This Is Your Brain On iPhone — With Dr. Anna Lembke

Dr. Anna Lembke is a professor of psychiatry at Stanford University's School of Medicine and chief of its Addiction Medicine Dual Diagnosis Clinic. She's also the author of Dopamine Nation, a bestseller that uses neuroscience to explain why the pursuit of pleasure so often leads to pain. In this episode, we discuss Dr. Lembke's fascinating thesis about what happens to our brain chemistry each time we pick a device. Stay tuned for the second half, where we discuss whether a more invigorating but less happy life is worth it. Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Alex Kantrowitz?

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• 0:43Alex Kantrowitz?

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• 1:03Speaker 01

  LinkedIn Presents.

• 1:19Alex Kantrowitz?

  Hello and welcome to the Big Technology Podcast, a show for cool headed nuanced conversation of the tech world and beyond. And before we introduce our guest today, I just want to say that we are trying to get some more ratings on both Apple Podcasts and Spotify. These ratings really help. They make sure that podcasts are seen by more people, which then enables us to get better guests and guests like our guest today, Professor Anna Lembke. So if you have a moment and you want to hit that five star on Apple or Spotify, you want to get a quick dopamine hit, feel good about it. We're about to talk about that. I just encourage you to go do that. And I can't even express how grateful we would be here at Big Technology Podcast if you make that happen. Okay, let me introduce our guest today. Our guest today is Anna Lembke.

• 2:03Alex Kantrowitz?

  She's the professor of psychiatry at Stanford University, author of Dopamine Nation, Finding Balance in the Age of Indulgence. It's a New York Times bestselling book. And what I love about about the book and what I love about hearing Dr. Lembke speak is that

• 2:21Alex Kantrowitz?

  We have had a long conversation about phone addiction, companies trying to addict us to our phones. Is it evil? Is it something we can resist? I think the debate has largely been unhinged. And the reason is because it's been so far removed from the actual science of the matter. And when you listen to Dr. Lembke speak, I think you're going to start to hear some of that come through. Not the unhinged part, the science of the matter.

• 2:43Speaker 02

  Maybe a little bit of the unhinged part.

• 2:45Alex Kantrowitz?

  That'll be, I'll handle that as usual. But, but I think that, that we need more voices, like the one you're about to hear. And I'm excited to bring this interview to you. So, Dr. Lembke, welcome to the show.

• 2:58Speaker 02

  Thanks for inviting me. I'm happy to be here.

• 3:01Alex Kantrowitz?

  Great to have you. We're living in a very interesting age. We have the most affluent countries in the world as the most depressed, the most interested in, in suicide, to be, to be frank about it, the most anxious in those that experience the most physical pain. You've written about opioids, we can get into that in the second half. It's wild because there's more comfort now than you've ever seen before. So I think we should start simply by hearing from your point of view, the point of view of someone who works with patients in psychiatry, someone who knows the science. What happens in our brains when we use our phones?

• 3:44Speaker 02

  So it's very clear, you know, based on imaging studies, that screens are lighting up our brains reward pathway, which is the circuit in our brain that also responds to addictive substances like cannabis, cocaine, alcohol, you name it, as well as, you know, potentially addictive behaviors, gambling, sex, pornography. So, you know, online content is very reinforcing, very stimulating, leads to the release of dopamine in the, that very specific brain circuit.

• 4:24Alex Kantrowitz?

  And so I think it's very interesting that you point out all these other vices in the beginning. There is a feeling amongst some that tech is responsible for basically all evil in the world.

• 4:37Speaker 02

  Hahaha.

• 4:38Alex Kantrowitz?

  It's clearly from your opening statement here, not that, however, it does in combination with things like alcohol or like, you know, the other, the other vices that we might have. It's one ingredient in what's making the society, you know, so unhealthy. And so I think we should, we're going to cover all of it, but we should get into exactly, you know, what happens with tech as an ingredient. And then we can sort of expand a little bit. So let's talk a little bit about our relationship with dopamine and how we get dopamine from the apps that we use on our phone, from messages that we use on our phone, and where that might be leading to some unhealthy situations.

• 5:22Speaker 02

  Okay, first, let's, let's back up a little bit. I mean, it's interesting that you use the word vices. It's kind of moralizing language about ingesting, you know, certain types of substances or engaging in certain behaviors. On the one hand, you know, I get that. On the other, on the other hand, I think a lot of people are probably react negatively to that kind of moralizing language. Because in a way, these are all just behaviors, right? You know, drinking alcohol, it's really just a behavior. Going online and betting on a sporting event, it's, it's just a behavior. And I think we're likely to make more progress

• 6:06Speaker 02

  if we just conceptualize those behaviors as, as behaviors and recognize that for some people who come with an innate vulnerability, you know, to the problem of compulsive overuse, and who happen to find their lock and key, right? So that specific sort of, let's say, I'll just call it a drug, right? For, for, you know, just kind of keep it down to a catchall term for all kinds of substances or behaviors that are reinforcing in that we have the potential to get addicted to.

• 6:41Speaker 02

  You know, there's a lot of interindividual variability. So what may be reinforcing for me is not necessarily reinforcing for you and vice versa. But I think one of the ways to maybe move the conversation forward is to just, you know, recognize that these are all behaviors that people do. And that in moderation, they're not necessarily bad and possibly even good. But it's really, you know, a matter really of degree. And whether or not that behavior then interferes with our ability to care for ourselves and others as kind of a, sort of a starting point.

• 7:21Speaker 02

  Because the whole field, you know, is moving toward, you know, using phrases like people who use drugs as opposed to addicts, right? Or even, yeah, or actually even people who are addicted, people who use drugs.

• 7:35Alex Kantrowitz?

  But the tech, the tech community still calls the people that use their products users, so we could talk about that.

• 7:40Speaker 02

  Yeah, right, right. So, so that kind of language, right? The users, I mean, yeah, we're all users, right? When it comes to technology and digital stuff. So, and you know, just like most people who, who use alcohol don't get addicted to alcohol. In truth, most people who use online content are not going to get, you know, addicted according to our clinical criteria, which by the way are just criteria. We don't have a blood test or a brain scan for any of that. It's based on what we call phenomenology or patterns of behavior over time that meets our criteria. Anyway, sorry to interject that, but I thought that might be worthwhile.

• 8:13Alex Kantrowitz?

  Yeah, I, I think it is. And just to like, I mean, just to talk about this word vice, I feel like it's worth, worth spending a moment on.

• 8:22Speaker 02

  Yeah, I agree.

• 8:23Alex Kantrowitz?

  There's definitely like a moralizing element to it. There's also, I think, one of the things that I've heard in the past is that everyone kind of needs one, you know? People need outlets and it doesn't mean to the point of excess. But I've never looked at a vice as something that is, you know, a moral failing because I do believe that life is stressful enough. And you're, you talk about this in your research, so we can go deeper into this. But life is stressful enough that sometimes you do need an outlet, you know, whether that's an occasional cigarette or a beer once in a while, you know, or an hour on TikTok. And I do think that, yeah, maybe there are folks who look down upon that. I think that when you do get, though, into the addictive area, that's when it's,

• 9:07Alex Kantrowitz?

  it becomes problematic for people and you start to want to investigate the root causes.

• 9:12Speaker 02

  Right. And, and to even acknowledge that, you know, when, when is it that people cross that line from, you know, recreational or even productive advantageous use of a substance or behavior into sort of maladaptive use? And again, just emphasizing, it's not like we can scan the brain and say, oh, you know, look at that, look at that one, that person's addicted. It's not like that. It's, you know, in many cases, much more subtle. In some cases, it's not subtle. Like people with, you know, addiction is a spectrum disorder. There are mild, moderate, and severe cases. Some people, everybody could identify that. I mean, people can die of their disease of addiction. But most of us sort of fall somewhere, you know,

• 9:54Speaker 02

  before that on the spectrum. And, you know, it's not always easy to know when we cross the line. Generally, the overriding definition of addiction is the continued compulsive use of a substance or behavior despite harm to self and/or others. And typically, we look for the four Cs, control, compulsions, cravings, and consequences, as well as physiologic signs of dependence, like withdrawal, tolerance, needing more and more of a time to get the same effect, and, you know, a kind of narrowing of our focus on that drug.

• 10:29Alex Kantrowitz?

  Right. And the way to get there is, well, I'm going to throw out the assertion that I have based off of what I've, you know, read of your research, and you can let me know if this is right or wrong. The path to get there is that you start to do these little things. Drink a beer, you know, take a hit of a joint, you know, you spend time on social media, and that gives you these dopamine hits. And from my understanding, what your research shows is that Your body then gives you a withdrawal or some sort of painful stimulus to help get you back to center and you just crave more and more. So can you go deep, more deeply into that because, and this is where we're going to start setting up the tech conversation,

• 11:12Alex Kantrowitz?

  because tech is filled with those little dopamine hits. So can you talk about how those small dopamine hits build up to something bigger?

• 11:19Speaker 02

  Yeah, happy to do that. So I think this is a really exciting neuroscience of pleasure and pain that, you know, so many wonderful research, researchers and scientists have worked on in the past 75 to 100 years. And to me, one of the most exciting findings is that pain and pleasure are co-located in the brains of the same parts of the brain that process pain, also process pleasure, and they actually work like opposite sides of a balance. So if you imagine a teeter totter in a kid's playground, we experience pleasure, it tilts one way and we experience pain, it tilts the opposite. But there are certain rules governing that balance. And the first rule is that it wants to remain

• 11:59Speaker 02

  level. And after any deviation from neutrality, our brain, our self-regulating mechanisms will work very hard to restore that level balance, or what neuroscientists call homeostasis. So for example, you know, when I, let's say, read a romance novel, which, you know, I got, I developed a mild behavioral addiction to reading romance novels about 10 years ago, I get a hit of dopamine, which is a chemical made in our brain. It's a neurotransmitter. It's one of the most important neurotransmitters for pleasure, reward, and motivation. And it's released in a very specific circuit of the brain called the reward circuit. So I read a romance novel, I get a little bit of increased dopamine in my reward pathway,

• 12:42Speaker 02

  that feels good. And this metaphorical balance tilts the side of pleasure. But no sooner has that happened than my brain immediately adapts to the increased levels of dopamine to try to bring it back down to baseline tonic levels of dopamine firing, because we're always firing dopamine at kind of baseline levels. And I like to imagine that as these neuro-adaptation gremlins, like these little gremlins that just hop on the pain side of the balance to bring it level again. But the gremlins really like it on the balance, so they don't get off as soon as it's level, they stay on until it's tilted an equal and opposite amount to the side of pain. And that's called the opponent process

• 13:23Speaker 02

  reaction. And we experience that as the hangover, the come down, that moment of wanting to read one more chapter, even though I said, when I finish this chapter, I would put the book down and go to sleep, right? Now, if we wait long enough, those gremlins will hop off the pain side of the balance and homeostasis will be restored. But the key message here for people to realize is that the way the brain restores neutrality is first by tipping an equal and opposite amount to whatever the initial stimulus is. So that means for every pleasure, for every pleasure, we pay a price, and that price is the come down. And it may be subtle, and it may be outside of our conscious awareness, but it's always there.

• 14:09Alex Kantrowitz?

  Homeostasis is different for everyone. Some people's homeostasis might be, you know, a very happy place. And some people's homeostasis might be a very unhappy place.

• 14:19Speaker 02

  Right. That's right.

• 14:21Alex Kantrowitz?

  And I'm curious how you, how you think about that. And this is obviously, we're still building up to the tech side, but I think this is important to get into, so let's do it now. And, and so I'm kind of curious, you know, if, okay, we want to get to homeostasis. Let's say homeostasis is sad. What does that mean?

• 14:38Speaker 02

  Right. So, so yeah, that's such a great, great question because, you know, we all sort of assume that we start out with a level balance, a balance that's sort of equal between pleasure and pain. But the truth is that, you know, some of us, you know, who are, let's say, innately dysphoric or depressed or anxious, or who have some kind of chronic physical pain condition, don't start out with a level balance. We start out with a balance that's tightly slightly tilted to the side of pain. And that's just, that's homeostasis for us. That's, that's our baseline. And that's important because, you know, that, that means that those individuals are

• 15:22Speaker 02

  Probably, and we have the epidemiologic data to support this, at increased risk of reaching for a drug in all its manifold variety, you know, to try to feel better. And indeed, you know, the data show that people who have psychiatric disorders like depression, anxiety, schizophrenia, you name it, are at increased risk of getting addicted to drugs and alcohol. And again, the hypothesis there is that on some level, they're trying to self-medicate that underlying, you know, psychiatric disorder. Same thing with people with chronic pain, you know, gosh, you know, physical chronic pain is devastating.

• 16:06Speaker 02

  And of course, those individuals are looking for something to help them, you know, get out of that, that kind of painful state. The problem is that these various potent intoxicants that tilt our pleasure/pain balance to the side of pleasure. Unfortunately, the brain still will work very hard to restore homeostasis, whatever that initial homeostasis may be. So even if, you know, we start out slightly tilted to the side of pain, our brains will work to get us back to, to that baseline state.

• 16:45Speaker 02

  And, you know, the problem of addiction comes out of repeatedly exposing our brains to reinforcing substances and behaviors, ultimately accumulating more and more of these neuro-adaptation gremlins on the side of the, on the pain side of the balance, such that that initial response to pleasure gets weaker and shorter, but that after response to pain gets stronger and longer, so that no matter where we start out with repeated exposure to reinforcing drugs and behaviors, we end up in this dopamine deficit state, we're tilted to the side of pain, even below whatever our initial pain state might have been.

• 17:21Alex Kantrowitz?

  You can alter your homeostasis then.

• 17:23Speaker 02

  Right.

• 17:23Alex Kantrowitz?

  You could start out as a happy person, but if you go too hardcore on dopamine. Uh, inducing activities, perhaps your baseline then becomes more sad because you have all these pain gremlins that are saying, I shouldn't be here.

• 17:36Speaker 02

  Yeah, that's, that's exactly right. And you know, we see this clinically all the time. I have patients who come in, they say, I'm depressed, I'm anxious, I can't sleep, I can't pay attention. You know, and then I discover in the process of my clinical exam that they're smoking pot all day or playing video games all day or on social media all day. So one of my first interventions, you know, 20 years ago, I would have written them for a prescription of an antidepressant, anti-anxiety. Now my first intervention is really, I asked them to abstain for long enough for those neuro-adaptation gremlins to hop off the pain side of the balance and for homeostasis to be restored. And in the vast majority of individuals who are willing and able to do that, they will come back a month later and say, I feel so much better. I feel less depressed,

• 18:19Speaker 02

  less anxious. And they're really surprised. That's the consistent theme, how surprised they are because they feel like their drug is relieving their underlying psychiatric disorder, but really all it's doing is medicating withdrawal from the last dose.

• 18:34Alex Kantrowitz?

  Now, we as a species have worked really hard to build the good life for ourselves. I'm curious, from your perspective, over the course of the last couple hundred years or human evolution, whatever timeline you choose to pick, do we have far more instances available to us where we can trigger, you know, that dopamine release than we did in the past? Like, is it, are we in the all time leading moment of being able to give ourselves dopamine hits? And, and what has that evolution looked like?

• 19:04Speaker 02

  Yeah. Well, I mean, if Mark Zuckerberg has his way with the metaverse, we're not even at the peak yet of access to highly reinforcing drugs and behaviors. There's yet, yet more potent versions to come. But certainly, you know, the last 200 years.

• 19:20Speaker 02

  Is essentially characterized by an unprecedented change in our environment whereby through technology, which has created more leisure time, you know, more mechanized work, more disposable income and more access, variety and novelty of highly potent reinforcing drugs and behaviors now at the touch of a fingertip, that we've essentially changed the world that we live in. And there's a term for this called the anthropocene to characterize our age. It's usually used in reference to climate change, but I think it's aptly used to describe the kind of dopamine overload that we experience now where we're insulated

• 20:01Speaker 02

  from pain. We have access to almost infinite pleasures without having to work for them. So that's really important because the way that our ancient, you know, neural machinery is wired is for us to be the ultimate seekers, to be motivated to work very hard to get a very modest pleasure. And now the world we're living in, we have access to incredibly potent pleasures, much more potent than our brains can handle or than we ever had before. Fentanyl, for example, is an opioid that is 50 to 100 times more potent than morphine, which is the opioid which is derived from a poppy plant and exists in nature. So, and then that's true for almost every drug, you know, you can look at, we see increased potency,

• 20:45Speaker 02

  increased access. I mean, imagine if cocaine were immediately as plentiful as TikTok, right? We would have many more people struggling with cocaine addiction. And the fact that TikTok is infinite really increases its addictive potential because quantity and frequency matter when it comes to addiction. The more we do of our drug and the more often, the more gremlins we accumulate on the pain side of the balance and more likely are to get into this dopamine deficit state. And once we're there, now we're using not to get high, but just to restore homeostasis and feel like our normal selves. When we're not using, we're experiencing the universal symptoms of withdrawal from any addictive substance, anxiety, irritability, insomnia, depression and craving.

• 21:28Alex Kantrowitz?

  Right. And so compared to like 200 years ago where like you'd work the field and you know, maybe you'd like, your availability of different dopamine hits was probably limited to like. I don't know, maybe a romantic relationship and a beer.

• 21:44Alex Kantrowitz?

  Now, we have all these forms of drugs. We have Netflix, endless Netflix, endless TikTok. We have really, you know, amazing food. You know, people call it dope food, you know, no, no joke, right? It's, you know, because it's addicting and everything at our fingertips.

• 21:59Speaker 02

  Yeah, I think, you know, right. Yep, I agree. And, and the thing is that, you know, people have always used intoxicants. And since the beginning of recorded human history, there have always been a subset of people who have not been able to use in moderation. People we would consider to, you know, have the disease of addiction. But even so, even, you know, the use of intoxicants through the ages, you know, basically people have used relatively mild intoxicants. And they were hard to procure and they ran out and they were expensive. And people had limited time, you know, in which to indulge in these intoxicants. And all that has really been turned on its head.

• 22:40Alex Kantrowitz?

  And you can almost, so, so I'm going to posit that, you know, our society now is like even less happy than we were when we didn't have all this amazing stuff. Before iPhones and MacBooks and, I don't know, Zoom MP3 players even. And you could almost see that as a control variable experiment in our world today. Where the richest countries, it started leading off with this, but like the richest countries, countries with all this technology, the countries with the highest iPhone, you know, per capita. Are, and I think you've mentioned this, the most depressed, the most anxious, the most, you know, contemplative of suicide, et cetera, et cetera.

• 23:20Alex Kantrowitz?

  It's weird to think, but is there a link to like, you know, the fact that there's all this, all this stuff available at our fingertips is what's causing, you know, all these issues? And I think you mentioned that, like, when our body is out of homeostasis, we are in a mode of stress. And, and, you know, you, we always think of stress as the negative, but sometimes the positive can cause stress. I'm throwing out a lot of stuff out there, but, but I'd love to hear your thoughts on this.

• 23:45Speaker 02

  Yeah, yeah, no. So, I mean, when I was doing the research for my book, one of the most fascinating things that, that I discovered was that. Unhappiness of nations is directly correlated with wealth of nations.

• 23:59Alex Kantrowitz?

  Unbelievable.

• 24:00Speaker 02

  You know, we have Adam Smith's Wealth of Nations, this idea that capitalism would solve all ills and the invisible hand and the free market. And once people, you know, lived in free and capitalist societies, you know, they would be so happy. And yet, what we see is that those countries with the most successful forms of capitalism, who've accumulated the most wealth, we're seeing the highest rates of depression, suicide, anxiety, and just general overall misery. And these are based on large-scale population surveys. I will also add that these are also countries in which we're seeing the highest rate of addiction, not surprisingly. And this is all in just about the last thirty to fifty years that we've seen this, you know,

• 24:43Speaker 02

  major sea change coming about, which really suggests a tipping point and which does coincide, you know, with the advent of the internet and these digital devices that have made everything so much more convenient, you know, for good and for bad. These are also countries in which people have more access than ever to mental health treatment. More antidepressants are prescribed in these countries than ever before. So, you know, this is not, you know, mental illness is largely destigmatized in these countries. So it's not, it's not a function of people not having access to mental health treatment. People are getting a lot of mental health treatment and they're not getting better.

• 25:27Speaker 02

  And I think that's really important because it suggests that we are misunderstanding the cause of our unhappiness. We are conceptualizing it as due to a mental illness, when what I would suggest is that it is due to a mismatch between a healthy but very old brain system and a world that is unlike, you know, the world that we were evolved to live in. And this is essentially the source of our problem.

• 25:56Alex Kantrowitz?

  Pretty amazing. So we build this wealth to, you know, effectively buy a good life, people go to war over it, you know, et cetera, et cetera. And in effect, it seems like a fool's errand, if I'm hearing you right, because what it is, is leading to all this unhappiness, because people keep triggering that dopamine response, and it keeps making them unhappier as a result.

• 26:19Speaker 02

  Yeah, I mean, I think, you know, it's important to acknowledge that like, our lives are really much better in so many ways, where we've cured a lot of life-threatening diseases. You know, people used to live on average to age thirty, they now live on average to age eighty. I mean, we don't experience the kinds of, you know, nasty, brutish, and short lives that characterize, you know, most of human existence. But we have reached some kind of tipping point where these advantages that are, you know, characterized by the scientific progress of our, of our age, have this dark side. There's this seedy underbelly, and we have to grapple with that.

• 27:01Speaker 02

  You know, if we don't, we're going to die of different reasons. So, for example, seventy percent of global deaths today are due to diseases caused by modifiable risk factors, and the top three are smoking, inactivity, and poor diet. So, in other words, we're now at a place where we are starting to die more often of diseases related to compulsive over-consumption addiction than diseases related to, you know, let's say, what historically have been the cause of death for most of, you know, human, human existence, things like infectious diseases and cancers.

• 27:40Alex Kantrowitz?

  Yeah, and I don't know if I'm allowed to, to tell this joke, but whatever, I'll do it, because I think it was so perceptive that, you know, Louis CK, before he had his whole situation, did this bit that everything is amazing and no one's happy. And he's talking about how someone's like throwing a fit on an airplane because he can't connect to wifi. And he's like, "You are on a steel tube, you know, flying at incredible speeds, taking you to your destination, and you're gonna land." And you're mad about the Wi-Fi? And we never really understood why, but I think the science really goes a long way towards explaining what's happening.

• 28:14Speaker 02

  Right, like that pleasure pain balance and the hedonic set point and the fact that if we constantly press on the pleasure side of the balance, our brains are trying to accommodate that and will recalibrate to the side of pain until we get to this point where we need a whole lot of pleasure to feel anything at all that's pleasurable. And even the merest pain is painful. And I think anybody, any of us who does sort of a gut check on our own lives or the culture today can really, you know, that really resonates as just plain old true, right? The types of things that people experience now as difficult or traumatic or painful

• 28:54Speaker 02

  are just orders of magnitude less than what people have endured with resilience in prior generations. And it's not to say that we're wimpier now. I really contend it's physiologic. It's like, it's because we are constantly bombarded with dopamine that we have physiologically, literally changed our ability to tolerate pain.

• 29:16Alex Kantrowitz?

  Professor Anna Limke is with us. She's the professor of psychiatry at Stanford University and author of the bestselling book, Dopamine Nation: Finding Balance in the Age of Indulgence. I'm sure you've already gone out and bought it already, but in case you haven't, you have some time to do so during the break. We'll be back right after this. This episode is brought to you by AVPoint. Everyone's racing to roll out AI right now. Copilots, chatbots, agents doing real work. But here's the part nobody loves talking about. All that AI runs on your data and most teams have no single way to see it, secure it, and prove it's under control. That's exactly what AVPoint does. For 25 years, they've been the trusted layer beneath the world's most demanding data,

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• 30:34Alex Kantrowitz?

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• 31:38Alex Kantrowitz?

  And we're back here with Professor Anna Lempke, professor of psychiatry at Stanford University, author of Dopamine Nation: Finding Balance in the Age of Indulgence. Well, why don't we talk about tech? Because we've spent the whole first half setting the stage. No regrets about that. It's August, you're probably hanging out, having time to, you know, hear a little bit more about how your brain works. Now we're going to get into some of the industry stuff. It seems to me, Professor, that there, we talk about different ways to get dopamine hits. You know, maybe watching a nice movie via a DVD, you know, was that 15 years ago. But now we have the iPhone or an Android phone in our hands, or maybe a Windows phone if you're still in a bunker somewhere in Redmond, Redmond, anyway, in Seattle.

• 32:25Alex Kantrowitz?

  And so how has the introduction of the phone changed our, the amount of dopamine that we've introduced into our daily lives? Is it like the exponential force multiplier that's sent all this stuff into overdrive and really hit us with a shock to our systems? And before, before you answer, I just want to point out, I love talking about it through this lens, A, because I think it's right, and B, because it actually comes to show you that this is not, you know, an evil plot by the tech industry to hijack our brains. And it's just kind of how the thing works. It's not like we're, you know, being taken over. It's just like, okay, we have this at our, you know, our, our access and it's naturally addictive. It's not designed in an addictive way, even though some of, there

• 33:10Alex Kantrowitz?

  might be some game, you know, theory that goes on in Silicon Valley development houses. But they almost don't have to work that hard because our brains are doing it for us anyway.

• 33:19Speaker 02

  Well, I would say it's a combination. I mean, I think these things are intentionally made to be addictive, but you know, so is every product.

• 33:27Alex Kantrowitz?

  Right.

• 33:28Speaker 02

  You know, that is made. That's the point. People want to make it so that we will buy more of it, consume more of it and, and come back again. But, but there is something, I mean, I think there is something invidious about the digital products that we didn't anticipate. You know, the, the extent to which we are compulsively engaged with our smartphones is really impressive. I mean, it's, it's, it's astonishing. You know, I have, I have interacted with many, many teens for whom even the thought of putting their phone away for 24 hours is enough to incite a panic attack. That, that's really, that's really spectacular. You know, it's, it's not something I think that anybody would have

• 34:13Speaker 02

  predicted in 2001 for the, when the first smartphones came out. In my clinical practice...

• 34:20Speaker 02

  After the advent of the smartphone, for the first time, I started seeing more and more people come in wanting help for behavioral addictions to things like online pornography and online gambling. And these were primarily middle-aged men who had gambled or used pornography, you know, in a manageable way through most of their lives. But then, once they got, you know, the internet and the smartphone in particular, just found they were no longer able to control their use and their use was out of control and with really significant consequences. So, you know, although that's not a large N, you know, that's just my clinical practice, it certainly stood out and it allowed me to sort of be on the front

• 35:03Speaker 02

  lines of observing very early on the potential dark side for some vulnerable individuals, in particular, the nature of this sort of 24/7 access to this digital content. And hence, I've likened, you know, the smartphone to the hypodermic syringe. The hypodermic syringe was invented in the 1850s. It was the first way to administer fluid and chemicals right into our bloodstream. Morphine, which was available in the early 1800s and then quickly led to severe morphine addiction by the middle of the 1800s, 1850s. Interestingly, the hypodermic syringe was going to be the invention that solved the morphine addiction problem.

• 35:46Speaker 02

  The hypothesis was, well, if you inject morphine directly into the bloodstream, people won't get addicted. Obviously, that was a failure. But it was, it was the advent of that technology that, you know, really accelerated addiction to morphine. And today, of course, we all know that intravenous drug use is one of the most addictive ways to use drug because it goes, drugs because they go right to the bloodstream. And I think the smartphone is like that, you know, because, because we can take it anywhere we go, we have more access. And remember, quantity and frequency matter when it comes to the potential for developing addiction. If you recall this pleasure-pain balance and those gremlins.

• 36:27Speaker 02

  The gremlins will always hop on the pain side to counteract pleasure. But if we wait long enough in between, they'll hop off and that craving to reuse will pass and homeostasis will be restored. But if, when the gremlins are already on the pain side of the balance, we reach for more and more and more of our drug, again, that is what gets us into this dopamine deficit state where we change our hedonic set point. And that's exactly, you know, what's happening with digital content where because we've now got, we're mainlining it, we don't give our brains any opportunity to recover in between. And that, you know, accelerates and puts us all at greater risk for addiction to digital drugs.

• 37:04Alex Kantrowitz?

  Yeah. And so going back to the characterization of what Silicon Valley, I'm not making excuses for people who are trying to build addictive products, but it's almost a feature of, of, of the form where if you're in a world where you're using DVDs, okay, you put the DVD in, you gotta go buy another one, maybe put another, you're, you're gonna sit there for an hour and a half. With a Tic Tac, you know, you're looking at a minute video and then the next one and the next one.

• 37:30Speaker 02

  Yeah, I mean, yeah, right. I mean, I think the way.

• 37:32Alex Kantrowitz?

  It's inherently more addictive.

• 37:33Speaker 02

  Yeah. When I think about.

• 37:35Alex Kantrowitz?

  Go ahead.

• 37:35Speaker 02

  I'm sorry, you go ahead, you finish.

• 37:37Alex Kantrowitz?

  I was just gonna say it's inherently more addictive because the videos are coming much more frequently. It's the nature of the form.

• 37:44Speaker 02

  Yes. Yes, it's the nature of the form. I think the key piece here, when we think about the culpability of the corporations who make and profit from these, uh, these digital drugs is, um, to really analogize it to cigarette makers.

• 38:01Alex Kantrowitz?

  Hmm.

• 38:01Speaker 02

  You know, I think early on, the cigarette makers were the first to know that their product was harmful, but they hid it for a very long time and they also weren't willing to do, do anything about it. So I think that's an important analogy because I think it's not, it's, it's accurate to.

• 38:20Speaker 02

  Analogize cigarettes to, you know, smartphones or to the digital content. And admit that these are, you know, addictive products. They're legal addictive products, but we really do have to treat them as addictive products, which means that they shouldn't be marketed to children. There should be age restrictions. People should have warnings. You know, they should be taxed and disincentivized. All of those kinds of barriers. We as individuals need to take responsibility for our choices and actions around our consumption. But when you're dealing with a highly addictive product that's aggressively marketed and pushed out there, you know, just it can't be left just up to the individual.

• 39:04Speaker 02

  Corporations, federal government, everybody needs to get on board with trying to help solve this problem. At least that's my opinion.

• 39:10Alex Kantrowitz?

  Yes, so from your perspective, it's companies. But it's almost like the companies would have to shut down in order to stop this. Like, yes, some of the reforms that you mentioned are common sense. However, like, it's still gonna be Instagram. It's still gonna be TikTok at the end of the day, even if you don't market this stuff to kids. And I don't think, you know, is there a way, again, going back to this is the form? And maybe, you know, I don't know, I'm not saying this to make excuses for the industry. Maybe this is what we need to do. You know, uh, you know, is there a way to, to then have this stuff? And not create all these negative effects? Because at the end of the day, a feed of like one minute videos tailored to your interests are, is a feed of one minute videos to your interests. It's not romance novels.

• 39:55Speaker 02

  What do you mean? I mean, to me, it's not that different from romance novels. If your drug of choice is romance novels and you'll get hooked on that. If it's one minute videos, you'll get hooked on that. You know what I mean?

• 40:05Alex Kantrowitz?

  But the, the availability, so I would say, isn't the availability? And the time that you can spend with romance novels very different from the availability? And time that you can spend with tech, tech apps? I mean, they're on your phone, your phone's with you all the time. Whether you're at your desk, online to, you know, buy something at the supermarket, at home on your couch, about to go to bed, waking up in the bathroom, they're with you all the time. Whereas like romance novel, like, it's just not gonna be in this, the same set of availability, which is why I think that like, you know, speaking about your research, we don't have, we didn't have a rise of anxiety and depression when we had the introduction of romance novels. But we do have this rise with the iPhone and the Android.

• 40:49Speaker 02

  Well, you know, as somebody who got addicted to romance novels.

• 40:53Alex Kantrowitz?

  Okay, I don't mean to minimize that, yeah.

• 40:56Speaker 02

  Yeah, primarily propelled by acquiring a Kindle and fueled by a romance novel industry, writing these novels according to a formula that they know will hook you. And the sheer volume of romance novels available today, including romance novels for free, sold on Amazon to get you hooked and keep you coming back. I really don't think there's a difference. You know, I was at a point where I was reading romance novels at work between patients. You know, you can read romance novels on your smartphone. Right? So it's, it's, it's really a matter, to me, it's, it's all the same. These are all, you know, the, the, what, what, what is, what makes something addictive?

• 41:41Speaker 02

  It needs to release dopamine in the reward pathway. There's interindividual variability. What releases dopamine in your brain may not release dopamine in mine and vice versa. And then we have modern, you know, supply chain and innovation and technology that allows for four things. Increased quantity of our drugs, increased potency of our drugs, increased novelty of drugs, meaning that there are drugs that didn't even exist before, and increased access to our drugs, meaning that we can access them 24/7, really wherever we are. So quantity, potency, novelty, and access. Those things apply to almost any reinforcing drug and behavior.

• 42:21Speaker 02

  And I would contend that almost all human consumptive behaviors have become drugified in a modern capitalist society. And that there's really not a big distinction between TikTok, cocaine, and romance novels. The distinction is how ubiquitous are they? Are they legal? How socially normalized are they? And what is your particular drug of choice?

• 42:44Alex Kantrowitz?

  Okay, I hadn't thought about it that way, and I appreciate you bringing it to, to light. That's, I appreciate that. My mind's changed. So I'm going to come back to the question, then what do you do about it? I mean, it's one thing again to like have have kids, you know, not market to kids, but there are a lot of you. You mentioned middle aged adults that that were suffering a lot of the impacts here. I mean, here's a here's a stat that I read that I wanted to bring up that.

• 43:12Alex Kantrowitz?

  I mean, friendship declines and loneliness is clear across the board.

• 43:17Alex Kantrowitz?

  I'm seeing that in men in particular, you know, that people who have no close friends in 1990, it was 3%. Now it's 15% of men. When people have one friend, 3% up to 6%. I mean, two friends, 8% up to 12%. So what do you do?

• 43:37Speaker 02

  Yeah, I mean, you know, we often talk about how addiction breeds isolation and isolation in turn puts people at risk for addiction. So it's a vicious sort of two way cycle. And I think you're right to sort of question the the voices or the chorus around saying, you know, get rid of Facebook. Because if we were to get rid of Facebook tomorrow, we would have five other social media companies rising up in its place. But that doesn't mean that that we can let the corporations off the hook, right? I think this is a hard problem to solve. We don't have the answer, but we need to start looking for it.

• 44:21Speaker 02

  We need to do that collectively as individuals and also as school systems and as governments and as parents and as corporations. I mean, it's interesting to look at, for example, what a country like China has done, where they have, you know, set regulations, nationwide regulations that minors cannot play video games, except for two days a week, two hours a day. And they have held the corporations responsible for creating a software that limits minors having access, including using facial recognition.

• 44:54Speaker 02

  Software. Now, of course, you know, teenagers and younger children even are going to figure out ways around that. But it's nonetheless an important message. And for most minors who use, it's going to be a deterrent. And for parents in China, I can only imagine they're ecstatic because they now collectively can say when their kids are saying, well, you're not comparing my kids. There's only go, you're not playing me playing video games. All my friends are playing video games, you know, I'm, I'm, I'm not going to have any friends if I can't go on and play video game. In China, kids can't say that. It's like, nope, nobody else is on, you know, except for on Friday and Saturday for two hours a day. So I think, you know,

• 45:34Speaker 02

  we really do have to think of it like a, like a, a global sociological as well as a psychological and biochemical problem. And that these kinds of top down measures as well as bottom up measures are going to be really important, just like with climate change, right? I mean, we all need to drive less and not use plastic bags and plastic bottles and, you know, do whatever we can on an individual basis. But that's not gonna, that's not gonna alone save our, our planet. We need the government to implement, you know, regulations around gas emissions, around waste emissions, around cleaning up our waterways, et cetera.

• 46:14Alex Kantrowitz?

  Right. Yeah. And I was going to ask about the individual responsibility because like the other side of this. So we have like two groups who talk about this. We've, we both had them on, we've had, I've had both of them on the show. Tristan Harris, we talked about the company's responsibility. And Yal talks about individual personal responsibility. Or how much of this is on, on people to actually, you know, I guess nears perspective is, you know, you, you, as soon as you say people are addicted to technology, you know, you're inherently insulting them and calling them weak. And everybody has the ability to unaddict themselves to these technologies. So we need to stop giving the company so much credit. So what's your perspective on that?

• 46:53Speaker 02

  Yeah, I mean, I know, I know Nir Eyal's work. He and I actually debated this in an online forum called PAIR A Graph, spelled P A I R, like a pair, too. And, you know, I mean, we fundamentally disagree because, basically, I consider addiction to be a brain disease, at least in its severest form. And it's a brain disease that's characterized by loss of agency. It doesn't mean you have no agency, but it's very mitigated autonomy and agency. It's really an inability to choose what you want. And instead, you're really sucked into this black hole of compulsive review, such that you can't stop even when you want to.

• 47:35Speaker 02

  And, you know, I've, I've spent 25-plus years treating patients with severe addiction. And trust me, they want to stop and they are not able to. And I think the same thing can happen with these, you know, with this digital content. Most people, and this is an important point, just like most people who consume alcohol will not get addicted to alcohol. Most people online are not going to develop the severe forms of addiction to online content. They're going to see themselves going down a rabbit hole and they're going to be able to kind of self-correct. But there is a subset of the population, which is probably going to be about 10% prevalence, because that's what it is for drugs and alcohol. And I'm not saying it's the same 10%. So that's the other interesting thing is that even people

• 48:19Speaker 02

  who are immune to addiction to drugs and alcohol, because of their chemical makeup, can get addicted to digital drugs, which means that we're extending, you know, the risk overall in the population because we have these drugs that didn't exist before, which will appeal to certain brains that are otherwise, you know, not vulnerable to the problem of addiction. But I have certainly seen tragic cases of people who are suicidal because of their online gambling, because of their online gaming, because of their online pornography use, because of their online social media use, you know, depressed, anxious, addicted, suicidal, who are unable, without help, to stop.

• 49:01Alex Kantrowitz?

  Yeah, and I think the amazing thing here is you don't even need to be, and by the way, I tend, I'm on, I fall more on your side than on Neer's side. I appreciate what Neer's doing. I happen to think there are some flaws there. If you're interested in a new listener, you can go check out my interview with him sometime last year. But I just want to, you know, ask about this because it's not just the addicts, right? It's the people who may never show up in your office for a session of therapy, but are just totally rocked by constant checking of Twitter, constant checking of Instagram, constant checking of email. I mean, I feel like everyone, I, you know, I have a part of a generation that grew up,

• 49:43Alex Kantrowitz?

  you know, as like the first group of users of Facebook. I know people who are like in the first couple dozen to log on. Everybody in this generation is messed up some way by these phones. You can't sit at dinner with most of them without having, you know, about half of it taken over by phone checking. And when you look at what people are doing, it's nothing. Right? So it's not just the addictive part. It's, that's the addict clinical. It's those, it's the sort of the middle. That's the sad part.

• 50:09Speaker 02

  Yeah, I absolutely agree with you. It's sort of like the sub-threshold functioning of people who aren't going to end up in my office, but are nonetheless have impoverished lives as a result of their attachment to the technology. And I see that, you know, sadly, even in my, you know, my own children, right? The ways in which they're constantly checking and we're not aware, you know, if we really got real numbers about, you know, how many times we touched our phone and looked at this line, how much time it took and how much time we wasted. I mean, I think all of us would be shocked, you know, to realize the ways in which that behavior is not productive, is making us less happy, is really interfering

• 50:51Speaker 02

  with our goals and values. So it's, I agree with you. It's a, it's a big problem, not just at the extremes, but all of, all of us in between there.

• 51:00Alex Kantrowitz?

  Yep. Okay. I need to ask you this final question. So now I like will reveal, I feel like I'm pretty addicted to my phone. I don't think that like it's, it's clinical level, but it's very difficult for me to put it down. And oftentimes I like, I'll take, think of an app like Twitter, for instance. I know you talk about this a lot on podcasts, but anyway, here we go. I feel like Twitter makes me less happy, without a doubt. I'm less happy for using Twitter. But I think that it makes my life more enriching. I mean, I definitely feel like I learned so much from it and I enjoy the interactions. And I say, I'm less happy, but I'm more enriched.

• 51:40Alex Kantrowitz?

  And as of today, I will take the more enriching life versus the quote unquote happier life. What do you think about that? There's gotta be a balance here because all these things that we talked about is bad up until this point. They do, they deliver a lot that people are interested in. And so I'm curious, like, is, have you thought about the balance between happiness and, and, you know, enrichment at the trade off there? And what's your perspective on it?

• 52:05Speaker 02

  Yeah, I mean, I think that's a really important question. And that's really the fundamental question, right? Where the genie, we're not going to put the genie back in the bottle. The technology is here to stay. It's embedded into our lives. It's part of our DNA. So how do we live in relation to the technology? What is the optimal trade off? And I think, you know, it's going to be different for every person. And for you, it really may be true that, you know, your life is better off with Twitter than without, even if Twitter makes you a little bit unhappy. However, as a psychiatrist and one who deals with addiction, I wouldn't just take that at face value. I would really want you to break it down for me. Okay, you're saying it's, you're more enriched. In what ways are you more enriched?

• 52:50Speaker 02

  You know, you're saying it, it, it adds to your life. Okay, in what ways does it detract from your life? Let's really look carefully at that. Can we talk to other people who know you, who might weigh in on ways in which your phone usage detracts from your life in ways you can't see? So one thing that's certainly true is when we're chasing dopamine, we can really be, become blind to cause and effect and not really see the adverse consequences because those dopamine hits, and this is part of the loss of autonomy. They kind of strip our ability to be objective and truly aware of the true impact on our lives. So I would want to do like, talk to other people who know you well and see if they think that, you know, your usage of your phone and Twitter is really enriching your lives. And then

• 53:34Speaker 02

  I would say almost most importantly, if you're in doubt about about it, my recommendation to you would be to give Twitter up for a whole month. Why a month? Because a month is about a minimum amount of time it takes to reset those reward pathways, to reassert homeostasis, to get your prefrontal cortex back online, talking to your gremlins, and for you to really be able to see true cause and effect. Because when I have my patients do that, often they'll come back 30 days later and they'll say, I don't even recognize that person who was on Twitter all the time. Like, that just seems crazy to me now. But they can't see it when they're in it.

• 54:10Alex Kantrowitz?

  Yeah. No, I mean, I did give up Twitter for, I think, six months while I was writing my book, and it was definitely happier. And, you know, it's interesting. So I say, like, less happy, more enriched, but you also use another phrase, better off. And that, to me, is the question. Am I better off being less happy but more enriched, still working through that? And I think it's going to be a question for as long as I have one of these things in my pocket or in my hand at dinner while people are trying to talk to me.

• 54:40Speaker 02

  Yep.

• 54:41Alex Kantrowitz?

  Okay. Well, this has been such an amazing discussion. And Professor, I just want to say, I appreciate you being here. I appreciate the work that you're doing. Again, I think it's bringing a level of science, level-headedness, and practical experience to the conversation that's been lacking up to date. So for those who don't have it yet, the book is Dopamine Nation: Finding Balance in the Age of Indulgence. And then when you finish that one, you should read Drug Dealer, M.D., another book by Professor Lembke. Professor Lembke, thanks so much for joining. Really appreciate it.

• 55:15Speaker 02

  You're very welcome. Thanks for having me.

• 55:17Alex Kantrowitz?

  Thanks for being here. Thank you, Nick Watney, for doing the audio. Thank you, LinkedIn, for having me as part of your podcast network. Thanks for all of you who are going to take the risk and hit five stars to give yourself that reward. Oh, boy, I can't believe I said that after this whole conversation, but you might want to try it. It feels good. We'll be back next week. I'd love to hear what you think about this conversation. Drop some comments on my LinkedIn or hit me an email, [email protected]. We have another great interview for you next week with a tech insider, outside agitator, but man, it's going to be hard to stop this one. Thanks again for Professor Lembke for being here, and until next week, take care.

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