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bilibili_data_75123309_BV1nL4y1N7TN_p34_BV1nL4y1N7TN_p34_m4-dialogue_0309189
[S1] I would imagine will be very uncomfortable. [S2] Yes. [S1] They're going to suck, basically, to be quite honest, because what, if, the way you describe this pleasure-pain balance, to my mind says that if you remove what little pleasure one is getting, or a lot of pleasure from engaging in some behavior, that's gone. The pain system is really ramped up and nothing is making me feel good. I'll just use myself as an example. I'm not in recovery.
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[S1] But, you know, that ten days is going to be miserable. [S2] Right. [S1] Anxiety, trouble sleeping. [S2] Yep. [S1] Um, physical agitation. [S2] Yes. [S1] And to the point where, you know, um, maybe impulsive, angry. [S2] Yes. [S1] Should, should one expect all of that? Should the family members of people expect all of that?
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[S1] As long as they have access to their drug or behavior, they're not able to stop themselves. And that's why we have, you know, higher levels of care- [S2] Sure. [S1] ... or residential treatment. So this is not going to be for everybody, this intervention, but it's amazing how many people with really severe addictions to things like heroin, cocaine, you know, very severe pornography addictions, I posit this, and I do it as an experiment. I said, you know, let, let's try this experiment.
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[S1] So the way you describe it, um, seems like it's hard. [S2] Mm-hmm. [S1] But it's doable for most people, not everybody. [S2] Yeah. Right. [S1] And we'll return to the, that category of people who can't do that on their own.
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[S1] Well, then days 21 through 30, uh, people are feeling better. The sun is starting to come out, as you mentioned. They, it, which translates in the narrative we've created here in support by biology that dopamine is starting to be released in response to the taste of a really good cup of coffee, for instance. [S2] Yes, exactly. [S1] Whereas before it was only to insert, you know, addictive behavior. [S2] Right, that's right. [S1] Whichever it happens to be. [S2] Of course, coffee can be addictive too, but, but we'll leave that aside. [S1] Sure. Yeah.
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[S1] ... that aside. [S2] Yeah. [S1] [LAUGHS] [S2] I feel like coffee has a kind of, um, consumption limiting mechanism built in where at some point you just can't ingest anymore. [S1] Yeah. [S2] Um, but maybe that's wrong. Sorry to give lift to the caffeine addicts out there. [S1] [LAUGHS] [S2] As I, as I clutch my, my mug. Um, so days 21 through 30, um, I've seen a lot of people go through,
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[S1] the real window of, let's say, being able to access my compassion around people who are repeat relapsers, even when their life is so much better, when they're in recovery. [S2] Oh, yeah. [S1] Yeah, it's like, it's like a no-brainer, right? Um, is, is to conceptualize this balance and the dopamine deficit state and a balance tilt, tilted to the side of pain.
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[S1] And to imagine that for some people, after a month or six months or maybe even six years, their balance is still tipped to the side of pain. That on some level, that balance has lost its resilience and its ability to restore homeostasis. [S2] It's almost like the hinge on that balance is messed up. [S1] Yes, exactly. And so, I mean, for, for someone who's never experienced addiction like yourself, maybe one, one way to conceptualize it is,
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[S1] Well, I didn't say that. [S2] Oh, okay. [S1] No, I was not, I, to be clear, I w- I was not referring to myself, but I, I, I, in this example I was given, I, if I were, I, I would, I would, um, come clean. I, I would reveal that. Um, but I, I think that especially after hearing some of your lectures and descriptions of the range of things that are addi- addictive, I think, um, I, I've been fortunate that I don't have a propensity for drugs or alcohol. [S2] Right, okay. [S1] I'm, I'm lucky in that way. [S2] Right, right. [S1] That,
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[S1] Frankly, if they remove all the alcohol from the planet, I'll just be relieved because no one will offer it to me anymore. [S2] Right, right. [S1] So don't send me any alcohol. [S2] [LAUGHS] [S1] It won't go to me. [S2] Right. [S1] But, uh, but I don't have that, um, I like to think I have the compassion, um, but I don't have that, uh, empathy for
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[S1] You know, taking a really good situation and what from the outside looks to be throwing it in the trash. [S2] Right, right. Yeah. So, okay, so, so is that what that, that means? And this is really, I think, important because I, I also had to come to an understanding of this and I feel that I have in my 20 years of seeing these patients, and of course addiction is a spectrum disease, right? [S1] Sure. [S2] And so you've got the severe end of things. Um,
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[S1] That's a great description. And actually in that description, I can feel a bit of empathy because the way you described scratching an itch in your sleep. [S2] Yeah. [S1] You know, I've, I've done that with mosquito bites in the summer. [S2] Right. [S1] And scratching, and you're like, "Oh, you wake up scratching that- [S2] Right. [S1] ... that, that mos- mosquito bite." And I also have to admit that I've experienced not feeling like I wanna pick up my phone because it's so rewarding, but just finding myself doing it. [S2] Yes, of course. Yes. [S1] Like, I'm not gonna use
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[S1] Right. [S2] And I, I know enough about brain function to understand that we have circuits that generate deliberate behavior and we have circuits that generate reflexive behavior. And one of the goals of the nervous system is to make the deliberate stuff reflexive so you don't have to make the decision because decision making is a very costly thing to do. [S1] Exactly. [S2] Decision making of any kind. [S1] Right, right. [S2] So that does really help. Um, and,
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[S1] ... the, uh, I, I want to just try and weave together this, um, this dopamine puzzle, however, because if by week, let's, so first phase of this, uh, 30 or 40 day, um, detox, it's like a dopamine fast. [S2] Right. [S1] Right? Okay. First 10 days are miserable. Middle 10 days, the clouds are out, there may be some shards of sunlight coming through, and then,
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[S1] All of a sudden, sun starts to come out, it gets brighter and brighter. Why is it, then, that people will relapse not just after getting fired from a job or their spouse leaving them, but when things are going really well? [S2] Yes. [S1] Is it this un- unconscious mechanism? 'Cause I've seen this before, is, uh, they have a great win. I have a friend who's a,
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[S1] Really impressive, creative. Um, I don't want to reveal any more than that, but, uh, and relapsed upon getting another really terrific opportunity to create for the entire world. And I was like, how can that happen? But now I'm beginning to wonder, was it the dopamine associated with that wind- [S2] Mm-hmm. [S1] ... that opened the spigot on this dopamine system? [S2] Mm-hmm. [S1] Because, um, it happened in a phase of, of a really great stretch of life.
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[S1] Right. [S2] I have to assume that those things are braided together in our nervous system for the specific intention of when you feel something- [S1] Yes. [S2] ... good, then you feel the pain. [S1] Yeah. [S2] But maybe you don't notice it. [S1] Yeah. [S2] And then the next thing you know, you're pursuing more of the thing that- [S1] Yes. And I
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[S1] Former addicts often do. They've got these great sayings. Um, but I think it fits very well with what you're describing. He said, you know, "No matter how far you drive, you're always the same distance from the ditch." [S2] [LAUGHS] [S1] And I, and, and I said, "Well, that's kind of depressing." And he said, "No, that's actually what gives me peace." [S2] Yeah. [S1] Because what would happen is for so many years of relapsing and relapsing, getting, recovering and relapsing, he felt like it was hopeless. And then somehow conceptualizing that,
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[S1] The vigilance can never go away. [S2] Mm-hmm. Mm-hmm. [S1] Instead of making him feel burdened. [S2] Yeah. [S1] It made him feel relieved. So I often think about that, uh, that statement, you know, "No matter how far you drive, you're always the same distance from the ditch." Because in my mind, I conceptualized that as, "Gosh, that's a, that's a tough way to drive down the road." But actually, on a road where you know where the ditch is and where you know where the lane lines are, it's actually a pretty nice drive. It's when you don't know where the shoulder is that you constantly have to be looking around. So there's this,
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[S1] I do want to ask about those communities. Uh, I have a question which might be a little bit, um, controversial, uh, for- [S2] Great. [S1] ... which is, is it possible that people who were addicted to drugs or alcohol or some gambling or some other behavior get addicted to the addiction community? Because one thing that I think I observe over and over is that there's some circuit in the brain of human beings that has to,
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[S1] ... tell you about the dream they had the night before, for whatever reason. [S2] [LAUGHS] [S1] Um, there's another circuit that leads people to, uh, wake you up if they, themselves can't sleep. I don't know what the- [S2] [LAUGHS] [S1] ... there is. I'm being facetious here. But there does seem to also be a circuit in the brain of addicts to discuss and want to
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[S1] They'll say, "Great meeting." [S2] Yeah, right, right. [S1] They're like, "That was such an amazing meeting." Or they find a group. [S2] Right, yeah. [S1] They find a group in a location. [S2] Yeah. [S1] Like we see, I, this is almost an inside joke in those communities. Again, I'm not reporting, I'm not talking about a "friend," in quotes, this isn't me reporting. Well, they'll, um, they'll talk about how attractive people are at a given meeting or how, how bonded they feel to people at a given meeting. [S2] Right, right. [S1] That the meetings themselves become their own form of dopamine hit. [S2] Yes, yes, yes. [S1] And, and
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[S1] Yes. [S2] And, and again, I'm not being disparaging. [S1] Yes. [S2] I just, I, I want to understand this. [S1] Right. So, yeah, so, uh, so a lot of times patients will say to me, "Oh, you know, I don't want to go to AA. It's a cult." And my response to that is,
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[S1] ... relationships where the one person is not in recovery, and like, you're going to so many meetings, you're always talking about recovery, but you know what? Much better than them being intoxicated, right? I mean, so, although you may tire of your friends talking about their, their, you know, meetings all the time, I'm sure you would rather have them do that than, than, you know, be in their addiction, so. [S2] Yeah, absolutely. And, um, this is now the second time you've done this during this discussion. [S1] [LAUGHS] [S2] But now I have empathy because the way you describe their enthusiasm about meetings- [S1] Yes. [S2] ... is probably the way that people feel about me- [S1] Yes. [S2] ... at work.
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[S1] Right. [S2] And my, in neuroscience. I mean, I've been getting up in front of the class since I was eight years old and talking about things I read over the weekend. Now I just happen to have this thing called a podcast. [S1] Right. [S2] I've been doing, I've been doing it since I was little, and it annoys a lot of people, right? I've learned to suppress it a little bit. [S1] Right. [S2] Some people like it, but I, I'm poking fun at myself just to say that I now can, uh, understand that the way I feel about their reports about yet another amazing meeting, or, and, or for,
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[S1] This is a different form of this, but there are some people for which they just love intense experiences. [S2] Yes. [S1] They're always t- like trying to-
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[S1] pull me off to Bali because they're talking about how sensual it is all the time. I'm sure Bali is wonderful. [S2] [LAUGHS] [S1] But there's this kind of ratcheting up. It's like seeking Burning Man all year long. [S2] Right. [S1] I've never been to Burning Man. No desire to go to Burning Man. [S2] Right. [S1] Um, but inside of academia, I mean, if I were to just turn the mirror at myself, inside of academia or here in Silicon Valley, work.
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[S1] and the pursuit of more success. Even if money is kind of divorced from that, sometimes it is, sometimes it isn't. Academic work is, you know, for sake of pursuit of knowledge. It sounds to me like the same mechanism. [S2] Yeah. [S1] In fact, it feels to me very much like the, the, the same mechanism.
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[S1] So Andrew, here's what I love about you. First of all, you're willing to bring your own flaws and foibles to this conversation. [S2] Well, they're everywhere. [S1] Well, you know what? It's wonderful. And then you're really open and curious and wanting to understand, 'cause I can't tell you how many people I have met who really see addiction as some kind of otherness. But the truth is, we're all wired for addiction. And if you're not addicted yet, it's, it's just, it's right around the corner. Do you know what I mean? Especially with the incredible
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[S1] For me, it made me feel safe. [S2] Okay. [S1] I felt like, um, yeah, I just felt like this. And I paused there 'cause it's like, it's like peace. I'm like, "Ah, I can relax for a moment." [S2] When you're talking about neuroscience. [S1] No, or just when I'm, when I've, when I feel like I'm on the right path. [S2] Yeah, okay. [S1] And I'm-
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[S1] ... and I'm on to something, or if I see something that I'm excited about- [S2] Right. [S1] ... I'm like, I feel, um, filled with, it must be dopamine. [S2] Yes. [S1] I feel flooded with pleasure, literally from head to toe. [S2] Right. Yeah. [S1] And then my next thought is, more. [S2] [LAUGHS] So true. You're, you're, you're really, you're a true addict. [S1] Yeah. Okay. [S2] You are. [S1] Thank you. [S2] You are, but you-
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[S1] You're, you're, you're really, you're a true addict. [S2] Okay. [S1] You are. [S2] Thank you. [S1] You are, but you just got really- [S2] I think that- [S1] You really got lucky with the fact that- [S2] Uh-huh. Yeah. [S1] ... that what, you know, what you're drawn to is, is adaptive, essentially, you know? Um, and, and then your challenge is going to be that your life doesn't get too out of balance in the sense that you're 24/7 work and you don't stop and do some other things- [S2] Sure. [S1] ... or think of other- [S2] In my life,
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[S1] But the dog is good because that draws you out of yourself and a little bit away from the work. But again, you know, I think the key here is for people who feel like they don't, they've never experienced addiction or they don't know anybody with addiction or if they do, they don't get it, just think of that one thing that is the most important thing in your life that you do that gives you pleasure and meaning and purpose, and then imagine if you couldn't do it. [S2] Oh, yeah. Let's not talk about that. [S1] [laughs] [S2] [laughs] [S1] Right.
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[S1] Right. [S2] Uh, well, I appreciate the, the feedback and, uh, you can send me a bill at the, at the end. [S1] [LAUGHS] [S2] Um-
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[S1] Really. So I had a very lovely patient who was, uh, had a severe alcohol addiction, and she got into recovery from her alcohol addiction, um, for many years, but she kind of had a sort of a polydipsia or an urge to be drinking something a lot. And so she drank a lot of water, and slowly over time, she realized that if she drank enough water, she could become hyponatremic and delirious and be out of herself, which is- [S2] You can die from it, right? [S1] Right.
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[S1] Right. Which is, which she just wanted to be out of her own head. And so she would periodically, intentionally overdose on water in order, you know, to, to, I know it was so sad. So sad. [S2] What happened to her? [S1] She eventually t- took her own life. [S2] Wow. [S1] Yeah, it was really- [S2] That's rough.
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[S1] Wow. That's, that's intense. Um, in your book, uh, "Dopamine Nation," you also describe some amazing paths to recovery. People that, um, you know, from reading it, I would, I won't say which ones and who, 'cause there's some great surprises in the book too, both, um, tragic and, and, and triumphant, as they say. Um, you've often described your patients as your heroes. [S2] Yeah. [S1] Yeah. Tell us a little bit more about that.
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[S1] And you take their remar- remarkable accomplishment, and then you imagine the world that we live in now, where we are constantly invited and tempted, and really bombarded with opportunities to become addicted at every turn. [S2] It's like feeling an itch everywhere. [S1] Oh, yeah. I mean, you can't-
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[S1] You know, as I talk about in my book, I have my own addictions and I really just, like, took a page right out of there, but I was like, "Okay, what do I do now? All right, what did this patient do? What'd that, okay, I'm gonna try that." [laughs] [S2] It is, it is an amazing community of- [S1] Yeah. [S2] ... of, of, of people that- [S1] Yeah. [S2] ... they are very sage. I wanted to, um, just touch on something that you mentioned, which is, uh, the shame.
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[S1] intensity in my human connections. Like I'm really not interested in and bored by and made anxious by, um, casual, um, interactions. But, you know, like having this kind of discussion with you that's very intense and also intimate and self-disclosing is very rewarding for me. So that's a, an important source of dopamine. Thank God I became a psychiatrist. [S2] Mm-hmm. Yeah, absolutely. [S1] Right. [S2] Right.
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[S1] Well, what I love about, I love many things about your book. I, I read it in one sweep. [S2] Oh, thank you. [S1] And, and I was like, "Wow." Is, um...
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[S1] I was a su- pleasantly surprised, but I was like, "Wow, she's really opening up in this book from the very beginning." [S2] Yeah. [S1] Um, and I don't wanna give, uh, it a- away, but it's, yeah, you're, you're very open, uh, where it's appropriate. And, um, and also, I think that this question about truth-telling, I- I, I always think about, like, tell the truth, be, uh, you know, 100% about the truth. But there's also this element about, do you,
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[S1] ... report previous lies. [S2] Mm-hmm. [S1] Right? Like what about prior behavior? [S2] Mm-hmm. [S1] And, and I'm, I'm fascinated by this 'cause to me, telling the truth is, has many facets, but the, the three sides of this thing, uh, in my mind are one is reporting everything accurately. The other is what do you withhold, what do you not withhold, right? Because some people say, um, tell the truth or at least don't lie. [S2] Mm-hmm. [S1] That's sort of a- [S2] Mm-hmm. Lies of, lies of omission, right? [S1] Yeah, so lies of omission. [S2] [LAUGHS]
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[S1] ... still threaten to the future. [S2] Right. [S1] So how important is it for the, the addict or the, every person really- [S2] Right. [S1] ... to, um, 'cause it sounds like cultivating the circuitry between prefrontal cortex and the dopamine system would be great for anybody, um, since we're all addicts. [S2] Right. [S1] Everyone should do it. But in, in all seriousness, it sounds like a good thing for everybody to do. How, um, how much work needs to be done on all the priors, all the stuff we've hidden. [S2] Mm. [S1] And, um-
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[S1] Um, you know, are there situations when it's maybe not a good idea because of the, that person or the nature? Sure. You know, there are always gonna be, it doesn't have to be like, it's not, we're talking about not like, not like Kant's idea about like, never lie, but, you know, a robber's in your house and he's, you know, you're still away. You can't lie even about that. It's like, no, there are probably situations where- [S2] Absolutely. [S1] ... you know, um- [S2] For sake of other people's safety. [S1] Right. [S2] Children's safety. [S1] Right, right, right. [S2] Sure.
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[S1] And they kind of haunt me. [S2] Mm-hmm. [S1] You know, it's been as though I have nightmares, right? Um, and I think that's true for most people. I mean, I occasionally will meet somebody who's like, "Oh, I don't have any regrets," and I'm like, "Wow." Like, I, I cannot relate to that at, at all. Um, so, you know, this idea of, like, catharsis and,
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[S1] ... use that language, but, you know, uh, patients may have to say like, "I, I really feel badly about, you know, this thing." And I'll be like, "Yeah, I get it." [S2] Mm-hmm. [S1] I, I understand that you feel- [S2] Well, guilt is a- [S1] Right. [S2] There's a circuit for that too. [S1] Right. And it's, it's-
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[S1] Right. It's really, yeah, like, oh my God, I did that horrible thing. Right, right. And then, so, I mean, I've done horrible things that, um, I haven't gone back and said, "I did this horrible thing." But I'm, maybe I've tried to pay it forward. Like I've told my kids, you know, when I was younger, I did this horrible thing and it still haunts me. So if you're ever tempted to do something like what I did, you might think about my situa- So, you know, some kind of way. [S2] Yeah. [S1] But I think wrestling with that is, is important.
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[S1] Oh, I think it's a really important element to all of this. And there's not, um, I love that there's neuroscience being done on truth-telling- [S2] Yeah. [S1] ... and the value of truth-telling. [S2] Yeah. [S1] I th- I think, uh, it, if I were to predict a, a new and truly exciting area that people are gonna be really curious about in, um, in this huge sphere we call neuroscience, I, I hope they'll continue to do more work. [S2] Yeah. [S1] Also speaks to, I'm so glad to hear that's happening here at Stanford. [S2] Uh,
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[S1] Uh, no, that's the, that, the, well, the, the, the literature that I look at isn't Stanford work, but, um, but there's work. There might be, it might be people- [S2] Regardless of where it's happening. [S1] Yeah, yeah. [S2] Um, more of that and all the rest, please. [S1] Yeah. [S2] Um, I want to ask you about using drugs to treat drug addiction. [S1] Mm-hmm.
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[S1] Um, these days, there's a growing interest, or at least discussion, about Ibogaine. [S2] Mm-hmm. [S1] People going down, going out of country, because I think it's still illegal here, um, or is illegal here, going out of country to, I don't know, either, um, inject it or smoke it or whatever it is, or people going and doing Ayahuasca journeys or, um, MDMA, which,
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[S1] Experience that's also chemical and extreme, often of the extreme serotonin and/or extreme dopamine type. So MDMA, hexacy, for instance. [S2] Mm-hmm. [S1] Tons of serotonin dumped. [S2] Mm-hmm. [S1] Tons of dopamine dumped. How neurotoxic, if neurotoxic, debatable, et cetera, et cetera. Not the topic for now, but a lot.
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[S1] This violates at, at a, at a rash, purely rational level. This violates everything we've talked about in terms of dopamine biology. [S2] Yeah. [S1] It would, if this arrangement is the way I described it.
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[S1] Cause more addiction. It is anything but a dopamine fast. It's a dopamine feast. [S2] Mm-hmm, mm-hmm. [S1] So we hear about successful transition through this, at least anecdotally, and may, um, maybe some clinic say, what is going on? [S2] [LAUGHS] [S1] [LAUGHS] What is going on? Doesn't make any sense to me. Uh,
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[S1] So either, typically it's a high dose of psilocybin or, or three dose, as I saw it for the MAP study of, of MDMA, of ecstasy. [S2] Right. [S1] Those are sort of the, seem to be the kind of- [S2] Yes, the typical, right. [S1] ... the kind of bread and butter of this kind of work. [S2] Right, right. But the thing to really keep in mind is that this is completely interwoven with regular psychotherapy and that these are highly selected individuals. [S1] And clinical trials. [S2] Right, right. And these are clinical tri- [S1] We're referring to legal clinical trials. [S2] Right, right. And, and,
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[S1] And so, you know, it, it, I want, I think the metaphor that I, that, that helps me think about this is, there are many ways to the top of the mountain, and these are sort of like taking the gondola instead of walking up. It's sort of, instead of doing like a year of psychoanalysis where you're sitting on the couch every week reflecting on your life, it's a condensed version of psychoanalysis or psychotherapy plus, you know, MDMA, which gets you there faster. [S2] Creates the intimacy, presumably, because of the- [S1] Right. Well, I think-
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[S1] Yeah, the two addicts I know that, that did MDMA, MDMA-assisted psychotherapy as far as, as part of this, um, thing, both got worse. [S2] Yeah. [S1] Um, but the people I know who had severe trauma- [S2] Uh-huh. [S1] ... who did this, who took this approach, seemed to be doing better. [S2] Okay.
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[S1] Interesting. [S2] And so I, um, I think that, uh, the discussion as we hear it now is just sort of psychedelics, which is a huge category of- [S1] Right. [S2] ... that includes many different drugs and compounds with different effects. And we hear about trauma and addiction lumped together. [S1] Mm-hmm. [S2] And I think that, um, I'm a splitter, not a lumper, as we say in science. [S1] [LAUGHS]
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[S1] Michael Pollan's book. [S2] Yeah, yeah. [S1] Well, and, and, and I don't know him, and so, um, I don't have a problem taking a, taking a stance, um, uh, so I'll just say my stance on that is the narrative of popular authors can expand and wick out so fast- [S2] Yes. [S1] ... that pretty soon people are essentially taking their mental health into their own hands. [S2] Right. [S1] And I, I actually have, I have great optimism for this, uh, business of, of clinical,
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[S1] use of, um, psychedelics, including MDMA. Matthew Johnson at Johns Hopkins is doing fabulous work on this. Um, and, and there are others too, of course. But those are controlled settings. [S2] Right. [S1] And the pharmacology is being tuned up. And one thing that I think is coming, uh, there are several papers published recently in great journals like Nature and Science, et cetera, where there are
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[S1] Scientists who are removing the hallucinogenic components of these drugs and finding that they still have the antidepressant effects. [S2] Interesting. [S1] And so the experience of a psychedelic and the long-term effects of the psychedelic might actually be dissociable. [S2] Mm-hmm. [S1] And so I, again, I, um, and I'm always careful to say I'm, I'm neither for something or against it. I, I just think that, um,
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[S1] Sure. And, uh, I'm going to be sitting down with Matthew Johnson at some point and we'll discuss this. And I think that, uh, that care and that, um, that cocoon of, of real clinical care does seem to be an important component. [S2] Yes. [S1] Uh, well, I'm glad we could touch on it. And, um, it, you know, I'm sure I'll get a bunch of comments telling me that. [S2] [LAUGHS]
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[S1] You were featured in The Social Dilemma. Uh, it was a powerful movie. I think many people avoided seeing that movie because it, it reflects back on us just how addicted we all are and how manipulated we all are. [S2] Yes. [S1] But it doesn't seem to have changed behavior much. [S2] Mm-hmm. [S1] I, I have to say that the, the movie changed my understanding and my perception, but not my behavior too much. [S2] Mm-hmm.
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[S1] If we look at addiction as a maladaptive thing, something that's making our lives worse or our, our, us less functional at work and in relationships, I could imagine a version of social media where it's making me more connected. I mean, this is a podcast after all. [S2] Yes. [S1] I post videos. [S2] Yes. [S1] This will show up on YouTube and, um, and elements of it on Instagram as well. So much like, uh, sugar or, um, other things,
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[S1] far more keenly aware of how we look and how we sound and how we are being perceived than we were ten years ago. [S2] Right. [S1] So, first of all, social media, um, how addicting is it, really, and what is healthy social media behavior?
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[S1] Well, remember texting and driving? There were all these books about texting and driving, how terrible it was. [S2] Yeah. [S1] Even the governments have largely given up. You see these, these billboards. [S2] Yeah, terrifying. [S1] Like, "Don't text and drive," or, "Any text can wait," or, "Not worth dying for." [S2] Right. Right. [S1] But everybody's texting and driving.
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[S1] Right. And if you look at young people today, teenagers, I mean, they're basically cybernetically enhanced. The, the phone is there, you know, it's like they're talking to you and texting 12 friends at the same time. And there's no stopping it. I mean, the genie is out of the bottle where, you know, it's not, we're not going back. [S2] Right. [S1] You know? So we, we do need to figure out, you know, how to make this, this tool something that's,
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[S1] Yeah, so I think it's, it's, it depends on the person and it's sort of a combination. We talked earlier about, you know, having an itch and scratching yourself at night. We've gotten to a point with smartphones, people are pulling them out and they are utterly unconscious of doing so. Pulling them out, you know, a couple text, a couple swipe. They don't know they're doing it. [S2] I have a friend who, who works in, uh, does, delivers babies. [S1] Yeah.
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[S1] And, um, many pregnant mothers won't actually deliver without their phone in hand. And this used to be the hand that was connected to their spouse. [S2] Right. Yeah. [S1] This may be a comment on, on, on spouses. [S2] Oh, yeah. Yeah. [S1] Uh, more than on phones, but, um, but, uh, it sounds like they're, it's a, kind of a security blanket of sorts. [S2] Right, like a transitional object. Yeah. [S1] Yeah. Actually, that reminds
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[S1] Yeah. [S2] Yeah. [S1] Actually, that reminds me, you've referred to, um, the phone. I think it's the phone, but maybe it's our online persona or ourselves as we've become sort of infantile in our need for it. It's like a baby in a bottle. [S2] Right. Right. [S1] And so I do wonder if, if we have regressed, and I do think we've regressed a bit, um, in terms of our online behavior, our inability to con-
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[S1] Act like, yeah, I always thought an adult was somebody that can control their behavior. [S2] Yeah. [S1] That's the difference between a baby and an adult. You don't have to be a developmental neurobiologist for very long to understand that a young organism can't control its behavior and older one can. So, to me, a, a mature organism, mature in years organism that can't control its behavior is a baby. It's a, it's an immature version of itself. [S2] [LAUGHS] [S1] And there's neuroscience, there's neuroscience to support that statement. Um, I look at my own behavior with the phone sometimes and I think,
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[S1] I'm a grown man. [S2] [LAUGHS] [S1] Like, what is the problem here, right? Um, you know, I don't eat baby food, but I'm acting like a baby with the phone. [S2] Yeah, right. [S1] All right? Um, in the sense that I'm reflexively picking it up. [S2] Mm-hmm. [S1] I'm, I'm not being intentioned and deliberate with it. [S2] Right. [S1] Um, do I need a full 30 days, Anna? [S2] [LAUGHS]
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[S1] So, so, yeah, so, so- [S2] 30 days away from my phone. [S1] Yeah, yeah, as you know, that's my recommend of the full 30 days to reset. I think, you know, if you're, if you're severely addicted, that, that I recommend the 30 days. But if you're just a little bit addicted like most of us, you probably don't need 30 days. In fact, a single day not only would be challenging, but, um, but probably maybe sufficient. [S2] My phone is off for substantial segments of the day. [S1] Okay, that's great.
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[S1] So I take the liberty of just replying when I, when I'm able to. [S2] Yeah, that's right. [S1] Yeah, or want to. [S2] Yeah, we, right. [S1] Yeah. [S2] But which touches on one of the big challenges about social media is that as more and more of us are spending more and more time on social media, we're divesting our libidinous energies, et cetera, from real life interactions. So that means even when we
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[S1] Oh, you're all doing the dopamine fast together. So these are some of the tricks that, you know, we can come up with, but- [S2] I like that. [S1] Yeah. Okay, good. [S2] I like that. I don't allow, I have a home gym and I, I love working out. I, I just enjoy it and I always have. And I, I don't allow my phone- [S1] Yeah. [S2] ... in my gym anymore. [S1] Right. [S2] And I live in an area where I don't get any reception, like two meters outside my door. [S1] Right. [S2] So all my dog walks now are just with the dog. [S1] Right. [S2] And they were boring as hell. [S1] Yes. [S2] I also have a bulldog. He doesn't like to walk. It's really slow. [S1] [LAUGHS] [S2] Uh, and it was so boring for a while.
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[S1] 'Cause I was so used to taking calls while I walk, and it's super efficient. [S2] Yeah. [S1] Why wouldn't I do that? [S2] Yeah. [S1] The walks now are p- some of my favorite part of the day. [S2] Yeah, right. [S1] Because, and if the phone were, if I were to get a call on one of those, or they brought reception to the area, I would be very dismayed. [S2] Yeah, right. [S1] So I can attest to this, and, um, I, I don't think I'm a phone addict, um, but I do put work into regulating my phone.
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[S1] And then you never get that opportunity to finish that thought, which is really the source of creative energy and an original thought, right? You're not just reacting to what's coming at you. [S2] Right, and something that could contribute to the world. [S1] That's right. [S2] I'm a big, I'm, I'm a big believer that you're either consuming or you are creating.
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[S1] Being a constant consumer of visual information and information of all kinds can, can be a problem. But, but there's some really great sources of information on the internet. [S2] Yes. [S1] And, um, uh, and I, I certainly benefit from, from the fact that that, those channels exist. Um, narcissistic preoccupation. Am I a narcissist? [S2] You know, I th- First of all, there, there's, there's healthy- [S1] Or is the fact that I asked, does that take me out of- Would a narcissist never ask that question? [S2] Oh,
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[S1] ... you know. [S2] Where you just, you know, we're at Stanford after a lot of high achievers here. [S1] Right. [S2] Right. Um, some phenomenal, amazing people like yourself and other colleagues of mine that just, I'm always in awe. Like, it's just amazing. Like, the mean is shifted so high. And also people who have amazing paths to get here. [S1] Yeah. Mm-hmm. [S2] Uh, coming from very little and accomplishing so much. But it's also the pressure. [S1] Yeah. [S2] Right? Um, you know, the way that,
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[S1] This career was described to me the day I got my job was one colleague of mine, the late Ben Barah said, "Welcome to schizophrenia," [S2] [LAUGHS] [S1] 'cause you're never gonna be able to complete anything for, without getting interrupted. [S2] Uh-huh. [S1] That was partially true, although I've created buffers. And the other one, um, very, uh, successful scientist, a member of the National Academy, et cetera, said to me, "You know, just remember, it's pinball. You never win." [S2] Mm-hmm. [S1] "The best you can do is just keep playing." [S2] Yes. Right. [S1] And I thought,
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[S1] Wow. Okay. [S2] Mm-hmm. [S1] Okay. And then you just go. [S2] Right. [S1] But I think that as we achieve more, not just academics, of course, but as anyone achieves more, there's the relishing in the accomplishment.
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[S1] There's often the desire for more, but there's also the pressure of, well, now I have to do this for the next 30 years, even though I love it. It's the pressure of, well, if the mountain is this high, then how do I get here and here and here? And then you start shoveling more dirt on so you can keep climbing. And it's a lot of work. [S2] Yes. [S1] And I think that the, um, the perception of success is that there's a roar of the crowd and you cruise. [S2] Right. [S1] You don't cruise. [S2] Mm-hmm. [S1] They just give you more to do. [S2] Right. [S1] Or you give yourself more to do.
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[S1] It's like a mirage in the one case. [S2] Yeah. Yeah. [S1] And it's like a, um, like a, yeah, it's on the, when, it's almost like dopamine can create these mirages. [S2] Yes. [S1] That there's some place there. [S2] That's right. And if I just, it's that pot of gold, right? If I, if I just- [S1] Constant dopamine. [S2] Right, right. That's right. [S1] Constant dopamine. [S2] That's right.
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[S1] ... be a good doctor. I was like, I guess I'm just gonna try to figure out how to be a good doctor, and I'm here to learn that. And now, I see these medical students, and they're wonderful. They're brilliant, and they're well- [S2] They are. [S1] ... they're well-intentioned, all of that. But they're like, um, how can I, you know, write the great American novel, do my startup, go to Africa, apply for that grant? You know, it's like, really? I was just trying to f- learn how to be a doctor. And it's, as you say, it's a lot of pressure on them- [S2] Mm-hmm.
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[S1] And it's also kind of a weird leapfrogging of the real way to accomplish something. [S2] Right. [S1] By, which isn't about like, "Oh, how can I accomplish something?" It's like, "What can I do today that would be of service?" Right? And then finding that, of trying to be of service, you know, and, and not really going for recognition can sometimes lead to what people call success, although that wasn't what you were aiming for.
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[S1] And it's all the more beautiful when it's not what you're aiming for. [S2] Oh, so much better. So much better. [S1] Yeah, I'm a big believer that when one can, um, align their compulsion with some greater good.
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[S1] ... a service to humanity or the planet or animals, whatever it is, that, um, that's the, that's where the, the really good stuff emerges because it, there's a lot of reciprocity there. The world starts to, you're supporting the world and then it starts to support you in a way that feels very fluid. [S2] And it comes back. [S1] Yeah. [S2] Right. And I mean, that speaks to, like, your generosity to me vis-a-vis my book. And I have to say that- [S1] Well, I love the book.
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[S1] Well, I love the book. [S2] I know. [S1] There's like, we're, we're not in a business deal, folks. It's just purely that I heard Anna lecture in my course. I wanted to learn more about dopamine. She taught me. I asked her if she would come on the podcast. It turned out she wrote this amazing book. She sent me a vast copy of the book. I read it in one sweep. It's incredible, and I love it. So just like the eight-year-old version of me, uh, now the 45 version, uh, of myself, I can't stop blabbing about the things I love.
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[S1] Which is not the right way to think about it. Not how you are, and also not how the world works. 'Cause when we give away to other people, we, we get back so much more. But it, it takes a long time, and it might not come through that path. [S2] I never think about the, about reciprocity. [S1] Yeah. [S2] But I was, um, weaned by good advisors. [S1] Oh, that's very nice. [S2] Yeah. [S1] Yeah. [S2] I think I just, this or got drilled into me that the more, the more you give, the better your immediate life.
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[S1] Anna, Dr. Lemke, I, I should be a formal, forgive me, I've been referring to you- [S2] No, no, that's fine. [S1] ... Anna the whole way through- [S2] That's fine. [S1] ... 'cause we're colleagues, but thank you so much for sharing this information and, um, I know I learned a ton and I know everyone else is gonna learn a lot more about addiction and the good side of dopamine. [S2] That's right. Thank you for having me. It's been really, really great to talk with you.
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[S1] As Chief of Staff to the Group CEO, Paul spearheaded the preparation for the opening of the Paris Bus Market 2 competition and is well-placed to tell us how the tramway can provide a track of success for Hong Kong. Welcome, Paul. [S2] Good evening, Eugene. [S1] Paul, um,
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[S1] As Hong Kong people call the tramways, Ding Ding has been operating in Hong Kong for more than a century. [S2] Okay. [S1] And it's one of our large scale, um, transportation, the first one, and has been carrying generations of Hong Kong people over the, over 100 years. So what is the tram's ridership situation right now, and how does it compare to previous years?
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[S1] over 65, it is less than the $2 concessionary scheme, uh, at the moment. So, and it is key for us as a kind of social company to deliver a good transportation system to Hong Kong people at an affordable price. [S2] Mm, I'm sure many viewers would be surprised to know that actually it takes quicker than the MTR. [S1] Yeah. [S2] Something you just mentioned. [S1] Yeah.
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[S1] Yeah, exactly. [S2] Can you elaborate that a little? [S1] For short trips, I mean for very short trips along the tram line, because to take the MTR, it takes some time to go to the platform and, uh, walking time. Some, sometimes the platforms are quite remote from the access points in the street. So, okay, the tram stations are very well located in the street, every 250 meters. So, for very short trips from point A to point B, it, it may be faster to take the tram. Actually, we proved it with a YouTube influencer called Dong Fengqing last year.
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[S1] He had a race against one of our drivers, tram drivers, and our tram driver took the tram, Dong Fengqing took the MTR, and our driver won the race. [S2] Oh, really? Right. So what are the strategies? Can the tram race used to enhance what we call an appeal to attract and sustain a broader base of riders? [S1] Actually,
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[S1] They can enjoy it, as I said, on a regular, a daily basis. They can, uh, take the tram and enjoy the views of Hong Kong, the sounds of Hong Kong, the smells of Hong Kong. For example, they can smell the dried seafood. They can have party trams. So we have the party tram called Tram Number 18. [S2] Right. [S1] Which is the most premium tram, uh, that we have with leather seats, with air-con, with a toilet cabin as well. Uh, it, yeah, definitely it is, it has been in service for, uh, two years right now, and, uh, it is a very,
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[S1] I guess Hong Kong people are happy to celebrate together and to enjoy very cheerful moments with friends and families. And, uh, it's, it proves very and very popular. Actually, party trams are booked several weeks, several months in advance. [S2] Yeah. [S1] So if you want to book a party tram, better to, to prepare for it early. [S2] Right. [S1] And, uh, this very, uh, I mean, for us it's meaningful, very meaningful, uh, to deliver this, uh, very positive moments to, to Hong Kong people. [S2] Right.
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[S1] Just now, Paul, you mentioned that, like, 20% of your riders are tourists. [S2] Yeah. [S1] So how would you, um, what, what would you have made extra efforts to attract the tourists and showcase the tram as a unique cultural and historical attraction within the city? [S2] Actually, as I mentioned, we have this touristic tram, the Tramoramic. Uh, it is specially designed for tourists with an open balcony, uh, with audio guides in eight different languages for the tourists to discover the city.
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[S1] of, uh, they attend some fairs. Next week they will attend a fair in Taipei and in Macao, for example, with a tourism board to make trams a part of packages delivered by, uh, travel agencies all over the world to enjoy a full Hong Kong experience. [S2] Right. Do you also been able to tap into what we called sort of Instagram ch- chasing tours from, say, from mainland, like the, the, uh, what we call the Little Red Book. Have you tried on that as well? [S1] Yeah.
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[S1] Yeah, definitely. We, we are trying. Actually, there is a very popular spot in Kennedy Town. [S2] Right, yeah. [S1] Which, which attracts a lot of, um, uh, I mean, visitors, uh, advised, recommended by the Little Red Book. And most of them take the tram to go to the, this spot. So we try to have this kind of Instagram, Instagram-able spots and, uh, to work with, uh, influencers as well, K-O-L from mainland China. [S2] Right. [S1] To make trams as a popular destination for tourism from all over the world and mainland China in particular.
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