Dr Anna Lembke - The Role of Dopamine in Addiction - Meeting 149

Dr. Anna Lembke's  latest book, Dopamine Nation: Finding Balance in the Age of
Indulgence was an instant New York Times and Los Angeles Times bestseller and has been translated into 25 languages. It combines the neuroscience of addiction with the wisdom of 12-Step recovery to explore the problem of compulsive overconsumption in a dopamine-overloaded world. 

To qualify to receive 1 of 6 free copies of Dopamine Nation, be one of the first 6 people to go to https://www.speakpipe.com/reco12shares and read the “ground rules” and then record a 2-5 minute recovery share. When completed, input your email address in the text box and submit it. I will then contact the first 6 who do this and get contact info so I can mail the book to you. These shares will be used in the future "Reco12 Shares" Podcast. The goal is to accumulate lots and lots and lots of each of these so that when Reco12 Shares goes live in podcast format that we have a very solid base to start from.  

Reco12 is a self-supporting service and we appreciate your help in keeping us working our Step 12 in this manner.  We gratefully accept contributions and effective today, we started a new subscription program called Reco12 Spearheads.  Here is a little about the ideas that the Reco12 Spearhead program will help shape and fund:

• Reco12 also has some future plans to create other podcasts and services to assist the addict of any variety who still suffers or who is supporting those who still suffer. Some of these ideas include:
• A new podcast that will be launched by March 1, 2023 called Reco12 Shares.  You can learn more about that in the chat, shownotes, and at reco12.com/shares.
• Another future roundtable-type podcast discussing The Big Book of AA and recovery.

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Resources from this meeting:
Dr. Anna Lembke Books:
Dopamine Nation
Drug Dealer, MD
Dr Anna Lembke Website

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Outro music is “Standing Still” by Cory Ellsworth and Randy

Transcript

Now I'm going to introduce our guest speaker for today, a Reco12 newcomer dr. Anna Lembke, whose topic will be the role of dopamine in addiction. Now here's a little bit about her Anna Lembke is a professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. 

A clinician scholar, she is the author of more than 100 peer reviewed publications, has testified before the United States House of Representatives and Senate, and has served as an expert witness in federal and state opioid litigation and is an internationally recognized leader in addiction medicine, treatment and education. In 2016, she published drug dealer MD. How Doctors were Duped, patients Got Hooked and why it's so hard to stop. She's also been highlighted in The New York Times as one of the top five books or that has been highlighted as one of the top five books to read and understand the opioid epidemic. Dr. Lemke appeared in the Netflix documentary The Social Dilemma, an unvarnished look at the impact of social media on our lives. 

And her latest book, Dopamine Nation finding Balance in the Age of Indulgence was an instant New York Times and Los Angeles Times bestseller and has been translated into 25 languages. And I've got several copies of that we'll be giving out here in some giveaways in this, and I'm grateful about that. It combines the neuroscience of addiction with the wisdom of recovery to explore the problem of compulsive overconsumption in a dopamine overload world. Take it away, Anna. The floor is yours. 

Well, thank you so much. I'm very excited to be here and talk to all of you. I'd like to start by describing an interaction I had with a patient of mine, Jacob, and Jacob's given me permission to tell his story. I tell his story in my book Dopamine Nation. So I bet I met Jacob about ten years ago. I remember how nervous he was in the waiting room. As I walked him back to my office, the first thing that he said to me was that he thought that I would be a man, not a woman. And I knew then that were going to be talking about sex. At that point, I had been seeing increasing numbers of patients coming in wanting help, specifically with pornography and sex addiction. 

And almost universally they had told me that what had started out as a manageable behavior became unmanageable with the advent of the Internet and then especially smartphones in the early two thousands. So I wasn't surprised. But as his story unfolded, I became more and more internally distressed, because I was really, one level, quite horrified by the nature of his addiction visa vis modern technology. And without going into too many details, what he described to me was that he eventually built a masturbation machine, which, by the way, is not all that uncommon. People have been doing that for hundreds of years. But his disease progressed to the point where he eventually had created a machine that would allow other people on the internet to manipulate him in ways that were potentially life threatening and obviously psychologically very damaging for him and for others. 

And as I was sitting there internally processing my deep sense of compassion for him, combined with, honestly, a sense of horror, it suddenly struck me that really what he was doing was no different than what all of us were doing. And that in some very real sense, our smartphones and our devices had become our masturbation machines. And that we had reached a point in technology when were essentially using these devices and using technology to quite literally titillate ourselves to death. And the sort of realization came to me in a very personal way because some years prior to seeing Jacob I had been struggling with a Burgundy romance novel addiction. 

And it started out very innocently with my reading The Twilight Saga somewhere in my early forty s and just being absolutely transported by it in a way that I hadn't been really ever in my life. I've always been a reader, but there was just some way in which this particular and I had never read romance novels, so it was sort of an absolutely new genre for me. And by the way, I was really happy in my life. Wonderful husbands, great kids, meaningful work. So it wasn't as if I was escaping something or self medicating something. 

But what happened was I was so transported, so able to escape my own thoughts and ruminations, that I became obsessively involved in reading romance novels which would have remained at a manageable level had I not then acquired a kindle which then allowed me to download romance novels immediately such that I was staying up later and later in the night. No sooner had I finished one than I was going on to the next one. And of course I needed then more and more potent versions of the same boy meets girl story in order to get the same effect. So I was experiencing what we call tolerance, which is where you need more of your drug over time or you find that your drug is not working. This is all part of what's happening in the brain as we become addicted. 

Of course I didn't see it happening as it was happening, but I essentially progressed to the point where I was reading Frank Erotica, which is socially sanctioned pornography for women. I was taking novels on my Kindle to social functions and hiding out in a room and reading. I was not spending time with my husband and children as a result of my reading. And I think the nadir for me was really one occasion when I brought my Kindle to work and found myself in that ten minutes between patients reading a romance novel. And I raised this because even as much as I know and knew about addiction and should have been able to recognize what was happening to me, I really didn't see it. And this, I think, profoundly speaks to the ways in which we've all become vulnerable to the problem of addiction. 

The ways in which these digital devices and the drugs they deliver are so incredibly potent that they really work on our brains in the same way that substances like alcohol and cannabis can. And that even if we don't come to these drugified experiences and substances with innate vulnerability for addiction because of course, we know there's genetic vulnerability or we don't come with a sense of our lives being troubled and wanting. To self medicate or escape. We can still get caught up and caught up in it because of the incredible potency, the access, the quantity, the variety. These are things that make something highly addictive. And so I want to talk about what's going on in the brain like how does that happen? And in order to understand that, it's first important to understand dopamine. Dopamine is a neurotransmitter. 

It's a chemical that we make in our brain that's fundamental for the experience of pleasure, reward and motivation. Now, it's not the only neurotransmitter involved in that process, but it is the final common pathway for all reinforcing substances and behaviors including digital drugs and screens which clearly light up our reward centers and release dopamine. The more dopamine that's released and the faster that it's released, the more likely that substance is to be addictive. And here's where the very important concept of drug of choice comes in. So what releases a lot of dopamine in my brain i. E. Romance novels and chocolate may not release a lot of dopamine in your brain and vice versa. This concept of drug of choice is not very well understood and there's limited research on it. 

But because we have so much more potent versions of drugs that have been around for thousands of years as well as new drugs that didn't exist before, we're now at a point in time in human history when we've all become more vulnerable to this problem of addiction. So what happens in the brain as we get addicted? In order to understand this, it's essential to appreciate that pleasure and pain are co located in the brains. The same parts of the brain that process pleasure also process pain. And they work like opposite sides of a balance. So if you imagine that in your brain's reward center there's a teeter totter like a beam on a central fulcrum. That's how we process pleasure and pain. When we experience pleasure, it tips one way, pain the other. 

Now, there are important rules governing this balance and the first and most important rule is that the balance wants to remain level to the ground. And that with any deviation from neutrality, which neuroscientists call neutrality homeostasis with any deviation from homeostasis, our brains will work very hard to restore a level balance. In fact, the definition of biological stress is a deviation from homeostasis. And in fact, the work that we do to restore a level balance sets off our whole adrenaline cortisol system. So we tax our system to restore that balance. But that's the universal physiologic drive of all living organisms. So how do we restore a balance that's key to understanding the process of addiction? What happens is when we for example, when I read a romance novel, I released dopamine in my reward pathway, my balance tilts to the side of pleasure. 

But no sooner has that happen than my brain adapts to increase dopamine transmission by down regulating dopamine transmission through a process called neuroadapaptation. And I like to imagine that as these little neuroadaptation gremlins hopping on the pain side of the balance to bring it level again. But the thing about the gremlins is that they like it on the balance, so they don't get off as soon as the balance is level. They stay on until it's tilted an equal and opposite amount to the side of pain. That's called the opponent process reaction hangover come down. Now, in my case, that's wanting to read one more chapter before I put the book down or have one more piece of chocolate even though I told myself I would only have one piece if I wait long enough. 

Those gremlins do hop off and homeostasis is restored and the craving passes. But until they hop off, the physiologic urge to reach for my drug again is almost overwhelming. And when we live in a world in which access to our drug is immediate and the quantity is enormous and the potency is very high, that means it gets harder and harder to resist that temptation. Which brings us to the second rule of the balance, which is that with repeated exposure to the same or similar reinforcing stimulus, that initial deviation to pleasure gets weaker and shorter, that's tolerance. But that after response to pain gets stronger and longer. In other words, those gremlins multiply, they get bigger and stronger, more abundant. Pretty soon they're camped out on the pain side of the balance, tents and barbecues in tow. And now we've entered addicted brain. 

Which means that now we need very large quantities of our drug of choice not to get high and feel pleasure, but just to level the balance and feel normal. And when we're not using, we're walking around with a balance tilted to the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance which are anxiety, irritability, insomnia, dysphoria and craving. If we widen the lens on this phenomenon, what becomes clear to me is that our world of infinite access to highly reinforcing drugs and behaviors may indeed be putting all of us into a chronic dopamine deficit state. In other words, maybe we're all walking around with our balance reset to the side of pain because we're always stimulating that dopamine reward pathway which might then explain why we're seeing increasing rates of depression, anxiety and suicide, especially enriched nations. 

If you look at epidemiologic studies and you look at the rates of depression, anxiety and suicide over the past 30 to 50 years, sadly, they're going up, especially in rich nations. It's what I call the paradox of plenty. And even in those places where we have more access than ever before to mental health treatment, people are not getting better. And I think that may be due in part to the fact that we are misunderstanding the problem. And what we are identifying as being a phenomenology that originates out of too much suffering and too much trauma might actually be a phenomenon that is fundamentally caused by too much pleasure. 

And the ways that our brain are trying to compensate for this fire hose of dopamine, you might well ask why on earth would Mother Nature make a pleasure pain balance that insists that we tilt to the side of pain before restoring homeostasis? Well, it is an ingenious strategy for a world of scarcity and ever present danger, which is the world in which humans have survived for most of human history. It's really only in the last 200 years or so that not only do we have our basic survival needs met, but we have more disposable income, more access to leisure goods, more leisure time. We're living not only longer, but we have more time on any given day. And of course, the hope was with all of this time and all of this leisure and all of this abundance, we would all be reading Aristotle. 

But instead, what we're doing is we're playing video games, we're watching pornography, we're eating cupcakes, we're masturbating, we're smoking, we're drinking, you name it. What to do about this paradox of plenty? Well, my hypothesis is that we can look to people in recovery from severe addictions for a wisdom of how to live in this world. And we need to create a world within a world in which we actually intentionally set out not only to abstain from highly reinforcing drugs and behaviors, or to use them infrequently and intermittently and in low potency, acknowledging the vulnerability that we all have for addiction. But we also need to intentionally pursue a new form of asceticism. That is, we actually need to seek out inconvenience hardship, challenges and physical pain. 

Because it turns out that when we intentionally press on the pain side of that balance, for example, by exercise, ice cold water plunge, prayer, meditation, cleaning out our closet intermittent fasting all of which is effortful engagement. What happens is that those neuroadaptation gravels hop on the pleasure side of the balance to bring it level again and then tilt to the side of pleasure, increasing our underlying dopamine transmission. But the secret there is that because we're paying for our dopamine upfront, we never enter that dopamine deficit state. And you can see that in lots of research that's been done with exercise, also with ice cold water immersion, dopamine levels increase slowly over the latter half of those activities and remain elevated for hours afterwards before going back down to baseline conditions. 

Now the caveat here is that anything that releases dopamine has the potential for addiction. So yes, we can get addicted to ice cold water pump plunges, we can get addicted to exercise, anything that we do that causes pain that's all of a sudden and really intense, like cutting is not what we're talking about here. That's not healthy, adaptive, what we call hormesis or intentional exposure toxic or noxious stimuli in order to get the dopamine indirectly when we do it too much or we do too much pain all at once, that is maladaptive. We're essentially taking pain then and turning it into a drug which we don't want. 

But in mild to moderate doses, used steadily over long periods of time, aceticism can be a way in which we reset our reward thresholds so that we have a greater capacity to experience pleasure from life's everyday, unexpected, more modest rewards. And we're also more resilient in the face of painful stimuli, physical and psychological because we've built up the mental calluses in order tolerate it. So I think I'm going to go ahead Justin, and stop there and would love to open it up to discussion. 

Thank you so much and I really appreciate your experience, really appreciate your expertise and your background on this and I think there's a lot of great things that have come up. We've got a couple of questions that have already come in from the live audience. I've written down a couple, a reminder to our live audience, please. If you have questions for Dr. Lemke, please type them in the Q and A link at the bottom of your window. We'll get to as many of those as we can and we'll jump into this right away. We will be doing a giveaway for six copies of Dopamine Nation. I've got a few more that we'll do some things in the future with, but I will put in the chat here during this session or during the Q and A, how we can do that. 

So for questions for Dr. Anna Lembke, first one we'll go with Gregory. Gregory's, got a few in here, but I'm going to go with the first one here. And this is relating to, you know, our recovery programs that we're talking about here, ana. In step one, we have the concept of we are powerless and that our self will is not enough to stop our addiction. How does that work in our brain? Why are we powerless? 

Oh, that's such a great and profound question and I'll do my best to answer it based on my experience, my knowledge of the neuroscience, but also my intuition, because I think that's a really deep question that nobody knows the answer for sure. So essentially we have to recognize that we reflexively approach pleasure and avoid pain. So it's a reflex and when I say a reflex, it means something that we do automatically. We don't need to think about it. And our survival through most of human existence has been contingent on this reflex functioning appropriately. 

And by the way, this reflexive area, this pleasure pain balance has been conserved not only for millions of years of human evolution but also over millions of years of all kinds of organismal evolution down to even the most primitive nematode which will release dopamine in response to food in its environment. So this is reflexive. It's innate, it's deeply conserved. But over many years of evolution we have laid on additional layers of our gray matter in our cortex to help us inhibit some of these reflexes. Especially now we know the prefrontal cortex is innately part of what we must engage in order to be reflective and not let, for example, those gremlins take over and to be able to make the change. But having said that, there is a point at which even this prefrontal cortical willpower part of our brains is insufficient. 

And we see that again and again in people with severe addiction. And that's where this kind of surrendering and turning it over to a power greater than ourselves really can give us strength that we ourselves don't have. And I've seen it again and again in my patients for whom spiritual transformation has been the key to their recovery. I've experienced spiritual transformation in my own life in another context which gave me the courage to move forward at a time when I couldn't have done it. Relying on my own will. And how that happens neurologically is really fascinating and nobody really knows. But there is probably a spirituality circuit that gets engaged in the brain and then allows us to change our behavior in ways that are not possible without engaging that circuit. 

Yeah. Thank you so much, Anna. Now, I'm going to combine a couple of questions one that I've written with one that was in the chat you talked about seeking out inconvenience the slow burn that's not fun to build, that stasis to bring the dopamine in a slower way rather than the quick burn way. Along with that, one of the questions in here is in the twelve steps, especially from the third step on it mentions that selfishness and self centeredness are the root of all our problems and that selfishness and self centeredness is usually a quick thing hey, I want what I want and I want it now. How do we balance that character defect if I want what I want now and put it off with that slow burn in order to make it a more healthy situation? 

I'm not sure I understand the question but let me do my best to respond to what I think you're getting at which is to say how do the twelve steps fit into this neurobiological process? And I think step four is so pivotal because step four is really the moment when we have to stop running away from our pain, which were biologically and socioculturally conditioned to do, and instead really turn and face ourselves and most importantly, acknowledge our character defects and what we have contributed to our problem. Because so much of addiction is about blaming other people for why we're using and why we're unhappy. In essence, when we engage in that fourth step and focus on our character defects and sit there and tolerate the discomfort of the truth of what we have contributed, that's pressing on the pain side, and that's very hard. 

And then when we further share that with another human being, with God and another human being, there's, of course the terror that we will be rejected, shunned, abandoned, turned out for being flawed. And instead, what happens in Twelve Steps is that we're embraced and we're brought in. So that very thing that we anticipated doesn't happen. And I think we really get an intimacy explosion then definitely followed by a dopamine surge when we're embraced and accepted for who we are, even with all of our flaws. And again, that's a great example of the good kind of dopamine. It's not that dopamine is good or bad, it's how we get it. And whether or not the way that we get it is adaptive. And to get our dopamine by doing things that are hard is healthy and adaptive. 

And engaging in the Twelve Steps is really hard, especially when we have to look at our own flaws and share them with others. So I think it's a way of pressing on the pain side of balance. Did that answer the question? 

I think that definitely went right to the core of the question. That was kind of a circuitous question. Thank you. Thank you for addressing it that way. All right, question from Chanel from our live audience. Chanel asks, does childhood trauma contribute to a person's compulsion to chase for pleasure dopamine? Is there a connection there? 

So there is now a wealth of evidence that serious childhood trauma makes us vulnerable to all kinds of negative health outcomes. Not just psychological problems and psychiatric diseases like addiction, but also physical diseases like diabetes, heart disease, asthma. So it's very clear that significant childhood trauma probably causes what we call epigenetic changes, that is to say, changes in protein expression at the level of DNA that then permanently alters the way that we move through the world. So, yes, it's absolutely true that childhood trauma contributes to addiction vulnerability. But I think what's also important to acknowledge is that in my 20 plus years of clinical experience, it's also very clear that if we get stuck in our trauma and sort of circle the drain around our trauma and sort of prepare on it, we typically are not going to move forward into recovery. 

And that when people move forward in recovery, not only do they change their narrative around who's responsible, acknowledging their own responsibility even if it was just showing up or even if as a child doesn't have much responsibility. But we can be responsible for how we conduct ourselves and going forward in our adult life. And so I think this movement through trauma has got to really be emphasized as the pathway to recovery. 

Yeah. Thank you. And that went back and talked about the step four thing that you talked about in that previous share. Thank you. All right, question from Alan from our live audience. Is there any kind of vitamin or food that can be helpful with the balance of dopamine, or is it mostly action? 

Well, diet does matter, of course, because just like so many behaviors have become drugified in the modern world, food has become drugified. We add more chemical salt, fat, sugar to food than you could probably even imagine. I think people from even 500 years ago wouldn't even recognize what we now call food. And so it's a landfine. We have to be much more thoughtful and careful about the food that we put into our bodies and make the extra effort if we have the means and the financial wherewithal. Because it turns out eating healthy is really expensive and eating badly is cheap. But of course, try to minimize the salt, fat, sugar and other intoxicants in food is going to be really important as opposed to things like in terms of things like supplements that could increase dopamine. 

There's really no reliable evidence that you can do that by ingesting supplements of any sort. You can't eat dopamine. It doesn't pass the blood brain barrier. L DOPA, which is a precursor of dopamine that does pass the blood brain barrier, is used to treat things like Parkinson's disease, which is caused by a depletion of dopamine in another part of the brain called the substantial nigra. There are many reports. Now, it's been well established that some people who take the dopamine precursor to treat Parkinson's end up with a kind of an addiction phenotype that increased ingestion of dopamine actually leads to compulsive overconsumption of things like gambling and shopping. Probably because the brain responds to any external dopamine by down regulating its own dopamine production and transmission. That is to say, gremlins hopping on the pain side of the balance. 

Thank you. All right, I'm going to combine a couple more questions from our live audience somewhat similar. Got one who says I'm addicted to lust and p*** and the other one who says, my addiction centers around love, addiction validation, and people pleasing. Will brains ever heal? And does the same rationale apply to these types of thinking and these types of addictions that we struggle with? 

Yeah. So first of all, absolutely. I mean, love, it can absolutely be an addiction. Again, anything that releases dopamine has the potential for addiction. Everybody is different. What releases a lot of dopamine in one person's brain may not release a lot of dopamine in another. For example, I always like to say I thought I was immune to addiction because alcohol gives me a headache, caffeine doesn't wake me up or do anything positive. But of course, I did discover in midlife that my drug of choice is social connection, is love, is romance, is o*****. And so I can really relate to the difficulty of this category of addiction in the world in which we live today. A world of social media, of online pornography, a world in which the triggers are just endless. 

I mean, even if you try to hide from pornography, you can't, because even perfume ads are virtually pornographic. Now, having said that, the brain really can heal. And the secret to healing is abstinence. Abstaining for long enough to reset reward pathways, have those neuro adaptation grandma's hop off to reset homeostasis, and then to create a world within a world where we're insulating ourselves not just from our drug, but also from triggers. Because of course we know that triggers or reminders of our drug, or even euphoric, recall and fantasy can set us into that same dopamine spiral that we have with the drug itself. There are studies now showing that even just Qinduced reminders of a drug will release dopamine, make us a little high, and then lead afterward to that minidopamine deficit state. So the gremlins once created, never entirely go away. 

They're always waiting in the wings. They want to hop on the balance again. And they will do so even with triggers which temporarily go to pleasure. But then you have these gremlins, hordes of them, because we've made a lot of them over time, slamming us down to the side of pain. So we need to then find a way to insulate ourselves, what I call self binding strategies, not just between ourselves and our drug of choice, but also triggers. So it could be, for example, my patient Jacob, when he got into recovery through Twelve Step, he realized that he couldn't look at pornography, but he also couldn't watch YouTube videos. That once he started to watch YouTube videos, that very quickly took him down the path of pornography. For me, it was listening to popular music, which almost always includes some theme of love. 

And I would find even just driving the car, if I listened to a pop music station, I had cravings for romance novels. So these are the types of things we have to recognize. And I think importantly, it can feel like, oh gosh, I'm not going to be able to have any pleasure in life, I'm going to have to wall myself off in some kind of monastery. That sounds horrible, but the truth is that if we reframe this as really doing ourselves a wonderful, generous, loving favor by insulating ourselves from these triggers, then it takes on a whole new meaning, right when we recognize I'm really doing myself something really good and loving in a really crazy, mixed up world that's constantly inviting us to titillate ourselves and to be addicted and to consume. 

Yeah, thank you. I want to follow up on that you just brought up. For your experience was pop music can be a trigger for that. And then right after that you go, well, am I going to have to live in a monastery and not do that? So how does limiting pop music in this case, does that bring freedom? Or do you still feel confined in that because of that you've mentioned, hey, I'm doing myself a favor, but is there freedom or is it confined? Freedom. 

Right. So first of all, whenever we stop using our drug of choice or limit our triggers, which are a stepping stone to our drug of choice, the first thing that happens is that our pleasure pain balance slams to the side of pain and we are in withdrawal. And so initially, it's not only a prison that we put ourselves in, but we're being tortured in that prison. And so it's important to just acknowledge that. But with enough time, those neuroadaptation gremlins will eventually hop off. With enough brain plasticity, homeostasis will be restored, and then we are truly free because we're not constantly spending our energy and creativity trying to avoid getting sucked into the vortex of our addiction. Now we have our mental capacity to think about other things, to enjoy more modest rewards. 

We're not carrying around this ball and chain of this kind of reflexively focusing on our drug of choice, but it definitely takes a while to get there. It takes a while to get there. 

Yeah. That reminds me of some of the Step Ten promises from the Big Book of Alcoholics Anonymous where if I'm in spiritual condition, if I'm in solid recovery, I can do things that other alcoholics wouldn't typically be able to do. I can go places. Yeah, exactly. Thank you. Okay, question from anonymous attendee. And this goes to self harm. This person says, I understand how self harm is a maladaptive way to get dopamine. How do I break these dopamine hits from self harm? 

Yeah. So this is what I talk about in the book, that it really starts with a dopamine fast or what can be called an abstinence trial or abstinence sampling. This is where we commit to four weeks of not using our drug of choice. And that would include if your drug of choice is cutting, that would be to set a quit date, get rid of your razors and your other cutting instruments, tell somebody, get a recovery buddy, and really commit to no cutting for four weeks, recognizing that it's going to get worse before it gets better. It's really hard. Our brands will make up all kinds of stories why it's really okay to cut, why it's no big deal, why I deserve to cut, because this person said this or that happened. 

But if you can just ignore, you know, those voices that stink and thinking you can get to about ten or 14 days, typically the craving starts to ease up. And then by week three and weeks four, people notice the sun coming out. Those gremlins have hopped off homeostasis, begins to be restored. We begin to up regulate our own dopamine and of course, finding other healthier, adaptive ways of coping. To, again, going to meetings, reaching out to a sponsor, but it's not easy. But it's time limited, so the pain is time limited. 

Thank you. Okay, question from Emma from our live audience, and this goes into your conversation or your discussion on step four. Emma says you mentioned about step four and wanting to run away from the pain rather than to sit with the pain and rather to sit with the pain. And that addiction is a result of running away from that pain and not wanting to face it. How do we face the pain without using different things when it's what we've always done? Step four is asking us to face that without using it. Yeah. Thoughts on that? 

Yeah, that's such a great question. And I would just say I really want to normalize the behavior of running away from pain because all of us do. It not just people with addiction. Like, nobody wants to sit with thinking about the things that our conscience brings up, the way that we've harmed other people, the lies we've told, the things we've stolen, the harm we've caused, intentionally or otherwise. We've all done those things. There's no human that hasn't done those things. We're all flawed, and we don't want to look at those things because it's really reflexive and because we have a culture that tells us we shouldn't. We have a culture that tells us, lose yourself in some distracting behavior or watch a Netflix show. Eat an ice cream cone so you're not alone, is what I'm trying to say. 

And I think the key here is to I know for me, the running finally stopped when I just got so exhausted I couldn't run anymore. I couldn't outrun. It wasn't because I wanted to face the pain. It was like I was just too tired to keep running. And it's terrifying in that moment to then turn and go, okay, I guess this is it. But something remarkable happens when we do that is we recognize, you know what? It's okay. Like, I'm going to be okay. There's something very incredible and paradoxical when we stop running from pain and we just let it wash over us and we realize, you know what? There's nothing I can do. You know, it is what it is. 

And I do think here, this is where the higher power comes in and just really turning our will over and asking for help. Right? That's another just like, help me, help guide me, help me, let me endure this. We can get a lot of courage and strength from that. 

Thank you. Okay, question from live audience lust in p***. Love addiction. Visual addictions go from the eyes to the brain. Alcohol, for example, is more of a physical substance we take in. Is it the same type of addiction in the brain? Does it work the same way? 

Yeah, it really does. So I see all types of addictions and they all pretty much work the same way. They work the same way in the brain in that they release a lot of dopamine all at once in a specific part of the brain called the reward pathway followed by this neuroadaptation effect over time where we need more of our drug to get the same effect or in some cases, it actually turns on us and has the opposite effect. And then we end up in this chronic dopamine deficit state where we're not able to take joy in anything else. We have this narrow focus and we basically sacrifice ourselves on the altar of drug seeking and the same trajectory. People usually start out using whatever their drug is either to have fun or to solve a problem. 

If it works for them, they'll use more and more over time and then that same process will occur and the intervention is the same too. When it comes to sex and p*** addiction, it's not often just the behavior that we have to abstain from. It's also the fantasy life that goes with it because that fantasy life is like a stepping stone. And that took me a long time. So once I gave up my romance novels, I still engaged in fantasy. But I eventually realized that was just kind of stoking the fire and that I had to engage my creativity, my creative mind in a different kind of way. And I think that's a lot of it too, that in some ways people with severe addiction are super creative without a good outlet. 

And so if people with addiction can just find a problem worthy of their tenacity and attention, that can be very helpful as well. 

Yeah, thank you for that. Love it. All right, going back to trauma, another question from our live audience nera who asks this question on trauma. If not handling trauma can hinder recovery, how does that relate to relapse? 

Well, if we don't handle our trauma or if we don't process our experience or make sense of our lives or create a narrative that helps us move forward, then we're vulnerable to reverting back to those primitive coping strategies that we used when were as a direct result of the trauma. And we will. So, for example, just again going to animal experiments, there's a series of experiments showing that if you take a rodent and you teach it that if it presses a lever it can get cocaine, it will press that lever till exhaustion or till it dies. If you then remove the cocaine, eventually that lever pressing will extinguish and the animal will realize, oh, there's no more cocaine coming from here. I'm not going to press the lever, and it will go and do different things. 

If you then expose that animal to an incredibly painful foot shock, it has to be a really painful trigger. The first thing the animal will do is run to the lever and start pressing it for cocaine. So, in other words, when we have experienced significant trauma, if we don't somehow metabolize that trauma and make sense of it and intentionally create healthier coping strategies, then when new stresses occur in our lives, we will automatically go back to pressing that lever for cocaine. 

Thank you. Question from Danny from the live audience. Danny says I have fantasy addiction. Sex and love. Anonymous. I never noticed how much I lie. I feel like I have a compulsion to lie. It's almost like when I tell the truth, I am not even sure it's the truth. I feel so much shame over this. How can I work through this? I've committed to no lying and was doing great during the pandemic, but then it all came back. So how can one deal with that situation? 

Yeah. So I have a whole chapter in my book called Radical Honesty, which unpacks the whole lying phenomenon. Because, of course, lying is a big part of addiction and truthtelling is a big part of recovery. And one of the things that I've learned from my patients who get into good, robust recovery and maintain long term recovery is that they've learned they can't lie at all. So not only can they not lie about their drug use, drugs and behaviors, but they can't lie even about little things like why they were late for a meeting. I'll never forget a patient of mine who told me that when he was deep in his addiction, if somebody called him and said, Where are you? And he was at McDonald's getting lunch. He would say, oh, I'm at Burger King. 

And then if they called him when he was at Burger King, he would say, I was at McDonald's. The point being that he lied about everything, and it didn't even make any sense anymore. And the reason that telling the truth is so important for recovery is because truth telling is really, on some level, not natural to humans. Like, the average adult tells one to two lies per day. We're kind of natural manipulators on some level, especially when it comes to showing ourselves in a good light. So that means that in order to be radical truth tellers, we have to be intentional about it and actually set up a little place in our minds where we fact check ourselves. And we have to do that effort fully until it becomes more automatic. But even then, we can slip. 

But it's really worth doing it because, as I postulate in the book, probably what happens when we're truth telling is that we're strengthening our prefrontal cortex, and our prefrontal cortex is absolutely essential for keeping those gremlins in check. And it's also essential to tell the truth in order to foster intimacy, but also to be able to tell truthful autobiographical narratives. Because the stories that we tell about ourselves and our lives to ourselves and others aren't just a way to organize the past. They also create a roadmap for the future. And if we're lying, then we don't even know what the evidence is anymore, right? As you say, sometimes you lie so much you don't even know what the truth is. 

So really important to intentionally put effortful, energy pressing my paints out of bounds in order to tell the truth, even about little things, especially things that we think are maybe not that consequential and don't matter, but if were to tell the truth about it, might put us in a little bit of a bad light. Those little lies accumulate into much bigger lies. I knew one thing I noticed about myself about truth telling, or when I'm telling somebody about something that happened to me, I often have this desire to exaggerate the circumstances because I feel like the truth is not exciting enough and that then somehow I'm not exciting enough, or I'm not interesting enough, or I'm not good enough. 

So that's something else that others maybe can relate to, that I've observed in myself that there's almost it's the lying in the form of, like, exaggeration in order to make my story more interesting and myself more interesting. And those are dangerous lies as well, because what we're depriving our other people of is the opportunity to judge for themselves whether or not that was an interesting story or a dramatic story where, again, it's a little bit self will run riot. We're trying to manipulate other people's experience. Anyway, that was probably too volume answer, but I have a lot to say. 

On that topic, and I love that chapter in the book. I've I've reread that chapter a few times. That's a powerful chapter on radical honesty. Is that the radical honesty? Yes, radical honesty. Thank you. Highly recommend it. Well, I highly recommend the whole book, but chapter eight is one that has meant a lot to me. We're only going to have time for one, maybe two more questions. There are several more in here. What I'll do with the questions we don't get to in this is I'll post them in our WhatsApp group and also on Facebook page, and you guys can all get in and talk with each other about that if that's what you choose to do. So let's talk a little bit about this question from Deborah. Since this Dopamine stuff is biologically in all organisms, why are not all people addicts? 

Why is it just a fairly small percentage? 

Well, people are born with differing degrees of vulnerability to the problem of addiction. We aren't all equally vulnerable. And if you have a biological parent or grandparent that has a history in particular of alcohol addiction, because that's what we have data on. We know that you're at increased risk of becoming an alcoholic yourself, even if raised outside of the alcoholic home. However, having said that, as our world has become more drugified, as access to drugs have increased, as we have developed new drugs that didn't exist before, made old drugs more potent, we are in fact, seeing rising rates of addiction. So just to take alcohol as an example, rates of alcohol use disorder in women has increased 80% and in older people has increased 50% in the last 30 years. 

So these are groups, demographic groups, that we previously thought were more insulated to this problem. What explains that human beings haven't changed in terms of their evolution in the past 50 years? What's changed is the environment and the access. So I think I would suggest to you that really all people are addicts today. All you have to do is look around you and see how people are engaged with their smartphones. 

Excellent. Thank you very much. Okay, well, before we go into the closing bit here, I like to leave the last couple of minutes for any words of wisdom or any wrap up information that the speaker may have. So if you've got anything that you'd like to wrap up with or words of wisdom for us, let's do that here. 

Well, maybe I do see just one short. I'll wrap up with that. In response to this question by Anonymous Attendee, “can the twelve steps help with trauma?” And I would just say the twelve steps can absolutely help with trauma. And I think one of the ways that the twelve steps can help is, again, having us really acknowledge what we have contributed to our traumatic experiences. I know that sounds illogical because the word trauma in and of itself implies that we are victims. And we very much can be bona fide victims of trauma. But I think if we don't stop and look at even the small ways we might have contributed to that situation of trauma, we're probably not going to get past it. 

Thank you for that. That's often such a hard thing to look at. Hey, how did I contribute to this? And like you mentioned earlier, if there was some abuse that happened when I was a small child, my part in that really wasn't much. But how did I perpetuate that as I was growing up in other relationships that I have? That's my part in it, I think. And thank you for sharing that. It's always so powerful to look at that. All right. If you in the live audience or you in the listening audience and podcast, if you're one of the first six people to go to the link that is listed in there at SpeakPipe. 

Reco12 Shares and share a two to five minute share on your experience, strength and hope in this and leave your email address not in the recording, but there's a text box. When you submit it, I'll get in contact with you and send you a copy of Dopamine Nation. Wow. Thank you so much, Ana. That was a great Reco12 weekly speaker meeting. And now if we didn't get to your questions or if you have other questions, please consider joining our WhatsApp community by sending an email with your WhatsApp number to Reco12 pod@gmail.com that's rec twelve@gmail.com and join in our community there and ask those questions, answer other questions that may come up. I invite the audience to come back next week. If you have not yet rated and reviewed the podcast and Apple podcast, please go do so now. 

It's a great way to help us continue sharing this message with more who need this message. Next week we'll be hearing from another Reco12 first time speaker. Excited about this, and she is too. Her name is Ashley S, and she's been very excited about sharing her experience, strength and hope for many months. Her chosen topic is an earnest seeker and I'm really looking forward to hearing her share next week. Now we'll launch off into the rest of our day with the prayer of St. Francis that Anna has chosen and that I'll say for us. Lord, make me an instrument of your peace. Where there is hatred, let me so love. Where there is injury, pardon. Where there is doubt, faith. Where there is despair, hope. Where there is darkness, light. Where there is sadness, joy. For it is in giving that we receive. 

It is in pardoning that we are pardoned. And it is in dying that we are born into eternal life. Amen. Everybody keep coming back. Let's trudge this happy road of destiny together. Work it. You are worth it.