0:00 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. I 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. >> Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and opthalmology at
0:46 Stanford School of Medicine. My guest today is Dr. Anna LMK. Dr. Dr. Anna LMK 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. Lumpky 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 into how giving up our attempt to control certain things actually allows
1:31 our brain to access new strategies to overcome major challenges, including addiction, as well as codependency, and altogether 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 LMK'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. And now for my conversation with Dr. Anna LMK. Dr. Anna
2:16 LMK, welcome. >> Good to see you again, Andrew. >> Great to have you back. Your book, Dopamine Nation, and many things that you were 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 8 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 next
3:03 >> yeah yeah I mean I think there has been a big change just in terms of awareness, not not unfortunately in terms of our behaviors. If 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. >> Are you seeing this clinically? Are are people coming in specifically with the issue I can't unplug from whatever it is, Instagram, X, Reddit, YouTube, media more generally. >> Yep. So, they're bringing themselves in or um very often parents are bringing
3:48 adolescents in. Our adolescent clinic now about 50% of the referrals are for digital media addiction in some form. 50% of the referrals at this point for our adolescent clinic. Huge problem. >> Does it look like classic addiction? And maybe we could define or if you would define that again for us. >> Yes. So, 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. Um we look for the four C's. 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
4:33 effect, and also withdrawal, finding that we're experiencing a painful physiologic response to stopping or cutting back. >> What's so unique about social media and online addiction is that it's often woven into vocation, social connection. Yes, >> 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. Yes. 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
5:18 how? >> Yeah. And I think this is a 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 guard rails like controlling the amount of waste that people can dump into rivers and oceans and into the air and and all of that stuff. And I think we're going to have to conceptualize digital media similarly. Like we as individuals have
6:03 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 initification. 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 a process called inshitification of technology. I can't remember the the name of the guy. Maybe someone can look it up and I can sound like I remember his name, but it's it's a great term because it is sort of the progression that you see in a lot of digital media products. >> Take us back to the circuitry, the brain circuitry that underlies uh these and
6:48 all forms of addiction. If you could tell us about dopamine and the circuitry and what's involved in resetting the circuitry. >> 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 spa a gap or a space between them. That gap is called the syninnapse. And dopamine is a neurotransmitter that bridges that gap being released from the presinaptic neuron binding to a receptor on the outside of the post synaptic 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.
7:33 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, 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 neurom modulators like indogenous opioids, indogenous canabonoids, etc. 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 a th000%. Which is why I like to say that's why we first have dinner, then have sex, then have a cigarette. >> >> Um, and even though the data you just uh cited
8:19 are from rodents, can we assume that parallel kind of scaling of dopamine with different um behaviors and and substances is also occurring in humans? >> Yes, we can. I mean, it's not an exact one to one and it's much harder to me measure absolute dopamine levels in humans than it is in rats. In rats, you can put a probe right in the nucleus cumbent, measure dopamine levels um directly. You know, we're not doing that in humans. It's usually relative comparisons, but there are there are ways to 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.
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11:21 Again, that's helixleep.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 a a sort of um inverse of that um that takes place as that experience wears off. It doesn't necessarily, you know, cast them forward just feeling much better about everything in life. What do we know about the circuitry underlying that? 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
12:06 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 um a beam on a central fulcrum. And when it's at rest, that's baseline homeostasis. Pleasure and pain very simply work uh at like opposite sides of a balance. When we experience pleasure, it tips one way, pain, it tips the other. And the rules governing that that this balance begin with the primary rule that the 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
12:52 happens that makes us vulnerable to addiction. So for example, if uh 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 level balance. I like to imagine that as these neuro adaptation gremlins hopping on the pain side of the balance to bring it level again. 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 uh
13:37 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 hideonic or joy set point. 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 when 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,
14:24 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'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 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
15:10 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 in one of two ways. They can abstain for long enough for those gremlins to get the message they need to hop 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 uh cycle of
15:57 accumulating these gremlins. And that's things like buprenorphine or methadone to treat opioid addiction. >> 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, etc., etc." Right? >> That all seems great, but it also seems
16:44 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." >> Right. Right. >> Nicotine tickles this dopamine pathway. It puts, you know, some 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, 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? >> Right? So great, great question. Let me back up a little bit and just say, so if somebody comes in and they says they say, "I'm addicted to X, Y, or Z." The
17:30 first thing out of the gate is not, "Okay, you need to abstain from that." So, so just to make it very clear, we we establish a therapeutic alliance. We discuss, you know, their use, the impact that it's had on their lives. We talk about uh, 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 and in our outpatient setting, if someone had repeatedly tried to quit on their own and been unable to, we 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." 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
18:15 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 nucleiocumbent. 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. 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
19:00 cannabis use or escalate their alcohol use or start you know uh compulsively watching pornography or what have you. As long as they really just remove that thing we see improvements. >> We see improvements. So there 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 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
19:46 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. 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.
20:31 Why 30 days? Because on average, that is the amount of time it takes to begin to reset reward pathways. >> Yeah. What I'm trying to understand, 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? 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 uh clinical expertise because I have none truly um is very common. Like you go to a 12step meeting, uh let's just say used to see a lot of smoking, now you see a lot of uh oral nicotine use. You see a
21:16 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. >> Recovery is going to be something different for everybody. >> The philosophy in 12step 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
22:02 like philosophical and spiritual definition of addiction. And so yes, I mean the dopamine nation is all about the that we live in a drug world that almost everything has become more accessible, more reinforcing, more 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-ole 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 the dopamine fast or the 30 days of abstinence, you know, or the stopping using substances is really just the
22:47 first step. I mean recovery is ultimately about so much more than that and it really is a biocschyosocial spiritual disease and so we have to intervene at all those levels if our circuitry is primed for this like we we we're in a world that's filled uh 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 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. Um social media is socially acceptable and it's become the main frame for um
23:34 interaction among humans at least a certain generation of humans. So how are we supposed to navigate in this world? Uh given that the circuitry is within us, there's no escaping that. the lures are everywhere and in some sense the algorithms and just our our deficits in life as as well as what we're drawn to um basically set us up to engage in things until they become too much. I mean is is this part of everybody's life arc to figure out what your trip wire is and then get over it and then that's the is this part of the hero's journey? >> I think we are all struggling with some form of compuls over overconumption in the modern age because everything has been drugified. I mean, I've called it the the modern plague. I've called addiction the modern plague. And I think that's accurate. I think if you look in
24:20 the foreseeable future, you know, 50, 100, 500 years, we're living in a world of plenty. Um, 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 like we're mostly just um, you know, masturbating to images online. Um, some version of that. So, it it's a it's a very important question, you know, beyond the question of just the mechanics of early
25:05 recovery and abstaining sort of what 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 uh the problems that people with addiction are are dealing with. you know, um, as my friend Kent Stunnington has said that people with addiction are 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
25:50 wisdom that we could all learn from because we are living in a drug 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 the essence of it really is acknowledging that we don't have control uh 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 hopes of uh 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
26:35 meaning and purpose and the spiritual pivot is is really essential. >> 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 I want to just um ask your opinion about two areas uh related to addiction that we see a lot of uh 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 is 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
27:21 dopamine circuitry and and and 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 um and their deficits are at the root of all of it. And I realize none of this is mutually exclusive with the model that >> right >> 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 the um 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. So I'd like to know if that's true or
28:06 not, sometimes, often times, 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. >> 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
28:52 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. 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
29:38 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, you are at increased risk to develop an alcohol use disorder even if you're not raised in an alcoholusing home. There are access risk factors. So and then that's one of the main focuses of dopamine. Like simply having access to a drug means you're more likely to use it, more likely to
30:24 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 nearperfect 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 uh you know phenomenon. So you know these these two things exist simultaneously. I think the danger that can happen and and and in my career span was very common is that you have psychiatrists and psychologists and many 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
31:11 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, we'll spend a 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. 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 disregulated, and then they can ga engage in in the trauma work. The other thing too that I think is is happens
31:57 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 uh sort of character inventory what did 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
32:42 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 and to move on from there. Now, getting to uh the idea of consequences. I don't know if you've seen there's a great Key and Peel sketch where I don't remember the details exactly, but Key or Peel or one of them, you know, he's getting up there and he's talking to a he's like in re 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 and 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
33:29 people with severe addiction do not get into recovery until they have 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. So we just like like whatever happens, you know, a DUI, a car crash, a lost relationship, uh you know, pancreatitis, our brain just does this clickity clickity click, some weird, really weird mental madness like, well, it's 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
34:14 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 hitting rock bottom. It's just it's a moment where you get and you're just like, "Okay, I 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 they're home they got to end up homeless or in jail or bankrupt or much more significant consequences before so people are different you got your high bottoms your low bottoms but the bottom line is everybody sort of has that moment where it's like okay that
35:01 like I I just can't do this anymore >> I don't know if there are any data on it but do interventions work >> there are wonderful intervention interventionists out there many of them are people who have um you know struggle 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. Um 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
35:46 held hostage to that. >> 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 HMBB, and zinc carnosine. Each serving has 5 g of creatine monohydrate to support muscle strength and performance. as well as brain health, calcium HMBB to support muscle recovery and reduce muscle breakdown, and zinc carnosine 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
36:33 now. 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 co-enzyme Q10 with your first subscription. Again, go to drinkag1.com/huberman to get a free bottle of omega-3 co-enzyme 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, but I do recall sharing a story. It's true story about a friend
37:20 who was badly addicted to drugs and alcohol and had gone through multiple relapses, gone to um various private clinics, uh 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. Um he uh he won't mind me sharing this. Um I checked with him. One of their kids had gotten into a stash. There 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. >> He ended up um going to a place where the entire treatment was uh faith-based. >> Mhm. And I remember when he told me he
38:05 was headed off there, I was like, "Okay, this is like like no." He went there for a week or so. Um came out. Um that was something like 4 and 1/2 years ago. He's actively in 12step and that's keeping him going, >> right? >> Um 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, >> right? >> 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
38:50 had wrapped his truck around a pole at 7:00 a.m. after taking pills. That this was prior to that. I mean, he had had so many of these in the short time that I'd known him. and and now it's been a long time. So I'm like man that is awesome. When I ever 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. >> Mhm. >> And I'm like so what the heck's going on? >> Yeah. I mean it it is fascinating and in my career I have seen that many times over. Um you know either either through 12step or many different types of religious practices. people who couldn't get into recovery in any other way and then this this spiritual pivot um just became key for them and I think
39:37 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. 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, blood, fire. We are born with a mental model of the world, what I'll call a mind map. Um, our mind map is different from the mind map of a fish. So, we're not we're not born with tabular rasa. It's not just a blank slate. We already have an
40:22 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. 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. Uh so that now we're attending to things that match with our
41:07 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. 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
41:54 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. through my addictive behaviors, I can create this world within a world where my focus narrows. I 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
42:39 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 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
43:26 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 again because we have so many levers for control we've made ourselves masters of the universe we 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 but if I choose this career that I'm maybe that I maybe I should be going to this career. It's
44:12 this idea if I am the only arbiter of my destiny, then like what if I mess it up? It's all on me. So, there's terror and anxiety. And that'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 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
44:59 generation ago would have been a disappointment, but not a life-threatening one, right? A a a grant not received, a social rejection, an 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 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 tail spin. And that all leads to ultimately what is what is the answer to that? What is the antidote? It's the spiritual pivot. It is radical surrender. It's acknowledging the limits
45:45 of what we can control. Giving that will over however we define it and merging with our lives unfolding rather than trying to engineer some future perfection. >> Incredible. I've never thought about this uh 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 their uh bags. I've never been a powder taker uh except creatine. Um I I confess. I confess it's bettered my life. You do you, but it's bettered my life. And this need to quantify. M >> and I was just thinking about that for a moment in light of what you just said
46:31 because that behavior could be viewed as you're you're establishing some certainties about the future. 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 the fear of >> you know basically not being able to control one's future state >> right? you know, for many years, uh, before it became essentially legal or decriminalized. I had friends that, uh, were pretty chronic, uh, cannabis users, >> and they didn't re 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 take put in my shoe. This is before edibles became really common, right? You know, so like they were basically telling me
47:17 that they they could do fine without it, but they just don't do without it. Yes. >> And and I found them >> they could do fine without it until they actually had to go without it. >> 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. >> Right. >> 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've said about addiction that 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
48:03 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, waking up to run in the middle of the night just because you're you're healthy. >> Are you addicted? I mean, are you addicted to control? I mean, where do you draw the line? It can become a very jagged line, too. >> Yes. Uh, 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. Um what I am talking about is the mismatch and you know similar argument with dopamine nation. The mismatch in dopamine nation
48:48 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 I'm talking about a control paradox where we evolved to reduce uncertainty in a chaotic world. That was essentially our teologic mandate, right? or our reason for existence. 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
49:33 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 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, um sports betting, right? I mean 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
50:19 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. 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.
51:04 >> So as long as we have a way to control a situation, we're going to inhibit for example the per perry aqueductal gray which is sort of like the hub of this spirituality network. And 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 it reignites sort of this like people even atheists you know will we'll pray in a moment of absolute
51:49 terror. It 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. >> You mentioned periqueductal gray. Uh you and I are familiar with that. Uh we should probably inform the listeners and viewers about PAG PhD. we first uh met uh because we were team teaching neuro anatomy, right? And in neuro anatomy, 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 but that's a very superficial understanding. you'll you'll tell us what is known about PAGE in the context of what you're talking about and
52:34 are there any components of the circuitry that make it makes sense that Pag would be involved in the experience of of spirituality or letting go of control. >> 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 neuroimed 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 light lights up. So, it's very essential in the face of like imminent death in sort of coordinating
53:20 like what am I doing now? And then there's a very fascinating experiment or or series of experiments that have come out looking at lesions in humans and lesions that either increase or decrease spirituality whether you know parts of the brain remove removed dur 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 uh this sort of network that
54:07 essentially is going to function to allow us to come up with an entirely new approach because what we've been doing hasn't been working. So the PAG is rich in uh muopioid 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 PGA is essential for increasing neuroplasticity or learning in the face of rapid change. And again getting back to addiction,
54:54 what 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 def 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 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 going to be different this time. It's really in large part of function because our prediction machines or our mental models become calcified or rigidly in sconc. We're we're too attached to them. And so we do need to on some level have this
55:40 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 a new. 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 the leaves are greener, the sky is bluer. this is probably really happening like perception is enhanced. I'm no longer trying to impose my rigid mental models on the world. Instead, I'm letting go of
56:25 those pre 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. >> It's a um ceasing to uh rely on the algorithms, the strategies that we've been using, >> right? >> And it becomes this openness to the reality that that wasn't working.
57:10 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. >> I'm going to number one acknowledge the limits of my control. So, I'm going to rightsize 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, you know, it t it's a lot, you know, in our disease, right? It's it's a constant management. And I'm just going to 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 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
57:55 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. Um, and when that happens, it it starts a whole physiologic process which is restorative. >> So, I realize 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. >> 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
58:40 for you. Um, that kind of pivot. I think >> 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. Cuz 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 going to I'm going to give it over to God." >> Yeah. >> And then suddenly, and I've seen this over and over again,
59:25 >> right? >> 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 is actually going to drive better and it's not a Tesla. >> 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 um retreat uh re-evaluate and potentially find a new way around because what you've been doing isn't working. >> And in fact repeated frustration or our
1:00:11 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 5HT2A serotonin 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. This is not working. And it's 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 there's maybe a spiritual thing
1:00:56 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 activation of serotonin which is the down reggulation 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 an again a felt experience an affective experience of analesia.
1:01:41 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 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 then 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 going to try to follow that, right? Instead of me trying to juggle 14 balls in the air, I'm I'm going to let them all drop and I'm just going to show up here and I'm going to do the next
1:02:27 right thing and I'm going to take it one day at a time. So you also narrow the sort of scope of what you're trying to manage. >> The serotonin piece is really interesting. I know you have mixed skeptical you'll update us feelings about the use of psychedelic medicine for um 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 it's main mechanism for engaging plasticity is to you know activate the serotonurgic pathway and these particular receptors seems not coincidental. Um maybe maybe unmasking connections maybe allowing new contingencies to be formed. But I'm also reminded there's a really cool paper uh it doesn't get talked about very much
1:03:12 but a guy by the name of Lombberto Mafay did some really cool studies reopening critical 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, uh, the the SSRI are effectively getting to a similarish place of increasing serotonin and thereby plasticity. So much of what we're beginning to understand about the spirituality and spiritual surrender is through the research with psychedelics and psilocybin. I mean, so that that research is amazing. You know, people's
1:03:57 subjective experience. 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 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 risks associated with it and that the sort of um you know the promise just doesn't get too far ahead of the the evidence because of course in my clinic what I see is people misusing and addicted to psychedelics in many
1:04:43 different forms >> including psilocybin. >> Yeah, absolutely. because the the word out there is that you know it has a very very high uh you know lethal dose uh that you know it's far safer than alcohol um you know 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 an asskicking 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
1:05:28 possible thing for them to do. >> 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 uh 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. >> Sorry, ED, >> sorry, emergency department harms. Yeah. So, so the that you know that early narrative about it being much less harmful than other drugs, I I don't
1:06:13 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, pers persistent hallucinosis, severe mood. So again, you know, every drug is going to have risk, benefits, and alternatives. And I'm not sitting here saying we shouldn't study it or that there's no benefit because clearly I've met and talked to many people who have had um 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. >> I'd like to take a quick break and acknowledge our sponsor, Function. Function provides over 160 advanced lab
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1:08:29 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 um control the sleep score, dare I say. Right. >> I don't know. I know a few people for whom their you know their um 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 at between optimization a healthy life and over optimization is just 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 to just get another good night's sleep. But with that said, it seems that the
1:09:15 Pag gets activated when we run out of options, nothing's working, >> right? >> Then serotonin related mechanisms and other neurom modulators help our brains come up with new >> new plans that might work. >> Yeah. >> 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 it's going to come from out there, >> right? >> Not not from the PAG, but from out there. But you're saying in a in the strictly neurobiological model, the PAG is actually like offering up new opportun new strategies to try like, hey, maybe try this strategy instead. Well, I mean, I I think, you know, in
1:10:01 talking about the PGA and serotonin and psychedelics and what's happening in the brain, all we're really saying is that there's a there's a neurobiological machinery that gets activated in this moment of spiritual surrender and in surrendered practices, right? So, like in in prayer focused on surrender, again, the prefrontal cortex goes quiet. uh 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 you know involved in providing wisdom and guidance. I think the subjective experience is very much that we are opening ourselves up to guidance
1:10:48 from a higher power and people will talk about getting that wisdom and getting that guidance um and even you know hearing the voice of you know 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 mean I have a lot of respect and honor for however people are conceiving of of their higher power. What I think is really salient for me, having grown up in a secular household, having practiced psychiatry, being in, you know, the
1:11:34 bastion of science and rational materialism, is that this sort of inwardlooking 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 surrender, our son being diagnosed with and dying from leukemia. Like the I did many hours of psychotherapy. I read every paper there was on, you know, Q23 transllocation,
1:12:22 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 say, 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 overmanage 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 was different maybe from someone 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
1:13:07 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 of spiritual surrender, it felt profoundly spiritual but also physiologic like my brain got reset. I mean it was really very powerful and mysterious. >> Is the book the first time you've talked about that publicly? >> Yeah. >> Yeah. This I have >> I may have occasionally mentioned it but I' I've never written about it. Yeah. I find it um at once amazing that many of my colleagues, our colleagues in uh science and medicine don't even want to go close to the conversation about
1:13:53 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. I think I think thanks to the generosity of donors, it's like really true. It's a beautiful place. um where hard things and great things happen. >> Yes, >> they have a chaplain. >> They have uh people from every religious denomination that can come talk to people like these people are paid a salary for a reason, right? So we so like at once we acknowledge there's a memorial church on campus, there's a meditation center, wind hover, uh you know, like so it to me it's like there's this like collision of values that no one really uh wants to acknowledge. So it's like it's just kind of there. Yeah, >> it's supposed to be anti-science or
1:14:39 anti-modern medicine to acknowledge these things, but you got these uh people hired specifically to to help people and you got a place for people to go pray and listen to music and you know and to meditate. So So what do you think of that? I'm 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 be believe in magic like a like like Santa Claus. That's that's how some people feel about it. They think it's nonsense, >> right? Yeah. Yeah. Yeah, I mean I you know in preparation for for writing this book, I can't tell you how many Stanford faculty I spoke to who have these secret
1:15:25 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 it's a shame. I think it's really a shame because you know also in in in in working with patients I have so many patients who never get asked about their spiritual lives and yet again their spiritual faith their practices are at the core of their ability to handle their mental illness whatever their mental illness may be. the core of their ability to you know overcome even while they're also engaging in modern western medicine and doing psychotherapy like it's it doesn't have to be to the
1:16:12 exclusion of um 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? It 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 don't get me wrong but just wanting to emphasize like the spirit of science is a spirit of open curiosity.
1:16:58 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. I mean, that that's basically us, you know, on the planet. Like there's so much mystery out there and it, 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 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
1:17:45 devoid in psychotherapy and in mental health. the idea that values matter and that we can enrich our lives by you know living a valuebased life. 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.
1:18:31 How do we endure and continue on when we can't change the reality of our existence? And spirituality is is absolutely huge there. >> Yeah. I get um let's just say frustrated when spirituality gets cast by uh very accomplished people as low IQ. >> Yeah. >> 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? >> Yes. And then you look at people's lives and you get a a closer look. And I I don't take any pleasure in people's, you
1:19:16 know, unfortunate circumstances or discomfort and and you start to realize like often times 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 Sulk Institute who was member of the National Academy of Sciences incredible scientist and he because of a back surgery developed a a really bad oxy addiction. Um 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? And they're like, "Yeah, uh, it was like literally like these are people who can talk about anything. They're hyper articulate, right? If I had said like, oh, like tell me what's going on with
1:20:01 like plexin receptors in the developing hippoc campus." They're like, they can tell you. >> Yeah. >> 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." >> Yeah. >> And it's as if the circuits that we understand thanks to your work and others like Malanka and others, it's like we we don't actually think they apply to us, >> right? in some way that it's almost like if we were to go there, it makes us more mortal. >> Yeah. >> So, I feel like there's also in in this thing about spirituality, in this um 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 going to die. >> Yes. >> Which I actually believe is at the root of all addictions. Like, like it's a it's scary as hell. Like, we're going to die. We don't know what happens after. It's got to be terrifying. So we started
1:20:46 doing all this stuff in between now and then to try and control >> which is kind of the essence of this whole thing. >> 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 what we're surrendering to is we're not running away from that
1:21:32 anymore. We're turning and we're saying, "Yeah, that's true. 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 respit from the suffering so again it's just this fascinating you know surrender paradox >> let's talk about crisis when everything's falling apart >> yes >> we want to fix it >> yes >> we want to know how long it's going to last, when it'll be fixed. >> Uh you're suggesting a potentially different uh set of solutions. >> Well, I mean, the modern crisis is really a crisis of the will because we've gotten so used to control so much
1:22:18 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 12step 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 I can't control. 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
1:23:04 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 going to hold the world in the palm of my hand and shape shape it into whatever I want it to be. And with that spiritual pivot, that acceptance, that surrender, we access, you know, our own innate ability to transcend suffering. We rightsize our place in the universe. Um, I mean, this
1:23:49 and these are, you know, all of the major religions as and philosophies. It's 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 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 arrive 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
1:24:34 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 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 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 it again this
1:25:20 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 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 be 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
1:26:05 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 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 I can stop sort of
1:26:51 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 I have no control over that. I don't know what you're going to think about this conversation after you go home or what any of your listeners are going to think. So I I I I don't I'm not trying right I 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 this spiritual pivot is like all I can do is just show up for my life unfolding and that's all other people
1:27:36 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'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. And I I to me that's just has been core to my ability to try to be a
1:28:21 good parent, but also enjoy parenting. >> The letting go process is is um nothing short of magic uh in life. Uh I'm a big, you know, I've been open about this. I'm I'm a big proponent of prayer and not just because David Denno's lab at Nor Eastern shows that all these health benefits. I mean, there's that, too. But, um, 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 going to be people who are going to bristle and be like, "Oh my god." Like, really? We were talking about this before we uh 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 uh there. So, I'm coming into it clean. I realize some
1:29:07 people it's very loaded, 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, right? 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 a different for them. So, I 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've 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
1:29:52 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. 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 PM 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, in women, around in parenttokid relationships, in pretty much in every direction, right? You've got someone maybe she's the super overachiever and
1:30:37 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, may we just drill into codependency a little bit because I think it's so common. >> Yes. >> And it's really its own form of addiction. >> Yes, absolutely. 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. >> 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 Alanon which is a 12step group for the loved
1:31:23 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 inshed 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 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 um addicted person, you know, I would posit because we're all on some level now addicted to control. Um it is a
1:32:11 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. 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 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
1:32:56 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. 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 disregulated. And the technology has made all of this much worse. So all of this technology that we have to like
1:33:41 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. 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 co constant codependent loop. And it's just such a it's a terrible place to land. >> I know so many people that are
1:34:27 codependent with addicts. >> Yes. And you know, we all have to ask ourselves like, you know, like uh like I have the Furbo thing to monitor my dog, >> right? And it's actually worse. We were on vacation this summer in Europe and 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 warm enough? Is he cold?" It's better if we just don't know. That's right. You just don't want to know at some level, but of course, you want him to be comfortable. So there it's it's different than addiction at some level because it isn't this obvious like harm to sell for others. It's more it's more subtle. >> I disagree. It's more cryptic. Excuse me. Yeah. It's more cryptic hidden. >> And of course we're the martyrs, you know, we're sacrificing oursel for the other. But I I think it's >> I think it's just as addictive, just as
1:35:12 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 Alanon meetings or codependency anonymous and and like take care of themselves and just say case saras with my loved one who's add 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 sides of the same rope, you're not going to 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 like
1:35:58 clockwork. Like absolute clockwork. >> Based on our uh mutual colleague uh Carl Des's words at one point, uh by the way, congratulations Carl for winning a Nobel Prize. So deserved. So deserved. It was only a matter of when, not if. Yes. >> Once I heard him give a 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 uh non-verbbally expressing, but like really try and stay out of other
1:36:44 people's heads. >> Yeah. >> Especially when there's nothing to do about it. >> That's right. >> But so much of online behavior is about trying like people trying to get into each other's heads. True. >> To be able to control outcomes that are really about them. >> 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 readad. 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 at. Disaster. Absolute disaster. Because you just, you never know. And unless you ask people and you
1:37:30 really attend to and listen and they're willing to share, you just can't know. >> I have a friend, he's got three decades plus in sobriety and uh 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 get me to second guess my thinking about. He's like I don't speak in riddles. And I love it. I love it because it's it's like there's this tendency in all of us codependent or not 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. >> Oh yeah. I mean a lot of the conflict in my own marriage I generally speaking
1:38:15 have a very good marriage. I'm very grateful for a husband who's much ser than I am at baseline. Uh, 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. And 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 video. It's like, >> 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
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1:39:45 doing, especially on hot days when I'm sweating a lot and losing water and electrolytes. Element has a bunch of great tasting flavors. In fact, I love them all. I love the watermelon, the raspberry, the citrus, and I really love the lemonade flavor. So, if you'd like to try Element, you can go to drinkelement.com/huberman to claim a free element sample pack with any purchase. 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 are more often the classic addicts. Is that true? >> Well, I can say that in all honesty clinically when I see families that dynamic is relatively true. So mothers
1:40:33 tend to be more caught up in this codependent enshment and enabling and fathers tend to withdraw and be detached. That's a pretty common dynamic with addiction. >> Detach from the addict. >> Detached from the whole kitten kaboodleoodle the all detach from all the crazy. >> Just like up there spinning over here and I'm on my computer. >> So in that sense not a whole lot's changed. Well, I I don't have numbers, but just in terms of yeah, clinically what I see that there are gender patterns and and I do think that, >> you know, by virtue of how women are wired a little bit differently than men that we will have a tendency to get more caught up in these codependent
1:41:19 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 Winnott 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 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 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
1:42:04 different. >> Yeah. What's that saying from uh recovery? It's like when the uh when the addict gets sober, uh the sick get angry. >> Yes. >> 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. Yeah, >> 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. >> Absolutely. Well, I mean it this is this is such a common pattern um where when the identified sick person in the family gets well, like the identified addict gets into recovery, all of a sudden the other person's like substance use disorder kind of blossomed. So, in a way, this person being addicted sort of
1:42:49 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 then it destabilizes everything because it's like, well, if all of our problems were related to you're being sick and you're not sick anymore, what what you know, how do we manage that? And so that's really interesting to see. >> What are some of the steps people can take to get out of codependent thinking or action? You know, 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 for you know for those for whom it's appropriate kind of that spiritual pivot you know is can be very helpful
1:43:34 looking for guidance and sucker and strength and wisdom from a power outside of yourself however you may define that and reeregulating around that rather than regulating your emotions around how this person is doing on any given day or in any given moment because that's what ends up happen. Oh today he didn't drink I'm feeling better. Oh he drank I feel terrible. you know, it's it's all in meshed. So, and then of course 12 steps for um people with codependency is is really really helpful. There are wonderful 12step meetings, you know, in in our community. I I've been to, you know, some of them, especially for parents of kids with se I mean, it's just devastating to have a child who's addicted and really severely addicted
1:44:19 might die, you know. I mean, how do you how do you self-regulate around that? Very hard. But uh codependency anonymous alanon very very helpful for those types of things. >> Yeah. So about youth and addiction being 51 I can remember a time before social media uh 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 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? I mean, I don't think anybody's formally studied that, but I think we could certainly hypothesize
1:45:04 that living in the digital age when we're constantly in seeking validation, um, 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 I 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. 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. I don't know if you get into
1:45:49 this in the book, but uh recently because of some guests we've had on the podcast, Michael Pollen, Paul Stammits, and others that it used to be that young people u boys and girls would go through some um kind of uh rights of passage >> and often times those rights of passage were about in a 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 like scroll Tik Tok or like I want to go eat now. It's like, no, they're you 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. >> Yeah. >> And once they do that, it hopefully it becomes a state that's familiar enough that they they realize that they can
1:46:34 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 right of passage back into American society? I mean, what would that even look like? >> Yeah, I mean, I think we can get back to some of that. I think we absolutely need to. And I do think it be 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
1:47:19 be good at. I do think there's optimism and hope here. A lot of Jenzers are with intention coming together in spaces where they're not on their 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 I was really struck recently uh 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 their for their
1:48:05 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 they never settle because there's always this thing I'm I'm there's 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 it's again that openness, that curiosity, show up for the unfolding of experience. I think that's really where we need to go. >> Yeah. These days I play with the idea of doing things with no intention of it being
1:48:50 >> put out into the world. >> Yes. >> Ever. >> Yeah. >> Deliberately. >> Yes. >> Like no vaulted. Just because it then you can just be in the puress of the experience. >> 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. >> 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. >> It's not on straa. >> It's not exactly. It's you just do it like you do it for you and then you just get really into the the joy of it. It's complicated. I also understand the desire to share an accomplishment. I mean I think that's innately human. >> 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. >> Yeah, I'm a hypocrite cuz um if I don't
1:49:36 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, >> their emotion, >> right, >> their feeling. I think it takes the the the rawness of the emotion away. I think it it just literally goes out there. >> It doesn't incubate. you're not processing it. You don't have time to really sort the meaning of it. >> 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. Um, and happily so. Um, so what are some other concepts of of surrender? We talked about codependency. We talked about you talked about praying even if
1:50:22 you don't necessarily believe that you're praying to something specific. >> Right. Right. >> I think uh I heard and I don't know if this is true. We have to fact check this. Internet, do your do your thing. Um 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 >> and could live the way that she did, then like I think we're we're all on stable ground praying anyway, >> right? Yeah. >> I don't know if it's true, but I I like the story. >> 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,
1:51:07 that we don't have a verb for fathing. 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 and comfort. You know, that is at the core of prayer really. It's it's an affective experience uh that doesn't require um belief. It just requires taking the posture, you know, the humble posture and asking for help. 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
1:51:53 for that or for ourselves, but what about because it's common in uh for people with a religious um bend to say, "I'll pray for you." 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 um 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
1:52:39 know anything about that. That's not something I've really looked at. >> In researching the book and spending time on on the book, was there anything that you encountered where you like, whoa, that's wild? >> 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 proverating 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 uh moment when we will let go of these
1:53:24 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 you know Buddhist practices which for some people is religion for other people it's more of a psychology of 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 kind of reflexive. We just do it. And certainly
1:54:10 that that was true for me when our son Lucas died. I began having these thoughts that he died of leukemia because I named him Lucas. So of course completely irrational thought. I didn't really believe that there was a causal relationship. And yet at the same time my mind um had produced this kind of narrative which again is not comforting um you know and and and and was a source of distress to me. But this was before this 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
1:54:57 didn't think about a 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. >> 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 we're looking for symbols. There's and then there's this uh I don't like the word. Um but there's this what is it? Uh periodia, 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
1:55:42 the shape of this thing. It's like or a tree that looks and like people we project these ideas onto objects. It's insanity. It's like, well, okay. >> 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 loss um 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 not just talking about sort of people who regularly engage in kind of woo woo thinking. These are like flatout scientists, atheists. They will endorse having these experiences. I think it's
1:56:28 healthy, you know, unless it sort of teeters into frank delusions and mental illness. 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. >> Yeah. There's a thread running through a lot of conversations I've had on this podcast recently and I just like your thoughts on this. So we had Max Crumblon who's one of the developers of amunotherapy. He's at UCSF. He's an immunologist. Uh we've had Michael
1:57:13 Pollen. He's talking about consciousness. We talking the mushroom guy Paul Stammits. And you know with each of the Robert Green 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 you call the ego but just like our body us right Anna Andrew like and we can become a wei if we say oh like we're both at Stanford or we're both podcasting like the the the flexibility of the Wii is very very powerful but the 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 um birth of a
1:57:58 child or things that we we feel this expansion, >> right, >> of like me becomes we in some way that isn't like a typical affiliation, >> right? 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 um Ross Edgely 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 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 and so in thinking about like getting outside of ourselves It's really I do think it's a way of like bypassing the ego >> and getting to this notion of like
1:58:44 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 >> right >> you're just no longer alone >> and you're relegating your own thinking as you've pointed out to >> some additional information from out there. >> Yes. >> And it's beautiful and it's clearly useful. >> Oh yes. >> But we hate to do it. Mhm. >> at the like we hate to do it until we taste the magic, right? >> Like why do you think people are so darn resistant to it to the point where it often like can their well-being? 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,
1:59:30 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. Um, 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, you know, the ego as the source of our suffering is the foundational belief in in Buddhism, right? This idea that the self is a delusion. Uh, and yet it's a delusion that we're very caught up in. uh and when we can let go of that
2:00:15 delusion, we we e we ease our suffering. I think for people who believe in God or who think about this higher power outside of themselves, it it's the same idea but manifested as I am a vessel through which God's plan happens um 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. You know, some 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
2:01:01 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. >> Well, we've all, at least for those of us on social media, we've all been cast in a reality TV show. Yeah. >> 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. people with their time and their own TV show that is social media. >> Yes. And and the reverse, it's kind of
2:01:47 wild. >> Yeah. Yeah. >> The reason the immunologist Max Crumbl was the one who first sparked this 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, 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 is really good at at taking concepts and 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? Um, what are some things that you do in
2:02:32 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 you've covered in your books? >> Yeah. So, I mean, I 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
2:03:17 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 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 is really a very potent drug. So I really try to limit my use of video. Reading online auditory processing is is much less vulnerable a 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
2:04:03 or I feel in doubt or regularly I will it's a it's a outward pivot and an opening. 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. >> 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 um challenges, addictions, and and serious issues come about with ketamine? Because I I think it's starting to fall into this kind of diffuse and misunderstood category
2:04:48 >> uh for a lot of people. >> So ketamine is FDA approved for the treatment of treatment 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 Guerell, called the Montreal model. The Montreal model is a way of using ketamine inhouse. So in the clinical setting, not to take home, in combination with psychotherapy,
2:05:33 specifically to treat depression, but also depression in combination with alcohol use disorder. And um Nicholas Gerell is seeing really exciting results from from this. And let's face it, people with treatment 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 but I think that that's a potential future use as well. >> But do you have people coming into your clinic who are using ketamine recreationally and having issues with it? Cuz you hear about this or maybe hear about it less nowadays. I don't know. >> We absolutely do. So um we we see people get very addicted to ketamine, get it from the black market, use you know very
2:06:20 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 diiathesis 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 it's a complicated issue. Certainly anytime a doctor is prescribing any addictive substance for any illness at all, we must keep in mind that that individual just because they have an illness that might indicate that
2:07:06 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. Um, 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 bonafide conditions and you can still get addicted to the medication that you're being prescribed to treat that condition. >> Do you see a lot of stimulant addiction nowadays because of the well at the extreme end things like Adderall, Viveance, etc. But at the like kind of more over-the-counter uh level like all the consumption of oral nicotine and
2:07:52 energy drinks is it like kind of it seems it's like they're kind of a mainstay of life now. >> Well, we've seen especially since co is an explosion of people getting addicted to stimulants that they got online through a teleaalth prescriber. So it's not that tellaalth is innately bad but tellaalth can be done very badly and so you get a kind of a pill mill situation going via tellahalth uh where there's very limited ability to kind of steward stimulants and make sure that the person number one is 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. >> The GLPs, >> right? >> Um, the only peptide we're going to talk about on this uh podcast because we won't need to talk about all the others.
2:08:37 We've done other podcasts about all the other peptides. The GLPS uh, 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 ahidonia, lack of pleasure generally, >> right? What have you observed clinically? >> 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 GLP1 they get into recovery when nothing else worked. 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
2:09:23 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 new mechanism is going to get people who haven't responded to other other interventions. And it it's also interesting because from a you know neuroscience or mechanistic perspective it may be working centrally right on the reward pathway by decreasing the amount of dopamine that's released in the nucleus encumbent in response to the drug of choice which is very much how people describe it working like when they're taking GLP1s 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 uh not that interested. or they might have euphoric recall for how good it's going to taste and they
2:10:09 taste it and it's like not not really that reinforcing which, you know, 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. And now if you have a drug that dampens that initial release, it's just it's exciting. >> Can we be addicted to thoughts? >> Most definitely. Um, you know, one of the core um features of sex addiction is fantasy. As one of my patients put it, the bar is in my brain. Uh, 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. Yeah. And it it was only that when that
2:10:54 became their sort of bottom line uh 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 because we know that these cues that precede the drug also release dopamine and are reinforcing. With the example of sex addiction, the fantasizing makes sense because of the positive anticipation. Uh what about negative thoughts? Um like can people get addicted to anger, resent, us versus them stuff like they're we're all being oppressed. In some cases, people obviously are being oppressed, but uh I'm just curious. You
2:11:41 see a lot of behavior and language online that suggests that maybe people are addicted to the feeling of like just that negative arousal as opposed to positive arousal. Do we What do we know about that? >> 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 aholics, you know, people who get addicted to becoming enraged and like get an adrenalized good feeling from that and then we'll manufacture situations. We talked about codependency that can happen in diads where you have a ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra aaholic with a a codependent and they're doing this kind of continual dance that's mutually reinforcing. I have written about feeling like I got addicted to my own worry, my own ruminations. Now the
2:12:27 overlap between sort of addiction and obsessivecompulsive disorder is pretty tight here, but I feel like the addiction lens does capture 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 uh >> yeah you know letting go of or abstaining intentionally abstaining from uh these kinds of obsessive ruminations. >> It's the uh meanest possible question to ask for somebody that is uh just about to you know hit the the trail for a new book. But uh do you think you'll write another book? And if so, what in the back of your mind it might be the thing
2:13:13 and don't feel any need to share? >> 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 I it was justestating and I kind of had a feeling eventually I would want to try to capture uh this phenomenon and these ideas. But right now I got nothing. It's blank up there. So um we'll see. I I I'm you know trying to practice what I preach and live a surrendered life and just see what what life offers me, what life calls calls me to do. Anna, thank you so much for coming here to talk
2:13:58 about radical surrender, revisit the addiction uh 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. And I love the topic of the new book. I think it's fantastic. I can't wait to read it. Um, as I loved and, uh, continue to, you know, um, >> talk uncontrollably about 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 and share knowledge that's useful to people. And you've been doing this a long while with with a lot of fearlessness or if the fear is there, you're doing it anyway. >> The fear's there. >> All right. Great. Well, you're doing it anyway. And we're all grateful for it. >> Thank you. You, too.
2:14:43 >> Thank you. I really appreciate you as a as a colleague and a and a a colleague both at Stanford and as a public educator. You've really enriched the world. Thank you. >> Thank you. Likewise, >> thank you for joining me for today's discussion with Dr. Anna Lumpkkey. 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 andor enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zerocost 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 fivestar 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
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