<p><a href="https://peterattiamd.com/annalembke/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=241014-pod-annalembke&utm_content=241014-pod-annalembke-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=241014-pod-annalembke&utm_content=241014-pod-annalembke-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=241014-pod-annalembke&utm_content=241014-pod-annalembke-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Anna Lembke is the Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic and author of Dopamine Nation: Finding Balance in the Age of Indulgence. In this episode, Anna dives deep into the biochemistry and neurobiology of addiction, exploring the critical role of dopamine and the prefrontal cortex. She shares her framework for diagnosing and treating addiction, providing real-world examples involving alcohol, gambling, cannabis, social media, and more. Anna outlines the risk factors for addiction, including inherited and nurture-based risks, explores the rise of addictions in younger generations, and discusses effective ways to address these issues with children. Additionally, she touches on healthy coping strategies, the evolution of the "marshmallow experiment," and provides insights into GLP-1 agonists as a possible tool for addiction treatment. Finally, she reflects on the value of 12-step programs and how she navigates the emotional challenges of her work.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>The role of dopamine and the prefrontal cortex in addiction [3:00];</li> <li>The clinical definition of addiction and the behavioral criteria for diagnosing it [13:00];</li> <li>Assessing alcohol use: patterns, risks, and addiction diagnosis [17:15];</li> <li>Applying the addiction diagnosis framework using gambling as an example [21:45];</li> <li>Exploring addiction variability: how nature, nurture, and access shape individual vulnerability and drug of choice [25:15];</li> <li>How abstinence from addictive behaviors can help reset the brain's reward system and improve mental health [41:15];</li> <li>Safely abstaining from addiction substances, drugs needing medical supervision, and other key considerations [51:30];</li> <li>Transitioning from abstinence to long-term recovery: tools and considerations [59:00];</li> <li>Exploring behavioral addictions like sex addiction, and the gender differences in addiction patterns [1:08:30];</li> <li>Factors contributing to the increasing levels of addiction across the world [1:13:45];</li> <li>How online pornography can affect young boys' developing brains and lead to addictive behaviors, and strategies for parents to address this issue [1:23:30];</li> <li>The link between social media use and declines in mental health, potential solutions, and protective measures [1:34:45];</li> <li>How exercise affects brain chemistry, the role of dopamine and endorphins, and how exercise can become addictive [1:44:00];</li> <li>Cold-water immersion for mood regulation, and other healthy coping strategies [1:47:15];</li> <li>The "marshmallow experiment": how broken promises affect behavior and trustworthy environments help children develop self-control [1:54:00];</li> <li>Can GLP-1 agonists be useful in treating addiction? [1:58:30];</li> <li>The benefits of 12-step programs [2:06:00];</li> <li>Why understanding a patient's story is essential for meaningful psychiatric care [2:11:45]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Implement a Four-Week Dopamine Fast
Try abstaining from your “drug of choice” (substance or behavior) for four weeks to reset your brain’s reward pathways, as this “dopamine fast” often significantly reduces anxiety and depression without further medication or therapy.
2. Utilize Self-Binding Strategies
Create literal and metacognitive barriers to consumption by implementing self-binding strategies like removing the substance from your home, setting strict rules for use (e.g., never alone, specific limits), meticulously tracking consumption, or discussing appropriate medications like naltrexone with a doctor.
3. Adopt a Holistic Recovery Philosophy
For sustained recovery, cultivate a life philosophy that integrates recovery principles into all aspects of your life, such as practicing radical honesty, as this broader orientation is crucial for maintaining change.
4. Model Truth-Telling and Reliability
Consistently model truth-telling and reliability by always following through on your commitments as a parent, as this fosters trust and teaches children self-control, making them more resilient to addictive behaviors.
5. Self-Assess for Addiction
To identify if you might have an addiction, evaluate your behavior against the “four C’s” (out of control use, compulsive use, cravings, continued use despite consequences) and check for signs of tolerance or withdrawal.
6. Identify Root Causes of Use
Explore why you engage in certain substances or behaviors, recognizing if it’s for pleasure or to cope with underlying issues like social anxiety, loneliness, or boredom, as this understanding is crucial for addressing the problem.
7. Explore 12-Step Recovery Programs
Consider joining 12-step peer recovery groups for addiction support, as they offer free, accessible, and evidence-based help in a non-judgmental environment, providing a powerful sponsorship system for ongoing guidance.
8. Harness “Pain First” for Dopamine
Engage in activities like exercise or cold exposure (e.g., ice-cold showers) where the physical or mental challenge precedes pleasure, as this method of indirect dopamine release is less prone to addiction and can also help regulate mood when dysregulated.
9. Limit Child’s Unsupervised Internet Access
To protect children from highly reinforcing and potentially harmful online content, limit unsupervised internet access, especially for those under 13, by providing only basic phones and engaging in open, honest discussions about potential risks.
10. Discuss Pornography Openly with Kids
Have open and curious conversations with your children about pornography, asking non-judgmental questions like “What did you think about that?” and “How did you feel afterward?” to help them understand its impact and potential for negative after-effects.
11. Support Smartphone-Free Schools
Advocate for policies that remove smartphones from schools to foster tech-free learning environments, enabling adolescents to concentrate, socialize, and learn more effectively without digital distractions.
12. Prepare for Initial Abstinence Discomfort
When abstaining from an addictive substance or behavior, anticipate feeling worse with increased depression, anxiety, and insomnia for the first 10-14 days, but expect significant improvement in mood, sleep, and cravings by weeks three to four.
13. Quantify Alcohol Intake
Track your daily alcohol consumption for seven days using the “timeline follow-back method” and compare it to standard drink guidelines (12oz beer, 5oz wine, 1-1.5oz liquor) to identify potential high-risk patterns.
14. Recognize Universal Withdrawal Symptoms
Be aware that anxiety, irritability, insomnia, dysphoria, and craving are universal withdrawal symptoms from any addictive substance, which can indicate physiological dependence even without other obvious physical reactions.
15. Assess Moderation Effort vs. Abstinence Ease
After a period of abstinence, if you attempt moderation, critically assess the significant effort required to maintain it; many individuals find that complete abstinence is ultimately easier and more conducive to long-term well-being.
16. Seek Medical Advice for Severe Withdrawal Risk
If you are concerned about potentially dangerous withdrawal symptoms from alcohol, benzodiazepines, or opioids, consult a medical specialist before attempting to stop use.
17. Embrace Boredom for Creativity
View boredom that arises during abstinence from addictive behaviors as a catalyst for creativity, using the newfound time to explore new interests and activities.
18. Discuss GLP-1 Agonists for Addiction
For individuals with treatment-resistant alcohol use disorder or binge eating disorder, consider discussing the potential off-label use of GLP-1 agonists like semaglutide with your doctor, as they have shown promise in reducing cravings.
19. Prioritize Patient’s Life Story
Healthcare professionals should prioritize listening to a patient’s full life story, including their upbringing, milestones, and influences, to cultivate empathy and gain a deeper, more holistic understanding beyond just symptoms.
20. Cope with Patient Loss Through Curiosity & Self-Care
When facing challenging patient outcomes or loss, maintain curiosity about the individual, practice humility by reflecting on your own actions, make amends if needed, and prioritize self-care and family time to sustain your well-being.
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