This week, we bring you the second part of our 2023 conversation on the perils of too much pleasure. Psychiatrist Anna Lembke explains the neuroscience behind compulsive consumption. She also shares techniques she’s learned from her patients to overcome the lure of addictive substances and behaviors. Then, Anna responds to your questions and comments on everything from dopamine fasts to kids' use of cell phones in our segment "Your Questions Answered."If you missed the first part of this episode, listen to it here.Looking for the perfect holiday gift for the Hidden Brain fan in your life? How about a membership to our podcast subscription, Hidden Brain+? You can learn more about gift subscriptions at patreon.com/hiddenbrain/gift. If t-shirts, tote bags and mugs are more your thing, you can find all kinds of Hidden Brain swag at our online store -- just go to shop.hiddenbrain.org. And if you prefer to give the gift of an experience, consider tickets to our live tour! To see where we’re headed in 2026, go to hiddenbrain.org/tour. Thanks and Happy Holidays! Episode illustration by Anna Kutukova for Unsplash+ Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
Chapter 1: What is the main topic discussed in this episode?
This is Hidden Brain. I'm Shankar Vedantam. It seems like the simplest choice in the world. Given the option between pain and pleasure, we ought to choose pleasure. Is it better to be hungry or full? Better to be tired or alert? Better to watch another episode of our favorite TV show or do the dishes? It isn't just our own minds that tell us to choose the path of enjoyment and indulgence.
Our friends remind us that life is short. Say no to dessert or another round of drinks, and someone might call you a spoilsport. At Stanford University, psychiatrist Anna Lemke has heard the same messages. But as a scientist, she's also studied the way our brains balance pain and pleasure.
The two sit on opposite ends of a neural seesaw, and the brain constantly attempts to bring them into equilibrium, or what is known as homeostasis. When we press down hard and often on the pleasure side of the seesaw, triggering bursts of the neurotransmitter dopamine, Anna says the brain automatically compensates by pressing down on the other side, producing a dopamine deficit.
Over time, as people press down too much or too often on the pleasure side of the equation, the brain compensates so forcefully that we start to walk around with a chronic dopamine deficit. This can manifest as anxiety, irritability, and depression. There is complex neurochemistry behind the process of homeostasis, but Anna has come up with a simple way to visualize this.
When you press down on one side of the seesaw, imagine a bunch of gremlins inside your head jumping on the other side of the seesaw. We explored how this mechanism works and why it exists in our previous episode. If you missed it, I strongly suggest you listen to it first. Today, we continue with the second part of our story about the paradoxical effects of pleasure.
And we ask what it means to live a life of balance and harmony. How to work with the brain rather than against it. This week on Hidden Brain.
Maija here from OP Pohjola. Hi. Now you're focusing on this. No, you're focusing on this.
I mean, focusing. Concentration makes a bonus. As an owner and customer of Osuuspank, you can choose which OP bonuses you use. The option choices are bank and insurance service fees. op.fi bonus. Vahinkovakuutukset offers Pohjola Vakuutus Oy. Henkivakuutuksen offers OP Henkivakuutus Oy. Anna Lemke is a psychiatrist at Stanford University.
She has worked with many patients who have addictions, not just to drugs like cocaine and heroin, but to everyday activities taken to excess. She has treated patients with a range of out-of-control indulgences, from eating and drinking to online shopping and sports betting. Around the time she turned 40, Anna found herself in the grip of an addiction.
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Chapter 2: How does Anna Lembke explain the neuroscience behind addiction?
At one point, she found herself swept up in the novel Fifty Shades of Grey. The story, later made into a movie, revolves around a sadomasochistic relationship between a college student and a business tycoon.
There's some people who say that I don't have a heart at all.
Why would they say that?
Because they know me well.
Do you have any interests outside of work?
I enjoy various physical pursuits.
I asked Anna what drew her to the book. I'm honestly not even sure I know because it didn't really matter when I was reading it. That is to say like the plot and the characters mattered not at all. I was reading it for the sex scenes. You know, embarrassing to admit that, but it's true. But I remember rationalizing it to myself as a modern day pride and prejudice. But, you know, not really.
Yeah, you don't think Jane Austen would have written Fifty Shades of Grey?
Don't think so.
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Chapter 3: What techniques can help overcome addictive behaviors?
Hi. Now you concentrate here. No, you concentrate here.
That is, to concentrate.
Concentration makes a bonus. As an owner and customer of Osuuspank, you can choose which OB bonuses you use. The option choices are bank and insurance service fees. op.fi bonus. Vahinkovakuutukset offers Pohjola Vakuutus Oy. Henkivakuutuksen offers OB Henkivakuutus Oy. This is Hidden Brain. I'm Shankar Vedantam.
In our previous episode, which I highly recommend you listen to if you haven't heard it yet, Stanford University psychiatrist Anna Lemke explained how our minds come with an internal seesaw. It's designed to keep things in balance to achieve what is called homeostasis.
When you bite into a delicious dessert or bet on a sports game and wait excitedly for the result, you're pressing on the pleasure side of the seesaw. You trigger a burst of dopamine. To return to balance, the brain compensates by pressing down on the other side of the seesaw.
Over time, if we press too hard or too often on the pleasure side, the brain starts to compensate more and more forcefully, leaving us with a dopamine deficit. This can leave us feeling down and miserable and prompt us to go find our next jolt of pleasure. You can see how this quickly can become a vicious cycle.
Anna, it's clear that simply seeking out more pleasure and more intense pleasure or more constant pleasure is not the answer. And you often recommend something that you call a dopamine fast to your patients. How does it work?
Well, the dopamine fast is a little bit of a misnomer in the sense that we're not actually ingesting dopamine. In fact, what we're doing is using substances and behaviors that trigger the release or increase in firing in dopamine that we make in our brain.
What the dopamine fast refers to is to abstain from the substance or behavior for long enough for our brain to get the memo, oh, wait a minute.
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Chapter 4: How can relationships and community support recovery from addiction?
You have even here in the United States, rising rates of anxiety, depression, and suicidal thinking among teenagers. corresponding specifically with the past 20 years and the increasing amounts of time that people are spending on the internet and consuming digital media.
And then you have a much smaller data point, which is what we see clinically when we intervene and ask people to stop ingesting these high reward substances and behaviors. People who come in seeking help for anxiety, depression, suicidal thinking,
And what we find is that their anxiety, depression, and suicidal thoughts in the vast majority get better without her having to do anything else other than cut out for a period of time their high dopamine substances and behaviors.
When we come back, techniques to get addictive behaviors under control and the crucial role that relationships and community can play in helping us to reset our brains. You're listening to Hidden Brain. I'm Shankar Vedantam. Thank you for watching. This is Hidden Brain. I'm Shankar Vedantam. Psychiatrist Anna Lemke is the author of Dopamine Nation, Finding Balance in the Age of Indulgence.
She argues that when we seek out pleasures on a nonstop basis, whether those pleasures are legal indulgences or illegal substances, we mess with the neurochemistry of the brain. Paradoxically, the more we chase pleasure, the more the brain tries to compensate, leaving us in a dopamine-depleted state. Anna recommends multiple techniques to help get indulgences under control.
She calls these self-binding techniques.
Self-binding techniques create both literal and metacognitive barriers between ourselves and our substance or behavior of choice so that we can press the pause button between desire and consumption. And there are many different ways to do that. I sort of organize it into time, space, and meaning to give us a fighting chance to be able to abstain.
So what would some of these look like? For example, the physical or spatial self-binding that you talk about, what does that look like?
That looks like, for example, not having the substance in the house, if it's alcohol or potato chips or cookies or whatever it is, not having it in the house is a really simple one.
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Chapter 5: What is the relationship between ADHD and addiction?
I'm wondering if you can tell me a little bit about the role of community here. There are many groups that have sprung up to try and fight addictions, you know, groups like AA or NA or Gamblers Anonymous, for example. Tell me about the role that they play. And in some ways, is it part of the same equation that we're looking at here, the role of human relationships in battling addiction? Yeah.
So AA, Alcoholics Anonymous and Narcotics Anonymous, in my opinion, are among the most remarkable social movements of the last 100 years. These are amazing grassroots organizations composed of people with addiction trying to help other people with addiction. And it's remarkably successful for those who actively participate. So you'll read a lot in the media now about
how AA and other 12-step organizations don't work, but that's not really a faithful representation of the evidence. There are many people who will not participate or get anything out of it, but for those who actively participate, engagement in AA and other 12-step groups is as effective and possibly even more effective than professional treatment. So what is the secret of these 12-step groups?
Well, first of all, they provide a sober social network. They provide a specific path for recovery. But importantly, they're also really de-shaming because you realize, oh, wow, I'm not the only one.
And like I have this thing that happened to my brain because I'm human and I have this particular vulnerability and other people have experienced and done similar things that I have done in pursuit of their drug. And that is an incredible burst of intimacy and yes, dopamine, right?
That we get then from being taken into the fold of like-minded individuals who understand us and accept us in all our brokenness.
One important idea that Anna has adopted in her own life powerfully resonates with the message of groups such as AA and NA. Change begins with telling the truth.
Yeah, so this was really something that I learned from my patients. Over many years of seeing patients get into recovery from severe addictions, what I noticed was that those who seemed to get into the best recovery and be able to maintain recovery the longest were those who were committed to telling the truth.
That was a central value for them, which they saw as just pivotal for maintaining sobriety and recovery. And I thought that was really interesting. Like, what is it about truth telling that enables recovery and enables people to stay in recovery? Because it just was such a consistent theme, whether they got into recovery through 12 steps like AA or NA or just through their own, you know, journey.
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Chapter 6: How does dopamine fasting work and what are its benefits?
That is, to concentrate.
Concentration makes a bonus. As an owner and customer of Osuuspank, you can choose which OB bonuses you use. The option choices are bank and insurance service fees. op.fi bonus. Vahinkovakuutukset offers Pohjola Vakuutus Oy. Henkivakuutuksen offers OB Henkivakuutus Oy.