← Huberman Lab

Understanding & Treating Addiction | Dr. Anna Lembke

Episode 33 Aug 16, 2021 1h 59m 25 insights
This episode I interview Dr. Anna Lembke, M.D., Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University School of Medicine. Dr. Lembke is a psychiatrist expert in treating addictions of all kinds: drugs, alcohol, food, sex, video games, gambling, food, medication, etc. Dr. Lembke is also an expert in the opioid crisis, and the author of Dopamine Nation. We discuss the biology and psychology of why people become addicted to certain substances and behaviors and the key role that our "dopamine balance" plays in creating addiction. We also discuss the science and practice of how to conquer addictions, why people relapse and how to avoid relapsing. Dr. Lembke also shares her expertise on topics closely related to addiction such as community, shame and lying and she explains why telling the truth—even about the most basic things in daily life, adjusts dopamine levels in our brain. This episode is an important one for anyone struggling with addictions of any kind, for their friends and families and for health care professionals. It is also for anyone who has defeated addiction and is determined to stay clean. Last but not least, it helps explain why all humans do what we do, and how we can all maintain a healthy sense of pleasure seeking in life. Read the full show notes for this episode at hubermanlab.com.
Actionable Insights

1. Undertake a 30-Day Dopamine Fast

To reset your brain’s reward pathways and regenerate dopamine transmission, commit to 30 days of zero interaction with any addictive substance or behavior. This period is clinically observed as the average time needed for the brain to equilibrate.

2. Anticipate Two Weeks of Discomfort

When initiating a dopamine fast, expect to feel worse for the first two weeks, experiencing anxiety, irritability, insomnia, and dysphoria. Improvement typically begins in week three, with significant relief by week four, as your brain re-regulates.

3. Endure Dopamine Come-Downs

After experiencing pleasure from a high-dopamine activity, allow the subsequent ‘come down’ feeling (a tip to the pain side of the balance) to pass without immediately re-indulging. This prevents your dopamine system from becoming chronically imbalanced and entering a deficit state.

4. Cultivate Space Between Desire and Action

Practice creating a deliberate pause between the thought or desire to do something and actually acting on it. This helps reduce impulsivity, a key vulnerability factor for addiction, by allowing for self-editing and consideration of consequences.

5. Limit Chronic High-Dopamine Exposure

Be mindful of and avoid chronic exposure to substances or behaviors that repeatedly release large amounts of dopamine in your brain’s reward pathway. Sustained high-dopamine input can lower your tonic dopamine baseline over time, leading to a state akin to depression.

6. Practice Radical Truth-Telling

Commit to telling the truth in all aspects of your life, even about minor details, beyond just avoiding lies about addictive behaviors. This practice is believed to strengthen prefrontal cortical circuits and their connections to limbic and reward brains, crucial for self-control and a balanced life.

7. Make Amends for Past Harms

Reflect on ways you’ve harmed others in the past and actively make amends by apologizing, without necessarily expecting forgiveness. This act is cathartic and renewing, allowing you to shed past burdens and begin anew in your life.

8. Process Shame and Guilt

Allow yourself to recognize and experience appropriate shame and guilt for past actions, rather than avoiding these painful emotions. Feeling appropriate shame is an important, albeit painful, corrective mechanism for recovery and personal growth.

9. Address Immediate Environmental Needs

Instead of searching for a grand ‘passion,’ stop distracting yourself and actively look for immediate, simple tasks that need to be done in your environment, such as taking out the garbage. This cultivates functional action steps and connects you to your present reality.

10. Live One Day at a Time

Concentrate on making the current day good and meaningful, rather than overly focusing on long-term plans or outcomes. This ‘one day at a time’ approach allows positive days to accumulate into significant periods of progress and well-being.

11. Engage with Your Immediate Environment

Be awake and alert to your immediate environment, actively connecting with it rather than seeking escapism through distractions. Escapism ultimately disconnects you from the groundedness, authenticity, and sense of being in your own life.

12. Identify Vulnerability During Good Times

Reflect on whether you are most susceptible to addictive behaviors when things are going well, such as celebrating success. If so, put protective barriers or strategies in place to guard against relapse or overindulgence during these times.

13. Understand Trigger-Induced Cravings

Recognize that triggers, even just thinking about an addictive behavior, cause a small dopamine spike followed by a mini deficit state, which manifests as craving. Understanding this neurobiological basis can help in managing cravings.

14. Plan Intentional Social Media Use

Approach social media use thoughtfully, with intention and advance planning, treating it like any other potent drug. This helps you maintain control over your use and prevents you from getting ‘sucked in’ by its engineered addictive qualities.

15. Establish Social Media Barriers

Create literal physical and metacognitive barriers to control your social media use, ensuring it’s not ’too much, too often, or too potent.’ This helps prevent constant self-interruption and distraction, preserving focus and creative energy.

16. Cultivate Offline Connections

Actively preserve and maintain offline ways to connect with other people. This is crucial to combat loneliness and ensure a sense of belonging, as humans are social animals who thrive in real-life tribal connections.

17. Undertake Group Dopamine Fasts

If you are doing a dopamine fast or limiting high-dopamine activities, consider doing it with friends or a group. This reduces the ‘fear of missing out’ (FOMO) and provides mutual support, making the process easier.

18. Prioritize Creating Over Consuming

Be mindful of whether your time is primarily spent consuming information/content or actively creating something. Shifting focus towards productive output and original thought can be beneficial, as constant consumption can be problematic.

19. Align Compulsions with Greater Good

Seek to align your natural compulsions and drives with a greater good, such as service to humanity, the planet, or animals. This alignment creates a reciprocal relationship where supporting the world leads to personal fulfillment.

20. Question Imagined Success Prizes

Be aware that often the ‘prizes’ or successes we intensely pursue can be unsatisfying, while unexpected achievements can bring genuine fulfillment. This shift in perspective can lead to a more process-oriented approach to life.

21. Practice NSDR or Meditation

Utilize meditation apps or protocols like Non-Sleep Deep Rest (NSDR) or Yoga Nidra, even for short 10-minute sessions. These practices can help place the brain and body into different states and greatly restore cognitive and physical energy.

22. Optimize Hydration with Electrolytes

Ensure adequate hydration and electrolyte intake by dissolving one packet of Element in 16-32 ounces of water first thing in the morning and during physical exercise. Proper hydration and balanced electrolytes (sodium, magnesium, potassium) are critical for optimal brain and body function.

23. Ensure Adequate Vitamin D3K2

Consider supplementing with Vitamin D3K2, as D3 is essential for brain and body health and many are deficient, even with sun exposure. K2 is also important for regulating cardiovascular function and calcium in the body.

24. Supplement Daily with Athletic Greens

Incorporate an all-in-one vitamin, mineral, and probiotic drink like Athletic Greens into your daily routine, once or twice a day. This helps cover basic nutritional needs, make up for deficiencies, and support microbiome health.

25. Approach Psychedelics with Caution

Exercise extreme caution and skepticism about self-prescribing psychedelics for mental health or spiritual awakening outside of controlled clinical settings. The current data on their use is based on highly controlled environments with carefully selected patients, and misuse can lead to negative outcomes or addiction.