In this episode of The Knowledge Project Podcast, Dr. Anna Lembke, a renowned psychiatrist and professor at Stanford University, provides a comprehensive understanding of addiction.
She discusses the role of dopamine, the balance of pleasure and pain, and the impact of modern life on addictive behaviors.
She also shares insights into the treatment for addiction and the success of Alcoholics Anonymous.
Modern Life’s Impact on Addiction
Modern life’s constant stimulation and pleasure hits, such as phone usage, caffeine consumption, and binge-watching, can contribute to stress and deviate from our neutral baseline position.
This constant deviation can lead to addictive behaviors.
The Pleasure-Pain Balance
Pleasure and pain are intertwined in the brain, functioning like a balance.
When pleasure is experienced, the brain compensates by reducing dopamine receptors and production, leading to a tilt towards pain.
This can result in a strong desire to seek more of the substance or behavior that initially caused pleasure.
Primary Progressive Nature of Addiction
Addiction is a primary progressive disease.
Regular and large-scale use of addictive substances alters the brain, leading to the disease of addiction.
This disease persists even if the initial problem that led to substance use is resolved.
Success of Alcoholics Anonymous
Alcoholics Anonymous (AA) has been successful in treating addiction due to its philosophy of surrendering to a higher power and sharing lived experiences.
Its independence, focus on sobriety, and provision of a sober social network contribute to its effectiveness.
Importance of ‘Radical Honesty’ in Treatment
Patients are encouraged to practice ‘radical honesty’ during treatment, which involves refraining from lying for 30 days.
This approach is based on the observation that patients who are truthful about everything tend to have the most robust recovery.
Dopamine’s Role in Addiction
Dopamine, a neurotransmitter associated with pleasure, reward, and motivation, is a key player in addiction.
All reinforcing substances and behaviors trigger the release of dopamine, with the speed and amount of release determining their potential for addiction.
Defining Addiction
Addiction is characterized by the compulsive use of a substance or behavior despite harmful consequences.
It is diagnosed based on four C’s: control, compulsions, cravings, and consequences.
While the quantity and frequency of use are not part of the diagnosis, they can increase the risk of addiction.
Approach to Addiction Treatment
Addiction treatment is a holistic process that addresses biological, psychological, and social aspects.
The first step is to restore baseline dopamine firing, usually achieved by 30 days of abstinence from the addictive substance.
Psychological interventions such as individual and group psychotherapy are also effective.
Pleasure and Pain are co-located in the brain, so the same parts of the brain that process pleasure also process pain, and they work like opposite sides of a balance. – Dr. Anna Lembke
Challenges of Abstinence
For some individuals with severe addiction, abstaining for 30 days can be extremely challenging.
In such cases, intensive outpatient programs or residential facilities are recommended.
These provide a controlled environment that helps patients regain control over their decision-making abilities.
Severe Pain’s Role in Addiction
Severe pain can trigger a significant dopamine release, similar to drugs, leading to compulsive drug-seeking behavior.
This highlights the complex relationship between physical pain and addiction.
Hormesis in Recovery
During recovery, patients are encouraged to engage in challenging activities based on the science of hormesis, which uses pain to reset reward pathways.
Activities such as exercise, cold water baths, mind-body work, prayer, and meditation can help restore the pleasure-pain balance.
Unique Stress of Poor People in Rich Nations
Poor individuals in rich nations face the stress of unemployment, poverty, and often racial discrimination, while also having access to potent, cheap forms of dopamine.
This combination creates a perfect storm of risk factors for addiction.
Dopamine is the most important neurotransmitter for the experience of pleasure, reward, and motivation. It’s not the only neurotransmitter involved in that process, but it is the common pathway for all reinforcing substances and behaviors. – Dr. Anna Lembke
