Prepare to be captivated by an enlightening conversation with our esteemed guest, Dr. Anna Lembke, a renowned professor of psychiatry and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. We dissect her New York Times bestseller, Dopamine Nation: Finding Balance in the Age of Indulgence, and examine the scourge of overconsumption in this dopamine-fuelled world. We're opening up about our own battles with addiction, and how this once vital component of survival is now swamping our brains, leading to numerous problems we encounter today.
Probing into the brain's intricate workings, our dialogue with Dr. Lembke demystifies the neuroscience of addiction and dopamine's complex role in achieving a balance between pleasure and pain. Have you ever wondered how our brain attempts to maintain equilibrium, and how refined food consumption impacts this? Our discussion dives deep into this, shedding light on the pleasure-pain vicious cycle and drug reminders' unsettling effects on dopamine levels. The path to abstaining from addictive substances isn't smooth, yet we'll equip you with strategies and emphasize the importance of recognizing triggers that could spike dopamine levels.
Shifting our focus to discomfort, we explore its transformative power. We uncover the intricate links between addiction, dopamine, pleasure, and pain, offering practical tips to introduce pain in manageable doses, thereby counteracting addiction effects. The potential of mutual help groups and collective suffering in dealing with discomfort and pain might surprise you. New neural networks can be formed through activities such as cooking and exercising, which can be helpful in addiction management. Join us as we navigate the rough terrains of addiction and recovery, examining their challenges and effects.
Take the first step and join us on this enlightening journey. Let's navigate the complex terrains of addiction and recovery together, one step at a time.
Florence's courses & coaching programs can be found at:
www.FlorenceChristophers.com
Connect with Florence on:
FACEBOOK | TWITTER | INSTAGRAM | YOUTUBE
Prepare to be captivated by an enlightening conversation with our esteemed guest, Dr. Anna Lembke, a renowned professor of psychiatry and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. We dissect her New York Times bestseller, Dopamine Nation: Finding Balance in the Age of Indulgence, and examine the scourge of overconsumption in this dopamine-fuelled world. We're opening up about our own battles with addiction, and how this once vital component of survival is now swamping our brains, leading to numerous problems we encounter today.
Probing into the brain's intricate workings, our dialogue with Dr. Lembke demystifies the neuroscience of addiction and dopamine's complex role in achieving a balance between pleasure and pain. Have you ever wondered how our brain attempts to maintain equilibrium, and how refined food consumption impacts this? Our discussion dives deep into this, shedding light on the pleasure-pain vicious cycle and drug reminders' unsettling effects on dopamine levels. The path to abstaining from addictive substances isn't smooth, yet we'll equip you with strategies and emphasize the importance of recognizing triggers that could spike dopamine levels.
Shifting our focus to discomfort, we explore its transformative power. We uncover the intricate links between addiction, dopamine, pleasure, and pain, offering practical tips to introduce pain in manageable doses, thereby counteracting addiction effects. The potential of mutual help groups and collective suffering in dealing with discomfort and pain might surprise you. New neural networks can be formed through activities such as cooking and exercising, which can be helpful in addiction management. Join us as we navigate the rough terrains of addiction and recovery, examining their challenges and effects.
Take the first step and join us on this enlightening journey. Let's navigate the complex terrains of addiction and recovery together, one step at a time.
Florence's courses & coaching programs can be found at:
www.FlorenceChristophers.com
Connect with Florence on:
FACEBOOK | TWITTER | INSTAGRAM | YOUTUBE
Welcome to the Kicks Sugar Coat podcast. Join me each week as I interview experts who will share the science of sugar, sugar addiction and different approaches to recovery. We hope to empower you with the information and inspiration, insights and strategies you need to break up with sugar and fall in love with healthy, whole foods so you can prevent and reverse chronic disease, lose weight, boost your mood and energy. Feel free to go to my website for details on my coaching programs and to access free resources KicksSugarCoachcom. Hello everybody, welcome back.
Speaker 1:I am very pleased and very excited to interview and introduce Dr Anna Lemke. She is a professor of psychiatry at Stanford University School of Medicine, the chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She's a clinical or clinician scholar has published more than 100 peer reviewed papers, book chapters and commentaries. She sits on a variety of different boards. She, in 2016, published a book called Drug Dealer MD how Doctors Were Duped, patients got hooked and why it's so hard to stop. I believe that's in relation to the opiate crisis. This book was highlighted in the New York Times. This is one of the top five books to understand the opiate epidemic. Dr Lemke also recently appeared in the Netflix documentary the Social Dilemma, talking about the impact of social media on our lives and most recently she has published the book A Dopamine Nation Finding Balance in the Age of Indulgence, which became an instant New York Times bestseller, and it explores how modern I'm sorry compulsive overconsumption is happening in our dopamine overloaded world. Welcome, dr Lemke.
Speaker 2:Thank you for having me. I'm excited to be here.
Speaker 1:Well, I have to just start by saying if you have not yet got your copy of Dopamine Nation, you can read it in hard copy. You can also listen to it on Audible, which is what I did. And it starts out with this gripping story of one of Dr Lemke's patients who very, very young I believe it was at the age of four got hooked on masturbation. Really, but really the most elaborate, shocking story, like if it was in a movie I would think in my head. Who thinks these things up Like you think it was, like you made these stories up in your book, but obviously you know you didn't.
Speaker 2:So yeah, and I yeah. So first let me just express gratitude to my wonderful patients who are willing to share their stories Sudanese, using pseudonyms, because I was very brave of them to do that, and very generous, but also important. Importantly, all of the stories are true. None of it is made up. Some slight maybe demographic or geographical things are changed to hide identity, and I do think that that's a strength of the book, that it's not a composite patient, not that there's not value in that, but that these are real life people and really art does imitate life, because these are situations that it's hard to imagine we can get ourselves into and yet we do. These are the lives that we live now and any of us could end up there.
Speaker 1:And really, in some ways, when I was listening to them, some of those stories, I was just gobsmacked by some of them. Some of the intensity and the creativeness of getting these dopamine fixes blew my mind. And then I think, florence, you think back to some of the stuff you've done with food, girlfriend, and it is no less crazy. I have dug food out of the garbage. When I was a kid, I used to go down and pick gobs of gum from underneath seats, like stuff that disgusts me today. Right, like no, we're probably all falling somewhere on this spectrum these days, and it's good to be forced, or be invited to be reflective of what ways are we hooked on dopamine and what ways is it narrowing our lives and creating despair and pain. And so talk to us about what's so wrong with being hooked on dopamine and how did we get all, how did so many of us get hooked on dopamine?
Speaker 2:Yeah. So first of all, thank you for sharing those honest details about your own struggles. I always find that very moving and I'm grateful for that. So dopamine, it's not bad or good. It is a chemical that our brains make that are essential to our survival, because dopamine is the molecule that tells us whether or not this is something that we should approach or try to get more of.
Speaker 2:And for most of human existence, we have lived in a world of scarcity and ever-present danger, which means that our ability to strive to get the things that we need to survive are absolutely fundamental, and dopamine allows us to do that. Essentially, when we have an experience that our body tells us is necessary for survival food, clothing, shelter, finding a mate that releases dopamine in a very specific part of the brain called the reward pathway and that tells us first of all it feels good. So dopamine is constantly firing at a tonic baseline level. When we do something that our brains interpret we need for survival, dopamine firing increases above baseline levels. The higher it goes, and the faster it goes, the more reinforcing it is. So the fundamental sort of signature of things that are addictive are things that release a lot of dopamine and release a lot of dopamine very quickly and again, we're wired for that. We want to recreate that experience.
Speaker 2:It is what has allowed us to survive in a world of scarcity, the problem being that now we no longer live in that world. We now live in a world of almost universal access to instant gratification. Science has allowed the engineering of highly potent, highly reinforcing drugs and behaviors really at the touch of a fingertip and, as a result, our brains are now having to process a fire hose of dopamine, and that is what has led to the kinds of problems that we're seeing today. So it's not that dopamine is bad. It's that dopamine is the molecule that gets us to approach and seek out and want more of, and that's really adaptive in a world that is very unlike the world that we inhabit now.
Speaker 1:Yeah, it has always struck me as completely insane that my body would crave and call for processed foods that I knew would trigger consistently, would trigger migraines, depression, infections, later cancer. Like 45 pounds extra on my body, like it was like so confusing to me. Why are you calling for this while you're slowly, it's slowly killing you? Like what kind of malfunction is going on in my body and of course, I thought I was the malfunction. I thought what is wrong with me that I'm? I know if I eat this pizza tomorrow I'm going to be sick. Like what is going on here. Can you help us understand why the body would drive us towards substances that are killing us at the same time?
Speaker 2:Yeah, so I love that you have shifted the frame, which is a fundamental shift, that it's not that there's something wrong with our brains per se.
Speaker 2:It's that we have created a drug that is so reinforcing that it releases far more dopamine than our drugs, than our brains evolved to accommodate. So, then, there's nothing wrong with that. It's. The problem is that it's a mismatch between our primitive wiring and the modern ecosystem.
Speaker 2:So I think that's really important, because what you identified in your younger years as something wrong with you because you wanted to eat more pizza also then goes along with shame and blame, whereas if you had been able to see that, oh, pizza is food that has been engineered to be addictive, and that means that it is very easy for my brain to mistake pizza as essential for my brain, it's essential for my survival, when, in fact, what pizza is really doing is confusing my reward pathways by releasing so much dopamine all at once.
Speaker 2:That then again leads to this spiraling decompensation mechanism, where we then go into this dopamine deficit state which I talk about in dopamine nation, using this extended metaphor of a balance. But the bottom line is then we get into that vicious cycle where, even when that drug is no longer giving us pleasure, because with repeated exposure, what happens is it stops releasing dopamine and instead leads to this dopamine deficit state. But the drive and the motivation and the equating that drug with survival that persists and that's the ways in which our brain becomes confused when faced with a drug that's been engineered to be addictive.
Speaker 1:Right, right. And with respect to process refined carbohydrates and all to processed foods, which is kind of the focus of our summit, because there's so many of us that have been listening to the news and watching the science roll out and we all know better now that really we should be significantly reducing, if not eliminating, these refined carbohydrates. And as we start on that path we realize dang, this is harder than I thought Like why it shouldn't be this hard. And I suppose innocently at first, our clever little brains we learned how to turn grains into powders and that turned into sugar really quickly in our bodies and spake to feel good neurotransmitters. And then over time I think what was probably an innocent refinement process that brought some pleasure became like almost a sinister genius lab.
Speaker 1:You know engineering, like the hitter bliss point into, have us become hooked. And the food giants they know what they're doing now, like they know what, what hits the spot and gets us right and eating these foods despite the fact that we're obese and depressed and have cancer. Like I've had clients that have come to me that have had diabetes for 20 years and cancer twice and I say, okay, now I'm ready. Like I'm ready. Like now I want to really know I've needed to get off this, but now I'm scared, and so what do we do when these, these foods that have been processed, that are creating such a dopamine hook, how do we begin the process of unhooking?
Speaker 2:I think the first thing is to recognize what is happening in our brain and the fact that pain and pleasure are co located in the brain and work like opposite sides of a balance and one of the overarching rules governing that balance, with planet pleasure on one side and pain on the others, that it wants to remain level, or what neuroscientists call homeostasis, and that our bodies and brains will work very hard to reassert a level balance or homeostasis. And that's not any deviation from neutrality. And the way the brain does that and this is really the key is first by tipping an equal and opposite amount to whatever the initial stimulus was. So when we refine foods, we get a release of dopamine and the reward pathway our brain balance tilts to the side of pleasure. But no sooner has that happened that our brain will want to restore a level balance. But it doesn't do it just by going level, it does it first by tipping an equal and opposite amount to the side of pain. That's the come down, the after effect, the hangover, and that's what we get from eating sugar and refined foods. We go into a dopamine free fall right where we we have a come down and, of course, the natural response when our pleasure pain balance is tilted the side of pain. After that, the initial pleasure is to reach for more of said drug to get us out of that painful state. So that's, I think, really the key is that when you have these potent pleasures that cause this huge deviation from neutrality which is, by by the way, also a trigger and triggers cortisol and the stress response in the process of trying to restore homeostasis what you get is its opposite in pain and in an environment where you then have immediate, easy access to more of that drug, then you will take more of it right to try to get it.
Speaker 2:Here's the tricky part with repeated exposure to the same or similar initial stimulus, that initial deviation to pleasure gets weaker and shorter, but the after effect to pain gets stronger and longer and ultimately, over time, we get a pleasure pain balance that's tilted to the side of pain or in a dopamine deficit state. And now we need our drug not to feel good but just to level the balance and feel normal. So that's the vicious cycle that we're dealing with and that that informs what we need to do about it. And what we need to do about it is, first and foremost, abstain from our drug of choice long enough to give the body time to reset normal dopamine firing and for that balance to restore homeostasis in the absence of drug. The other thing we need to do is put barriers between ourselves and our drug of choice, self binding strategies so that if we experience a dopamine, you know a little dopamine hit and it's opposite the come down. So we can more easily press the pause button between wanting to restore homeostasis by grabbing more of our drug and actually grabbing it because it's not immediately available to us. So these are common sense strategies, like not having the potato chips in the house.
Speaker 2:But the other thing to recognize is that that dopamine spike can be triggered, is triggered not just by the drug itself but also by reminders of the drug. And reminders of the drug can be people, places and things, as they say in a but can it can also be our own euphoric recall and we think about and this is where these insidious food videos are so horrible. You know, when we watching a food video or we're just remembering, you know a euphoric experience with eating one of, usually one of the earlier experiences because of course, as time goes on, with repeating exposure, there's no longer pleasure but we're still craving it because we're in that dopamine deficit state. So even euphoric recall can release a little bit of dopamine, which is followed by a dopamine deficit state which then creates the craving to go out and get the drug to be to restore homeostasis.
Speaker 2:So I think the key piece here is that, although we often think of addiction as about pleasure seeking, it's really not about that. It's really about getting out of pain and restoring homeostasis. After we've gone into this dopamine deficit state, which is very similar to a kind of clinical depression, because the universal symptoms of withdrawal from any addictive substance or anxiety, your ability, insomnia, dysphoria and craving Again, simple first line interventions abstain from the drug for long enough to reset dopamine homeostasis On average this takes about 30 days and then implementing self binding strategies. These are literal and metacognitive barriers that we put between ourselves and our drug of choice so that if we do through, let's say, euphoric recall or triggers, have a craving to use. We would have to do a lot more work to get it Right because it's not easily accessible.
Speaker 1:Amazing. So with respect to the whole abstaining we have, almost every addict, in the early stages of hearing those words, are like terrified, and they feel grief and know there's got to be another way. You know, and of course we try all kinds of things. Some of us are so desperate to avoid abstaining from our drug of choice and our case, sugar refined carbohydrates that will. We would be able to do supplements or surgeries or pharmaceuticals or therapy or something right will do almost anything to try and be able to do anything except for truly abstain.
Speaker 1:So with respect to abstinence, though, it's like really interesting that the research is showing that we do need to abstain to repair the brain, to bring it back to baseline. But the question then becomes because every addict knows, okay, great, even if I put down this drug that I've got, there's other ones that crop up. So to what extent do we need to like really be tuned into what exactly are the things in our lives that are tweaking our blood or, sorry, our dopamine levels above baseline? That's still keeping that addict brain alive. That's just spinning us around, just in different directions in different ways.
Speaker 2:So first of all, let me backtrack a little bit and say that the surgeries and things that that people get some people you know are needing to do that in order to abstain. So it's not necessarily always like you either abstain or you get the surgery. Sometimes people need the surgeries or other kinds of medical interventions, let's say medication, to help them abstain, and I think that's okay. You know, we have to, like make room in that for more severe cases where people just they need that additional help. So, in terms of cross addiction, so all drugs, all addictive substances and behaviors because behaviors can also be addictive gambling, pornography, social media, gaming, shopping, you name it All of those drugs and behaviors work on the same final reward pathway. They all release dopamine ultimately. So they work by different mechanisms the endogenous cannabinoid system, the endogenous opioid system, serotonin or penefren but the final common pathway for all of these substances and behaviors is dopamine, which means that as we're working on one drug of choice, we are vulnerable to what's called cross addiction, where we just switch to another substance or behavior to replace the first behavior and unfortunately that doesn't really work, because what ends up happening is that initially it may help us restore homeostasis. But ultimately, as I talked about these neuro adaptation gremlins, more of them will hop on the pain side of the balance and will be in the same position. This has been shown with animal studies. For example, if you take a rat and you get it addicted to cocaine and then you remove cocaine for a year which is about a rat lifetime and then you expose that rat to cannabis, it's much easier to get that rat addicted to cannabis if it had previously been addicted to cocaine that if it had never been addicted to anything. So that's one of the many clues we have that once people become addicted, it does leave a kind of latent scar in the brain that makes them vulnerable to future addictions. So that means we just have to be very mindful of cross addiction.
Speaker 2:This kind of standard idea that you can just replace one drug with another or one reward with another as a way to get out of addictive use really doesn't work in the long term, and instead what you need to learn to do is to sit with and tolerate discomfort, which is something that we really don't learn. You know, in our culture we don't have many opportunities to practice that because there are so many distractors and ways to comfort ourselves. It's very counter cultural. So we also feel like we're the only ones and everybody else is out there having fun, where and it's hard to you know suffer alone, whereas if you're suffering, you know, with others, for a common purpose and meaning. It's much easier to tolerate pain. In fact, we can tolerate a lot of pain if we feel like we're not the only one and it's for some higher meaning or purpose. This is where kind of mutual help groups can be really helpful, to where you, you know you have a group of peers going through the same day at the same time, suffering together, but counter intuitively.
Speaker 2:The other thing that we can do is intentionally do things that are more painful than the pain of withdrawal, and the reason for that is, if the initial stimulus is pain, then actually those neuro adaptation gremlins hop on the pleasure side and that means that the the opposite effect of the initial stimulus of pain is actually pleasure. And this is the runners high after exercise. This is the kind of mood boost that people get from ice, cold water baths or really any kind of hard thing. You know that we do incrementally, in small doses over longer periods of time, and they're just saying to me. Well, how can I get through the pain of withdrawal?
Speaker 2:The intuitive thing is well, you know, make yourself comfortable. You know, watching Netflix show. You know, use another reward instead of the. You know the way you're trying to give up. But that only goes so far. What I also do patients is, well, you know, in that moment, do you know if you can do? Do do 25 sit ups right, or plunge your face in an ice cold water, the idea being that pleasure pain, because they're co located, are tied to each other and their relative. So one of the ways to escape pain is to do something that's more painful and then that first pain, relatively speaking, doesn't look so bad.
Speaker 1:I remember them when you said it in the book, like that is really an interesting strategy. And how, how long do people need to do that to actually sort of make themselves feel more pain before the brain heals and they can feel good without leaning on, you know, substances of abuse or behaviors of?
Speaker 2:pain. Yeah, so my hypothesis is that because we live in a world that's saturated with dopamine and we have at our fingertips so much access to these highly reinforcing intoxicants, and because we're relatively so insulated from pain that it is become that that we as humans actually now need to intentionally invite pain into our lives on a regular basis. So how long does it take? You know? How much do you have to do that painfully? I would argue we have to do that as a daily practice for life, right, that we really have to reframe pain and think about cutting on yourself. In fact, cutting on yourself releases endogenous endorphins, because the way that pain is healing is that it tells your body oh my gosh, we're in a dangerous situation.
Speaker 2:Need to up, regulate production of feel good neurotransmitters, dopamine and serotonin and norepinephrine. But we need to make sure that we don't do pain in two high doses, because what we get with cutting, for example, is we get a surgeon, endogenous opioids, which leads to the release of dopamine, but very quickly our brain adapts to that, so that effectively cutting amounts to an intoxicant, right? So we're not talking about that type of thing, because that type of thing can in and of itself be addictive. Even exercise can be addictive or other. So we're talking about sub threshold levels of pain, mild to moderate, whatever you can tolerate in regular you know regular increments on a regular basis in order to change our you know pleasure pains.
Speaker 1:that point, Right, and I love that it could be something as simple, as I really don't want to get off the couch and stop watching Netflix and eating popcorn. I'm going to get up, I'm going to put my shoes on and I'm going to go for a walk around the block right, because it's painful. I don't want to be doing this. My body wants to just be comforted, and so that would be an example.
Speaker 2:Great example, because that's pretty much where we are as a society. Society we're not talking about, for most of us, climbing Everest. We're talking about finding the will inside of ourselves to not press next episode and instead to get up off the couch, put on our shoes, go outside and go for a walk, and just to keep the pain that the walk will be possibly unpleasant the entire time, that it won't be fun and won't feel good, but that we're, you know, resetting our reward pathways.
Speaker 1:Amazing and I definitely call that the daily grind, because once we put down sugar, refined carbohydrates, it's one thing to stop a behavior, but then we have to start the behavior of making three whole meals and it's a grind. It's a lot of work to wash and shop and cook and you know like really take care of our bodies really well, and there's like eight different ones that we kind of recommend and they are hard work and they are uncomfortable. Yes, over time it's really interesting that almost all of us recognize the slowly our body starts to crave it.
Speaker 1:We crave the walk in the rain, we crave the run, we crave getting into the kitchen to make a beautiful meal, to sit down and eat it mindfully that we begin to crave the things that truly nurture and nourish and and strengthen our bodies.
Speaker 2:And so great. And so the other thing that's happening in the brain with that is that we're creating new neural networks. So you know what fires together, wires together the neural networks that we practice daily, whether they're in the addiction direction or in a healthy and adaptive direction. That's what then ends up, you know, getting a lot of oxygen. So it is the repetitive behaviors over time in a healthy direction that ultimately deprive those maladaptive circuits of oxygen, strengthen those new circuits, and then those become the default, the default circuits or the, you know, the default resting networks as we think about it. And you know that is essentially what it habit formation is.
Speaker 2:Habit formation is our neural circuits that we use reflexively without the cognitive load of having to decide to do it one way or another. And once you get into healthy behaviors and healthy habits that's just sort of your default circuit it'll be harder to decide to not make the healthy meal and go to McDonald's then to just do the thing that you've been doing for the past 100 days, which is, you know, buy the groceries and go to McDonald's, then to just do the meal and sit down and eat it. And so we really are quite simple, you know beings in a funny kind of way we make things complicated. But you know, with repetition of behavior, the behaviors become habitual. And this is really important because I often tell you, know you don't, you can't wait till you feel like doing a new behavior, because that day will never come.
Speaker 2:You have to do the new behavior repetitively until it becomes an ingrained neural network and then you will discover that you enjoy the behavior or that the behaviors are rewarding, or that you don't even recognize the person who did the other behaviors. But you have to kind of act contrary to feelings. And this is, of course, very counter cultural too. Right, because we are all about what am I feeling in the moment? Why am I feeling this? If I only understood why I feel what I feel, that I would change my behavior. But it's really not true. Behaviors get a life of their own and we have to change behaviors.
Speaker 1:Is great saying in a fake it till you make it, which is really important in early recovery to those first couple of months of, you know, not using this is so cool because I think that we can endure pain and hard things and tough times if we know they're going to end and if we know we're heading in a better direction. And and I feel like, if every sugar addict can think about the hard work of being tired and miserable and having cravings and our moods are really long or irritable and we just think this is going to go on forever and will crave sugar and feel deprived and left out for the rest of our lives and know that that's just a temporary phase of recovery and that every day, as we do, the painful grind, that painful grind of doing things differently, is actually tipping, rebalancing our brain. It's like the healing work, because it doesn't feel that way when you're in the middle of it.
Speaker 2:That's right, it's so interesting. One of my patients described recovery as akin to a scene in Harry Potter when Dumbledore progresses down a dark alley and on his way lights the lamppost as he goes and then, when he gets to the end of the alley, turns around and sees that the alley's, you know, illuminated. And I think that's a wonderful metaphor for recovery, because it takes a lot of courage to enter and go down a dark alley and not know where you're going to end up and to be frightened and to be groping in the dark. But if you just light each lamppost as you go, you will get to the end and you'll look behind you and it'll be this wonderful illuminated scene.
Speaker 1:So I love that and you know which one has come to mind for me. There's a scene in oh gosh with Simba the lion, the lion king, and he's born into this beautiful lush landscape with his wonderful family that loves him and their friends, and everyone's wonderful and all kinds of color.
Speaker 1:And then, slowly, as he moves toward where the hyenas are, and it's dark and it's gray and it's cold and it's sinister, it's like the dark alley that's scary, where that, to me, is the land of addiction right and and so it's colorless and all we're doing is we're just living for these little scraps of something that might try and take the edge off the pain and despair and anxiety in us and and, but slowly, as we walk out of the dark, gray hyena land, the addiction world, we get more color and it gets warmer and the sun comes out, and then the birds are chirping and there's beautiful, happy people there that are walking the road of recovery and they're welcoming you and saying you came, you arrived, but we don't believe, while we're walking, that we're ever going to get there. It's just so. What words can you offer people? That the brain will heal, that we will end in this lush, loving, new happy place?
Speaker 2:well, I again. I like to talk a little bit about the neuroscience here and the ways in which addiction is the process of disconnecting the prefrontal cortex from the midbrain limbic structures. So the midbrain limbic structures, that's the reward pathway, this pleasure, pain, balance, and when things are working correctly, that's kind of like the accelerator of the car. And the prefrontal cortex, which is the gray matter area right behind our foreheads, is the breaks of the car. The prefrontal cortex is where we anticipate future consequences, it's the storytelling area, it's the delayed gratification area and it's really important for us to, you know, mindfully manage our consumption by putting the breaks on, you know, at certain intervals. But and what you'll see very clearly in the brain is there are these strong neural connections between the deeper reward pathway, the limbic emotion structures, and this prefrontal cortex. They're, those are really. That's like it's a highway, right, they're talking to each other and dopamine is very involved in that. And what seems to happen in the process of becoming addicted is that we actually disconnect the prefrontal cortex from the limbic area, so they're no longer talking to each other and that means that that limbic area gets a life of its own and we're being driven by that raw animal, what's often referred to as the triune brain or the lizard brain. Why is it called that? Because it's been our. Our reward pathway is essentially unchanged over millions of years of evolution and identical to a lizard and any other species you could name. That's how conserved it is in nature.
Speaker 2:And once we're in lizard brain we really cannot see true cause and effect. We lack truly lack, the capacity to see the impact of our drug use on our lives. We cannot see it, just like a person with bipolar disorder in mania can't see that they're not really god, or a person with schizophrenia and delusions can't really see that there's not a chip implanted in their brain. Right, it really is a kind of a delusional state where we can't see that the connection. And that's why that homeostasis is so important and the period of abstinence is so important.
Speaker 2:It's hard, but once we reset reward pathways, the other thing we reset is the connections between our lizard brain and the prefrontal cortical area behind our forehead, so that they're talking to each other again.
Speaker 2:Once that happens, then we're able to say oh, wow, and I see this all the time in my patients. After they abstain for a month they will come back and say I really wasn't able to see the impact of my drug use on my life, but now I can see it and in fact, when I look back at my drug using self, it's surreal to me and I love the use of that word, surreal, because there really has that quality, like who is that person that was willing to do those crazy things and sacrifice so much for that drug? It seems bizarre I don't even I can't feel it now what that person was feeling. It's so bizarre. And yet when we're in it it's the only thing that makes sense is to get more of our drug. So that's very, you know, fascinating to me how, how abstinence can allow for that circuitry to reconnect, allow us to have the insight which we absolutely need to get, you know, to be able to make informed decisions going forward how does abstinence do that?
Speaker 1:why does the neocortex come back online after a 30 day break like a clean, total break?
Speaker 2:well, I think it's a matter of valence right. So again we have this notion, this is Hebb's notion what wires, what fires together wires together. This is a fundamental neuroscientific concept that the circuits that we use most often are the ones that get strengthened right and make new circuits. There's what's called synaptic plasticity. The synapse is the area between neurons, and they become elaborated and they're changing all the time, making new connections.
Speaker 2:So what essentially happens in, you know, in addiction, is that we stop using our prefrontal cortex right. We stop telling true stories. We tell stories that are not true, that are addiction stories, that allow us to continue to leave this double life lie to ourselves, lie to others. We're essentially not telling those stories go offline. We're not engaging that part of the brain that allows us to truthfully anticipate the future consequences of our behavior, which is what the prefrontal cortex does.
Speaker 2:For example, imaging studies have shown that when people are engaging in immediate rewards, like rewards that they get right away, the part of the brain that lights up is the emotion brain, the lizard brain, not the prefrontal cortex. When people are engaging in a task related to remote rewards, that is to say, rewards far in the future, the part of the brain that lights up is the prefrontal cortex. What happens in addiction? Just like any muscle, we stop exercising the prefrontal cortex and it atrophies. Bless you, we're exercising our pleasure, pain, balance, our emotion brain, our immediate reward brain, and then that just takes over. Then we're basically behaving at a very primitive, animalistic level.
Speaker 1:Right, very self-harming, which is just baffling that somehow it's like this loophole. It just seems to me that addiction is like a malfunction at the brain level. With respect to food addiction, is it possible that it might take us longer than 30 days to reset? Because I think, generally speaking, most of us coaching and working in the space in 12-step programs, let's say we need a full 90 days, it seems, for that neocortex to really be strong enough to start to apply the brakes with some confidence. What would you say to that?
Speaker 2:Oh yeah, when I say 30 days 30 days is like the bare minimum in my clinical experience that people need to begin to have some insight, to begin to be able to see that there's a light at the end of the tunnel, that they actually start to feel better. The key piece here is that in those first two weeks people go into withdrawal Again universal symptoms of withdrawal from any addictive substance or behavior, including food, anxiety, irritability, insomnia, dysphoria and craving. But in my experience, once people get to about week three and four, they start to feel better. Does that mean that they're completely restored homeostasis and they're good to go? Absolutely not, especially for a drug that involves food, which we need to survive.
Speaker 2:We can't just not eat. So we're talking about having to create different eating habits, not stop eating altogether. So that's more challenging in many ways. So, and the data will show and this is also true for alcohol like alcohol, you're just kind of barely coming out of your stupor at 30 days, really 90 days those people tend to do better. So, and that's that's been shown with traditional drugs as well that people who abstain longer have a greater chance of success going forward, and I would say that that healing process goes even further than that. You know, like probably most of the time, once we've been addicted we're talking 18 to 24 months really to get to that place where people are in a robust recovery and can have confidence and kind of count on their recovery as they continue to do their work. Because we know, in a dopamine overloaded world, you know we're all at risk for relapse because we're constantly being chased down by these drugs. We can't avoid them when we want to.
Speaker 1:Yes, I love that. That, yeah, because I've heard that too. 18 to, you know, year and a half to two years to really feel like you've got a very solid, resilient recovery. Oh gosh, I just had a really good question just went out of my head. Just give me one second. Oh, I know, I know. So you're going to hear this. I'm sure you hear this from your clients. I hear it all the time. I've thought this in my entire time as my own self. But can't I just just have a bite? Can't I just make one? It's my birthday. Can't I just make an exception? What would you say to that?
Speaker 2:So what I like to do is cite this really important animal study that basically took a bunch of rats and exposed them to injections of cocaine consecutively over seven days, and typically a rat in a cage will hide and hover along the edges. Rats don't like to go out into the exposed middle area, but with each successive day of cocaine rats will move into that middle area and they'll start jogging and then they'll start running and by day seven they're in a running frenzy, just going all over right Because cocaine is a stimulant. Then if you don't give that rat any cocaine for a year which again is about a rat lifetime and then you take that same rat and you give it a single injection of cocaine, what you observe is that the rat is immediately in a running frenzy, in a running frenzy similar to what they were at day seven. In other words, once the rat is in a running frenzy, once the rat has been exposed to a week of cocaine, it does appear that there's some type of fundamental permanent brain change such that even after a rat lifetime, a single exposure of that same drug can plunge the animal right back to where they were at the height of the running frenzy. And we see this all the time in clinical work.
Speaker 2:A patient who's been in recovery from addiction, let's say from alcohol, for decades has a single exposure to alcohol, or maybe to a drug like an opioid, which works on the endogenous opioid system, and alcohol works on the endogenous opioid system, so they're similar. And then immediately that person is plunged back into their severe addiction without any kind of startup time, again, suggesting that that brain is fundamentally altered. The neuroscience shows that, too, that recovery is probably a process of creating new neural networks that reroute around those damaged areas, and that those damaged areas probably never heal. Right that there's, healing occurs, but it occurs because of rerouting and new neural networks being created. Those networks never go away. And so that's really important because when we think about oh, just one bite, what we're really doing is tempting fate there, and we're tempting biology more importantly, because we're really inviting the possibility of reawakening those latent neural pathways and potentially plunging ourselves right back into it.
Speaker 2:And that's not going to happen to everybody. What is a more common scenario is an initial ability to sort of moderate and then a slow slippage back to addictive use for many people with severe addiction. In my experience, it's a real minority of people who can moderate their use once they've been addicted to a drug. I do see that, but it takes a lot of effort, so much so that many patients will say it's not worth it, like it's more exhausting to me to try to moderate my use than to just abstain. But it can take a long time for people to realize that.
Speaker 1:Oh my gosh that's oh, this is the most precious interview. I love it, Right. So we just have a little bit of time left and I want to indulge a question about a really interesting part of your book. In the book you're talking about some science around gambling and how gamblers the height of their dopamine. It peaks In that moment of uncertainty before, oh, is that going to land in my? Am I going to win or am I going to lose?
Speaker 2:Yeah.
Speaker 1:And I stopped the recording because I listened to the book on Audible. I was like what did she just say? And I went back and I listened to it again and I went back and it was like two or three times and I was like that is gobsmacking. What implications might that have for my own addiction and for other addictions, like what is there is? And then at the end you had shared a story about a woman who said you're right, like I am, as I almost want to lose.
Speaker 2:That was the part.
Speaker 1:She said yeah, it's like my body wants to lose. I thought why? Why would an addict want to lose?
Speaker 2:Yeah.
Speaker 1:And so I thought do I want to feel bad as a sugar addict, Like, do I actually get some kind of sick brain reward for being miserable for? Being in states of deprivation, being in cortisol and fatigue and whatever else you know it was doing to me. What would you have to say about that?
Speaker 2:Well, yeah, that's a great question. I think it works on a bunch of different levels. For first and neuroscience. So this is a really interesting series of experiments looking at dopamine release in the brains of addicted gamblers and healthy controls and finding that with with winning you know, during a gambling task both gamblers and healthy controls had an increase in dopamine. Thank you. The fascinating part was that when healthy controls lost, they had no dopamine spike, but when addicted gamblers lost, they actually had a dopamine spike, so somehow or another, losing was also rewarding for them. And in fact, the greatest dopamine spike for addicted gamblers is at the point of maximal uncertainty, when the chances of winning and the chances of losing are equal. So that is really fascinating, because what it tells us is that for an addicted gambler, it's not really about accumulating the tangible reward or the intangible reward, if it's like some kind of virtual currency, which a lot of people describe now getting addicted to something where they're not even really actually winning money, but they're winning a virtual currency that they can't even use to buy.
Speaker 2:Now what happens with people who get addicted to gambling, who are vulnerable to this problem, is that it's not really anymore about winning, it's about being in that state or that flow state of gambling. So what they're addicted to is the process of the game which allows them to. It's a transformed and really transcendent mental space where they're not having to be in the world. And that's what they're looking for, the escape. And it's not about getting money.
Speaker 2:It's about being in that point of maximal uncertainty, anticipating the maximal dopamine and then wanting to do it again, even if that means losing, because a lot of times, as gamblers will talk about actually wanting to lose, because they know if they lose then they'll get to play longer, because once they lose then they have to keep playing to earn it back. So I think that's a piece of it. I think another piece of it is the ways in which we can actually get addicted to being unhappy. So, even outside of the drug chasing moment, we can get attached to our anxiety, our loneliness, our resentments. Right, because they're familiar, right, that's the world we inhabit and we've now created a very tiny box in which we've squeezed ourselves. And it's horrible, it's absolutely horrible, but on some level it's better than the unknown, right, or the uncertainty of having to do something new or go out into the world or risk being happy.
Speaker 1:Amazing that vulnerability, the feelings of all in the real world that we need to reckon with. With respect to food addiction, I'm wondering if there might actually be. I probably the science hasn't been done, if there isn't a parallel between the gambler who has noticed that they get a reward from losing, and I wonder if and it becomes a process of the chase and the losing and the chase, and the winning and the losing and the chase how is that different than dieting? Really, you know what I mean.
Speaker 2:Yeah, I do. Yeah, I think you're absolutely right, it's. You know my colleague, rob Malenko. He loves to say that the way that he measures addiction in animals is how hard they're willing to work to get their reward. And when it comes to dieting it's kind of it's more complicated, but you're right, it's all that investment in creativity and thought and mental preoccupation.
Speaker 2:Really, what is addiction? It's largely the mental preoccupation with getting the drug, using the drug, hiding the drug use, starting over again. And that's what we have in addiction. We have this vast neural network that becomes entirely focused on the drug, such that, in a way, we don't have to think about other things, right, because all of our mental real estate is being occupied by this one narrowed goal. And it's that narrowing of the vision that is so awful about addiction, but also, again, kind of safe, right and kind of like at least I'm in control of this. So the extent to which addiction is really about control, it's really the illusion of control, but it's the illusion that we have that we are controlling at least this space, that it is part and parcel of the addiction itself.
Speaker 1:Oh my gosh, so fascinating, right. It's like it creates its own crisis and then we're so focused on this crisis that we can't even think about anything else. It's like the whole point of it.
Speaker 2:Right, yeah, yeah.
Speaker 1:Yeah, so interesting. Is there any fun or words you'd like to share today on the topic of sugar addiction? Addiction recovery?
Speaker 2:Well, I just think it's great that we are now looking at these food problems through the lens of addiction. I've thought for a long time that the lens of addiction was a useful lens in which to conceptualize eating disorders, and so I'm really glad to see that there's a strong groundswell in that direction, because I think that's right.
Speaker 1:Yes, it really is. I know when there's it's so tempting to deny that it's an addiction.
Speaker 1:We wanna call it a bad habit. We wanna call it, oh there's. You know my trauma from a childhood. It's a character flaw, right that, the whole brain science coming into those of us. One last question, because it's my understanding with the animal studies around addiction is that if you introduce, let's say, 100 rats just easy math or 10 rats easy math that about 15% of them will they're all introduced to cocaine, water, let's say, or cocaine, and then you know they're the cocaine's taken away and water's brought back in, and then the cocaine's brought back in, that only roughly 15% of those rats or mice will remain addicted and die of their addiction. That 85% of them will not go back. Is that the science roughly?
Speaker 2:So it is true that not all it's not that all animals universally, including rats, will get addicted to a given drug, and that these animal models, although they're pretty good models, they're not perfect models and that it can be really effortful on the part of the scientists to get some strains of animals addicted to certain substances. So, for example, the alcohol models with rats, they're challenging. Like there's a strains of rats who will get addicted to alcohol and other strains. Like you can just be giving them intravenous alcohol and they still really won't choose alcohol.
Speaker 2:So yeah, I mean it's not a perfect model, but I think, as animal models go and we're looking at psychiatric disorders, really the models for addiction are far superior to models, for example, like for depression or ADHD or anxiety, because we're actually, you know, the animals are in fact ingesting the substance and we definitely can get these animals and they will get addicted to the point where they will press the lever for a substance until exhaustion or until they die. So there are robust animal models but you're right, it's not universal. It does depend on the substance. In general, it's easier to get animals, you know, addicted to opioids and stimulants than alcohol, in particular, and food, for example, food addiction yeah, I mean animals will get that too. So I think in general it's still a really useful model, but it's absolutely not a perfect model and also we're not rats, right, so you take it all with a green assault.
Speaker 1:Yeah, it's like a little window of insight for those of us who are on the addiction spectrum to say I might be one of those strains that this substance in my biochemistry just work. They just. It just lights up my brain up and it's not.
Speaker 2:Yeah, and I think that's an important point this inter-individual variability in this concept of drug of choice, that you know what is addictive for one person is not going to be addictive for another person. For some people they can't imagine, you know, being addicted to food. Others can't imagine being addicted to, you know, a stimulant. And that's our individual wiring and that's probably evolutionary too. Like in a tribe, you wouldn't want everybody to be seeking out the same reward To the benefit of the broader group. You would want people putting in effort to get different things. So as a group we have everything we need.
Speaker 1:Oh, that's a fascinating angle on all that. Thank you so much. This was a wonderful interview. Thank you for your book and everybody you go out and buy it. See you soon.
Speaker 2:Thanks so much, great conversation.
Speaker 1:Thanks for tuning in this week. If you would like more interviews, more information and more inspiration on how to break up with sugar, go to my YouTube channel, kicksugarcoach or my website KicksugarCoachcom. See you next week.