Dr. Anna Lembke

Because when we are tilted to the side of pain, the overwhelming drive to restore a level balance or restore homeostasis as quickly as possible overwhelms any other rational thought about the consequences of my drug use, right? It's just like, get back to the level position because if I do that, I'll at least feel temporarily better.

Because when we are tilted to the side of pain, the overwhelming drive to restore a level balance or restore homeostasis as quickly as possible overwhelms any other rational thought about the consequences of my drug use, right? It's just like, get back to the level position because if I do that, I'll at least feel temporarily better.

Absolutely. I agree with you. And I think, you know, this metaphor, it makes an assumption that we all start with a pleasure-pain balance that's level with the ground, but actually that's probably not true, right? Some people at baseline may actually be more depressed or more anxious or may have had life experiences that sets them up for a kind of chronic stress reaction. And

Absolutely. I agree with you. And I think, you know, this metaphor, it makes an assumption that we all start with a pleasure-pain balance that's level with the ground, but actually that's probably not true, right? Some people at baseline may actually be more depressed or more anxious or may have had life experiences that sets them up for a kind of chronic stress reaction. And

And we know that people with co-occurring psychiatric disorders, for example, are at increased risk of developing addiction probably because they're reaching for that substance to self-medicate their psychiatric problem. The issue with that is that it's not medicinal, right? It's not healing.

And we know that people with co-occurring psychiatric disorders, for example, are at increased risk of developing addiction probably because they're reaching for that substance to self-medicate their psychiatric problem. The issue with that is that it's not medicinal, right? It's not healing.

Although in the short term, substances can help with those kinds of feelings of psychological and physical pain. Over time, because of the way the brain adapts, as we've discussed, substances and other addictive behaviors just make psychiatric problems worse, right? As we drive ourselves further into the kind of, you know, the pain side of the balance.

Although in the short term, substances can help with those kinds of feelings of psychological and physical pain. Over time, because of the way the brain adapts, as we've discussed, substances and other addictive behaviors just make psychiatric problems worse, right? As we drive ourselves further into the kind of, you know, the pain side of the balance.

Yeah, to numb ourselves, to not be present in our reality and have to deal with what's going on there.

Yeah, to numb ourselves, to not be present in our reality and have to deal with what's going on there.

It's all the same. Dopamine originally was to help us find those things that we need to survive. Food, clothing, shelter, a mate. We call those natural rewards. But today... That same reward pathway that relies on dopamine has been hijacked by all of these artificial rewards that our brain confuses as necessary for survival, which is why people with severe addiction will –

It's all the same. Dopamine originally was to help us find those things that we need to survive. Food, clothing, shelter, a mate. We call those natural rewards. But today... That same reward pathway that relies on dopamine has been hijacked by all of these artificial rewards that our brain confuses as necessary for survival, which is why people with severe addiction will –

be willing to lose, you know, not consciously but unconsciously, their loved ones, their homes, their jobs, everything they have in pursuit of their drug of choice. It's because their brain has been hijacked and they now confuse the drug as necessary for survival. The other thing about drugs is that they're incredibly potent.

be willing to lose, you know, not consciously but unconsciously, their loved ones, their homes, their jobs, everything they have in pursuit of their drug of choice. It's because their brain has been hijacked and they now confuse the drug as necessary for survival. The other thing about drugs is that they're incredibly potent.

They release a lot of dopamine all at once, which again is confusing for our brain. Natural rewards require upfront effort where we do a lot of work and then we get a little bit of dopamine. And that's what our brains evolved for.

They release a lot of dopamine all at once, which again is confusing for our brain. Natural rewards require upfront effort where we do a lot of work and then we get a little bit of dopamine. And that's what our brains evolved for.

Can I get back to your question about trauma and stress? So there's a very interesting series of experiments in rodents, mice and rats, where they – first of all, rodents very easily get addicted to cocaine. They will press a lever for cocaine until exhaustion or death. Right.

Can I get back to your question about trauma and stress? So there's a very interesting series of experiments in rodents, mice and rats, where they – first of all, rodents very easily get addicted to cocaine. They will press a lever for cocaine until exhaustion or death. Right.

But if that cocaine is then taken away, that behavior will extinguish, which means that the mice will eventually just stop pressing the lever, right, because they're not getting any cocaine. Totally makes sense. And then they'll go off and do something else in the cage.

But if that cocaine is then taken away, that behavior will extinguish, which means that the mice will eventually just stop pressing the lever, right, because they're not getting any cocaine. Totally makes sense. And then they'll go off and do something else in the cage.