Anna Lembke

People have, I mean, just temperamentally different needs for intensity and engagement.

And I would hate to send the message that any kind of intense engagement is an addiction.

That's not at all what I'm saying.

And I think it trivializes the disease of addiction, which can be not just debilitating, but also life-threatening.

That's right.

Exactly.

Oh, I wish that it were, that we could use that as a criteria, but that would be incredibly misleading because it's very easy to lose sight of

of true cause and effect when we are engaging in these types of highly reinforcing behaviors.

And in fact, it's so well known in the field of addiction that there's a term for it, denial.

And it's a powerful, powerful thing, denial.

It's

It's profoundly true that even people with very severe addictions can have very limited awareness of the harm that their behavior is causing, even though it's patently obvious to everyone around them, even if they've gotten to the point where they've incurred serious health consequences, relationship consequences, legal consequences.

And that's not true for everybody with addiction, obviously, but it's true for enough people that it's a common trope in the field.

In fact, I had a patient say to me that denial is actually an acronym for don't even know I am lying.

So there's fairly reliable evidence, epidemiologic evidence, to show that children who are diagnosed with ADHD are at increased risk of developing addiction later in life.

And it's not clear why that is, but one of the...

enduring character traits that you can test for that is also associated with the development of addiction is impulsivity.

And impulsivity is the tendency to have difficulty putting a pause between the thought of doing something and actually doing it.

So if ADHD is indeed a difference in prefrontal cortex wiring that limits a person's ability to, let's say, control their impulses or appreciate delayed consequences, then it makes sense that those individuals might be more vulnerable to the problem of addiction getting older.

There's also, I believe, although I'm not really familiar with this literature, a