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How Habits Are Formed: A Neuroscientist Explains the Science of Addiction · RECOVERable: Mental Health and Addiction Experts Answer Your Questions

• 0:13
  SPEAKER_00: Dopamine's not designed to be pleasant.
• 0:15
  SPEAKER_00: Dopamine's there to drive us into action.
• 0:18
  SPEAKER_01: World-renowned psychiatrist, neuroscientist, and best-selling author Dr.
• 0:21
  SPEAKER_01: Judson Brewer shares his groundbreaking research on what works to break cycles of addiction and anxiety.
• 0:29
  SPEAKER_00: From a neuroscience perspective, when we look at how habits are formed and how we break bad habits, it has nothing to do with willpower.
• 0:40
  SPEAKER_01: Welcome to Recoverable.
• 0:41
  SPEAKER_01: I'm your host, Terry McGuire.
• 0:42
  SPEAKER_01: Joining us today is Dr.
• 0:44
  SPEAKER_01: Judson Brewer, and we will be talking about the neuroscience of addiction.
• 0:48
  SPEAKER_01: We're going to do something a little different this time and start with some myth or fact lightning round.
• 0:53
  SPEAKER_01: You up for it, Dr.
• 0:54
  SPEAKER_01: Brewer?
• 0:55
  SPEAKER_01: Absolutely.
• 0:56
  SPEAKER_01: Excellent.
• 0:56
  SPEAKER_01: You want to ask me to call you Dr.
• 0:58
  SPEAKER_01: Judd.
• 0:58
  SPEAKER_01: Yes.
• 0:58
  SPEAKER_01: So I'll go with that.
• 1:00
  SPEAKER_01: All right.
• 1:00
  SPEAKER_01: Myth or fact.
• 1:02
  SPEAKER_01: Addiction is just a lack of willpower.
• 1:06
  SPEAKER_00: Myth all the way.
• 1:08
  SPEAKER_00: Tell me why, briefly.
• 1:10
  SPEAKER_00: Willpower is more myth than muscle.
• 1:12
  SPEAKER_00: And if you look at it from a neuroscience perspective, that's not how we form habits and that's not how we break habits.
• 1:17
  SPEAKER_01: Dopamine is the chemical that makes you feel high.
• 1:20
  SPEAKER_01: Myth or fact.
• 1:21
  SPEAKER_00: Depends on how you define high.
• 1:23
  SPEAKER_00: So if you talk about that restless, itchy, urgy quality of do something, that's what dopamine's all about.
• 1:29
  SPEAKER_00: It's a motivation molecule.
• 1:31
  SPEAKER_01: And if we're thinking about a different kind of high?
• 1:33
  SPEAKER_00: If we're talking about pleasantness, dopamine's not designed to be pleasant.
• 1:38
  SPEAKER_00: Dopamine's there to drive us into action.
• 1:40
  SPEAKER_00: So dopamine not pleasant, not designed that way.
• 1:45
  SPEAKER_01: Okay.
• 1:46
  SPEAKER_01: Myth or fact.
• 1:47
  SPEAKER_01: Relapse means treatment failed.
• 1:50
  SPEAKER_00: Myth.
• 1:52
  SPEAKER_00: Relapse can mean a lot of things to a lot of different people.
• 1:55
  SPEAKER_00: So here, relapse just means somebody relapsed to using a substance or doing a behavior that they were trying not to do.
• 2:03
  SPEAKER_01: How about myth or fact?
• 2:05
  SPEAKER_01: Relapse means you failed.
• 2:08
  SPEAKER_00: No, absolutely not.
• 2:09
  SPEAKER_00: That's another myth that I think keeps people down.
• 2:12
  SPEAKER_00: You know, this isn't about people failing.
• 2:14
  SPEAKER_00: This is about this is about people not knowing how their brain works.
• 2:18
  SPEAKER_00: Can't wait to learn.
• 2:19
  SPEAKER_00: Myth or fact.
• 2:20
  SPEAKER_00: The teenage brain is more susceptible to addiction.
• 2:23
  SPEAKER_00: I would say probably fact.
• 2:26
  SPEAKER_00: You know, there's a lot of research showing that the teenage brain is particularly neuroplastic, meaning that it's at a very uh rapid growth stage.
• 2:34
  SPEAKER_00: And so there are a lot of places where things can get locked in in the teenage brain that make it harder to learn or unlearn as an adult.
• 2:40
  SPEAKER_01: We'll be talking about that more.
• 2:42
  SPEAKER_01: Myth or fact.
• 2:43
  SPEAKER_01: Medication-assisted treatment or MAT is just swapping one drug for another.
• 2:47
  SPEAKER_00: Oh, myth.
• 2:48
  SPEAKER_00: Absolutely.
• 2:49
  SPEAKER_00: Certainly in my own personal experience, prescribing medication and seeing people use MAT absolutely can be very helpful for a lot of people.
• 2:57
  SPEAKER_01: Myth or fact.
• 2:58
  SPEAKER_01: You have to hit rock bottom before you get help.
• 3:01
  SPEAKER_00: Myth.
• 3:01
  SPEAKER_00: So a lot of people do hit rock bottom and then go for help.
• 3:05
  SPEAKER_00: And that's really unfortunate.
• 3:07
  SPEAKER_00: But when people start to see the negative consequences of whatever it is that they're struggling with, that's an opportunity for them to start to lean into leaning out of that behavior, let's say.
• 3:18
  SPEAKER_00: And so they don't have to hit rock bottom before they can start moving away from it.
• 3:22
  SPEAKER_01: So myth or fact.
• 3:23
  SPEAKER_01: Prescription pills are safer than street drugs because a doctor made them.
• 3:28
  SPEAKER_00: Well, that's a myth in one sense because people's brains don't know the difference between whether their opioid receptor, for example, is occupied or not.
• 3:38
  SPEAKER_00: But the fact is that it's really hard to know what you're actually getting on the street.
• 3:42
  SPEAKER_00: And so in one sense, somebody could say this is a medication that's made by a pharmaceutical company or something, and you don't know that that's actually true.
• 3:50
  SPEAKER_01: And you can also get addicted by something you're prescribed, right?
• 3:53
  SPEAKER_00: Oh, absolutely.
• 3:54
  SPEAKER_00: So the medications can be just as addictive and are just as addictive as any street drug, uh, depending on what receptor they're hitting and how they're hitting it.
• 4:02
  SPEAKER_01: Myth or fact.
• 4:03
  SPEAKER_01: The brain can never fully recover from long-term drug use.
• 4:07
  SPEAKER_00: Myth.
• 4:08
  SPEAKER_00: Brain can absolutely recover.
• 4:10
  SPEAKER_01: At any point?
• 4:12
  SPEAKER_00: Well, when at any point is an interesting yes, I think I would say it can it can take some time for the brain to recover.
• 4:20
  SPEAKER_00: And it often can feel like somebody is not fully recovered for their entire life, so to speak.
• 4:25
  SPEAKER_00: But from a brain perspective, I think you can find a place where the brain, you know, it's indistinguishable one brain from another where somebody's had an addiction in the past versus somebody that hasn't.
• 4:36
  SPEAKER_01: Myth or fact.
• 4:37
  SPEAKER_01: Addiction is 100% genetic.
• 4:40
  SPEAKER_00: Myth.
• 4:41
  SPEAKER_00: Yeah, there's a certainly there are some genetic components that can contribute to addiction, but there's a whole lot of learned elements in that, you know, that's on top of the genetics.
• 4:52
  SPEAKER_01: We'll wrap up our lightning row with one last question.
• 4:55
  SPEAKER_01: Sugar addiction is exactly the same as cocaine addiction.
• 4:59
  SPEAKER_00: There's a lot of stuff on the internet about that.
• 5:02
  SPEAKER_00: I would say sugar certainly hits fires off the same type of dopamine cascade that can happen in the brain as cocaine, which is why you know there have been studies in rats and other non-human animals showing that you can get the same reward pathway firing with cocaine and sugar.
• 5:21
  SPEAKER_00: So in that sense, they're the same.
• 5:23
  SPEAKER_00: But in another sense, you know, cocaine specifically is blocking a dopamine transporter, whereas sugar is firing, uh hitting the dopamine pathway slightly differently.
• 5:33
  SPEAKER_00: So they hit the same pathways, but they're not exactly the same.
• 5:36
  SPEAKER_01: And they'll have really different impacts.
• 5:38
  SPEAKER_00: They certainly can.
• 5:39
  unknown: Yeah.
• 5:40
  SPEAKER_01: So I want to make sure that our viewers are not intimidated by the fact we're using words like neuroscience of addiction, because I know that we have chosen you specifically because you're very good at breaking things down.
• 5:52
  SPEAKER_01: And I need to say I have a BA, not a BS.
• 5:54
  SPEAKER_01: So I will be asking questions until I understand it in the hopes that viewers and listeners will also understand.
• 6:00
  SPEAKER_00: Great.
• 6:00
  SPEAKER_00: And I'll try not to give you too many BS answers.
• 6:04
  SPEAKER_01: Thank you.
• 6:04
  SPEAKER_01: I appreciate that.
• 6:06
  SPEAKER_01: So I wanted to start before we get into the internet questions, talking about some of your research because when I was researching you, I found this habit loop and I was like, oh, that would be so helpful to know.
• 6:18
  SPEAKER_01: So tell me what the habit loop is and how understanding it could help us.
• 6:23
  SPEAKER_00: And habit loop is really something that we all have.
• 6:26
  SPEAKER_00: It's evolutionarily conserved, meaning that we share the same type of learning all the way back to the sea slug, which is a big sea slug.
• 6:35
  SPEAKER_00: You know, you imagine a slug that's in the ocean and it only has 20,000 neurons.
• 6:40
  SPEAKER_00: And those neuron pathways, those, you know, those brain cell pathways have been been mapped, showing that sea slugs learn in a similar way to humans.
• 6:50
  SPEAKER_00: And how that works is in through a process called positive and negative reinforcement.
• 6:55
  SPEAKER_00: And so let's take our ancient ancestors as an example.
• 6:59
  SPEAKER_00: When they had to forage for food, you know, they didn't have refrigerators, so they had to go foraging on the savannah in the in the woods.
• 7:06
  SPEAKER_00: When they found food, their um their brains would light up and say, Oh, wait a minute.
• 7:11
  SPEAKER_00: You know, here's the food.
• 7:12
  SPEAKER_00: They would eat the food, and that would actually send this dopamine signal to their brain that says, remember what you ate and where you found it.
• 7:19
  SPEAKER_00: So a habit loop is made up of three elements: a trigger, a behavior, and a result.
• 7:24
  SPEAKER_00: So the trigger would be seeing the food, the behavior would be eating the food, and then the result would be this dopamine surge that says, Oh, that was good.
• 7:31
  SPEAKER_00: Remember where that is.
• 7:32
  SPEAKER_00: So that's positive reinforcement.
• 7:34
  SPEAKER_00: Negative reinforcement is very similar.
• 7:37
  SPEAKER_00: Instead of kind of finding something pleasant and learning to do that again, we find something that's unpleasant and learn to avoid it in the future.
• 7:45
  SPEAKER_00: So our ancient ancestors, if they're out foraging for food and they get chased by a bear or wolf or a saber-toothed tiger, right?
• 7:52
  SPEAKER_00: The behavior, the trigger is they see the saber-toothed tiger, the behavior is they run away.
• 7:57
  SPEAKER_00: And the results or the reward from a neuroscience perspective is that they don't become lunch.
• 8:02
  SPEAKER_00: Yes.
• 8:03
  SPEAKER_00: And so that rewarding property feeds back and says, hey, here's a new habit loop.
• 8:08
  SPEAKER_00: Avoid that place in the savannah.
• 8:09
  SPEAKER_00: You know, trigger, see the lion behavior run away.
• 8:13
  SPEAKER_00: And the result is you live to uh to avoid that part of the savannah in the future.
• 8:18
  SPEAKER_01: One of the things I read that you said is our brains do not distinguish between good and bad habits.
• 8:23
  SPEAKER_00: They simply learn what leads to a reward.
• 8:26
  SPEAKER_00: Yes.
• 8:26
  SPEAKER_00: To our brains, it's all about survival.
• 8:28
  SPEAKER_00: So a habit is something that helps our brains survive in everyday life.
• 8:35
  SPEAKER_00: So, for example, most of the habits that we form are actually extremely helpful.
• 8:40
  SPEAKER_00: We don't even pay attention to them.
• 8:41
  SPEAKER_00: So imagine all of the habits that we all have every day that we act out as soon as we wake up.
• 8:47
  SPEAKER_00: So we swing our legs over the bed and stand up and start walking.
• 8:51
  SPEAKER_00: Well, that's something that we've learned to do.
• 8:53
  SPEAKER_00: We learned to walk at a very young age.
• 8:55
  SPEAKER_00: We put on our clothes.
• 8:56
  SPEAKER_00: That's something we learn to do.
• 8:58
  SPEAKER_00: We uh maybe we talk to somebody, we we learn to do that.
• 9:02
  SPEAKER_00: We make coffee, we put food in our mouth, we learn to do that.
• 9:05
  SPEAKER_00: Remember, you know, when we're all babies, the food kind of landed in the direction of our mouth, and then eventually we learn to get it in our mouth.
• 9:12
  SPEAKER_00: All of those are extremely helpful habits.
• 9:15
  SPEAKER_00: So our brains learn those as survival mechanisms.
• 9:18
  SPEAKER_00: Okay, this is good, do it again.
• 9:20
  SPEAKER_00: So it's not necessarily good and bad from a survival standpoint, but some of these habits can, you know, seem helpful at the time, but then either become not so helpful or get tapped into in terms of this, you know, this addiction mechanism where it's it's a little too good to be true because it is.
• 9:42
  SPEAKER_00: And those are the habits that are formed that aren't actually helpful for us, but we're compelled to do despite um trying not to do them.
• 9:49
  SPEAKER_01: So habit would be the big umbrella word, and an addiction would be under it.
• 9:54
  SPEAKER_01: It's one of the habits we can have because we're also talking about you've used anxiety.
• 9:58
  SPEAKER_01: We talked a lot about that that worrying can be habitual.
• 10:02
  SPEAKER_00: Yes.
• 10:02
  SPEAKER_00: So I think of these along a spectrum.
• 10:04
  SPEAKER_00: So there are extremely helpful habits like walking, tying our shoes, all those things.
• 10:09
  SPEAKER_00: And then along the spectrum are the ones that we might do that aren't so great, but they're not terrible.
• 10:14
  SPEAKER_00: And then at the far end of the spectrum is addiction.
• 10:17
  SPEAKER_00: So the definition of addiction I learned in residency was continued use despite adverse consequences.
• 10:24
  SPEAKER_00: Right.
• 10:24
  SPEAKER_00: And so there's a habit that we might be fully aware of, but we really feel compelled to do and don't feel like we can stop.
• 10:30
  SPEAKER_00: Contrary to that, most other habits are things that we do automatically.
• 10:34
  SPEAKER_00: That's kind of the definition of a habit, is an automatic behavior.
• 10:39
  SPEAKER_01: So is the habitual nature of an addiction the reason willpower doesn't work to stop it?
• 10:48
  SPEAKER_00: I'd like to say simply yes, but it's it's a little more complex than that.
• 10:54
  SPEAKER_00: And in the sense that we learn habits because they're rewarding, right?
• 10:58
  SPEAKER_00: You that dopamine surge that says do this thing again.
• 11:01
  SPEAKER_00: Willpower, I'll just put this bluntly, willpower is more a myth than muscle.
• 11:06
  SPEAKER_00: And what I mean by that is willpower is probably a story that we tell ourselves that we either have or we don't have or we had and we don't have later, or something like that.
• 11:18
  SPEAKER_00: But from a neuroscience perspective, when we look at how habits are formed and how they how we break bad habits, it has nothing to do with willpower.
• 11:26
  SPEAKER_00: I'll just say my clinic, my outpatient clinic would look a lot different if willpower was actually a thing.
• 11:32
  SPEAKER_00: You know, patient would come in, I want to quit smoking.
• 11:35
  SPEAKER_00: Okay, stop it.
• 11:36
  SPEAKER_01: Yeah.
• 11:37
  SPEAKER_00: You know, one visit and they're cured.
• 11:40
  SPEAKER_00: You know, that's not that's not how it works.
• 11:42
  SPEAKER_01: So let's dive into your three gears of habit change so we can talk about how habits can be changed, and then we'll again get to the internet questions.
• 11:50
  SPEAKER_01: I just found this all so interesting.
• 11:52
  SPEAKER_01: You said that there are three and that they have to happen in order.
• 11:55
  SPEAKER_01: The first being awareness.
• 11:57
  SPEAKER_00: Yes.
• 11:57
  SPEAKER_00: So the first step, or that we call these gears in our mind shift recovery program.
• 12:02
  SPEAKER_00: The idea is that you've got to become aware of the behavior.
• 12:05
  SPEAKER_00: And so from a full perspective, you can map out what the trigger is, what the behavior is, and what the result is.
• 12:12
  SPEAKER_00: But really to simplify it, it's zooming in on what the behavior is.
• 12:16
  SPEAKER_00: The reason for that is there could be a thousand things that trigger the behavior.
• 12:20
  SPEAKER_00: And more importantly, the triggers don't actually reinforce the behavior, meaning that they just set the wheel in motion, but they don't keep it going and they don't make it stronger or weaker.
• 12:32
  SPEAKER_00: So I've had plenty of patients who have come to me and said, you know, I've spent decades in therapy trying to figure out why I'm anxious or why I have this addiction.
• 12:41
  SPEAKER_00: And they're a little startled when I say, you know what, the why may not matter as much as you think.
• 12:46
  SPEAKER_00: And the reason it doesn't matter is that, well, I shouldn't say it doesn't matter.
• 12:51
  SPEAKER_00: So certainly somebody's history and their lived experience is very important.
• 12:54
  SPEAKER_00: But when we talk about changing a habit, that why isn't what drives it and keeps it going.
• 13:01
  SPEAKER_00: It just sets the loop in motion.
• 13:03
  SPEAKER_00: So that first step is really recognizing what the behavior is.
• 13:07
  SPEAKER_00: You know, am I picking up my phone?
• 13:09
  SPEAKER_00: Am I picking up a cigarette?
• 13:10
  SPEAKER_00: Am I picking up a bottle?
• 13:12
  SPEAKER_00: You know, am I picking up a joint?
• 13:14
  SPEAKER_00: Whatever it is.
• 13:15
  SPEAKER_00: That's the behavior that we can zoom in on the first as part of the first step.
• 13:19
  SPEAKER_00: And that's important because otherwise we might do it automatically.
• 13:22
  SPEAKER_00: I've had a lot of patients who say, you know, they just kind of wake up with a half-smoked cigarette in their fingers and they don't remember lighting it or smoking the first half of it.
• 13:32
  SPEAKER_00: That's autopilot.
• 13:34
  SPEAKER_01: The why is the beginning.
• 13:36
  SPEAKER_01: The why there was a reason at some point that, as you say, gets the ball rolling.
• 13:40
  SPEAKER_00: Yes.
• 13:40
  SPEAKER_01: Then at a certain point, it's just automatic.
• 13:42
  SPEAKER_00: Yes.
• 13:43
  SPEAKER_00: Let's use smoking as an example.
• 13:45
  SPEAKER_00: Most of my patients and the folks in our clinical studies started smoking around the age of 12 or 13.
• 13:52
  SPEAKER_00: So that happens typically not because somebody says, hey, you know, smoking's good for you.
• 13:56
  SPEAKER_00: And they had cigarettes taste great.
• 13:59
  SPEAKER_00: You know, and two great things go great together.
• 14:01
  SPEAKER_00: No, it's typically we see cool kids at school.
• 14:04
  SPEAKER_00: We want to fit in, we want to rebel, whatever it is.
• 14:07
  SPEAKER_00: And that's actually more rewarding than all of these negative signals we're getting from a cigarette because nicotine's pretty toxic.
• 14:15
  SPEAKER_00: The first time somebody smokes, they feel nauseated because that's the nicotine telling them, hey, you're putting toxin in your body.
• 14:21
  SPEAKER_00: Are you sure you want to do this?
• 14:23
  SPEAKER_00: Yeah.
• 14:23
  SPEAKER_01: And I remember coughing and all of it.
• 14:25
  SPEAKER_01: All of it.
• 14:26
  SPEAKER_00: Yes.
• 14:26
  SPEAKER_00: Not great, but it's something that we overcome because there's something that's more rewarding.
• 14:32
  SPEAKER_00: And that why, whenever it got set up, however it got set up, in the moment where it's habitual, it doesn't matter that much because we're just repeating the habitual behavior at this point.
• 14:44
  SPEAKER_01: And in your example of smoking in high school or whatever age you are, wherever schooling you are at 12 or 13, you're not trying to be a cool kid anymore, you know, when you're 50 and still smoking.
• 14:54
  SPEAKER_01: No, it's pretty anti-cool.
• 14:56
  SPEAKER_01: Yeah.
• 14:57
  SPEAKER_01: It's yeah, it's that that why is long gone.
• 14:59
  SPEAKER_01: Yeah.
• 15:00
  SPEAKER_01: So you say that awareness, though, is just the first step and not enough.
• 15:04
  SPEAKER_01: So I can know I shouldn't, you know, shouldn't drink so much.
• 15:07
  SPEAKER_01: I shouldn't.
• 15:08
  SPEAKER_01: A million things, a million bad habits, but that won't stop me from doing it.
• 15:12
  SPEAKER_00: No, and I it might shame me.
• 15:14
  SPEAKER_00: Yeah.
• 15:15
  SPEAKER_00: Right.
• 15:15
  SPEAKER_00: It might.
• 15:15
  SPEAKER_00: And it might get us into some shaming habits where we beat ourselves up.
• 15:20
  SPEAKER_00: You know, I you've probably heard the joke, we should all over ourselves, right?
• 15:24
  SPEAKER_00: You know, if we could only, I should have done this, I shouldn't have done that.
• 15:27
  SPEAKER_00: Well, all of that just pulls energy away from actually changing a habit.
• 15:30
  SPEAKER_00: So once we're aware of whatever the behavior is and we can become aware of it, you know, many times a day.
• 15:36
  SPEAKER_00: So if we smoke a pack of cigarettes a day, which could be as many as 20 times a day.
• 15:40
  SPEAKER_00: The next step is really dialing into our brain and asking a simple question, which is, what am I getting from this?
• 15:49
  SPEAKER_00: And this is related.
• 15:50
  SPEAKER_00: So some people may be familiar with motivational interviewing.
• 15:54
  SPEAKER_00: When I learned this in residency, the basic it boils down to the question, you know, patient comes in and wants to quit smoking.
• 16:00
  SPEAKER_00: I say, Well, why don't you smoke more?
• 16:02
  SPEAKER_00: And they look at me like, my doc just asked me why I don't smoke.
• 16:05
  SPEAKER_00: Well, the idea is to really see all of the results of the behavior.
• 16:11
  SPEAKER_00: So if somebody, you know, I asked somebody why don't they smoke more, they might answer, Well, I get this cough in the morning.
• 16:17
  SPEAKER_00: I can't taste food very well.
• 16:18
  SPEAKER_00: I have, you know, bad breath.
• 16:20
  SPEAKER_00: I know, you know, it's not good for me.
• 16:22
  SPEAKER_00: I could get cancer, emphysema, it makes my skin, all these things that are negative, but those are all up in their head, right?
• 16:28
  SPEAKER_00: But they can start to surface those in their embodied experience, right?
• 16:32
  SPEAKER_00: So it's like, oh, why don't I smoke more?
• 16:34
  SPEAKER_00: Well, it's expensive, and all these things come up.
• 16:36
  SPEAKER_00: And they can start to feel into those direct results of smoking, which they largely ignore when they're smoking automatically.
• 16:43
  SPEAKER_00: So this taps into a part of the brain, not that it's important, but I'll just mention it.
• 16:48
  SPEAKER_00: It's called the orbitofrontal cortex.
• 16:50
  SPEAKER_00: It's kind of in the front part of our brain.
• 16:52
  SPEAKER_00: And that actually determines and stores how rewarding a behavior is.
• 16:57
  SPEAKER_00: And it's important for our everyday survival because it helps us make decisions very quickly.
• 17:02
  SPEAKER_00: So we don't have to try everything every day.
• 17:04
  SPEAKER_03: You know, imagine touch the stove.
• 17:06
  SPEAKER_00: Right, right.
• 17:06
  SPEAKER_00: Oh, I learned that that's not such a good idea.
• 17:08
  SPEAKER_00: Yeah.
• 17:08
  SPEAKER_00: Or do I like this food more than this food?
• 17:10
  SPEAKER_00: Right.
• 17:10
  SPEAKER_00: And so we set up these reward hierarchies.
• 17:13
  SPEAKER_00: And I think of this with habit formation as set and forget.
• 17:16
  SPEAKER_00: So we set the reward value something of something, and then we forget about the details.
• 17:22
  SPEAKER_00: The reward value for smoking gets set up at the age of 12 or 13 when somebody starts smoking at that age.
• 17:28
  SPEAKER_00: And then they're just smoking habitually.
• 17:30
  SPEAKER_00: And in fact, when they become addicted to the nicotine, they're smoking to avoid the withdrawal symptoms, you know, where every two hours, as that nicotine, as those nicotine levels get low in the bloodstream, their body's saying, Hey, I need more nicotine, get it in here.
• 17:44
  SPEAKER_00: And that unpleasant feeling that triggers the behavior to smoke and that reinforces the lube.
• 17:49
  SPEAKER_00: So here we can start with the second step is be is really asking, what am I getting from this?
• 17:57
  SPEAKER_00: And so it's not thinking about how bad cigarettes are for us or whatever the substance or the behavior is.
• 18:04
  SPEAKER_00: It's really feeling into the direct experience in the moment.
• 18:07
  SPEAKER_00: Like so, with my patients, I have them go ahead and smoke.
• 18:11
  SPEAKER_00: And they look at me like I'm crazy, like my doc told me to smoke.
• 18:14
  SPEAKER_00: Well, I say, go ahead and pay attention as you smoke.
• 18:16
  SPEAKER_00: Because you can't stop right now anyway.
• 18:18
  SPEAKER_00: So I'm not telling you something that you're not already going to do, but you can pay attention when you smoke.
• 18:23
  SPEAKER_00: And I still remember somebody said, you know, as she was really paying attention as she was smoking, she smells like stinky cheese and tastes like chemicals.
• 18:32
  SPEAKER_00: Yuck.
• 18:33
  SPEAKER_00: And so where's the reward in that?
• 18:36
  SPEAKER_00: Right.
• 18:36
  SPEAKER_00: And what she was highlighting for herself in her own direct experience was what she was actually getting in the moment from smoking cigarettes.
• 18:45
  SPEAKER_00: And the short of that was she wasn't getting much.
• 18:48
  SPEAKER_00: In fact, it wasn't pleasant at all.
• 18:51
  SPEAKER_00: And for a lot of people, that becomes the basis for a big shift where they can start to really feel into this and see what they're actually feeling and getting in that direct, in that moment.
• 19:03
  SPEAKER_00: So with smoking in particular, I have patients pay attention as they puff, as they take that drag.
• 19:09
  SPEAKER_00: What does it feel like going into their mouth?
• 19:11
  SPEAKER_00: What's it feel like going into their lungs?
• 19:12
  SPEAKER_00: What's it smell like coming out as they breathe out or breathe out of their mouth or their nose?
• 19:17
  SPEAKER_00: There's a lot of negative stuff that comes from that, just from that one puff that they can start to dial into and see how unrewarding it is.
• 19:25
  SPEAKER_00: This is where people develop disenchantment.
• 19:28
  SPEAKER_00: And I think of this as a Santa Claus moment, right?
• 19:31
  SPEAKER_00: So imagine young listeners tune out.
• 19:34
  SPEAKER_00: Right.
• 19:34
  SPEAKER_00: Right.
• 19:35
  SPEAKER_00: So for all of us that believed in Santa Claus at a young age and then went to the mall and pulled on Santa Claus's beard and realized it was just some old dude paid to for our parents to figure out what we wanted for Christmas.
• 19:46
  SPEAKER_00: For those of us that had the privilege of, you know, getting presents, you know, we start to see, oh, this isn't real.
• 19:52
  SPEAKER_00: And so the myth that that you know, the the smoke-filled haze of the, you know, the the draw of a cigarette is not there anymore.
• 20:02
  SPEAKER_00: And you can't unsee that once you've seen that.
• 20:04
  SPEAKER_00: You can't untaste or unfeel or unsmell that once you've had that experience.
• 20:09
  SPEAKER_00: So this is how people develop disenchantment.
• 20:12
  SPEAKER_00: And it really goes right back to this orbitofrontal cortex in the brain, where it's it's updating that reward value.
• 20:18
  SPEAKER_00: And the only thing that's needed for updating is awareness.
• 20:23
  SPEAKER_01: And you're saying feel, use the verb feel through that hole.
• 20:27
  SPEAKER_01: It it's not cognitive.
• 20:29
  SPEAKER_01: It's like you're you're trying to get us into our or research shows that when we're in our bodies and we smell it and we taste it and we see how it makes us feel.
• 20:38
  SPEAKER_01: That's the just distinction.
• 20:40
  SPEAKER_00: Yes.
• 20:40
  SPEAKER_00: I'm glad you bring that up because that's a critical distinction.
• 20:44
  SPEAKER_00: If our cognitive abilities were really strong, we could just think our way out of all these things.
• 20:48
  SPEAKER_00: This is where willpower would work.
• 20:50
  SPEAKER_00: Yeah.
• 20:50
  SPEAKER_00: And so this highlights how much of a myth it is.
• 20:53
  SPEAKER_00: You know, if I could just tell myself to stop smoking or doing whatever, I would just stop doing it.
• 20:58
  SPEAKER_00: So really, reward value is driven in and through an embodied experience.
• 21:03
  SPEAKER_00: What does it feel like?
• 21:04
  SPEAKER_00: What's it taste like?
• 21:05
  SPEAKER_00: What's it smell like?
• 21:06
  SPEAKER_00: That's our, you know, I think of it as a bottom-up approach where our body is telling us everything that we need to know, which is wow, this isn't as great as I thought.
• 21:17
  SPEAKER_01: So that awareness and then feeling it actually leads to a change.
• 21:21
  SPEAKER_01: If I if I suddenly am smoking and I remember looking at the filter and being like, oh wow, it's not catching at all, and this is getting in me.
• 21:29
  SPEAKER_01: That probably didn't make me stop.
• 21:31
  SPEAKER_01: I know what did, but it's it's that will actually lead to a change.
• 21:36
  SPEAKER_00: Would you are you more excited to smoke now than you were before?
• 21:40
  SPEAKER_01: Oh, absolutely not.
• 21:41
  SPEAKER_00: Yeah.
• 21:42
  SPEAKER_00: But so we'll we'll get to some of the pieces, okay, whether your experience or others.
• 21:47
  SPEAKER_00: But the piece here is when people really get the direct experience of the lack of reward from the behavior, that's where they they develop the disenchantment.
• 21:58
  SPEAKER_00: And it's much easier to stop doing the thing because they're not as excited to do it.
• 22:02
  SPEAKER_00: It's not as rewarding.
• 22:04
  SPEAKER_00: Now, I should add one piece here.
• 22:06
  SPEAKER_00: We're talking about cigarettes where they tend not to intoxicate people, right?
• 22:10
  SPEAKER_00: They can be a stimulant, uh huh, but they don't cloud people.
• 22:13
  SPEAKER_00: People's awareness.
• 22:14
  SPEAKER_00: So with intoxicants, when somebody is literally intoxicated, so maybe they uh they drank too much alcohol and they can't see straight, so to speak, or they're high on some other substance, it's hard to pay attention.
• 22:29
  SPEAKER_00: And it's hard to see what the results are.
• 22:31
  SPEAKER_00: So in this case, what I have my patients do is pay attention afterwards, right?
• 22:36
  SPEAKER_00: Where they see all the results of that behavior.
• 22:39
  SPEAKER_00: And they can also compare this, and we'll talk about this with step three, but they compare what it's like to having done the thing versus simply not having done the thing.
• 22:49
  SPEAKER_01: So use the example, please, of drinking.
• 22:52
  SPEAKER_01: And say you, you know, have a substance use disorder with alcohol and you had a real bad night.
• 22:58
  SPEAKER_01: And the next day, next days, I don't know when you say look back on it and see what would that be like.
• 23:04
  SPEAKER_00: Well, as soon as they sober up is the best time to do it.
• 23:07
  SPEAKER_00: So as close to the behavior as possible helps us really limit any interference when it comes to feedback.
• 23:15
  SPEAKER_00: So, you know, we let's say that we drink and we black out or something, and then we wake up the next morning and we start to piece together all the stuff that didn't go so well the night before.
• 23:26
  SPEAKER_00: Those are the direct results of drinking.
• 23:28
  SPEAKER_00: And we can see very clearly, okay, I crashed my car, I ruined this relationship.
• 23:33
  SPEAKER_00: Oh, wow, I can't believe I did that.
• 23:35
  SPEAKER_00: There are a lot of things that can happen when we black out, for example, but we don't even need to do that.
• 23:40
  SPEAKER_00: It could just be that somebody did something very embarrassing when they were intoxicated.
• 23:44
  SPEAKER_00: It could be that they got in a fight, or it could be, you know, all these negative things.
• 23:48
  SPEAKER_01: Called an X.
• 23:49
  SPEAKER_01: That's a big one.
• 23:50
  SPEAKER_01: Yes.
• 23:50
  SPEAKER_00: Called an X.
• 23:51
  SPEAKER_00: And, you know, oh, I can't believe what did I say?
• 23:53
  SPEAKER_00: You know, and they're now they're furious or whatever.
• 23:55
  SPEAKER_00: And so all these things can help point to us what the actual results are of doing the behavior.
• 24:02
  SPEAKER_00: And so we can compare those to what it was actually like to be intoxicated.
• 24:06
  SPEAKER_00: Now, the irony is when somebody's intoxicated, they're only aware for a little while until they're not very aware anymore.
• 24:13
  SPEAKER_00: So somebody can say, Yeah, that was great.
• 24:15
  SPEAKER_00: Well, what was so great about it when you can't even remember what that was?
• 24:19
  SPEAKER_00: You know, so certainly I'm, you know, I don't want to cover over the effects that a lot of people say, well, you know, I have a drink and I feel much more relaxed.
• 24:27
  SPEAKER_00: I feel less anxious, I feel these things.
• 24:29
  SPEAKER_00: And I've certainly had plenty of patients like that.
• 24:31
  SPEAKER_00: This is not to say that's not true, because for a lot of people, it is true, right?
• 24:36
  SPEAKER_00: But what they find is, you know, it's it's not as true as they hoped it to be.
• 24:40
  SPEAKER_00: So for example, I've had a lot of patients report that like half a drink gets them the pleasant aspect.
• 24:47
  SPEAKER_00: And anything beyond that's not so good.
• 24:50
  SPEAKER_00: Where they're like, they have that next half and then they feel compelled to drink the next one, and then the next one, and then the next one, and then it's, you know, game over from there.
• 24:58
  SPEAKER_00: Whereas that half drink that got them calm, they can start to ask, well, is there some other way that I can actually feel calm as compared to this that doesn't have all of these negative consequences that come with it?
• 25:10
  SPEAKER_00: So that's where we can start to add up, and not in an intellectual way, but an embodied way.
• 25:15
  SPEAKER_00: Like, well, how good is this really versus how bad is this really?
• 25:19
  SPEAKER_00: And when all the bad stuff adds up to much more than the good stuff, that's where people become disenchanted.
• 25:26
  SPEAKER_01: So when and addiction, I I do not study it, but I have interviewed a number of people and and they seem quite aware.
• 25:33
  SPEAKER_01: You know, it's I've lost, I've lost everything.
• 25:35
  SPEAKER_01: You know, you hear that.
• 25:36
  SPEAKER_01: I lost my job, I crashed my car, I lost my family, lost my kids.
• 25:40
  SPEAKER_01: And yet they continue to drink.
• 25:42
  SPEAKER_01: So why would that be?
• 25:43
  SPEAKER_01: Is it not doing that assessment, not being capable of doing it?
• 25:48
  SPEAKER_00: It's a good question.
• 25:49
  SPEAKER_00: So here, and I don't want to generalize too much, but here I think there's a differentiation between all these negative things and then knowing how to work with the craving.
• 26:00
  SPEAKER_03: Okay.
• 26:01
  SPEAKER_00: So we can have all these negative things happen, and then we have this really strong craving and we don't know how to deal with it.
• 26:07
  SPEAKER_00: So we just succumb to it.
• 26:09
  SPEAKER_00: That's with full acknowledgement.
• 26:10
  SPEAKER_00: Like, yes, last time all this bad stuff happened, or the last 20 times or last 200 times, right?
• 26:17
  SPEAKER_00: They're like, and this feels so bad right now, I need to do something about it.
• 26:22
  SPEAKER_00: So our brains are actually really focused on the present moment experience.
• 26:27
  SPEAKER_00: And when our present moment experience is this is really bad, make it go away.
• 26:31
  SPEAKER_00: And the only thing that they know to make it go away is to drink or smoke or whatever, then they're gonna go to that thing.
• 26:37
  SPEAKER_00: So when we start to see what all the negative results are, then we can start to find something that's better.
• 26:44
  SPEAKER_00: And this is where the third step comes in.
• 26:46
  SPEAKER_00: I call it finding the bigger, better offer.
• 26:49
  SPEAKER_00: For some people, finding the bigger, better offer might be simply not doing the thing.
• 26:54
  SPEAKER_00: You know, I've had plenty of patients who, when they've had a bad night of drinking, they've been, I'm thinking of one who embarrassed herself in front of her teenage kids yet again, and she would, and she had anxiety.
• 27:06
  SPEAKER_00: And so she'd wake up feeling anxious and feeling even more anxious after the hangover, and then see all the negative results from the night before and feel even worse.
• 27:13
  SPEAKER_00: Right.
• 27:14
  SPEAKER_00: So here, when she could start stringing together uh nights of sobriety, she could compare the two, where it's like, oh, she woke up with a clear head.
• 27:23
  SPEAKER_00: Her kids were, you know, would look her in the eyes, you know, as compared to being embarrassed.
• 27:28
  SPEAKER_00: Uh, she wasn't as anxious.
• 27:29
  SPEAKER_00: She didn't have a hangover, all these beneficial qualities of that.
• 27:32
  SPEAKER_00: And part of what helps her do that was learning how to be with the cravings themselves.
• 27:38
  SPEAKER_00: So cravings feel pretty unpleasant.
• 27:41
  SPEAKER_00: And if somebody doesn't have the, you know, hasn't learned the tools to work with the cravings, it's going to be really hard for them to just white knuckle it and try to, you know, try to not do the thing.
• 27:52
  SPEAKER_00: This is why so many people relapse.
• 27:55
  SPEAKER_00: They're like, swear whatever the thing is off and then they get to the situation and they're like, well, this is so bad and I don't know what to do with it.
• 28:03
  SPEAKER_00: And I can't deal with this, this unpleasant feeling.
• 28:06
  SPEAKER_00: So they just go back to the thing.
• 28:07
  SPEAKER_01: Is this where treatment comes in?
• 28:09
  SPEAKER_00: Treatment can come in and support them that way.
• 28:12
  SPEAKER_00: And I've certainly seen a lot of patients base benefit from treatment there.
• 28:16
  SPEAKER_00: So, you know, going, getting some type of treatment can be really helpful.
• 28:20
  SPEAKER_00: And as part of this, really learning distress tolerance skills, I think is critical.
• 28:25
  SPEAKER_00: You know, I, for example, I had a patient, I was working at the VA hospital and in my outpatient clinic, I had a patient whose craving was so strong.
• 28:34
  SPEAKER_00: He said he was trying to quit smoking, comes into my office and he goes, Doc, I feel like my head's going to explode if I don't smoke.
• 28:40
  SPEAKER_00: Right.
• 28:40
  SPEAKER_00: So that's how strong these cravings can be.
• 28:43
  SPEAKER_00: So I taught him a very simple practice to actually be with those cravings.
• 28:48
  SPEAKER_00: And the way we worked with it, I just kind of did it in real time in the moment.
• 28:51
  SPEAKER_00: I wasn't like, oh, let's pull out a book and learn how to work with this.
• 28:55
  SPEAKER_00: So I just went up to my whiteboard and I started mapping out with him in real time what his experience was.
• 29:01
  SPEAKER_00: So I said, describe what it's what's that head exploding feel like.
• 29:04
  SPEAKER_00: So he was describing tightness, tension, burning, heat, restlessness, all these things.
• 29:09
  SPEAKER_00: And at the same time, I was asking him to describe how intense they were.
• 29:13
  SPEAKER_00: It's getting more and more and more and more and more intense.
• 29:15
  SPEAKER_00: And then eventually that craving peaked and started to go down.
• 29:19
  SPEAKER_00: And he had this big aha look in his eyes.
• 29:22
  SPEAKER_00: And I said, What just happened?
• 29:23
  SPEAKER_00: He said, I was smoke before, because the extrapolation is dot, dot, dot, my head's going to explode.
• 29:31
  SPEAKER_00: Yeah.
• 29:31
  SPEAKER_00: So he'd always smoke a cigarette because he didn't want his head to explode.
• 29:35
  SPEAKER_00: Who wants an exploded head?
• 29:36
  SPEAKER_00: Yeah, I don't think anybody wants that.
• 29:38
  SPEAKER_00: So here he realized that just by learning to be with his experience, that craving would come and go on its own.
• 29:47
  SPEAKER_00: So we trained him to be with those feelings of craving and those bodily sensations at the end that they come and go.
• 29:56
  SPEAKER_00: And he learned that the only thing he needed to do was to be with his experience.
• 30:01
  SPEAKER_00: And that might seem pretty scary to a lot of people.
• 30:04
  SPEAKER_00: I've had patients come in and say, you know, Doc, I feel like this slave, this craving's lasted forever.
• 30:08
  SPEAKER_00: And I say, well, so has it been there your whole life?
• 30:11
  SPEAKER_00: And they're like, well, not really.
• 30:13
  SPEAKER_00: So I'll even have people go home and set a timer the next time they have a craving, you know, and get really curious.
• 30:18
  SPEAKER_00: Like, what's this craving feel like in my experience?
• 30:21
  SPEAKER_00: Are you ready?
• 30:22
  SPEAKER_00: What what do you think the longest craving has been over the last decade of me having patients do this?
• 30:28
  SPEAKER_00: Just take a while to do that.
• 30:29
  SPEAKER_00: For what?
• 30:30
  SPEAKER_01: Are we talking smoking?
• 30:30
  SPEAKER_01: It doesn't even matter.
• 30:32
  SPEAKER_01: Ooh, an hour.
• 30:33
  SPEAKER_00: Much shorter.
• 30:34
  SPEAKER_00: 20 minutes.
• 30:35
  SPEAKER_00: Shorter.
• 30:36
  SPEAKER_00: 10 minutes.
• 30:37
  SPEAKER_00: 13 minutes.
• 30:38
  SPEAKER_00: Wow.
• 30:38
  SPEAKER_00: Yeah.
• 30:39
  SPEAKER_00: So it's not that long.
• 30:40
  SPEAKER_00: Now that 13 minutes might not feel very pleasant for 13 minutes, but it's extremely informative.
• 30:47
  SPEAKER_00: It helps people see, oh, 13 minutes, you know?
• 30:51
  SPEAKER_00: And distract myself.
• 30:52
  SPEAKER_00: Yeah.
• 30:53
  SPEAKER_00: Or I can learn to lean in.
• 30:55
  SPEAKER_00: Even more important.
• 30:57
  SPEAKER_01: I was off.
• 30:57
  SPEAKER_01: Yes.
• 30:58
  SPEAKER_01: Yes.
• 30:58
  SPEAKER_01: Yeah.
• 30:58
  SPEAKER_00: So we can certainly learn to distract ourselves, but distractions don't always work.
• 31:03
  SPEAKER_00: Yeah.
• 31:03
  SPEAKER_00: And I've seen that, I've seen distractions fail many, many more times than they've succeeded.
• 31:09
  SPEAKER_00: Okay.
• 31:10
  SPEAKER_01: So when it's something like anxiety and worry, and you and that that cycle starts, works the same for a mental health versus a substance?
• 31:20
  SPEAKER_00: For a number of mental health issues, yes.
• 31:23
  SPEAKER_00: So the most important thing that I never learned in medical school was that anxiety could work the same way.
• 31:30
  SPEAKER_00: And the way I learned this was actually through my own struggles.
• 31:33
  SPEAKER_00: So, well, several of them.
• 31:35
  SPEAKER_00: One is I had I've had plenty of anxiety through my life, and I've written about that in my books.
• 31:40
  SPEAKER_00: Uh, so I had pretty strong anxiety in college, uh, to the point where I got irritable bowel syndrome.
• 31:46
  SPEAKER_00: Like that was my body saying, Hey, wake up, you're pretty anxious.
• 31:48
  SPEAKER_00: And I was like, oh, me, anxious.
• 31:49
  SPEAKER_00: And it's like, wake up, yes, you.
• 31:51
  SPEAKER_00: Yeah.
• 31:52
  SPEAKER_00: The other piece was I started to get panic attacks in residency.
• 31:55
  SPEAKER_00: You know, a great, a great formula for panic attacks is like sleep deprivation, being put in charge, you know, being responsible for people in the hospital, all this stuff.
• 32:05
  SPEAKER_00: Like it's pretty stressful.
• 32:07
  SPEAKER_00: So yeah.
• 32:08
  SPEAKER_00: So I know a little bit personally about anxiety, but when I started working in my clinic, in my outpatient clinic, when I finished residency, even prescribing the best medications for anxiety, only about one in five people would show a significant reduction in symptoms.
• 32:25
  SPEAKER_00: There's a fancy term for this called the number needed to treat, which just means how many people you need to give a medication to or a treatment to before one person benefits.
• 32:34
  SPEAKER_00: And so that number needed to treat for the best medications is 5.2, meaning you have to treat more than five people before one person benefits.
• 32:43
  SPEAKER_00: So I basically play the medication lottery when prescribing a medication for anxiety.
• 32:48
  SPEAKER_00: I don't know which one person is going to be that lucky individual.
• 32:51
  SPEAKER_00: And I don't know what to do with the other four.
• 32:54
  SPEAKER_00: So this is where I started looking back and seeing, you know, starting asking this question, what can we do about this?
• 33:01
  SPEAKER_00: And fortunately, we'd been developing programs for uh for habits for a couple of years at that point.
• 33:08
  SPEAKER_00: So we had done a study with some of our mindfulness training programs, and we had found that we could get five times the quit rates of gold standard treatment for smoking cessation, right?
• 33:19
  SPEAKER_00: People quit five times more using mindfulness training than cognitive therapy.
• 33:24
  SPEAKER_00: And you can see how all of that lines up with those three steps that I talked about because it's really about being aware of the habit, seeing what you get from it, right?
• 33:33
  SPEAKER_00: Seeing how cigarettes smells, smell like stinky cheese and taste like cigarettes, right?
• 33:38
  SPEAKER_00: That type of thing.
• 33:39
  SPEAKER_00: But then also learning the skills to lean into the cravings themselves.
• 33:44
  SPEAKER_00: So we've gotten five tons of quit rates of gold standard treatment for smoking.
• 33:48
  SPEAKER_00: We'd done other programs for eating, helping people overcome whether it was binge eating or junk food or even overeating.
• 33:57
  SPEAKER_00: We've gotten a 40% reduction in craving-related eating.
• 34:00
  SPEAKER_00: And in that program, people were saying, hey, you know, anxiety is driving me to stress eat.
• 34:06
  SPEAKER_00: So if you take the habit loop there, the feeling of anxiety is not very good.
• 34:10
  SPEAKER_00: Somebody can distract themselves by eating some food.
• 34:13
  SPEAKER_00: If you eat some engineered type of food, it can be even more addictive where it says eat, you know, the potato chip slogan is what, bet you can't eat just one.
• 34:20
  SPEAKER_00: Yeah.
• 34:22
  SPEAKER_00: Yeah, exactly.
• 34:23
  SPEAKER_00: Exactly.
• 34:24
  SPEAKER_00: So you can see how people could get locked into a habit of stress eating, but it just drives more eating.
• 34:29
  SPEAKER_00: So when my patients were saying, hey, can you develop a program for anxiety?
• 34:33
  SPEAKER_00: At first I was thinking, I don't know what to do.
• 34:36
  SPEAKER_00: I just prescribe medications.
• 34:38
  SPEAKER_00: But as a habit change researcher, I went, it put a bug in my ear.
• 34:42
  SPEAKER_00: And so I went back and looked at the literature.
• 34:44
  SPEAKER_00: And lo and behold, there was a guy, Thomas Borkovic, a psychologist, who suggested back in the 1980s that anxiety could be driven through negative reinforcement.
• 34:54
  SPEAKER_00: That's that uh habit loop that we talked about earlier, where something unpleasant's there, we do something to make it go away, and then we feel a little bit better.
• 35:02
  SPEAKER_00: Now that got buried in the promise of Prozac.
• 35:05
  SPEAKER_00: You know, when everybody thought, oh, great, we're gonna have these SSRIs, these selective serotonin re-uptake inhibitor classes of medications.
• 35:12
  SPEAKER_00: So we're all cured.
• 35:14
  SPEAKER_00: Unfortunately, that didn't turn out to be the case.
• 35:17
  SPEAKER_00: And in some studies, the SSRIs are no better than placebo.
• 35:22
  SPEAKER_00: For you know, for the lucky few, uh, they can be very helpful, but for the majority of people, unfortunately, they're not the silver bullet.
• 35:30
  SPEAKER_00: So here, what I think of is like everybody can learn how to work with their brain.
• 35:35
  SPEAKER_00: So what Borkovec suggested was that the feeling of anxiety can drive the mental behavior of worrying.
• 35:43
  SPEAKER_00: So often we think of behaviors as things that you can see, right?
• 35:46
  SPEAKER_00: You stress eat, you smoke a cigarette, you drink a drink of alcohol.
• 35:50
  SPEAKER_00: But in fact, there's plenty of behavior going on in our in our minds all the time.
• 35:54
  SPEAKER_00: And one of those for people who are anxious is worrying.
• 35:57
  SPEAKER_00: That's actually one of the main behaviors that occupies a lot of their day.
• 36:01
  SPEAKER_00: This is where people with generalized anxiety disorder, they spend a lot of their energy, a lot of the day worrying.
• 36:07
  SPEAKER_00: And we think it's helping.
• 36:09
  SPEAKER_00: We do.
• 36:09
  SPEAKER_00: Yeah.
• 36:10
  SPEAKER_00: So why might that be the case?
• 36:11
  SPEAKER_00: Well, it can distract us from the feeling of anxiety.
• 36:14
  SPEAKER_00: So it feels a little bit better.
• 36:15
  SPEAKER_00: Okay.
• 36:16
  SPEAKER_00: So it's rewarding in that way.
• 36:17
  SPEAKER_00: It can also make us feel like we're in control.
• 36:20
  SPEAKER_00: It gives us this illusion of control.
• 36:22
  SPEAKER_00: And as my patients put it, it feels better than doing nothing.
• 36:26
  SPEAKER_00: Well, until you pay attention to what you're actually getting from it.
• 36:29
  SPEAKER_00: So, what are you actually getting from worrying?
• 36:31
  SPEAKER_00: Oh, it's feeding back and making them more anxious.
• 36:34
  SPEAKER_00: So that's a critical piece where patients can really and people can really lean into this and ask that second step question what am I getting from worrying?
• 36:43
  SPEAKER_00: You know, is it keeping my family member safe?
• 36:46
  SPEAKER_00: Is it solving that problem?
• 36:48
  SPEAKER_00: Is it, you know, it's not planning?
• 36:50
  SPEAKER_00: You know, what you can plan something a couple of times, but when you've planted it 17 times, you're just worrying.
• 36:57
  SPEAKER_01: This hour.
• 36:57
  SPEAKER_00: Yes.
• 36:59
  SPEAKER_01: We got to get to the internet questions, but this is fascinating to me.
• 37:02
  SPEAKER_01: So if I am anxious, which I can be, if I am thinking of picking up a cigarette and I don't smoke anymore, but I did.
• 37:09
  SPEAKER_01: If I wait 13 minutes or 15 minutes, if I actually set a timer and say, I'm just gonna sit here and maybe do some deep breathing, something that would be present, not distracting myself.
• 37:21
  SPEAKER_01: Might I wait it out?
• 37:23
  SPEAKER_01: Might it be different at the end of that?
• 37:24
  SPEAKER_01: Will it be?
• 37:25
  SPEAKER_01: I shouldn't say might, it's your research.
• 37:26
  SPEAKER_00: Well, what we found is that you know, cravings tend to go away within you know within 13 minutes.
• 37:32
  SPEAKER_00: And we can actually make this an active process so it's not white knuckling, like looking at the watch, waiting it out.
• 37:39
  SPEAKER_00: So here, I love this saying, you probably are familiar with it.
• 37:42
  SPEAKER_00: The only way out is through.
• 37:44
  SPEAKER_00: Yeah, I love that.
• 37:45
  SPEAKER_00: Yeah.
• 37:45
  SPEAKER_00: Yeah.
• 37:45
  SPEAKER_00: The only way out is through.
• 37:47
  SPEAKER_00: So often let's take worrying, for example, or a craving.
• 37:51
  SPEAKER_00: A craving comes up, anxiety comes up, and we have this habitual reaction of oh no, right?
• 37:56
  SPEAKER_00: So we try to fight the craving, we get stuck in worrying.
• 38:00
  SPEAKER_00: Not so good.
• 38:01
  SPEAKER_00: It just feeds the process.
• 38:02
  SPEAKER_00: So instead, what we can train people to do is get curious and in flip that oh no to oh, oh, is directed on the what, not the why.
• 38:14
  SPEAKER_00: Not why am I having this craving or why am I worrying or why am I anxious, but what does this actually feel like in my body?
• 38:22
  SPEAKER_00: So going back to the patient, head exploding patient that I talked about earlier, we can get really curious about what those embodied sensations are.
• 38:30
  SPEAKER_00: And as we get curious, we start to see that those sensations aren't as bad as we thought they might be, because we've been running away from them.
• 38:38
  SPEAKER_00: We don't know what they actually feel like.
• 38:40
  SPEAKER_00: So we turn and run toward them and we get really curious about them.
• 38:44
  SPEAKER_00: And here I love this quote from James Stevens, who is an Irish uh author and a poet, where he said, curiosity will conquer fear even more than bravery will.
• 38:54
  SPEAKER_00: Curiosity will conquer fear even more than bravery will.
• 38:58
  SPEAKER_00: And so the idea is we can be afraid of our embodied sensations or we can get curious about them.
• 39:05
  SPEAKER_00: And when we get curious, it empowers us.
• 39:08
  SPEAKER_00: It gives us the power back where we can see, oh, these are sensations.
• 39:13
  SPEAKER_00: Oh, I can be with these sensations.
• 39:16
  SPEAKER_00: And what that does is help us develop distress tolerance, right?
• 39:20
  SPEAKER_00: We can be with things that are distressing, and the being is the active process of doing, meaning we don't have to do anything but learn to be with our experience.
• 39:30
  SPEAKER_00: And how do we learn to do that?
• 39:32
  SPEAKER_00: Through curiosity.
• 39:33
  SPEAKER_00: So we train that curiosity muscle until it becomes the new habit.
• 39:38
  SPEAKER_01: Does it matter what you do in those 13 minutes?
• 39:41
  SPEAKER_01: I mean, in terms of not running from it, not distracting yourself.
• 39:45
  SPEAKER_00: Well, here the critical piece is to run toward it.
• 39:48
  SPEAKER_00: So we get what does that mean?
• 39:50
  SPEAKER_00: Oh, yeah.
• 39:50
  SPEAKER_00: So we get into our body.
• 39:52
  SPEAKER_00: Like, what does this craving feel like?
• 39:54
  SPEAKER_00: Okay.
• 39:55
  SPEAKER_00: Where is the worry in my body?
• 39:57
  SPEAKER_00: Is it on the right side or the left side?
• 39:59
  SPEAKER_00: Yeah.
• 39:59
  SPEAKER_00: Yeah.
• 39:59
  SPEAKER_00: Is it on the right?
• 40:00
  SPEAKER_00: Is it in the front?
• 40:01
  SPEAKER_00: Is it in the back?
• 40:02
  SPEAKER_00: Is it a tightness?
• 40:03
  SPEAKER_00: Is it heat?
• 40:04
  SPEAKER_00: Is it, and not even looking for something in particular, but just getting really curious about what we're actually experiencing.
• 40:12
  SPEAKER_00: And that experience is going to be different moment to moment.
• 40:15
  SPEAKER_00: So we can get really nuanced as we get curious.
• 40:18
  SPEAKER_00: And that very active process helps us not grit our teeth or try to brace ourselves.
• 40:24
  SPEAKER_00: You know, that's saying what we resist persists.
• 40:27
  SPEAKER_00: So instead of resisting our experience, which we often habitually do, we actually lean into it, we open to it, and we say, bring it on.
• 40:35
  SPEAKER_00: Okay, what does this feel like?
• 40:37
  SPEAKER_00: So we're really noticing whatever our body is telling us in that moment as that craving comes up and kind of washes through us.
• 40:46
  SPEAKER_01: Thomas, now we'll switch to the internet questions like we were supposed to.
• 40:50
  SPEAKER_01: But when I read that research, I was like, oh, we can all use that, whether we have, you know, a substance user addiction or a mental health condition or not.
• 40:58
  SPEAKER_01: The number one question on the internet, and this is both Google and YouTube related to this topic, is addiction really a brain disease or is it a choice?
• 41:07
  SPEAKER_00: It's a brain disease.
• 41:08
  SPEAKER_00: Yeah, absolutely.
• 41:10
  SPEAKER_00: So often people who believe that myth of willpower talk about addiction as a choice because they're kind of seeing it through that lens of, oh, there's something broken in you or wrong with you, or something like that.
• 41:25
  SPEAKER_00: When in reality, you can think you can think of it as a brain disease, and you can also just think of it as a brain mechanism that our hat our brain has that's there to help us survive.
• 41:36
  SPEAKER_00: And it kind of got off track a little bit.
• 41:38
  SPEAKER_00: So I don't even like to think of it as a disease because then it suggests that there's something we're diseased, there's something wrong with us.
• 41:45
  SPEAKER_00: When in reality, it's kind of these habit formation systems in our brain that are extremely helpful and they kind of got co-opted a little bit.
• 41:53
  SPEAKER_00: And so we just kind of can tweak them back into place.
• 41:56
  SPEAKER_01: That's a that would be a that description makes it sound like it can be overcome, managed, whatever word would be next, being broken and having a disease.
• 42:06
  SPEAKER_01: Same as using the term mental illness, right?
• 42:08
  SPEAKER_01: Can feel so like you're squished under its thumb.
• 42:12
  SPEAKER_00: Yes, yes, and we need much less of that.
• 42:15
  SPEAKER_01: Yeah, absolutely, because it it makes us freeze.
• 42:18
  SPEAKER_00: Yeah, it makes us feel subhuman even sometimes.
• 42:23
  SPEAKER_01: The next question from the internet is using the word disease again.
• 42:26
  SPEAKER_01: So I'm gonna go with it.
• 42:27
  SPEAKER_01: If addictions are a disease, does that mean the individual has no responsibility for their actions?
• 42:32
  SPEAKER_00: Well, we could get into philosophical debates about willpower and free will and all of that.
• 42:38
  SPEAKER_00: But I would say the more awareness we have, the more ability we have to work with our brains.
• 42:46
  SPEAKER_00: And so here, when we can learn that awareness is not only our friend, this curiosity is our superpower, it puts us back in the driver's seat.
• 42:56
  SPEAKER_01: The idea of having some control when it feels like we have none is very helpful.
• 43:02
  SPEAKER_00: Absolutely.
• 43:03
  SPEAKER_01: Is it realistic?
• 43:05
  SPEAKER_00: I see I've seen this in my studies, I've seen this in my clinic.
• 43:09
  SPEAKER_00: It's not gonna work a hundred percent every time for every person, but on average, we see a lot of results that are good in that way.
• 43:17
  SPEAKER_00: And so it's just learning to lean into and build that superpower of curiosity.
• 43:22
  SPEAKER_00: I think of this as developing evidence-based faith, right?
• 43:26
  SPEAKER_00: So in medicine, we talk about evidence-based medicine.
• 43:29
  SPEAKER_00: Is there a, you know, is there a randomized controlled trial showing, you know, these fancy terms, right?
• 43:34
  SPEAKER_00: Showing like, is this actually helpful?
• 43:36
  SPEAKER_00: And those trials can be helpful to separate out what actually works versus what might just be placebo or something like that.
• 43:43
  SPEAKER_00: And so here, you know, every time we're able to run toward a craving and lean into it and ride it out, we've developed a data point showing, oh, I can actually learn to be with a craving and my head won't explode.
• 43:58
  SPEAKER_00: And then the next time we do it, we develop another data point and we get all of this evidence from our own experience that actually helps give us the faith that we can do this.
• 44:08
  SPEAKER_00: Now, it's not to say that we'll never have a craving ever again.
• 44:12
  SPEAKER_00: There are plenty of people.
• 44:13
  SPEAKER_00: That have had cravings pop up 25 years later, where they're like, where'd that come from?
• 44:18
  SPEAKER_00: Right.
• 44:18
  SPEAKER_00: Those things can just lie dormant.
• 44:20
  SPEAKER_00: And it's not a problem.
• 44:21
  SPEAKER_00: It's just kind of like, oh, there it is.
• 44:23
  SPEAKER_00: Well, I had another craving because they know how to work with it.
• 44:26
  SPEAKER_00: They've got the tools, they've developed this mental muscle to be able to lean into the craving every time it comes up.
• 44:33
  SPEAKER_00: One marker that I look for is when people can kind of shift from being afraid of cravings to kind of saying, bring it on, because they've developed all that evidence base where they know no matter how the strong the craving is, they can actually lean into it.
• 44:48
  SPEAKER_00: And in fact, every time a craving comes up, it makes them stronger.
• 44:53
  SPEAKER_01: Wow.
• 44:53
  SPEAKER_01: Do you use it yourself?
• 44:55
  SPEAKER_00: Oh, yes, absolutely.
• 44:56
  SPEAKER_00: This is like the most important thing I ever learned.
• 45:00
  unknown: Yeah.
• 45:01
  SPEAKER_00: All sorts of cravings, yes.
• 45:03
  SPEAKER_00: I wrote a whole book called The Craving Mind, a lot of it based on my own experience.
• 45:07
  SPEAKER_01: Yeah, there you go.
• 45:08
  SPEAKER_01: Yours is a craving mind as well.
• 45:10
  SPEAKER_01: That's good to know.
• 45:10
  SPEAKER_00: Yeah.
• 45:11
  SPEAKER_01: Um, why do only some people become addicted to certain substances or behaviors?
• 45:16
  SPEAKER_00: That's a great question.
• 45:17
  SPEAKER_00: I don't really know the answer to that.
• 45:18
  SPEAKER_00: I don't think anybody has a great answer.
• 45:21
  SPEAKER_00: Certainly, there are genetic components that can predispose us to these.
• 45:25
  SPEAKER_00: Certainly, there can be lived experience elements where somebody's had, you know, childhood trauma, um, adverse experiences in childhood can certainly predict the likelihood that somebody's um going to become addicted to a substance or a behavior.
• 45:38
  SPEAKER_00: But there are a lot of different things that can add up.
• 45:40
  SPEAKER_00: And you can look at two people that have had the exact same situations where one person becomes addicted and another doesn't.
• 45:47
  SPEAKER_00: So the honest truth is we don't have a great handle and can't predict who's going to become addicted and who's not.
• 45:53
  SPEAKER_00: But we certainly have things that can predispose people that can make them more vulnerable to addiction.
• 45:58
  SPEAKER_00: So, for example, adverse childhood events are one of the big ones.
• 46:02
  SPEAKER_01: Is there more of an influence from genetics than environment, or is even that unknown?
• 46:08
  SPEAKER_00: I would say it's largely unknown.
• 46:10
  SPEAKER_00: If I had to guess, I would probably say it's more environmental than genetic.
• 46:15
  SPEAKER_00: Interesting.
• 46:15
  SPEAKER_00: Which is good news because we don't have control over our genes.
• 46:18
  SPEAKER_01: Yeah.
• 46:18
  SPEAKER_01: Okay.
• 46:19
  SPEAKER_01: The third most asked question on the internet, and this is from TikTok and YouTube.
• 46:22
  SPEAKER_01: Why can't I stop an addictive behavior even though I really want to?
• 46:27
  SPEAKER_00: Because you don't know how your brain works.
• 46:30
  SPEAKER_00: And I don't say that like flippantly, like I know how your brain works and you don't.
• 46:34
  SPEAKER_00: It's just that people have probably been watching too many TikToks or YouTube videos from influencers who are trying to garner a bunch of hits, but are not exactly trained in neuroscience and are not, you know, trained medical professionals.
• 46:47
  SPEAKER_00: And I would even say there are a lot of trained medical professionals that don't have the neuroscience background that helps them really get addiction at its core.
• 46:57
  SPEAKER_00: I didn't learn this stuff in medical school.
• 47:00
  SPEAKER_00: That's why I had to do the research in my lab to figure out what are the best ways to do this.
• 47:04
  SPEAKER_00: And so what I, you know, I'd like to see is that as the medical education uh develops and grows and matures, especially with addiction, that people are bringing in some of these evidence-based um findings, whether it's from the clinical side or even from the neuroscience side, and actually training people to do that.
• 47:24
  SPEAKER_00: And then hopefully the TikTok influencers can learn to read a neuroscience paper and really dissect, you know, the pieces where they can get at the core of like, oh, this is what reinforcement learning does.
• 47:35
  SPEAKER_00: Oh, here's how Rosquorla and Wagner, you know, these two researchers that came up with the formula really understood it.
• 47:41
  SPEAKER_00: And then they can go out and influence people based on accurate information as compared to something that sounds good.
• 47:47
  SPEAKER_01: It's literally why we're doing this podcast, the way we're doing it.
• 47:50
  SPEAKER_01: Because it's so hard when you're in a bad place, whether again, that's an addiction or a mental health condition, and you go online to get information.
• 47:56
  SPEAKER_01: Yeah, you don't know who you're getting it from and where they got it, including maybe made it up because it would be great clickbait.
• 48:04
  SPEAKER_03: Right.
• 48:05
  SPEAKER_00: So I am a trained psychiatrist and a neuroscientist for the record.
• 48:09
  SPEAKER_00: I appreciate that.
• 48:10
  SPEAKER_00: That's why I've actually done the research and I've actually treated the patients.
• 48:14
  SPEAKER_01: Yeah, great.
• 48:15
  SPEAKER_01: That's why we wanted you here.
• 48:16
  SPEAKER_01: Does this explain why people in addiction often lie or steal?
• 48:20
  SPEAKER_01: Or is that just survival brain taking over?
• 48:23
  SPEAKER_00: I would say that's more survival brain taking over.
• 48:25
  SPEAKER_00: You know, it's amazing what the brain will do in survival mode that is not only embarrassing, but it just it's it's heart-wrenching when people look back on experience and they just feel so guilty for what they've done.
• 48:41
  SPEAKER_00: You know, and I would say that's that's your survival brain taking over.
• 48:45
  SPEAKER_00: You know, good luck fighting with that thing because it's helping, it's trying to help, it thinks it's trying to help you survive.
• 48:50
  SPEAKER_01: Yeah.
• 48:50
  SPEAKER_00: It just doesn't know how to do it.
• 48:52
  SPEAKER_01: One more under that same heading.
• 48:54
  SPEAKER_01: Are there any practical tips that you can suggest that you know work to help the logical brain take over in a moment of crisis?
• 49:01
  SPEAKER_00: Here I would say don't rely on the logical brain, right?
• 49:04
  SPEAKER_00: So the logical brain is the youngest and weakest part of the brain from an evolutionary perspective.
• 49:09
  SPEAKER_00: It's the first that goes offline.
• 49:11
  SPEAKER_00: I would say rely on the embodied mind.
• 49:14
  SPEAKER_00: And what I mean by that is really leaning back into all the experience that people have had.
• 49:21
  SPEAKER_00: So they don't have to go and drink again or use a substance again or gamble again or go on a porn site again.
• 49:28
  SPEAKER_00: They can reflect back on all the things that they got from the previous times that they've done it.
• 49:32
  SPEAKER_00: And I call this retrospectives, where they can do a retrospective and look back on their previous behavior.
• 49:38
  SPEAKER_00: In fact, a future behavior, the best way to predict future behavior is based on past behavior.
• 49:43
  SPEAKER_00: So if we can reflect on past behavior and really keep that in our working memory, right?
• 49:48
  SPEAKER_00: Really keep that in mind as we have that craving come up.
• 49:52
  SPEAKER_00: Like, oh, I have this craving to do this thing.
• 49:54
  SPEAKER_00: What did I get from this last time?
• 49:56
  SPEAKER_00: Well, I got all this negative stuff.
• 49:58
  SPEAKER_00: Am I as excited to do it now?
• 50:00
  SPEAKER_00: No, it helps dampen that enthusiasm, so to speak, for our brain.
• 50:04
  SPEAKER_00: And then we can bring in these tools to help us write out the craving.
• 50:07
  SPEAKER_00: And that one-two is a really useful one-two punch to help work with those cravings.
• 50:13
  SPEAKER_01: And where would someone learn them?
• 50:14
  SPEAKER_01: Because if we're not, we go to our doctor and they say, you just have to quit, or here's a pill, or whatever it is.
• 50:21
  SPEAKER_01: Where would the average person who is listening and or watching say, I want to learn that.
• 50:26
  SPEAKER_01: I want to stop or start whatever it is, you know, so badly.
• 50:29
  SPEAKER_00: Yeah.
• 50:30
  SPEAKER_00: Well, I wish this was in standard medical education, but it's not.
• 50:34
  SPEAKER_00: So we formed a nonprofit called Mind Shift Recovery.
• 50:37
  SPEAKER_00: And there's actually a free app called Mind Shift Recovery that people can download onto their phone and it will teach them everything that they need to know.
• 50:44
  SPEAKER_00: They'll learn these three steps.
• 50:45
  SPEAKER_00: We call these three gears in the program.
• 50:47
  SPEAKER_00: And there are mini courses for each of the addictions that people might have, ranging from substances to behaviors uh like gambling or porn to even uh problematic phone use, you know, like technology addiction.
• 51:00
  SPEAKER_00: Absolutely.
• 51:01
  SPEAKER_00: And so we've put that resource out because it's not widely available.
• 51:05
  SPEAKER_01: TikTok and YouTube, right?
• 51:07
  SPEAKER_01: What is a dopamine hit actually doing to my brain?
• 51:10
  SPEAKER_00: Well, dopamine is an interesting molecule.
• 51:13
  SPEAKER_00: It it serves two main functions in our brain, and both of those have to do with learning.
• 51:18
  SPEAKER_00: So the first hit means that we get a dopamine spritz at a time when something important happens.
• 51:25
  SPEAKER_00: And the importance often is when something surprising happens.
• 51:29
  SPEAKER_00: So go back to the the image that we talked about earlier with survival, right?
• 51:34
  SPEAKER_00: So if we're foraging for food on the savannah, our brain doesn't actually have the brain space to remember every single plant that we walk by.
• 51:42
  SPEAKER_00: It's not actually that important.
• 51:44
  SPEAKER_00: What our brain needs to learn is where the food source is.
• 51:47
  SPEAKER_00: And so we find the food, remember that's the trigger.
• 51:50
  SPEAKER_00: We eat the food, there's that behavior, and then that's dopamine hit.
• 51:55
  SPEAKER_00: So dopamine literally fires in our nucleose accumbens for what it's worth.
• 52:00
  SPEAKER_00: Um, but part of this reward system, and it says, hey, remember this.
• 52:04
  SPEAKER_00: So there's a surprise.
• 52:05
  SPEAKER_00: Oh, wow, there's food here, right?
• 52:06
  SPEAKER_00: So there's a surprise that happens.
• 52:08
  SPEAKER_00: Also, when something dangerous happens that surprises us.
• 52:11
  SPEAKER_00: We almost get hit by a car.
• 52:12
  SPEAKER_00: Oh, maybe I should put my phone away and look both ways before I cross the street or whatever it was that we did where we were in a dangerous situation.
• 52:20
  SPEAKER_00: So that dopamine hit first happens when something surprising happens.
• 52:25
  SPEAKER_00: But when we go back and do the thing again, that dopamine firing shifts to not, because it's not surprising anymore.
• 52:31
  SPEAKER_00: We know the food's there.
• 52:33
  SPEAKER_00: So it shifts to anticipatory firing, meaning that it says, hey, you're hungry.
• 52:39
  SPEAKER_00: Don't just sit here, go get that food.
• 52:42
  SPEAKER_00: You know where it is.
• 52:43
  SPEAKER_00: So dopamine is often described as this motivation molecule.
• 52:46
  SPEAKER_00: And so we're going to get a dopamine hit when we're motivated to do something.
• 52:51
  SPEAKER_00: So that could happen when we're hungry.
• 52:53
  SPEAKER_00: That could happen if we're addicted to cigarettes, when we're our nicotine levels and our bloodstream are getting low, where that dopamine starts firing and says, do something, do something, do something, go get that thing.
• 53:04
  SPEAKER_00: So that's what a dopamine hit is about when we've already learned a behavior.
• 53:09
  SPEAKER_00: It's an anticipatory hit that says, go do the thing.
• 53:13
  SPEAKER_00: Remember, not about pleasure.
• 53:14
  SPEAKER_00: Dopamine shouldn't be about pleasure.
• 53:16
  SPEAKER_00: Because if we were pleasurable, we'd be like, oh, I don't need to do it.
• 53:19
  SPEAKER_00: I feel fine.
• 53:21
  SPEAKER_00: Dopamine's there to motivate us to get off the couch or get out the door or do whatever and go do the thing.
• 53:26
  SPEAKER_01: So is dopamine fasting a real scientific solution or an internet trend?
• 53:32
  SPEAKER_00: Internet trend for sure.
• 53:34
  unknown: Okay.
• 53:34
  SPEAKER_00: Because well, there's no neuroscience behind it.
• 53:39
  SPEAKER_01: Is there any danger to it?
• 53:40
  SPEAKER_01: What what let's ask what it is?
• 53:42
  SPEAKER_01: What is dopamine fasting that we hear about on the internet?
• 53:44
  SPEAKER_00: So my understanding of it, and I haven't thoroughly scoured the internet, but my my understanding is that people on the internet say, oh, dopamine, that's the problem, right?
• 53:56
  SPEAKER_00: As we talked about, that's the thing that gives you Jonesing to go do the thing.
• 54:00
  SPEAKER_00: So just fast from dopamine.
• 54:02
  SPEAKER_00: Just don't just don't do it.
• 54:03
  SPEAKER_00: So I'm not exactly sure how that works.
• 54:05
  SPEAKER_00: So people say, oh, well, I'm just not gonna go on the internet for a while if if that's where I get all my dopamine.
• 54:11
  SPEAKER_00: Okay.
• 54:12
  SPEAKER_00: Don't go on the internet for a while and then they go back on the internet.
• 54:17
  SPEAKER_00: In fact, I think the internet's often pretty useful to find information, right?
• 54:22
  SPEAKER_00: Not always useful if we're scrolling all the time, but you know, I check my email on the internet.
• 54:27
  SPEAKER_00: I get directions when I'm in a different city on the internet.
• 54:31
  SPEAKER_00: There are a lot of places where the internet can be helpful.
• 54:32
  SPEAKER_00: So it's kind of hard to avoid the things that cause dopamine.
• 54:36
  SPEAKER_00: The other thing is dopamine's not the problem.
• 54:39
  SPEAKER_00: It's just learning how to work with the dopamine and not feed these loops.
• 54:44
  SPEAKER_00: So somebody does a dopamine fast and they haven't actually dismantled that habit loop at all.
• 54:48
  SPEAKER_00: They've just kind of put it on hold for a while, which actually it's kind of like water behind a dam.
• 54:54
  SPEAKER_00: You build up that water pressure and suddenly that dam bursts.
• 54:58
  SPEAKER_00: So there's a scientific term for this called the abstinence violation effect.
• 55:02
  SPEAKER_00: So, so you dopamine fast, you abstain from whatever it was your dopamine hit was for a while.
• 55:09
  SPEAKER_00: And then your brain's like, oh, I really want to, I really want to.
• 55:13
  SPEAKER_00: And then we do the thing.
• 55:15
  SPEAKER_00: My patients, they have a more formal term for this.
• 55:18
  SPEAKER_00: They call it the eff it's okay.
• 55:21
  SPEAKER_00: So they're like, F it, I can't handle this anymore.
• 55:24
  SPEAKER_00: And they just do it and they go nuts, right?
• 55:26
  SPEAKER_00: And so it's like somebody's fasted from chocolate because that's their dopamine hit, and suddenly they're indulging in chocolate.
• 55:32
  SPEAKER_00: You know, that's what's that movie, chocolates, where the uh the mayor abstains from chocolate for all of Lent and then he tastes this little bit of chocolate and then he goes nuts and goes on this chocolate rampage.
• 55:43
  SPEAKER_00: So I think I think that's probably a great picture of how well dopamine fasting works, which is it works until it doesn't.
• 55:52
  SPEAKER_01: Okay.
• 55:53
  SPEAKER_01: We will stop this conversation here.
• 55:54
  SPEAKER_01: We will be back next week and we will go through six because we only got to four of them now of the top questions asked on the internet.
• 56:01
  SPEAKER_01: I greatly appreciate your perspective and I love that it is based in your lived experience, your research, your clinical experience, all the things that we need to learn from and believe in.
• 56:12
  SPEAKER_01: Thank you.
• 56:12
  SPEAKER_00: Thank you.
• 56:13
  SPEAKER_01: And we'll be back next week and continue this discussion with Dr.
• 56:16
  SPEAKER_01: Judson Brewer.