.000And so the meaning for them of the injury was going home.
00:45:16.000So our prefrontal cortex You know, that area right behind our forehead communicates with our lower brainstem, lizard brain reward pathway, and incredibly, you know, modifies and modulates that experience to sort of describe,
00:45:37.000There was a case report of a young man, a construction worker, who jumped on a giant nail that went right through his boot, through his foot.
00:45:44.000He showed up in the emergency room, intense pain.
00:47:05.000No, to me—I mean, it's an extreme example, but to me it shows how— Our interpretation of what has happened to our body has a huge impact on how we experience that injury or that stimulus.
00:47:25.000Right, but is that interpretation because the person has not experienced actual real injuries before and it's just massive anxiety because they've lived a sheltered life?
00:47:38.000So for example, people with chronic pain, we know that when they have anxiety, it opens up the gates to the experience of pain and their pain gets worse when they have stress.
00:50:58.000Clearly, there's a psychological element that you highlighted earlier when you were talking about these soldiers.
00:51:04.000They could be disemboweled, losing limbs, but yet they weren't experiencing pain.
00:51:09.000Because of the psychological element of the fact that they were coming home, The fact that they were alive, so they had put this injury into a different place than the average person would, say, if you were in a car accident and experienced the same injury.
00:51:56.000I mean, there are experiments, for example, showing that if you apply a pain to different parts of the body at the same time, the stronger pain will lessen the experience of the lesser pain.
00:52:11.000So there's something biological that happens, again, as our brains adapt and process those dual signals.
00:52:21.000So, I mean, you know, psychological differences are also brain differences, right?
00:52:33.000Yeah, so resilience is based on graded exposure.
00:52:37.000So, for example, people with anxiety disorders or specific phobias, a treatment for that is actually to expose them in measured ways to the thing that they're afraid of.
00:52:47.000Like spiders, like driving over bridges, like going on airplanes, like talking to people, which more and more young people have social phobia.
00:52:56.000Exposing them to other difficult things, does that make them more resilient in other ways?
00:53:01.000Like one of the things I've gotten into recently is cold plunges.
00:54:46.000I mean, that's so much of the work that, you know, that I do with patients is trying to get them to do things that are hard, that builds up their actual biological, psychological resilience to hard things, but also importantly,
00:55:03.000gives them a touchstone for For confidence and competence and self-efficacy.
00:57:04.000My friend Kelly sends me these videos all the time because he knows I freak out.
00:57:09.000Of like people riding their bike on the ridge of a cliff or that kind of stuff, or people who are jumping from like ledge to ledge, like that kind of shit.
00:58:29.000You know, I mean, I could only speculate what's going on in Alex Honnold's mind, but...
00:58:34.000I suspect that it is this, like he must have early in his career found climbing incredibly reinforcing, you know, got a huge dopamine hit in his reward pathway.
00:58:48.000And then, you know, climbing is sort of naturally a thing where you can always escalate it, you know, harder mountains, no ropes, you know, higher and higher.
00:58:59.000And so there is a way in which, and I have a patient who's a climber, He's addicted to alcohol.
00:59:06.000But he says he has to be very careful that he doesn't apply those same sort of addictive tendencies to climbing because he said it would be very easy to do that.
00:59:33.000Well, but see, it's hard to do that, right?
00:59:37.000Once you've devoted all that time and energy and creativity.
00:59:40.000And then also, I guess, you know, again, importantly, people then also rely on it for their homeostasis and maintain their dopamine levels, right?
00:59:48.000So then if you were to stop doing that, naturally, there would be a come down, right?
00:59:53.000I know a lot of folks who had addiction issues with substances who got into endurance sports.
01:00:11.000Yeah, and I actually prescribe exercise to my patients who are trying to quit drugs and alcohol and pornography and gambling and whatever it is, because we do know that exercise is a great way to get that opponent processed dopamine, the after-effect dopamine that our own bodies make.
01:00:29.000And we do know that it helps tolerate the withdrawal from drugs and alcohol.
01:00:46.000So, for example, if you put one of those running wheels in a rat's cage, they are less likely to self-administer drugs like cocaine and methamphetamines.
01:00:56.000So when those studies were first being performed, the running wheel was thought to be a way to just measure baseline activity or as a healthy alternative to self-drug administration.
01:01:12.000But over time, scientists began to see that the running wheel was in and of itself reinforcing.
01:01:18.000So a rat or mouse will run longer in a running wheel than they will on a flat treadmill or in the wild.
01:01:27.000Some mice or rats will run so long in the running wheel that their tails will curve up and remain permanently curved in the shape of the running wheel, and some rats will run on that running wheel until they die.
01:01:41.000And that was the first indication that that running wheel in and of itself can be a drug, that it has its own reinforcing properties.
01:01:50.000I'm sure you're aware of the studies that they did with rats with heroin and cocaine and that they did it in cages and they found that these rats would self-administer heroin and cocaine to the point where they would drink the water that had heroin and cocaine in it and avoid the regular water and they'd do it until they died.
01:02:12.000Until they set up a happy environment for these rats.
01:02:15.000And this is what gets me to this whole hunter-gatherer thing again.
01:02:38.000And that the environment itself of these cages with the bright fluorescent lights, these were extremely distressful, and so the rats were essentially self-medicating to avoid the distress that they were being put into.
01:02:57.000Addictive behaviors that exist in human beings today, are they exacerbated by the circumstances of our modern world?
01:03:06.000Cubicle life, commuter life, being on the subway or whatever you're doing where you're just droning in and out and constantly being around people and constantly being in these Unnatural environments.
01:03:20.000And then, again, this theme of doing something you don't want to do all day long.
01:03:27.000Something that's not rewarding and not interesting and then you get home and you medicate.
01:03:42.000So, yes, you know, absolutely, you know, this idea of our not being in an enriched environment that's conducive to good health can absolutely lead to the problem of addiction.
01:03:58.000However, I think that a central problem today which is not appreciated is that we have turned rat park into rat amusement park.
01:04:13.000Even in an ideal environment, people can get addicted because they have access to so many highly reinforcing drugs and behaviors that are mediated through technology, access, potency,
01:04:31.000If you put a running wheel in this enriched rat park environment that you talk about, rats will spend an inordinate amount of time on the running wheel and they won't explore the maze, right?
01:05:42.000And that's what I'm trying to get at, Joe, that technology has changed the world such that we are chronically ingesting and engaging in these highly reinforcing drugs and behaviors which have engendered a dopamine deficit state,
01:06:03.000making us all more anxious and depressed.
01:06:05.000And it's not necessarily a matter of Trauma or social inequality or not having an adequate maze.
01:06:36.000And they put it both in an urban area where feral mice voluntarily and obsessively ran in the wheel, and they put it in a more rural environment and dune setting where animals obsessively engaged in this kind of...
01:07:07.000And they discovered, just in general, looking at the reinforcing properties of a running wheel, that mice, for example, prefer a square running wheel.
01:07:16.000And they prefer a running wheel with little obstacles in it.
01:07:48.000Well, I mean, I think this is the crux of the matter is there is no evolutionary benefit.
01:07:53.000It's a mismatch now between what was a neural network that was adapted to the world, which is no longer adapted to the world we have created.
01:08:06.000But with humans, I would imagine that a video game sort of piggybacks on your need to problem solve and you're dealing with like combat scenarios that would sort of highlight parts of the brain that were designed to fight off neighboring warring tribes or something.
01:08:22.000And the whole treasure hunting, you know, part of our brains wanting to find that next best thing.
01:08:27.000Sure, those are all innate good things, but, you know, then we've turned it up to 11, right?
01:08:31.000I mean, or 12 or, you know, 500. I mean, so we've, you know, turbocharged these digital products in a way that our minds really don't have the capacity to manage.
01:08:47.000And then we're just absolutely sucked in there.
01:08:50.000Do you think that all of those things, I mean like there's a, for sure there's people that make a living out of playing video games.
01:09:28.000Almost every single one of them will tell me that the way they rationalized to themselves that the amount that they were playing was okay was because they were going to be that guy, you know, who was like a world famous video.
01:09:46.000And so, you know, to me, that's again, that's how our brain, even when we're very far from being that guy, everybody thinks they're going to be that guy.
01:09:55.000And that's part of that rationalization, the justification or the denial that can happen in this whole process of addiction.
01:10:11.000So it's not to say that nobody should try.
01:10:15.000Well, I don't know if I'm a good example because the things that I'm talking about, like the things that I've been successful about, I don't necessarily think you would call podcasting an addiction unless I'm addicted to conversation.
01:12:41.000And when they put food in the rat's mouth, it would eat the food and seem to enjoy it, however much you can determine that, you know, looking at a rat.
01:14:06.000And then we get a much bigger spike of dopamine when we actually ingest our drug.
01:14:09.000It makes so much sense what you're saying about the rat when you talk to people that are depressed because one of the things they say is they don't have the motivation to even get out of bed.
01:14:18.000It's very hard for them to get out of bed.
01:14:20.000So when they're at this dopamine deficit state, for them there's just no momentum.
01:14:54.000And they're very skeptical that a month of dopamine fasting is going to reset the reward pathways.
01:15:01.000But if they're willing to do it, 80% of them will come back after a month and describe that they feel much better.
01:15:07.000And the reason for that is because they've been in this dopamine deficit state.
01:15:11.000If they abstain, the gremlins hop off, they start to make their own dopamine again, and then they restore homeostasis, and they're able to take pleasure in more modest rewards.
01:15:21.000Telling someone to just abstain, to just take time, just, hey, put the video games down, stop gambling for a month, whatever it is, stop drinking for a month.
01:15:52.000Well, first of all, let me say, you know, this is a spectrum disorder, and people on the very severe end are not going to be able to stop on their own.
01:15:59.000Those are individuals who have to go into hospital or go into a residential treatment setting.
01:16:18.000Well, you know, hopefully you're not forcing them.
01:16:21.000I mean, in some countries this does happen by force.
01:16:24.000Here in the United States, try to make everybody on board with the plan with the hope that, you know, they'll feel better if they abstain for a month.
01:16:31.000But recognizing that In their current environment, their willpower will not do it.
01:16:36.000And that's just a matter of the severity of the illness.
01:16:40.000But for people who have more mild to moderate addictions, this outpatient approach of, you know, the dopamine acronym, which is basically D stands for data, you know, gather specific information about how much you're using, what you're using.
01:16:55.000The O of dopamine stands for objectives.
01:17:02.000The P of dopamine stands for problems associated with you.
01:17:05.000So really thinking aloud about what are the negative and unintended consequences, like you did with video games, realizing, wow, I'm up all night and I'm exhausted.
01:17:15.000Just writing that down or expressing those to another human being really makes it alive for patients that it's not necessarily going to be when it's just pinging around in their heads.
01:17:43.000It's validating that it does something positive or people wouldn't do it, but also having people really talk about what they're actually doing so it can't remain hidden in that dark closet of denial.
01:17:54.000Is cold turkey the only way to get off of that, or is there a slow drip method?
01:18:05.000So the A of the dopamine acronym stands for abstinence, or this four weeks of abstinence.
01:18:09.000You know, so, I mean, maybe some people can gradually taper.
01:18:14.000And obviously, if they're physically dependent on something like alcohol or Klonopin or opioids, they wouldn't want to cold taper.
01:18:20.000It could be dangerous, so they'd want to do a medically supervised taper.
01:18:24.000But in my experience, for people who are on the addiction spectrum, if they're able to just stop, it's better than if they try to go down slowly.
01:18:36.000There's something about abstaining for a single month that people can wrap their head around.
01:18:46.000And what I warn patients about is that they're going to feel worse before they feel better.
01:18:51.000Their pleasure-pain balance, once they get rid of that constant reward, will tip to the side of pain.
01:18:57.000And in those first two weeks, they're going to experience withdrawal.
01:18:59.000But if they can just wait long enough and get to a month, the gremlins will hop off, homeostasis will be restored.
01:19:05.000And, you know, again, 80% of folks will come back a month later, those who've been able to do it, and say that they feel a lot better.
01:19:13.000Now, that other 20% are individuals who probably have a co-occurring psychiatric disorder, anxiety, depression, whatever it is.
01:19:22.000That's also really useful information, right?
01:19:24.000Like, okay, we need to treat this co-occurring psychiatric disorder at the same time that we address this compulsive overconsumption problem.
01:19:31.000And then the rest of the acronym, just really quickly, is dopamine.
01:20:10.000When patients come back after a month of abstaining, we talk about the pros and cons, and then we make a plan for the next month.
01:20:16.000And then the E of dopamine stands for experiment.
01:20:19.000With this plan in place, whether it's another month of abstinence, or whether they want to try to go back to using, but using in more moderate amounts, which is what most people want to do.
01:20:36.000So that month of absence, not only does it reset reward pathways, but it also allows people to look back and see true cause and effect.
01:20:43.000Because when we're in our addiction, we really can't see the true impact of those behaviors on our lives.
01:20:49.000Yeah, you just kind of get caught up in the momentum of it all, right?
01:20:54.000When I was talking about people that are addicted that eventually go into endurance sports, it seems like there's something about endurance sports in particular that is very attractive to people that are former addicts or recovering addicts.
01:21:09.000In that you're completely at the mercy of this activity while you're doing it.
01:21:19.000My friend John Joseph, he's the lead singer of the Cro-Mags, this band, but he's also a hardcore triathlete.
01:21:28.000And he was an addict when he was younger.
01:21:31.000And he now abstains, lives a very healthy lifestyle, eats very healthy.
01:21:38.000And all he does is, I mean, he trains constantly.
01:21:43.000He goes on these massive bike rides, these long swims.
01:21:47.000And it seems like the difficulty of these endurance sports...
01:21:54.000Whether it's running or Ironman or any of those things.
01:21:57.000It's so hard to do that you have to be in the moment.
01:22:02.000You're thinking about every step you're taking as you're running because you're exhausted.
01:22:16.000And you have to actually do that work.
01:22:19.000And there's something about that that's very appealing to a lot of former addicts.
01:22:24.000There's been quite a few addicts that fight in MMA as well.
01:22:30.000And one of the things I noticed about them is so many of them are incredibly determined, like unusually determined, like unusual endurance, unusual work ethic, unusual ferocity in competition.
01:22:43.000And I wonder if that also is like whatever led them to be an addict, to be like obsessed with drugs and just ruining their life.
01:22:54.000When they turn that around and can focus it on something positive, they have an extraordinary amount of focus.
01:23:06.000I mean, I think people with addiction are some of the most tenacious people that you will ever meet.
01:23:11.000And when they can redirect this tenacity to something that's a more adaptive behavior, and I do think sports can be that, you know, it's a very good thing and they tend to be very successful behaviors.
01:23:42.000Let's say painful, and I know you don't love that word, but I think of it as painful, you know, physical activities or endurance sports.
01:23:50.000They also are a way to escape ourselves because we're so fully in our bodies when we're doing them that we're not, you know, dealing with our constant ruminations.
01:23:59.000Well, I think with endurance sports, I would call it painful.
01:24:25.000And then the neuroadaptation happens to the site of pleasure.
01:24:27.000So it's a way that they maintain a kind of baseline positive increase in dopamine levels.
01:24:34.000It seems to me like to be an extreme winner, though, and I keep coming back to Michael Jordan, to be a person like that, you almost have to be an addict.
01:24:45.000Yes, you have to have that single-minded pursuit.
01:24:50.000I mean, I guess maybe we need to better define, like, what is addiction?
01:24:56.000Right, because if they're very healthy, and they're doing really well, and maybe they've narrowed down their obligations outside of that, so all they do is focus on maybe just their family, and then their work.
01:25:09.000I mean, addiction broadly defined is the continued compulsive use of a substance or behavior despite harm to self and or others.
01:25:18.000And if there's not harm to self and or others, then it's probably not an addiction, even if it's a very intense, focused endeavor.
01:25:27.000The problem is that the person who is in their addiction may not be able to see the harm to self and or others, whereas people around them can see it.
01:25:38.000And I think there's also a problem in that it's just part of being a human being in America.
01:25:46.000We value success that's measurable above all others.
01:25:52.000Like when we think about a person that's successful, say if a guy is a businessman who works 12 to 14 hours a day and he's worth a billion dollars, but his personal life is a shambles.
01:26:29.000And one of the interesting things as a psychiatrist is that I really get to look under the hood of a lot of different types of people, including a lot of people who on the outside look like they have it all.
01:26:40.000But on the inside are really, really suffering.
01:26:43.000Give me an example without revealing the person.
01:26:46.000I mean so many, you know, I work in Silicon Valley.
01:26:50.000I see incredibly wealthy people, you know, brilliant scientists, really smart people, you know, who on the face of it you would never in a million years imagine that they're struggling in any way, much less with a serious addiction,
01:28:05.000Yeah, I mean, I have a regular practice of biking up Page Mill Road in our neighborhood, which is a very steep mountain, and I never want to do it before I start out, but I'm always happy afterwards.
01:28:19.000So you've developed your own mitigation methods for dealing with all these problems that we're talking about.
01:28:28.000So say if you have a person that is dealing with maybe a pornography addiction or something like that, and you encourage them to abstain from a month, do you also encourage them to engage in some sort of difficult physical activity?
01:28:45.000So, I mean, it depends on the person, right?
01:28:48.000If, like, sports or exercise is not really their thing, I still encourage it, but I don't expect that that will be the solution for everybody.
01:29:01.000Absolutely prescribe other effortful activity, difficult cognitive activities.
01:30:18.000If my patient has any kind of pathway to any kind of spiritual practice, I ask them, you know, what kind of spiritual practices are you familiar with?
01:30:28.000And I recommend that they do that too.
01:30:31.000The other thing that I also often recommend in that month of abstinence is that they tell no lies, not about anything, not even little white lies about, you know, why they were late for a meeting.
01:30:44.000And the reason for that is really something that I learned from my patients in recovery, that telling the truth about all things is absolutely key for recovery.
01:30:53.000And I've explored some of the neuroscience behind why that is, but I actually prescribe that to patients when they're trying to quit a substance or behavior that they've become addicted to.
01:31:12.000Why do you think that there's an evolutionary need for prayer?
01:31:17.000Okay, so I'm still studying the neuroscience of that.
01:31:22.000I'm thinking about that for maybe a future book that I'm writing.
01:31:25.000So I'm still sort of at the tip of that.
01:31:27.000But there have been interesting studies sort of showing the parts of the brain that light up when people are engaging in meditation or Or people who have, you know, very strong meditation practices or prayer practices, how their brains might be the same or different.
01:31:40.000I'll have to come back another time when I've learned more and tell you about that.
01:31:44.000But you're pretty confident there's something going on with that.
01:31:48.000You know, my clinical work, I mean, so many people in recovery have gotten into recovery through a spiritual practice of one sort or another.
01:32:00.000And it's been really important in my own life, you know, having this kind of, like, just for lack of a better word, I'm just going to call it spiritual, sort of a loaded term.
01:32:11.000But I think, you know, some kind of practice that sort of, you know, relates to transcendence.
01:32:33.000One reason why I think we struggle with this today is light pollution.
01:32:42.000And I got this out of an experience that I had once in Hawaii, where I went up to the Keck Observatory.
01:32:49.000I've been there several times, but this is the first time and the only time I really nailed it, in that we got there at a perfect time where there was no moon at all, and you get to see every star.
01:33:51.000Which I think was with human beings from the beginning of time.
01:33:55.000And when human beings start to take into consideration their environment and the parameters of their world and where things are, and then you're faced with this impossible vision of size and of scope and of just this epic proportion When you see all the stars and you see how big it is and you can't imagine that those things are literally thousands of light years away.
01:34:25.000And you're looking at this, you're like, what is all that?
01:35:14.000Yeah, I mean, so awe is a really interesting emotion, which has been defined as that experience of encountering a stimulus that is more than our mind can process.
01:35:29.000And I think that's an interesting definition because I think there's something to that.
01:35:38.000It's both wonderful and terrorizing at the same time.
01:35:43.000To me, that's awe and that's that kind of feeling that you get or that I get when looking up at the stars.
01:35:49.000And I do think you make a really good point about overstimulation.
01:35:54.000One of the things that I noticed during quarantine, which of course was tragic for people who were ill, for people who had family members die, but I saw for a lot of my patients, it was actually a really positive experience because it was de-stimulating.
01:36:14.000It was like all of that frantic running around and all of that sort of All of those constant, you know, stimulating, multiple interactions with multiple people a day, it all kind of went away.
01:36:25.000And for some of my patients, it was like, oh my gosh, this is what, this is how my life needs to be like.
01:36:33.000That way I was living before was really crazy making.
01:36:36.000So I think, you know, I think you're absolutely right.
01:36:38.000I think there's a way in which we're all overstimulated.
01:36:42.000And that way we really need to dial that back for our mental health.
01:36:46.000I think we're definitely overstimulated and I think there's definitely an argument that we learn something from the pandemic with a lot of people.
01:37:37.000Even though, you know, oftentimes it comes with a very painful experience or feeling of brokenness or feeling like, you know, you're not good enough.
01:37:46.000Well, you know, when we can arise from that and sort of hang on to that humility, I think it's really it's a very good and positive thing in our lives.
01:38:00.000I grew up in the Northeast and the Northeast gets very cold in the winter and you get a lot of snow and it's, you know, I lived in Massachusetts and it gets, it's just part of life.
01:39:39.000I think all the time that people are spending on screens, I mean, some people's only experience of nature is like a Photoshopped version of it.
01:40:28.000I think there's something about it, even as terrifying as an encounter with a bear, where it sort of lets you understand you are walking through life with blinders on.
01:40:42.000Which is why, you know, there's a pretty robust therapeutic intervention for people with severe addiction, which is called wilderness.
01:40:51.000And of course, you know, there's a lot of criticism of different types of treatments, but that can be really transformative for some young people to be out in nature.
01:41:22.000I think, I mean, I don't want to say people are meant to live any way, because I think people are meant to live a bunch of different ways.
01:41:30.000There's a lot of people that are very happy doing things that wouldn't make me happy, and I think there's obviously a lot of variety with human beings.
01:41:37.000But I think that The way our bodies are designed is not much different than the way the bodies of people that were designed 10,000 years ago were.
01:41:47.000Or people that lived 10,000 years ago were rather.
01:41:49.000And those people, their lives were around community.
01:41:53.000Their lives were around their whatever crafts and whatever skills that they had to develop in order to survive and contribute to the tribe.
01:42:05.000Hunting and gathering and then it was about raising children and teaching them the rituals of adulthood that were all designed to facilitate your growth and advancement so that you could contribute to this tribe so that everyone could all sustain and stay alive together and feed each other.
01:42:31.000And now we're staring at TikTok all day, and now we're doing all sorts of weird things that we're not designed for.
01:42:40.000And that's one of the things that led me to my video game addiction.
01:42:44.000I was recognizing that I'm not designed for this.
01:42:48.000That this was a hijacking of whatever systems that I had that were in place that craved excitement and stimulation.
01:42:59.000And I was getting this digital version of it, which if you could handle it, it's really fun.
01:43:06.000But if you can't handle it, and if you're a person like me who obsesses on things, you know, you could say an addiction or you could say, why do you choose to call it, why do you think it's an addiction or a disease rather than an addictive personality disorder?
01:43:29.000So, I mean, that change in language has occurred over approximately the last 20 years or so, moving away from calling it like an addictive personality to calling it the disease of addiction.
01:43:42.000And the reason for that is, I mean, there are many reasons.
01:43:47.000One is just the simple neuroscience, the explosion in neuroscience.
01:44:12.000A disease potentially improves access to treatment because it destigmatizes.
01:44:17.000So when we call it a disease and we treat it like a disease in the healthcare system like any other, people get better at the same rates that they do from other chronic relapsing and remitting disorders like type 2 diabetes, heart disease, obesity.
01:44:32.000So I think there are just practical reasons as well for calling it a disease.
01:44:38.000And again, you know, you and I have used the term loosely to define a broad spectrum of behaviors and a broad spectrum of severity.
01:44:46.000And when I do that, it's not at all to trivialize severe addiction and the kinds of very serious life consequences that it has for people.
01:44:58.000But it's rather to explain that the same neural networks that drive compulsive overconsumption of checking our phones is at play in people who become severely addicted to drugs and alcohol.
01:45:17.000It's really just a matter of severity.
01:45:26.000Like human beings, their desires, the things that they seek out, the kind of artistic and creative endeavors that they seek out, the pleasure endeavors that they seek out, all the different things that they seek out.
01:45:39.000When you're dealing with an individual patient, you call them patients?
01:46:19.000So one of the things that I have concluded is that there's no point initially in spending a lot of time trying to figure out, number one, why the person got addicted, or number two, whether or not they'll be able to get better.
01:46:35.000Number one, it's a waste of time to figure out why initially, because it doesn't matter.
01:46:41.000Whatever your doorway into addiction was, once you develop addiction, the intervention is the same, and recovery starts with abstinence and requires all of the interventions that we do.
01:46:56.000Later on, you can spend time kind of trying to unpack, gee, how did we get here?
01:47:01.000What are some of the early antecedents, including like childhood antecedents or trauma?
01:47:06.000Although, again, there's a danger there in focusing too much on the why and not enough on, okay, how do I get better?
01:47:14.000The other thing that I've learned after many years of being a psychiatrist is that I am terrible at predicting who's going to get better and who isn't.
01:47:22.000I used to think that I could tell when someone walked in, oh, this person, oh, they're going to do great, and this person, there's no hope.
01:48:14.000And one of the tricks, or at least my Achilles heel that I've learned over time, is if I identify with the patient, I'm more likely to think that they're going to get better and more likely to miss some key things.
01:48:28.000Are there any sort of standard things that you notice about people who do well versus people who don't?
01:48:53.000So when people have insight into the fact that they are addicted, that is helpful, but that's not necessarily a guaranteed winner.
01:49:00.000I have had patients who have incredible insight into their addiction and don't get better.
01:49:05.000So that's not the key, although it's helpful.
01:49:09.000One of the things that I've noticed over the years is that if I have a patient who comes in and they tell their story in a way that blames everybody else for their problems, that person is...
01:49:29.000I wouldn't say they're totally, you know, not going to get better because one of the very interesting things that happens in the process of recovery is people start telling their story differently.
01:49:42.000Yeah, and that's, of course, part of the 12 steps of Alcoholics Anonymous is kind of acknowledging our part and our responsibility and where we've contributed to the problem.
01:49:52.000And when people are in really good recovery, they get really good at that.
01:49:56.000Because, of course, it's a muscle, too, that you practice.
01:49:58.000And they, you know, are constantly taking their inventory.
01:50:01.000Saying, okay, you know, where did I, how did I, I'm feeling uncomfortable.
01:50:04.000You know, how did I, where did I mess up on this?
01:50:28.000Well, I think it was something that they felt was very controversial to the point where they didn't want to have it a part of the program.
01:50:37.000But what I've read about him, and Jamie, see if you can pull up the history of Al Cox Anonymous and LSD. Wilson wrote a letter to Heard saying, Most Alcoholics Anonymous people were strongly opposed to his experimenting with a mind-altering substance.
01:51:08.000And then there's another one from The Guardian, LSD could help alcoholics stop drinking, AA founder believed.
01:51:13.000You know, this is all in, when was this, what was the year?
01:51:18.000I want to say it was in the 40s, right?
01:51:20.000When did he experiment with LSD? This article here says 20 years after setting it up in 1935, so the 50s?
01:51:29.000Well, when did Hoffman synthesize LSD? Because it was before there was a stigma attached to it, right?
01:51:36.000There was a sweeping psychedelics acts of 1970, which essentially made all these things that used to be used for clinical research illegal, including MDMA. Well, MDMA was later, but...
01:51:49.00043. So these people were, there was no stigma attached to using these substances that in many ways, I'm not, and I've experienced LSD, but I'm not an enthusiast.
01:52:04.000I haven't had enough experiences to really talk about it.
01:52:07.000But one thing that people who have had multiple like very heavy trips have told me is that they gain an insight into themselves that they don't think is available without it.
01:52:21.000It removes them from them and allows them to look at themselves in a deeply introspective way.
01:52:29.000This is also true of Ibogaine, and Ibogaine has had tremendous impact on people with addictions, including my friend Ed, who started up a clinic in Mexico.
01:52:45.000He had a back injury and got hooked on opiates and was trying to find some way around this and trying to figure out what to do.
01:52:53.000And in the process, he found out about Ibogaine, had an Ibogaine experience.
01:52:59.000He did a session and then completely cured himself of that and then wound up opening up his own Ibogaine retreat because it was so beneficial to him and he wanted it to be available to other people.
01:53:10.000What are your thoughts on those sort of treatments?
01:54:50.000Google, what is the mechanism that helps addicts with Ibogaine?
01:54:58.000In which method does Ibogaine help addicts with addiction?
01:55:04.000Because there's something that happens where it rewires Certain aspects of the brain, and this has been demonstrated in trials to the point where there's people seriously considering trying to figure out how to get it passed through the FDA and how to get it brought through whatever the regulations are in America.
01:57:06.000If the drug, which has a unique chemical shape, finds a corresponding keyhole on the command center, it activates the center and tells it to release its chemicals such as dopamine.
01:57:16.000Ibogaine is able to work by regulating dopamine surges that occur in addiction because it can inhibit the access to some of these dopamine receptors.
01:57:23.000In other words, it gets in the way and will not allow the drug like an opioid or an opiate to attach to the receptor and stimulate it.
01:57:30.000Ibogaine can also block transporter molecules that work to shift dopamine into brain cells.
01:57:54.000Yes, that would be wonderful, except that, you know, history would say that whenever there was going to be a new drug that was going to fix addiction, it usually didn't turn out very well.
01:59:12.000So they got, you know, one of these substances on the dark web, self-administered, and were administering, you know, every 10 minutes for a week and ended up in the ICU. So that's the world I'm coming from.
01:59:30.000I'm all for adults being able to make their own informed decisions, though, and I think that...
01:59:38.000The way they have these things set up the way I know they have set up in many of these clinics is you're dealing with people that are trained professionals that have had these experiences personally and have had great benefit from it and they're dedicated to guiding people through this addiction process.
01:59:57.000But then I don't think you have to worry about Ibogaine as a recreational one.
02:00:23.000I mean, when I talk about self-binding strategies, one of the self-binding strategies that I talk about is categorical self-binding, meaning that we put the substance into a category.
02:00:36.000And that can be a category that we either will use or we won't use.
02:00:41.000But one of the categories is actually the category of the sacred.
02:00:45.000And that would include, in a way, the category of medications administered by modern-day shamans, you know, doctors potentially, right?
02:00:55.000Because when we regard these molecules as sacred and special, we develop rituals around using them.
02:01:03.000We use them in discrete ways that have shown to be helpful.
02:01:08.000I absolutely think there's a role for that.
02:01:12.000I'll never forget, I'm not remembering the details of like what society or village this was, but I remember reading about a quote-unquote primitive village, you know, some many years ago where the entire village would become intoxicated,
02:01:31.000But they all did it together, and it was part of a sacred ritual.
02:01:35.000So it wasn't like a binge drinking pattern of addiction.
02:01:37.000It was a sacred substance done in a safe, ritualized way.
02:01:42.000And I definitely think there's, you know, a role for that, for sure.
02:01:46.000The problem is when, you know, we sort of ignore set and setting, when we ignore the sacredness so we use more often, when we, you know, don't respect that ritualized environment, which is so necessary to keeping it safe.
02:02:00.000Right, the difference between a sacred shamanic setting versus the way you feel when you go to the bar to have a few beers.
02:02:09.000Or just trying to, even if you're telling yourself, I'm doing this because I'm going to have a spiritual awakening, so I'm going to do it with my friend at the top of Kite Hill.
02:02:20.000I always wonder about these things like...
02:02:26.000What would happen if they were made freely available and legal and how much abuse would happen and how much we could mitigate that abuse with education and just time.
02:02:41.000I mean, there's plenty of abuse of alcohol, right?
02:02:48.000But there's no real benefit other than social lubricant.
02:02:51.000Occasionally, you know, you come up with some great ideas when you're a little lit.
02:02:55.000But the benefit of psychedelics is so well established in terms of the way it makes people reframe their life, the way it shifts your perceptions and allows you to think of things in a different way that might not really be possible without them.
02:03:30.000And, you know, how would we screen to make sure that, you know, the right people get it in the right way?
02:03:37.000I just really think that we need more data.
02:03:40.000And the good news is that research is very active now, and a lot of You know, young people that I mentor are really excited about this area.
02:03:50.000So there's a whole generation of people coming up who are excited about this and are working on it and want to work on it.
02:03:57.000I just think we need to wait, wait for more data.
02:04:01.000Well, thank you to MAPS and Rick Doblin and all the great people that have done some incredible work with psychedelics and working with people with PTSD and all sorts of issues and doing it the right way.
02:04:13.000Doing it with controlled studies and doing it out in the open and completely legal and approved.
02:04:22.000And they've found great benefit with some of these things, particularly like MDMA with people with PTSD. That's one that they're working on a lot with soldiers and with other people that have experienced trauma.
02:05:21.000And, you know, I hear that all the time from patients in recovery, that they're actually grateful for their addiction because without their addiction, they would have never found recovery.
02:05:32.000So recovery and sort of the structure that it provides has been so beneficial to them in giving them like a clear like a scaffolding or a framework for life that it's better to have gone through it.
02:05:47.000You know, we were talking earlier about humility and how important, you know, humility is to a life well lived.
02:05:53.000And there's, boy, nothing that will humble you more than, you know, getting seriously addicted and having to crawl your way out of that.
02:06:00.000So yeah, these are incredibly courageous, humble, wise people.
02:06:06.000And I've learned a lot from my patients.
02:06:08.000Isn't it fascinating that that seems to be a tenet of most religions is this humility, humbling yourself towards God, humbling yourself towards the divine?
02:06:19.000You know, I think that self-aggrandizement is really at the core of so much of our suffering.
02:06:24.000And when we can figure out how to let that go, we're really free and ultimately, you know, live better lives.
02:06:31.000I think it's also not just the feeding of the ego, but why the ego wants to be fed.
02:06:37.000What is it about you that wants to proclaim yourself that you're so great?
02:06:42.000Yeah, I'll never forget when I was pregnant with our daughter and I went around to different nurseries, you know, nursery schools to look for one that would fit her.
02:06:51.000And I was scanning the room looking around at all these little kids and this one little girl sees me scanning the room and she goes, look at me, look at me!
02:07:27.000It's also the area where we're most vulnerable to injury because once we've invested ourselves, if our competence is threatened, then we experience a narcissistic injury and that goes right to our core.
02:07:45.000We're like retaliating, like not even maybe to the person who injured us or at another time that has nothing to do with the way that they injured us.
02:07:52.000But nonetheless, there is this concept of healthy narcissism.
02:07:56.000It's when narcissism, you know, goes to, like anything, to a pathological degree that it becomes very bad.
02:08:04.000And unfortunately, our culture really feeds this kind of narcissistic self-preoccupation.
02:08:11.000Getting back to athletes, you know, I think that's one of the real dangers about being, well, a celebrity of any sort, is that the media kind of wants you to, you know, to be all about you, even when you don't want it to be all about you.
02:08:26.000And what happens, you know, essentially...
02:08:29.000Narcissism separates us from our tribe.
02:08:32.000You know, we stand out from our community.
02:08:36.000And when we do that, we're really deprived of the good kind of dopamine that we get from those close, intimate attachments.
02:08:44.000So it's a very dangerous but highly seductive thing because it's sort of the trope of our modern culture.
02:08:53.000And the opposite is very detrimental too, which is not having any sense of self-worth.
02:09:00.000That's probably maybe even harder because I think it's easier to dial it back than it would be to become confident or to have feelings of self-worth.
02:09:17.000If you're a depressed person, Who looks at all these other people and thinks everyone's better than you and you're not valuable and you're worthless.
02:09:25.000There are people like that out there for whatever reason, whether it's abuse as a child or whatever has caused them to think like that.
02:09:56.000It's all the people, the dead bodies around them.
02:10:00.000Whereas people with, you know, like chronically low self-esteem and lack of confidence, that's in some ways more treatable because they're often more treatment-seeking.
02:10:10.000And the harm is mostly to themselves, not necessarily to other people.
02:10:15.000But just to turn it on its head a little bit, there's also a way to be narcissistic about being the worst person.
02:10:23.000And that sometimes, you know, comes up in clinical care, too.
02:10:55.000But my perspective was just that from my experience and just people doing things that are difficult to do, that confidence is very important and it's extremely difficult to get someone to develop confidence.
02:11:09.000Whereas You can get a narcissist or at least someone who's kind of made a mess out of their life to recognize how much of it is their fault and how much of it is the way they interface with people around them and how much of it is these narcissistic tendencies that maybe could be exposed by experiences,
02:11:27.000whether they're negative experiences or psychedelic experiences or maybe even just some sort of therapy where you're recognizing patterns in your life.
02:11:36.000Yeah, I mean, you know, for the narcissist, the treatment is, you know, the shattering of the ego and the, you know, engaging in a kind of selflessness and merging with others as opposed to seeking that self-aggrandizement.
02:11:50.000But I do, in my experience, people who have low self-esteem and lack self-confidence...
02:11:57.000And again, their project is then engaging in difficult things in small incremental ways and seeing success and then being able to use that as a touchstone.
02:12:08.000I can do the next hard thing and the next hard thing after that.
02:12:12.000And a little bit that's just getting back to like psychedelics.
02:12:16.000That's a little bit one of my worries too about that kind of intervention because, you know, there are other ways to get to that top of the mountain.
02:12:25.000And if you do it through your own hard incremental work over a long period of time, Maybe you get to the same place as the person who used psychedelics, but you did it through your own work.
02:12:35.000And that means then your new perspective also relies on this touchstone of self-efficacy, which is why I like the idea of psychotherapy better than this kind of one-time medication thing.
02:12:49.000But those two can be combined, too, potentially.
02:12:52.000Yeah, I think there's probably a bunch of different ways to get better at pretty much everything, right?
02:12:58.000But the idea is that you're focusing on getting better.
02:13:04.000I've always felt like one of the things that's troubling for people, one of the things that we have a problem with is there's no real guidebook on how to live your life.
02:13:42.000To establish some guidelines of how to live your life and it's one of the things that I think is so beneficial about these sort of tribal rituals that you were talking about is that people have these guidelines and I think holidays and festivals and rituals and the thing about those things that are good is that they sort of establish some sort of structure and for whatever it is about people There's something about having no structure
02:14:13.000that for a lot of people, it feels very lonely and confusing.
02:14:21.000I mean, it's amazing to me how often when I'm working with patients, I have to tell them things that really should be absolute common sense and things that they should have learned growing up.
02:14:34.000Things like Get up every day and, you know, eat your breakfast and exercise and have a schedule and try to show up and try to show up on time and tell the truth and all these kinds of things that we kind of knew once but we sort of forgot.
02:14:56.000You know, the whole wellness movement now really is about trying to create guidelines for people to remember stuff that we seem to have forgotten.
02:15:06.000I think one of the more interesting things about your work that's very beneficial to people is recognizing what is going on.
02:15:15.000Like recognizing that there are these chemical pathways, that there's these real things that are happening inside your mind and this is not just some sort of a psychological airy-fairy sort of like an idea.
02:15:30.000That there's real science behind this.
02:15:33.000Yeah, and that really clearly resonates for people now.
02:15:36.000If you give them a neuroscience framework for approaching their lives, that's exciting for people.
02:15:44.000Whereas if, let's say I were to use a religious framework or a moral framework, people are not going to cotton on to that in quite the same way.
02:16:18.000But now whenever I crave a cigarette, I just think about the gremlins hopping on the paints in my mouth.
02:16:22.000And he said, it's really silly, but it's really helpful for me, you know, because I know if I just wait long enough, they'll hop off and homeostasis will be restored and I'll be able to move on.
02:16:32.000Yeah, it's hard in the moment though, right?