Loading summary
Transcript84 lines
- [00:00]
NetSuite Advertisement
This podcast is supported by NetSuite.
- [00:03]
Okay, business leaders, are you here to play or are you playing to win? If you're in it to win, meet your next mvp. Netsuite by Oracle. Netsuite is your full business management system in one convenient suite. With NetSuite, you're running your accounting, your finance, your HR, your e commerce, and more, all from your online dashboard. Upgrade your playbook and make the switch to NetSuite, the number one cloud ERP. Get the CFO's guide to AI and machine learning at netsuite.com NYT netsuite.com NYT.
- [00:38]
Lulu Garcia Navarro
From the new York Times, this is the interview. I'm Lulu Garcia Navarro. We live in a moment where things are more available than ever. You can whip out your phone right now and order lunch, bet on sports, listen to this podcast, watch porn, buy a car, meet a friend, get therapy from an AI bot. But all that convenience isn't making us any happier. In fact, in the developed world, we are more lonely, anxious and depressed than ever. Dr. Anna Lembke likens it to the plenty paradox. The more we have, the less satisfied we are. Lemke is a psychiatrist who works at Stanford University and she's written extensively, including in her best selling book, Dopamine Nation, about the science behind addiction. Turns out our brains are wired to constantly seek stimulus stimulation, which our modern era delivers in overdrive. I'm sure if you look at your life, maybe there's something you are indulging in a little too frequently than is good for you. For me, the turning point came at the start of the pandemic, when my sister died of liver failure brought on by alcoholism, something I shared with Dr. Lembke before our interview. It made me take a hard look at my life. After a lifetime of obesity, I ended up taking Ozempic, which curtailed my obsessive relationship with food. Then two years ago, I stopped drinking alcohol. But while I feel physically great, it hasn't stopped some other destructive behaviors. Hello, online shopping. So how do we find balance in a world designed to be filled with temptation? And are we all addicts now? Here's my interview with Dr. Anna Lemke. Hi, how are you?
- [02:32]
Dr. Anna Lembke
I'm good. How are you?
- [02:34]
Lulu Garcia Navarro
I'm good. So you published your book Dopamine Nation in 2021 with the thesis that the overabundance of modern culture has us constantly stimulated by dopamine. And that's only accelerated since your book was published. And I'm just wondering broadly, does it feel like a whole new world for Your research has opened up just since you've written your last book.
- [03:00]
Dr. Anna Lembke
I think the irony is that amazing research has been going on for a long time, but for whatever reason, the American public hasn't been particularly interested until very recently. And why that shift? I mean, I have my theories. I think that with the advent of smartphones and 247 access to the Internet, all of a sudden people who saw addiction as a. That somebody else had began wondering about their own compulsive consumption of digital media. And then I think Covid just really like, you know, we just went off a cliff with COVID because.
- [03:43]
Lulu Garcia Navarro
Sure did.
- [03:43]
Dr. Anna Lembke
Yeah. And it was, I think, along the lines of, like, life is really weird. Like, I am at home all day long in my pajamas, consuming more alcohol, more cannabis, more YouTube shorts. And I think all of a sudden people are like, wow, this addiction thing is real. And I do think that that's been a big cultural shift. And so I think it's more that the spotlight has turned toward this problem.
- [04:13]
Lulu Garcia Navarro
You work in Stanford's addiction medicine dual diagnosis clinic, which is a bit of a mouthful, but essentially you see patients, right? About addiction?
- [04:22]
Dr. Anna Lembke
Yes.
- [04:23]
Lulu Garcia Navarro
So generally speaking, have you seen things in your practice that weren't there before that you're seeing now since the pandemic?
- [04:32]
Dr. Anna Lembke
It's not like all of a sudden things shifted in 2020? I think what happened was Covid just accelerated the trends that were already happening. So to put it in perspective, just from, you know, my clinical front row seat, such as it is, you know, in the early thousands, what we were seeing is a sudden increase in people addicted to the very same p doctors were prescribing to them foremost opioids for chronic and minor pain conditions, leading to our current day opioid epidemic. But also a signal early on, in the early 2000s, middle aged men coming in with severe Internet pornography addiction and compulsive masturbation, primarily men who had been able to consume pornography in reasonable moderation without a lot of harm to their lives until the advent of the Internet. And then especially, you know, in the first decade of the 2000s, the smartphone, and that was probably our earliest signal for behavioral addictions. And then around 2012, 2013, we were seeing a bunch of teenage boys brought in by their parents primarily for Internet gaming disorders. And then sort of roughly 2015, 2016, we started to see the earliest signal of social media addiction, online shopping, a huge increase in online gambling addiction. And then what I would say I've seen primarily in the past five years is a sort of diffuse Addiction to the Internet. So people will have their drug of choice, whether it's shopping or social media or video games or pornography or what have you. But if that's not available, they'll switch to something else.
- [06:16]
Lulu Garcia Navarro
This is like a timeline of, like, our culture that. That is very, very. And I'm gonna use the word sobering because it is very sobering.
- [06:23]
Dr. Anna Lembke
Yeah.
- [06:24]
Lulu Garcia Navarro
I do wanna sort of establish some of the basics of. Of the language that you've already used so we can understand what it means. How do you define addiction?
- [06:35]
Dr. Anna Lembke
So addiction is the continued compulsive use of a substance or a behavior despite harm to self and or others. Importantly, there is no brain scan or blood test to diagnose addiction. And there won't be for a very long time, if ever. We still base our diagnosis on what we call phenomenology, which is patterns of behavior that repeat themselves across individuals, temperaments, cultures, time periods, et cetera.
- [07:05]
Lulu Garcia Navarro
Is there a difference between addictive behaviors and being an addict?
- [07:10]
Dr. Anna Lembke
Oh, interesting.
- [07:13]
Lulu Garcia Navarro
And I'll tell you why I asked this, because my understanding has always been that addicts cannot control their compulsion. And then addictive behaviors are more habits that can be moderated or controlled. But I think what I'm hearing from you suggests that that's not the right way to think about it.
- [07:30]
Dr. Anna Lembke
Well, I mean, I think these issues are debatable. And the use of language is important. When I use the term addiction, I am talking about a form of psychopathology, which is a spectrum disorder. So there is mild, moderate and severe addiction. When we see severe addiction, we all recognize it. Like there's. It's obvious, right? They're struggling, they're suffering. There's incredible consequences as a result of their use, and yet they can't stop using without significant help. On the less severe end, you know, it's much harder to tell when we might cross over from healthy, recreational and adaptive use of a substance or a behavior into unhealthy maladaptive use. And often that's a judgment call. And it's also culturally informed. So, for example, when we think about something like work addiction, right. We. We live in a culture that absolutely celebrates workaholism. So we're not really gonna that as a problem, typically.
- [08:32]
Lulu Garcia Navarro
And when you're saying it's like a judgment call, is that a judgment that one makes oneself, or is that a judgment that someone like you would make if I went to go see you?
- [08:40]
Dr. Anna Lembke
It is both. Right. So sometimes an outside observer might say, hey, this is clearly a problem, but, you know, a part of the addiction process is that we ourselves don't necessarily recognize a problem, even when it's obvious to others. This is why people talk about denial as an important part of the addictive process. People end up with this kind of double life phenomenon where they have this secret life where they're engaging in their addictive behaviors, and then they have this other life that other people see. And the lives are so separated and the addictive life is so covert that we can actually convince ourselves that it's not really happening or it's not happening to the extent that it is, or that it's not causing problems even if it is happening.
- [09:28]
Lulu Garcia Navarro
So, you know, we've become extremely attached to our phones, and phones do seem to be like the gateway to a lot of these new addictive behaviors. Online sports betting has exploded. Pornography use, as you mentioned, is up, even as actual sex is down. I mean, I was reading a study that said in 2024, Gen Z spent six to seven hours a day scrolling on average. So I guess it seems like it's more a systemic problem than an individual problem.
- [10:01]
Dr. Anna Lembke
I agree 100%. This is a collective problem. I see it as part of the Anthropocene, which is a term that's been coined to describe the age we live in now when human action is changing the face of the planet for the first time in history. You know, climate change is often included in this idea of the Anthropocene. But I do think that the stressors of overabundance should also be included in that. In the richest countries in the world, we have more leisure time, more disposable income, more access to leisure goods than ever before. And I think that, you know, as a result, we are all struggling to know what to do with all that extra time and money. And one would hope and think that we would be like, engaging in deep philosophical discussions, helping each other, cleaning up the garbage.
- [10:55]
Lulu Garcia Navarro
I'm laughing, of course.
- [10:57]
Dr. Anna Lembke
But instead, what we're doing is spending a whole lot of time masturbating, shopping, and watching other people do things online. And essentially what's happened is we're spending more and more time of our energy and creativity investing in this online world, which means that we are actually leeching our real life existence of our energy and creativity. So when we try to get off out of the metaverse and re enter the real world, it actually is more boring, right, because there's less going on because there's nobody there.
- [11:30]
Lulu Garcia Navarro
You've called this the plenty paradox, right? Which is the more we have, the worse off we are because we're being bombarded all the time with dopamine producing things, and that makes us actually feel worse.
- [11:45]
Dr. Anna Lembke
Yes, exactly. And it seems to me we've kind of crossed over some kind of abundance set point where we went beyond meeting our basic survival needs and now have so much access to so many pleasure inducing substances and behaviors that we may actually be changing our brain chemistry such that we're in a dopamine deficit state. Now we need to keep using these highly stimulating drugs and behaviors not to get high and feel good, but just to level the balance and feel normal. And, you know, interestingly, even more recently, I'm part of a state of the nation project, and some of the findings that we're seeing for the United States are that despite the fact that a lot of parameters would suggest the nation is doing better, from a mental health perspective, we're doing worse. And that's true around the world. Rates of depression, anxiety, and suicide are going up in countries all over the world, and they're going up fastest in the richest nations of the world. So there's some kind of phenomenon where this overwhelming overabundance has reached a tipping point such that now we're actually dealing with the stress of overabundance, which our ancient reward pathways were not really evolved for.
- [13:06]
Lulu Garcia Navarro
Do you see us all as addicts now?
- [13:09]
Dr. Anna Lembke
No, I don't. I mean, I think we all struggle with appetitive control in the modern world. But I do think it's important to use this term addiction, or as the DSM defines it, a use disorder, as when we've crossed that threshold into self and other harm that is, on some level, out of our control. So I don't want to just say, like, everybody's addicted. But I do think that the problem of compulsive overconsumption has become something that all of us are probably struggling with in one form or another. And, you know, although I've been treating addiction for, gosh, going on 30 years and thought that I personally was somewhat immune to the problem of addiction, it wasn't until I got addicted to romance novels that I was like, oh, wait a minute, like, even I can get addicted to something.
- [14:13]
Lulu Garcia Navarro
Hmm. I mean, you know, you have great authority and expertise on this area, but also you are part of the Anthropocene era, and you are a human in this world and also a mother. And I'm just wondering how you navigate this for yourself and for your family.
- [14:34]
Dr. Anna Lembke
Yeah, I'm always a little reluctant to talk about sort of what we as a family did because I don't want people to feel like, oh, you know, we should have done that, or we should do that. I really think every family has to kind of find their own way. And I will say up front, I mean, my family struggles with this as much as the next family. But one thing that we did as a family that I am very grateful for and my kids are grateful for, is that we did not have any devices in the home environment until our eldest started high school. Now, when our daughter started high school, she came home and said, I actually can't function as a student in high school unless we get a connection to the Internet. You know, we're in the heart of Silicon Valley. So we realized that that was true with the constantly changing high school schedules, all of the assignments in line, like, there was no way to participate in high school life without connecting to the Internet. And this was already, you know, some eight years ago when she started high. So we got Internet connection and really, it was downhill from there. I mean, it was just.
- [15:40]
Lulu Garcia Navarro
I just wanna pause here. You didn't even have Internet in your home.
- [15:43]
Dr. Anna Lembke
We did not have Internet in our home. And I did not own a smartphone, if you can believe it, until about 2019 when I was forced through work to get one in order to be able to prescribe controlled substances using Duo security. Again, I wanna emphasize, like, I'm not judging other people, because I get it.
- [16:03]
Lulu Garcia Navarro
Most people, I'm just in awe.
- [16:05]
Dr. Anna Lembke
Yeah. Well. And, you know, have the kind of work that allows me to do that most people do not have that.
- [16:12]
Lulu Garcia Navarro
I am gonna tell the New York Times that I am just unplugging from the Internet, and I don't think it's gonna go very well.
- [16:17]
Dr. Anna Lembke
Exactly. Exactly. But, you know, what can I tell you? My kids are now between ages 18 and 23. They have struggled to various degrees with their time online, but. But what I'm really grateful for is that they have at baseline this notion that too much time on the Internet is not a good thing. It's not a good thing for relationships, it's not a good thing for mental health, it's not a good thing for physical health. So even if they intermittently struggle with spending occasionally too much time online, they have this very strong idea rooted in let's be present, let's be present together. Let's not be distracted to the point where this past winter holiday, we decided to go to Yosemite Valley together as a family. And we had done tons of vacations with the kids, always device free, which, by the way, Is like being a blind person. Now when you're traveling, it's literally like you cannot see because everything is. You need to the QR code. But we've done it. And I said, are you guys still game for device free? Cause it had been a couple years since we'd gone on that kind of trip together, and they were. And from the moment we got into the car and started driving to Yosemite Valley, I felt a distinct difference in the quality of the presence of all of us even in the car. And it lasted through the whole three days. It's like we played board games, we had meals together. And the key thing there was like nobody was sort of looking toward the end of the meal to go check their device because there was no device to check. We lingered, right? We extended the. These conversations. We moseyed along after dinner, you know, under the stars. It's just, it was so different. And I became even more convinced that we need Internet free communal spaces. We need places where we come together. Not all of the time, but some part of the time we come together and nobody is connected to the Internet and they can't get connected because when, when the ability to choose is removed, it changes the state of craving.
- [18:41]
Lulu Garcia Navarro
You know, I'm imagining this beautiful utopia where we have communal spaces where there's no Internet. And obviously you can get that by going out into the wilderness. But the way that our society is moving is that we are now having wearable devices like glasses. There are discussions about implants in our heads. And we have, of course, the rise of artificial intelligence. I mean, the New York Times just published a profile of a woman who fell in love with her AI boyfriend. I mean, it seems like a lot of these technologies are actually going in the direction to pushing us to even more engagement.
- [19:22]
Dr. Anna Lembke
Yeah, I think that's right. We are now turning to these devices and to the Internet to meet our physical, emotional, sexual, educational. Every need we have. We can now we don't really need other people anymore. We can get those needs met from the Internet. And I think that's a very scary prospect because I think it means that we will get more and more isolated. The surgeon general issued an advisory on our loneliness epidemic. And the irony is that even though the Internet can connect people, you know, across oceans and borders in a way that's amazing, it also, I believe, engenders and creates more isolation because people aren't needing other people in the same way anymore. They're getting their needs met through the Internet. And originally the concern was sort of like, oh, well, they're getting their needs met through other people in chat rooms or what have you for good and bad. But. But, yeah, as you point out now with AI and large language models, it's not even real people. It's like this amalgam of collected language creating a simulated person. I don't know. It's really scary.
- [20:44]
Lulu Garcia Navarro
After the break, Dr. Lembke shares her theory about why modern life is making us so susceptible to addiction.
- [20:51]
Dr. Anna Lembke
We're essentially struggling with endemic narcissism, where our culture is demanding that we focus on ourselves so much that what it's creating is this deep need to escape ourselves.
- [21:17]
NetSuite Advertisement
This is an advertisement from the American Petroleum Institute. America's energy future begins now. We have the opportunity to strengthen our economy and reduce inflation. And with this opportunity comes great responsibility. Working together, we can harness our energy advantage and improve the lives of every American. More American energy means more jobs, more security, and more innovation. That's the promise of America's oil and natural gas. America's moment is now. Learn more@lightsonnergy.org this podcast is supported by NetSuite.
- [21:52]
Okay, business leaders, are you here to play or are you playing to win? If you're in it to win, meet your next MVP NetSuite by Oracle NetSuite is your full business management system in one convenient suite with NetSuite, you're running your accounting, your finance, your HR, your e commerce, and more, all from your online dashboard. Upgrade your playbook and make the switch to NetSuite, the number one cloud ERP. Get the CFO's guide to AI and machine learning at netsuite.com NYT netsuite.com NYT.
- [22:23]
Lulu Garcia Navarro
New York Times games make me feel like I'm amazing.
- [22:26]
Dr. Anna Lembke
Wordle makes me feel things that I don't feel from anyone else. I absolutely love Spelling bee. The Times crossword puzzle is a companion that I've had longer than anyone outside of my immediate family.
- [22:37]
Lulu Garcia Navarro
When I can finish a hard puzzle without pins, I feel like the smartest person in the world.
- [22:42]
Dr. Anna Lembke
When I have to look up a clue to help me, I'm learning something new. It gives me joy every single day. Join us and play all New York times games@nytimes.com.
- [23:07]
Lulu Garcia Navarro
So even as we've seen the rise of temptations, we've also seen the rise of other things to counterbalance them. In 2021, I was an early adopter of Ozempic, which is part of that class of drugs known as GLP1s. And I had done everything to lose weight, including surgery. But this was the first thing that really worked for me. And I know we don't know exactly how these drugs work, but one thing that we are seeing is that it seems to curb other addictive behaviors. And I'm wondering what you make of that.
- [23:42]
Dr. Anna Lembke
Right. So the data here is really preliminary and we need a lot more research. But there is clearly a signal that the GLP1 agonists can help with alcohol addiction. We have patients in our clinic who have failed all other treatments for whom we have prescribed things like Ozempic and Mounjara and seen benefit. And these are people who literally have tried everything and struggled for years and years and now report sustained remission from alcohol in a way that's just so hopeful and wonderful. I think there are some studies showing its benefit in possible behavioral addictions like gambling disorder and sex addiction. So, yeah, I mean, I wanna emphasize that they don't seem to work for everybody. So it's not like some kind of miracle cure. I mean, we have patients for whom, as I just described, they seem like a miracle cure. And then we have other patients for whom they don't really seem to do much. And that's true across the board with our medication treatments for all kinds of addictions. They work for some people and not for others. Which is why it's so important that every individual has access to all the different options so they can use what works best for them.
- [24:54]
Lulu Garcia Navarro
You know, in your book, you seem to be skeptical of medical interventions. And one undercurrent of the conversation around GLP1s is how long people should stay on them. Do you encourage people to create new habits to try and get off the medication, or is there no problem, as far as you can see it, with staying on them long term?
- [25:16]
Dr. Anna Lembke
So I know that my work is often interpreted that I'm skeptical of medical interventions. I guess I would nuance that a little bit and just say I have seen that our medical system overemphasizes prescribing pills and performing procedures because it's more lucrative and it's faster and because we have a system that's not well set up to deal with chronic relapsing and remitting disorders like addiction and other mental health concerns. But I very much, you know, use all kinds of medical interventions. I prescribe psychotropics and other types of medications on every clinic day. So what I'm seeking is more balance here and the recognition that, first of all, that psychotropics are overpriced, prescribed, and that many patients experience debilitating polypharmacy where they're on 13, 14, 15 different psychotropics to the point where it becomes completely unclear what's working, what's not. Plus you have drug interventions which can be really dangerous. But getting back to GLP1, I mean, you know, I don't have really a judgment one way or another about whether people should stay on them long term. I think it depends on the person. You know, it does appear that when people stop the GLP1 agonists, they have with food addiction, a resurgence in their appetite and they're at risk to gain the weight back. I've seen reports of individuals now kind of pulsing the GLP1 agonists, so using them for a period of time and then going off of them and then going back on for brief periods in a kind of pulsing way if. If the weight starts to creep up again or the relationship with the food starts to get verklempt again.
- [27:00]
Lulu Garcia Navarro
Yeah, I mean, it's interesting talking to you because one of the things that you emphasize a lot are the systems that we live in, the food systems, the pharmaceutical systems, the cultural systems that we inhabit. And I also do wonder what you make of these large cultural shifts that we're seeing in regards to behaviors. You know, a lot is being written now about the sober, curious trend, and I guess this is the other side of the spectrum, which is not medical, it's cultural. But do you actually see those shifts as producing long term results or are they just fads?
- [27:38]
Dr. Anna Lembke
I think those cultural shifts can have a huge impact. I think we are seeing that with alcohol. More people, especially in the last two to three years, seem to be interested in drinking less alcohol. This is outside of the temperance movement and prohibition. It's definitely a new trend, but I think like most things, it tends to be a pendulum swing. We typically go too far in one direction and then too far in another. I mean, in general, I think it's very good, obviously, given my profession and all the terrible harms I've seen associated with alcohol and drug use and other addictive substances and behaviors. You know, I'm glad that there's more awareness and that people are interested in finding out about how to have fun together without using substances. I do have a fear though, that progress in the arena of drugs and alcohol might be happening because people are turning to digital drugs. I don't know. I hope that's not the case, but I do have some concern in that regard.
- [28:48]
Lulu Garcia Navarro
That's interesting, the idea that we're retreating from, you know, real world dopamine Fixes to digital world. Dopamine fixes.
- [28:56]
Dr. Anna Lembke
Exactly.
- [28:57]
Lulu Garcia Navarro
I mean, big question. Are we just playing whack a mole with our addictions?
- [29:02]
Dr. Anna Lembke
Yeah, it's a really fair question. And I think on some level, we really are. Which then begs the question, what is it about human nature, or I would argue, what is it about modern life that makes us so vulnerable to these addiction problems? I have kind of a, you know, some theories on that. Totally, you know, speculative.
- [29:23]
Lulu Garcia Navarro
Hit me.
- [29:24]
Dr. Anna Lembke
All right. You know, I think that we essentially have. We're essentially struggling with endemic narcissism, where our culture is demanding that we focus on ourselves so much that what it's creating is this deep need to escape ourselves. And I think that is what is driving much of our pursuit of intoxicants as a way to just not have to think about ourselves for a blessed hour or two.
- [29:59]
Lulu Garcia Navarro
Let me break this down for a moment to see if I understand what you're saying, which is that modern life requires us to just constantly think about ourselves and be on display. And the use of these ways to take us out of ourselves is increasing because we're constantly narcissistically thinking about ourselves. Is that right?
- [30:20]
Dr. Anna Lembke
Yeah, that's right. And it's not like the whole explanation, because obviously the whole point of Dopamine Nation is that we also live in this world of abundance with constant access, and access alone is a risk factor. So I've already, you know, kind of made that point. But although I think access is important and supply is more important than we have given credit for, we do have to focus on the demand part of this equation. Is it about our lives now that make us so desperate to essentially be intoxicated in one form or another. And I do think it is this sort of obsessive self focus.
- [30:55]
Lulu Garcia Navarro
But this is weird for a therapist to say because so much of our culture is now inundated with this therapy speak where we're all trying to analyze ourselves and think about ourselves and actualize ourselves.
- [31:07]
Dr. Anna Lembke
Yes, it's true. I think that we can, like most things, take it too far and end up up doing harm with all the time that we spend thinking about ourselves. Now, having said that, I think that good therapy gets us to a place where we can mindfully observe ourselves without being self absorbed. But ultimately, I think the goal is to tune out. That is, not to tune out as in not listen to ourselves, but to get out of our own heads ultimately.
- [31:38]
Lulu Garcia Navarro
Hmm. This naturally, I think, leads us to how we break the cycle of addiction. For me, it's something that, you know, I think about a lot simply because, you know, my sister died of her addiction and it was one of the catalysts for making me stop drinking. And, you know, it's the two different paths. You know, I took sobriety and she, with a lifetime of struggle, of trying to be sober, it ended up defeating her and she lost her life. I mean, what have you learned about why some people can do it and others can't?
- [32:15]
Dr. Anna Lembke
Yeah, I mean, it's a really sad, sad thing when people die of their, you know, mental disorder, addiction or otherwise. You know, there are lots of risk factors for addiction. There are genetic risk factors. If you have a biological parent or grandparent with alcohol addiction in particular, where the evidence is strongest, you're at increased risk for alcohol addiction, even if raised outside of that alcohol consuming home. So we know there are genetic vulnerabilities. People don't come into the world with equal risk. Having said that, given all of the different drugs, including drugs that didn't exist before, and the increased access, I think even without a genetic risk, we're now all more at risk than we were before. You know, there are social determinants of health that make a big difference in terms of people's ability to get into recovery. We know that poverty is a risk factor. Multigenerational trauma, unemployment, these are all enormous risk factors that if we could target, we would improve people's chances of, you know, pulling out of the spiral of addiction. Gosh, I mean, there's a whole element too, I would say, of just unpredictability. Like I used to think that I could predict what, when a patient came in, whether or not they would be able to get into recovery. And I've long given up that idea. I've seen people with decades of severe and life threatening addiction miraculously late in life get into recovery. And I've seen people who I thought for sure were helpable who ended up dying of their disease. So, you know, there is still a lot we don't know.
- [33:56]
Lulu Garcia Navarro
I do wonder what made you become an addiction specialist. I mean, was there a reason or was it just something that you were interested in?
- [34:05]
Dr. Anna Lembke
So my father's alcoholism was a major factor in my childhood. He was a surgeon, but he would go long periods without drinking, and then he would have long periods where he was drinking large amounts every day. I remember coming home from elementary school with my best friend Laura and finding him not on the hammock, but under the hammock, passed out and just looking at her and saying, let's go to your house. So, you know, that was sort of a specter in my childhood. What I first did with that in medical school and residency was to not want to have anything to do with addicted patients. Just cause that's kind of what we call negative countertransference. But also hadn't really learned very much in medical school or even residency. So I didn't have the tools, didn't know what to do. And then very early in my career, I was specializing in treating mood disorders, and I had a young woman in my clinic. I was treating for depression. Her parents were paying for the care, and I saw her weekly, and we had in depth discussions about her childhood. I talked about every conversation she'd ever had with her mother. I was prescribing an antidepressant, and I noted that she would often nod off in the sessions. And I thought, huh, that's funny. I wonder why she's so sleepy. Maybe she's asleep. You know, I was like. I was trying to draw on, you know, what I had learned in medical school. And then one day, her brother calls me out of the blue, and he says, she's been in a rollover car accident. I said, oh, my goodness, that's terrible. What happened? And he said, well, she's been using again. And I literally did not understand the structure of that sentence as using. I said, using what? He said, well, using heroin. Isn't that what you've been treating her for?
- [36:01]
Lulu Garcia Navarro
Oh, wow.
- [36:02]
Dr. Anna Lembke
Yeah. And that was the moment that I realized I'm a bad psychiatrist because the kind of don't ask, don't tell policy, because I never once did ask her about drugs and alcohol, and she never once volunteered the information. But that's not really her job. Right. It's my job to get that information. So I was really doing harm to patients out of my ignorance. And that was a huge turning point in my career. I realized, oh, my goodness, I need to figure out something about addiction or I'm gonna be a menace. And the irony is that as soon as I started asking patients about drugs and alcohol, they were eager to talk about it. And the majority of my patients had problems with drugs and alcohol. And when I started treating that problem alongside their other psychiatric disorders, they got better in ways I had never seen prior to that. And the work was fun. It was so enjoyable. People got into recovery. They were amazing people. Their recovery impacted their spouses and their children and their parents and their workers. It's like the most rewarding work. So a lot of times people say, well, how can you do this work? I say, are you kidding? It's the best work, it's the best population.
- [37:19]
Lulu Garcia Navarro
So. So we've mostly talked about forms of addiction that have obvious negative consequences in a person's life. But I also, you know, do wonder about what we say we can become addicted to. You know, when we started talking, you used this example of struggling with romantasy novels. I'm also a big fan by the way. But you know, is there something trivializing about calling stuff like that an addiction? Because you can die from alcoholism, but you can't die from reading romanticism?
- [37:48]
Dr. Anna Lembke
Yeah, there is something trivializing about doing that. And I don't mean to do that, you know, I don't mean to compare my relatively modest compulsive over consumption of romance novels with people who are struggling with life threatening addictions. On the other hand, by drawing a comparison between what they're struggling with and what I struggled with, I'm also attempting to humanize the behavior and to acknowledge the ways in which we're all vulnerable to compulsive overcoming over consumption given enough access to our drug of choice. So again, just looking at my own life, as I mentioned, father with severe alcoholism, alcohol does nothing for me. Absolutely. It's not reinforcing. And so therefore I've never been vulnerable to alcohol addiction and so thought I just wasn't vulnerable to addiction, period. But the truth was I just hadn't yet met my drug of choice. And my drug of choice turned out to be this behavior I have done as an escape behavior since childhood, which is read. But then once, you know, kind of discovered a certain type of romance vampire novel at a certain critical period in my life, plus the applied technology of a Kindle, which meant I had immediate access 24 7. I was off and running. And yeah, it never got to the point where it was life threatening, but it did get to the point where I was staying up till three in the morning every night reading. I was bringing romance novels to work and reading in the 10 minutes between pages. I was taking romance novels to neighborhood parties and going and finding a room during the party and reading romance novels rather than.
- [39:29]
Lulu Garcia Navarro
You mean that's not normal?
- [39:34]
Dr. Anna Lembke
Exactly.
- [39:38]
Lulu Garcia Navarro
So we've been just having this very wide ranging conversation about all sorts of different types of addiction and all the struggles that we have. And I mean, I don't want to land this on you, but what are we supposed to do?
- [39:51]
Dr. Anna Lembke
You know, what I argue for is a combination of trying to avoid using intoxicants in high volume too often. So it's not that I imagine that we're never gonna use intoxicants. We wouldn't be human. And it's a deep part of our culture, and it can be neutral or even beneficial. But we have to really be careful about over consuming intoxicants, consuming them too often. And I do think, given this world of abundance, that we have to now intentionally seek out things that are hard because our lives have become so easy, so convenient, so sedentary. The default is a state of consumption that's ultimately not good for our bodies or our minds. So I do think that we have to kind of simulate hardship and intentionally create inconvenience and create struggle for ourselves.
- [40:51]
Lulu Garcia Navarro
You know, that is something that I, in my own personal journey, did. But the other side of this, of course, is that while I'm happier and healthier, I also sometimes wonder if I'm becoming an amoeba. You know, that all this abstinence is just making me into, you know, someone who is always saying no to dopamine and to pleasure. Do you hear that concern often?
- [41:15]
Dr. Anna Lembke
Well, I've never heard the amoeba analogy. Just kind of funny. Yeah. I mean, Right. There's the risk here that it all starts to sound too school marmy. Right. Or kind of scolding or judgy. And that's a real danger. And I wouldn't want. I'm sure I probably do come off that way. And that's not at all not my intention.
- [41:41]
Lulu Garcia Navarro
I sometimes feel like that.
- [41:43]
Dr. Anna Lembke
Yeah, right, right, exactly. I mean, I've got kids, so you can imagine how they feel. I mean, you know, again, I can certainly appreciate a criticism of my. Including things like that, like, oh, that lady doesn't want us to do anything. We're just gonna be bumps on a log and not do. But I think what I'm advocating for is something like a reframe, you know, when we decide not to indulge in the pleasures the culture has us telling ourselves that we are denying ourselves. And I think a potent reframe here is, no, I'm actually going towards something that's good for me and that, in the long run, makes my life better. So, you know, I mean, that's just. That's just what I see clinically. That's what I've experienced in my own life. And I think people often are unhappier than they'd like to be and kind of can't figure out why.
- [42:46]
Lulu Garcia Navarro
That's Dr. Anna Lembke. She's the author of Dopamine Nation. This conversation was produced by Seth Kelly. It was edited by Annabelle Bacon mixing by Sophia Landman Original music by Marian Lozano Photography by Devin Yalkin Our senior booker is Priya Matthew and Wyatt Orme is our producer. Our Executive producer is Alison Benedikt. Special thanks to Rory Walsh, Renan Borelli, Jeffrey Miranda, Maddie Masiello, Jake Silverstein, Paula Schumann, and Sam Dolnick. If you like what you're hearing, follow or subscribe to the Interview wherever you get your podcasts. To read or listen to any of our conversations, you can always go to nytimes.com theinterview and you can email us anytime at the interviewytime Next week, David talks with Denzel Washington I've taken every job for money. There's no job. I've taken where I went. You know what? You guys just keep the money. I'm just so happy to be. I'm just so glad to be an actor. I don't even want the money. I'm Lulu Garcia Navarro and this is the Interview from the New York Times.
- [43:57]
Dr. Anna Lembke
Foreign.
- [44:03]
NetSuite Advertisement
This podcast is supported by NetSuite.
- [44:06]
Okay, business leaders, are you here to play or are you playing to win? If you're in it to win, meet your next MVP. NetSuite by Oracle NetSuite is your full business management system in one convenient suite with NetSuite, you're running your accounting, your finance, your HR, your e commerce, and more, all from your online dashboard. Dashboard. Upgrade your playbook and make the switch to NetSuite, the number one cloud ERP. Get the CFO's guide to AI and machine learning at netsuite.com NYT netsuite.com NYT.