Dr. Anna Lembke

You know what I mean?

That in multiple ways.

Yep.

And I didn't even finish it.

And it was really only in retrospect that I could see in myself what my patients had been describing where, you know, it was like, oh, I'll never use heroin.

And then all of a sudden, you know, they're in the tenderloin, you know, selling their jacket and their laptop for a tiny amount of black tar heroin.

You know, this kind of like, sort of this kind of lowest common denominator, anything to get my fix.

Yeah.

Again, dopamine is our reward neurotransmitter.

It is what signals to us that something in the environment is important for our survival.

We should approach it, explore it, and potentially exploit it.

Dopamine evolved to bring us to the natural rewards that we need to live, food,

clothing, shelter, finding a mate.

What happens in addiction is that that dopamine signal and the reward pathway gets hijacked by this drug that resembles a natural reward and works through that similar mechanism, but is not in fact

a natural reward and is actually adverse or contrary to our well-being.

But we no longer recognize it as such, in part because over time, our brain adapts to that increased dopamine firing.

Eventually, we end up in this chronic dopamine deficit state.

And now we're needing to use, not to get pleasure, but actually just to bring ourselves

back up to baseline and stop feeling pain.

But we don't see that.