Prof. Anna Lembke | Dopamine, Addiction & the Modern Brain

[00:00:00]Part of modern suffering is that we've all become more vulnerable to the problem of addiction. But also importantly, we've changed our physiology and now we are all of us operating in a chronic dopamine deficit state. That is to say, we've developed reward insensitivity. What actually defines addiction? Dr. Lia. Yeah, the DSM gives us certain diagnostic criterias, but in daily life in clinical practice, we see many patterns beyond these categories. Addiction is a brain disease. It It's characterized by a distinct pathophysiology.

[00:00:33]And yet, we're still not at the point where we can do a brain scan to diagnose addiction. So my question is if we constantly remove obstacles, protect children from disappointment and make life as easy as possible, uh how might that shape the development of the dopamine system, reward learning and motivation and yet simultaneously exposed to graphic videos and images and ideas, especially you know sexualized images that my generation never saw.

[00:01:04]From an attachment perspective, this makes perfect sense. But through the lens of dopamine and through water learning again is the wonder.

[00:01:12]>> Yeah, it's a great question. I you know to me it hearkens back to the famous psychoanalyst JD Winnott and this concept of the good enough mother.

[00:01:19]Interesting about the GLP1s in addition to those aspects is that it looks like the GLP1s also decrease or dampen the release of dopamine in the brain's reward pathway. Again, if you look at the three criteria that make anything potentially addictive, is it plentiful?

[00:01:37]Is it potent? Is it personalized? AI meets all those criteria. Again, yeah.

[00:01:42]Well, thank you. I'm just excited that I get an opportunity to to speak to your audience and, you know, to be able to interact.

[00:01:50]>> Hello everyone and welcome. Today I have very special guest with me, Dr. Anna LMI. I've been truly excited to listen her to have uh this conversation. Dr. Anali is a professor of psychiatry at Stanford University School of Medicine, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic and the author of the well-known book Dopamin Nation. Uh today I'm going to ask some question about dopamine, addiction, parenting, resilience and how we can stay balanced in the world that constantly offer us more.

[00:02:29]>> That sounds that sounds great. Yes.

[00:02:31]>> Great. Then um to be honest, I have been very excited since last night. I hope my excitement will not take over too much and I will be able to ask my questions uh clearly. Um, as in a popular culture, dopamine is often called the happiness hormone or addiction molecule, we also hear very simplified ideas such as too much dopamine causes or too little dopamine cause Parkinson's disease and so on. What does dopamine actually do? How do different uh brain areas, dopamine pathways, receptors um change the picture?

[00:03:10]>> Yeah, great question. I mean I think you know our brains are complicated and um there's always there's a danger of oversimplifying of course but I do think that some degree of simplification provides a heristic or simple framework for understanding some of the essential aspects of what's happening in our brains and I think that can be very useful and that that is what I try to do in dopamine nation provide this sort of simple heristic istic or rule of thumb for understanding some of the most important properties to date about what dopamine is, how it works, and what changes as we become addicted. So, I think the best um and and sort of broadest way to think about dopamine is that it's our reinforcement neurotransmitter. And reinforcement is often associated with pleasure, but not always. So, um, you know, thinking of dopamine as the pleasure neurotransmitter is probably not entirely accurate. Although, honestly, typically things that are reinforcing tend also to be pleasurable, at least in the initial phases of exposure. And I think this is a really important concept. um making a distinction between initial exposure to a substance or a behavior and then down the line repeated exposure. Because what can start out as pleasurable ultimately can stop being pleasurable as the brain adapts and yet still be reinforcing because we're caught in this kind of reinforcement paradigm that has us wanting something even when it's no longer pleasurable for us. But backing up, um, you know, the way to think about dopamine, I think again, is this reward or reinforcement neurotransmitter.

[00:05:17]Neurotransmitters are molecules that we make in our brain that allow for fine-tuned control of the electrical circuits that essentially make up our brain. Our brain is in many ways a bundle of wires. The wires are neurons.

[00:05:34]Those neurons don't touch end to end.

[00:05:36]There's a gap between them. The gap is called the syninnapse and neurotransmitters are the molecules that bridge that gap to allow for fine-tune control of those electrical signals.

[00:05:49]Dopamine has become a kind of common currency for neuroscientists to measure the reinforcing potential of different substances and behaviors. So for example, if you uh take a mouse in a laboratory and stick a probe in their brain, especially in the nucleus circumbent, a key part of the reward pathway, and you measure dopamine firing, what you'll find first of all is that we're always releasing dopamine at a kind of tonic baseline level. And when we encounter a substance or behavior or have an experience that's reinforcing, often pleasurable, not always, but mostly, we temporarily increase dopamine firing above baseline. That's called phasic dopamine.

[00:06:42]And in these experiments with rats and mice, what scientists have found is that palatable foods increased dopamine firing 50% above baseline. Sex is 100%, nicotine is 150%, cocaine is 200% and methampetamine is a,000%.

[00:07:02]And in general, you know, a simplified rule of thumb is that the more dopamine that is released and the faster it's released, the more likely is that substance or behavior to be reinforcing for that organism. And indeed, if you put a rat in a cage with a lever to press for cocaine or methamphetamine, they will press that lever until exhaustion or death. And one of the ways that neuroscientists measure whether or not an animal has become addicted is how hard they're willing to work in order to get their drug of choice. Are they willing to press this lever till exhaustion or death? And if they are, that tells us number one, that substance or behavior is highly reinforcing and number two, it has a strong potential for addiction.

[00:08:01]Now a key thing that happens though as you go along the continuum and continue to press that lever is that the brain adapts. It becomes less sensitive to that reward. That means that we that basic uh increase in dopamine firing gets less over time. And also importantly our brain will compensate by going into a dopamine deficit state.

[00:08:29]what's often called the opponent process mechanism.

[00:08:33]And what can happen in addiction is that you actually get stuck in that chronic dopamine deficit state, which is kind of ironic because you're doing this thing that releases all this dopamine. You would think that people with addiction would have massive amounts of dopamine in their brains, but in fact, the opposite is true. Human neuroiming studies show that people with severe addiction have below normal levels of tonic dopamine in the nucleus cumbent.

[00:09:04]Yeah. The modern world pushing our dopamine system too far. Uh our phones, social media, short videos requires us to wait uh make effort or tolerate Yeah.

[00:09:18]uh boredom. Do you think the modern world gives us more rewards, faster rewards and easier rewards than our dopamine system can handle? And what is the possible long-term effects uh of constant easy rewards on our brain?

[00:09:35]Yeah. So this is essentially the big idea in dopamine nation that because we have created an ecosystem where we have been able to make almost everything into a drug by making it more potently reinforcing more plentiful and accessible and also by personalizing it for every given individual. We've essentially created an ecosystem which is mismatched for our ancient brains because our brains evolved for a world of scarcity and everpresent danger where we would have to work very very hard to get a tiny little bit of reward. Now we live in a world where we can just swipe right and swipe left and we are massively stimulated by digital dopamine almost instantly. And as a result, my hypothesis is that modern a part of modern suffering is that we've all become more vulnerable to the problem of addiction. But also importantly, we've changed our physiology and now we are all of us operating in a chronic dopamine deficit state. That is to say, we've developed reward insensitivity.

[00:10:54]such that now things that used to be pleasurable and reinforcing for past generations or even for us prior to the buildup of exposure to all these stimuli are no longer rewarding. Now we need more and more drugs in more potent forms not to get high or feel good or be rewarded but just to feel normal. And importantly, when we're not using, we are walking around in a dopamine deficit state, experiencing sub threshold withdrawal. And the universal symptoms of withdrawal from any addictive substance or behavior are anxiety, irritability, insomnia, dysphoria, and craving. And I do think that it is this reward deficit state that is contributing to our modern mental health crisis. Because if you look at happiness surveys or rates of depression, anxiety, and suicide all over the world, what you see is that the wealthiest nations of the world have the least happy or have progressively less happy people and have the fastest increasing rates of anxiety and depression. Yeah, definitely. Uh what actually defines addiction, Dr. Lank?

[00:12:18]Yeah, the DSM gives us certain diagnostic criteria such as alcohol use disorder, substance use disorder, gambling disorder but in daily life in clinical practice as you every time mention about this we see many patterns beyond these categories.

[00:12:37]Yeah. So addiction broadly defined is the continuous compulsive use of a substance or behavior despite harm to self and or others. That's a very broad definition. Addiction is a brain disease. It It's characterized by a distinct pathophysiology.

[00:12:55]And yet we're still not at the point where we can do a brain scan to diagnose addiction. We're not the science is not at that level. We still base the diagnosis on what we call phenomenology.

[00:13:10]These are patterns of behavior that repeat themselves across cultures, time periods, geographic regions. And when we make the diagnosis of addiction, we're we're basically looking for the four C's out of control use, compulsive use, uh craving, and consequences, especially continued use despite consequences. And we're also looking for tolerance, that is needing more of the drug over time to get the same effect. And also withdrawal, experiencing, you know, the symptoms of withdrawal when we cut back or stop using. As I said before, it's very important to recognize that we're not just dealing with traditional drugs and alcohol. We're dealing with all kinds of new drugified substances and behaviors from the food we eat to the games we play to how we socialize with other humans. Right? So, we've drugified our food supply with the addition of salt, fat, sugars, and flavor. So, and when we eat, we're not just getting the calories we need, we're also stimulating the reward pathway, which is why it's very hard to stop even when we're full.

[00:14:19]We now have drugified human connection through social media, right? Social media essentially distills human connection down to its most reinforcing elements.

[00:14:31]And it uses specific design features to make it reinforcing independent of content. So you can be watching, you know, um squirrels nesting or um a tub draining or someone starting their car over and over again. And that can now become a drug of choice because the medium itself has been engineered to be addictive. How has it been engineered? As I said before, what are the three criteria that make something addictive? It's plentiful, it's potent, and it's personalized. When we look at digital media, plentiful, it's 24/7 access on our mobile phones. You have infinite feeds. You have autoplay. It actually takes effort to stop the flow.

[00:15:21]That's how accessible and plentiful these drugs are. They're highly potent, right? short form videos are incredibly reinforcing the lights, the colors, the sound. Um, and then very interestingly, distinct from any drug uh including television, right, that has preceded us, digital media and the algorithms can personalize the experience for each individual. And now we're getting to this concept of drug of choice, which is to say in general things that are intoxicating, you know, that we think of as drugs are intoxicating for most people, but not everyone, right? Not everybody likes the way that alcohol makes them feel.

[00:16:06]What social media and digital media can do is in real time as we're interacting with it, change the experience so that the digital drug is personalized for each of our unique brains, making it incredibly reinforcing. And of course, social media functions on the same principles as a slot machine. That intermittent reward also makes it more reinforcing or very potent because it engages that kind of treasure seeking part of our brain that wants to keep exploring, keep foraging for something new and better. And I just learned recently that Meta is going to come out with a brand new platform called Arena, which is essentially one of these betting platforms, right, where you can now bet on anything, which means they they're essentially creating a massive personalized online slot machine for humans to participate. and and they will use the data they get from that in their data flywheel to just refine the algorithm to make it even more engaging thereby grabbing our attention. So yes, we need to recognize that uh digital platforms, digital media, they can be powerful tools, but they're also very potent drugs. And when we're using them as drugs to entertain, to change the way we feel, to solve psychosspiritual problems, we're probably waiting into dangerous territory and we're certainly vulnerable to addiction because digital media addiction is real.

[00:17:44]>> Yeah. Unfortunately, can be addictions that society rewards. Uh, as I observe, some behaviors are priced by society when they lead to success. For example, a surgeon who works constantly, a scientist who spend uh 7 days a week in a laboratory who devotes most of his life to work for when we call them life hardworking, ambitious, disciplined or highly motivated. But when the similar level of loss control, impulsivity and imbalance appears around another uh type of reward, we may call it addiction. uh where does the boundary begins, Dr. Lumpy?

[00:18:26]>> Yeah, it's a great question. I mean, again, um anything that's reinforcing and releases dopamine in the reward pathway has the potential for addiction.

[00:18:36]If you then take that something and drugify it, right? Make it again more plentiful, more potent and personalized.

[00:18:43]Now you've really taken something that maybe was previously healthy and adaptive. You've turned it into a drug and then you create that that vulnerability for addiction. We have definitely drugified work especially certain forms of highly um uh financially uh gainful work. So by by first of all you know bonuses uh stock options, high salaries um then in many ways people get much of their social validation through work right or people get famous through certain forms of work. politicians, um, actors, athletes, social influencers. So now you create an even more potent drug which is easily accessible. It's plentiful.

[00:19:34]There's no natural stopping point anymore for work. It used to be you went home from the office and like you were done basically. You couldn't keep working. You went on vacation, you couldn't work. That's obviously no longer true. And in fact, many of us are working from home or working on vacation. So you've got the plentiful, you've got potent again, you've got all these additional reinforcers that make work even more potent like I mentioned before and then you combine those, the fame, the money, uh the social validation. Now you've got this nexus of work being something that's all consuming and then you have the personalized bit of it. And obviously work is sort of inherently personalized because we are rewarded for what we individually bring to that. And we have a culture that really celebrates individualism almost I wouldn't say almost it's like in a very narcissistic way. We we have a culture of celebrating individual agency will achievement. So all of those things combined make us you know definitely vulnerable to work and to vulnerable to work addiction or workcoholism.

[00:20:44]The problem is that culturally we don't recognize it because workaholics are our modern heroes. So people like Elon Musk who talks about working so hard that he's sleeping under his desk and not going home at night. He's, you know, he's a he's a cultural hero for many people. Um people like Mark Zuckerberg, you know, who's constantly working and um his whole identity is his his company. uh Jeff Bezos, these these folks are our cultural heroes. So, it's very hard to say to people, well, stop doing that because it's not good for you. You know, you don't have balance um in your life. Uh because, you know, as a culture, we really celebrate that behavior.

[00:21:27]>> Yeah. I I I will say unfortunately I have a very important question for you. important for me uh about uh parenting and children. Uh when I think about my own childhood, parenting looked like very different like if we were say safe, fed and cared for that was often considered enough. Yeah. I don't know in your culture is it true or not. In my culture it was like that. Today many parents including myself uh we are trying to raise children differently. We focus on security, attachment, understanding emotions, avoiding an unnecessary pressure. I truly believe that it's positive um change. But I sometimes wonder uh whether children are becoming less tolerant of frustration.

[00:22:21]They seem to struggle more with waiting, facing challenges or doing difficult things. So my question is if we constantly remove obstacles, protect children from disappointment and make life as easy as possible, uh how might that shape the development of the dopamine system, reward learning and motivation in our children.

[00:22:47]>> Yeah. So I would start by saying every generation of parents makes its own mistakes. Um, you know, the my parents' generation, I think that, you know, we were the latch key kids. You know, the kids that basically parents were working all the time. We sort of took care of ourselves. Latch key refers to coming home from school, you know, finding the key under the mat, letting yourself in, cooking your own dinner, you know, putting yourself to bed. I mean, so that that at least in the United States, you know, I was of the latch key kid generation. My kids have had a very different experience. You know, my husband and I um have invested much more time and energy into our children for good and for bad. You know, the good is that they have the attention um you know that we really didn't have in a way. The bad is Yeah. I mean, I think many kids today are vulnerable to being what's sometimes referred to as snowflake children, right? They're so fragile um you know that you have to sort of treat them like delicate snowflakes. The slightest bit of challenge uh adversity or discomfort they can't handle you know they melt. Um and and frankly the the convergence of that with digital media um is really I think where we get into trouble because the ease of engagement on these platforms and the lack of frustration tolerance that they require, the lack of effort that they require to get an answer or to be entertained or to connect, you know, to have at least the illusion of connection with with other kids is so intense. sense that I think we've really um exacerbated this problem of, you know, a generation of kids that really is in, you know, paradoxically very childlike in their inability to do things for themselves and yet simultaneously exposed to graphic videos and images and ideas, especially, you know, sexualized images that my generation never saw. So you have this really strange paradox of kids who are infantilized, you know, until their mid20s or later and also treated as if they have adult brains that can engage with graphic sexual images with complex um you know cyber bullying situations, fraud, online fraud, um you know all kinds of you know images, an addictive platform that now are supposed to be able to, you know, navigate themselves, which, you know, with their developing brains is much harder to do. So, I think that this, you know, the younger generations, Gen Z and beyond, have a lot of unique challenges at the same time that we often talk about them having it so easy.

[00:25:46]>> Yeah, exactly. It even made me reflect on something as fundamental as um as infancy. As a parent and as a clinician, I found myself wondering where the boundary lies between responding sensitivity to baby's need and unintentionally creating a pattern of immediate reward. For example, breastfeeding. Yeah. Today, many parents are encouraged to feed on demand whenever a baby signals distress or discomfort. From an attachment perspective, this makes perfect sense.

[00:26:18]But draw the lines of dopamine and reward learning. Again, where's the boundary?

[00:26:24]>> Yeah, it's a great question. I, you know, to me it hearkens back to the famous psychoanalyst JD Winnott and this concept of the good enough mother, right? So, nobody's going to be the perfect mother. And I use mother broadly to to denote caregiver. Um, nobody's going to be the perfect mother, and you wouldn't want to be the perfect mother, right? Because the good enough mother responds intuitively and empathically to a child's needs but gradually as that child matures withdraws some of that immediate response so that the child can develop and tolerate frustration can learn and also importantly can begin to meet their own needs. So it's not an abrupt abandonment. It's also not this total inshment where you continue to do things for the child beyond the point when they should and could be able to do it for themselves. So, you know, like most wise teachings, it's somewhere in the middle.

[00:27:25]You know, finding that middle path is difficult and the good enough mother will make mistakes, will sometimes air on the side of too much indulgence. other times air on the side of kind of abandonment um and frustration and and you know retaliation against the child. It's the kind of acknowledging you know when we're doing what and trying to stay in that middle good enough mother zone >> you feel better.

[00:27:55]I'm glad.

[00:27:56]>> Yeah. Yeah. The other thing the other thing that I would also say about parenting, you know, which which, you know, I've experienced in my own parenting is like we're we're going to make mistakes, but you can go back and apologize and you can change what you've been doing, right? So, if you realize, oh, I this is not headed in a good direction. It's you don't you're not destined to just keep going. People are incredibly mal malleable and kids understand if a parent comes and say, "Hey, you know, we gave you the iPad. We thought it would be fine. It turns out it's not. We're going to take the iPad away. These are the behaviors we expect to see. You can have it back for a limited amount of time after you've completed these other, you know what I mean? So, you can it's like you can change it up. Uh, and you know, and and you can apologize when you've made a mistake. Um, thank you for your recent years, I have been thinking and working a lot on psychological resilience. I have also shaped my doctoral research around this topic. Do you think uh having a strong reward system is the same as having strong psychological resilience? Uh or is resilience not simply about wanting more rewards or producing more dopamine but about being able to continue meaningful behavior during difficult moments?

[00:29:19]>> I might use the word a resilient reward system.

[00:29:22]>> Yeah. And and I I think what a resilient reward system is is sensitivity to reward, right? So being able to experience the the the satisfaction of reward, but not have that reward be so intense that we then marshall all of our resources to repeat that experience, especially when our efforts to do so interfere with other aspects of our lives. On the flip side of reward or pleasure, I would say a resilient reward system must involve our ability to both tolerate pain and in this drug world intentionally seek out adversity and challenges because again we didn't evolve for this world of drug convenience. We really evolved to have to work a lot harder to get our rewards.

[00:30:16]And I think in order to stay healthy in the modern ecosystem, we have to sort of create a world within a world where we're reimulating scarcity and making sure that we're leaning into hard things. Um because ultimately I think that does make us more resilient. So if we're going to heir on the side of, you know, pleasure seeking or reward seeking versus adversity seeking, we don't want to go too far in either direction. But I do think we need to lean a little bit more toward the adversity part and we need to think about that with our children too. Um, in order to build a healthy and resilient reward system, we really need an adequate amount of friction because without that we're not building up the mental calluses that we need to be able to tolerate discomfort, frustration, adversity, as well as enjoy the rewards that come our way.

[00:31:12]Yeah, exactly. Um, then the dopamine detox. Uh, how should we understand dopamine detox? Does dopamine detox really mean reducing dopamine or does it mean giving the brain space to restore its pleasure pain balance?

[00:31:28]Yeah. So, so dopamine detox is really just a shorthand or a meme for reducing or abstaining from our drug of choice for long enough to kind of reset those reward thresholds. So, we talked about how constantly stimulating our brain with these frictionless potent rewards leads to reward insensitivity where those rewards are no longer rewarding.

[00:31:53]We need more potent forms in larger amounts to get the same effect. And when we're not using, we're in sub threshold withdrawal, experiencing anxiety, irritability, insomnia, depression, and craving. So the the dopamine detox or the abstinence trial is really an effort to reset those hydonic or joy thresholds. And we do that, you know, by abstaining from our drug of choice for 4 weeks. Now, does it have to be four weeks? Does it have to be total abstinence? No. I mean this is you can experiment but I can tell you in clinical practice what we find is that abstaining is actually easier than reducing in many instances as long as you're not at risk for life-threatening withdrawal from like alcohol or benzo.

[00:32:40]But if you if you can you know have a safe withdrawal we find in clinical practice with people with all range of addictions because it's a spectrum. uh if they can abstain for 4 weeks, the first two weeks they feel worse before they feel better and that's timelimited withdrawal mediated but we absolutely have to warn people that it's coming because otherwise they think oh this I need this to feel okay well they don't they don't what's really happening is it's contributing to anxiety, depression, insomnia but you have to abstain for long enough to get out of withdrawal before you appreciate the benefits.

[00:33:21]So if they can get through the first 10 to 14 days, which are typically very bad and uncomfortable, then usually by week 3 or four, people feel better. and they feel not only better than they did in the first couple of weeks of the dopamine detox, but oftentimes they feel better than they have in years because people can get into a vicious cycle where they're, for example, smoking pot every night or drinking alcohol every night because it helps them sleep, but eventually because of this opponent process mechanism and neuro adaptation, the alcohol or the cannabis is actually creating the insomnia. But you don't see it anymore because as soon as you use, you get temporary relief. So this is what's important. You have to get away from the drug for long enough in order to reset reward thresholds so that you're no longer in that that state of sub threshold withdrawal. And then people not only feel better, but they're also able to be more objective about what the drug is actually doing in their lives, which is really hard to do while we're actively using the drug because our brains tend to minimize the harms and maximize the benefits even when the harms greatly outweigh the benefits. So, you really need to get out of that vortex of addiction in order to reset reward thresholds to be able to look back and see true cause and effect and then make a decision about what you want to how you want to use that substance or behavior going forward. And frankly, most people want to go back to using, but they almost universally want to use less. They want to have a healthier relationship. So then we engage in a lot of discussion about, okay, what is that going to look like? And when patients say, "Oh, well, I'm just not I'm just going to use now and then," or, "Oh, I'm just I'm I'll be fine." I say, "No, no, no. That that does not work. You we need to get incredibly specific. We need to come up with a very specific plan. When are you going to use? How much are you going to use? Who are you going to use with? What are the circumstances when you're absolutely not going to use? What are your red flags for identifying when your use is again getting out of control? So, so these are the types of things. It's the dopamine fast itself for resetting reward thresholds and gaining an objective view and then it's the plan for what to do after along with accountability and careful monitoring.

[00:35:52]So, that's really key. And what I think is interesting is if you look at all so we know this from clinical experience that 4 weeks is sort of you know kind of a good place to start. Now people with severe addiction you know obviously many of them should never go back to using their drug of choice but nonetheless the discussion of moderation is really important because everything is drugified now. Tech is drugified and yet people can't just stop going on their devices. They need to do it for work, for family, for school. food is drugified. People can't stop eating, right? So, we have to talk about how what does moderation look like? You know, how will I categorize my addictive behaviors even while I'm using this broader category of the the substance or or the behavior. So, that's really important. Um, but I just think it's interesting if you look at every major religious tradition and many philosophical traditions, they have almost all of them built in a 4-week period of abstinence, right? whether it's Lent or whether it's Ramadan or you know what have you. And I think that's just age-old wisdom about the brain and how long it takes to begin to reset these reward pathways.

[00:37:04]>> Yeah, great explanation. Thank you for this. And I I I just want to ask about the G P1 receptors and the AI your choice start with.

[00:37:15]>> Sure. Yeah. I mean, so GLP1s are a new class of medication uh that in the United States have been FDA approved to help people with diabetes and with obesity because they regulate blood sugar, they create a sense of fullness, they slow gastric emptying, uh gastric emptying, so it decreases appetite, you know, through all these kind of gut hormone modulations. But what's very interesting about the GLP1s in addition to those uh aspects is that it looks like the GLP1s also decrease or dampen the release of dopamine in the brain's reward pathway in response to various rewards. And not only does it seem to be happening in response to aitive or salient foods, but also in response to alcohol, nicot nicotine, possibly opioids, maybe even behavioral addictions like uh sex addiction, digital media. So, it's very fascinating because it seems to work directly on the central brain reward pathways. it seems to get at this core mechanism uh of the dampening of the dopamine response and what patients will describe and here in our clinic we sometimes use it for uh alcohol use disorder for example they'll describe that they still get cravings for alcohol but when they take a drink it's doesn't taste good it's not reinforcing it's not doing for them what it used to do and as a result they have no desire to keep drinking And for people who want to stop drinking, that can really be a very helpful neurological nudge. Now, it's not, you know, the magic bullet and people still need to engage actively in other behavioral changes and it's not going to work for everyone and there are side effects. But it is very exciting that we have a new pharmacologic strategy.

[00:39:23]>> Yeah. And what about AI? Could AI become the most powerful behavior addiction technology in human story? What do you think? Again, if you look at the three criteria that make anything potentially addictive, is it plentiful? Is it potent? Is it personalized? AI meets all those criteria. Again, 24/7 free access to many AI platforms, right? Um unlike you know our real human relationships where people are not going to be constantly available to us when we need them cuz you know human relationships are complex and reciprocal. AI has no needs and is always available. If you look at potency, very very reinforcing and engineered to be reinforcing by constantly validating our questions, ideas, perspectives, right? Plus a little sort of anthropomorphism using the I pronoun. Um there's a real kind of sense of mystery. One of the most common queries to AI is apparently allegedly uh are you God? Right? and and and that people have this experience of sort of the numminous when they're engaging with this powerful tool. So that also makes it very very potent. And then talk about personalization, it doesn't get more personalized, right? Here's your own personal therapist in a box, right? Why why bother going to see you or going to see me? I can just talk to AI. So again, you've got that conundrum of a powerful tool and a potent drug all wrapped up into one. Um, which makes it very complicated and difficult to navigate. I would just emphasize that it it's clear to me that a child's brain should not be exposed to AI. The developing brain of a child needs the hands-on, tactile, sematic, emotionally complex interaction with other humans to develop in a healthy way.

[00:41:26]>> Exactly.

[00:41:27]>> How adults might use AI to their benefit. And I'm talking about the AI personalized. I mean, AI is everywhere.

[00:41:34]AI is in my washing machine, you know.

[00:41:36]So when you want to we're using the large language models here as shorthand for these personalized avatars that we're kind of interacting with as if they're our friends/therapist.

[00:41:46]And you know I see good and bad you know for an adult there and but even more more so I see inevitable.

[00:41:55]So we've got to figure out uh you know how to have how to have a healthier relationship.

[00:42:01]>> Yeah. Exactly. And the final message would you like to leave with our aud Dr. Leni? And I would say thank you. Thank you very much for this conversation. It was great.

[00:42:13]>> Yeah. Well, thank you. I'm just excited that I get an opportunity to to speak to your audience and you know to be able to interact with people all over the world which wouldn't be possible without this technology. So there are many many benefits but yeah I would really urge people to sort of reconceptualize digital media as a drug. Um and then think about you know how they want to use it. It's not to say you know humans have used drugs since the beginning of time. Uh but but there are so many drugs and they're so potent now and so accessible that we really need to be a lot more thoughtful and digital media is is one of the most potent drugs that we're exposed to in the modern age.

[00:42:54]It was great. It was great. Really great.

[00:42:57]>> Yeah. My my pleasure.

[00:42:59]>> Yeah. I felt so much though for me.

[00:43:02]>> Okay. Good. Yeah. Me too. Me too. Good.

[00:43:05]And I hope it's helpful for your Yeah.

[00:43:07]Hopeful helpful for your your your audience.

[00:43:10]>> Thank you very much.

[00:43:11]>> Yeah. You're very welcome.

[00:43:12]>> I I can see you next time.

[00:43:15]>> Yeah. Yeah. That be Yes, that'd be great. That would be great. Take care.

[00:43:18]Bye. Bye. Bye. Bye.