With Pleasure Comes Pain -Our Addiction to Dopamine- with Dr.Lembke | Empowering Neurologist EP131

We all want to feel content and connected, and what we are going to explore today is the idea that contentment and connectedness relates to keeping the neurotransmitter dopamine in check.
In her new book, Dopamine Nation, Dr. Anna Lembke, a psychiatrist and author, explores the exciting new scientific discoveries that explain why the relentless pursuit of pleasure ultimately leads to pain, and more importantly, what each of us can do about it. In the book, Dr. Lembke reviews the experiences of many of her patients who are suffering with addiction and hoping for redemption. And these compelling stories give all of us hope for managing our pleasure-directed consumption and transforming our lives.
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Anna Lembke, MD, is a professor in the department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and Chief of the Stanford Addiction Medicine Clinic.
In 2016, she published Drug Dealer, MD - How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press, 2016), highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic.
Dr. Lembke recently appeared on the Netflix documentary The Social Dilemma, an unvarnished look at the impact of social media on our lives.
Her forthcoming book that we review on today’s podcast, Dopamine Nation: Finding Balance in the Age of Indulgence, explores how to moderate compulsive overconsumption, including digital products, in a world where feeling good is the highest good.
annalembke.com
dopaminenation.com
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[@melissal3383]

I think I’m addicted to KZbin videos about dopamine

[@DavidPerlmutterMD]

Hahaha. Good one

[@elizabethl3392]

No really!!! I watch them all. Very fascinating and good the ideas by so hard to control myself with behavioral brain lectures.

[@derosa195]

Bryan johnson addresses food addiction follows basic vegan. . predetermined specific Food "blueprint" pkan

[@tatie7604]

​@@DavidPerlmutterMD What is humorous about this?

[@ginadellgrottaglia6897]

@@tatie7604 OP made a cute joke. Dr. responded appropriately. Pretty cut n dried here...

[@connie7851]

I am a recovered alcoholic of nearly 40 years and I would put out that when first abstaining from alcohol, we substitute feel good things like sugar, being massively busy or exercising,,, coffee, cigarettes and over the top behaviour.... and slowly the balance comes but it takes years with some... others like myself at least 2 years..... just my story

[@jessie9653]

Agree, my story is the same

[@chrissyprice7483]

Indeed, it did take time.. Began to see the light after 2 yrs (normal happiness didn’t stick around long but was sure in sight) Took 4 yrs to feel stable.

[@pepedragoni4393]

@@chrissyprice7483 oh damn.. i'm 1 month sober now, and just started to be able to feel a little stable in ocations.. it's a good motivator. i drinked for 13 years tho. Trying to keep positive and take one step at a time in this new life!

[@chrissyprice7483]

@@pepedragoni4393 Happy for you! Gets easier as time goes by. I was dependent on alcohol for 10 yrs.

[@pepedragoni4393]

@@chrissyprice7483Hi Chrissy, and how are you doing now? Thank you for your encourage! Means a lot

[@zbozz12z]

What an amazing interview. How amazing is this world of free to access information of this calibre!! Thanks Dr Perlmutter as always 🙏

[@howardmiller5411]

This explains why Bikram hot yoga (hatha yoga at 105F for 90 minutes) one of the most *painful* exercises I have ever done ends up making me feel blissful and relaxed for up to 48 hours. And it explains why 10 minutes in the steam room after a resistance work out is so relaxing to thereafter.

[@user-pe2lw1ze8i]

Buckram is a scam and harmful. Stick to room temp yoga with teachers who have good intentions

[@latinaalma1947]

If you never have had any adversity to overcome as a child, how you develop psychological resilience? I had Ricketts as a young child resulting in very bowed legs that required clunky metal braces on my legs as a preschooler. I called them "my boots"..I remember my legs aching at night..not unbearably, but the aches were there. My legs straightened over time. Then I was encouraged to take acrobatics, stretching of legs, ballet, stregthening my leg muscles further. I was encouraged to climb trees, swim, then long distance swim. Even in retirement I jogged and now walk distance.As a result, my legs have always been the strongest parts of my body at age 74.That little bit of pain I experience in my legs when I have always pushed them throughout my life had always been a mood lifter for me...THIS explains it. ALSO I believe it affected my personality...it made me perform at the extreme end of conscientioisness. I am highly motivated. As a child I had no option but to get up and walk in those braces ...we have an instinctual drive to WALK as toddlers and young children, it is biologically driven. That perseverance I developed as a child carried over to my education carrying me through the ten years of higher ed it took to get my PhD....the continued conscientiousness in my career, then the committment it took to live under my income, save and invest to retire early at 50 to reach my goal to sail for my first 10yrs of retirement...I LOOK for long term challenging goals and I think I owe that, at least the beginning of that habit, and NEED for longterm goals that require sacrifice, down to those braces. I am sure adults pitied me as a little child in those things but they turned out to be my BEST friend in life developmentally. So I believe in challenging children and developing in them resilience....taking on things that will be uncomfortable that result in a benefit to them. Packing children in cotton batting really diminishes their opportunity for these hidden positive experiences of mastery. Sybil Francis PhD clinical.psychologist. & professor since 1979

[@soulcostume]

Listening to Dr. Lembke is a therapy itself. Dr. David is known for his calming voice. Thank you for this treat💞

[@CalmVibesVee]

Yes they both have a graceful and calming spirit. I appreciate Dr David’s energy of peace and hope.

[@DavidPerlmutterMD]

Such kind words, thank you!

[@peterhernandez5618]

Glutamate and substance P (SP) are the main neurotransmitters associated with the sensation of pain. Lastly, dopamine is for pleasure. Neurotransmitter homeostasis is gotten by not tipping to much to either side. greetings from Ecuador, Portoviejo city. and thank you for sharing

[@gazels11]

Excellent discussion. This really helps us understand ourselves and others at a deeply empathetic level. We all have our demons and understanding them and trying to face them with grace and dignity is healing and makes it all the more possible. There is so much hope and this discussion proves that. Thank you very much. I have pre ordered Dr. Lembke's Audible book as well. Looking forward to it.

[@emh8861]

When I was young and would see those Laugh Now Cry Later faces, they made so much sense to me .

[@pianorama]

This makes so much sense.

[@KaceyAnnReynolds]

As a personal trainer working with clients who are addicted to food, I have seen how these people slowly get addicted to all forms of pleasure, social media, Netflix binging, sexting strangers, compulsive shopping, gossip, and even being hurtful to friends and family..... Then they feel so much remorse, pain, and shame, so they overeat even more......Weight loss surgery is the final step, which sometimes leads to addiction to more serious substances, and higher rates of suicide.... The core issue is addiction which the surgery cannot cure, and it will only worsen if the addiction issue is left unhealed.... I have had to set boundaries, as I feel unqualified to coach clients who have serious food addictions, it is too mentally draining for me.....

[@dawndan1267]

Very interesting interview. Hopefully I can apply what I’ve learned today in combating my own addictions. Thank you so much for sharing this information.

[@1life_Only]

I back you Dr Lembke on your findings. After few years of substance abuse, I finally utilised covid to stop for good with 1 tool that’s educating myself about my weird brain. It’s been nearly 2 years and I could not have felt better. Thank you both 🙏🏽

[@msanchez0125]

Really great conversation. I am in recovery from alcohol and opiates, and I can relate a lot. This is helping me to make more sense of what I've been through.

[@DavidPerlmutterMD]

Wishing you good health on your journey

[@johndoudna7055]

Great interview on an interesting subject with intelligent, articulate, participative persons. Thank you both.

[@NathanHarrison7]

Excellent discussion. Thank you.

[@pswoop14]

Great insight by Dr L.

[@richardflamburis9887]

I am clean and sober going on 39 yrs of complete abstince from all drugs, including alcohol, whether prscribed or street obtained. There is an occasional PTSD, less and less as I experience this spiritual transitioned that is referred to, by many, called life. I started shooting heroin at 15 and was

[@dauber1071]

That was great… but see you in four weeks 😬

[@soulcostume]

You can do it. On the other side is your win.

[@amen.7100]

Wellll...?!

[@dauber1071]

@@amen.7100 well, thank you for checking! A change of environment helped a lot. In my case, my little addictions exist to fill some kind of human connection and sometime just boredom. Lately I’ve been busy with bonding and traveling, so I’ve been lucky. I’d say good friends and love are the best antidote against addictions. Thanks 😊

[@raghubirsingh589]

oq

[@dawnholoboff3578]

This was an excellent very informative interview. Thank you so much

[@lorilea3188]

I am grateful to have found this video this morning, thank you for my introduction to Dr. Lemke. A week and a day without sugar, i was just tested at a conference laden with sweet treats i easily avoided; free alcohol, not so much. One day sober.

[@DavidPerlmutterMD]

Glad to know this information reached you at the right time!

[@chrispaulus4390]

great interview!

[@mikeb0607]

Thanks for the video. Well said.

[@s.d774]

I'm wondering if exercise can be used throughout the day to mitigate withdrawal symptoms. Example, 3 sets of 6 reps everytime someone starts feeling that depressed, bored and irritable/anxious feeling during some types of withdrawal. If it's isolated exercises, one could pick different muscles each time and therefore not damaged by overuse. I used to try this with stretching and wouldn't recommend that.

[@thechristiankaren2229]

Great interview!

[@philllove528]

True i love her analogy on pain biochemically in comparison to raising children in tough love

[@DJSTOEK]

Thank you

[@pratipkarmakar01]

Soooo much value in this video.

[@DavidPerlmutterMD]

Glad you think so!

[@keithdesantis1976]

Dr Lembke seems to be such an intelligent kind non-egotistical person.

[@leannekites4965]

I think eating disorders are a form of cutting in that it causes pain but afterwards gives a release or freedom until the need arises again. This lady is making sense about the pain and dopamine.so swapping pain of addiction for a substitute like pinching or something wakes up our pain response naturally? I hope this is true.

[@illinaphejbe6510]

Cold shower can be painfull but after you are happy for 2 hours at least

[@ddcmr9]

This is answered a lot of questions for me thank you so much. I am definitely dopamine deficit, i need help, bipolar, and miserable!!!!

[@vikasgupta1828]

Thanks

[@julietijerina8176]

I would love for Dr. Robert Lustig and Dr. Lembke could join forces and talk to us and our elected leaders about this dopamine/depression and how it's exploded since the advent of ultra-processed food.

[@CalmVibesVee]

Good topic as I am trying to fast from sweeteners right now. I have overused stevia greatly. Been keto and IF 4yrs and it has greatly improved my life also keeps me sober and no more overeating. Its been a miracle for my life actually. 2-3 day fasting for healing my gut is my goal and frequent use of sweetener has held me back. So Im trying to learn about dopamine healing as I think its applicable in my detox approach. Thank you 🙏🏼

[@downbntout]

What's the trouble with stevia? I use lots of it. What does it do?

[@InnerElev8tion]

So the case with the kid that was using suboxone. Does he continuously take it everyday? Like is he going to take it forever? I would love to share my experience with suboxone. I’ve always had a bunch of questions about the detox drug and the addictive properties it holds itself. I know we are all wired differently but I fee I found a sufficient alternate way of sustaining a happy and healthy life with out it after a short period of detoxing

[@deflo56]

This makes a lot of sense from a behavioral concept: Kinda why we are drawn towards the behavior, why we repeat the behavior, why we become dopamine resistant. Then again I wonder, in regard to carb addiction, if microbes drive the addiction. Often making it impossible through pain to remove their nutrients from your diet.

[@jamesemarsh]

I think you meant to say carbohydrates. Hydrocarbons are things like petroleum and natural gas.

[@thesoundpurist]

if the individual still tipping on the side of pain after a month of abstinence would the wim hof method be a good option before the buprenorphine option?

[@debshirley6904]

Love, love your haircut!!

[@leannekites4965]

5.27. Second rule. Dopamine hit is balanced harder by pain gremlins. Causing a dopamine deficit. Causing misery addiction And the need to take a hit of whatever you need to get it and the cycle repeatS.10.30. Abstaining Resets the pain side creating a balance or less need to get dopamine hit. 4.53. If you use something to relieve pain,

[@philllove528]

Most valuable note was that of chris....

[@geraldcollins7103]

No pain no gain

[@mrsrodriguez1372]

Does any of these experts say that the substance/ habit the person uses has impact on their recovery?

[@sylviekaiser1064]

In the poverty discussion- yes there seems to be a pattern(disturbing)- yet what about the confounders such as trauma and epigenetics…surely there are other pieces of that puzzle- nothing and noone occurs in a vacuum

[@Kikwatz]

It's like the famous swiss rapper DJ Bobo rapped in his smash hit from 1993, "Everybody": "Pleasure and pain, is sometimes the same...."

[@bobbycecere1037]

Freedom model of addiction says craving doesn't exist. They say it's an action that you take and not something that happens to you

[@ColonelClaypool]

What I don't think I understand regarding the pleasure pain mechanism... We require pain to balance out pleasure in order to achieve homeostasis. That way we can feel more pleasure again. But in reverse, couldn't that mean that we also should avoid pain at times? And if so that could be an excuse to stop doing things that are actually good for us, like exercising that bring us physical pain. Any ideas?

[@Mariam-id2xo]

I don't think exercising brings you that much pain. The benefits of doing sport overweighs the "pain" for sure. Also, I wouldn't recommend exercising so much that it gives you physical pain. That sounds counterproductive. On the other hand, drugs, excessive eating etc. bring you joy for a moment but the negative effects exceed this short-term pleasure by far.

[@hoavuong7199]

There are different kinds of pleasures and pains.

[@barbarawojciechowska7847]

What about serotonine?

[@timcepin3386]

How about how benzodiazepines leave us void of GABA and SSRIS such as Setraline leave us void of Serotonin! P.S. Before psychiatric medication is to prescribed, your amino acid, neurotransmitter, and microbiome ought to have to be tested all together before medication may be prescribed!

[@hanaeelkholti7168]

In our religion we fast for one month( 4 weeks) jwe don't do sex and we don't eat during the day! I'm just very surprised that it perfectly aligned with the science and with the time period that the doctor explained!

[@Mhumaikani1993]

But sex is allowed after the sunset prayer? Isn't it? And indulging in food is what people do after sunset prayer? Isn't it?

[@illinaphejbe6510]

@@Mhumaikani1993 yes it is alow till the second day when the fasting start again .

[@SouLightness]

I wonder if parkinsons has elements of having used too muc dopamine...

[@Moose808]

Can someone tell me why Dr Lembke says dopamine is the pleasure neurotransmitter - isn't it to do with motivation?

[@arnoldschwarzenegger1527]

pleasure is the serotonin.

[@downbntout]

This must explain why people get hooked on piercings and tattoos

[@Exodus26.13Pi]

4:00 title content

[@stephenrandell7152]

I wonder how this fits with people who have ADHD?

[@chuckbecker8735]

This is not a joke:: I must confess I am ashamed to the max that I'm suffering and destroying my life with a drug of choice which sounds so benign and ludicrous to others....... binge watching 14 hours/day Shark Tank & Dragon's Den. Not kidding.

[@loriwinters9999]

Try the cold showers? Good luck!

[@chuckbecker8735]

@@loriwinters9999 Thank you, my Crossfit trainer has been trying to get me to do various coldies for years. Now you've inspired me for psych reasons.

[@loriwinters9999]

@@chuckbecker8735 Dr Lemke briefly mentioned it in the video as a pre-emptive 'pain first' strategy. All the best.

[@chuckbecker8735]

@@loriwinters9999 Thank you. I am on day 3 of total abstention. Be blessed.

[@soulcostume]

@@chuckbecker8735 Keep the momentum! Listen to this and Andrew Huberman's recent podcast - on repeat to make yourself accountable!

[@davidnich3394]

Fascinating, gives you so much useful to think about. I've often wondered by beautiful women are so rare, so intensely pleasurable to look at, you'd think it would be a much more genetically successful trait, everywhere, but it's not, wonder if pleasure overload is why, infatuation with beautiful women has always lead to pure agony for me.

[@leannekites4965]

40.53. Take addiction out for 4 weeks.

[@cobytunapisac2]

so the Stoics were right...

[@debbiedebbie9473]

4:34

[@peouspaul1258]

Lack of healthy foods lead to addictive foods , drugs ..

[@cathyjennings5580]

Chronic FATIGUE means some women have DOPAMINE DEFICIENCIES, INSUFFICIENCY. HELP US!! WHERE CAN WE THIS without addictions. 🤒😪

[@pannitalmadge7464]

omg so starve and workout all the time

[@livondiramerian6999]

If we live according to the essence of life, we don't need to have pain only those who are addicted to drugs may have pain.

[@steveeickhoff1968]

How is this relative to Parkinson's Disease

[@hamsam789]

dopamine is related to movement too, watch Dr hubermans latest podcast for more info

[@dr.miguelo4622]

Is an addicted ever cured?

[@ddcmr9]

No

[@loriholman6125]

Body Brockers ‼️

[@tugcesenagurkan]

It’s concerning you have this mentality with kids. I assure you they will end up in theraphy, which is good as they will recieve a trusting relationship that does not see them as worth punishment or occasionally embarrasment. And if anyone else got triggered with what she suggests, you should not have been treated that way as a child and thought that is the type of love you deserve, and please don’t do that to your child. If you think you will, don’t bring them into this world. Boundaries and structure do not equal punishment and embarrassment.

[@kristenwilson6767]

Guiding children doesn't need to shame children as the Dr believes 🙄.

[@leslee7059]

Low Inome people tend to accept medications and surgeries more readily s they believe it is a "freebie" from the government. Higher income populations have other options.

[@matthewbradshaw4358]

Why would anyone suggest to an addict that going back to there drug of choice after a 4 wks is okay ? Thats insane.... always remember is to many and a thousand is never enough... put GOD 1st ... live out Matthew 6³³ ...

[@bjd15664]

Can't hear her

[@cathyjennings5580]

Drug free.

[@derosa195]

Not funny you tube addicted

[@cathyjennings5580]

Nuts!!! Acupuncture does NOT FEEL PAINFUL. FEELS GOOD. SOMETIMES there is NO PAINS DURING A TREATMENT Of 30 minutes or more. Note.

[@Carmen_Lapadat]

You do not know what you are talking, ADHD is real, I am medicated just as 48 year old. Before not. It is not social control. You do not know what is ADHD. Just go and read. I am telling you, challenges come anyway. You have no idea Poverty brings unhappiness and maybe "the look" for pleasure. Children have stress too. I really do not know what you are talking. You should look for others than Freud. You are blocked at Freud. That's horible, really... what you are talking. So, what, a child won't feel grief? To be friends with kids means to real understand them, like a friend in the Bible. Friend does not mean superficiality... life just party, wow... horrible interview and I am almost 49, I live in Romania, my first 14 years were in communism, almoust no tv, so seldom chocolate, no enough nutrients and though my parents had an appartement in Bucarest I lived years at the countryside without current water and bathroom in the house. I did not feel distress at that age at the countryside, but I felt in many other situations and I am convinced that it was not a good thing. I think you should stress more your brains, study more and think less about other people discomfort, especially when it is about ADHD, depression and anything serious. Even in the Bible there are cases of sensitive people and nice behaviour towards children. You took one proverb and you think that is the law of God or all the Bible. I am so sorry that I listened to you and to something like that. Even in the USA people face so often homelessness, they do not really afford nutritious food, work too much... What about losing neurons from stress? I think that is more common and no one escapes normal stress. And mostly very superficial people also apply to them the physical stress, so, even if they seek pleasure, they stress themselves enough at the gym, under the sun, on the waves of the Ocean. I cannot tell enough how wrong you are. You are too comfortable. You should do something to get a more sensitive brain so you two can think more at your faults than at others' faults.