Anna Lembke

but below baseline, which is this state that's really akin to a clinical depression.

Anybody with a severe addiction is going to need medical supervision and support, and especially if they're physiologically dependent to a chemical like alcohol or benzodiazepines or opioids, such that they would be at risk for life-threatening withdrawal.

Because essentially what happens in withdrawal is that we experience the opposite of whatever that drug does for us.

And with sedatives like alcohol, opioids, and benzos,

we can experience a physiologic storm, including life-threatening seizures.

So individuals who are struggling with that kind of severe chemical dependency should not just quit cold turkey.

They need medically monitored detoxification or tapering in order to get off of their drug of choice.

But the principle is still the same, that they need to get off of that chemical in order to allow their brain to heal.

Well, first of all, she came to me seeking help for anxiety and depression, not seeking help for cannabis.

uh in fact she identified cannabis as the only thing that helped with her anxiety and she wanted me to prescribe a pill or offer some kind of psychotherapy that would help with her anxiety and depression but what i said to her which is what i say to many people who now come to me wanting help with anxiety and depression other psychiatric symptoms whom i discover are using high dopamine rewards excessively

is that instead of prescribing them a pill or recommending any kind of psychotherapy, what I invite them to do is to engage in an experiment, which is the dopamine fast for four weeks in order to reset reward pathways.

Because there's a possibility, I tell them, that just by doing that alone, their anxiety and depression may get substantially better without our having to do any other intervention.

So that's what I suggested to Delilah.

When we're chasing dopamine, it's very difficult to see the true impact of our drug of choice, whether a substance or behavior, on our lives.

All we see is the immediate relief that we get from it.

We're not able to see that over time what's happening is that we're changing our brains in a way that's probably exacerbating the problem we're trying to solve.

So I suggested to Delilah that she try giving up cannabis for a month in order to reset her reward pathways.

And what she said to me is, you know, why would I do that?

You know, cannabis is the only thing that helps with my anxiety.

And I said to her, I hear you that in the moment you get relief from the cannabis, but what I suggest to you is that what you're really doing is medicating withdrawal from the last dose rather than treating your underlying anxiety disorder.