Dr. Anna Lembke

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.

But if they're then exposed to a very painful foot shock, right, so a very extreme physical pain, which you could equate to a serious life stressor, the first thing the rat will do is run over to the lever and start pressing for cocaine.

But if they're then exposed to a very painful foot shock, right, so a very extreme physical pain, which you could equate to a serious life stressor, the first thing the rat will do is run over to the lever and start pressing for cocaine.

which tells us that once our brain has discovered a drug that releases a lot of dopamine in our reward pathway, even after we stop using that drug, if we are exposed to an extreme stressor, Our brain will tell us immediately, go and do that thing that gives us a lot of dopamine because you are under stress and I need to be relieved of stress. Does that make sense? It makes perfect sense.

which tells us that once our brain has discovered a drug that releases a lot of dopamine in our reward pathway, even after we stop using that drug, if we are exposed to an extreme stressor, Our brain will tell us immediately, go and do that thing that gives us a lot of dopamine because you are under stress and I need to be relieved of stress. Does that make sense? It makes perfect sense.