Dr. Anna Lembke

Okay, great. So let me get there. Let me first say, though, that remember, after we do something that's highly pleasurable, our brain compensates with neuroadaptation, tilting an equal and opposite amount to the side of pain, and then restoring our balance back to the level position, right, or what we call homeostasis. So this doesn't last forever, right?

Okay, great. So let me get there. Let me first say, though, that remember, after we do something that's highly pleasurable, our brain compensates with neuroadaptation, tilting an equal and opposite amount to the side of pain, and then restoring our balance back to the level position, right, or what we call homeostasis. So this doesn't last forever, right?

It's to pleasure, then it's to pain, then it's back to the level position. But if we continue to consume our drug of choice over days to weeks to months to years, and we add in a whole bunch of other drugs, and now we're consuming, you know, pornography and smoking pot and eating—

It's to pleasure, then it's to pain, then it's back to the level position. But if we continue to consume our drug of choice over days to weeks to months to years, and we add in a whole bunch of other drugs, and now we're consuming, you know, pornography and smoking pot and eating—

donuts and, you know, you name it, all at the same time, then essentially what happens is those gremlins on the pain side of the balance end up camped out there.

donuts and, you know, you name it, all at the same time, then essentially what happens is those gremlins on the pain side of the balance end up camped out there.

Right. And now we've entered addicted brain, by which I mean that we've changed our hedonic or joy set point to the side of pain. Now we need more and more of our drug in more potent forms, not to get high and feel good, but just... to level the balance and feel normal. And this is not going to be enough.

Right. And now we've entered addicted brain, by which I mean that we've changed our hedonic or joy set point to the side of pain. Now we need more and more of our drug in more potent forms, not to get high and feel good, but just... to level the balance and feel normal. And this is not going to be enough.

To level the balance, I would have to like keep filling this much more than this container can hold. And that would be in pursuit really of just trying to level that balance so that we can feel normal. And when we're not using...

To level the balance, I would have to like keep filling this much more than this container can hold. And that would be in pursuit really of just trying to level that balance so that we can feel normal. And when we're not using...

We're walking around with a balance tilted toward the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance or behavior, which are anxiety, irritability, insomnia, depression, and craving.

We're walking around with a balance tilted toward the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance or behavior, which are anxiety, irritability, insomnia, depression, and craving.

More rocks.

More rocks.

Oh, gosh. I'm so glad you said that because I think that is the key to empathy for the disease of addiction, as well as for people with the disease. Having empathy for themselves is recognizing that on some level, it it's out of their control, right?

Oh, gosh. I'm so glad you said that because I think that is the key to empathy for the disease of addiction, as well as for people with the disease. Having empathy for themselves is recognizing that on some level, it it's out of their control, right?

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