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Dr. Anna Lembke: Between Pleasure and Pain

Feb 21, 2023 1h 8m 31 insights
Are you scrolling on your phone constantly? How badly do you crave that morning cup of coffee? Are you compulsively gambling, drinking, shopping, or even reading romance novels just to fall asleep? The potential for addiction is everywhere in our society, and on this episode of The Knowledge Project psychiatrist and author Dr. Anna Lembke discusses dopamine, addictive behaviors, warning signs and treatment for addiction, and how our brains handle all that pleasure and pain in life.   Dr. Lembke is professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She appeared in the 2020 Netflix documentary The Social Dilemma to discuss the addictive nature of social media, and she is the author of the 2021 New York Times bestseller Dopamine Nation: Finding Balance in the Age of Indulgence, which explores how to moderate compulsive overconsumption in a dopamine-overloaded world. -- Want even more? Members get early access, hand-edited transcripts, member-only episodes, and so much more. Learn more here: https://fs.blog/membership/ Every Sunday our Brain Food newsletter shares timeless insights and ideas that you can use at work and home. Add it to your inbox: https://fs.blog/newsletter/ Follow Shane on Twitter at: https://twitter.com/ShaneAParrish Our
Actionable Insights

1. 30-Day Dopamine Fast

If experiencing depression or anxiety potentially caused by compulsive consumption, abstain from the drug of choice for 30 days to reset reward pathways and allow symptoms to resolve spontaneously.

2. Practice Radical Honesty

Commit to not telling any lies for a month, not just about substance use, as even small lies can lead to bigger ones and undermine recovery.

3. Insulate From Addiction Triggers

Actively remove yourself from triggers and reminders of your drug of choice to avoid the dopamine spike from anticipation, which leads to a dopamine deficit state and intense craving.

4. Engage in Hormetic Activities

Leverage ‘pain’ to reset reward pathways by engaging in hard activities like exercise, ice baths, martial arts, yoga, prayer, or meditation, which indirectly boost dopamine in a healthy way.

5. Take It One Day at a Time

Practice the ‘one day at a time’ approach, focusing on abstaining for just 24 hours, and implement self-binding strategies to create barriers between desire and consumption, acknowledging that willpower is a finite resource.

6. Prioritize 30-Day Abstinence

The primary biological intervention for addiction is 30 days of abstinence from the drug of choice to restore baseline dopamine firing and homeostasis.

7. Seek Medically Managed Detox

If at risk for life-threatening withdrawal from substances like alcohol, benzodiazepines, or opioids, seek medically managed detox rather than attempting unsupervised abstinence.

8. Consider Higher Level Addiction Care

If unable to abstain in your usual environment, consider higher levels of care like intensive outpatient programs or residential treatment facilities to provide a restricted environment for recovery.

9. Join Mutual Help Groups

Join mutual help groups like Alcoholics Anonymous to share lived experiences and connect with others in recovery, which can be highly effective for maintaining sobriety.

10. Engage in Psychotherapy for Connection

Engage in individual and group psychotherapy to address addiction, as it can help reteach meaningful and intimate human connection, which addiction often replaces.

11. Understand Pleasure-Pain Balance

Understand the brain’s pleasure-pain balance, where pleasure is always followed by a tilt to the pain side, to better manage expectations and reactions to rewarding stimuli.

12. Avoid Continuous Overconsumption

Avoid continuous consumption of a ‘drug of choice’ without waiting, as this leads to accumulating ‘gremlins’ on the pain side, requiring more potent forms of the drug just to feel normal or get high.

13. Wait Out Pleasure’s Aftermath

If you experience the ‘come down’ or ‘after effect’ of pleasure, wait long enough for the neuroadaptation gremlins to hop off and restore a level balance, as this reduces the overwhelming urge to seek more of the substance/behavior.

14. Expect Two Weeks of Withdrawal

Understand that the first two weeks of abstinence will be difficult due to universal psychological withdrawal symptoms, but improvements in mood, anxiety, and overall functioning typically begin in week three or four.

15. Monitor the Four Cs of Addiction

Monitor for the ‘four Cs’ of addiction: out-of-control use, compulsive use, cravings, and negative consequences, and be open to feedback from others about the impact of your consumption.

16. Watch for the Lying Habit

Pay attention to the ’lying habit’ or ‘double life’ as an early warning sign of addiction, where you minimize or lie about consumption to yourself and others.

17. Recognize Addiction as a Secondary Problem

Be aware that regular, large-quantity use of addictive substances can lead to a secondary problem of addiction, which is a disease in itself, separate from the initial reason for use.

18. Treat Addiction as Primary Disease

Recognize addiction as a primary, progressive disease that requires direct intervention, rather than expecting it to resolve spontaneously by only treating underlying issues like depression or trauma.

19. Identify High-Dopamine Activities

Understand that substances or behaviors that release more dopamine faster are more reinforcing and potentially addictive, helping to identify high-risk activities.

20. Recognize Universal Withdrawal Symptoms

Be aware of the universal psychological withdrawal symptoms—anxiety, irritability, insomnia, dysphoria, and craving—when abstaining from any addictive substance or behavior.

21. Leverage Pro-Social Shame

Participate in recovery communities that celebrate abstinence and provide accountability, as the anticipation of declaring a relapse can motivate continued sobriety.

22. Return to Group After Relapse

If you relapse, return to your recovery group and declare yourself a newcomer, as these communities are designed to support re-entry without shunning, making you a valuable member by sharing your experience.

23. Seek Grassroots Recovery Support

If seeking support, consider grassroots, independent mutual help organizations that focus solely on recovery, as their lack of external affiliation contributes to their effectiveness.

24. Challenge Rationalizations for Use

Be aware of and challenge rationalizations like ‘I only use on special occasions’ or ‘I never drink alone,’ as these normalize and perpetuate problematic substance use.

25. Match Effort in Recovery

If you are seeking help, ensure you are working as hard for your own recovery as those trying to help you, as a red flag is when others are working harder than you are.

26. Consider Naltrexone for Addiction

Consider medications like naltrexone (an opioid receptor blocker) for treating opioid or alcohol addiction, as it can reduce the reinforcing effects and craving by blocking dopamine bumps from the drug or its reminders.

27. Exercise for Better Sleep

Incorporate regular exercise into your routine as a potent natural sleeping pill, though acknowledge it may not be a foolproof solution for all sleep issues.

28. Adjust Sleep Expectations

Adjust your expectations about healthy adult sleep, understanding that intermittent awakenings and waking up in the middle of the night are normal and not necessarily signs of a problem.

29. Accept Normal Sleep Interruptions

If struggling with sleep, learn to accept intermittent awakenings or mid-cycle awakenings as normal, rather than fighting them, and trust that good nights of sleep will balance out the difficult ones.

30. Understand Sleep Aid Effects

Be aware that sleep aids like Ambien primarily cause amnesia for awakenings rather than significantly increasing total sleep time, which can create a false sense of deep sleep.

31. Accumulate Small Daily Accomplishments

Focus on accumulating small accomplishments and positive experiences throughout the day, as many ‘good days’ contribute to a fulfilling life.