New Podcast Release: Anna Lembke
In the latest episode of Lives Well Lived, the podcast I co-host with Kasia de Lazari-Radek, we talk to Anna Lembke, professor of psychiatry at Stanford University and author of Dopamine Nation
In the latest episode of Lives Well Lived, the podcast I co-host with Kasia de Lazari-Radek, we talk to Anna Lembke, professor of psychiatry at Stanford University and author of Dopamine Nation, about the science of addiction, the role of dopamine in pleasure and motivation, and how modern society encourages compulsive overconsumption.
Anna explains how addiction is not just about substances but can extend to behaviors like social media use, gambling, and even compulsive reading. She discusses the impact of “limbic capitalism,” a system designed to keep us hooked on everything from digital devices to ultra-processed foods, and why increasing access to highly rewarding experiences can lead to a society more vulnerable to addiction.
Below are some highlights from our discussion, lightly edited for clarity. You can listen to the full episode on Apple Podcasts, Spotify, or your preferred platform.
Technology, Phone Use, and Digital Addiction
Kasia: I use my phone all the time. I am woken up by its alarm, I read news on it, I have it in my car when I check the quickest way home, I use it for emails, messages, social media, chat got, music and our podcast. When I drive my car and keep it in my bag and the bag at the back of the car, I feel bad as I can’t look at it, touch it, etc. Am I addicted?
Anna: You are very, very attached to your phone and that attachment runs deep. And it's not just a practical attachment, but there's a deep emotional attachment. And I would even say it's akin to the kind of attachment that we have to other living organisms that are very valuable to us. And it's probably in the future that we will be attached to devices in this way. So, I think to just sort of say, oh, anybody who's attached to their device that way is addicted, is not something that I would stand for or stand behind.
On the other hand, I think it probably would be useful for you to reflect on some of the pros and cons of your attachment to your phone. As I'd like to say, do an experiment where maybe you detach from your phone or parts of your phone or certain applications for a period of time and just sort of see what you discover about yourself.
Defining Addiction and Its Criteria
Anna: There is no brain scan or blood test to diagnose addiction. We base it on what we call phenomenology, which is patterns of behavior that repeat themselves across cultures, times, periods, temperaments. There are 11 criteria in the diagnostic and statistical manual of mental disorders for things like substance use disorders. In fact, there is no DSM criteria or category for a device addiction or a social media addiction - that hasn't yet made it into our time diagnosing these things. We do have gambling addiction. There is “internet gaming disorder” as a provisional diagnosis, but a device or phone or internet addiction isn't there.
Having said that, if we were going to summarize those criteria for addiction more broadly, the best way to remember them is to think of the four C's and tolerance and withdrawal. So the four C's are control, compulsions, cravings, and consequences, especially continued use despite consequences. And then there is tolerance, which is needing more of our drug in more potent forms over time to get the same effect or finding that our drug at the current dose stops working. And then there is withdrawal. It is a manifestation of a physiological rejection, or pain, in the wake of trying to cut back or stop our use. The universal symptoms of withdrawal from any addictive substance or behavior are anxiety, irritability, insomnia, dysphoria, and craving.
The Role of Dopamine in Addiction
Anna: Dopamine is a chemical that we make in our brains. It has many different functions, but one of its most important functions is that it's essential for the experience of pleasure, reward, and motivation. It may be even more important for motivation than for the pleasure/reward category. and there's controversy about that.
The more dopamine that we release in response to a given substance or behavior, the more likely that substance is to be something that we want to do again. So in general, we reflexively approach pleasure and avoid pain. It's not something that we have to think about. Dopamine is the neurotransmitter or the chemical that is central to that process of approaching, exploring, and doing it again and again and again because our brain identifies it as essential for survival.
The Impact of Capitalism on Overconsumption and Addiction
Anna: “Limbic capitalism” refers to the ways in which capitalism itself drives over consumption. On some level, the ideal end game for any successful capitalist economy would be to turn us all into addicts, compulsively overconsuming and doing pretty much nothing else. And I would say we're getting close to that vision, and it's very concerning.
We've essentially taken almost every substance and behavior, and we've made it more potent, and more ubiquitous, so that it constantly sends signals out in all kinds of different ways.
Despite all this material wealth, people in the wealthiest nations in the world are less and less happy and struggling with more depression, and more anxiety. In some countries, there are rising rates of suicide. The top three causes of death and the deaths of despair are related: liver disease, drug overdose, and suicide. We have a huge problem of compulsive overconsumption, along with our material abundance.
Addiction to Sex, Pornography, and Masturbation
Peter: Let's talk about masturbation, You have an example in your book, a man you called Jacob who's addicted to masturbation and clearly it's making him miserable. When I was growing up, the prevailing culture was that masturbation was somehow a disorder, or a sin, that you should avoid. We don’t want to go back there and make people feel guilty about masturbating, because all the studies show that about 90% of people masturbate at some point. So tell us what it is about Jacob that made him an addict, and that was bad.
Anna: I would just go back to the four Cs. Control, compulsion, craving, and consequences. he got to a point where he was spending many hours every day masturbating. To various forms of pornography. He was not, leaving his house. He was not doing his work. He was not interacting with other people.
He made a masturbation machine. He was an engineer. He made a machine. eventually over time that machine got more and more sophisticated. Then he hooked it up to the internet so that people in chat rooms could actually control the machine remotely, which put him at great danger. He could have been electrocuted, could have died.
He repeatedly tried and wanted to stop this behavior and was not able to, even when his wife left, and even when he almost lost his job, even when he was suicidal and almost took his own life, he had difficulty stopping this behavior.
The Role of Pain in Recovery and Cold Showers
Peter: In your book you describe how one of the ways a cocaine addict got over his addiction was by taking cold showers, and also ice baths, feeling this kind of extreme pain, but then getting a high afterwards. I thought, well, that's interesting. Let's see how that works. So I've been having cold showers the last few mornings. I should say that I'm in Melbourne where it's summer, so it's not so difficult to have cold showers. And yes, I feel pretty good after it. I've never taken cocaine so I don't know how the highs compare, but there is definitely a high you get after a cold shower!
Anna: Peter, I am delighted to hear that. Absolutely delighted. I'm gonna go home and tell my kids that because of my book, Peter Singer is now taking cold showers. I'm thrilled."
Personal Tragedy and a Life Well Lived
Anna: The real pivot point in my life was, we lost our first child to leukemia. And that kind of pulled the rug out from under me in terms of my whole worldview, what I thought I could control or not control, my identity, who I was in the world. It really completely changed me. And as painful as it was, it really changed me for the better. I think I was a better doctor, a better wife, a better mother, all things I value, you know, because of that terrible loss.