Overcome Addictions & Obsessions of All Kinds | Dr. Anna Lembke

Dr. Anna Lembke, MD, is chief of the Addiction Medicine Dual Diagnosis Clinic at Stanford and a leading expert in how to overcome addictions of all kinds. We discuss dopamine dynamics in the brain and how they impact risk-taking, mental obsession, and compulsive behaviors. We also discuss the most common addiction of all—people’s addiction to control—and how prayer and spiritual practices can open up new neural pathways and help end unhealthy thought patterns and behaviors, including codependence. Read the full episode show notes at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman Function: https://functionhealth.com/huberman Helix Sleep: https://helixsleep.com/huberman Lingo: https://hellolingo.com/huberman LMNT: https://drinklmnt.com/huberman Timestamps (00:00:00) Anna Lembke (00:02:14) Social Media, Digital Media Addiction, 4 Cs; Pollution Analogy (00:06:43) Dopamine, Reinforcing Behaviors & Addiction (00:09:03) Sponsors: Lingo & Helix Sleep (00:11:26) Pleasure & Pain, Homeostasis; Withdrawal & Relapse; Restoring Balance (00:16:02) Treating Addiction, Behavior Replacement, 12 Step (00:22:59) Addiction is the Modern Plague, Spiritual Transformation (00:26:39) Addiction Risk Factors, Trauma; Addiction Consequences; Interventions (00:35:47) Sponsor: AG1 (00:37:00) Spiritual Pivot, Addicted to Control; Anxiety & Shame (00:45:57) Control Paradox & Radical Surrender (00:51:58) Periaqueductal Gray (PAG), Spirituality, Addiction & Control (00:58:08) Dopamine & Serotonin, Higher Power & Surrender (01:02:34) Psychedelics, Psilocybin, Risk (01:06:50) Sponsor: Function (01:08:28) Neurobiology of Surrender, PAG, Hitting Rock Bottom (01:13:40) Aversion to Discussing Spirituality, Open Curiosity; Death (01:21:58) Crisis & Despair, Tools: Prayer; Do the Next Right Thing; Codependence (01:29:26) Codependence, Parenting, Technology; Making Assumptions (01:38:48) Sponsor: LMNT (01:40:08) Codependence, Mother & Father; Overcoming Codependency (01:44:28) Youth & Digital Age; Tolerating Uncertainty, Tool: Open Curiosity (01:50:13) “Faithing”, Praying for Others; Symbols (01:56:57) Transcending Ourselves, Modern Society & Resistance to Spirituality (02:02:24) Daily Spiritual Practices (02:04:23) Ketamine & Addiction, Depression; Stimulants Addiction (02:08:29) GLP-1s, Alcohol Addiction, Dopamine (02:10:28) Thought Addiction? Worry & Rumination; Next Book (02:14:52) Zero-Cost Support, YouTube, Spotify & Apple Follow, Reviews & Feedback, Sponsors, Social Media, Neural Network Newsletter Disclaimer & Disclosures Learn more about your ad choices. Visit megaphone.fm/adchoices

• 0:00Speaker 00

  In the severest cases of addiction, people are not actually addicted to that substance or that behavior. What they're addicted to is control. Through my addictive behaviors, I can create this world within a world where my focus narrows. Everything else falls away. I've simplified things. I just have this one lever like a rat in a cage. And as long as I can press that lever, I know I can change the way that I feel.

• 0:33Speaker 01

  Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.

• 0:42Speaker 01

  I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Anna Lembke. Dr. Anna Lembke is the director of the Dual Diagnosis Addiction Clinic at Stanford University School of Medicine and one of the world's leading experts in addiction, dopamine dynamics in the human brain, and how dopamine and other neurochemicals in the brain govern risk-taking, reward, and healthy versus unhealthy pursuits. Today, we discuss the latest science of addiction and dopamine dynamics and what Dr. Lembke herself has observed clinically in terms of the different kinds of addictions out in the world and how people can successfully overcome each of them. We also discussed her new book Radical Surrender, which I can tell you, because I've read it, is an absolutely fascinating and actionable exploration

• 1:27Speaker 01

  into how giving up our attempt to control certain things actually allows our brain to access new strategies to overcome major challenges, including addiction, as well as codependency, and all together live healthier, better lives. Most people are aware of what dopamine is and how it can work, for better or for worse, as well as what addiction is and the various ways that people strive to overcome addiction. Dr. Anna Lembke's perspective on these topics is uniquely different, actionable, and today, you're going to learn about all of it. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, today's episode does include sponsors.

• 2:12Speaker 01

  And now for my conversation with Dr. Anna Lembke. Dr. Anna Lembke, welcome.

• 2:17Speaker 00

  Good to see you again, Andrew.

• 2:19Speaker 01

  Great to have you back. Your book, Dopamine Nation, and many things that you are saying in and around that book have become true. So I want to start off by saying thank you. You were right. Most of the world is addicted to the internet in some form, social media. You were calling this. And I think now roughly eight years out from heavy use of social media, I think almost everybody can say they have to do some sort of active distancing from screens, from phones, in order to recapture some semblance of a healthy life. So you saw that train coming. What's next?

• 3:02Speaker 00

  Yeah, yeah. I mean, I think there has been a big sea change, just in terms of awareness. Not unfortunately, in terms of our behaviors. If anything, the medium has become even more compulsively reinforcing. We're all struggling. But certainly, in terms of the conversation, the awareness of potential harms, the addictive nature of the devices and the medium itself, I think there is a lot more awareness now, and that's good.

• 3:29Speaker 01

  Are you seeing this clinically? Are people coming in specifically with the issue I can't unplug from whatever it is? Instagram, X, Reddit, YouTube, media more generally?

• 3:43Speaker 00

  Yep, so they're bringing themselves in, or very often, parents are bringing adolescents in. Our adolescent clinic now, about 50% of the referrals are for digital media addiction in some form. 5-0% of the referrals at this point for our adolescent clinic. Huge problem.

• 4:02Speaker 01

  Does it look like classic addiction? And maybe we could define, or if you would, define that again for us?

• 4:08Speaker 00

  Yeah, so addiction broadly defined is the continued compulsive use of a substance or a behavior despite harm to self and/or others. Sometimes that's a harm that we can see. Sometimes it's a harm that we don't see, but others see. We look for the four Cs: out-of-control use, compulsive use, craving, and continued use despite consequences. We also look for tolerance, needing more of the drug over time to get the same effect, and also withdrawal, finding that we're experiencing a painful physiologic response to stopping or cutting back.

• 4:41Speaker 01

  What's so unique about social media and online addiction is that it's often woven into vocation, social connection.

• 4:52Speaker 00

  Yes.

• 4:53Speaker 01

  We could draw some parallels, like alcohol. When I was growing up, there were like, there was like happy hour, people with social lubricant. So you could go to a party and not drink and get some of the experience, but not all the experience. Now that's different, with fewer people drinking.

• 5:08Speaker 00

  Yes.

• 5:09Speaker 01

  But with digital addictions, it's almost like the opt-out can seem, or perhaps it's pretty bleak to people. Like, who else, who are you going to talk to? And how?

• 5:18Speaker 00

  Yeah, and I think this is a central part of the problem, that it's not just an individual problem. It is a collective problem. It's one thing to tell your kid to get off of their device and go outside and play hide-and-seek, but if there's no other kids out there, it's hard to get a game together. So I think looking at it as something akin to, let's say, pollution, right? We can't, we're not going to solve the pollution problem by just having everybody try to use cloth rather than plastic bags, although we could try to do that, and that would be a good thing. We also need top-down guardrails, like controlling the amount of waste that people can dump into rivers and oceans and into the air and all of that stuff. And I think we're going to have to conceptualize digital media similarly.

• 6:01Speaker 00

  Like, we as individuals have agency and need to exercise that agency, but we also need governments, schools, corporations that make and profit from these digital devices to really come to the table and help us help ourselves as we recognize the in-shitification, you've probably heard that term, of technology where first, the product adds value, but as time goes on, it's engineered to actually exploit value from the user as the corporations get richer and richer. This is a process called in-shitification of technology. I can't remember the name of the guy. Maybe someone can look it up. And I can sound like I remember his name. But it's a great term, because it is sort of the progression that you see in a lot of digital media products.

• 6:43Speaker 01

  Take us back to the circuitry, the brain circuitry that underlies these and all forms of addiction. If you could tell us about dopamine and the circuitry and what's involved in resetting the circuitry?

• 6:56Speaker 00

  So dopamine is a neurotransmitter. Neurotransmitters are molecules that we make in our brains that allow for fine-tuned control of the electrical circuits. Our brain is basically a bundle of wires. Those are the neurons, but they don't actually connect end to end. There's a gap or a space between them. That gap is called the synapse. And dopamine is a neurotransmitter that bridges that gap, being released from the presynaptic neuron, binding to a receptor on the outside of the postsynaptic neuron, and then controlling those electrical circuits. Dopamine has many different functions in the brain, but one of its primary functions is in reward and reinforcement. Very broadly speaking, the more dopamine that's released in the dedicated part of the reward pathway in the brain, and the faster that dopamine is released,

• 7:41Speaker 00

  the more likely we are to experience that substance or behavior as reinforcing and usually pleasurable when it's, you know, in concert with the other symphony of neuromodulators like endogenous opioids, endogenous cannabinoids, et cetera. For example, in mice and rats, chocolate increases dopamine firing 55% above baseline. Sex is 100%, nicotine is 150%, all the way up until methamphetamines, which is 1,000%, which is why I like to say, that's why we first have dinner, then have sex, then have a cigarette.

• 8:16Speaker 01

  And even though the data you just cited are from rodents, can we assume that parallel kind of scaling of dopamine with different behaviors and substances is also occurring in humans?

• 8:28Speaker 00

  Yes, we can. I mean, it's not an exact one-to-one, and it's much harder to measure absolute dopamine levels in humans than it is in rats. And rats, you can put a probe right in the nucleus accumbens, measure dopamine levels directly. You know, we're not doing that in humans. It's usually relative comparisons. But there are, there are ways to measure dopamine levels. But the idea is the same, that the more dopamine that's released, the faster that it's released in that dedicated reward pathway, the more likely that substance or behavior is to be reinforcing. And we know that things like social media, gambling, sex, activate the same reward pathway as drugs and alcohol.

• 9:04Speaker 01

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• 10:32Speaker 01

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• 11:17Speaker 01

  Right now, Helix is giving up to 27% off their entire site. Again, that's helixsleep.com/huberman to get up to 27% off. So if somebody... engages in a behavior or takes a substance and is like, I love this. You've talked before about there being a sort of inverse of that that takes place as that experience wears off. It doesn't necessarily cast them forward just feeling much better about everything in life. What do we know about the circuitry underlying that?

• 11:52Speaker 00

  One of the most important processes to understand in order to appreciate what happens in the brain as we go from recreational use of an intoxicant to maladaptive addictive use is to understand this concept of homeostasis. Homeostasis is a limited number of conditions that the organism needs to remain within in order to survive. And the metaphor that I like to use for that is to imagine that in your reward pathway, there's a scale or something like a balance, a beam on a central fulcrum. And when it's at rest, that's baseline homeostasis. Pleasure and pain very simply work at like opposite sides of a balance. When we experience pleasure, it tips one way, pain, it tips the other.

• 12:35Speaker 00

  And the rules governing this balance begin with the primary rule that the balance wants to restore homeostasis, such that with any deviation from neutrality, our brains will work very hard to get back to that level balance. And the way our brains do that is what happens that makes us vulnerable to addiction. So for example, if I do something pleasurable, which for me is like, I don't know, watching celebrity gossip videos and eating chocolate, that releases dopamine in my reward pathway. My pleasure pain balance tilts to the side of pleasure. No sooner has that happened than my brain's going to work to restore a level balance. I like to imagine that as these neuroadaptation gremlins hopping on the pain side of the balance to bring it level again.

• 13:19Speaker 00

  But the gremlins like it on the balance, so they don't get off as soon as it's level. They stay on until I'm tilted an equal and opposite amount to the side of pain. That's the come down, the hangover, or just that moment of craving, right? Wanting to watch one more video, even though I told myself that I wouldn't. Now, if I manage to resist the urge and I stop watching videos, then the gremlins get the message that their job is done, they hop off, and homeostasis is restored. But if I continue to consume my drug of choice over days to weeks to months to years, those gremlins multiply. They get bigger, they get stronger, they're lifting weights, and eventually they end up camped out on the pain side of the balance. And now I've changed my hedonic or joy set point.

• 14:03Speaker 00

  I need more of my drug in more potent forms, not to get high and feel good, but just to level the balance and feel normal. And what I'm not using, I'm walking around with a pleasure pain balance tilted to the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance or behavior, which are anxiety, irritability, insomnia, depression, and craving. And this is why so many people will relapse, even though they can see that their lives are better when they're not using it, it's because their brains aren't necessarily better. They're in a chronic reward deficit state. It's also why many people think that the reason they use their drug of choice is to

• 14:44Speaker 00

  self-medicate anxiety or depression, because withdrawal-mediated symptoms include anxiety and depression. And when they use their drug of choice, they do feel better temporarily because it restores homeostasis. But in the end game, all they're doing is adding more gremlins to the pain side of the balance and digging themselves deeper into that reward deficit hole. And that really is important to understand because it informs how we treat addiction. What we need to do to treat addiction first and foremost is to restore a level balance or get folks back to homeostasis. We can do that in one of two ways. They can abstain for long enough for those gremlins to get the message they need to hop

• 15:27Speaker 00

  off and for homeostasis to be restored. And for most substances and most people, that means 10 to 14 days of acute withdrawal, where you feel like it's never going to get any better, there's no light at the end of the tunnel. But usually by weeks three or weeks four, about 80% of folks will report starting to feel significantly better. The other way to restore homeostasis is to give folks a medication that we can actually put on the pleasure side of the balance that has a long enough half-life that it doesn't induce this sort of cycle of accumulating these gremlins. And that's things like buprenorphine or methadone to treat opioid addiction.

• 16:02Speaker 01

  I realize the answer to the question I'm about to ask doesn't really exist in the mechanistic neurobiological literature, but clinically speaking, I'm curious how the following scenario might work. So somebody is addicted to cocaine, or to gambling, or to sex, or to online behavior, and they come into your clinic and they say, my life is really challenged because of this. And you say, okay, you're going to need to abstain, and we're going to need to give you some other supports in that time. Social connection, you know, somebody else in the sobriety community, maybe you think about what led you to this, et cetera, et cetera.

• 16:40Speaker 00

  Right.

• 16:41Speaker 01

  That all seems great, but it also seems problematic based on the model you described because some of those things are also going to give some dopamine reward. Maybe the person also says, listen, I can abstain from high potency THC edibles and online behavior, but I need nicotine. I need the nicotine. Or I'm going to start the nicotine to kind of get me over the bump.

• 17:01Speaker 00

  Right, right.

• 17:02Speaker 01

  Nicotine tickles this dopamine pathway. It puts, you know, some weight on that side of the scale, so to speak. So the question is, if somebody's trying to get away from a certain unhealthy addictive behavior,

• 17:14Speaker 00

  Right.

• 17:15Speaker 01

  do they need to abstain from other dopamine-inducing behaviors, even if they aren't life-threatening, career-threatening, even if they aren't currently addicted to them?

• 17:23Speaker 00

  Right, so great question. Let me back up a little bit and just say, so if somebody comes in and they say, I'm addicted to X, Y, or Z, the first thing out of the gate is not, okay, you need to abstain from that. So just to make it very clear, we establish a therapeutic alliance, we discuss, you know, their use, the impact that it's had on their lives, we talk about, you know, some of the basic neurobiology, and then we sort of find out where they are and what their motivation and their degree of confidence. So just want to say that. And in our outpatient setting, if someone had repeatedly tried to quit on their own and been unable to, we wouldn't just say, well, try again. We would say, hey, maybe you need a higher level of care, something like an intensive outpatient treatment, or maybe a residential treatment.

• 18:04Speaker 00

  So just to, you know, make sure that your listeners know, like, these are nuanced conversations. But to get to your point, all reinforcing substances and behaviors do work on the same final common pathway, and dopamine has become a kind of common currency for measuring the addictive potential of many different substances and behaviors. They all have their own unique chemical cascade, but they all ultimately will release dopamine in the nucleus accumbens. Now, clinically speaking, you would think that if somebody was using nicotine, alcohol, and cannabis, and was just willing to give up one of those, that it wouldn't have like a restorative impact because you've got the other things going on.

• 18:45Speaker 00

  But it turns out clinically, what we see is even if they're only willing to give up, let's say nicotine, which is a common scenario, like, you know, I'm not going to give up my cannabis, but I want to stop nicotine products, as long as they don't replace it with something else, or escalate their cannabis use, or escalate their alcohol use, or start, you know, compulsively watching pornography or what have you, as long as they really just remove that thing, we see improvements. We see improvements. So there is this sort of fine tuning that goes on, and we will totally meet patients where they are and say, hey, what are you motivated to tackle? What's the most problematic in your life? Now, where we will make exceptions to this is, number one, if a patient just wants to

• 19:30Speaker 00

  give them all up at once, which we sometimes see, and there's data to support doing that. So for example, there are studies showing that for people who are addicted to alcohol and nicotine products, who give up both at the same time, compared to people who just give up alcohol but keep smoking, if you follow them prospectively, the people who gave up both at the same time tend to have better outcomes, which is, you know, makes sense from like the neuroscience perspective, right? Because you're now not constantly pinging your reward pathway with any really potent intoxicant. So we will ask people to give up more than one substance if they're obviously paired.

• 20:10Speaker 00

  So for example, if drinking coffee is almost always followed by craving for a cigarette, then we might ask them to give up caffeine and the cigarettes, you know, for this period of time. The other thing is that we introduce it really as an experiment. We invite them to be the scientists in their own lives and to give it up for 30 days, not a lifetime. Why 30 days? Because on average, that is the amount of time it takes to begin to reset reward pathways.

• 20:37Speaker 01

  Yeah, what I'm trying to understand, and I think many people ask me about this, is if I'm trying to move away from a particular compulsive or addictive behavior, what do I need to be mindful about in other areas of my life?

• 20:51Speaker 00

  Right.

• 20:52Speaker 01

  Now, some of that's obvious, right? Work, social connection, sleep, exercise, all of these things we know are healthy. We should continue to do those as much as possible. But replacement behaviors, in my completely naive clinical expertise, because I have none, truly, is very common. Like, you go to a 12-step meeting, let's just say, you used to see a lot of smoking, now you see a lot of oral nicotine use, you see a lot of tattoos, you see a lot... Now, there's some other things going on there, but there's this idea that everybody is going to be addicted to something, and you just need to carefully pick your something.

• 21:26Speaker 00

  Recovery is going to be something different for everybody. The philosophy in 12-step recovery is that even if you abstain from all the intoxicants, you're not really in recovery if you're not practicing a values-based life, if you're not following the 12 steps. There's this whole notion of the dry drunk, where you may not be using any intoxicants at all and be completely abstinent, and yet, if you are still enacting your sort of narcissistic pathology, then you're not in recovery. So that's a very, let's say, like philosophical and spiritual definition of addiction.

• 22:05Speaker 00

  And so, yes, I mean, Dopamine Nation is all about that we live in a drugified world, that almost everything has become more accessible, more reinforcing, more plentiful, you know, making us all more vulnerable to the problem of addiction. But I still think the aspiration is not just to move from, you know, one addiction to another, although that's very common, this whack-a-mole problem, but really to kind of get at those core behaviors that drive compulsive reuse and try to get ourselves out of that addiction vortex. So, you know, the dopamine fast or the 30 days of abstinence, you know, or the stopping using substances is really just the first step.

• 22:48Speaker 00

  I mean, recovery is ultimately about so much more than that, and it really is a bio-psychosocial spiritual disease, and so we have to intervene at all those levels.

• 23:00Speaker 01

  If our circuitry is primed for this, like, we're in a world that's filled with things that can easily tap into these dopamine reward and motivation circuitries, that we really are all walking around sort of lured to this or to that, and that people find their thing, it's just a question of whether or not you can find something that's not detrimental to self or others. Like, now you can gamble online so easily. Pornography is readily accessible. Social media is socially acceptable, and it's become the mainframe for interaction among humans, at least a certain generation of humans. So, how are we supposed to navigate in this world, given that the circuitry is within

• 23:43Speaker 01

  us, there's no escaping that, the lures are everywhere, and in some sense, the algorithms and just our deficits in life, as well as what we're drawn to, basically set us up to engage in things until they become too much? I mean, is this part of everybody's life arc, to figure out what your tripwire is and then get over it, and then that's the... Is this part of the hero's journey?

• 24:06Speaker 00

  I think we are all struggling with some form of compulsive overconsumption in the modern age, because everything has been drugified. I mean, I've called it the modern plague, I've called addiction the modern plague, and I think that's accurate. I think if you look in the foreseeable future, you know, 50, 100, 500 years, we're living in a world of plenty, more and more machines will be doing our work, people will progressively have more leisure time, more disposable income, more access to luxury goods, even for the poorest of the poor. And so, the question then becomes, what do we do with ourselves? And the hope had always been that we would sit around and have deep philosophical discussions and clean up, you know, the garbage in the planet and help each other, but it looks

• 24:51Speaker 00

  like we're mostly just, you know, masturbating to images online, some version of that. So, it's a very important question, you know, beyond the question of just the mechanics of early recovery and abstaining, sort of what then, what then? And it is why I think this spiritual element in particular is so important. First of all, there are many people with severe addiction for whom the spiritual transformation was the only way that they were able to get into recovery. Without that piece, it would have been impossible for them. And I think many humans are dealing with the problems that people with addiction are dealing with, you know?

• 25:36Speaker 00

  As my friend Kent Dunington has said, that people with addiction are modern-day prophets, because they show us who we really are. And I would add to that, that people with addiction who can get into recovery in this world really do have a wisdom that we could all learn from, because we are living in a drugified world. And this is, again, where I think this, the spiritual piece, however we define that pathway, you know, in 12 steps, it's... The essence of it really is acknowledging that we don't have control over our addictive behaviors and many other things, conceiving of a power greater than ourselves, however you define it, as long as it's not you. And then finally, you know, being willing to give our will over to that power in the

• 26:21Speaker 00

  hopes of being restored to sanity. And I really like that phrasing, because it suggests that we were once sane, and that we can be restored to being sane, and that that's part of the journey. So I do think that that sort of deeper meaning and purpose and the spiritual pivot is really essential.

• 26:40Speaker 01

  I want to talk about your new book, A Radical Surrender, and I want to talk about the spirituality piece, but before I do that, I want to just ask your opinion about two areas related to addiction that we see a lot of online. One is, there's a clip out there now, and I entirely believe that this was his experience, because he's self-reporting it. Ben Affleck was talking about getting over, I think it was, alcohol addiction. He's been asked several times, you know, what allowed you to finally do that? And he just said, "Well, the consequences just finally became intense enough, scary enough, that you just won't stand for it anymore." So it's perhaps an interesting window into this process and the dopamine circuitry and

• 27:23Speaker 01

  what's required to exit the addictive cycle once and for all. The other thing that we hear is that childhood trauma and early events and family structures and their deficits are at the root of all of it. And I realize none of this is mutually exclusive with the model that you presented, but there does seem to be a sort of divide in the public understanding and belief about addiction, where many people feel like, "Oh, no, you know, it's... This is all the playing out of an unhealthy narrative that occurred early. If we can understand that early set of dynamics, then we can escape the addictive cycle."

• 28:04Speaker 00

  Right.

• 28:04Speaker 01

  So I'd like to know if that's true or not, sometimes, oftentimes, always, never. And I also think that Ben's description is really important, because at the end of the day, even if one incorporates a higher power in order to move through addiction, there's this piece of like, enough, enough is enough, and that can come from the outside many, many times, but ultimately, the person has to do it for themselves. So just like, any thoughts on that or reflections about what could be going on with enough is enough and with trauma, and in particular, early childhood trauma as it relates to addiction?

• 28:42Speaker 00

  Yeah, so there's lots of evidence showing that childhood trauma is a significant risk factor for addiction. It's very clear that if you are raised in a home where you experience physical, sexual, emotional abuse, neglect, chaos, you are at increased risk for all kinds of mental and physical health consequences, including addiction. I also really appreciate a rat experiment where a rat is trained to know that if it presses a lever, it will get cocaine. Most rats will then press that lever till exhaustion or death. But if the cocaine is taken away, eventually that behavior will extinguish. The rat will stop pressing the lever, will go off and do other things.

• 29:25Speaker 00

  If you then expose that rat to a very painful foot shock, the first thing the rat will do is run back and start pressing the lever again. In other words, not only can stress and childhood stress in particular, be the progenitor of developing addiction later in life, but in the midst of trying to recover or of recovery itself, if you're exposed to a very extreme stressor, those neural networks are highly sensitive. They may die down, but the embers are still there and they can easily get reactivated by stress and trauma. So, super important to acknowledge that risk factor. But there are also other risk factors. There are genetic risk factors, right? So if you have a biological parent or grandparent with an alcohol use disorder,

• 30:09Speaker 00

  you are at increased risk to develop an alcohol use disorder, even if you're not raised in an alcohol-using home. There are access risk factors. So, and then that's one of the main focuses of dopamination. Like simply having access to a drug means you're more likely to use it, more likely to change your brain in the process, and more likely to get addicted, which is also why addiction doesn't discriminate. Like you can have the perfect family, the near-perfect childhood. You can have a great job, you can have great friends, and you can still get addicted because you're surrounded by addictive substances and behaviors, which, once you use them, will change your brain into this very specific physiologic, you know, phenomenon. So, you know, these two things exist simultaneously.

• 30:52Speaker 00

  I think the danger that can happen, and in my career span was very common, is that you have psychiatrists and psychologists and many different types of mental health providers who aren't very well-trained in addiction, so don't know much about it, don't want to ask about it because they haven't learned much about it and don't have the tools to intervene. And so, when a patient presents with a substance use disorder or behavioral addiction, will spend a lot of time trying to find the reason behind the addiction. And that is not productive, especially not initially, when that person is deep in their addiction.

• 31:36Speaker 00

  For people to really be able to process the trauma that might be contributing to the addiction, they first need to get into at least early recovery, get back to homeostasis, get their prefrontal cortex back online, not be constantly craving and dysregulated, and then they can engage in the trauma work. The other thing, too, that I think is, happens with the narrative of addiction, and this is just very common, because I've been listening to many narratives, you know, over many years. When people are in their addiction, they are very quick to blame others for their problems and not take responsibility themselves. And which is why the 12 steps can be so effective, especially, you know, your own sort of character inventory.

• 32:20Speaker 00

  What did I contribute to the problem, right? Forcing people to look at what they contributed as part of the 12 steps, even if the only thing they contributed was just showing up or maybe repeating the same patterns and not changing them from patterns maladaptive patterns from childhood. It's really important to acknowledge that that kind of victim narrative is just not productive for getting into recovery. It's important to process the trauma. It's important to know, you know, when you've been wronged, where and how. But it's equally important to know what you've contributed, how you are perpetuating the problem, and to move on from there. Now, getting to the idea of consequences. I don't know if you've seen, there's a great Key and Peele sketch where

• 33:02Speaker 00

  I don't remember the details exactly, but Key or Peele or one of them, you know, he's getting up there and he's talking to a, he's like in, I guess he's in recovery and he's talking to a bunch of high school students. And he's talking about, yeah, the only way to get into recovery is consequences. And then at one point, a big wrecking ball comes in and like hits him. He's, see, I told you consequences. Anyway, I'm probably butchering the scene, but I just found it hilarious. Practically speaking, in the reality of treating addiction, many people with severe addiction do not get into recovery until they have the serious consequences. And I think part of the phenomenon there is because the brain is just very masterful at minimizing consequences related to addictive behaviors.

• 33:47Speaker 00

  So we just, like whatever happens, you know, a DUI, a car crash, a lost relationship, you know, pancreatitis, our brain just does this clickety, clickety, click. It's some weird, really weird mental madness, like, well, it's actually okay. Or, it's not really, you know, the substance, or it wasn't really related to that behavior. We're just really, really good at that. You know, it's called denial, as you know, and it's incredibly powerful. And at some point, after a certain number of consequences, the denial just crumbles. And this is commonly referred to as, you know, hitting rock bottom. It's just, it's a moment where you get, and you're just like,

• 34:29Speaker 00

  okay, I can't pretend that this isn't happening anymore. And for some people, that place is just like the expression on their loved one's face when they're caught using late at night, when they were pretending that they were, you know, sober. And just the expression of the loved one. For other people, they, you know, they got to end up homeless or in jail or bankrupt, or much more significant consequences before. So people are different. You've got your high bottoms, your low bottoms. But the bottom line is, everybody sort of has that moment where it's like, okay, like I just can't do this anymore.

• 35:03Speaker 01

  I don't know if there are any data on it, but do interventions work?

• 35:06Speaker 00

  There are wonderful interventionists out there. Many of them are people who have, you know, struggled with addiction themselves. And they can be very helpful, yeah. Especially when they come into a home where parents are really struggling with a child, either an adult child or a minor, and just at their wits' end to try to, you know, extract some kind of behavior change. Especially since, again, with these computers and the digital medium, you know, people, kids can just stay in their rooms and stay at home and sort of, you know, engage in this sort of constant looping sort of self-titillation and not emerge. And parents very often can be held hostage to that.

• 35:48Speaker 01

  I'd like to take a quick break and acknowledge our sponsor, AG1. I'm excited to share that AG1 has just launched their newest formulation, AG1 Pro. AG1 Pro takes the clinically-backed AG1 formula, which is a blend of vitamins, minerals, probiotics, and adaptogens, and adds three important new ingredients: creatine monohydrate, calcium HMB, and zinc carnecine. Each serving has five grams of creatine monohydrate to support muscle strength and performance, as well as brain health; calcium HMB to support muscle recovery and reduce muscle breakdown; and zinc carnecine to support and improve the lining of your gut. All three of these ingredients have compelling science to support them, and therefore, I love seeing them added to the existing AG1 formula. As most of you know, I've been taking AG1 every day for nearly 14 years now.

• 36:33Speaker 01

  I started taking it long before I even knew what a podcast was. It's a great product, and it's now made even better with the new AG1 Pro formula. If you would like to try AG1 Pro, you can go to drinkag1.com/huberman to get a special offer. AG1 is giving away a free bottle of omega-3 coenzyme Q10 with your first subscription. Again, go to drinkag1.com/huberman to get a free bottle of omega-3 coenzyme Q10 with your first AG1 subscription. Let's talk about surrender and spirituality and everything that goes with surrender. I can't remember if the story was at a particular stage or not the last time we spoke on this podcast.

• 37:15Speaker 01

  But I do recall sharing a story, it's a true story, about a friend who was badly addicted to drugs and alcohol and had gone through multiple relapses, gone to various private clinics, like had tried so many different things. And I think I asked you, like, do you just give up? Right? Do you just give up? That story ended up in a pretty wild place. He, he won't mind me sharing this. I checked with him. One of their kids had gotten into a stash. It was a whole mess. Like it was like, it was like, this is it, or I'm taking the kids, I'm going. That's it, that's it.

• 37:53Speaker 01

  He ended up going to a place where the entire treatment was faith-based. And I remember when he told me he was headed off there. I was like, okay, this is like, like, no. He went there for a week or so, came out. That was something like four and a half years ago. He's actively in 12-step and that's keeping him going.

• 38:21Speaker 00

  Right.

• 38:22Speaker 01

  Never seen him or his family in better shape. It's super impressive. So, I ate my words. There's something there, something happened. So the question is, what happened? We know what would have needed to happen for the circuitry.

• 38:39Speaker 00

  Right.

• 38:39Speaker 01

  But clearly, something worked that hadn't worked anywhere else, any way else. And it was really bad. It was like, it was as bad as it could get. And that he had wrapped his truck around a pole at 7:00 AM after taking pills. This was prior to that. I mean, he'd had so many of these in the short time that I'd known him. And now it's been a long time. So, I'm like, man, that is awesome. Whenever I say, like, so great. And he's just like, he will tell you. Like, I mean, this isn't propaganda for me. He'll tell you, God, Jesus got him sober. And I'm like, so what the heck's going on?

• 39:15Speaker 00

  Yeah, I mean, it is fascinating. And in my career, I have seen that many times over. You know, either through 12-step or many different types of religious practices, people who couldn't get into recovery in any other way. And then this spiritual pivot just became key for them. And I think The core of understanding this phenomenon is to appreciate that in the severest cases of addiction, people are not actually addicted to that substance or that behavior. What they're addicted to is control.

• 39:56Speaker 00

  So we evolved over millions of years of evolution to reduce uncertainty, and it's what's kept us alive in a chaotic and dangerous world, full of famine, flood, fire. We are born with a mental model of the world, what I'll call a mind map. Our mind map is different from the mind map of a fish, so we're not born with tabula rasa. It's not just a blank slate. We already have an elaborated series of neural networks that prepare us to anticipate the world that we live in as human beings. And as we grow and develop and have human experiences, we're constantly predicting what will happen in the world.

• 40:39Speaker 00

  And when our predictions are right, that feels good and is reinforcing, releases dopamine, right? And when our predictions are wrong, we have really one of two choices. We can update the map, or we can update the world. Now, updating the world takes an interesting form. It's a way of further foraging and seeing if maybe I need to collect more data. It's a way of redirecting our attention, so that now we're attending to things that match with our mental model. But the bottom line is that we're constantly seeking to assert control and reduce uncertainty. And it's adaptive, and it's what's kept us alive.

• 41:22Speaker 00

  What has happened in the modern world is that we have developed so many levers to control our experience that we have become addicted to control itself. So we are constantly optimizing, right? We're relationship-maxing, we're career-maxing, we're looks-maxing, we're counting our steps, our sleep, our accomplishments, our calories, other people. We're trying to engineer perfection and get the perfect mental model of the world, to the point where our efforts to exert control are now quite divorced from what is actually happening in the world. And addiction is the quintessential example of that.

• 42:07Speaker 00

  Through my addictive behaviors, I can create this world within a world where my focus narrows, everything else falls away, I've simplified things, I just have this one lever, like a rat in a cage, and as long as I can press that lever, I know I can change the way that I feel. Now, as the disease progresses, my drug stops working, and maybe I even feel worse when I use it, but it doesn't matter, because I'm in control of changing the way that I feel in that moment. It's like with gambling addiction. People think that people who get addicted to gambling are addicted to money. They're not addicted to money, they're addicted to the game, which is why loss chasing happens,

• 42:52Speaker 00

  where pathological gamblers will tell you that a part of them actually wants to lose, because they know when they lose, they have a justification to stay in the game longer. The game is a world. It's a world within a world where I am God, I press the lever, I control on this minuscule level, and it's distorted, and it's messed up, and the rest of my life is going to hell, but right here and right now, everything's simple, I have that feeling of grip, I'm exercising control. This is all by way of saying that, in my opinion, it's not only people with, you know, classic addictions who are struggling with this addiction to control, but it's all of us now.

• 43:35Speaker 00

  Again, because we have so many levers for control, we've made ourselves masters of the universe, we exert our will over material reality in every way, and as a result, we are much more miserable. So, for example, what I see in clinical care, especially among young people, is incredibly anxious people who hate themselves. Why are they anxious? They're terrified they're going to choose wrong and end up missing out on their best life. It's a constant FOMO. It's like, oh, but if I choose this career, then maybe I should be going to this career. It's this idea, if I am the only arbiter of my destiny, then, like, what if I mess it up? It's all on me.

• 44:19Speaker 00

  So there's terror and anxiety. And there's also this illusion that, well, because we can control so much, we should be able to get it perfectly right, such that any fall from perfection, people are just filled with self-loathing shame. There's no sacred ballast of sort of forgiveness or grace. It's like, I messed up, I messed up my life. And of course, with the internet, our shame has legs, it ricochets all around the world. And, you know, very sadly, you know, working at a prestigious university, I see, you know, young people with all the promise, all the gifts, who end their own lives in the wake of what a generation ago would have been a disappointment, but not a life-threatening

• 45:03Speaker 00

  one, right? A grant not received, a social rejection, and an academic reprimand. Young people taking their own lives because the shame and the self-loathing in a world in which we're expected to manipulate our experience to achieve perfection, it's too much. We've lost our tolerance for imperfection, we've lost our tolerance for uncertainty. Now, just not getting the right, you know, soy mocha latte in the morning sends us for a tailspin. And that all leads to, ultimately, what is the answer to that? What is the antidote? It's the spiritual pivot. It is radical surrender. It's acknowledging the limits of what we can control, giving that will over however

• 45:48Speaker 00

  we define it, and merging with our lives unfolding, rather than trying to engineer some future perfection.

• 45:57Speaker 01

  Incredible. I've never thought about this addiction to control. Some years ago, you told me something that really stuck in my mind and made me kind of take a look at myself for a moment, where you said that addicts like to, like, line up their pills, or kind of count their bags. I've never been a powder taker, except creatine. I confess, I confess. It's better than my life, you do you, but it's better than my life. And this need to quantify. And I was just thinking about that for a moment in light of what you just said, because that behavior could be viewed as you're establishing some certainties about the future.

• 46:37Speaker 01

  I know I've got this, I can get into a certain feeling state if I need to, I can do that, you know, X many days apart if I need to extend it, you know, the fear of, you know, basically not being able to control one's future state.

• 46:51Speaker 00

  Right.

• 46:52Speaker 01

  You know, for many years, before it became essentially legal or decriminalized, I had friends that were pretty chronic cannabis users, and they didn't really meet the, you know, classic definition of addiction, but then I would always just say, well, how do you do when you travel? And like, not well, but I, you know, like, put it in my shoe, this is before edibles became really common, right?

• 47:15Speaker 00

  Okay.

• 47:16Speaker 01

  You know, so like, they were basically telling me that they could do fine without it, but they just don't do without it.

• 47:19Speaker 00

  Right, yes.

• 47:20Speaker 01

  And I found them to be...

• 47:21Speaker 00

  They could do fine without it until they actually had to go without it.

• 47:23Speaker 01

  Exactly, exactly. So, you know, and they were pretty irritable if they hadn't had it, or if they weren't certain when they could.

• 47:31Speaker 00

  Right.

• 47:32Speaker 01

  And these extreme levels of motivation to, like, ensure they could get high in the future came about, and I'm not trying to point fingers at them, I think we all have components of this. So, there are a number of things that you said about addiction that weave into this control piece. How is it, though, that we can separate out the healthy, mildly unhealthy, and truly unhealthy versions of this? So, for instance, many people enjoy exercise, and it gives them some feeling about their body aesthetics, their future body aesthetics, their longevity, and that could be semi-unhealthy to really unhealthy, but we're all told we need to exercise. So at what point are we addicted to exercise? If you exercise and you fulfill your job and family obligations, you're not, you know,

• 48:16Speaker 01

  waking up to run in the middle of the night just because you're healthy?

• 48:19Speaker 00

  Yeah.

• 48:20Speaker 01

  Are you addicted? I mean, are you addicted to control? And where do you draw the line? It can become a very jagged line, too.

• 48:25Speaker 00

  Yes. And, you know, I'm not sitting here in judgment of people who have highly controlled lives and are thriving and doing great. Again, we are wired to reduce uncertainty, it is completely adaptive to do that. What I am talking about is the mismatch, and, you know, a similar argument with dopamination. The mismatch in dopamination that I talked about is this plenty paradox, where we reflexively approach pleasure and avoid pain, it works great in a world of scarcity, it's a disaster in a world of plenty. In radical surrender, I'm talking about a control paradox, where we evolved to reduce uncertainty in a chaotic world. That was essentially our telelogic mandate, right? Or our reason for existence.

• 49:09Speaker 00

  If you look at active inference and the free energy principle, that is essentially the underlying theory of that neurocognitive branch of science, that we all exist to reduce uncertainty, to exert our will, to predict and to control. The problem is, again, a mismatch between what is highly adaptive in an organically uncertain world, and what now becomes maladaptive in a world that we've essentially paved over, right? And now we control everything. In fact... One of the big dangers, in addition to anxiety and self-loathing, is nihilistic boredom,

• 49:49Speaker 00

  because there's nothing that we're not in control of. So now we have nothing to exert our need to control on, right? And so what do we do in response to that? We engineer uncertainty. And this is at the heart of social media, slot machines, sports betting, right? Why do people love sports? And I love sports, too. So I'm not saying it's unhealthy to love sports, but it may be the last bastion where we don't know the outcome. It's genuinely uncertain, unless they're cheating and it's rigged. It's, we don't know. And it's, it's complex and it's many factors. People want to give themselves over to destiny with a capital D, right? To, to something greater than themselves.

• 50:33Speaker 00

  At the same time that we have a strong evolutionary psychology to control, we also have a strong need to surrender to something greater than ourselves. And both of those things coexist and may even work physiologically in our brains through an opponent process mechanism. So a lot of the, the science on this, and it's emerging science on spirituality, will tell you that our spirituality network can't actually get activated when our control network is online, because the control network is inhibiting the spirituality network. So as long as we have a way to control a situation, we're going to inhibit, for example, the periaqueductal gray, which is sort of like the hub of this spirituality network. And

• 51:14Speaker 00

  that aligns perfectly with what you see in the last 200 to 500 years, as we've been able to apply science and technology to exert more control over our day-to-day existence. People are moving away from spiritual practices. They're moving away from faith-based organizations. Churches and temples are being turned into nightclubs and community centers. People are becoming more and more secular. And, and yet, when some crisis occurs, all of a sudden, that sort of reignites sort of this, like people, even atheists, you know, will, will pray in a moment of absolute terror. It's, the circuitry is there, but we don't access it on a regular basis, because we're so busy trying to control our next move.

• 51:59Speaker 01

  You mentioned periaqueductal gray. You and I are familiar with that. We should probably inform the listeners and viewers about PAG, P-A-G. We first met, because we were team teaching neuroanatomy, right? And in neuroanatomy, we teach that the PAG, it's, it's a really cool structure, right? It's got these different, kind of like wedges of like, represents pain, pleasure, sensory input. It's a kind of an integrative hub, as I understand. But that's a very superficial understanding. You'll, you'll tell us, what is known about PAG in the context of what you're talking about? And are there any components of the circuitry that make it make sense that PAG would be involved in the experience

• 52:41Speaker 01

  of, of spirituality or letting go of control?

• 52:46Speaker 00

  Yeah. So the PAG is intimately associated with our threat response. So fight, flight, and freeze. In fact, there's a wonderful experiment where human brains are neuroimaged while playing Pac-Man. And as long as the, you know, Pac-Man enemy is far away, the prefrontal cortex, the control centers light up. But as soon as that Pac-Man is just about to die, you know, within the presence of the ghost, the PAG just goes wild. It absolutely lights, lights up. So it's very essential in the face of like imminent death and sort of coordinating, like, what am I doing now? And then there's a very fascinating experiment or a series of experiments that have come out, looking at lesions in humans and lesions

• 53:31Speaker 00

  that either increase or decrease spirituality, whether, you know, parts of the brain removed due to trauma, or cancer, or epilepsy. And what they found was that spirituality is a circuit. And this circuit, the hub of it, is probably the PAG. And it makes sense that a part of the brain that's intimately associated with imminent threat and death would also be associated with spiritual surrender, or, you know, letting go of control and accessing this sort of network that essentially is going to function to allow us to come up

• 54:12Speaker 00

  with an entirely new approach, because what we've been doing hasn't been working. So the PAG is rich in mu opioid receptors, which are our natural pain relievers. The PAG is rich in oxytocin receptors, which is our connection or love hormone. And both of those being activated then also stimulates a vast array of serotonin receptors. And serotonin, when it functions in this regard in the PAG, is essential for increasing neuroplasticity or learning in the face of rapid change. And again, getting back to addiction, what,

• 54:55Speaker 00

  what's happening with addiction is that we are rigidly holding on to our mental model and these control loops, even when they've stopped working for us. And this is essentially the definition of neurosis. The definition of neurosis, I think it was Freud way back when, said, neurosis is doing the same action over and over again and expecting a different outcome. But that's essentially what addiction is, right? You're, you're engaging this behavior. You can see that your life is going to hell, but somehow you keep thinking it's gonna, it's gonna be different this time. It's really in large part of function, because our prediction machines or our mental models become calcified or rigidly ensconced, we're, we're too attached

• 55:37Speaker 00

  to them. And so we do need to, on some level, have this spiritual pivot, let go of control, hit this bottom, surrender it, give it over. The control networks finally shut down, this PAG and spirituality network, you know, comes online, and we have the ability to sort of melt down these neuronal connections and, and begin anew. And many people will talk about, when they have a sort of a spiritual, let's say, awakening, or just a moment of transcendence that allows them to move forward, it is as if they can perceive more, right? The, the leaves are greener, the sky is bluer. This is probably really happening, like

• 56:17Speaker 00

  perception is enhanced. I'm no longer trying to impose my rigid mental models on the world. Instead, I'm letting go of those, the precision of my predictions. I'm letting that flatten, and I'm opening myself to what is really happening in the world. So it's like this embracing reality, acknowledging the limits of my will, giving it over, and then having the experience of serenity. So it is an affective experience, whether we're talking about the spiritual pivot or prayer. It's an affective experience of hope, serenity, peace, which then enables a different kind of action in the world.

• 56:56Speaker 01

  It's a ceasing to rely on the algorithms, the strategies that we've been using.

• 57:03Speaker 00

  Right.

• 57:04Speaker 01

  And it becomes this openness to the reality that that wasn't working. Those things weren't working. There's something else. I don't yet know what those new strategies are. So I'm going to give it over to God, as they say in 12 steps.

• 57:20Speaker 00

  I'm going to, number one, acknowledge the limits of my control. So I'm going to right-size my ego. I'm going to acknowledge that all of these things that I'm doing, like I'm running around like a chicken with my head cut off, you know, trying to manage it. Because it takes, it's a lot, you know, in our disease, right? Where it's, it's a constant management. And I'm just gonna stop. I'm gonna just, as one of my patients said, I realized I was at checkmate. There were no more moves, which I just thought was a great analogy. It's like, yeah, it's checkmate. I'm, I'm out of moves. You just stop, you, you recognize the limits of your will. And you just, that this pivot of giving it over to a power greater than ourselves. So this is the mysterious process. But again, I think we're just wired for this. We evolved for this pivot. And when that happens, it, it

• 58:05Speaker 00

  starts a whole physiologic process, which is restorative.

• 58:09Speaker 01

  So I realized I had it completely wrong. I assumed that the potency of the giving it over to a higher power was about acknowledging our inability to strategize in, in a way that's good for us. And just sort of the recognition, like, my brain can't do it on its own. I'm going to adopt this other rule system that is not of me and make it of me.

• 58:35Speaker 00

  I don't know that that's wrong. I mean, that's, that's the language that you've come up with, that makes it make sense for you, that kind of pivot, I think.

• 58:43Speaker 01

  The place where I get stuck is everything I know to be true about the dopamine reward reinforcement circuitry that you've described, says that giving up control ought to send somebody further down the path of addiction, not overcome it, right? Because it's like, okay, let's say this had alcohol in it. And I felt like I literally couldn't help, help it. I could ask Rob to help me out. I could ask you to take the cup out of the room. We could talk about it. We could talk about what led to, you know, a tendency to drink. But there's this kind of weird twist in all this, where if I just say, wait a second, I can't do it. You're not here. Producer Rob isn't here. So I'm just gonna, I'm gonna give it over to God. And then suddenly, and I've seen this over and over again, right?

• 59:26Speaker 01

  I've experienced this, like, then, then we can abstain. It, it doesn't work with our existing models of just the dopamine reward circuitry, because it would say, like, I'm going to take my hands off the steering wheel, and the car's actually going to drive better. And it's not Tesla.

• 59:40Speaker 00

  In many ways, at least when it comes to this, dopamine and serotonin work like opposites, right? So, so dopamine is the ultimate gain function modulator. It's what tells your brain, whatever you're doing now, get more of it. Do more of it, more of that thing. And it's a very strong signal. Whereas, whereas serotonin is the, oh, wait a minute, retreat, reevaluate, and potentially find a new way around, because what you've been doing isn't working. And in fact, repeated frustration, or our inability to accurately predict what's coming next, or to solve the problems in our lives. There's a lot of evidence that shows they're characterized by the proliferation of 5-HT2A serotonin

• 1:00:22Speaker 00

  receptors. So it's almost like our brain is getting ready for this transformative moment when we finally acknowledge my mental maps are not working.

• 1:00:34Speaker 00

  This is not working and it's, and you have to come pretty low to get there because nobody likes to give up control because we all want more dopamine, right? We all want the gain function modulator. But that moment when we finally accept that we are not in control and we let it go, then you get a very different, I mean, first of all, there's maybe a spiritual thing happening, like a god thing happening, I don't know. But also, we have the natural wiring to have a very then different physiologic experience where we, our executive function, our planning, all of that goes quiet and you get this massive

• 1:01:13Speaker 00

  activation of serotonin, which is the down regulation of our precision predictions, right? So now we're, we're, we're saying, hey, my rigid mental models are not working and it's a moment of plasticity. So it's like we're going back in time to a more open receptive state. And you get with that, and again, a felt experience, an affective experience of analgesia. So, right, less pain, of connectedness, of the thought that where I couldn't rely on my own strength, I can rely on the strength of surrender and giving it over.

• 1:01:54Speaker 00

  And that is what allows people then, through that experience, to, to not have that drink. They're getting the strength from the surrender itself, right? And, and also, I think importantly for many people, from the handing it over, right? This idea that, okay, I'm not in control, but this higher power is, and I'm just gonna try to follow that, right? Instead of me trying to juggle 14 balls in the air, I'm, I'm gonna let them all drop and I'm just gonna show up here and I'm gonna do the next right thing and I'm gonna take it one day at a time. So you also narrow the sort of scope of what you're trying to manage.

• 1:02:34Speaker 01

  The serotonin piece is really interesting. I know you have mixed skeptical, you'll update us, feelings about the use of psychedelic medicine for treatment of addiction, like taking a drug to get over drugs. But in the case of at least, let's just say psilocybin, I mean, its main mechanism for engaging plasticity is to, you know, activate the serotoninergic pathway and these particular receptors seems not coincidental. Maybe, maybe unmasking connections, maybe allowing new contingencies to be formed. But I'm also reminded, it's a really cool paper, it doesn't get talked about very much, but a guy by the name of Lomberto Maffei did some really cool studies reopening critical

• 1:03:17Speaker 01

  period plasticity by administering, it was rats, SSRIs. And you could reopen plasticity. And I know SSRIs get a really bad rap these days, but in both cases, psilocybin and SSRIs, the net effect is increased serotonin tone in the synapses. So, you know, love them or hate them, the SSRIs are effectively getting to a similar-ish place of increasing serotonin and thereby plasticity.

• 1:03:44Speaker 00

  So much of what we're beginning to understand about the spirituality and spiritual surrender is through the research with psychedelics and psilocybin. So that, that research is amazing. You know, people's subjective experience, I mean, I've talked to many people for whom their first access to the sacred in our secular world was through psilocybin or other psychedelic. So it's very clear that not only has this given us a tool to begin to understand what may be happening with spiritual surrender, but for many people, it's, it's a pivotal moment in their lives, life-changing and incredibly positive. My reservation just comes with, I want to make sure that people also understand the

• 1:04:28Speaker 00

  risks associated with it and that the sort of, you know, the promise just doesn't get too far ahead of the, the evidence. Cause of course, in my clinic, what I see is people misusing and addicted to psychedelics in many different forms.

• 1:04:44Speaker 01

  Including psilocybin?

• 1:04:45Speaker 00

  Yeah, absolutely.

• 1:04:46Speaker 01

  Okay, because the, the word out there is that, you know, it has a very, very high, you know, lethal dose, that, you know, it's far safer than alcohol, you know, barring people with, you know, predisposition to psychosis or, or mania, you know, this is kind of the, the new frontier. And, and I've, I've talked openly, I've had positive experiences with clinical use, not recreational use, but clinical use of, of psilocybin, but it is no easy ride. I mean, it's, it's a, I mean, to be quite blunt, it's, it's an ass kicking of a whole other kind and it involves therapy before, during and after. And I felt it benefited me tremendously, but I can think of a, many, many people for whom it would probably be the worst possible thing for them to do.

• 1:05:29Speaker 00

  Right. It's, it's highly unpredictable, is part of it, probably more unpredictable than other drugs. You just don't know what, what kind of response someone is going to have. And also importantly, the, the early data that was out there about saying it was much less harmful than, let's say, alcohol, was primarily attributable to the fact that not many people were using it. We published a paper looking at the number of ED visits and hospitalizations as a result of hallucinogens. And what we have shown is that as use goes up, the number of ED-related harms and hospital admission-related harms also goes up.

• 1:06:04Speaker 01

  Sorry, ED?

• 1:06:05Speaker 00

  Sorry, emergency department harms, yeah. So, so the, you know, that early narrative about it being much less harmful than other drugs, I, I don't think that's going to pan out. And, and our studies show that it's already, the related harms are already increasing. Psychosis, you know, suicide, persistent hallucinosis, severe mood. So again, you know, every drug is going to have risks, benefits and alternatives. And I'm not sitting here saying we shouldn't study it or that there's no benefit. Cause clearly I've met and talked to many people who have had amazing benefit, but I've also talked to and seen a lot of harm. So it's just a matter of being really thoughtful about it and, and sort of following the data.

• 1:06:50Speaker 01

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• 1:08:17Speaker 01

  To learn more, visit functionhealth.com/huberman and use the code huberman for a $50 credit towards your membership. Again, that's functionhealth.com/huberman. So we've got this model now, if I'm not mistaken, that a lot of addiction is the need to control, sometimes so much so that it's really the thing, separate from the high. It's the ability to get high, it's the ability to control the sleep score, dare I say.

• 1:08:46Speaker 00

  Right.

• 1:08:47Speaker 01

  I don't know that, I know a few people for whom their, you know, their commitment to, for lack of a better word, protocols has taken them away from life. I mean, I get asked about this a lot. I think that the line between optimization, a healthy life and over-optimization is, it is, all of the practices are so that you can lean into the rest of your life with more vigor and for longer and more presence. And like, that's all, the whole purpose of a good night's sleep is not just to get another good night's sleep. But with that said, it seems that the PAG gets activated when we run out of options, nothing's working.

• 1:09:20Speaker 00

  Right.

• 1:09:21Speaker 01

  Then serotonin-related mechanisms and other neuromodulators help our brains come up with new, new plans that might work.

• 1:09:32Speaker 00

  Yeah.

• 1:09:33Speaker 01

  But the only way to take that step is in acknowledging that what I've been doing hasn't worked and the new plan is going to come. The word surrender kind of makes it seem like it's going to come from out there.

• 1:09:45Speaker 00

  Right.

• 1:09:45Speaker 01

  Not from the PAG, but from out there. But you're saying in the strictly neurobiological model, the PAG is actually like offering up new strategies to try, like, hey, maybe try this strategy instead.

• 1:09:59Speaker 00

  Well, I think in talking about the PAG and serotonin and psychedelics and what's happening in the brain, all we're really saying is that there's a neurobiological machinery that gets activated in this moment of spiritual surrender and in surrendered practices, right? So like in prayer focused on surrender, again, the prefrontal cortex goes quiet, the PAG and other related structures become activated, possibly in like an opponent process mechanism. That in and of itself is not a commentary on whether or not there is a higher power who's actually involved in providing wisdom and guidance.

• 1:10:41Speaker 00

  I think the subjective experience is very much that we are opening ourselves up to guidance from a higher power and people will talk about getting that wisdom and getting that guidance and even hearing the voice of their higher power, however they conceive of that. And it's such a subjective thing. For many people, their higher power is simply nature or the cosmos or the beauty and mystery of the universe. And that's not, you know, they may talk to nature, but that's because we're human and that's how we interrelate, not because they think that their higher power is human, right? So these are all very personal, subjective, and I have a lot of respect and honor for however people are conceiving of their higher power.

• 1:11:26Speaker 00

  What I think is really salient for me, having grown up in a secular household, having practiced psychiatry, being in the bastion of science and rational materialism, is that this sort of inward looking reflection, which is so predominant in mental health treatment, this sort of like, if I look inward far enough and know myself well enough and find my authentic self, I'll find the answers there. And for me personally, that was helpful to a point, but was not helpful when I was faced with like a serious existential crisis in the form of, as I talk about in Radical

• 1:12:09Speaker 00

  Surrender, our son being diagnosed with and dying from leukemia. Like I did many hours of psychotherapy. I read every paper there was on Q23 translocation congenital leukemia. That was empty for me and it really wasn't until I got to this point of sort of a spiritual pivot and saying, I'm not in control and no other human being can tell me why this happened. You know, I'm going to surrender my attempts to over manage this situation and I'm just going to instead sort of just show up for life and see what happens. And in my life, that has made all the difference. So, you know, my sort of rock bottom, so to speak, was different maybe from someone

• 1:12:52Speaker 00

  with severe addiction and yet really quite similar because in many ways, prior to that moment, I also was addicted to control, to achievement, to optimization. I was going to tell my husband how he should grieve, you know, in the wake of that loss. And we were going to have another baby right away and replace the baby that we lost and that didn't work out. So there had to be the multiple consequences before it was like, this isn't working, you know? And then when I did have that moment of spiritual surrender, it felt profoundly spiritual, but also physiologic, like my brain got reset. I mean, it was really very powerful and mysterious.

• 1:13:32Speaker 01

  Is the book the first time you've talked about that publicly?

• 1:13:35Speaker 00

  Yeah.

• 1:13:35Speaker 01

  Yeah.

• 1:13:36Speaker 00

  I may have occasionally mentioned it, but I've never written about it. Yeah.

• 1:13:40Speaker 01

  I find it at once amazing that many of my colleagues, our colleagues in science and medicine, don't even want to go close to the conversation about spirituality, surrender, and they're not alone in that. But every major hospital, including Stanford Hospital, which is a very, very fine hospital, I'm not just saying that, it's also beautiful.

• 1:14:03Speaker 00

  Yeah.

• 1:14:04Speaker 01

  I think, I think thanks to the generosity of donors, it's like really true. It's a beautiful place where hard things and great things happen.

• 1:14:11Speaker 00

  Yes.

• 1:14:12Speaker 01

  They have a chaplain. They have people from every religious denomination that can come talk to people, like these people are paid a salary for a reason. So like at once we acknowledge it, there's a memorial church on campus, there's a meditation center, wind hover, you know, like, so to me, it's like, there's this like collision of values that no one really wants to acknowledge. So it's like, it's just kind of there.

• 1:14:37Speaker 00

  Yeah.

• 1:14:37Speaker 01

  It's supposed to be anti-science or anti-modern medicine to acknowledge these things, but you've got these people hired specifically to help people and you've got a place for people to go pray and listen to music and to meditate. So, so what do you think of that? I mean, not asking you to comment on Stanford specifically, but like, why is it so hard for most people to see the ways that these things can fit together and enhance one another as opposed to the view that like, oh, no, no, like you want me to believe in magic, like Santa Claus? That's how some people feel about it.

• 1:15:10Speaker 00

  Yeah.

• 1:15:10Speaker 01

  They think it's nonsense.

• 1:15:11Speaker 00

  Right. Yeah. Yeah, I mean, you know, in preparation for writing this book, I can't tell you how many Stanford faculty I spoke to who have these secret spiritual lives, like they're very spiritual people and they have deep spiritual practices, which are at the core of their lives and the lives of their families, and yet very reluctant to talk about it, you know, reluctant to admit it in scientific circles. And I think it's a shame. I think it's really a shame because, you know, also in working with patients, I have so many patients who never get asked about their spiritual lives and yet again, their

• 1:15:52Speaker 00

  spiritual faith, their practices are at the core of their ability to handle their mental illness, whatever their mental illness may be. It's the core of their ability to, you know, overcome, even while they're also engaging in modern Western medicine and doing psychotherapy, like it doesn't have to be to the exclusion of. Furthermore, you know, if you look at so many great scientists over the centuries, I mean, their faith and their worship of God was at the core of their science. Part of what makes science happen is an openness to understanding nature, right?

• 1:16:31Speaker 00

  It's in the service of God, wanting to understand this miraculous thing that is the universe. And yet so much of science now, it feels more adulterated with, again, sort of like optimizing for achievement. I mean, there's great, great work, don't get me wrong, but just wanting to emphasize like the spirit of science is a spirit of open curiosity. And the spirit of open curiosity is at the core of spiritual surrender. It's basically saying, hey, like, you know, William James said, like, we're like dogs and cats in the library. You know, we see the books, but we don't have any idea what it means.

• 1:17:13Speaker 00

  I mean, that's basically us, you know, on the planet, like there's so much mystery out there and, you know, and let's be enchanted by it and let's, let's celebrate it. Let's have it be a source of wisdom and guidance and all of that. You can even go back to the Stoics of ancient Greece who said, to live in accordance with God, we must live in accordance with nature. To live in accordance with nature, we must pursue virtue. And I think this is also, has been largely devoid in psychotherapy and in mental health, the idea that values matter and that we can enrich our lives by, you know, living a value based life.

• 1:17:55Speaker 00

  Now, this is coming online with some newer psychotherapies like acceptance and commitment therapy, which talks in non-religious secular ways about really acceptance and living a values based life and is completely resonating with people. Because what happens at some point in psychotherapy is you encounter a problem that's just simply not solvable. It's not solvable. No amount of Prozac and no amount of psychotherapy is going to change the facts of your life. What do you do then? That's where I think spirituality comes in. It's like from the heart of human helplessness, how do we endure and continue on when we can't change the reality of our existence? And spirituality is absolutely huge there.

• 1:18:41Speaker 01

  Yeah, I get, um, let's just say frustrated when spirituality gets cast by very accomplished people as low IQ.

• 1:18:52Speaker 00

  Yeah.

• 1:18:53Speaker 01

  I mean, let's just be really direct here, right? It's seen as like, people will believe things that they're told if they have low IQ. And so if they're believing in something for which you can't present me absolute evidence, they, people like, oh, that's like for dumb people. That's, that's kind of the stance, right?

• 1:19:09Speaker 00

  Yes.

• 1:19:10Speaker 01

  And then you look at people's lives and you get a closer look. And I don't take any pleasure in people's, you know, unfortunate circumstances or discomfort. And you, and you start to realize like oftentimes the people saying that are the people with the most, with some issues in their life. I mean, actually, I don't want to reference my book, but I will just say that in the introduction, I talk about a colleague of ours who was a, this was down at the Salk Institute, who was a member of the National Academy of Sciences, incredible scientist. And he, because of a back surgery, developed a really bad oxy addiction. Then his brother passed and then he like died. I still don't know if he overdosed, if he took his own life, if he died. Like no one, no one was willing to talk about it. And I went to many colleagues and like, hey, like what happened to this person?

• 1:19:53Speaker 01

  They're like, yeah, uh, it was like literally like, these are people who couldn't talk about anything. They're hyper articulate.

• 1:19:58Speaker 00

  Right.

• 1:19:59Speaker 01

  If I had said like, oh, like tell me what's going on with like plexin receptors in the developing hippocampus. They're like, they can tell you.

• 1:20:05Speaker 00

  Yeah.

• 1:20:05Speaker 01

  But you go like, what's going on in your life? They can tell you, but you go, let's, let's talk about this.

• 1:20:09Speaker 00

  Yeah.

• 1:20:10Speaker 01

  And it was, it's as if the circuits that we understand, thanks to your work and others, like in Malanca and others, it's like, we, we don't actually think they apply to us.

• 1:20:18Speaker 00

  Right.

• 1:20:19Speaker 01

  In some way that it's almost like if we were to go there, it makes us more mortal.

• 1:20:24Speaker 00

  Yeah.

• 1:20:25Speaker 01

  So I feel like there's also in this thing about spirituality, in this kind of aversion to thinking about it for some people, it's also to acknowledge that we're not in complete control is also to acknowledge that we're gonna die.

• 1:20:36Speaker 00

  Yes.

• 1:20:37Speaker 01

  Which I actually believe is at the root of all addictions. Like, like it's, it's scary as hell. Like we're gonna die. We don't know what happens after. It's gotta be terrifying. So we start doing all this stuff in between now and then to try and control.

• 1:20:49Speaker 00

  Yes.

• 1:20:49Speaker 01

  Which is kind of the essence of this whole thing.

• 1:20:51Speaker 00

  Yeah, it's all the different levels of denial, right? There's denial about my addictive behaviors, but then there's the everyday denial that we all engage in most of the time, which is, yep, I could die today. Like this could, I could walk out of here, get hit by a truck. That's it, I'm gone. And that proposition is, you know, can be terrifying, but it becomes more terrifying the more we avoid it, right? Whereas if we actually look at that and let that inform our lives, it becomes less scary. And of course, that, that's true for so much of our pain and our suffering. And that is at the core of surrender too. And part of what we're surrendering to is we're not running away from that anymore. We're turning and we're saying, yeah, that's true.

• 1:21:36Speaker 00

  That's really the truth and I'm, I'm afraid, you know? Or I'm anxious or, you know, I'm, I'm sad or whatever it is. We like embrace that affective experience. And yet in doing that, paradoxically, we get some respite from the suffering. So again, it's just this fascinating, you know, surrender paradox.

• 1:21:59Speaker 01

  Let's talk about crisis. When everything's falling apart.

• 1:22:02Speaker 00

  Yes.

• 1:22:02Speaker 01

  We want to fix it.

• 1:22:04Speaker 00

  Yes.

• 1:22:05Speaker 01

  We want to know how long it's gonna last.

• 1:22:06Speaker 00

  Yes.

• 1:22:06Speaker 01

  When it'll be fixed.

• 1:22:07Speaker 00

  Yes.

• 1:22:08Speaker 01

  You're suggesting a potentially different set of solutions.

• 1:22:13Speaker 00

  Well, I mean, the modern crisis is really a crisis of the will because we've gotten so used to control so much in our lives that now even the, the merest amount of uncertainty sends us into crisis. And essentially a crisis of the will is a narcissistic injury. And the narcissistic defense is rage, denial and doubling down on control. And that's typically where we are. And that's also kind of the heart of what 12 steps says is at the core of the disease of addiction, self-will run riot, right? So it's these things that I can't control that I'm trying to control. Now, there are other things over here that I can control. I'm actually ignoring those because I'd rather focus on these things that I can't control.

• 1:22:55Speaker 00

  And that just gets us to a much worse place, ultimately to this place of modern despair, which I characterize as again, paralyzing anxiety, self-loathing, shame, loneliness, and this nihilistic boredom. And from there, we can get stuck in that place and many, many of us do. Or we can acknowledge the limits of our control and become, you know, embedded and a part of porous with the greater universe, which is a very different worldview than the kind of rational materialist worldview of, I'm gonna hold the world in the palm of my hand and shape, shape it into whatever I want it to be.

• 1:23:35Speaker 00

  And with that spiritual pivot, that acceptance, that surrender, we access, you know, our own innate ability to transcend suffering. We right-size our place in the universe. I mean, this, and these are, you know, all of the major religions and philosophies, it's really the same basic concept. In terms of everyday practice, I really recommend that people pray, even if they're not sure they believe in a higher power. And I think all that's really required for prayer is just simply admitting the limits of our control and asking for help from a power outside of ourselves. I don't think you need to further define it, uh, just an acknowledgement that, yeah,

• 1:24:19Speaker 00

  like I'm not running the show and when I try to run the show, it doesn't go well. Or at least it can go seriously awry. And also it becomes a way to ignore the things I, I can actually have agency over, which is why one of the most important things I tell myself and my patients is do the next right thing. That is a core piece of radical surrender because instead of trying to engineer some distant future, I'm owning that I have no idea what the future holds, right? I don't have control over that. But I probably do have control right now over whether I take out the garbage. So I can take out the garbage. That's something that I can do. And I really believe that positive change happens in human communities when we are

• 1:25:03Speaker 00

  each of us doing the next right thing, one day at a time, and then stringing good days together into good weeks, good months and good years, so that we sort of find ourselves in a good place that we couldn't have engineered on our own. But it is again, this concatenation of doing the next right thing. That, that has become really core to my own spiritual practice. And again, you find it expressed in different ways, you know, values-based life, values-driven life, uh, the Stoics, in order to live in accordance with God, we live in accordance with nature, we must pursue virtue. So that's really key. The other thing I think that's really central to the disease of addiction and also has

• 1:25:44Speaker 00

  been one of the key things I've grappled with in my life is the problem of codependency. So where we are not just trying to control our, our own behaviors, we're actually trying to control other people's behaviors. And we're sort of using people, other people as our drug of choice, as the way that we manage our own emotions. And this is a well-known phenomenon in addicted families where loved ones can actually, in the spirit of, the professed spirit of trying to help their addicted loved one, they actually become enablers because they become caught up in the same rigid family system. So for me, you know, after my own kind of spiritual pivot and my decision to just try

• 1:26:28Speaker 00

  to live a surrendered life, taking it one day at a time, one of the hugest parts of the relief for me was the thinking that, okay, well, if, if my higher, higher power is taking care of me, then my higher power is also taking care of the people that I love. So I can stop doing all of that. You know, I can stop sort of trying to manage their experience because so much of my burden, without even really consciously realizing it, was like trying to manage your impression of me, right, right now, or manage your listeners and what, it's like, I, I have no control over that. I don't know what you're gonna think about this conversation after you go home or what any of your listeners are like.

• 1:27:11Speaker 00

  So I, I, I don't, I'm not trying, right? I'm just, what are the things that I believe? You know, how can I be truthful and honest and try to communicate clear? That's all I can do. I can only show up and do that. But for me, that has been one of the greatest gifts of sort of radical surrender or the spiritual pivot is like.

• 1:27:32Speaker 00

  All I can do is just show up for my life unfolding. And that's all other people can do either. And, and, and then we sort of come together and then we go, go apart, you know? I, I can't manage their experience, just like I really can't manipulate and control my own. And as a parent, all I can tell you is that has just made me, I, I've made so many mistakes, but whatever mistakes I've made are greatly lessened by the practice of surrender and knowing that, you know, my kids have their lives, they're going to make their decisions, they're going to have their suffering. I can really only be here and bear witness to it and try to help if they ask me to help. But otherwise, there's really nothing that I can do.

• 1:28:15Speaker 00

  And I, I, to me, that's just, has been core to my ability to try to be a good parent, but also enjoy parenting.

• 1:28:23Speaker 01

  The letting go process is, is nothing short of magic in life. I'm a big, you know, I've been open about this. I'm a big proponent of prayer and not just because David DeSteno's lab at Northeastern shows that has all these health benefits. I mean, there's that too, but, but for the reasons that you describe and, and others, I think there's, there's a ton there. Again, knowing as I say that, that there are going to be people who are going to bristle and be like, oh my God, like really? We were talking about this before we started recording. I, I benefit greatly from having no religion-based or faith-based trauma. Like I grew up in a mixed religion, complicated family home and like, I don't, I don't have any like negative experiences to draw on there. So I'm coming into it clean.

• 1:29:06Speaker 00

  Yeah.

• 1:29:06Speaker 01

  I realize some people, it's very loaded.

• 1:29:08Speaker 00

  Yeah.

• 1:29:09Speaker 01

  Right? Stuff, they had horrible experiences, traumatic experiences, or it just was like force fed to them in a way that, that makes it harder for them to digest a conversation like this.

• 1:29:18Speaker 00

  Right.

• 1:29:19Speaker 01

  It would be like having an abusive like track coach and we're telling everyone how like great running is. You know, it's like, it's different for them. So I acknowledge that. But, you know, I was, I was just having this, this thought as you were talking about the, the letting go and in particular the codependency. We've never talked about codependency on, on this podcast. And the stereotypical model of past was you got an alcohol, you're not allowed to call them alcoholics anymore. Sorry, I no longer tap dancer. I don't know all the nomenclature. There's a guy who's an alcoholic. He drinks too much. He meets all the criteria for alcoholism. Yes, he has another identity. But then the, the stereotypical picture was then he's got a wife who is codependent or a partner who's codependent.

• 1:30:04Speaker 01

  She gets something out of the fact that he's essentially chemically disabled in certain ways. He gets something out of the fact that she keeps pouring his drink or helps him with his denial or makes excuses. Like that was the old model. And when Pia Melody, I think was the, one of the first people to coin this phrase of codependency, that it was very much couched in those terms. But nowadays I see codependency in men and women around in parent-to-kid relationships and pretty much in every direction.

• 1:30:32Speaker 00

  Right.

• 1:30:33Speaker 01

  You've got someone, maybe she's the super overachiever and he's the stay-at-home dad who resents her, but does it anyway, but it allows him to never have to challenge himself in a work environment. You can see so many iterations of this. So if we could, maybe we just drill into a codependency a little bit because I think it's so common.

• 1:30:51Speaker 00

  Yes.

• 1:30:51Speaker 01

  And it's really its own form of addiction.

• 1:30:53Speaker 00

  Yes, absolutely.

• 1:30:54Speaker 01

  And I mention all of that backdrop because I think that still to this day, people hear codependency and they default to the, the inaccurate sort of classic stereotype.

• 1:31:04Speaker 00

  Well, I think it's, it's evolving. So it really originated in the early days of Alcoholics Anonymous in the 1930s as the mostly men got together and had their Alcoholics Anonymous meetings. Their wives got together and had their own meetings, which eventually became Al-Anon, which is a 12-step group for the loved ones of people with an alcohol addiction. And there, there are many different forms of it today. Codependency Anonymous. Pia Melody has done beautiful work in this space, others as well, writing about how people get caught up and enmeshed in an addictive family system. And then even, you know, when they think they're being helpful or trying to get their loved one to stop using, yes, they're on some level, either literally or metaphorically

• 1:31:48Speaker 00

  pouring the drink. But codependency, I agree with you. I think it's become a much bigger problem. And even in families where there's not clearly an identifiable addicted person, you know, I would posit because we're all on some level now addicted to control. It is a natural extension for us to now be trying to control the people around us. And I'm just going to talk about two very specific examples. One is the way that parenting now is so focused on achievement and skills acquisition.

• 1:32:28Speaker 00

  It is very hard to be a parent now and not be narcissistically invested in your child's achievement. I mean, I, I'm speaking from my own experience here and I work on these things in myself on a regular basis and yet still get pulled in, you know, like, oh, how did the race go? You know, it's like, I want to hear that my kid won, right? What grade did you get? And it's horrible. It's horrible. I wish I weren't caught up and I try to resist it. My kids can feel it when I'm like, you know, narcissistically attached to a certain outcome. Or I'm obsessively worried about my kids, right? And, and then wanting, you know, in that OCD loop, wanting reassurance that they're okay, getting reassurance, being calm for two seconds and then needing more reassurance, which is the OCD loop.

• 1:33:12Speaker 00

  The reassurance seeking actually makes it worse. But these, really any way in which we rely on other people to have a certain kind of reaction or a response in order for us to be okay. Right? So, and when we don't get the response that we want, i.e. control, we become emotionally dysregulated. And the technology has made all of this much worse. So all of this technology that we have to like track each other and to know what so-and-so is doing here online and what, what the quants were on that, you would think that all of those numbers and all of that track, like we'd be so calm and peaceful because, no, we're, we're more neurotic than ever.

• 1:33:56Speaker 00

  It's like now we're constantly checking, oh, did that person text me back? Why didn't they text me back? Why did I, why did I just get a pink heart emoji and not a red heart emoji? I mean, it, it, we're all now caught up in this kind of constant reactivity. We've lost the ground of ourselves. We've lost that spiritual tether to our transcendent selves, right? We're just all caught up in this kind of constant codependent loop. And it's just such a, it's a terrible place to land.

• 1:34:25Speaker 01

  I know so many people that are codependent with addicts.

• 1:34:29Speaker 00

  Yes.

• 1:34:30Speaker 01

  And, you know, we all have to ask ourselves like, you know, like, like I have the furbo thing to monitor my dog.

• 1:34:36Speaker 00

  Yeah, right. Exactly.

• 1:34:37Speaker 01

  I want to know he's okay.

• 1:34:38Speaker 00

  Right.

• 1:34:38Speaker 01

  And it's actually worse. We were on vacation this summer in, in Europe and at one point my girlfriend and I were like, let's not look at it because then we see it and then we're like, oh, does he have enough water? Is he warming up? Is he cold? It's better if we just don't know.

• 1:34:49Speaker 00

  That's right.

• 1:34:49Speaker 01

  You just don't want to know at some level. But of course you want him to be comfortable. So it's, it's different than addiction at some level because it isn't this obvious like harm to self for others.

• 1:34:59Speaker 00

  I disagree.

• 1:35:00Speaker 01

  It's more subtle.

• 1:35:00Speaker 00

  I disagree.

• 1:35:01Speaker 01

  Yeah, it's more cryptic.

• 1:35:02Speaker 00

  Yeah.

• 1:35:02Speaker 01

  Excuse me. Yeah.

• 1:35:03Speaker 00

  It's more hidden.

• 1:35:04Speaker 01

  Yeah.

• 1:35:04Speaker 00

  And of course, we're the martyrs, you know? We're sacrificing ourself for the other. But I, I think it's, I think it's just as addictive, just as harmful and pernicious. And the amazing thing is that in clinical care, what you see in a family, when you get the codependent person in that family to let go and just, just surrender and just start going to Al-Anon meetings or Codependency Anonymous and like take care of themselves and just say, case ra, sera with my loved one who's a day. What happens? Of course, you know what happens. As soon as the codependent lets go, this person gets into recovery or starts to make the moves. It's like when you're pulling on the opposite side of the same rope, you're not going to

• 1:35:49Speaker 00

  get anywhere. You drop that one end, oh, they're not pulling on anymore. I guess I'll drop the rope too and maybe, you know, go get into some recovery. I mean, it, it, it's like clockwork, like absolute clockwork.

• 1:36:01Speaker 01

  Based on our mutual colleague, Carl DeSaroth's words at one point, by the way, congratulations Carl for winning a Nobel Prize.

• 1:36:09Speaker 00

  Yay, Carl.

• 1:36:10Speaker 01

  So deserved. It was only a matter of when, not if.

• 1:36:12Speaker 00

  Yes.

• 1:36:13Speaker 01

  Once I heard him give a lecture and he said, we don't have any idea how other people feel. In fact, most of the time we don't even know how we feel. And ever since then, I've tried, tried, I fail often, but tried to stay out of other people's heads. To just not even try and understand what they might be thinking. Now, some people could say that's, you know, like, that's what we're supposed to do. We want to be empathic, but not what they're feeling or what they're expressing they need or maybe non-verbally expressing, but like really try and stay out of other people's heads.

• 1:36:44Speaker 00

  Yeah.

• 1:36:45Speaker 01

  Especially when there's nothing to do about it.

• 1:36:46Speaker 00

  That's right.

• 1:36:47Speaker 01

  But so much of online behavior is about trying, like people trying to get into each other's heads.

• 1:36:52Speaker 00

  That's true.

• 1:36:52Speaker 01

  To be able to control outcomes that are really about them.

• 1:36:54Speaker 00

  Yeah, or just spin narratives that like have a causal chain that is satisfying for them. No, you're absolutely right. One of the biggest mistakes that I make in my work as a psychiatrist and a therapist is when I mind read. Instead of asking what the patient is experiencing, I assume I know. That's often, especially if somehow they're similar to me in some way, you know, a middle-aged woman who's, I don't know, you know, working in academia. And I, I assume that I know what their operating system looks like. Disaster, absolute disaster. Cause you just, you never know. And unless you ask people and you really attend to and listen and they're willing to share, you just can't know.

• 1:37:35Speaker 01

  I have a friend, he's got three decades placent in sobriety and he has this great saying, you know, occasionally he'll say something and someone will ask him like, well, are you sure this? And he always just says, I don't speak in riddles. It's so good. It's like he really just, like, he's like, he's like, don't even try and get me to second guess my thinking about it. He's like, I don't speak in riddles and I love it.

• 1:37:59Speaker 00

  Yeah.

• 1:38:00Speaker 01

  I love it because it's, it's like there's this tendency in all of us.

• 1:38:02Speaker 00

  Yes.

• 1:38:03Speaker 01

  Codependent or not.

• 1:38:04Speaker 00

  Yeah.

• 1:38:04Speaker 01

  To just try and understand a bit more about what someone might be thinking so that you can anticipate outcomes. It's like this limiting uncertainty thing.

• 1:38:12Speaker 00

  Oh yeah. I mean, a lot of the conflict in my own marriage, I generally speaking have a very good marriage. I'm very grateful for a husband who's much saner than I am at baseline. But the, the recurring conflict is when I assume that he knows what I'm thinking, right? And just like, well, I mean, or, or I assume that I know what he's thinking. He's like, no, that's not what I was thinking. It's like, but that's what you always think in these situations. Well, it wasn't what I was thinking in this. It's like.

• 1:38:39Speaker 01

  We are wild creatures, aren't we? That we think we know what our spouses or dogs or kids or whatever are thinking, much less somebody on the internet. I'd like to take a quick break and acknowledge one of our sponsors, Element. Element is an electrolyte drink that has everything you need and nothing you don't. That means the electrolytes, sodium, magnesium, and potassium, all in the correct ratios, but no sugar. Proper hydration is critical for brain and body function. Even a slight degree of dehydration can diminish your cognitive and physical performance. It's also important that you get adequate electrolytes. The electrolytes, sodium, magnesium, and potassium are vital for the functioning of all cells in your body, especially your neurons or your nerve cells.

• 1:39:21Speaker 01

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• 1:40:04Speaker 01

  Again, that's drinkelement.com/huberman to claim a free sample pack. I'd like to dispel some myths, if in fact they're not true. One of the common myths about codependency is that it's women more often than men and men are more often than classic addicts. Is that true?

• 1:40:22Speaker 00

  Well, I can say that, in all honesty clinically, when I see families, that dynamic is relatively true. So mothers tend to be more caught up in this codependent enmeshment and enabling, and fathers tend to withdraw and be detached. That's a pretty common dynamic with addiction.

• 1:40:45Speaker 01

  Detached from the addict?

• 1:40:46Speaker 00

  Detached from the whole kit and caboodle, detached from all the crazy, just like up there spinning over here and I'm on my computer.

• 1:40:56Speaker 01

  So in that sense, not a whole lot's changed.

• 1:40:58Speaker 00

  Well, I don't have numbers, but just in terms of, yeah, clinically, what I see that there are gender patterns. And I do think that, you know, by virtue of how women are wired a little bit differently than men, that we will, we have a tendency to get more caught up in these codependent kinds of maladaptive cycles. Makes sense, right? In order to care for an infant child, you essentially have to merge with that child. The child is utterly helpless. You know, and then Winnicott talks about the good enough mother. The good enough mother is the mother who can initially attend to every need that the child has, and then as time goes on, gently kind of, you know, restrain herself from

• 1:41:42Speaker 00

  meeting every need so that the child has the opportunity to differentiate and begin to experience the world autonomously through their own agency, not just related to the mother. If you can't do that as a mother, that's generally not good for your child. Whereas a man has a very different biological role early on, and so I think the challenges later are different.

• 1:42:05Speaker 01

  Yeah, what's that saying from recovery? It's like when the addict gets sober, the sick get angry?

• 1:42:12Speaker 00

  Yes.

• 1:42:13Speaker 01

  You know, like you'll see somebody get sober and their spouse or other family member gets really angry because their codependency no longer has a place to go. You would think, oh, they're sober now.

• 1:42:22Speaker 00

  Yeah.

• 1:42:23Speaker 01

  They're like, they'd be so happy about this, but they think they're going to be left behind, that there's a lot of fear that comes up for people.

• 1:42:29Speaker 00

  Absolutely. Well, I mean, this is such a common pattern where when the identified sick person in the family gets well, like the identified addict gets into recovery, all of a sudden other person's like substance use disorder kind of blossomed. So in a way, this person being addicted sort of helped this person keep their own substance use in check, and now this person's better. But even more importantly, as a family system, what do you do when the person who is the identified sick person isn't really sick anymore? Then it destabilizes everything. It's just like, well, if all of our problems were related to you're being sick and you're not sick anymore, what, you know, how do we manage that? So that's really interesting to see.

• 1:43:12Speaker 01

  What are some of the steps people can take to get out of codependent thinking or action?

• 1:43:17Speaker 00

  Again, it's sort of the key steps of surrendering control over the things that we can't control, shouldn't control, and the harder we try to control, the worse we make it. And then, you know, for those for whom it's appropriate, kind of that spiritual pivot, you know, is can be very helpful, looking for guidance and succor and strength and wisdom from a power outside of yourself, however you may define that, and re-regulating around that, rather than regulating your emotions around how this person is doing on any given day or in any given month. Because that's what ends up happening. Oh, today he didn't drink, I'm feeling better. Oh, he drank, I feel terrible. You know, it's, it's all enmeshed.

• 1:43:58Speaker 00

  So, and then of course, 12 steps for people with codependency is really, really helpful. There are wonderful 12-step meetings, you know, in our community. I've been to, you know, some of them, especially for parents of kids with severe. I mean, it's just devastating to have a child who's addicted and really severely addicted and might die. You know, I mean, how do you, how do you self-regulate around that very hard? But Codependency Anonymous, Al-Anon, very, very helpful for those types of things.

• 1:44:28Speaker 01

  Yeah, so about youth and addiction, being 51, I can remember a time before social media, obviously, but there's a whole generation of people whose brains were literally shaped around, their reward circuitry was shaped around interaction with devices and the reward contingencies of scrolling or whatever it is. Is it much harder for them to get out of an addictive trench than it is for somebody who has engaged with those things less?

• 1:44:57Speaker 00

  I mean, I don't think anybody's formally studied that, but I think we could certainly hypothesize that living in the digital age, when we're constantly seeking validation, reacting to digital stimuli, there's very little kind of centering or contemplative or prayer practices happening when we're, you know, in this digital vortex. And again, I would argue that these machines have massively decreased our tolerance for uncertainty and our tolerance for imperfection, right? Because AI holds out the promise that there's the exact right answer out there if you just keep scrolling and looking and querying long enough.

• 1:45:38Speaker 00

  So I do think that this, this generation, you know, their brains have really been shaped in a very different way, leading to, you know, different types of struggles.

• 1:45:48Speaker 01

  I don't know if you get into this in the book, but recently, because of some guests we've had on the podcast, Michael Pollan, Paul Stamets, and others, that it used to be that young people, boys and girls, would go through some kind of rites of passage. And oftentimes, those rites of passage were about, in a safe way, in a healthy way, taking away all sense of control, like they don't get to decide when a ritual starts and ends. It's not like, hey, I have to get up and use the bathroom and like scroll TikTok or like, I want to go eat now. It's like, no, they're sort of give yourself over to the, to the, to the tribe, so to speak. The goal being that they learn to give up control.

• 1:46:27Speaker 00

  Yeah.

• 1:46:28Speaker 01

  And once they do that, hopefully it becomes a state that's familiar enough that they realize that they can survive it, it was in their best interest in those situations anyway. Is there a way that we can bring healthy, lack of control ritual and rite of passage back into American society? I mean, what would that even look like?

• 1:46:48Speaker 00

  Yeah, I mean, I think we can get back to some of that. I think we absolutely need to. And I do think it begins with at least spending some part of every day out from behind our screens, you know? Go outside, leave your device behind, look at the sky, look at the trees, talk to a human, make a mistake, apologize, keep going, you know, just embrace uncertain, do something you're bad at, cultivate something you will never, ever be good at. I do think there's optimism and hope here. A lot of Gen Z'ers are with intention, coming together in spaces where they're not on their

• 1:47:31Speaker 00

  devices, not connected to the internet, playing music together, not to become the next pop sensation, but just because they're enjoying the music. I was really struck recently in South Korea, talking to some folks who are really leaning into this sort of like getting off their devices, meeting up, you know, doing crochet, chatting, having unstructured, uncertain interactions, not knowing where it's going to go. And you know, for all these young people who are trying to like optimize for their career, optimize for their relationships, I mean, it's terrible now. It's like the dating apps, you know, oh, well, she's nice, but maybe there's somebody even better out there for me. You know, it's like they never settle because there's always this thing, I'm, I'm, there's

• 1:48:16Speaker 00

  a perfect person and how can I find her, you know, or him, or whatever the case may be. But, you know, instead, just opening yourself up to kind of not knowing what's going to be next, or maybe the person who's exactly right for you is not the person you would ever check the boxes on, right? So let's, again, that openness, that curiosity, show up for the unfolding of experience. I think that's really where we need to go.

• 1:48:44Speaker 01

  Yeah, these days I play with the idea of doing things with no intention of it being put out into the world.

• 1:48:51Speaker 00

  Yes.

• 1:48:52Speaker 01

  Ever.

• 1:48:53Speaker 00

  Yeah.

• 1:48:54Speaker 01

  Deliberately.

• 1:48:55Speaker 00

  Yes.

• 1:48:56Speaker 01

  Like, no, vaulted.

• 1:48:57Speaker 00

  Yeah.

• 1:48:58Speaker 01

  Just because it, then you can just be in the pureness of the experience.

• 1:49:00Speaker 00

  Yes, that's right. That's very nice. Yeah. And for you, such a public persona, that, that kind of space would be really important.

• 1:49:06Speaker 01

  Like, one of the great gifts of, I think, a healthy relationship to exercise or running is you don't tell anyone what you did. You just do the workout.

• 1:49:16Speaker 00

  It's not on Strava.

• 1:49:17Speaker 01

  It's not, exactly. It's a, you just do it. Like, you do it for you.

• 1:49:20Speaker 00

  Yeah.

• 1:49:21Speaker 01

  And you just get really into the, the joy of it. It's complete. I also understand the desire to share an accomplishment.

• 1:49:26Speaker 00

  Yes.

• 1:49:27Speaker 01

  I mean, I think that's innately human.

• 1:49:28Speaker 00

  Yeah, and that's okay. Again, it's not, you know, one extreme or the, or the other. It's trying to find that happy medium.

• 1:49:34Speaker 01

  Yeah, I'm a hypocrite, because if I don't acknowledge, I have some workouts out on the web, but they were trying to be educational. But yeah, it's, it's, there's a problem with adults and kids being able to broadcast with essentially no latency.

• 1:49:48Speaker 00

  Right.

• 1:49:49Speaker 01

  Their emotion.

• 1:49:50Speaker 00

  Right.

• 1:49:51Speaker 01

  Their feeling. I think it takes the, the rawness of the emotion away.

• 1:49:54Speaker 00

  Yeah.

• 1:49:55Speaker 01

  I think it just.

• 1:49:56Speaker 00

  Right.

• 1:49:57Speaker 01

  Literally goes out there.

• 1:49:58Speaker 00

  It doesn't incubate. You're not processing it. You, you, you don't have time to really sort the meaning of it.

• 1:50:02Speaker 01

  I mean, I'm struck by people who go to concerts and then are on their phones at the concert. But I acknowledge that I'm probably just getting old. And happily so. So what are some other concepts of, of surrender? We talked about codependency. We talked about, you talked about praying even if you don't necessarily believe that you're praying to something specific.

• 1:50:26Speaker 00

  Right, right.

• 1:50:27Speaker 01

  I think I heard, and I don't know if this is true, we have to fact check this, internet, do your, do your thing, that Mother Teresa claims that on only three, before she died, claimed that on only three nights of her entire life, did she, did she have a complete absence of doubt about the existence of God. Which, I was like, okay, if Mother Teresa had doubts.

• 1:50:49Speaker 00

  Yeah.

• 1:50:50Speaker 01

  And could live the way that she did, then like, I think we're, we're all on stable ground praying anyway.

• 1:50:54Speaker 00

  Right, yeah.

• 1:50:55Speaker 01

  I don't know if it's true, but I like the story.

• 1:50:57Speaker 00

  Yeah, and I, I learned from my friend and colleague, Kent Dunnington, who's a theologian and philosopher, that part of the problem is the language that we use, that we don't have a verb for faithing. Because there is apparently a whole tradition of having faith without belief, or having faith with an enormous amount of doubt, that you don't need belief in order to have faith. It is the practice of engaging in this kind of submissive surrender, acknowledging the limits, acknowledging our great need for guidance and, and comfort. You know, that is at the core of prayer, really. It's, it's an affective experience that doesn't require belief.

• 1:51:41Speaker 00

  It just requires taking the posture, you know, the humble posture and asking for help.

• 1:51:47Speaker 01

  What are the data, if any, on praying for others? Like, so often we hear prayer, and it's like, we're praying for this, or for that, or for ourselves. But what about, this is common in, for people with a religious bent to say, "I'll pray for you."

• 1:52:03Speaker 00

  There's good evidence that engaging in that kind of prayer for others serves the function of changing our mindset toward people more broadly, and leading us to act more pro-socially, you know, to pursue virtue. So I think, you know, that is pretty well established. Also, the idea of a sort of God watching us also promotes pro-social behavior. But like, whether or not our prayer actually leads to some material change for some person remote, for me, I, I really don't know anything about that. That's not something I've really looked at.

• 1:52:42Speaker 01

  In researching the book and spending time on, on the book, was there anything that you encountered where you were like, "Whoa, that's wild"?

• 1:52:50Speaker 00

  A lot of things. I mean, I, I was really fascinated by the whole, like, spirituality network and the role of serotonin, really fascinated by the ways in which perseverating around trying to keep doing the right thing and not getting the response we need actually is a type of suffering that leads to this proliferation of serotonin receptors, again, as if laying the foundation for this pivotal moment when we will let go of these rigid models and be open to something new. That was fascinating to me. I was struck by how convergent so many different religions and philosophies are, including,

• 1:53:34Speaker 00

  you know, Buddhist practices, which for some people is religion, for other people, it's more of a psychology or philosophy. But ultimately, again, wanting to transcend the self, wanting to have an affective experience that then leads to right action, that's all sort of part of it. I was struck by that. I really enjoyed researching the chapter on symbols and synchronicity, and the ways in which, in moments of crisis, we're all looking for patterns to provide a causal explanation for what happens. It's just, again, a kind of reflexive, we just do it. And certainly that, that was true for me when our son Lucas died.

• 1:54:14Speaker 00

  I began having these thoughts that he died of leukemia because I named him Lucas. So of course, a completely irrational thought. I didn't really believe that there was a causal relationship, and yet, at the same time, my mind had produced this kind of narrative, which, again, is not comforting, you know, and, and, and was a source of distress to me. But this was before the spiritual surrender. After the spiritual surrender, I had a very different view on it. I had the view that it's a symbol for me that represents how it's good for me not to always be exerting my control and instead letting things unfold. So that when we had our daughter, I didn't talk about a name, I didn't think about a

• 1:54:57Speaker 00

  name, and when she was born, I just turned to my husband and said, "What do you, what do you think?". And he offered a name, and I said, "That sounds good to me." So it became a symbol for me of, of surrender, of, of just trying to let my life unfold in this spontaneous, organic way, which is just, just made my life so much better.

• 1:55:18Speaker 01

  Yeah, it is wild. We, in moments of stress and uncertainty, we, we, like bumper stickers, like, can matter all of a sudden. We think they're there to tell us something for a reason, like, we were looking for symbols. There's, and then there's this, I don't like the word, but there's this, what is it? Peridelia, which is like, when you look at a cloud or an object, and it has a shape, and you see, you think, "Oh, like, that's in the shape of this thing". It's like, or a tree that looks like. And like, people, we project these ideas onto objects. It's insanity. It's like, it's, well, okay.

• 1:55:51Speaker 00

  I don't think it is. I don't think it is insanity. So I, I, I talked to a lot of, interviewed a lot of folks, and I was struck by, especially after a, a loss, you know, in the state of grief, so many people will have an experience where they're interacting with nature, and they see a shape in the clouds, or they see a bird, and that bird, they think it's maybe their loved one, or their, you know, their deceased loved one talking to them or communicating through them. And these are like atheists, right? So we're, we're not just talking about sort of people who regularly engage in kind of woo-woo thinking. These are like, flat-out scientists, atheists. They will endorse having these experiences. I think it's healthy, you know, unless it sort of teeters into frank delusions and mental illness.

• 1:56:33Speaker 00

  It's a way of reminding ourselves that there's a greater pattern out there, and we're all a part of it, and there's a benevolent structure, and, and, and we can take comfort in, in these sort of symbolic and synchronistic types of events, and, and really just be in awe, you know, even if, as we rationally know, that there's no causal relationship between these things.

• 1:56:57Speaker 01

  Yeah, there's a thread running through a lot of conversations I've had on this podcast recently, and I just, your thoughts on this? So, we had Max Crummell on, is one of the developers of immunotherapy, he's at UCSF, he's an immunologist. We've had Michael Pollan, he's talking about consciousness. The mushroom guy, Paul Stamets. And, you know, with each of the, Robert Greene, you're here, with each of these conversations, something keeps coming up, and that I think is perhaps thematically important, maybe even provide some insight, which is, like, at our core, we, we have an us. Like, we call it the ego, but just like, our body, us, right? Anna, Andrew, like, and we can become a we if we say, "Oh, like, we're both at Stanford", or "We're both podcasting".

• 1:57:42Speaker 01

  Like, the, the flexibility of the we is very, very powerful. But that, the flexibility of the me, for each of us, for you, for you, is not very flexible, inside of psychedelic experiences, or spiritual awakenings, or birth of a child, or things that, that we feel this expansion.

• 1:58:02Speaker 00

  Right.

• 1:58:03Speaker 01

  Of like, me becomes we in some way that isn't like, a typical affiliation.

• 1:58:07Speaker 00

  Right.

• 1:58:08Speaker 01

  Like, obviously, parent to child is that. But there's, so it's dynamic. So much so that we had a, like, a super athlete on here, Ross Edgley, and he was saying that, like, when his shoulder would start to give out on these, like, excruciatingly-long swims, he'd be like, "You're coming with me". He would dissociate from the shoulder, like, "Bring it along, we're still on a team", like, "Don't quit on me".

• 1:58:28Speaker 00

  Right.

• 1:58:29Speaker 01

  You know, but it was like, it was almost as if it was someone else's shoulder, or like, a, a buddy, that he's like, "Don't quit on me".

• 1:58:34Speaker 00

  Interesting.

• 1:58:35Speaker 01

  And so, in thinking about, like, getting outside of ourselves, it's, it's really, I do think it's a way of, like, bypassing the ego.

• 1:58:41Speaker 00

  Yes.

• 1:58:42Speaker 01

  And getting to this notion, like, you're just opening up to, in some cases, God, in some cases, the universe, and so, but something outside of you so that you're no longer alone.

• 1:58:52Speaker 00

  Right.

• 1:58:53Speaker 01

  You're just no longer alone.

• 1:58:54Speaker 00

  Right.

• 1:58:55Speaker 01

  And you're relegating your own thinking, as you've pointed out, to some additional information from out there.

• 1:59:00Speaker 00

  Yes.

• 1:59:01Speaker 01

  And it's beautiful, and it's clearly useful.

• 1:59:05Speaker 00

  Oh, yes.

• 1:59:06Speaker 01

  But we hate to do it.

• 1:59:07Speaker 00

  Mm-hmm.

• 1:59:08Speaker 01

  At the, like, we hate to do it until we taste the magic, right?

• 1:59:11Speaker 00

  Yes, right.

• 1:59:12Speaker 01

  Like, why do you think people are so darn resistant to it? To the point where it often, like, can cripple their well-being?

• 1:59:19Speaker 00

  I mean, I think a lot of it is modern culture, where we're very, you know, especially Western culture, but I would say, really, any capitalist system at this point, or partially capitalist system, which is frankly, most systems, very individualistic, very focused on individual accomplishments, we're more and more atomized. You know, as we talked about earlier, even the desire to be together in a collective is just getting harder. More and more people physically live alone. I'm not sure that this sort of we can be achieved if we're just communicating through the internet. But also, I would say this is an ancient problem. I mean, this is essentially...

• 2:00:01Speaker 00

  You know, the ego as the source of our suffering is the foundational belief in Buddhism, right? This idea that the self is a delusion, and yet it's a delusion that we're very caught up in. And when we can let go of that delusion, we ease our suffering. I think for people who believe in God, or who think about this higher power outside of themselves, it's the same idea, but manifested as I am a vessel through which God's plan happens, rather than, which is to me, a very similar pivot. It's just different language, a slightly different psychological conceptualization. And I think it's great that we have these different conceptualizations, because not everything is going to work for everyone.

• 2:00:46Speaker 00

  You know, for some people, it's going to be the inward meditative stance for other, and the mindfulness practices. For others, it's going to be that outward pivot, that giving it over to a higher power, conceiving of a higher power as having an ordered plan that we then become a part of. But all of that amounts to essentially the same things, transcending the self, the self being the source of our suffering, especially in this age of endemic narcissism, where, you know, we're constantly forced, really, by the technology and by society to focus on ourselves.

• 2:01:20Speaker 01

  Well, we've all, at least for those of us on social media, we've all been cast in a reality TV show.

• 2:01:25Speaker 00

  Yeah.

• 2:01:25Speaker 01

  Where it used to be, they would pay actors to be on shows. It's like then it was reality TV, you just kind of like give them products and the offer of fame, and then they'll do it for free.

• 2:01:34Speaker 00

  Yeah.

• 2:01:35Speaker 01

  And then now it's like, people actually pay with their time and their own money to like be in the reality TV show that is social media.

• 2:01:41Speaker 00

  Yeah.

• 2:01:41Speaker 01

  Like, it's, to me, it's like, the fact that there's news about social media.

• 2:01:45Speaker 00

  Yes.

• 2:01:45Speaker 01

  And the reverse.

• 2:01:47Speaker 00

  Right.

• 2:01:47Speaker 01

  It's kind of wild.

• 2:01:48Speaker 00

  Yeah, yeah.

• 2:01:49Speaker 01

  The reason the immunologist, Max Crummell, was the one who first sparked this line of thinking was because he said, you know, the immune system, like, the first thing you have to learn is what's of me and what's not of me, in order, and so it starts at the level of individual cells.

• 2:02:02Speaker 00

  Right.

• 2:02:02Speaker 01

  But then at some point, if we're so isolated, it's bad for us. Now, that's just analogy, but the human mind is really good at taking concepts and changing ways of living, if we're super conscious of it. So, the problem I have with any practice nowadays, any practice, is that there's so many other counterforces taking us away from that healthy practice. So, without getting scripted about how people have to do things, right? What are some things that you do in terms of from when you wake up until you go to sleep? Like, are you paying attention to like, certain times of day when your mind is more vulnerable to getting taken off track? Do you try and set the course of your day with certain types of thinking or practices, as it relates to what you've covered in your books?

• 2:02:46Speaker 00

  Yeah. So, I mean, I start my day, you know, lying in bed with an intentional prayer, asking, really, just help me out here. Help me, you know, show up the best that I can show up and do the next right thing. And then I also intentionally do not go on any device, or look at any screen, until I have finished my morning routine, which usually consists of some form of exercise, eating breakfast, making my bed, brushing my teeth, and kind of preparing for my day. Because I find, once I go on a device, it's a completely different wavelength. And then I try to be really intentional, as I go through the day, about using my devices as tools. And if I'm using them for entertainment, or

• 2:03:29Speaker 00

  to change the way I feel, that I'm also know that I'm doing that, and I'm intentional about it. I find that for me, watching moving video is really a very potent drug, so I really try to limit my use of video. Reading online, auditory processing is much less vulnerable space for me. And then I actually practice kind of surrendered practices, and asking for guidance and help from my higher power regularly throughout my day, when I'm interacting with my children, if I'm seeing a patient, and I'm not really sure how I can be helpful, or I feel in doubt, or regularly, I will, it's an outward pivot and an opening.

• 2:04:09Speaker 00

  It's like a, you know, dilation, rather than, and this is really key for me, looking inside myself for the answer, or relying on my own stories, because that's where I find I really get into trouble.

• 2:04:24Speaker 01

  Before we conclude, I have a few more questions about addiction and some specific things around it. Ketamine, not a psychedelic, it's a dissociative anesthetic. What are some of the valid clinical uses for ketamine? And where, if any, have you seen challenges, addictions, and serious issues come about with ketamine? Because I think it's starting to fall into this kind of diffuse and misunderstood category for a lot of people.

• 2:04:49Speaker 00

  So, ketamine is FDA approved for the treatment of, treatment of refractory depression. And, you know, it's good that we have new tools, and that people have access to different types of modalities. The concern about ketamine is that it is also addictive, and that when people are given any potentially addictive drug to take home and use on their own reconnaissance, there's vulnerability there. There is something that was created by a former mentee of mine, Nicholas Garell, called the Montreal Model. The Montreal Model is a way of using ketamine in-house, so in the clinical setting, not to take home, in combination with psychotherapy,

• 2:05:33Speaker 00

  specifically to treat depression, but also depression in combination with alcohol use disorder. And Nicholas Garell is seeing really exciting results from this. And let's face it, people with treatment of refractory alcohol use disorder, who also are severely depressed, are a hard population to effectively treat. So, again, I'm excited about these potential uses. You know, we need more evidence, but I think that that's a potential future use as well.

• 2:06:02Speaker 01

  Do you have people coming into your clinic who are using ketamine recreationally and having issues with it? Because you hear about this, or maybe you hear about it less nowadays? I don't know.

• 2:06:11Speaker 00

  We absolutely do. So, we see people get very addicted to ketamine, get it from the black market, use, you know, very large amounts, end up with very severe psychological and neurological problems. We also see people who have no business using ketamine to treat depression because of their addiction diathesis, and their past addiction to ketamine, who then find a ketamine provider, and either they don't tell that person that they've been addicted to ketamine, or that person doesn't ask, and then they end up getting ketamine in that setting, and then that sets them off. So, it's a complicated issue. Certainly, anytime a doctor is prescribing any addictive substance for any illness at

• 2:06:56Speaker 00

  all, we must keep in mind that that individual, just because they have an illness that might indicate that addictive substance, doesn't make that individual immune to getting addicted. So, this was the big myth with the opioid epidemic, right? As long as you are being prescribed opioids for pain, you're somehow immune to the problem of addiction. Absolutely false. Absolutely false. And the same is true for any addictive substance, whether it's Xanax for anxiety, or ketamine for depression, or stimulants for ADHD. You can have all of those bona fide conditions, and you can still get addicted to the medication that you're being prescribed to treat that condition.

• 2:07:38Speaker 01

  Do you see a lot of stimulant addiction nowadays, because of the, well, at the extreme end, things like Adderall, Viva Ants, et cetera, but at the, like, kind of more over the counter level, like all the consumption of oral nicotine and energy drinks? Is it like, kind of, it's like they're kind of a mainstay of life now?

• 2:07:57Speaker 00

  Well, we've seen, especially since COVID, is an explosion of people getting addicted to stimulants that they got online through a telehealth prescriber. So, it's not that telehealth is innately bad, but telehealth can be done very badly, and so you get a kind of a pill mill situation going via telehealth, where there's very limited ability to kind of steward stimulants, and make sure that the person, number one, you know, is really taking them as prescribed, isn't getting addicted to them. So, that's a whole Pandora's box that we've opened.

• 2:08:30Speaker 01

  The GLPs.

• 2:08:32Speaker 00

  Right.

• 2:08:33Speaker 01

  The only peptide we're going to talk about on this podcast, because we don't need to talk about all the others. We've done other podcasts about all the other peptides. The GLP is, you know, famous for helping people lose weight by reducing appetite, but there's also the kind of growing number of reports that it might, they might reduce alcohol craving, cravings of all sorts, maybe ahedonia, lack of pleasure generally.

• 2:08:55Speaker 00

  Right.

• 2:08:56Speaker 01

  What have you observed clinically?

• 2:08:58Speaker 00

  So, clinically, what we are seeing is that some of our patients who have severe alcohol addiction, who have tried and failed everything else, other psychosocial interventions, other medications, some of those patients, when we put them on a GLP-1, they get into recovery when nothing else works. So, that's very exciting, because in general, what we find is that, no matter what the tool is, it's only going to work for some of the people. It's not going to work for everybody. And so, a new tool, like a GLP-1, that has a totally new mechanism, is going to get people who haven't responded to other interventions. And it's also interesting, because from a, you know, neuroscience or mechanistic perspective,

• 2:09:40Speaker 00

  it may be working centrally, right on the reward pathway, by decreasing the amount of dopamine that's released in the nucleus accumbens in response to the drug of choice, which is very much how people describe it working. Like, when they're taking GLP-1s, they will look at some donuts, if they have food addiction, or alcohol, if it's an alcohol addiction, and they'll just be like, meh, you know, like, eh, not that interested. Or they might have euphoric recall for how good it's going to taste, and they taste it, and it's like, Not really that reinforcing, which is perfectly consistent with this idea that dopamine is our reinforcing reward neurotransmitter. The more that's released, the faster that it's released, the more reinforcing.

• 2:10:23Speaker 00

  And now, if you have a drug that dampens that initial release, it's exciting.

• 2:10:29Speaker 01

  Can we be addicted to thoughts?

• 2:10:31Speaker 00

  Most definitely. You know, one of the core features of sex addiction is fantasy. As one of my patients put it, "The bar is in my brain." What do I do in that case? And so, it's interesting. I've had patients with severe sex addiction who could not get into recovery until they stopped fantasizing. And it was only that, when that became their sort of bottom line, that they were able to get into a sustained recovery from, let's say pornography, compulsive masturbation, or just sex in general. So, there's no doubt that our thought loops can be both triggers in the form of craving and can become, to some extent, the drug itself.

• 2:11:13Speaker 00

  Because we know that these cues that precede the drug also release dopamine and are reinforcing.

• 2:11:20Speaker 01

  With the example of sex addiction, the fantasizing makes sense because of the positive anticipation.

• 2:11:26Speaker 00

  Yeah.

• 2:11:27Speaker 01

  What about negative thoughts? Like, can people get addicted to anger, resentment, us versus them stuff?

• 2:11:35Speaker 00

  Right.

• 2:11:35Speaker 01

  Like, we're all being oppressed. In some cases, people obviously are being oppressed. But I'm just curious. You see a lot of behavior and language online that suggests that maybe people are addicted to the feeling of just that negative arousal as opposed to positive arousal.

• 2:11:49Speaker 00

  Right.

• 2:11:50Speaker 01

  What do we know about that?

• 2:11:51Speaker 00

  We definitely see that. So, everybody's wired a little bit differently. And what's reinforcing for one person is not necessarily going to be reinforcing for another and vice versa. So, we see rage holics, you know, people who get addicted to becoming enraged and like get an adrenalized good feeling from that. And then will manufacture situations. We talked about codependency. That can happen in dyads where you have a rage holic with a codependent and they're doing this kind of continual dance that's mutually reinforcing. I have written about feeling like I've got addicted to my own worry, my own ruminations. Now, the overlap between sort of addiction and obsessive compulsive disorder is pretty tight here. But I feel like the addiction lens does capture

• 2:12:34Speaker 00

  the ways in which worrying can even be our happy place. It's kind of like that, at least it's the misery I'm controlling type of thing. And that part of getting out of that state of mind, that very uncomfortable state of mind is, yeah, you know, letting go of, or abstaining, intentionally abstaining from these kinds of obsessive ruminations.

• 2:12:57Speaker 01

  It's the meanest possible question to ask for somebody that is just about to, you know, hit the trail for a new book. But do you think you'll write another book? And if so, what in the back of your mind might be the thing?

• 2:13:12Speaker 00

  Oh, yeah.

• 2:13:13Speaker 01

  And don't feel like you need to share.

• 2:13:14Speaker 00

  No, you know, I very much have this feeling that this may be it for me. Like, when I finished Dopamine Nation, I knew I wanted to write Radical Surrender. I originally had a chapter in Dopamine Nation on spiritual surrender and its role in recovery. I ended up cutting it because I couldn't do it justice. But it was gestating and I kind of had a feeling eventually I would want to try to capture this phenomenon and these ideas. But right now, I got nothing.

• 2:13:43Speaker 00

  It's blank up there. So, we'll see. I'm, you know, trying to practice what I preach and live a surrendered life and just see what life offers me, what life calls me to do.

• 2:13:55Speaker 01

  Anna, thank you so much for coming here to talk about Radical Surrender, revisit the addiction material, some of which we touched on before, but most of which, you know, will be novel to people. And it's always good for us to understand how the world is acting on us and how we're acting in the world.

• 2:14:11Speaker 00

  Yeah.

• 2:14:11Speaker 01

  I love the topic of the new book. I think it's fantastic. I can't wait to read it. As I've loved and continue to, you know, talk uncontrollably about Dopamine Nation. You know, very few people have had the guts to just get out from behind the walls of clinic and academia and share knowledge that's useful to people. And you've been doing this a long while with a lot of fearlessness. Or if the fear is there, you're doing it anyway.

• 2:14:37Speaker 00

  The fear is there.

• 2:14:38Speaker 01

  All right, great. Well, you're doing it anyway.

• 2:14:40Speaker 00

  Yeah.

• 2:14:40Speaker 01

  And we're all grateful for it.

• 2:14:42Speaker 00

  Oh, thank you. You too.

• 2:14:43Speaker 01

  Thank you. I really appreciate you as a colleague and a colleague both at Stanford and as a public educator. You've really enriched the world. Thank you.

• 2:14:51Speaker 00

  Thank you. Likewise.

• 2:14:53Speaker 01

  Thank you for joining me for today's discussion with Dr. Anna Lembke. To learn more about her work and to find a link to her new book Radical Surrender, please see the show note caption. If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero cost way to support us. In addition, please follow the podcast by clicking the follow button on both Spotify and Apple. And on both Spotify and Apple, you can leave us up to a five star review. And you can now leave us comments at both Spotify and Apple. Please also check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast. If you have questions for me or comments about the podcast or guests or topics that you'd like me to consider for the Huberman Lab podcast, please put those in the comments section on YouTube. I do read all the comments.

• 2:15:38Speaker 01

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• 2:16:22Speaker 01

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