Understanding & Treating Addiction


Key Takeaways

  • Dopamine is not only associated with reward and pleasure but also triggers action

  • A dopamine spike is associated with a subsequent dopamine deficit where levels fall below baseline – this is the moment you chase more or ride out the tough part

  • Pleasure and pain work like a balance in the brain where one is only increased by reducing the other

  • The initial entry point into drugs is often a desire to escape pain, not an attempt to seek pleasure

  • You can be addicted to anything

  • Once you become addicted to something you are more vulnerable to addiction to other things

  • To reset the dopamine system and break addictive patterns: go 30 days without interaction with a drug, person, alcohol, social media, gambling, etc.

  • “The first message I want to get across about social media is it really is a drug. And it’s intended to be a drug.” – Dr. Anna Lembke

  • Our collective mission should be to make sure we’re finding ways to connect with others offline

Dullness Of Modern Life

  • Life today is more boring in many ways – our survival needs are met; we don’t even have to leave our home to have every single need met

  • Even the poorest have more excess leisure time than ever before

  • “Life today is hard in this weird way that we don’t really have anything that we have to do (for our survival) so we’re all forced to make things up.” – Dr. Anna Lembke

  • The easiness of our ability to survive today can be challenging for people who need friction and lead to addiction

  • Boredom is a necessary experience but highly anxiety-provoking

  • “Stop looking for your passion and instead look around where you are. Stop distracting yourself and see what needs to be done – not what I want to do, what needs to be done.” – Dr. Anna Lembke

  • There’s a burden in finding the perfect thing for you and imaging the key will fit perfectly in the lock

  • Build a life around what you can do at the moment and what opportunities are available to you right now to benefit yourself and others

Dopamine

  • Neurotransmitters bridge the gap between two molecules and allow for communication

  • Examples of neurotransmitters: dopamine, serotonin

  • Dopamine is associated with reward, pleasure, and movement – it triggers action

  • Dopamine is always being released in varying levels

  • If we expose regularly expose ourselves to things that trigger high levels of dopamine release, we will actually lower our baseline levels of dopamine over time

  • Experiences have an impact on where baseline dopamine level settles

Impulsivity

  • People with naturally impulsive tendencies are more vulnerable to addiction

  • Impulsivity: difficulty putting space between desire and action and withholding behavior

  • Impulsivity is not always bad – there isn’t self-editing or worrying about future consequences which can come into use in fight or flight scenarios

  • We live in a sensory-rich environment and have to constantly check ourselves

Pleasure-Pain Balance

  • There are two sides to pleasure: (1) seeking out high, euphoria – and (2) seeking experiences that dull or avoid pain

  • Oftentimes initial entry point into drug use is a desire to escape pain, not seeking pleasure

  • Pleasure and pain are co-located in the brain and work like a balance, tipping inversely

  • The brain works hard to keep pleasure and pain in constant balance and neutrality

  • We are not always aware of the pain until we begin to pay attention at the moment

  • Example: you gain traction on social media and can’t stop spending time on it because if you disengage you will have pain in missing that feeling of reinforcement


  • Pleasure is reduced by way of increasing pain

  • Pain mechanism has some competitive advantages over pleasure

  • After you do something pleasurable, the brain immediately compensates by downregulating dopamine

  • If you wait long enough after high, the brain will go back to its neutral state – but – if you don’t wait because the crash is too rough, you are resetting the brain to a dopamine deficit state

  • You want a resilient, adaptive balance where you don’t allow yourself to stay in pleasure or pain too long

Addiction

  • We really live in a time where we’re invited to become addicted to something – social media, email, checking our phone, etc.

  • The hallmark of any addictive behavior is that it releases dopamine at high levels

  • Addiction is a progressive narrowing of the things that bring you pleasure

  • The addictive process is the same, regardless of whether you’re addicted to gambling, drugs, sex, etc.

  • Once you’ve become addicted to anything, you’re more vulnerable to addiction to anything

  • People with severe addiction suffer from a lack of homeostasis in the pleasure-pain balance

  • Addiction is like having an itch and being told you can’t scratch it – it’s always there and maybe you’ll scratch it in your sleep because an unconscious opportunity

  • Addicts really cannot, not do it

  • We all have a propensity for addiction but some channel it into things that are more socially acceptable, like work or success

Recovery & Shame

  • Focus on just doing today right

  • Connect with your environment, not trying to escape it

  • To reset the dopamine system and break an addictive pattern: Do 30 days of zero interaction with drug, person, alcohol, gambling, etc.

  • Days 1-10 will be very uncomfortable – you will feel worse before you feel better

  • By week 2 the sun will come out

  • By weeks 3 and 4 you will feel better than before you started the addiction


  • The carrot is there’s a better life out there

  • Addicts want to discuss recovery: oxytocin is linked to dopamine release so when human connection is made, it’s stimulating

  • Telling the truth about details of life is central to recovery

  • Recovery isn’t just not lying about using drugs, it’s becoming transparent about everything

  • The act of righting past wrongdoings is cathartic – asking forgiveness is important in the twelve steps

  • Truth-telling strengthens circuits in the pre-frontal cortex and enhances connections to the limbic brain and reward brain

  • Being open and honest creates intimate connections which stimulate dopamine release

Relapse

  • Sometimes relapse occurs when things are going really well for the person because there’s a removal of the hypervigilant state

  • There are people who will die of disease of addiction

  • There are physiologic changes that will occur with sustained drug use

  • Thinking about triggers associated with drug use or drug use can already release anticipatory dopamine

  • The dopamine spike is associated with dopamine deficit where dopamine falls below baseline

  • Dopamine deficit state drives action to get drug

  • Another way to frame understanding addiction, recovery, relapse: think about the thing you love doing most in life – and imagine you couldn’t do it

Psychedelics

  • Condensed psychoanalysis + MDMA or drug which allows a person to get out of own head and look at life in a broader sweep

  • Dr. Lembke is skeptical about the longevity of psychedelic therapy long term for addiction recovery

  • Please be sure to see a legitimate guided psychedelic experience and don’t DIY

Social Media

  • “The first message I want to get across about social media is it really is a drug. And it’s intended to be a drug.” – Dr. Anna Lembke

  • Use social media with intention and with planning so you don’t get sucked in

  • No one who is getting addicted thinks they’re addicted

  • Things we’ve learned from other drugs also applies to social media: put barriers in place that allow you to remain in control of the use

  • Tip: try even a single day without your phone

  • The collective mission should be to make sure we’re preserving offline ways to connect

  • We’re losing the ability to have a sustained thought because we can just look anything up immediately

  • Social media is fueling a preoccupation with ourselves & success – we’re getting feedback all the time about ourselves


 

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