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  • Dave Asprey: Biohacking for High Performing Entrepreneurs | Mental Health | YAPClassic

    AI transcript
    0:00:06 Today’s episode is sponsored in part by Airbnb, OpenPhone, Shopify, Mercury, Built, Indeed,
    0:00:07 and Microsoft Teams.
    0:00:12 As always, you can find all of our incredible deals in the show notes or at youngandprofiting.com
    0:00:12 slash deals.
    0:00:25 Hey, Yap fam.
    0:00:30 I hope you enjoyed my interview with the father of biohacking, Dave Asprey, earlier
    0:00:30 this week.
    0:00:35 Dave had some great tips on how to get smarter about your workout and self-care routine and
    0:00:38 how you can save time while getting even better results.
    0:00:42 So be sure to listen to that episode if you haven’t already.
    0:00:44 But why stop there?
    0:00:49 If you want more biohacking strategies from the master himself, then stay right where you
    0:00:55 are because in this Yap Classic episode, we are revisiting Dave Asprey’s first time on
    0:01:00 the show back in 2022 in episode 149.
    0:01:06 In this conversation, Dave told me how he became one of the world’s most famous biohackers and
    0:01:10 how he went from hacking the internet to hacking his body.
    0:01:16 He also shared some great diet and energy biohacks, as well as his thoughts on spontaneous meal
    0:01:22 skipping, why women and men fast differently, and why he thinks humans will start to live
    0:01:24 well into their hundreds in the future.
    0:01:28 Dave also turned up to the interview with a blue tongue.
    0:01:33 And of course, it turned out there was a pretty good reason for that, too.
    0:01:34 All right, folks.
    0:01:39 It’s time once again to push the limits of human capability with Dave Asprey.
    0:01:47 We’d like to start off with backgrounds and childhoods and things like that.
    0:01:51 So in your own words, you were a fat kid growing up.
    0:01:54 At one point, you were almost 300 pounds.
    0:01:57 And it turns out you were sick and you didn’t even know it.
    0:02:03 So talk to us about your health journey and how you ended up starting this path on biohacking.
    0:02:10 When I was a kid, I had all the behavioral problems that are common in entrepreneurs, what
    0:02:11 we would now call ADHD.
    0:02:17 But I also had Asperger’s syndrome, which is a neurological condition.
    0:02:19 And it’s on the autism spectrum.
    0:02:23 I don’t present as someone with Asperger’s anymore.
    0:02:26 And I, in fact, don’t likely have it because it is a curable condition.
    0:02:28 It’s related to autoimmunity.
    0:02:30 I was also overweight.
    0:02:34 I had chronic fatigue syndrome, which was diagnosed by a couple of people.
    0:02:41 Fibromyalgia, thyroid problems, lower testosterone than my mom in my 20s in labs.
    0:02:43 High risk of stroke and heart attack before I was 30.
    0:02:46 Arthritis when I was 14.
    0:02:52 So I think I was pretty much, you could say, biologically a shit show as a kid.
    0:02:53 I don’t know if I can say that on here.
    0:02:54 You can beat me out or something.
    0:02:56 But not in a good place.
    0:02:58 That said, I did.
    0:02:59 Let’s see.
    0:03:03 I was at the top of my class in high school, but I was such a jerk that they wouldn’t let
    0:03:04 me be a valedictorian.
    0:03:05 Oh, my God.
    0:03:09 That’s not to say that I was doing that well in high school.
    0:03:11 I was just at a school that wasn’t that competitive.
    0:03:13 Well, that’s really cool.
    0:03:17 I mean, everybody knows you as Bulletproof, Dave Asprey.
    0:03:18 That’s what we know you as.
    0:03:22 But it turns out you had a whole super successful career before all of this.
    0:03:25 You made six million dollars by the time you were 26.
    0:03:27 You had a very successful career.
    0:03:31 And I actually did a bunch of research and found out that you were the first person to
    0:03:34 ever sell anything on the Internet.
    0:03:40 So talk to us about your whole background before being the father of biohacking.
    0:03:47 Yeah, in fact, it seems to make people mad when I talk about that in the early days of
    0:03:48 the Internet.
    0:03:54 I mean, early days before web browsers were created, it was entirely possible to know everything
    0:03:59 on the Internet because it was something called Usenet was where most people communicated and
    0:04:00 you could follow all of the groups.
    0:04:03 And these were kind of like Reddit forums today.
    0:04:05 But imagine if Reddit only had 100 forums.
    0:04:09 OK, you could follow all those if you wanted to spend a good amount of time doing it.
    0:04:12 So I did go out there.
    0:04:19 I had a that was a nine times increase in my tuition at the University of California.
    0:04:24 When I was on Joe Rogan show, I said it was 15 times I had made a math error.
    0:04:26 That was the only error that I had on that show.
    0:04:30 So anyway, I couldn’t pay for it.
    0:04:32 So I’m going to start a business here.
    0:04:33 What can I do?
    0:04:34 Well, I like caffeine.
    0:04:39 So I emailed a caffeine scientist and said, tell me about the caffeine molecule.
    0:04:41 And I’m whatever, 19 or something.
    0:04:44 And he tells me a bunch of stuff.
    0:04:47 So I made a T-shirt that said, caffeine, my drug of choice with a picture of the caffeine
    0:04:47 molecule.
    0:04:51 And I posted to the discussion group where we talked about coffee and said, you guys should
    0:04:52 buy this.
    0:04:56 And then, oh, two weeks later, and I did really well.
    0:04:58 I sold shirts in my first month to 16 countries.
    0:05:00 Okay.
    0:05:04 I’m living in a shared one bedroom apartment that I can barely afford.
    0:05:11 Like not, not the, the, you know, college experience that someone who was having their
    0:05:13 college paid for would have.
    0:05:17 And I’m thinking, okay, now I can maybe make ends meet.
    0:05:18 This is really good.
    0:05:22 And then a Rutgers professor of marketing says no one’s ever going to make money on
    0:05:22 the internet.
    0:05:28 So with a chip on my shoulders and angry mold exposed kid, I wrote back, said, well, you may
    0:05:31 be at an Ivy league school, but I’m already making money on the internet.
    0:05:32 So you’re wrong.
    0:05:32 Ha ha.
    0:05:38 And the next day, the Miami Herald called and they wrote about my little business and
    0:05:42 pretty soon I’m an entrepreneur magazine with a picture of me in a double extra large t-shirt
    0:05:45 talking about how you can make money on this inner something or another.
    0:05:53 Two weeks after that, the first spam came out and I apologize because the people who did
    0:05:54 that read the article about me.
    0:05:58 And in the article, I warned against marketing on the internet if you weren’t a part of the
    0:05:58 community.
    0:06:01 And so the first spammers on earth were attorneys.
    0:06:02 Their names were Cantor and Siegel.
    0:06:05 And if you look back on the history of the internet, that’s how it was.
    0:06:06 So yeah, I was there.
    0:06:07 I did it.
    0:06:10 And I did it one day before the guys who currently run wine.com did it.
    0:06:16 But at the time it was literally checks in the mail, t-shirts sent back, trying to make
    0:06:18 ends meet and also scooping ice cream at Baskin Robbins.
    0:06:20 I was just being scrappy.
    0:06:22 It seemed obvious to me.
    0:06:27 And this is why young entrepreneurs totally kick ass because you don’t even know how cool
    0:06:28 what you’re doing is until you look back on it.
    0:06:32 Because you don’t have the life experience to go, oh my God, it’s totally transformative.
    0:06:35 By the time you can tell it’s transformative, you’re probably too late.
    0:06:36 Yeah.
    0:06:37 Oh my gosh.
    0:06:38 What a cool story.
    0:06:43 And so probably so many people tuning in had no idea that you were the first one to sell
    0:06:44 anything on the internet.
    0:06:49 So you had this computer science background and you also had a love of coffee pretty early,
    0:06:53 which is kind of funny looking at your career now and the fact that you’ve created
    0:06:58 bulletproof coffee so many years later and it’s all started with caffeine t-shirts.
    0:07:04 It’s kind of, do you ever look back at that and think like, wow, like I was onto it already
    0:07:05 like since back then?
    0:07:09 Well, they always like to say, follow your passion.
    0:07:13 And it’s kind of true, but here’s the thing.
    0:07:17 My passion really was, I want to change the world to make it better.
    0:07:19 And coffee is a way to do that.
    0:07:25 Your day is measurably better if you have coffee in the morning, if you’re like 90% of people.
    0:07:29 So if you’re the other 10%, I’m sorry, you have bad genetics and you shouldn’t reproduce.
    0:07:30 Okay.
    0:07:30 Just kidding.
    0:07:34 But there are 10% of people who don’t tolerate coffee, but okay.
    0:07:37 That’s one way eating quality food makes the world a better place.
    0:07:42 But at the time, having a digital nervous system for the planet, so we could have the conversation
    0:07:42 we’re having right now.
    0:07:46 I worked on the network engineering and protocols that do this.
    0:07:52 When Google was two guys and two computers, the company that I helped to co-found a part
    0:07:55 of this company that held their servers and designed architecture for many of the biggest
    0:07:56 brands out there.
    0:08:01 when it was the Facebook, that mattered because we were building a way for all of us to connect
    0:08:03 so that you and I could have this conversation.
    0:08:08 Because if you go back 25 years, there was no way for us to know about each other, much
    0:08:09 less to meet each other and have a conversation.
    0:08:12 So the world has become much better because of that.
    0:08:17 And in the last two years, now that we’ve turned on government censorship, it’s become
    0:08:19 actually maybe worse because of it.
    0:08:21 So we’ve got to fix that, but that’s a short-term blip.
    0:08:22 Yeah.
    0:08:25 So let’s go back to, you said you got into Entrepreneur Magazine.
    0:08:31 I think I read that you were 297 pounds when you were in that magazine.
    0:08:35 So what made you decide like, you know what, I’ve had it with computer science.
    0:08:40 I want to kind of take what I learned with computer science and apply it to my body now
    0:08:42 because I’m almost 300 pounds.
    0:08:45 Well, I’m going to make a bunch of people mad now too.
    0:08:49 I got tired of studying computer science because here I was, I had a webpage.
    0:08:55 I had started a business online and all of computer science was how do you do esoteric math
    0:08:56 on large computers?
    0:09:00 Like this isn’t how, this doesn’t match my view of where the world’s going.
    0:09:04 So I dropped out and I got a degree instead in something called information systems, which
    0:09:06 is how do you solve problems?
    0:09:09 And my concentration was in a form of artificial intelligence there.
    0:09:11 How do I make a business work better?
    0:09:17 How do I solve a problem using computers instead of how do I do science stuff in a lab somewhere?
    0:09:22 And a lot of computer science still to this day is very esoteric and theory-based versus
    0:09:23 let’s go out there and change something.
    0:09:29 And as an entrepreneur-minded person, it hurts to not make things better.
    0:09:32 And so that was why I went out.
    0:09:37 But then I got to Silicon Valley and by the time I was 26, I did make 6 million bucks.
    0:09:38 I lost it when I was 28.
    0:09:40 It’s an important part of the journey.
    0:09:44 This is about having a good mentorship, good advice and being willing to take it.
    0:09:49 But that whole path, I said, okay, I’m going to lose the weight.
    0:09:54 I’ll just work out hour and a half a day, six days a week, go on a low fat, low calorie diet.
    0:09:55 I will use my willpower.
    0:10:01 And after 18 months of that, what I found was I could max out all but two of the machines
    0:10:01 at the gym.
    0:10:03 I still had a 46 inch waist.
    0:10:05 I still weighed 300 pounds and now I was tired.
    0:10:09 So it didn’t work.
    0:10:15 And it was sitting down at Carl’s Jr. with some friends.
    0:10:19 And I thought to myself, wait a minute, I’m having the chicken salad with no dressing and
    0:10:21 no chicken, right?
    0:10:23 Because I’m the lowest calorie, low fat thing.
    0:10:25 My friends are eating double Western bacon cheeseburgers.
    0:10:28 I work out more than all my friends combined and I’m the fat one.
    0:10:33 And I thought, it isn’t that I’m doing something wrong.
    0:10:34 I used to think it was a moral failing.
    0:10:35 It was a weakness.
    0:10:37 It was that I needed to eat less lettuce.
    0:10:39 No, what I was doing wasn’t working.
    0:10:40 And I just said, wait a minute.
    0:10:45 I just studied how to manage a complex system where you don’t know what’s going on.
    0:10:46 Because that’s what the internet is.
    0:10:50 I teach classes at the University of California on how to do this and I can’t do it to myself.
    0:10:53 My doctor, when I went in, said something’s not right.
    0:10:55 So maybe you should try to lose weight.
    0:10:56 I’m like, no, really?
    0:10:57 You think so?
    0:10:58 Tell me how.
    0:10:58 Eat healthy.
    0:11:01 And I just fired the doctor.
    0:11:03 I literally said, you’re fired.
    0:11:05 When he didn’t know some very basic info about nutrition.
    0:11:08 And I went off and said, I’m going to do it myself.
    0:11:18 And so every night after I’d finish the building cloud computing phase of my career, I would go home and I would study biology because I didn’t want to die and I was tired of feeling like crap.
    0:11:20 So it was enlightened self-interest.
    0:11:25 I started learning from people three times my age who ran an anti-aging nonprofit group who had more energy than I did.
    0:11:26 And I hacked it.
    0:11:35 And then I said, okay, I’m a VP at a publicly traded computer security company in charge of cloud security.
    0:11:37 So I have some credibility in that space.
    0:11:41 And I started blogging.
    0:11:50 I said, you know, five people are going to read my blog, but it’s going to prevent them from spending hundreds of thousands of dollars on recovering their health.
    0:11:55 And I’m performing better than I ever have, better than I ever thought was possible, even when I was younger.
    0:12:02 And so if five people avoid my pain, avoid all the money that I spent, I have done a solid for the world and I’m okay with that.
    0:12:04 I wasn’t starting a company.
    0:12:08 I was sharing hard earned knowledge through suffering.
    0:12:12 And it turns out more than five people liked what I had to say.
    0:12:16 And pretty soon I said, I want to make coffee that doesn’t make me crash.
    0:12:18 So I said, this will be my first product.
    0:12:21 The market size for functional coffee was zero.
    0:12:23 It’s a multiple hundred million dollar product.
    0:12:25 I said, I want a protein powder that works.
    0:12:30 I’m going to do the research and the work around collagen.
    0:12:32 Today, collagen is a billion dollar category.
    0:12:32 It was not.
    0:12:36 And I said, hmm, MCT oil from the anti-aging world.
    0:12:38 It’s an unknown thing.
    0:12:40 It’s now a billion dollar category.
    0:12:51 So what I started as a blog to help people not go through what I went through with all the brain fog and obesity and arthritis and just acting like a jerk because you have enough energy to be nice.
    0:12:55 Well, I wrote it not for heavy people.
    0:12:56 I wrote it for entrepreneurs.
    0:13:03 I wrote it for tech people because we are the ones who put the most mental energy and I don’t care if I have dad bod.
    0:13:04 Okay.
    0:13:04 I’m married.
    0:13:05 I have kids.
    0:13:07 I care about building companies.
    0:13:09 I care about leading teams.
    0:13:10 I care about innovating and creating.
    0:13:12 And that requires energy.
    0:13:17 And it turns out I grew abs as a side effect, not as the goal.
    0:13:23 You can build abs and feel like crap or you can build energy and abs grow.
    0:13:28 And I wanted to teach that to my people, which were the geeks pretty soon.
    0:13:29 Go ahead.
    0:13:31 I’m just going to say I love that.
    0:13:32 I just love the story.
    0:13:33 You go ahead.
    0:13:37 Pretty soon, though, it wasn’t just entrepreneurs in Silicon Valley.
    0:13:39 It was Wall Street where it took off next.
    0:13:40 Let’s see.
    0:13:43 These people are working 16, 18 hour days.
    0:13:44 They never get a break.
    0:13:46 They need their brains to work all the time.
    0:13:55 My seed capital for what became Bulletproof was actually an investment bank hiring me to fly around the world to meet with hedge fund managers to teach them how to be smarter.
    0:13:58 And I did this so they could walk into the room with me.
    0:14:06 So their salespeople could come in because the hedge fund managers wouldn’t take a meeting with a banker, but they would take a meeting with a brain hacker and a banker walking in with them.
    0:14:10 So I was the booth babe, for lack of a better word, for hedge fund managers.
    0:14:15 I took the money from that and I used it to buy my first round of coffee and to hire the first members of my team.
    0:14:17 So that’s how it got started.
    0:14:22 And I started until I could replace my salary from a publicly traded company.
    0:14:25 I worked as a VP and I grew Bulletproof.
    0:14:28 That is such an amazing story.
    0:14:41 And it’s so cool how just having good intentions will almost always when you’re starting a business or starting something, having good intentions and just wanting to help people, eventually the money will come find you.
    0:14:51 You know, you just wanted to put that information out there to the world and it all worked out because you were doing a service to others and having pure intentions with it.
    0:14:53 I find that a lot with all the people that I talk with.
    0:14:56 It’s cool that you mentioned that.
    0:15:01 When I was young, it was like, look, I’ll do anything for money because money is going to make me happy.
    0:15:05 And I really believe that and it motivated a lot of my decisions.
    0:15:11 What taught me that the two biggest lessons in my career, it was like money and fame are what people want.
    0:15:13 We’re told that that will make us happy since we’re young.
    0:15:13 Okay.
    0:15:16 So here I am, I’m 22, 23, whatever.
    0:15:19 I’m in Entrepreneur Magazine, like full color photo.
    0:15:20 Right.
    0:15:24 And I got some phone calls and some emails from people.
    0:15:28 And then two weeks later, okay, that was cool, but it didn’t make me happy.
    0:15:29 And I was like, what the heck?
    0:15:30 I’m famous.
    0:15:31 I should be happy.
    0:15:32 I was happy for 10 minutes.
    0:15:33 Right.
    0:15:37 And then I said, okay, a little while our money.
    0:15:38 So I made a ton of money.
    0:15:45 $6 million in late 1990s dollars is $18 million in today dollars because of inflation driven by the government.
    0:15:48 So it should be enough, right?
    0:15:56 I looked at a friend who all of us at this company, I mean, this was, let’s see, our market cap hit $36 billion.
    0:15:58 We split three times on one year NASDAQ.
    0:16:03 This is one of the most phenomenal companies that helped to build the first wave of internet companies.
    0:16:06 It’s called Exodus Communications for people who were around back then.
    0:16:14 And I looked at a friend and I said, I’ll be happy when I have $10 million because $6 million wasn’t enough.
    0:16:20 And if you are motivated by money, you will probably act like a jerk and you will never be happy.
    0:16:23 And you will have what the Buddhists call hungry ghost syndrome.
    0:16:27 And in the hungry ghost realm of hell, it’s one of the many levels of hell Buddhists talk about.
    0:16:34 This is where no matter what you eat, you’re constantly hungry and you walk around with a distended belly and you can never be satisfied.
    0:16:41 So if, when I finally figured out, I’m going to start this thing as a, it’s just a blog.
    0:16:42 I just want to share things.
    0:16:44 It makes me feel good to help people.
    0:16:48 I didn’t understand that flow states come from service to others because we didn’t have the science for that.
    0:16:58 So all of a sudden I’m motivated to stay up late and write these blog posts and to share this knowledge and to start a podcast before podcasts were really much of a thing.
    0:17:03 I’ve been blessed to be, I don’t know if it’s genetic or something, but I’m a futurist.
    0:17:07 I can see what’s coming and like podcasts.
    0:17:09 Yeah, that’s going to be, it’s going to be a big thing.
    0:17:14 And it’s why I was successful in tech as well, because I could say, I could tell the direction of it.
    0:17:16 And if some people are good at telling the weather, that’s what I do.
    0:17:17 I tell the future.
    0:17:22 And so for, for this, this just seemed like it mattered.
    0:17:23 Yeah.
    0:17:26 And I wanted to do it for no financial motivation whatsoever.
    0:17:30 I just didn’t want anyone to suffer the way I had no other motivation.
    0:17:32 And now it’s made me pretty successful.
    0:17:34 That’s super powerful.
    0:17:40 So speaking of being a futurist, you think that people are going to start living a lot longer.
    0:17:45 And you say that you think you’re going to live to 180 years old.
    0:17:47 Now, the average human.
    0:17:47 Hold on a second here.
    0:17:48 You’re trying to cut me short.
    0:17:50 It’s at least 180.
    0:17:52 Oh, at least 180.
    0:17:52 That’s not the ceiling.
    0:17:53 That’s the floor.
    0:17:54 That’s the floor.
    0:17:55 Oh, okay.
    0:17:56 I didn’t realize that.
    0:17:59 So you think you’re going to live to at least 180 years old.
    0:18:00 I believe you.
    0:18:04 I mean, I know that you’ve spent hundreds of thousands of dollars biohacking your body
    0:18:06 and we can get into that later.
    0:18:13 So I definitely believe you on this because humans are, you know, living to be older and
    0:18:15 hopefully we figure out the science to do this.
    0:18:19 But talk to us about why you think this is even possible, because a lot of people are hearing
    0:18:24 that and, you know, the average lifespan is 80 years old and we’re tacking on 100 years
    0:18:24 to that.
    0:18:27 Why is that even possible in your opinion?
    0:18:29 Here’s why it’s possible.
    0:18:33 Do you know what the best we can do today is?
    0:18:37 120 or something like that.
    0:18:37 There you go.
    0:18:39 It’s about 120, 122 maybe.
    0:18:41 So our current best is 120.
    0:18:47 If you were 120 years old today, you were born around 1901.
    0:18:49 We didn’t have airplanes.
    0:18:53 World War I would be fought largely on horseback.
    0:18:56 We didn’t have DNA because we couldn’t spell it.
    0:18:56 Actually, we had it.
    0:18:57 We just didn’t know about it.
    0:18:59 We had no antibiotics.
    0:19:05 We didn’t have public sanitation and you still live to 120.
    0:19:08 So if that’s possible and you probably drank and smoked every day too.
    0:19:11 Okay.
    0:19:20 If you can do that, why can’t we do 50% better than our current best in the next hundred years?
    0:19:21 Okay.
    0:19:25 Because the next hundred years is going to be way different than the last hundred years.
    0:19:30 Because the last hundred years, we did not have computers to make ourselves faster and better.
    0:19:34 What we’re doing now is every 18 months, we double our compute capacity.
    0:19:35 That’s Moore’s law.
    0:19:38 And it’s held strong for ridiculous amounts of time.
    0:19:46 What that means is that you and I are going to live longer because we have the technology to talk about living longer that we didn’t have before.
    0:19:56 And my company, 40 years of Zen, that does neuroscience brain upgrades, has the ability to do machine learning on your brain waves.
    0:20:09 One of the companies I am an investor and advisor to, Viome, just discovered 10,000 new species of gut bacteria that didn’t exist, that live in humans, that we didn’t know about.
    0:20:12 And it’s 2020, whatever it is today, right?
    0:20:14 That is phenomenal.
    0:20:25 So given all of that, if a comet doesn’t hit the planet, it is inevitable that we will improve only 50% on our current best in the next hundred years.
    0:20:26 In fact, we’ll do way better than that.
    0:20:35 My job is to explain and make it real so that everyone knows this is possible and it is coming.
    0:20:37 And so it becomes our expectation.
    0:20:43 The same thing happened if you go back to when the Wright brothers were about to fly.
    0:20:47 They’re working on flying machines and everyone looks around and goes, those idiots.
    0:20:48 Who do they think they are?
    0:20:50 Don’t they know man will never fly?
    0:20:53 Literally, they were saying that a week before it happened.
    0:20:55 And then all of a sudden it happens.
    0:20:57 And then, oh, yeah, of course we can do that.
    0:20:58 It’s always been that way.
    0:21:07 So every great change that is brought about, usually by entrepreneurs or entrepreneurs in combination with crazy inventors, when they pair up, it’s very powerful.
    0:21:12 And when that happens, magically, suddenly it’s obvious.
    0:21:15 And we’re at that stage right now with anti-aging.
    0:21:26 When I started this, I was the only person under 30 attending a meeting, a nonprofit that was based next door to Stanford University called the Silicon Valley Health Institute.
    0:21:27 I ended up becoming chairman.
    0:21:31 I’m learning from an 88-year-old and I’m 26.
    0:21:33 And he had more energy than I did at the time.
    0:21:34 Okay.
    0:21:35 What?
    0:21:38 These guys were considered truly crazy.
    0:21:40 And so did the people who talked about smart drugs.
    0:21:42 Where we are now with nootropics.
    0:21:44 Nootropics are a thing and people know that they work.
    0:21:46 And I played a hand at that as well.
    0:21:51 I went on Nightline and said, guys, I’ve took a smart drug called modafinil for eight years, which is the limitless drug.
    0:21:53 And it got me through Wharton Business School.
    0:21:55 And I don’t regret it one bit.
    0:21:56 It was a beautiful thing.
    0:21:59 I don’t need it anymore because my brain’s that fast without it.
    0:22:02 By the way, have you noticed?
    0:22:05 Yeah, your tongue is blue.
    0:22:06 What’s that about?
    0:22:08 I kissed a smurf.
    0:22:15 I use a compound called methylene blue, which I’ve written about in a couple of my books that enhances mitochondrial function.
    0:22:16 It’s a nootropic.
    0:22:18 It’s just one that makes your tongue blue.
    0:22:24 Well, it’s super interesting, you know, what you’re saying about how long we’ll live.
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    0:24:17 Hey, Yap Gang.
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    0:27:27 Do you think that there’s a max limit to the human lifespan?
    0:27:33 Like, what do you, I just want to, like, pick your brain about the future of what humans will look like, in your opinion.
    0:27:38 There is a maximum life, absolutely.
    0:27:39 Actually, there’s two of them.
    0:27:43 The longest one is the universe, as we understand it, will collapse in on itself.
    0:27:44 Okay?
    0:27:48 There’s probably going to be a hard limit that’s based on physics and stuff like that.
    0:27:49 I’m less worried about that.
    0:27:53 The real limit to human lifespan is curiosity.
    0:28:04 As long as you have a reason to live, to be of service to others, to be curious about things, to be constantly learning, and walking around with that childlike curiosity going, I wonder why that works.
    0:28:05 How is it that way?
    0:28:06 How can I make that better?
    0:28:16 However, if you have the biology, so that when you’re old, you look and feel like you do now, we’re not talking about the skin so thin you can see through it with tubes and monitors and diapers and not knowing your own name.
    0:28:17 People think that’s aging.
    0:28:19 That is an aberration.
    0:28:24 It has never existed in all of human history, except for in the last maybe 40, 50 years, and it’s sick and wrong.
    0:28:41 So we are on the path of returning to having our village elders, the keepers of the knowledge, and returning them to what is right, which is a level of respect and veneration for our elders, because they will keep us from making mistakes.
    0:28:42 And here’s why this matters.
    0:28:50 You look back to when I made that $6 million, or even better yet, when I sold that first T-shirt online.
    0:28:57 Now, I was exactly the same age as Mark Andreessen, who’s a really famous investor, multi-multi-billionaire.
    0:28:59 Now, Mark created the first web browser.
    0:29:01 I did the first e-commerce.
    0:29:04 Very similar, about as similar as you can.
    0:29:09 In fact, I wrote an article as a journalist about his first web browser.
    0:29:10 So we’re in the same thing.
    0:29:12 He flew to Silicon Valley.
    0:29:13 I would have had to drive.
    0:29:15 I was 80 miles from Silicon Valley.
    0:29:20 But he flew to Silicon Valley, and he found a guy, 20 years older, who ran one of the large tech companies and said,
    0:29:21 Teach me.
    0:29:22 And he did.
    0:29:24 What did I do?
    0:29:26 I said, I’ll do it all myself.
    0:29:27 I knew everything.
    0:29:28 Right?
    0:29:29 I had a big ego.
    0:29:30 Right?
    0:29:32 So I did not do that.
    0:29:36 And at this point, Mark’s a multi-billionaire, and I’m not.
    0:29:36 Okay?
    0:29:37 I’m okay with that.
    0:29:38 I’m doing quite well.
    0:29:39 Thank you very much.
    0:29:50 But it took me another 10 or 15 years to figure out the value of mentorship and to basically get control of my ego so that I could listen to and learn from others so I didn’t have to make all the mistakes myself.
    0:29:53 And that’s a really, really big thing.
    0:29:54 We can do that with aging.
    0:29:56 We can do that with everything.
    0:29:59 But it comes down to curiosity and willingness to learn.
    0:30:01 And we’ve just got to get that.
    0:30:02 That’s what keeps you young.
    0:30:13 So once you’re bored, even if you have the biology, the real goal of anti-aging, you should die at a time and by a method of your choice.
    0:30:15 When you’re done, you’re done.
    0:30:17 That is so interesting.
    0:30:19 And it’s so important.
    0:30:21 I definitely want to drive this point home.
    0:30:26 There’s like 13 million people by, I think, 2050 are going to have Alzheimer’s.
    0:30:30 And I think the rate of Alzheimer’s is at an all-time high.
    0:30:30 It keeps increasing.
    0:30:32 And there’s so much dementia going on.
    0:30:41 And like you said, when we think of older people, we think of children now instead of these wise people where we should be getting information from.
    0:30:51 And it’s so important that as we all grow older, that people actually have the mental capacity to tell the knowledge to everybody else so that we can learn from those people.
    0:30:55 I love it that you brought up Alzheimer’s.
    0:31:03 My book, Headstrong, was on the New York Times monthly science bestseller list sandwiched between Homo Deuce and Sapiens, two of my other favorite books.
    0:31:05 I’m like, oh, I finally made the big list.
    0:31:06 I look at me.
    0:31:06 I’m a big deal.
    0:31:11 But I was just sort of in awe going, oh, my God, I can’t believe that.
    0:31:12 I wasn’t expecting it.
    0:31:16 But that book is largely based on research around Alzheimer’s.
    0:31:20 And I’ve had Dale Bredesen on my podcast who wrote The End of Alzheimer’s.
    0:31:25 And I was a couple years ago the largest donor to the women’s Alzheimer’s movement, which is Maria Shriver’s charity.
    0:31:27 She’s been on my show as well.
    0:31:30 Women get Alzheimer’s twice as much as men do.
    0:31:32 And we don’t talk about that nearly as much as we should.
    0:31:35 Alzheimer’s is preventable and avoidable.
    0:31:37 It’s not even that hard, given what we know now.
    0:31:40 But reversing it is a little bit more work.
    0:31:42 And if you’re a late stage, it might not be reversible.
    0:31:55 But if you and your mind today listening to this are saying, oh, it’s inevitable that I’m going to get cancer, cardiovascular disease, diabetes, and Alzheimer’s, which are the big four killers that you have to avoid to live a long time, you’re totally wrong.
    0:31:56 These are metabolic diseases.
    0:31:58 You can fix your metabolism.
    0:32:02 In fact, my newest startup, the one where I’m CEO and fully focused now is called Upgrade Labs.
    0:32:13 And we’re opening franchise locations across the US and Canada to start and soon the world where you can come in and fix your metabolism in less time than you currently spend going to the gym.
    0:32:24 So you get your cardio, get your strength, get your neurofeedback, and fix your metabolism because we know how, because of machine learning, because of artificial intelligence, because of tech.
    0:32:26 So you can do better than cavemen did.
    0:32:31 And this is all necessary if you don’t want to go down that path of slow degradation.
    0:32:33 That is not natural.
    0:32:34 Yeah.
    0:32:37 I’m so happy that you’re working on all this kind of stuff.
    0:32:39 It’s really important that you’re doing this kind of work.
    0:32:43 So a couple last questions before we move on to fast this way.
    0:32:47 You’re currently, I believe, 49 years old.
    0:32:49 I’d love to know.
    0:32:49 48.
    0:32:50 Here’s the deal.
    0:32:51 Okay.
    0:32:55 It is ageist to talk about someone’s age, right?
    0:33:07 So if I am allowed to specify the gender I identify as, and I’m allowed to choose the race I identify as, I’ll be damned if I’m not allowed to choose the age I identify as.
    0:33:08 I’m 28% right now.
    0:33:13 I’m 28% of my goal, so I’m not 49, I’m not 48, so I’m 28%.
    0:33:19 And everyone listening, get this, pick a number, that’s your goal, you are the percentage of that.
    0:33:23 And if you believe in this whole, oh, identify with the calendar, no, screw the calendar, the calendar’s wrong.
    0:33:27 If you measure my biology, I am measurably younger than my number of years.
    0:33:28 So that’s what I identify as.
    0:33:30 That’s exactly what I was going to ask you.
    0:33:32 And by the way, I totally agree.
    0:33:34 I look way younger than I am.
    0:33:35 Are you like 24?
    0:33:37 No, I’m not.
    0:33:41 I’m in my early 30s and nobody believes, and like I look way younger.
    0:33:41 It’s awesome.
    0:33:45 And so I hate when people ask me because I’m like, no, I worked out my whole life.
    0:33:50 I eat healthy and yeah, I look younger and I’m not, I don’t feel my age.
    0:33:54 And so I totally, I love that, like saying a percentage of your goal.
    0:33:58 So how, what are you biologically and how do you figure that out?
    0:34:02 And the second part of the question is how much money have you spent on this?
    0:34:05 And what are the types of things that you do to reverse your aging?
    0:34:07 All right.
    0:34:12 Well, it depends on which, which measure of age you want to look at.
    0:34:16 And right now there isn’t one accepted thing.
    0:34:18 I just did a big show on this.
    0:34:22 And one of the, the probably more trustworthy tests is called true age.
    0:34:30 And this is one that looks at the, the types of sugar molecules that line your cells.
    0:34:32 And it looks at DNA methylation.
    0:34:35 Like actually those are two different methods of looking at aging.
    0:34:41 So you look at those things and I am between five and eight years younger than my biological
    0:34:41 age right now.
    0:34:46 And when I get the new tests, I would not be surprised if now it’s going to be about 12
    0:34:51 years because I just did some more interventions that are lengthening telomeres, but telomere length,
    0:34:56 which is the old way of measuring aging probably isn’t as accurate as we hoped it would be.
    0:34:59 So there’s all sorts of discussions about it.
    0:35:04 But the number one thing is, do you wake up and you have more energy than you did 20 years ago?
    0:35:07 That’s a pretty good sign that something’s working, right?
    0:35:08 And do you wake up and your body hurts?
    0:35:10 That’s a sign something’s not working.
    0:35:15 So like, like you, you have an unfair advantage.
    0:35:18 See, I started out with bad genetics and bad lifestyle that I thought was a good lifestyle.
    0:35:20 And I recovered from all that.
    0:35:24 You are preventing the damage in the first place because you’re in your thirties.
    0:35:27 And we know more now than we did when I was in my thirties.
    0:35:29 And you actually took action early in your life.
    0:35:30 Most people are like, are you kidding?
    0:35:32 Here’s what I care about in my twenties.
    0:35:37 I care about having enough money to make sure that I get laid.
    0:35:42 Sorry, human development, all personal development right there.
    0:35:49 People care about power and they care about reproduction, not because we choose to, because our biology does that for us when we’re not paying attention.
    0:35:52 And then we’re like, oh, why did I go on the date instead of the job interview?
    0:35:55 You just blame yourself when you think you’re a bad person.
    0:35:57 No, it’s because your biology told you to do that.
    0:35:59 And your biology is in charge more than we like to think.
    0:36:02 And this is the struggle of personal development.
    0:36:10 So whatever you did, whatever your parents did that made you wise enough to take care of your hardware means that your rate of aging is going to be flat.
    0:36:16 Whereas someone who says, I’m just going to go party and drink way more than I should and eat ramen all the time because it’s cheap.
    0:36:18 Their rate of aging is going to be really steep.
    0:36:20 They just don’t feel it until they’re 35.
    0:36:22 So kudos to you.
    0:36:27 And I want everyone to not do what I did when I was 16 because I just didn’t do it right.
    0:36:27 Yeah.
    0:36:30 Well, this has been so interesting.
    0:36:34 I would love to move on to your book fast this way because there’s so much.
    0:36:37 Before we get there, I didn’t answer your last question.
    0:36:38 You wonder how much I spent.
    0:36:39 How much you spent.
    0:36:39 Yes.
    0:36:43 How much you spent and what are the types of things that you’re spending your money on?
    0:36:51 So I have spent at this point around $2 million on anti-aging on upgrading my biology.
    0:36:56 Part of that, I built a lab here at my house that has all of the gear that is now a part of Upgrade Labs.
    0:37:03 So when you’re able to go to an Upgrade Labs or if you open an Upgrade Labs franchise in your neighborhood, a lot of the gear there, well, I bought all that gear.
    0:37:13 And I’ve spent God knows how much on lab testing, on traveling around the world and trying all of the anti-aging technologies that billionaires are doing right now.
    0:37:19 And that was the subject of Superhuman, which is my big anti-aging book that tells you all of the stuff that you can do now, including the free stuff.
    0:37:25 So the problem is that when you’re young, you’re not going to spend $100,000 on a stem cell treatment.
    0:37:29 It doesn’t even make sense because you don’t need to because you have young stem cells, right?
    0:37:31 So that’s part of it.
    0:37:35 But there are things you can do now that we know what’s making you older.
    0:37:44 The things you can do that are free, that give you the advantages so you can hold off on spending lots more money as you age in order to not age.
    0:37:52 So the biggest one you can do that has the highest ROI is intermittent fasting, which is my latest book.
    0:37:54 Love it.
    0:37:56 So why don’t, well, let me ask you one other thing.
    0:37:59 What is, so you spent $2 million.
    0:38:03 What would you say is the most effective thing that you’ve done so far?
    0:38:06 Wow.
    0:38:13 It’s sort of like, okay, you have a car and you want to keep your car running for a long time.
    0:38:18 So what was more important, changing the oil or rotating the tires?
    0:38:20 They’re probably both important.
    0:38:25 Like if you don’t rotate the tires, you’re going to have a blowout and flip the car and that’s no good, right?
    0:38:28 But if you don’t change the oil, the engine is going to wear out before it’s time.
    0:38:28 So which one was more important?
    0:38:37 It’s really hard for me to say that, but I will tell you that having a healthy metabolism that makes energy very effectively from air plus food.
    0:38:48 If you can hack that system, everything else, including your cognition, your meditation, your personal development, your rate of aging, your DNA methylation, all of it will be better.
    0:38:52 So fixing your metabolism would be the number one thing.
    0:38:55 And of all the things I’ve done, which fixed it a lot.
    0:38:56 The supplements are important.
    0:39:00 You absolutely need to be taking supplements.
    0:39:01 The reason is straightforward.
    0:39:08 You’ll never get all of your nutrients from food because that presupposes you get all of your toxins from mother nature.
    0:39:11 You live in a world that is not the natural world.
    0:39:14 You need to support the systems in your body for the world you live in.
    0:39:15 That’s why you use supplements.
    0:39:22 The other thing is intermittent fasting, brief periods of exercise, not over-exercising, is also very important.
    0:39:26 And so those are some of the very basic cheap things.
    0:39:28 And frankly, sleeping, learning how to sleep.
    0:39:32 When I was a young entrepreneur, like sleep, why would I do that?
    0:39:34 I could learn instead of sleep.
    0:39:38 So I would sleep five hours a night sometimes because I had work, because I had things to do.
    0:39:40 The ROI on sleep is very high.
    0:39:52 But a new study came out literally two days before we recorded this that showed sleeping more than six and a half hours a night is related to negative changes neurologically.
    0:40:01 The correct amount of time for high-performance, healthy people who are not under undue stress is about six and a half hours a night.
    0:40:15 I went from five minutes of deep sleep and five minutes of REM sleep in a six and a half hour period 15 years ago to getting an hour and a half to two hours of deep sleep and an hour and a half to two hours of REM sleep.
    0:40:19 That is more sleep than a 20-year-old gets in eight hours.
    0:40:25 I’m getting as a 48-year-old who identifies as a 28-year-old in six and a half hours.
    0:40:28 So less sleep, but more quality.
    0:40:31 That in and of itself is your biggest anti-aging strategy right now.
    0:40:33 So learn how to sleep and learn how to skip breakfast.
    0:40:38 Those two things are going to buy you 20 years, even if you don’t spend any money on it.
    0:40:39 Okay.
    0:40:46 Well, this is a great segue into your new book that came out last January called Fast This Way.
    0:40:52 So I thought the best way to kick this off is to get your definition of fasting because it’s not only about food.
    0:40:56 Fasting means to go without.
    0:40:57 That’s it.
    0:41:01 And people say, well, fasting means you can have no calories.
    0:41:02 You can only have water.
    0:41:05 Because that’s what mice did in a study.
    0:41:09 I’m like, well, I hate to tell you there’s something called dry fasting.
    0:41:12 That’s when you fast without water too.
    0:41:15 So which is the real fasting, right?
    0:41:19 Well, there is no real definition other than the one I just gave, which is to go without.
    0:41:20 You can fast from alcohol.
    0:41:21 It’s called abstaining.
    0:41:22 You can fast from sex.
    0:41:26 It’s called chastity or celibacy, whatever you want to call it.
    0:41:31 And you can fast from hate, which is called compassion meditation.
    0:41:33 It’s called forgiveness.
    0:41:39 All of those are practices of fasting, saying I am not going to do X for some period of time.
    0:41:45 And it turns out when fasting from food, it’s not even fasting from calories.
    0:41:51 It’s fasting from specific types of calories that cause metabolic changes you don’t want.
    0:41:59 So I wrote the first book, which is about fasting for performance, a working fast versus fasting for a spiritual fast.
    0:42:03 And I fasted in a cave for four days led by a shaman who was remote from me.
    0:42:08 So I’m all by myself because I knew that if I didn’t eat, this was going back to 2008.
    0:42:13 If I didn’t eat six meals a day, I would go into starvation mode, which is not a real thing.
    0:42:18 And then that would make me fat and some bizarre mental gymnastics taught to me by big food.
    0:42:26 I also knew that I would get hypoglybitchy, which meant that if I didn’t eat often, I would yell at everyone around me because I would get cranky.
    0:42:29 So I’m like, put me in a cave, no food, no one to yell at.
    0:42:30 Everybody wins.
    0:42:36 And the book is actually based on the psychology of fasting plus the physiology of fasting.
    0:42:38 And I just tell you, here’s how to fast without pain.
    0:42:42 So you work better than you did before and you save money and time in the morning.
    0:42:46 And then here’s what to do on a weekend or when you want to do a spiritual fast.
    0:42:53 And to date, 70,000 people have done the free fasting training, the challenge that comes with the book.
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    0:43:00 And I just want people to learn if you skip breakfast the right way, you’re nicer to the people around you.
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    0:48:03 So let’s stick on that since you brought it up, skipping breakfast.
    0:48:06 I think it’s, you got to wait six hours.
    0:48:10 I think in your book you said six hours after you wake up is when you should first,
    0:48:13 you know, break your fast, I guess, or eat your lunch.
    0:48:14 Is that true?
    0:48:16 It’s not true.
    0:48:16 Okay.
    0:48:22 And the reason the book is called Fast This Way is that there isn’t one way.
    0:48:24 It’s biologically unique.
    0:48:29 So let’s just suppose that last night you went out and you maybe had a few drinks with
    0:48:32 friends and you stayed up till midnight, right?
    0:48:35 And then you woke up this morning and said, I’m going to fast.
    0:48:39 You already blew out your biology.
    0:48:40 You messed with your sleep.
    0:48:41 You had alcohol.
    0:48:43 You probably ate way late.
    0:48:46 You’re, maybe you worked out the day before too.
    0:48:46 Okay.
    0:48:48 So you’re already at a point of biological stress.
    0:48:52 Adding fasting as a stressor on top of a stressed body isn’t going to work very well.
    0:48:53 Have some breakfast.
    0:48:54 It’s okay.
    0:48:55 Right.
    0:48:58 And then let’s say that another day you went to bed on time.
    0:49:03 You didn’t have a late dinner and you didn’t have a bright TV in your eyes and whatever.
    0:49:06 So you wake up and you’re just fully charged and you’re ready to go.
    0:49:09 Maybe you should fast for more than six hours.
    0:49:14 The evidence shows at least a 12 hour fast, three days a week.
    0:49:18 This is in women over 40 specifically creates metabolic benefits.
    0:49:23 So for most people, most days, at least 14 hours without food is a good idea.
    0:49:25 However, 14 hours, I would starve.
    0:49:28 Now, when you’re asleep counts, it’s like have dinner.
    0:49:29 Earlier dinners are better.
    0:49:30 So have dinner at five.
    0:49:32 Let’s say you’re done eating at six.
    0:49:41 If you, if you don’t eat snacks and dessert after that, and you wake up at 6 a.m., you already fasted 12 hours.
    0:49:44 You can just wait two more hours and you did a 14 hour fast.
    0:49:45 So you have breakfast at eight.
    0:49:49 It’s not that big of a deal, but that midnight snack ruins you biologically.
    0:49:52 And if you’re saying, okay, I didn’t want, I can go past eight.
    0:49:56 I’m just going to wait and I’ll have some breakfasty kind of thing at 10.
    0:49:59 Well, you just did a 16 hour fast.
    0:50:00 You wait till noon.
    0:50:01 Oh my God.
    0:50:04 You did an 18 hour fast and 18, six fast.
    0:50:05 That’s what all the paleo people do.
    0:50:08 It’s not that hard, but here’s when it’s hard.
    0:50:11 And I say this as a guy who was obese for much of my life.
    0:50:21 If when you wake up, you have a gnawing hunger and all you can do is think about food and you go into the office and someone has a plate of donuts there, the donut’s going to win.
    0:50:23 It’s going to say, eat me.
    0:50:24 And you’re going to say, no.
    0:50:26 And it’s going to say, eat me.
    0:50:27 And you’re going to say, no.
    0:50:29 And the conversation gets more and more shrill.
    0:50:30 And it’s like arguing with the two-year-old.
    0:50:34 Eventually there’s going to wear you down and you go, fine, I’ll eat half.
    0:50:35 And you have just a bite of donut.
    0:50:37 And then you go, God damn it.
    0:50:38 Why am I such a bad person?
    0:50:39 I’m so weak.
    0:50:39 No.
    0:50:44 Theology dictates that this will happen to you, especially when you’re not fat adapted.
    0:50:46 We don’t have a flexible metabolism.
    0:50:52 So what I teach people to do in the fasting challenge or by reading the book, but the fasting challenge is free.
    0:50:53 Fast this way.com.
    0:50:59 It’s look, there are things you can do that turn off hunger so that in the morning, I just don’t care about food.
    0:51:03 The donuts are in front of you and there is no voice telling you to eat it because you’re like, I don’t want it.
    0:51:10 And it’s so much, it’s just easier that way because what happens is your willpower is a finite resource.
    0:51:16 And if you spend all of your willpower saying no to donuts, no to your biology, it just keeps asking you because your biology doesn’t have what it needs.
    0:51:23 You’re probably not going to have enough left over to be nice to the people around you, to be focused at work, to do what you want to do.
    0:51:25 And then you’re going to beat yourself up and think it was you.
    0:51:32 So fast this way is about the mindset and the physical tools to make yourself never hungry when you’re fasting.
    0:51:33 And then it’s just easy.
    0:51:35 So fastestway.com.
    0:51:37 I’ll stick that in my show notes.
    0:51:41 So when people think about fasting, I think the big buzzword is ketosis.
    0:51:45 Everybody knows about ketosis and that’s what they, they want to enter into a state of ketosis.
    0:51:51 But then there’s also another important world called, called autophagy, phagy, autophagy.
    0:51:52 Autophagy.
    0:51:52 Autophagy.
    0:51:53 Sorry, I read it.
    0:51:54 I didn’t hear it.
    0:51:55 Autophagy, right?
    0:51:59 So tell us about the difference between ketosis and autophagy.
    0:52:12 People who read my first big book called The Bulletproof Diet, that’s probably more than half a million copies now, 16 languages, and people have lost more than a million pounds on the Bulletproof Diet.
    0:52:18 It was probably the first modern keto book, except it wasn’t just about keto.
    0:52:27 What ketosis is, is something that happens when you fast or when you only eat fat or maybe very, very small amounts of carbs and protein and all.
    0:52:31 But it’s when your body says, I’ve got no carbs and no protein to burn, what will I do?
    0:52:33 I guess I should burn fat.
    0:52:37 This is a major part of how I lost the hundred pounds of fat that I lost.
    0:52:46 The only problem is that in the Bulletproof Diet, I teach people, here’s how to use ketosis for a brief period and then how to switch out of it and then go back in.
    0:52:55 And if you’re saying, I’m only going to eat peanut butter and margarine, you’re not going to have the same results as if you eat the stuff that I talk about.
    0:52:57 Actually, grass fed butter instead of peanut butter.
    0:53:00 So the type of things you eat when you’re doing ketosis matters greatly.
    0:53:04 But essentially, it’s fat burning mode and we’re all capable of it.
    0:53:11 And if you go into ketosis even briefly, it has a side effect that no one talks about that’s so important.
    0:53:18 When I weigh 300 pounds, there were many times I would lose 30 or 40 pounds and it would come roaring back plus 10.
    0:53:28 It happens to anyone who’s been fat and right now it’s like 60, 70% of the U.S. is overweight and struggling with exactly what I went through and what I don’t ever think about now.
    0:53:36 And when you go into ketosis, it resets your body’s hunger to that of your current body weight.
    0:53:43 If instead you go, oh, I’m going to do what those 1970s people online say, oh, you just have to work out more and eat less and you’ll lose weight.
    0:53:44 No, I tried that.
    0:53:45 I beat myself up.
    0:53:47 I gave myself an autoimmune condition doing that.
    0:53:48 It does not work.
    0:53:51 You might lose weight for a little bit of time, but it will come back.
    0:53:54 So what happens there?
    0:53:58 You go in ketosis and all of a sudden, if I weighed 300 pounds, I lost 50 pounds with ketosis.
    0:54:03 I’m still going to have the hunger of a 300-year-old unless I use ketosis, right?
    0:54:05 So that’s why it matters so much.
    0:54:06 So that’s keto.
    0:54:08 And autophagy is a totally different thing.
    0:54:14 If you think about Las Vegas, all those lights everywhere before they turned to LEDs, there were teams, hundreds of people.
    0:54:18 Their job was to go out and find the dim bulbs and the bulbs that were out and go up on a ladder
    0:54:21 and take out that bulb and put in a new one so that you didn’t have any bulbs out.
    0:54:28 Well, your body has quadrillions of little power plants and some of them are weaker than others.
    0:54:31 When you fast, your body goes through and says, what are the weakest ones?
    0:54:37 Let me get rid of those, break them down, and use them as building blocks to make new, healthy, young mitochondria.
    0:54:44 So when you fast, you get the benefits of ketosis, weight loss, and mental function, and the reduction in Alzheimer’s.
    0:54:49 And you get the benefits of autophagy, which is replacing older power plants with younger ones.
    0:54:50 Oh, and how much did it cost?
    0:54:56 You actually got paid to do it because you didn’t spend money on breakfast and you didn’t spend time on breakfast.
    0:54:59 It is the simplest thing to just go, oh, this makes sense.
    0:55:02 It is so, so interesting.
    0:55:08 You know, I was always never a fan of fasting because I grew up Muslim, right?
    0:55:10 I’m the least religious person ever.
    0:55:11 Ramadan.
    0:55:15 And so, like, I was tortured being fasting during Ramadan.
    0:55:19 And it was so hard because you’re not even allowed to drink water.
    0:55:22 And I think spiritually, I respect it.
    0:55:30 You know, I haven’t fasted since high school because I decided that it made me sluggish and that I couldn’t compete.
    0:55:34 I wasn’t going to, you know, when I was getting my MBA, I was like, I won’t get a 4.0 if I fast.
    0:55:36 When I was in corporate, I won’t be competitive.
    0:55:37 Now I’m an entrepreneur.
    0:55:38 Same thing.
    0:55:41 I feel like I can’t be competitive if I’m fasting for a month.
    0:55:45 And then plus, I feel like it’s kind of an unhealthy way to do it.
    0:55:48 So you only eat when it’s dark outside.
    0:55:50 And a lot of people usually wake up at 4 a.m.
    0:55:55 They eat, then they wake up, then they’ll eat again at like 7 or 8 when the sun goes down.
    0:55:56 And they’ll probably eat all night.
    0:56:01 And then you can’t have water or coffee during the day.
    0:56:04 So what do you think about this kind of fasting?
    0:56:05 It can’t be good for you.
    0:56:15 Well, it turns out a lot of the studies I reference in Fast This Way are using Ramadan, which is one of our biggest studies of a certain style of fasting.
    0:56:18 And it’s intermittent dry fasting, right?
    0:56:22 It turns out there are health benefits to Ramadan, which are built in.
    0:56:29 And a lot of the ancient nutritional practices that you’ll find through whatever culture you’re looking at are around health.
    0:56:32 For instance, the don’t eat pork that you find in multiple religions.
    0:56:36 It’s because pork usually had parasites in it.
    0:56:40 And pork that is not refrigerated properly has high levels of histamine, which is inflammatory.
    0:56:46 So if you were making rules for your population, you’d be like, don’t eat that stuff because it causes problems a lot of times.
    0:56:50 However, if it’s preserved properly and it’s fed properly, it has different effects.
    0:56:53 But they didn’t have the technology or the abilities there.
    0:56:55 So they’re like, just don’t do it, right?
    0:56:56 Which makes sense.
    0:57:00 Now, what I would say is that it actually is healthy.
    0:57:03 And there are many, many people who practice Ramadan.
    0:57:10 And the last thing they have before they go into Ramadan, right before the sun comes up, is a huge cup of bulletproof coffee.
    0:57:21 And they do that because in Fast This Way, I talk about the mechanisms of butter and specifically the MCT oil and coffee itself to turn off hunger for long periods of time.
    0:57:25 So at that point, their ketone levels spike and the ketones suppress hunger.
    0:57:28 So then they don’t think about hunger all day long.
    0:57:32 And get this, when your body is burning fat, guess what a side effect of burning fat is?
    0:57:35 I don’t know.
    0:57:36 Losing weight?
    0:57:36 Water.
    0:57:37 Water?
    0:57:37 Okay.
    0:57:38 It makes water.
    0:57:40 That’s why camels store fat in their humps.
    0:57:42 No, they store fat in their humps.
    0:57:42 But it’s water.
    0:57:46 So they burn the fat in the hump to make water so they don’t need to drink water.
    0:57:54 So if you are in Ramadan and you have ketosis going on, you are hydrating yourselves through burning fat.
    0:57:55 And you’re not hungry because you’re burning fat.
    0:57:58 And then it’s a much less painful fast.
    0:58:00 Now, eating after dark is just not good for you.
    0:58:01 But that’s traditional in the Middle East.
    0:58:08 I’ve spent a lot of time in Dubai, been to Oman, and have investors in my companies from that part of the world.
    0:58:10 And I do have a hard time.
    0:58:11 I have dinner at 10 o’clock at night.
    0:58:12 I don’t sleep as well.
    0:58:14 But that’s because of the intense sun during the day.
    0:58:17 So you’ve got to adjust what you do for where you live.
    0:58:17 Yeah.
    0:58:20 So, well, that’s all really helpful.
    0:58:24 I guess you gave me a little bit of motivation to figure out how I could do it.
    0:58:26 I do this next time it’s Ramadan.
    0:58:28 You haven’t done this in a long time.
    0:58:30 Connect to your roots.
    0:58:32 Try it for just a week.
    0:58:33 Just a week.
    0:58:34 Not the whole month.
    0:58:37 And see if instead of being sluggish, tired, slow.
    0:58:46 The reason you’re sluggish and tired and slow is because what you eat at night is full of sugar and carbs and stuff like that.
    0:58:54 But when people say, oh, I’m going to practice Ramadan, but I’m going to eat foods that don’t cause hunger all day long, suddenly it’s like rocket fuel.
    0:58:56 And it’s totally sustainable for a month.
    0:58:58 That’s super interesting.
    0:59:03 So let’s talk about – I know we’re running a little short on time.
    0:59:04 So actually, I’m going to skip to something else.
    0:59:06 Let’s do a quick fire segment.
    0:59:10 I’m going to rattle off some ways that you can fast.
    0:59:14 And why don’t you tell us quickly what they are and the good and the bad with each one.
    0:59:17 So let’s start with the 16-8 fast.
    0:59:24 16-8 fast means that you don’t eat for 16 hours and you eat whatever you want during that eight hours.
    0:59:29 This is what works for most people most of the time as long as you don’t do too much of it.
    0:59:35 And it gives you most of the benefits of intermittent fasting, which can be slightly longer or slightly less long.
    0:59:35 Okay.
    0:59:38 Let’s do OMAD, one meal a day.
    0:59:42 One meal a day means what it says.
    0:59:43 So it’s a 24-hour fast every day.
    0:59:50 In fact, if during Ramadan, you were to say, I’m just going to eat breakfast right before sun comes up, you’d be doing OMAD.
    0:59:52 OMAD is fantastic.
    0:59:53 It gives you more autophagy.
    1:00:02 However, most people I find who do OMAD every single day for more than especially about five days, their sleep quality goes down.
    1:00:05 Women’s before men’s because women and men actually do fast differently.
    1:00:07 That’s part of the teachings in Fast This Way.
    1:00:10 The 5-2 fast.
    1:00:12 5-2 fast.
    1:00:18 That’s a fast where for two days of the week, you either eat very low calories or no calories.
    1:00:21 And five days, you eat whatever the heck you want, whenever the heck you want.
    1:00:24 And there’s plenty of evidence that says that works.
    1:00:27 I find it’s much less sustainable for long periods of time.
    1:00:29 Probably doesn’t work as well as just skipping breakfast most days.
    1:00:32 Okay, spontaneous meal skipping.
    1:00:36 Spontaneous meal skipping just says, oh, I don’t feel like eating.
    1:00:37 I’m not going to eat.
    1:00:38 You should always do that.
    1:00:40 But here’s the deal.
    1:00:44 If you want to eat within four hours of a meal, your last meal was built wrong.
    1:00:46 You have that kale salad you thought was healthy.
    1:00:47 No, it wasn’t healthy.
    1:00:48 It just made you hungry.
    1:00:51 So, if you just don’t feel like eating, don’t eat.
    1:00:56 The problem is that skipping meals doesn’t really make it fasting.
    1:00:58 Unless you’re skipping breakfast or you’re skipping dinner.
    1:01:02 Because you just aren’t getting that 12-hour plus window of having no food.
    1:01:03 Okay.
    1:01:08 So, let’s go back to, you just mentioned something that I want to touch on.
    1:01:10 You said that women and men fast differently.
    1:01:11 Why is that?
    1:01:14 There is something I call the fasting trap.
    1:01:16 And it’s the same as the exercise trap.
    1:01:18 It’s the same as the keto trap.
    1:01:19 It’s the same as the vegan trap.
    1:01:24 If you think something is good and you got results, more of it must be better.
    1:01:26 It’s just basic human thinking.
    1:01:31 The problem with fasting is that when you fast too much, then bad things start to happen.
    1:01:33 But you’re convinced that fasting works for you.
    1:01:36 So, then you fast even more and you end up making yourself sick.
    1:01:39 Women hit the fasting trap before men do.
    1:01:42 Usually in about six weeks of over fasting.
    1:01:46 Men, it’s usually closer to eight or even 12 weeks.
    1:01:49 Here’s what it looks like for women when you over fast.
    1:01:50 You get that fasting trap.
    1:01:54 And over fasting means just fasting for too long, too many days in a row.
    1:01:58 Number one, you wake up and you feel like you didn’t sleep.
    1:01:59 Your sleep quality goes down.
    1:02:03 Number two, your hormones start not working right.
    1:02:04 Your cycle is less regular.
    1:02:06 You have more symptoms.
    1:02:06 Huh?
    1:02:07 I don’t normally get that.
    1:02:09 And then number three is hair thinning.
    1:02:14 And with guys, it hits us a couple of weeks later if we’re over fasting.
    1:02:16 Number one, we don’t sleep as well.
    1:02:20 If you’re monitoring your sleep, you see changes or you just wake up and feel just not well rested
    1:02:20 today.
    1:02:22 Maybe I’ll just have more coffee and fast extra today.
    1:02:23 Not a good idea.
    1:02:27 Second thing, guys, experience is you wake up without a kickstand.
    1:02:32 And the third thing is you’re looking at me like you don’t know what I’m talking about,
    1:02:33 but you know what I’m talking about.
    1:02:35 Now I just got it.
    1:02:36 Now I got it.
    1:02:37 It took me a minute.
    1:02:38 I was like kickstand.
    1:02:46 And then the third one is, see, I didn’t trigger any warnings there.
    1:02:49 The third one for guys is also hair thinning.
    1:02:52 So this is why for women and men, it’s different.
    1:02:56 And women are more susceptible to over fasting.
    1:02:58 And it isn’t true for all women.
    1:03:00 This is why fast this way.
    1:03:04 You must fast based on your current biological state, your current readiness.
    1:03:09 So there are also changes that occur at different times of the month where you are in your cycle.
    1:03:10 Right.
    1:03:14 So for some women, when you’re menstruating, like, OK, I really do great fasting.
    1:03:17 Other women, I need to eat because my blood sugar is unstable.
    1:03:21 But you got to figure out what it is so that you feel good and you’re not overdoing it.
    1:03:23 And I talk about the techniques in the book for that.
    1:03:27 Guys, I have to say fastest way has so much information.
    1:03:31 There’s so many things we didn’t get to talk about, really, like sleep related to fasting,
    1:03:33 exercise related to fasting.
    1:03:35 You guys can get all that information in Dave’s book.
    1:03:41 Dave, the last question I ask all my guests is, what is your secret to profiting in life?
    1:03:49 My secret to profiting in life is don’t worry about profiting in life.
    1:03:50 That’s not what you’re here to do.
    1:03:53 You should evolve in life and profit to side effect.
    1:03:54 Love it.
    1:03:57 And where can our listeners go to learn more about you and everything that you do?
    1:04:00 Go to Dave Asprey dot com.
    1:04:03 There’s three thousand articles, a thousand hours of video.
    1:04:06 There’s a vibrant learning community called the Upgrade Collective.
    1:04:11 And there are free challenges where I just teach you all my books for free because I just want you to have the knowledge because,
    1:04:13 well, if you have that knowledge, then you won’t suffer the way I did.
    1:04:14 And everybody wins.
    1:04:15 Amazing.
    1:04:16 Thank you so much.
    1:04:17 I love this conversation.
    1:04:18 It was so good.
    1:04:19 It was fun.
    1:04:20 Thank you.

    Tech entrepreneur Dave Asprey once found himself battling chronic fatigue, autoimmunity, and the threat of a stroke – all while climbing the Silicon Valley ladder at 300 pounds. Confronted with life-or-death stakes, he poured millions into biohacking his brain health, metabolism, diet, and sleep to reclaim his energy and sharpen his mindset. In this episode, Dave reveals the science-backed strategies behind fasting, longevity, and peak health that earned him the title “Father of Biohacking,” and that any entrepreneur can use to boost energy, productivity and mental clarity.

    In this episode, Hala and Dave will discuss:

    (00:00) Introduction

    (01:29) Dave Asprey’s Early Life and Health Struggles

    (03:05) From Internet Pioneer to Biohacking Guru

    (06:24) The Birth of Bulletproof Coffee

    (09:31) The Philosophy Behind Biohacking

    (17:21) The Future of Human Longevity

    (25:40) Preventing and Reversing Alzheimer’s

    (26:46) Dave Asprey’s Current Ventures and Closing Thoughts

    (27:57) Redefining Age: Biological vs. Calendar Years

    (28:54) Measuring Biological Age: True Age and Telomeres

    (29:46) Personal Development and Biological Influence

    (31:15) Anti-Aging Investments and Strategies

    (32:32) The Power of Intermittent Fasting

    (35:27) Understanding Fasting: Beyond Food

    (41:56) Ketosis vs. Autophagy: The Science Explained

    (45:03) Fasting During Ramadan: Health Insights

    (49:05) Quick Fire: Different Fasting Methods

    (51:04) Fasting Differences: Men vs. Women

    Dave Asprey is a four-time New York Times bestselling author, founder of Bulletproof 360, and host of the Webby Award-winning The Human Upgrade Podcast. Recognized globally as the “Father of Biohacking,” Dave is a Silicon Valley veteran who pioneered functional coffee and popularized MCT oil. He also launched Upgrade Labs, the world’s first human performance center. Dave has been featured on TODAY, CNN and in The New York Times for his groundbreaking work in brain health, nutrition and longevity.

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    Resources Mentioned:

    Dave’s Book: Fast This Way: https://www.amazon.com/Fast-This-Way-Inflammation-High-Performing/dp/0062882864 

    Dave’s Website & Upgrade Collective: daveasprey.comDave’s Podcast, The Human Upgrade: https://bit.ly/THU-apple

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    Entrepreneurship, entrepreneurship podcast, Business, Business podcast, Self Improvement, Self-Improvement, Personal development, Starting a business, Strategy, Investing, Sales, Selling, Psychology, Productivity, Entrepreneurs, AI, Artificial Intelligence, Technology, Marketing, Negotiation, Money, Finance, Side hustle, Startup, Career, Leadership, Mindset, Health, Growth mindset, Mental Health, Health, Psychology, Wellness, Biohacking, Motivation, Mindset, Manifestation, Brain Health, Life Balance, Self-Healing, Positivity, Happiness, Sleep, Diet

  • 5 Startups That Looked Dumb—Until They Were Worth Billions

    AI transcript
    0:00:04 the headline here is they made the investment so it’s not like they passed they made the investment
    0:00:10 and their best case scenario they wrote was 400 million as an exit value 400 million and now it’s
    0:00:18 140 billion i feel like i can rule the world i know i could be what i want to i put my all in it
    0:00:23 like my days off on the road let’s travel never look let me uh tell you about something that i’ve
    0:00:28 been thinking about and i thought it was really cool and our friend shiel just shares the best
    0:00:33 stuff and so i’m sharing man on x the most interesting man on x the most interesting man
    0:00:39 i know actually he does a lot of amazing stuff but he shared something but so i got to give him credit
    0:00:44 but basically i saw this jeff bezos quote and i want to know what you think about it and he said
    0:00:50 something where he said um i think it’s generally human nature to overestimate risk and underestimate
    0:00:54 opportunity and then he went on to say and so i think entrepreneurs in general would be well advised
    0:01:00 to try and biased against that the risks are probably not as big as you perceive the opportunities may be
    0:01:05 a lot bigger than you perceive and so uh the interviewer was like you seem really confident and
    0:01:09 he goes well you call it confidence but maybe i’m just accepting that human bias and i’m trying to
    0:01:14 compensate against it and i thought this was interesting i’ve been thinking about this i i saw
    0:01:19 this like weeks and weeks ago and every time i’ve been thinking i’m like there’s so many businesses
    0:01:24 or opportunities that i see where i’m like i can’t believe that that thing is that big and i myself
    0:01:29 fight this as well and where i think this thing can’t be that big you know i think i’ve said this
    0:01:33 multiple times for different products that i said that will never work and it becomes huge and even
    0:01:37 jeff bezos by the way he fell victim of this there’s this one quote where he was like driving
    0:01:42 packages he says when i was driving packages to the post office myself and taping up and typing up
    0:01:47 all the listings i thought maybe if i’m lucky maybe this can be a hundred million dollar revenue
    0:01:52 company someday and so like everyone has this but i saw this amazing thing where it was shiel sharing
    0:02:01 a memo from bessemer so bessemer is a vc i think they’re a fantastic vc but they’re a big vc so they
    0:02:06 created this part of their website where they release old memos and if you don’t know what that is a memo is
    0:02:12 where whoever wants to invest into a company who works at a vc they make a memo justifying their thoughts
    0:02:15 and then typically the partners like agree on it they’re like yeah that was a persuasive argument
    0:02:21 we’re on board and so they did a cool thing where they released the memos from past deals
    0:02:28 and they had this amazing deal or this amazing memo on shopify and this was when shopify was raising
    0:02:32 five million dollars at a 20 million dollar valuation the company was doing five million in revenue
    0:02:40 and i want to show how bad bessemer who is a professional vc i think they have tens of billions in
    0:02:46 under management i want to show how bad they are predicting stuff so they said this is straight these
    0:02:54 are quotes from the memo they said in 2010 uh shopify had 132 million dollars in gmv which would
    0:03:03 put shopify in the top 50 online retailers and so at the time that is how small the category was
    0:03:07 let’s let’s say the other numbers because that sounds like a big number right so they had 5 000
    0:03:13 they had 10 000 customers total and they were doing 5 million of revenue themselves so the 5
    0:03:18 million of revenue that’s the company’s revenue and then all the shops on shopify their sales total was
    0:03:24 132 million right and now do you know how many you know how many customers there do you actually know how
    0:03:31 many they have now i know that they add more than 10 000 paid customers every week now i think there’s
    0:03:35 there’s multiple million customers they have multiple million and i believe so the company is
    0:03:44 now worth 130 billion i believe uh at 1.200 billion i believe they do something like close to a trillion
    0:03:50 dollars in gmv so i can’t even tell you what that math is what the multiple is they’re probably doing
    0:03:56 this amount like the 132 million like every hour like an hour yeah every hour yeah you’re saying we
    0:04:02 underestimate the the upside of of these things we underestimate the market size and the the headline
    0:04:07 here is they made the investment so it’s not like they passed they made the investment and their best
    0:04:14 case scenario they wrote was 400 million as an exit value and so 400 million and now it’s 140 billion
    0:04:22 they said if all things work out we think in four to six years this company could sell for 400 million
    0:04:29 dollars right and we will 20x our money something like that uh 15x our money obviously that’s wrong
    0:04:35 the company’s worth 130 billion dollars but they had all these other stats that were wrong and in the
    0:04:41 memo they even have updated quotes so the person who wrote the memo will give you an update and he
    0:04:48 wrote in the memo he goes a few months after we invested oracle had acquired one of shopify’s
    0:04:54 competitor for 500 million dollars and i remember emailing toby who’s the ceo of shopify about how
    0:05:00 great it would be if someday maybe we can achieve that outcome but i thought it was just a little bit
    0:05:07 too aspirational and then he has this other line where he goes um some of the other uh employees and
    0:05:12 advisors at shopify when we made our investment they thought to themselves you know i think like this
    0:05:18 company at best is going to be worth around 50 million dollars and so the associate at bessemer
    0:05:23 who made this deal he goes look toby these guys are saying 50 million dollars can we put something
    0:05:27 in the contract that says you are not allowed to sell the company for less than 50 million dollars
    0:05:32 because this guy was like that’s all it’s going to be worth and toby was like dude i’m not agreeing
    0:05:36 to anything like that but i’ll give you a handshake offer i promise you i won’t sell until at least
    0:05:44 75 million dollars and so it’s just funny that this is like how small the best of the best presumably you
    0:05:48 know top one percent are thinking about different opportunities that today are so obvious to us but
    0:05:50 back then were really hard to predict
    0:05:59 you don’t become the world’s most valuable women’s sports franchise by accident angel city football club
    0:06:04 did it with a little help from hubspot when they started data was housed across multiple systems
    0:06:10 hubspot unified their website email marketing and fan experience in one platform this allowed their
    0:06:15 small team of three to build an entire website in just three days the results were nearly 350 new
    0:06:22 signups a week and 300 database growth in just two years visit hubspot.com to hear how hubspot can
    0:06:29 help you grow better all right back to the pot so i have a bunch of follow-ups on this because
    0:06:33 this is a subject i’ve literally been thinking about i’ll tell you i’ll tell you why i was thinking
    0:06:37 about this simultaneously but let me first just uh let’s start with a little bit of humbling so
    0:06:43 um here’s a list of products that i was totally wrong about meaning they were already working so
    0:06:49 forget the scenario of ah that’ll never work but like yeah that’s working but that’s probably small
    0:06:53 probably niche okay so here’s products that i personally was wrong about over the last 15 years
    0:07:01 um calm and all the meditation apps my buddy alex was doing it he was in my peer group who’s in our
    0:07:06 mastermind group and i was like that’s cute you know that’s cute like i hope you know i don’t really
    0:07:10 understand what you’re doing here maybe you’ll make some some money it’ll be like a job i didn’t really
    0:07:17 fully understand it do like meditations now like a like there’s multiple meditation apps that are
    0:07:21 billion dollar companies that seemed implausible at the time he was also really successful already
    0:07:28 yeah yeah exactly so so i didn’t doubt him i thought he was awesome and i didn’t even think
    0:07:31 like it wasn’t gonna work it’s like oh it’ll work but it’s just small it just seems like a
    0:07:37 too small of a market okay other markets i thought were too small on snapchat my username was like has
    0:07:42 the word test in it still to this day because i was like yeah cool like but this is never gonna be
    0:07:47 a thing and i mean this is just like a goofy kind of sexting thing how big is the market for that
    0:07:53 another one airbnb so i met the founder of couch surfing before i heard about airbnb and we hung
    0:07:59 out at my office and i was like wow couch surfing what a crazy idea go sleep in someone else’s just go
    0:08:04 sleep in their house and they’re in the extra you know couch or air mattress that they have um all right
    0:08:10 cool so airbnb comes out and i’m like wow great you’re trying to be couch surfing how ambitious of you
    0:08:14 and um i think couch surfing topped out at like 50 million dollars or something like that
    0:08:21 uh like it maybe it was max like 100 or 200 million and you know airbnb today is a like 100 billion
    0:08:31 dollar company so i i i read that i think in america one out of every 30 dollars spent on travel is on
    0:08:38 airbnb that’s a cool stat i like that’s insane right it’s insane i want absolutely insane yeah
    0:08:47 in america yeah one minute out of every day for every entrepreneur on average is spent listening
    0:08:53 to our podcast i bet there’s like a number like that that’s true right yeah like they said it in like
    0:08:59 one of their pitch decks but it’s just absolutely astounding that you and everyone else me too thought
    0:09:05 that it was just couch surfing but it’s just it’s not 10 times better it’s not 100 times bigger it’s
    0:09:12 10 000 times bigger uber was another one uh black uber was like black car limos i was like cool rich
    0:09:17 people in san francisco who takes black cars small idea i don’t understand why you know the founder of uh
    0:09:22 of stumble upon is like doing this but okay whatever i guess rich guys just lose touch and they just start
    0:09:27 working on niche things that nobody nobody’s gonna be too niche another one musically i remember we were
    0:09:32 at the office trying to build social products and morgan this guy who worked with me he was like hey
    0:09:38 my daughter loves making these lip sync videos on musically and it was actually even maybe even a
    0:09:43 different thing besides musically but this idea of like you record yourself on video and then there’s
    0:09:48 music mixed in and you’re kind of lip syncing and dancing uh you make little dance videos and i was
    0:09:52 like okay cool morgan but can we get to work now like we’re trying to build the next big thing here
    0:09:57 and like you know stop distracting us with this and uh you know has anyone ever just like showed
    0:10:00 you a briefcase full of cash and then you like accidentally kick it into the gutter that’s what
    0:10:05 that’s what we were doing um okay so those are things that i was totally wrong about well hold let me tell you
    0:10:10 one more alex lieberman shared a dm that he got from the founder of cursor so cursor is a company that in
    0:10:18 or something like that grew to 10 billion dollars and the guy emailed alex lieberman asking for advice
    0:10:25 or like what he should do and left him off yeah left him on red hey we all miss in fact bessemer has a
    0:10:29 part of their website called the anti-portfolio have you ever seen this no they were the first bc i think
    0:10:35 that did this so they created if you go bessemer bvp.com slash anti dash portfolio it’s basically just
    0:10:40 honoring the companies we missed and it’s just like airbnb apple ebay google like it’s all the
    0:10:46 companies they had the opportunity to invest in but passed for varying reasons um and they just like
    0:10:50 humble themselves with this so this is like the this is the opposite of the hey let me show you our memos
    0:10:56 of how smart we were um this is like you know the other side of the coin and it’s crazy man for any
    0:11:00 anybody who’s like worth a damn in business your your anti-portfolio is going to be much bigger than
    0:11:05 your portfolio which is just a bizarre situation if you’re any good if you’re if you’re any good and
    0:11:10 you’re in the game for any like decent amount of time your anti-portfolio is much bigger part of this
    0:11:16 is underestimating the size of markets and the other there’s many things here the other part is not
    0:11:24 understanding math because 10 000 times or 1 000 times whatever that’s actually it’s really hard to
    0:11:30 estimate and so like to put it in really simple terms i remember working with financial uh my financial
    0:11:37 advisor and they there was like this line item for 250 000 in 18 years and i was like griffin what is
    0:11:43 this man he goes uh well that’s i just baked in like college expenses uh and i was like but i’m not
    0:11:47 gonna pay for all four years up front or are you thinking we’re gonna have triplets what’s the deal
    0:11:53 here and he was like no i just took the trailing 20 year growth rate of college education and i assumed
    0:11:59 that they’re gonna go to like a top 75 like cost school and i just applied that number to the to the
    0:12:04 to the future and that’s just what it came out to 250 000 a year and i was like i it’s just it’s it’s
    0:12:10 really hard to understand what like five percent growth is per year or whatever it is and a really
    0:12:14 good way to understand this though that i’m trying to like get beyond the math is i’m been really
    0:12:20 obsessed with thrive so uh josh kushner and one of the reasons why i’m into it is you hosted this event
    0:12:26 and we had the founder of oscar come you had um mario come and i thought he was i thought he was
    0:12:30 like the most impressive smartest guy there and so i was like going down the rabbit hole i’m like
    0:12:34 all right you partnered with josh kushner and josh kushner is now leading all these amazing things
    0:12:40 and josh kushner recently invested in open ai at a 250 billion dollar valuation which is astoundingly
    0:12:45 expensive that’s just that number’s hard to comprehend and someone was questioning josh kushner
    0:12:49 and he was like what i learned was in the real estate days you know his parents are real estate
    0:12:58 tycoons in new york city he was like i’ve learned that you can’t really over spend on park avenue real
    0:13:02 estate so park avenue is on the upper east side that’s where like the louis vuitton store the tiffany
    0:13:07 store he was like there’s just been so many examples where someone said in the fanciest part of new york
    0:13:13 city that this building is way too expensive but when you buy the best typically it’s never too expensive
    0:13:17 like there’s always going to be someone in 10 years who wants to pay more for it so my logic is
    0:13:25 i’m going to find the park avenue of startups so open ai cursor whatever it is and i’m willing to
    0:13:29 spend what people think is it a crazy amount of money i don’t care about the valuation because i just
    0:13:34 think that those will outperform those the other ones and i’ve been really trying to like embrace that
    0:13:39 even though it’s very challenging to like actually do that this is michael saylor’s argument about
    0:13:46 bitcoin so his argument about bitcoin is basically that of all the digital assets bitcoin is digital
    0:13:53 manhattan and there’s only 21 there’s only 21 million uh million blocks that’s that’s the real
    0:13:58 estate that’s the land you want to get as many of the 21 million as you can at basically any price
    0:14:02 because this is digital manhattan and over the next hundred years that’s all that’s going to matter
    0:14:06 is basically like how much of that did you own you know i shouldn’t say that’s all that’s going to
    0:14:12 matter but basically you don’t look for the third best thing you buy manhattan right like you don’t go
    0:14:16 try to figure out what’s going to be the seventh thing because it’s cheaper right now like no no
    0:14:20 the move is always you buy the manhattan thing and you just plan to hold it over the long haul
    0:14:25 when you know it’s a scarce rare asset and like that’s the whole thing with crypto is like there’s
    0:14:32 it’s a scarce rare asset which is conceptually that is way easier to understand than 1000x uh you know
    0:14:35 like because i see manhattan real estate i’m like yeah this is like bumping this is great
    0:14:41 then it goes to the next stage which is having the courage to believe that your opinion is right
    0:14:46 yeah and so like for example someone like you who’s who’s in the bitcoin or it was or is in the crypto
    0:14:50 industry and you do believe in it it’s like well if you believe that to be true why aren’t you borrowing
    0:14:56 every dollar you can to do it and that is where uh courage comes into play and that’s really hard to
    0:15:01 buy into this concept so i say i buy into this concept conceptually but i’m not truly acting on it
    0:15:10 at least not in uh not not in a 100 type of way all right folks this is a quick plug for a podcast
    0:15:14 called i digress if you’re trying to grow your business but feel like you’re drowning in buzzwords
    0:15:20 and bs then check out the i digress podcast it’s hosted by this guy named troy sandage he’s helped
    0:15:25 launch over 35 brands that drive 175 million dollars in revenue so if you want to get smarter about scaling
    0:15:30 your business listen to i digress wherever you get your podcasts all right back to the pod
    0:15:37 there’s also other factors so for example uh i have a very funny goal my last goal on my like
    0:15:46 you know uh annual goals is just called it just says avoid ruin because my life is great and so
    0:15:53 actually like one key thing at all times is avoid ruin like do not do extremely dangerous things take
    0:15:59 care of my health and don’t make disastrously risky financial investments that like even if i believe
    0:16:04 even if i have conviction even if the upside is there i really just don’t need to i just don’t
    0:16:09 need to risk ruin at any given time i think it’s the kelly criterion just do not risk ruin keep yourself
    0:16:13 in the game is always important so like you don’t need to borrow every dollar even when you have
    0:16:18 conviction right there’s like there’s but i think that’s what separates uh not all the best so i don’t
    0:16:23 think buffett has ever like risked uh you know he famously has said uh don’t risk what you have for
    0:16:26 what you don’t need or something like or don’t risk what you need for what you don’t want or i forget
    0:16:32 exactly the quote where but it’s like risky needlessly risking things yeah but my brother john
    0:16:35 who i’m visiting in missouri he’s not into startups and he was like why do you why are you still doing
    0:16:39 this like why don’t don’t don’t risk anything i was like well i don’t really risk anything but he’s
    0:16:44 like but do the really successful like the elons risk everything and i was like a lot of them i think
    0:16:51 do i think that like there are like the 10 out of 10 the best of the best the crazy elons of the world
    0:16:55 i think that when they say i was sleeping on couches i think you don’t really want to believe
    0:16:59 that because their friends are billionaires or whatever yeah i’ve been around enough of these
    0:17:05 yeah it’s a really nice couch but i’ve been around enough of these like crazy crazy crazy like
    0:17:08 one percent of the one percent the freaks amongst the freaks some of them i actually do think
    0:17:16 don’t avoid ruin correct i just don’t think that’s wise i don’t think i don’t think a lot of them
    0:17:19 very wise i think they’re great achievers and but they’re not necessarily i don’t think they’re wise
    0:17:23 and i don’t want to do that but don’t you agree with that though that like have you who have some
    0:17:29 people do definitely take it to that extreme right like uh there’s there’s levels right so like buffett
    0:17:33 actually has been very concentrated at many times i think it’s you know recently had 50 percent of his
    0:17:37 portfolio just in apple stock right so like that’s a very concentrated thing and he believes in
    0:17:41 concentration but concentration is not the same thing as like you know risking ruin in a way
    0:17:48 even somebody like elon you know the ruin for him isn’t losing his money because he’s a money
    0:17:53 making machine he’s a achievement machine at any given time he could have even if he had lost it all
    0:17:58 through spacex and tesla and whatever he’d be rich again in 10 years and i think he knows that deep
    0:18:03 down too right so like the risk of ruin for him might be reputational right there’s a great leaked email
    0:18:09 where open ai is talking about um their path forward and this is like when this is when elon eventually
    0:18:14 got like sort of kicked out slash left the project of open ai right he’s a co-founder he put the first
    0:18:19 40 billion dollars in uh but along the way they realized they need a lot more money and the leaked
    0:18:25 email basically shows the brainstorming that they were doing sam altman greg and elon and basically elon’s
    0:18:31 idea was so they all came to the realization holy shit this is like this kind of works but we need way more
    0:18:36 money like this is going to need way more money to train these models like we’re talking 100 million
    0:18:41 dollars plus just for a single training run like let alone operating the company operating
    0:18:45 the business from operating the the project and paying all the salaries and now it’s for what
    0:18:49 like servers or something like that like uh like literally the gpus and the compute and the electricity
    0:18:54 to train one model and then you’re not going to stop there you’re going to train a better model right
    0:18:57 so once they realize shit we need 100 million and we’re a non-profit this is not going to really
    0:19:01 work who’s going to just elon’s giving us this but like are you elon are just going to give us like
    0:19:05 billions that’s probably not going to happen but that’s where this is going and so when they realize
    0:19:11 that they’re like we need a way forward so elon’s suggestion was let’s make open ai a part of tesla
    0:19:16 tesla will be the commercial machine and then we’ll take some of that profits as r and d and put it into
    0:19:21 open ai we’ll fund it that way now sam and greg didn’t like that because they’re like well yeah but
    0:19:25 then like you control everything and we’re just kind of like you little bitch we don’t really love that
    0:19:30 idea so what if we uh and they were exploring other ideas so they had a microsoft idea which
    0:19:34 is what they ended up doing so he’s like microsoft is really interested in giving us you know like
    0:19:40 you know potentially like you know multi-billions of dollars uh and free compute but then you know
    0:19:43 we’d have to work out a deal of what’s in it for microsoft and then elon basically replies being like
    0:19:50 ew like lame being a part of microsoft you know that was like in his reply basically he’s like why not tesla
    0:19:55 and then sam altman then there was like a email that referred to sam has been exploring the idea
    0:20:00 of an ico so to do a token launch and like what if we find like it was during the crypto like heyday and
    0:20:05 they’re like ah i guess like you could just raise a ton of money for kind of nothing like a promise
    0:20:14 um if you just do an ico and elon’s reply is basically like uh i am like i am against the ico it is
    0:20:19 like i think reputationally disastrous and i will not be a part of the project if you guys pursue that path
    0:20:24 like i will take my name off this project because even if that would succeed i just do not like i
    0:20:28 don’t think the risk is worth it and so it’s interesting right because like the guy is willing
    0:20:34 to risk you know certain things all of his money but not necessarily others right like you you may not
    0:20:39 always there there may be other risks it’s weird that was not weird i mean it’s just like intriguing
    0:20:43 that he thinks the ico thing is the risky thing but not like the political thing or not like well he did
    0:20:48 with the political things initially he was saying i won’t endorse a candidate and i won’t be donating to
    0:20:52 them that was his initial stance because same thing it’s like the michael jordan you know oh
    0:20:57 you’d like my opinion on this sorry no comment republicans buy shoes too yeah and like one of
    0:21:03 the great lines in in you know in in history and so initially elon did have that stance he got pushed
    0:21:09 over the edge you know due to a number of factors that maybe only he can truly describe some people
    0:21:14 think it’s because his companies were getting like overly regulated and he just was like we can’t do
    0:21:18 spacex and tesla if there’s this much regulation some you know people were basically pushing back
    0:21:24 on on you know uh capitalism or attacking him so like you know it’s unclear what all the motivations
    0:21:29 were of why he decided to then throw his weight into it but when he did he throws all his weight into it
    0:21:33 but he initially did not want to take that risk because it seemed unnecessary you know you take you
    0:21:39 only take as much risk as you see necessary what what’s cool about elon is once he sees it’s necessary
    0:21:44 he’s willing to do it whereas most people will still dilly dally or hesitate to do it which is the gap
    0:21:49 that i was talking about you know it’s like courage is a hard thing and then i also but i also think that
    0:21:59 we underestimate how different the outliers are in terms of personality to the normal people and so
    0:22:07 what i mean is is you and i are live on coasts we are work in a weird tech world it’s pretty fringe
    0:22:16 but then there’s people that are 50 times that do you know what i mean in terms of how strange and
    0:22:21 unique thinking they are so so for example the collison brothers of stripe i’ll hear like their
    0:22:27 opinion on things and i even to me i’m like wow that’s just like way different that’s like he’s so
    0:22:32 out there in terms of how this framework or how you believe that it’s just so logical and you totally buy
    0:22:39 into that that’s really challenging for me to understand but imagine to someone who is right in the
    0:22:46 mean like just like of understanding how different the different people are in terms of their thinking
    0:22:50 yeah there’s level there’s levels to this um there’s levels to everything there’s levels to
    0:22:54 intelligence there’s levels to crazy there’s levels to risk-taking there’s levels to all that
    0:22:58 that is pretty hard to comprehend until until you get closer and closer and closer to that edge
    0:23:02 and you realize like oh what i thought was level 10 was not level 10 it was
    0:23:08 7 and there’s that this is what 10 is right just imagine what brian johnson the extent brian johnson
    0:23:15 goes to for his health there are people who live you know 30 miles in my radius here that are doing
    0:23:19 that in just ways that they’re just not publicly broadcasting at but not in just health they’ll do
    0:23:23 it in finance they’ll do it in their obsession over specific technology in the lifestyle choice that
    0:23:28 they make whether it’s you know a polyamorous lifestyle or it’s a you know the extent to
    0:23:33 which they delegate extreme delegation like we were laughing when we were hanging out with mr beast and
    0:23:36 he had a he had his runner outside it’s like wait so you got kind of like a personal door dash guy
    0:23:42 that just waits around in case you need something but like yeah there’s that like there’s a lot of people
    0:23:47 that have these like lifestyle quirks where it’s like wait you peter teal when he flies to a place
    0:23:53 has a mattress shipped that hotel so that he gets right sleep because that’s his favorite mattress
    0:23:58 and he just actually some hotels store the peter teal mattress in the lobby or like in there’s like
    0:24:03 storage facility in case he’s gonna come because that’s his demand it’s like yep there’s people
    0:24:07 that do that it’s like oh wow i thought taking i thought taking my sleep seriously was like wearing
    0:24:11 this whoop band i guess there’s levels to this right i guess there’s like an infinite level level
    0:24:18 levels to this it’s a honda civic versus a nascar or it’s making the jv like i was telling my brother he
    0:24:23 was like he was comparing me to someone and i was like i don’t think you understand i’m
    0:24:30 one of the best on jv at a big high school and these guys are olympians like this right that is
    0:24:36 the gap that the you know i think um the guy from uh you told me this story about um the redhead
    0:24:41 basketball player the celtics what’s his name scallop scallop and he was like he was like joked
    0:24:48 as being the worst nba player but he would go to like uh you know blacktop games and just crush everyone
    0:24:53 and he was like you don’t understand that i’m closer to lebron than you are to me yeah and that
    0:24:58 made that’s sort of like what we’re describing here you want to do something else well i do i
    0:25:01 have one other thing but i want to go back to the market size thing because i have i have something
    0:25:07 that i think is a pretty sick example of this all right so there is an amazing story about this
    0:25:13 from uber so i remember when i was living in san francisco uber had like just come out i think i
    0:25:19 moved there 2012 and i was like it was all pretty new then and i think uber that was such a fun era
    0:25:24 that was such a fun era wasn’t it yeah that was like you know our version of like the dot-com boom
    0:25:30 right it’s like mobile it was so exciting and so i remember getting in my i got there my friend who
    0:25:33 lived in san francisco was like yeah here our rides here and we got into the stranger’s car and i was
    0:25:38 like what the hell is this it was actually a sidecar which was the third company after uber and lyft that
    0:25:44 just died it didn’t make it i remember uber started getting like a pretty big investment and it just seemed
    0:25:49 pretty crazy and they just kept getting crazier and crazy they would raise it like you know first it was
    0:25:53 was tens of millions and hundreds of millions then billions of dollars valuation and i remember
    0:26:00 reading um this bill gurley blog post that really changed my thinking and the blog post is called
    0:26:07 how to miss by a mile is the name of the blog post and bill gurley gurley was one of the early believers
    0:26:14 and early investors right yeah he’s oh he’s a legendary vc and now retired and he was one of the main
    0:26:18 investors in uber um and like you know famously at the end like you know they ended up kicking travis
    0:26:22 out and there’s you know it got it got messy at the end but he was one of the early and biggest
    0:26:27 believers okay so basically he talks about this guy um i don’t know how to say his name exactly but it’s
    0:26:31 i think it’s aswath damaraddon or something like that this guy who’s like a he’s a well-known
    0:26:39 thinker on valuations he’s a professor at nyu stern and he teaches like you know finance and
    0:26:44 economics there and so he had wrote an article that said uber is not worth 17 billion this is when uber
    0:26:50 raised at a 17 billion valuation he was right by the way uber was not worth 17 billion it is actually 10
    0:26:56 times more than that but he was making the opposite argument he was like i think uber is vastly over um
    0:27:02 overvalued and bill gurley sort of breaks down this argument and this totally changed my thinking and how
    0:27:09 you think about startups so what he said was he goes uh this professor just did this wrote this article i
    0:27:13 i wrote this blog post and it seems really well thought through and he’s a very like you know
    0:27:17 respected expert and i you know i don’t i’m not saying anything about the guy but i think his
    0:27:22 analysis is wrong and he starts with he goes the funny thing about any analysis with hard numbers like this
    0:27:27 is that it gives you a false sense of security and he talks about like anyone who’s in math knows the
    0:27:33 difference between precision and accuracy precision would be you know oh wow you’ve really forecasted this
    0:27:39 down to the second decimal and accuracy is like yeah but it’s just wrong it’s precise but wrong uh it’s
    0:27:43 not it’s not on target he was basically saying he’s like he makes two arguments so he makes one argument
    0:27:50 about the tam so the total addressable market of the of the of what uber’s market potential is and then
    0:27:55 market penetration so how much of it uber will get and he basically is like he goes the tam mistake is
    0:28:00 the mistake of thinking that the future will look quite like the past but the arrival of a new product or
    0:28:06 service will have a non-zero impact on the overall car for hire market so he goes basically it’s a new
    0:28:11 offering it’s got new levels of convenience new price points which will open up new use cases and
    0:28:17 he gives a story he goes you know once upon a time at&t paid mckinsey a million dollars to forecast how
    0:28:20 big will the cell phone market be they want at&t want to know should we become like a cell phone
    0:28:27 maker manufacturer or like should we should we care about that market or not and the mckinsey’s top you
    0:28:33 know analysts who are getting paid uh predicted that the market in 2000 the year 2000 would be
    0:28:38 900 000 people using cell phones which was less than one percent of the actual number it was 109
    0:28:44 billion and they were predicting 20 years out which is really freaking hard correct but it was it was
    0:28:49 look it was hard numbers it gave you a false sense of security and so at&t decided not to go not to
    0:28:54 invest in that area they ended up to make you know once it was once they realized they were behind the
    0:28:58 the ball and you know actually cell phones were going to be a big deal uh they ended up having to
    0:29:02 buy the cell company for 12 billion dollars so it’s basically a 12 billion dollar mistake and by the way
    0:29:08 now like you know five or six billion people have cell phones it’s like just absolutely ubiquitous
    0:29:12 aaron levy the founder of box has this tweet where he said sizing the market for a disruptor based on the
    0:29:17 incumbents market is like sizing the car industry based on how many horses there were in 1910
    0:29:24 and so uh girly’s talking about this now of course you might say well is this always the case like you
    0:29:28 could always say well you know forget the past you’re just being you’re stuck in that old way of
    0:29:34 thinking that think about the bright future and uh of course no that’s not always true in fact it’s
    0:29:40 probably usually correct that the you know the near future will look like the the near past but the funny
    0:29:47 thing about entrepreneurship or any tech investing is that it’s a hits it’s a hits driven game so you only need
    0:29:52 one and you can actually be wrong eight or nine times out of ten as long as you get the one right
    0:29:58 in a really really big way and that’s not true in other businesses like that’s not true in school you
    0:30:02 can’t pass a test that way it’s not true at your job you can’t just like have one great day and then
    0:30:08 like have nine duds um like you can’t do that in private equity warren buffett famously was like you
    0:30:12 know picking stocks rule number one don’t lose money you know vcs lose money all the time entrepreneurs
    0:30:17 get it wrong all the time it’s a very distinct difference and so like and this is actually a
    0:30:24 distinct difference oftentimes in you and i’s uh personality which is buffett is predicting that the
    0:30:31 future will repeat itself and that the past is the past won’t change for the future vc investing tech
    0:30:36 investing is doing 100 the opposite correct both are valid games but you have to know what both are
    0:30:40 right you have to know they’re right in their game so like in the stock market that’s probably the right
    0:30:44 way to think about things and value investing that’s probably the right way to think about things and
    0:30:48 private equity is probably the right way to think about things in entrepreneurship or tech investing
    0:30:51 it’s absolutely the wrong way to think about things you won’t make any money doing that other
    0:30:58 way and so in our business i have this phrase which is that in our business you know the cynics get to be
    0:31:03 right and the optimists get to be rich and so it’s like the cynics will be right and you get to be right
    0:31:08 eight out of ten times that might feel good but the optimists are the one who get who get rich and you
    0:31:14 have to just know that going in what are your uh what your employees replied all like sean i’m just
    0:31:20 asking if you want pizza or hamburgers for lunch like can you just tell me like this might be why
    0:31:25 i have no friends but i have a podcast i think you nailed it
    0:31:34 so you guys know this but i have a company called hampton joinhampton.com it’s a vetted
    0:31:40 community for founders and ceos well we have this member named lavon and lavon saw a bunch of members
    0:31:44 talking about the same problem within hampton which is that they spent hours manually
    0:31:49 moving data into a pdf it’s tedious it’s annoying and it’s a waste of time and so lavon like any great
    0:31:55 entrepreneur he built a solution and that solution is called molku molku uses ai to automatically
    0:32:00 transfer data from any document into a pdf and so if you need to turn a supplier invoice into a customer
    0:32:05 quote or move info from an application into a contract you just put a file into molku and it
    0:32:10 auto fills the output pdf in seconds and a little backstory for all the tech nerds out there
    0:32:15 slavon built the entire web app without using a line of code he used something called bubble io
    0:32:20 they’ve added ai tools that can generate an entire app from one prompt it’s pretty amazing and it means
    0:32:25 you can build tools like molku very fast without knowing how to code and so if you’re tired of copying
    0:32:34 and pasting between documents or paying people to do that for you check out molku.ai m-o-l-k-u-dot-a-i
    0:32:42 all right back to the pod this is a a great um a great blog post the guy who’s like the the the
    0:32:47 anti-hero on this like where is he now he’s still there professor he’s still a professor of course he
    0:32:52 is because you know you know skin in the game you can never really be wrong um and so he that guy had
    0:32:57 estimated the global taxi market to be a hundred billion so anyways let me zoom it in so i remember
    0:33:02 living in san francisco and when this happened girly pointed something out which was that
    0:33:09 in san francisco the taxi market size whatever it was let’s just pretend it was like 150 million dollars
    0:33:16 uber didn’t just have some percent share of that market it was actually three times bigger than what
    0:33:22 the total taxi market was in san francisco it was a total like market expander of a force and you see
    0:33:27 that over and over and over again any new product that’s creating a new category it doesn’t just eat
    0:33:33 some share of the existing category it just explodes and becomes bigger than that thing so let me kind of
    0:33:39 like fast forward to to another area that this came up so i was watching these videos from sequoia
    0:33:45 sequoia recently had an ai event and my invite must have gotten lost but i was able to catch it on youtube
    0:33:51 afterwards luckily and so i was i think uh darmash was one of the speakers yeah yeah i know so again
    0:33:57 maybe my speaker invite also was lost i’m not exactly sure what happened uh but but it’s all
    0:34:03 it’s all love amongst amongst me and sequoia so the very first speaker this guy i think it’s pat grady
    0:34:07 he’s a partner of sequoia and he has a slide on the screen i’m gonna show you the slide it’s
    0:34:13 maybe a top five ugly slide like this might be the worst slide i’ve ever seen in my life
    0:34:18 like not only is it ugly it doesn’t even make any it’s illegible like you look at this it doesn’t
    0:34:23 even mean anything but he explains it so okay so check out the slide you see this thing right here
    0:34:29 yeah so like i remember taking the act where it was like showed you like three shapes or three numbers
    0:34:33 and you had to predict the fourth one based off of the pattern i cannot do this with this okay exactly
    0:34:38 so if you look at this slide it basically is like a bunch of pie charts but the pie charts have no
    0:34:41 annotations just random numbers and then there’s an arrow and there’s a question mark and it just
    0:34:45 says so what at the top all right so let me explain what this is because it’s actually kind of insightful
    0:34:51 so what he was saying was basically like um if you look at the the let’s say the three most recent
    0:35:00 waves of of like tech so you had software which was like i buy cds i put i put the cd-rom inside my cd
    0:35:07 or i install uh software on my server at our office that was like software 1.0 and then 2.0 was like
    0:35:12 the cloud it was like oh the software just lives in the cloud it’s a sass it’s a service you just kind
    0:35:17 of like use what you need you don’t need the servers and the cds and he’s like now we have ai
    0:35:24 and so he talks about like basically the software market at the time when cloud came out when like
    0:35:32 salesforce came out the entire software market was 350 billion dollars of revenue cloud is already 400
    0:35:37 billion right like like just just like the top cloud players are like more than 400 billion so
    0:35:42 basically it’s like cloud didn’t just take some percent share of the software market wasn’t like oh
    0:35:47 yeah maybe like 10 of these applications will now go to the cloud or become sass it was like sass
    0:35:53 became bigger than the entire software market before that uh and it became bigger by i think uh uh i
    0:35:56 don’t know why the numbers here are like again the pie chart is very confusing but it’s basically some
    0:36:02 order like it was like you know two or three times bigger and then he’s talking about like ai and he’s
    0:36:07 like ai actually is interesting because ai replaces software but ai also replaces labor like you just
    0:36:14 you don’t need people to do those tasks it’s services and software and so um he’s like the
    0:36:18 the labor market is basically like whatever like 10 trillion this is some some ridiculous number and
    0:36:24 he’s like we don’t even know how big the ai market is going to be predicting that with any accuracy would
    0:36:30 be foolish but it’s probably a good bet that ai is going to be bigger than the entire cloud market today
    0:36:38 and the labor market in the future and so um how big is the labor market isn’t isn’t the labor market
    0:36:45 like the market that’s like the main one i mean like like isn’t that everything ever yeah kind of and
    0:36:50 so you know in the same way that when girly was talking about uber he’s like you know um it’s going
    0:36:55 to be bigger than taxis because it’s more convenient than taxis right if you called a taxi you didn’t
    0:36:58 know when it was going to pick you up you didn’t know if it was going to pick you up with uber you got
    0:37:03 precise you know you precise timing it’ll pick you up anywhere before taxis didn’t really go to rural
    0:37:07 areas uber had more drivers so it was available everywhere because it was available everywhere
    0:37:12 you got lower price points because there was more liquidity in the system so when it’s a lower price
    0:37:15 point maybe i wouldn’t have called a taxi just to go from here to my friend’s house but if it’s a
    0:37:20 eight dollar uber i’ll actually do it and because you get the price points now you get new use cases
    0:37:27 so like people use ubers to like help their elderly parents travel or kids or like and the big one was
    0:37:30 basically he’s like the big use case i think people are missing is that some people just won’t
    0:37:34 buy a car because they’ll be like i’ll uber when i need it so i just don’t need to own a car which is
    0:37:38 exactly what happened to me i sold my car in san francisco because i was like why would i deal with
    0:37:44 this car parking issues getting get broke into insurance gas all that like no just uber when i need
    0:37:49 a ride and so he’s like it unlocked part of the rental rental car market it unlocked part of the
    0:37:54 car ownership market and once you calculate those you’re like oh shit this is a trillion dollar
    0:37:58 market not a hundred billion dollar market and so you’re off by you know 10x if you had done
    0:38:02 the calculation wrong with the wrong assumptions and so ai is going to do the same thing because
    0:38:08 i won’t hire a person to do these little things that i’m basically like telling ai agents to do in
    0:38:13 my life right like you know i’ll build little i build a little app for piano tracking for my piano
    0:38:18 practice or for my health tracking or i’ll uh you know i don’t hire a concierge doctor but i’ll
    0:38:23 feed my lab results to chat uh chat gpt and i’ll pay them to like i’ll pay it to analyze all my blood
    0:38:29 results and so things i wouldn’t have otherwise hired people for i’m willing to pay ai a little
    0:38:38 bit for it and so there’s a new market how many hours a week are you consuming information on just
    0:38:45 staying in the know on this topic on ai specifically yeah we had greg eisenberg on the pod and he was
    0:38:52 telling me things where i was like i was almost i i found myself having fear i had fear of like
    0:39:00 oh this is clearly the future and if i’m not like in the know of this it’s gonna come and destroy me
    0:39:05 therefore i owe it to like that’s how serious it was it wasn’t like i’m missing out on an opportunity
    0:39:09 to make my business better i’m missing it was like oh no i gotta protect my family like like
    0:39:16 this is like my job and so i felt extreme fear over he was saying like magnus have you heard of magnus
    0:39:21 is that like the new chinese agent platform yeah yeah yeah and there’s no g just like i think it’s like
    0:39:27 manis manis and he was explaining but he’s like three things where i’m like how do i not know about
    0:39:32 this yeah like do i need to sign up to like an ai trade magazine like what’s going on right um and
    0:39:37 his answer was horrible when i said greg how do i how do you know he’s like i just do or he said
    0:39:40 something like that or he’s just like i just hear about it like i was like well that’s like extremely
    0:39:46 not actionable for me thanks a lot dick uh so how are you much time are you spending learning about
    0:39:53 this topic and where are you turning to look there’s two minds about it one i would say i have no risk of
    0:39:59 over investing my time in this i have pretty big risk of under investing my time in this but no risk of
    0:40:04 over investing my time in paying attention to what’s going on with ai and being able to like play with
    0:40:09 the tools understand what the companies are doing like really think through like where this puck is
    0:40:16 going at the same time i’m not trying to drive myself insane so you know like i do think there’s a very
    0:40:22 unproductive version of this which is the constant whiplash of new demo new model new this new that new
    0:40:28 whatever and so what i’m doing is basically like an intermittent fasting style model where it’s like i
    0:40:35 mostly not paying attention to it as in like i’m not actively trying to like react to everything i see
    0:40:41 or go seek out or go read every single thing out there or sign up for every single tool what i’m doing is
    0:40:45 i’m trying to make it very useful for me so when i have a problem i now add it into my like sort of
    0:40:51 solution list like oh do i think ai could solve this so then whatever research i’m doing it’s
    0:40:57 actually like a just-in-time solution to a problem i actually have versus just like the kind of like
    0:41:02 intellectual jacking off of like just keeping up with everything just like trying everything just
    0:41:04 wanting to know everything watching every podcast listen to every youtube video it’s like
    0:41:09 no i’m mostly trying to like if i have a problem i try to see could i solve this day i
    0:41:13 maybe yes maybe no but that’s interesting i learn a little bit each time i do that but at
    0:41:17 least i’m trying to solve a problem i have the second thing is i am carving out free time so like
    0:41:21 last year i thought i think i told you what i did this i did like an ai hack week a think week where
    0:41:25 i just basically said clear my calendar the only thing i’m doing this week is just going in depth
    0:41:29 and the beauty of that is it’s kind of like checking your email you’re like if you want you could
    0:41:34 check your email every three minutes and you might find a new email but you’ll just consistently
    0:41:38 like it’ll just keep tearing your attention away whereas if you just batch your email and you
    0:41:43 just check your email once at noon and once at you know 8 pm or something like that you’re totally
    0:41:48 up to date on email but you didn’t have to like have this nervous energy just constantly doing it
    0:41:54 and so i’m treating it more like that i agree with you it was nice to um catch up with you i’m getting
    0:42:00 all pumped about all this stuff i i’m currently in um saint louis missouri i’m about to go to the zoo
    0:42:06 so i’m gonna go to the zoo i’m gonna go see some family tonight um but i was happy i was able to uh
    0:42:11 do this podcast from this hotel and potentially reach hundreds of millions or hundreds of or rather
    0:42:16 hundreds of thousands of people and uh hundreds of millions of red blood cells what are we what
    0:42:21 are we counting here well because like you just started talking about this ai stuff and i’m like
    0:42:26 literally staring out the window right now like whenever you talk about this i have notepads here
    0:42:31 and i like get flustered where i’m like like i sometimes i think and i’m like what should i say next
    0:42:35 but then other times i’m like oh he’s talking about this ai shit like what am i going to do what
    0:42:38 i got to do this thing i gotta do that thing like that’s how i feel right now yeah yeah i
    0:42:43 definitely feel that by the way i have a couple of of things i forgot to say on the the uber thing
    0:42:48 that are great this is the funniest part of the uber thing at the end of that professor’s blog post
    0:42:53 you know what he wrote after he wrote this huge like valuation teardown of uber he goes as i attempt
    0:42:57 to attach value to uber i have to confess i just downloaded that but have not used it yet i spent most of
    0:43:03 my life in in the suburbs where i go for days without seeing a taxi or if i’m in new york i
    0:43:09 just use the subway and so it’s like the experts who literally like not only are they not betting on
    0:43:14 this enough skin in the game literally never even use the product it’s like but they should just end it
    0:43:21 with like ps but what the fuck do i know like that would have saved him a lot of exactly a lot of like
    0:43:27 uh reputation there like there’s some great quotes by the way from some ceos who underestimated their
    0:43:33 market size so jan coom ceo of whatsapp he said we’re just trying to make messaging better not build
    0:43:39 some big business sells for 20 billion um somebody said i thought i’d make a little side money enough
    0:43:46 to quit my job that’s sarah blake the founder of spanks oh so you know female bill you know one of
    0:43:53 the like first female billionaire entrepreneurs of this like generation mobile gaming so one of the
    0:43:59 first mobile games ever was snake on the nokia phones if you remember so the head of nokia nokia’s
    0:44:04 mobile gaming division so this guy is in charge of mobile gaming here’s what he said i think mobile
    0:44:09 games are just a small add-on it’s not a real market mobile gaming turns out to be 120 billion
    0:44:14 dollar market here’s another one the domino ceo in 2010 the year i graduated from college he said
    0:44:20 delivery is a convenience it’s not a game changer at the time delivery was uh 10 billion dollars a year
    0:44:25 across food delivery it’s now you know more than 10 times that it’s more than 15 times that
    0:44:31 in fact i read a crazy stat that some some i don’t know if this is legit but some study came out or that
    0:44:36 somebody was doing some analysis and they said that for most local restaurants now 70 of their order
    0:44:43 volume is uh delivery orders they’re no longer restaurants that do delivery they’re delivery machines
    0:44:47 that also happen to have a restaurant table you know like a table just a down on if you want i go to
    0:44:51 restaurants all the time where i feel like i’m the only person there and drivers are coming in and out
    0:44:56 the whole time yeah brian chesky we didn’t know the size of the market because we were inventing it if
    0:45:00 we listened to market research we would have just made a better couch surfing app and the last one is
    0:45:05 elon i don’t care about the market size i care about if we can make something fundamentally different
    0:45:11 because if you make something great the market will come it is sick this is this this was like a little
    0:45:14 impromptu topic that turned into a whole thing that was awesome
    0:45:32 all right so when my employees join hampton we have them do a whole bunch of onboarding stuff
    0:45:37 but the most important thing that they do is they go through this thing i made called copy that copy that
    0:45:41 is a thing that i made that teaches people how to write better and the reason this is important is
    0:45:47 because at work or even just in life we communicate mostly via text right now whether we’re emailing
    0:45:53 slacking blogging texting whatever most of the ways that we’re communicating is by the written word
    0:45:57 and so i made this thing called copy that that’s guaranteed to make you write better you can check
    0:46:03 it out copy that dot com i post every single person who leaves a review whether it’s good or bad i post it
    0:46:07 on the website and you’re going to see a trend which is that this is a very very very simple exercise
    0:46:10 something that’s so simple that they laugh at they think how is this going to actually impact us and
    0:46:15 make us write better but i promise you it does you got to try it at copy that dot com
    0:46:21 i guarantee it’s going to change the way you write again copy that dot com

    Episode 710: Sam Parr ( https://x.com/theSamParr ) and Shaan Puri ( https://x.com/ShaanVP ) talk about how to evaluate risk and upside of new ideas. 

    Show Notes:

    (0:00) Bessemer’s $140B misjudgment of Shopify

    (5:47) Shaan’s Anti-portfolio

    (15:26) Goal: Avoid Ruin

    (21:30) Outlier personalities

    (24:51) Underestimating Uber

    (32:16) “You can’t overinvest in AI”

    Links:

    Want Sam’s Playbook to Uncover Business Opportunities? Get it here: https://clickhubspot.com/bzo

    • “How to miss by a mile” – https://tinyurl.com/2rxubfwa 

    • Leaked OpenAI emails – https://www.techemails.com/p/elon-musk-and-openai 

    Check Out Shaan’s Stuff:

    • Shaan’s weekly email – https://www.shaanpuri.com 

    • Visit https://www.somewhere.com/mfm to hire worldwide talent like Shaan and get $500 off for being an MFM listener. Hire developers, assistants, marketing pros, sales teams and more for 80% less than US equivalents.

    • Mercury – Need a bank for your company? Go check out Mercury (mercury.com). Shaan uses it for all of his companies!

    Mercury is a financial technology company, not an FDIC-insured bank. Banking services provided by Choice Financial Group, Column, N.A., and Evolve Bank & Trust, Members FDIC

    Check Out Sam’s Stuff:

    • Hampton – https://www.joinhampton.com/

    • Ideation Bootcamp – https://www.ideationbootcamp.co/

    • Copy That – https://copythat.com

    • Hampton Wealth Survey – https://joinhampton.com/wealth

    • Sam’s List – http://samslist.co/

    My First Million is a HubSpot Original Podcast // Brought to you by HubSpot Media // Production by Arie Desormeaux // Editing by Ezra Bakker Trupiano

  • 633. The Most Powerful People You’ve Never Heard Of

    AI transcript
    0:00:09 For the past couple of years, I’ve been letting a very good book collect dust on my shelf.
    0:00:15 A friend had told me about the book, and I did read the introduction, a wild introduction,
    0:00:21 about the CEO of a British company who flies his private jet into the middle of the Libyan
    0:00:27 Civil War to make an oil deal with the rebel army, an army which happened to have the covert
    0:00:31 support of the governments of Britain, Qatar, and the U.S.
    0:00:37 So, yeah, I probably should have kept reading, but I had 30 other books I wanted to take a look at.
    0:00:42 A Dirty Little Secret about me, there are a lot of books where I read only the introduction
    0:00:45 or a couple chapters, even books I like.
    0:00:49 This may strike some people as a wasteful practice, but I recommend it.
    0:00:55 Anyway, as fascinating as I found that introduction about the oil trader in Libya,
    0:00:59 the book didn’t seem relevant at that moment.
    0:01:06 But at this moment, with the U.S. signing a mineral deal with Ukraine, with Donald Trump
    0:01:11 expressing his appetite for the natural resources in Greenland and Canada, even at the bottom of the
    0:01:17 ocean, and of course, with an on-again, off-again trade war, the book is very relevant.
    0:01:24 It’s called The World for Sale, Money, Power, and the Traders Who Barter the Earth’s Resources.
    0:01:30 So, I finally took it off the shelf, read it, and, well, wow.
    0:01:37 The traders in this book are not the kind who sit at a desk in New York or London and buy and sell the
    0:01:38 options on commodities.
    0:01:43 These are the people who finance, procure, and trade the actual commodities.
    0:01:47 Petroleum products, agricultural products, and metals.
    0:01:49 This is high-stakes territory.
    0:01:57 When you think about a commodity trader, it has to have a bit of the Wolf of Wall Street character.
    0:02:01 It has to have a bit of James Bond character.
    0:02:06 And it has to have a lot of the character of Pirates of the Caribbean.
    0:02:12 The authors of this book are two Bloomberg journalists who also used to work together at the Financial Times,
    0:02:15 Javier Blas, whom you just heard, and Jack Farchi.
    0:02:20 The main subjects of their book are trading firms that you have likely never heard of.
    0:02:25 Glencore, Vital, Trafigura, Gunvor Group, Mercuria, and Cargill.
    0:02:30 These firms operate all over the world, and their reach is massive.
    0:02:31 Here is Jack Farchi.
    0:02:37 The revenues of the four largest is just under a trillion dollars last year, which, in terms
    0:02:45 of global exports, would make them, I think, the fourth largest country behind the U.S., China,
    0:02:47 and Germany, and ahead of Japan.
    0:02:53 Have you ever thought that you really understood something, that you were looking into the heart
    0:02:57 of it, only to realize that you were just looking at the surface layer?
    0:03:01 That’s the sensation I had while reading The World for Sale.
    0:03:07 These commodity traders are often at the center of big political and economic events.
    0:03:14 Civil wars and military coups seem to be a specialty, but they usually operate deep in the shadows.
    0:03:20 Today on Freakonomics Radio, with the help of Javier Blas and Jack Farchi, we try to shine a light.
    0:03:40 This is Freakonomics Radio, the podcast that explores the hidden side of everything, with your host, Stephen Dubner.
    0:03:53 Last year, there was a record $33 trillion in global trade.
    0:03:56 Commodities make up about a third of that.
    0:04:00 Here are the two journalists who try to follow that money.
    0:04:01 My name’s Jack Farchi.
    0:04:04 I’m a senior reporter covering energy and commodities at Bloomberg News.
    0:04:06 How did you get onto this beat?
    0:04:08 I started my journalism career at the FT.
    0:04:13 I started out in 2008, just as the financial crisis was happening.
    0:04:14 Good timing for you, really.
    0:04:17 Yeah, much better than I had anticipated.
    0:04:21 I thought I was interested in geopolitics, global affairs.
    0:04:25 I didn’t think I was very interested in finance or business or markets or economics.
    0:04:29 Then I sat in the middle of the FT, not understanding half of what was going on,
    0:04:33 as the global financial system was collapsing and taking the world economy with it.
    0:04:35 And I realized, actually, I was wrong.
    0:04:37 I was looking for my first reporting job.
    0:04:41 And Gillian Tett, back then, was the capital markets editor, said,
    0:04:44 why don’t you go and work with Javier writing about commodities?
    0:04:46 My name is Javier Blas.
    0:04:49 I’m a commodities columnist for Bloomberg Opinion.
    0:04:54 And for the last 25 years, I have been writing about energy and natural resources.
    0:04:57 How did you become interested in that?
    0:04:59 Or were you shoved into it?
    0:05:00 How did that work?
    0:05:02 I went to college.
    0:05:03 I wanted to become a journalist.
    0:05:09 I ended writing about the Spanish economy and was quite bored at my job.
    0:05:13 My dream was to be Jerusalem bureau chief or Beirut bureau chief.
    0:05:17 One day, the oil correspondent in the newspaper I was writing left.
    0:05:20 So there was no one to write about the oil market.
    0:05:24 I raised my hand and they say yes.
    0:05:30 I started talking to a couple of oil companies and I went to see how they were buying crude oil.
    0:05:34 The trader that I was sitting with was a gentleman called Paco Garcia.
    0:05:37 He was working at Repsol, the Spanish oil company.
    0:05:44 Basically, he was babysitting me because everyone on that trading floor realized I have not a clue what I was even asking.
    0:05:47 Literally, I didn’t know what they were doing.
    0:05:55 He invited me to the trading floor and gave me his second headset and said, do you want to buy some barrels of oil?
    0:05:56 I say, sure.
    0:05:57 How?
    0:05:58 When?
    0:06:00 And he said, now on the phone.
    0:06:07 He was negotiating a deal for two million barrels of Iranian oil out of Kar Island, the main export terminal of Iran.
    0:06:09 They argue about the price.
    0:06:10 It’s all on the phone.
    0:06:11 They agree on a price.
    0:06:13 And one said, do we have a deal?
    0:06:15 The other one says, we have a deal.
    0:06:16 That was it.
    0:06:18 I said to the trader, what just happened?
    0:06:20 He said, we just bought the oil.
    0:06:22 And I was like, what do you mean?
    0:06:23 I mean, that was on the phone.
    0:06:25 Did you sign a contract?
    0:06:25 I said, no.
    0:06:27 I said, we have a deal.
    0:06:28 He said, we have a deal.
    0:06:28 And that’s it.
    0:06:31 We better find a tanker to bring the oil.
    0:06:35 And I became hooked and I became an oil reporter.
    0:06:46 Explain the difference between the commodity traders you write about in your book and the people who buy and sell financial instruments on commodity exchanges.
    0:06:58 These traders are very different to what people think about a trader behind a computer screen, trading on the keyboard and the mouse, Wall Street, Goldman Sachs, JP Morgan.
    0:07:02 These traders work in physical stuff.
    0:07:04 They are buying actual barrels of oil.
    0:07:08 They buy an actual consignment of copper.
    0:07:12 They buy a full shipload of wheat or soybeans.
    0:07:20 Something that most commodity traders spend a lot of time trying to explain is they don’t tend to care very much which way prices go.
    0:07:31 Oil traders, for example, for the most part, when they buy a cargo of physical oil, will at the very same time hedge the price of oil by selling a future on the futures exchange.
    0:07:40 So the oil price element of what they’re doing, they don’t care about at all, whereas your trader on a screen, that’s exactly what they’re trading.
    0:07:45 They’re betting on the ups and downs of the prices and they’re saying, okay, there’s a trade war, prices are going to go down, I’ll sell.
    0:07:50 Or actually the trade war fears are overdone, I’m going to come and buy.
    0:08:01 Whereas the physical commodity traders do definitely bet on outright prices sometimes, but they’re also, and on a day-to-day basis, trading a whole load of other factors.
    0:08:20 For example, they’re lending money to some producer in a country where they don’t have much other ability to borrow money, or they’re trading differences in prices between copper in Africa and copper in the US, or they’re trading differences in prices between one grade of oil and another grade of oil.
    0:08:30 And maybe they have several different producers who they have contracts with, and they’re buying oil from all three of them and blending it together, and then they can sell it for a higher price than the three barrels would have got individually.
    0:08:35 So Jack, you said you thought you were interested in geopolitics and so on.
    0:08:45 To me, the irony is that by coming in this side door, I’m sure you’ve learned a lot more about geopolitics than a lot of people who might have been on that beat directly, don’t you think?
    0:08:53 Yes, exactly. What I’ve learned is that to understand what’s going on in politics, you have to understand the money.
    0:09:04 And a lot of the time, not all of the time, obviously, but a lot of the time, the money is commodities, because commodities are a huge source of global trade, a huge source of profits for some companies in some countries and costs for others.
    0:09:15 In a lot of places in the world, be it Russia or the Middle East or South America or Asia, following the money means following the oil, means following the copper, the soybeans.
    0:09:20 So if you don’t understand that, then you’re missing a huge part of the political picture.
    0:09:27 I’m sure that a lot of people would think that they can follow the money by following the publicly traded markets.
    0:09:34 But if I have it right, a lot of the deals that you write about are totally hidden from public view.
    0:09:42 And so you’re offering what strikes me as an almost secret window into how a big part of the economy operates.
    0:09:44 Am I giving you too much credit?
    0:09:46 Probably, but I would agree with you.
    0:09:47 I think that’s right.
    0:09:50 That was our experience in coming to this trading industry specifically.
    0:09:55 Our job was to explain why the oil price was up or the copper price was down.
    0:10:06 And we found ourselves more and more hearing about this handful of privately owned, often very secretive commodity trading companies, people in the market telling us,
    0:10:14 oh, well, if you really want to know why the oil price is moving or what’s going on in Nigeria, then you need to talk to these guys.
    0:10:20 And as we did begin to talk to them, realising that there were these stories going on behind the news headlines,
    0:10:27 I think it would be an overstatement of the importance of the commodity traders to say, oh, yes, they’re always the hidden hand moving political events.
    0:10:29 Occasionally they are, but a lot of the time they’re not.
    0:10:30 But they’re very often there.
    0:10:36 The number of examples, including in recent history, we see where there are big geopolitical shifts.
    0:10:43 And the first people there are the commodity traders, be it the Libyan civil war or when South Sudan became independent.
    0:10:49 Within days after South Sudan declared independence, a whole team of traders from Glencore arrived trying to do an oil deal.
    0:10:54 And in fact, with $800,000 in cash to pay bribes at the same time.
    0:10:57 Let me back up and ask a super basic question.
    0:10:58 What is a commodity?
    0:10:59 What is it not?
    0:11:02 It’s a fungible raw material.
    0:11:05 It has to be something where one is as good as any other.
    0:11:13 A ton of pure copper, it doesn’t matter if it comes from Chile or Peru or Congo or Poland, they’re all the same.
    0:11:18 There’s one price and you can exchange one for another and it doesn’t matter too much.
    0:11:22 Whereas a bottle of fine wine is not so much a commodity because they’re all different.
    0:11:27 And connoisseurs will pay a huge price for one and pay nothing at all for another.
    0:11:29 Okay, so that’s a commodity.
    0:11:35 Javier, give me an example of a commodity trader’s role in a given transaction.
    0:11:43 Just imagine that you are a big coffee roaster, the Starbucks of this world, and you need lots of coffee.
    0:11:50 You are not going to go yourself to different producing countries and farming companies.
    0:11:53 And in some cases, these commodities are produced by smallholders.
    0:11:58 You will need to be talking to thousands of farmers to get the commodities.
    0:12:08 So you call, say, Cargill, the world’s largest agricultural trader, a very discreet company based near Minneapolis in the United States.
    0:12:10 And you say, we need coffee.
    0:12:15 So Cargill will go into the business of procuring coffee on your behalf.
    0:12:16 They will go to Brazil.
    0:12:18 They will go to Vietnam.
    0:12:20 They will go to Colombia.
    0:12:22 They will go to West Africa.
    0:12:26 And they will buy coffee from many suppliers on those places.
    0:12:36 They will move those commodities, often in trucks and then into ships, into whatever port in the United States, often the New Orleans area.
    0:12:44 That’s where they will perhaps roast the coffee on your behalf and then deliver it to the final destination.
    0:12:48 Sometimes they are financing the whole crop and harvesting operation.
    0:12:56 It’s a very complex business from the first purchase to the final delivery, for the first finance to the final payment.
    0:13:03 There may be six months where the commodity is in transit and where the finance needs to be there.
    0:13:06 Let’s hear about the history of this book.
    0:13:12 I’m just curious to know how the collaboration started and then how the work happened with the book.
    0:13:16 The desire to write the book came from a frustration.
    0:13:24 As a journalist, when you are assigned to a new sector, the first thing that you do is you go to the person that was doing the job before you.
    0:13:26 And then you ask, OK, so what is the basics?
    0:13:31 Can you share with me your phone book and also what I should read?
    0:13:37 You go to cover Wall Street, you’re going to read a book on the history of J.P. Morgan or Goldman Sachs, et cetera, et cetera.
    0:13:44 When Jack and I started working together at the Financial Times, Jack asked me what I should be reading.
    0:13:48 And I think Jack was a bit perplexed that my answer was like, well, there is not a book.
    0:13:56 He didn’t believe that in this important industry, no one has the book with capital letters that everyone will read.
    0:14:06 Considering it’s such an important topic, considering how much money is at stake, considering how many people are affected by commodities and commodity trading, why was there no book?
    0:14:11 I think that there was no book because it was difficult to write about the industry.
    0:14:14 The industry wanted to keep everything secret.
    0:14:22 As we were writing the book, some of the executives told us, we’d rather have you abandoning this project.
    0:14:31 I suppose also that during much of the 90s, there was not a lot of interest in commodities because prices were relatively low.
    0:14:36 Therefore, why are you going to write a book about commodity trading if no one is really interested in commodities?
    0:14:49 A lot of people were writing books about those financial commodity traders, the Wall Street type, the hedge fund manager type, but not about the people who were buying and selling the stuff.
    0:14:57 At some point, the question moved from how is that no one has written the book to maybe we should write the book.
    0:14:59 Describe the research and the reporting.
    0:15:00 What was your methodology?
    0:15:09 We started going through every source, whether it was public records to contacts at banks, at commodity trading houses.
    0:15:15 Anyone who had worked in these companies had kept an annual report that was confidential, but they have it at home.
    0:15:21 It was very easy to get from some companies the annual report from, say, 1975.
    0:15:25 It was a lot more complicated to get the annual report from 2015.
    0:15:34 Then we used phone email to everyone in the industry that we knew and said, we’re going to write a book.
    0:15:37 Would you sit down to talk to us on the record?
    0:15:41 And surprisingly, a lot of people say yes.
    0:15:48 A lot of the old hands of the industry really help us because I suppose that they were long retired.
    0:15:52 The people who were active in the industry were a lot more complicated.
    0:15:59 Some of them said to us, what I’m going to tell you is not all the true and nothing but the true.
    0:16:05 Others arrived to the meeting with their personal lawyer alongside the public relations officer.
    0:16:10 You left the interview with them after two hours and you felt that you have been boxing almost physically exhausted.
    0:16:24 But generally, for an industry that thrives in secrecy, a lot of the old hands were wide open and willing to tell stories that often you couldn’t believe.
    0:16:30 It sounds like you’re saying they are willing because what they did was kind of extraordinary.
    0:16:43 These people who were retired, they were telling you deals that they did in Angola in 1975 or on Cuba in 1985 or in the Soviet Union after the collapse of the Berlin Wall.
    0:16:47 They were very proud of what they did and how they made money.
    0:16:55 Also, it was a bit of a different world where perhaps corruption was not seen as is today.
    0:17:16 These were executives which made business in very difficult corners of the world and they were operating from Switzerland, a country that not only allowed companies to pay bribes overseas, but allowed companies to deduct the payments as a tax credit.
    0:17:21 Bribes were tax deductible in Switzerland until about a decade ago.
    0:17:31 To understand how Switzerland became the epicenter of this industry, it helps to understand a commodity trader named Mark Rich.
    0:17:34 Blas and Farchi write about Rich a good bit in their book.
    0:17:39 There’s also a very good Mark Rich biography called The King of Oil by Daniel Amman.
    0:17:42 At least the chapters I read were very good.
    0:17:44 Here’s Farchi again.
    0:17:48 Mark Rich was the godfather of the modern commodity trading industry.
    0:17:51 To a significant extent, invented the industry.
    0:17:59 Rich was born into a Jewish family in Belgium in the 1930s, like many other Jews in Europe in the 1930s.
    0:18:07 And like many of the people who would go on to be big players in the commodity trading industry, moved to the US because of the rise of Nazism in Europe.
    0:18:23 In the post-war period, got his apprenticeship at Philip Brothers, Fibro, which was in the 1950s and 1960s, the dominant force in commodity trading and really kind of invented a lot of the ways in which commodity traders do business and make money.
    0:18:26 But there was something gentlemanly and genteel in Philip Brothers.
    0:18:33 Mark Rich was this super aggressive, totally driven, always focused entirely on money and nothing else character.
    0:18:36 Philip Brothers was too small for him.
    0:18:45 In 1974, Rich and his trading partner, Pincus Pinky Green, left Philip Brothers to form their own firm, which would become a powerhouse.
    0:18:47 It was called Mark Rich and Co.
    0:18:56 He got his big break when the oil market began to fragment and the Seven Sisters, these big American European oil companies, began to lose control of the oil market.
    0:19:04 And he started trading oil with abandon at a time when the tradable oil market was only just becoming a thing.
    0:19:15 Talk about the ways in which he did things differently from everybody, or maybe another way to put it is the risks he was willing to take, the different actors he was willing to engage with, etc.
    0:19:29 A lot of what you needed to do to make money in the oil trade in those early days was to have a good enough relationship with one of the big oil producers that they would sell you oil at a price that was probably too low.
    0:19:41 One of his big trade flows was through this extremely secretive pipeline that went through Israel that was built as a joint venture between Israel and Iran before the fall of the Shah in great secrecy.
    0:19:58 Mark Rich would be buying Iranian oil, putting it through the pipeline, supplying Israel, but also supplying Europe through this pipeline, which then became enormously valuable when the Suez Canal closed in 1967 after Israel launched an attack on Egypt and Syria.
    0:20:02 This brief war was over, but the Suez Canal stayed closed until 1975.
    0:20:06 And for Mark Rich, that was a gift from the gods, and he made huge amounts of money.
    0:20:12 Mark Rich became this almost larger-than-life figure in commodity trading, the most profitable commodity trader ever.
    0:20:27 We spoke to a number of former senior people at Mark Rich who said that the company made a billion dollars of profit in 1979, the year of the Iranian Revolution, which in those days would have made it one of the 10 largest companies in America.
    0:20:33 And this was a company owned by a small handful of people that only people in the commodities industry had ever heard of.
    0:20:49 But that didn’t last because Mark Rich caught the attention of US law, and particularly of Rudy Giuliani, then a prosecutor, who indicted him for tax fraud and for trading with Iran during the hostage crisis.
    0:21:02 So he and his partner, Pinky Green, fled the US to Switzerland, became fugitives from US justice, and then carried on their business of being the world’s largest commodity trading house, despite this US indictment hanging over their head.
    0:21:18 So his real undoing came when he lost money in 1991, 1992, when one of Mark Rich’s zinc traders, under the influence of Mark Rich himself, attempted to corner the zinc market, and it went horribly wrong.
    0:21:24 Mark Rich lost about $170 million on this attempted zinc corner.
    0:21:25 That was really the last straw.
    0:21:28 His underlings rounded on him and forced him out of the company.
    0:21:33 The company was renamed as Glencore and continues as one of the largest commodity traders today.
    0:21:39 Glencore is not only the world’s largest commodity trader, but it’s also a conglomerate.
    0:21:41 They do everything and anything.
    0:21:48 They trade a lot of energy, whether it’s crude oil, natural gas, refined products, a lot of coal.
    0:21:54 They used to trade a lot of agriculture, and they trade a lot of metals and minerals.
    0:22:00 It strikes me that the commodity traders are performing a variety of big functions.
    0:22:02 They’re acting like bankers.
    0:22:12 They’re acting as sort of a government coming in to help another country try to stabilize itself, or maybe more like one of the big financial institutions like a World Bank.
    0:22:18 Can you think of any, in history, parallels to the functions that these commodity traders were performing?
    0:22:24 The commodity traders look like one of those Swiss knives where you could have everything out of them.
    0:22:29 They are the bankers of last resort when no one else will take your phone call for a credit line.
    0:22:31 They will offer you money.
    0:22:37 They are the McKinsey, the consultant for lost causes, where someone doesn’t know how a market works.
    0:22:39 They will come there and explain it to you.
    0:22:45 And they’re almost like diplomats for hire, where you have a foreign affairs problem, they can’t explain how to make it work.
    0:22:55 The joke in the oil trading industry was that Betel, the world’s largest oil trader, was the trading arm of MI6, the secret service of James Bond.
    0:22:58 There is a grain of truth behind that joke.
    0:23:02 I can’t imagine the same joke doesn’t exist for the CIA, correct?
    0:23:06 The CIA, I don’t think that they have an in-house trading house.
    0:23:20 However, Philip Brothers of Fibro, a big American trading house of the 70s and 80s, was known to have very close links to the CIA and just generally the American government.
    0:23:47 Coming up after the break, when the political situation gets turbulent, the commodity traders are often the first people to step into the breach.
    0:24:02 There comes a time when governments need things to happen, where having a commodity trader helping may come handy, and where everyone can deny their involvement.
    0:24:06 I’m Stephen Dubner. This is Freakonomics Radio. We’ll be right back.
    0:24:24 The book we are talking about today is called The World for Sale.
    0:24:28 Money, power, and the traitors who barter the Earth’s resources.
    0:24:34 The authors are Javier Blas and Jack Farchi, a pair of financial journalists at Bloomberg.
    0:24:51 I once had a professor who said that when historians write books, they always search for the big macro thesis, all the different events and populations that contribute to producing whatever it is, a war, a new country or whatever.
    0:24:58 But that often it really is the product of two people sitting in a room, making a deal, having conversation, shaking a hand.
    0:25:03 To that end, I’d like you to talk about Jamaica for a minute and the story you tell in your book.
    0:25:09 Single moments and single deals and single trades can shape the course of history.
    0:25:19 The Jamaican example was the early 1980s, and this was told to me by a guy called Hugh Hart, who was at the time the Minister for Mines and Energy in the Jamaican government.
    0:25:22 The Jamaican economy was in pretty tough shape.
    0:25:29 It was reliant on oil imports, and oil prices had surged in the oil crises, and the Jamaican economy was pretty much on its knees.
    0:25:34 Each month, Jamaica would import about 300,000 barrels of oil.
    0:25:35 Which is like one tanker, you know?
    0:25:39 It’s one tanker of oil, exactly, by the standards of today’s big tankers.
    0:25:41 A fraction of a tanker.
    0:25:49 It would import 300,000 barrels of oil, which would go to the refinery in Kingston, and that would supply Jamaica’s oil consumption for the month.
    0:25:56 In order to do that, the central bank would open a letter of credit, which would allow Jamaica to pay for the oil.
    0:26:04 So Hugh Hart was in his office one Friday afternoon, and someone came to see him from the central bank in a state of agitation.
    0:26:06 He said, what’s going on?
    0:26:06 What’s the matter?
    0:26:07 He said, we’ve got a problem.
    0:26:09 Problem is, we don’t have any money.
    0:26:11 We can’t open the letter of credit.
    0:26:16 Without that, Jamaica wouldn’t be able to buy this cargo of oil.
    0:26:18 They would run out of oil over the weekend.
    0:26:21 And they’re literally burning oil for electricity, right?
    0:26:22 Yeah, and fueling cars.
    0:26:25 You know, the petrol stations would run dry, and there would be chaos on the streets.
    0:26:35 This was a fairly febrile time in the Jamaican economy and Jamaican politics, and he thought there would be riots and revolution if they didn’t get any oil.
    0:26:39 And this was a Friday afternoon, so he thought, who do I call?
    0:26:43 And the only person he could think of to call was Mark Rich & Co., the company that is today Glencore.
    0:26:47 He called his contact at Mark Rich, who was in New York, who said, I can’t help you.
    0:26:48 I’m a metals trader.
    0:26:50 But try Mark Rich himself.
    0:26:52 And so he calls Mark Rich in Switzerland.
    0:26:53 It’s two in the morning.
    0:26:54 He gets Mark Rich out of bed.
    0:26:56 Mark Rich says, who are you?
    0:26:56 What do you want?
    0:27:00 He says, well, I’m the Minister of Energy in Jamaica, and I need some oil.
    0:27:03 And Mark Rich says, huh, OK, call back in an hour.
    0:27:22 And in that hour, Mark Rich has arranged for a tanker of oil that was going from Venezuela to the US to be diverted to Jamaica, delivers the oil, averts the crisis without even a contract being signed, without any payment, and saves Jamaica’s day, as Hugh Hart told it to me.
    0:27:27 Which is an amazing story of a commodity trader, very likely changing the course of history.
    0:27:31 Because there might have been a new government in Jamaica by Tuesday if he hadn’t done that.
    0:27:32 Absolutely.
    0:27:33 What did Mark Rich get out of that?
    0:27:37 Mark Rich got a very long relationship in Jamaica that made him an awful lot of money.
    0:27:43 Jamaica was then a really big producer of alumina, which is the raw material for aluminium.
    0:27:51 Mark Rich came in and struck a whole series of deals to buy Jamaican alumina below the global market price.
    0:27:58 And made hundreds of millions of dollars over the years to the point that later Jamaican governments turned around and said Mark Rich was taking advantage of the country.
    0:28:03 They were making far too much money and Jamaica was losing out, which probably was true.
    0:28:08 But at the same time, there was a moment in the early 1980s where Mark Rich saved Jamaica’s skin.
    0:28:19 So this relationship between Mark Rich and Jamaica deepened and took all kinds of interesting turns to the extent that Hugh Hart later on took a portfolio in charge of sport.
    0:28:34 And when Jamaica was putting together a bobsleigh team for the 1988 Olympics, Mark Rich actually helped to finance this bobsleigh team that then, of course, became the star of the Disney film Cool Runnings.
    0:28:36 And that was paid for by Mark Rich.
    0:28:46 Mark Rich died in 2013, but before he did, he pulled off one more mega deal.
    0:28:50 He got himself a presidential pardon from Bill Clinton.
    0:28:53 Critics called this contemptuous.
    0:28:56 Even Clinton himself would later say he regretted it.
    0:29:02 So how did commodity traders like Rich come to be so powerful in the first place?
    0:29:09 In their book, Javier Blas and Jack Farchi point to four key factors since World War II that have shaped the industry.
    0:29:10 Here’s Blas.
    0:29:31 The first one is nationalizations of the oil industry starting from 1950, but really culminating in the 1970s, where a lot of Middle East and North African countries took control of their oil destiny, kick out foreign powers and nationalize the industries.
    0:29:35 Say just a little bit more about the Seven Sisters and how the new players came in there.
    0:29:45 The Seven Sisters were seven vertically integrated American, British and French companies that, until 1973, dominated the oil market.
    0:30:01 At that point, typically, a barrel of oil will be produced in an Exxon oil field, transported in an Exxon pipeline or an Exxon tanker into an Exxon refinery and an Exxon fuel station.
    0:30:10 Every step of the chain, Exxon has its name, and the same for BP, Shell, and what is today Total of France.
    0:30:21 At one point, that is broken apart, and the companies lose a lot of access to the production, and that production is nationalized.
    0:30:29 It’s no longer the Saudi American oil company, but the Saudi Arabian oil company that does the drilling in Saudi Arabia.
    0:30:45 They have a lot of oil to sell and found that commodity traders were willing to buy the oil, and also that they didn’t ask too many questions, and they were very happy to pay a few bribes in the process.
    0:30:53 Also, it’s a time where oil goes from a rather boring commodity to really a big business.
    0:30:54 Prices explode.
    0:31:03 They go from a couple of dollars to $5 to $11 to $30 in the space of about 15 years.
    0:31:12 A lot of these companies make a lot of money because they replace the traditional vertical integrated oil company with something in between.
    0:31:22 They became the link between the new, very rich Middle East petro-states and the consumers in America and Europe.
    0:31:25 Okay, that’s the first big factor you identify.
    0:31:28 Number two is the collapse of the Soviet Union.
    0:31:30 Walk me through how that shaped the commodity trade.
    0:31:40 We have to remember that at the time of the end of the Berlin Wall and the Soviet Union, Moscow was one of the worst largest producers of commodities.
    0:31:49 Not only gas, but crude oil, aluminum, and a number of other metals, and also a significant producer on agricultural commodities.
    0:31:57 All of a sudden, the commodity traders have a lot of new production free and available for them to intermediate.
    0:32:02 These countries were connected only among themselves.
    0:32:06 Russia was making business only with communist countries largely.
    0:32:15 They didn’t have the experience of how to place oil or wheat or aluminum into the international market.
    0:32:19 They didn’t have the money to finance all of those commodity flows.
    0:32:25 And the commodity traders have the expertise and the money to help.
    0:32:35 In some cases, they help literally getting bags of money flying into an aluminum smelter in Siberia and saying to the manager,
    0:32:38 here is the money for the salaries on the last day of the month.
    0:32:40 You pay the people.
    0:32:42 You keep producing the aluminum.
    0:32:45 I will take care of that aluminum into the global market.
    0:33:04 So in a very short time frame, between 1989 and around 1994, billion-dollar-sized fortunes were made just buying and selling what the Soviet Union have to offer to the global economy.
    0:33:12 You write that around the same time, there was another big development, which was the financialization of the global economy.
    0:33:14 Why was that so important to the commodity traders?
    0:33:20 One of the big problems of a commodity trader is that you are taking a lot of risk price-wise.
    0:33:22 You are buying a cargo of oil.
    0:33:25 That oil sits on a tanker for, say, 40 days.
    0:33:30 Until you sell it, you have no way to hedge that price risk.
    0:33:42 The financialization of the global economy introduces a new number of commodity derivative contracts in Wall Street that allows the commodity traders to hedge the risk.
    0:33:50 They can buy and immediately sell a cargo in the paper market, guaranteeing the price that they’re going to get.
    0:34:04 That allows them to try more to secure profits and allows them also to raise finance more easy so they can expand very quickly and also makes their business just a touch more safe.
    0:34:14 One of the problems of the commodity traders before the 1980s and 1990s is that they went up very quickly and then collapsed because they lost money on a big transaction and that was the end of the day.
    0:34:21 Commodity traders started getting bigger and there were few failures after the financialization started.
    0:34:32 Okay, and the fourth big development you cite, the most recent, is, quote, the spectacular rise of China that spurred a massive commodity boom in the early 2000s.
    0:34:33 Tell me about that.
    0:34:44 China needs a lot of commodities and it goes to the very same players that everyone else have gone through the 70s, 80s, and 90s.
    0:35:01 It goes to the commodity traders who see the opportunity and start shifting flows of commodities from the typical end users in Europe and in the United States, Canada, Australia, Japan, into the new buyer, which is China.
    0:35:09 It is a spectacular growth in demand and that demand is met mostly by commodity traders.
    0:35:14 They see the pie of global trade increasing very rapidly.
    0:35:18 It also increases the price of most commodities.
    0:35:26 You have more demand, larger margins, so the commodity traders start making money like they have never done before.
    0:35:44 After this huge expansion of Chinese imports, you then had a situation in 2010 when the market was pretty tight and then you had this massive Russian crop failure, a huge drought in Russia that caused Russian supply to reduce a lot.
    0:35:51 And importers of grain of wheat and barley, particularly from Russia, started to panic and started to panic buy.
    0:35:54 Prices rose very rapidly.
    0:36:06 There was this key moment in the crisis when the head of Glencore’s grain unit in Moscow went on Russian TV and encouraged the government to ban exports.
    0:36:09 A couple of days later, that’s exactly what the government did.
    0:36:18 What was panic buying by some importers turned into a huge panic and massive buying and you had this enormous price spike.
    0:36:27 It’s not very clear what Glencore was trying to achieve and whether that was an official Glencore position or whether it was just one guy from Glencore’s Moscow office doing what somebody had asked him to do.
    0:36:41 But regardless of that, the impact was it gave the Russian government political cover to do something pretty extreme, which was to ban exports, caused a massive run-up in prices and panic from importers around the world, which caused prices to run up even further.
    0:36:48 As a result, between middle of June 2010 and early 2011, the price of wheat had more than doubled.
    0:36:56 Glencore, by the way, did very well out of that, made a record profit, as often happens in these moments of huge commodity price spikes.
    0:37:13 But the political implication was more significant because a doubling of the price of wheat, the people who were most severely affected by that were the poorest people in the world, the people who depend on wheat as a staple and who don’t have a lot of money to buy bread.
    0:37:22 And when the price of wheat doubled in a few months, that caused huge inflation, particularly for the poorest people in the Middle East and North Africa.
    0:37:24 And what happened in early 2011?
    0:37:34 Well, the Arab Spring began when a young fruit seller set himself on fire in Tunisia and set off a chain of events that led to the Arab Spring.
    0:37:39 Now, can we directly say the Russian export ban caused the Arab Spring?
    0:37:40 No, we can’t.
    0:37:42 Was the doubling of the price of wheat an important factor?
    0:37:43 Yes, absolutely, it was.
    0:37:54 You describe how sanctions and wars and any kind of chaos are impediments for most people, but for commodity traders, they can be opportunities.
    0:37:56 The chaos is actually pretty good for them.
    0:38:00 Give me some evidence for this argument with examples, please.
    0:38:14 I don’t think I have ever seen any sector of global business, with the exception, obviously, of the manufacturers of weapons, that actually thinks that a civil war can be a business opportunity.
    0:38:21 And for commodity traders, often that’s the case, and in very incredible, imaginative ways.
    0:38:31 Let’s go back to Libya about 15 years ago, when the east of the country rises against the dictatorship of Muammar Gaddafi.
    0:38:35 The eastern rebels are short of money.
    0:38:41 Surprisingly, for a country as oil-rich as Libya, they don’t have much gasoline and diesel.
    0:38:44 And you cannot fight a war without gasoline and diesel.
    0:38:47 You don’t have gasoline, the trucks are not moving.
    0:38:50 They don’t have that because they don’t have refineries, or why?
    0:38:52 The rebels didn’t have any working refinery.
    0:38:55 All the big refineries were controlled by the troops of Gaddafi.
    0:39:02 So they are trying to get refined products into the areas that they control to fuel their military.
    0:39:07 A big political and financial backer of the Libyan rebels was Qatar.
    0:39:16 So the Qataris, on behalf of the Ragtag Army of Libya, calls Vitol, the worst largest oil trader, and said,
    0:39:19 will you help these guys on our behalf?
    0:39:28 Here is a Middle East country asking someone to get into business with an army of a country in the middle of a civil war.
    0:39:30 And by the way, the army is the rebel army.
    0:39:32 It’s not recognized by anyone.
    0:39:33 They don’t have a central bank.
    0:39:34 They don’t have a prime minister.
    0:39:35 They don’t have anything.
    0:39:40 Most businesses will have run away as fast as they could.
    0:39:41 Vitol say, yes, of course.
    0:39:44 Most governments would have run away, too, by the way, right?
    0:39:45 Everyone.
    0:39:51 The only people that were flying into Libya were oil traders, journalists, and spies.
    0:40:00 So not only Vitol agreed to provide gasoline and diesel with the rebels, but say, look, since you guys don’t have money,
    0:40:08 but you control an oil field where you can produce crude, we will take barrels of oil in payment for the refined products.
    0:40:12 Then there was a problem because Gaddafi blew up the pipeline.
    0:40:15 Most companies, again, will have said, well, sorry, guys.
    0:40:21 We were prepared to do this very complicated barter agreement, crude oil for gasoline.
    0:40:25 But since you don’t have crude oil, you cannot pay us, so we are out.
    0:40:27 And Vitol said, no, no worries.
    0:40:29 Actually, we can help you.
    0:40:37 Let us extend you a credit card of a billion dollars, and you buy from us gasoline with that credit card.
    0:40:41 When the war ends and you win, you pay us back.
    0:40:48 So they were effectively taking a bet on who was going to win the civil war in Libya.
    0:40:57 You make it sound as though Vitol took this deal and fronted them the money sort of just the way you make a deal with anyone, say, I know you’re good for it.
    0:41:00 When in this case, it wasn’t clear that they were good for it at all.
    0:41:00 They have to win a war.
    0:41:02 But there’s more to it than that, right?
    0:41:09 Because Vitol knows that Qatar theoretically could make them whole if the rebels had totally imploded.
    0:41:10 Yes?
    0:41:17 This is where the political connections of the commodity traders come at play, and that is a very important element of the commodity traders.
    0:41:26 They are really well connected politically, not only in places like Libya and Qatar, but also in London, in Brussels, in Berlin, and in Washington.
    0:41:39 There comes a time where governments need things to happen in the market and in politics, where having a commodity trader helping may come handy.
    0:41:44 And a situation where everyone can deny their involvement.
    0:41:50 Was Qatar acknowledging that they were asking Vitol to do what they did?
    0:41:50 No.
    0:41:59 Was the British government telling Vitol, oh, you should go to Libya, do this deal, because actually London is supporting the rebels?
    0:42:00 No.
    0:42:10 But I think that the conversations behind the scenes, everyone was tapping the shoulder of Vitol and say, come on, guys, do it, but keep it quiet.
    0:42:19 Would you say it’s gotten harder or at least different for commodity traders to operate today than 15 or 20 years ago?
    0:42:28 One thing that has happened pretty recently, the last five, 10 years, is that governments, and in particular the U.S. government, has started paying an awful lot more attention to them.
    0:42:34 Coming up after the break, what does this attention translate into?
    0:42:40 And what happens when the U.S. government itself gets into the commodity trade?
    0:42:41 I’m Stephen Dubner.
    0:42:43 This is Freakonomics Radio.
    0:42:43 We’ll be right back.
    0:43:07 In their book, The World for Sale, Javier Blas and Jack Farchi describe a multitude of bribes and handshake deals with a multitude of warlords and dictators.
    0:43:12 Today, the top commodity trading firms will tell you, they have changed their ways.
    0:43:22 In 2022, Glencore pleaded guilty and agreed to pay more than a billion dollars for making and concealing corrupt payments and bribes and for manipulating oil prices.
    0:43:27 That case was brought by prosecutors in the U.S., Britain, and Brazil.
    0:43:32 That same year, Glencore released its first-ever ethics and compliance report.
    0:43:36 The firm’s chairman said that the company aimed to operate, quote,
    0:43:42 transparently under a well-defined set of values with openness and integrity at the forefront.
    0:43:48 This kind of corporate speak has been echoed by other big commodity trading firms.
    0:43:50 Here is Jack Farchi.
    0:44:00 We have seen in the last five years, almost all of the largest commodity traders have pleaded guilty to misconduct, mostly corruption, but also market manipulation.
    0:44:06 As a result, we’ve seen them all invest a lot in compliance and due diligence.
    0:44:13 It’s fairly clear that commodity traders today can’t do the kind of things that Mark Rich was doing in the 1970s.
    0:44:15 Fewer suitcases full of cash.
    0:44:17 Certainly fewer suitcases full of cash.
    0:44:18 Probably.
    0:44:21 These days, it’s a thumb drive with some crypto on it.
    0:44:24 If Mark Rich were starting out today, what would he be doing?
    0:44:31 He’d probably be trying to trade Russian, Iranian, Venezuelan oil, selling it to India and China.
    0:44:40 Those are the dodgy bits of the oil market where there is huge amounts of money to be made and which rely on having good connections and a willingness to bend or break the rules.
    0:44:42 Now, somebody is doing that, plainly.
    0:44:43 Lots of people are doing that.
    0:44:57 For the most part, not the principal characters of our book, because the principal characters of our book have become such enormous companies that they’re too reliant on the U.S. dollar system to risk falling foul of the U.S. government.
    0:45:06 For the most part, that Russian oil flow, for example, Iranian oil flow, which is subject to even stricter sanctions, has gone into the hands of more shadowy traders.
    0:45:20 There’s this new set of traders that has popped up in Dubai who changes name every few months, including sometimes because they get sanctioned by the U.S. government, which is involved in trading a lot of the Russian oil.
    0:45:33 A lot of the Iranian oil gets traded or even bartered directly by Chinese companies and Chinese buyers, sometimes gets shipped via Malaysia, where it gets rebranded as Malaysian oil and then imported into China as Malaysian rather than Iranian oil.
    0:45:40 There are political scientists who make the argument that sanctions often fail for a variety of reasons.
    0:45:48 Do they factor in what you’re talking about right now, which is just that there are shadow dealers, essentially, who are finding ways to get around the sanctions?
    0:46:02 One of the key arguments for why people say that sanctions don’t work, particularly sanctions on things like commodities, because if commodities are produced, then as a rule, they tend to flow and they tend to find a market because they’re fungible.
    0:46:03 It’s quite hard to trace them.
    0:46:05 I wouldn’t say it’s universally true.
    0:46:15 For example, in 2012, when the U.S. and Europe ratcheted up sanctions on Iran, Iranian oil production and exports did fall pretty substantially.
    0:46:26 And is that because that was the period when the bigger firms were a little bit more concerned with compliance and there hadn’t yet arisen these smaller, more shadowy firms to fill the space?
    0:46:27 Yes.
    0:46:32 And because it takes time to build up new networks of trading to circumvent sanctions.
    0:46:36 At the end of the day, the U.S. is very powerful.
    0:46:41 It probably was more powerful then than it is now in terms of being able to exert its influence on countries like India and China.
    0:46:49 And so there was an ability for the U.S. to unofficially say to China, we’d like you to significantly reduce your purchase of Iranian oil and for it to happen.
    0:46:53 So predicting the future, as we all know, is really hard.
    0:46:57 But let me ask you about a past prediction and why it was so wrong.
    0:47:05 Peak oil, which was an argument that was really prominent in mainstream media, just about everywhere for a long time.
    0:47:07 And then it turned out to just be wrong.
    0:47:13 Why do you think the estimates were so off and what role did commodity traders play in the reality?
    0:47:20 The estimates were so wrong with peak oil supply because people keep betting against two things.
    0:47:21 One is American engineering.
    0:47:27 If you give an American engineer enough time and enough money, it will solve any problem.
    0:47:30 And the second one, they bet against American capitalism.
    0:47:33 We got $100 oil.
    0:47:39 It was just a question of time that someone in America was going to find a way to make money out of that.
    0:47:41 And that was the shale industry.
    0:47:53 The commodity traders were very helpful because all of a sudden, these are not the typical American big oil companies like ExxonMobil or Chevron or Occidental Petroleum or Conoco.
    0:48:03 These are a bunch of, with all due respect, cowboys in Texas with small companies drilling oil wells in a different way, and they need to sell it.
    0:48:10 All of a sudden, the U.S. government, who have banned the export of crude oil for many years, says,
    0:48:12 OK, guys, it’s fine.
    0:48:13 You can export the crude oil.
    0:48:24 Small oil producers, which need finance, which need expertise, which need advice, and a government which is willing to let the commodity to flow into the international market.
    0:48:35 It’s almost like if all of that was written by the executives of a commodity trader on, like, my Christmas shopping list of all what I need, and bang, you got it.
    0:48:47 There have been some pretty significant events in global politics and economics since you published the book.
    0:48:54 How do you see the Russia-Ukraine war as connected to commodities and commodity traders?
    0:49:00 The invasion of Ukraine by Russia has a huge impact in the commodity markets.
    0:49:05 Both countries are huge players in natural resources.
    0:49:14 The commodity traders were one of the most active Western business interests in Russia.
    0:49:29 I don’t think that Putin will have made it all the way from Crimea to the final invasion if the commodity traders have not been helping Russian companies to sell their cargos in the market.
    0:49:31 These are against U.S. sanctions, correct?
    0:49:35 There were, again, some American sanctions, but not European sanctions.
    0:49:40 So all this business was legal all the way until the final invasion of Ukraine.
    0:49:44 But a lot of companies didn’t really want to get into that business.
    0:49:51 There were some restrictions, but they were not breaking the law of the respective countries where they were doing it.
    0:50:06 But they were very, very important for Vladimir Putin to the point that Putin personally gave one of the highest medals that you could get as a foreigner to Ivan Glassenberg, the CEO of Glencore, for service to Russia.
    0:50:11 In that period, in between Crimea was invaded and the rest of Ukraine was invaded.
    0:50:17 So the big firms that have reformed to some degree, as you’re describing, are they still doing well financially?
    0:50:19 They’re doing better than they’ve ever done before.
    0:50:26 This period of the last four or five years, the energy crisis in Europe, COVID, the oil price went negative.
    0:50:28 It feels like a lifetime ago, but it happened.
    0:50:35 2022 was a bonanza year for all of them because oil prices and gas prices surged.
    0:50:36 There was massive volatility.
    0:50:40 Many of them had contracts to buy from Russia.
    0:50:45 And then the price of Russian commodities collapsed and they were buying at very low prices and making a lot of money.
    0:50:57 The four largest commodity traders made profits of $48 billion in 2022, which is more than Amazon, Meta, NVIDIA and Tesla combined that year.
    0:51:00 Talk to me about the first few months of the Trump administration.
    0:51:05 How do you assess this administration through the lens of commodity trading?
    0:51:14 For the commodity trader, Trump has had some very important and perhaps not very widely appreciated benefits.
    0:51:22 One is that Donald Trump has instructed the Department of Justice to effectively don’t care about foreign bribery.
    0:51:33 Considering that some of these commodity traders have to plead guilty in U.S. court of very serious crimes related with foreign bribery and pay hundreds of millions of dollars in fines,
    0:51:36 that is huge news for the commodity trading.
    0:51:40 One commodity trader told me that this is like we are back to the 70s.
    0:51:42 We can do whatever we want again.
    0:51:50 The other thing has been that all the trade policies of Donald Trump have introduced a lot of volatility in commodity trading.
    0:51:57 Tariffs, sanctions, restrictions, those kind of things, as long as they don’t affect economic growth,
    0:52:04 They are good for commodity traders because typically they open trade opportunities that were not there before.
    0:52:12 The problem for commodity traders is that a lot of the current policies from the White House are probably going to lead to lower economic growth.
    0:52:20 Typically, commodity traders want a healthy economy because the more the global economy grows, the more it consumes commodities,
    0:52:23 the more it demands the business of a commodity trader.
    0:52:33 Early in his second administration, President Trump prioritized a mineral deal with Ukraine in exchange for supporting Ukraine in its war with Russia.
    0:52:40 The deal, which was signed in April, gives the U.S. a cut of future revenue from Ukraine’s natural resources.
    0:52:45 These include minerals used to make electronics, what are often called rare earth metals.
    0:52:49 I asked Javier Blas how rare these metals actually are.
    0:52:52 The rarity is not their concentration.
    0:53:00 The rarity is to find enough of them on a place where you can process them into the actual metals that you can use.
    0:53:03 They are also very small in size.
    0:53:09 The United States imports about $170 million worth of rare earth metals.
    0:53:11 Let me put it this way.
    0:53:16 The price of rare earth metals could go up by a factor of 25 times.
    0:53:29 And the import bill of the United States for rare earth metals will just start to approach the import bill of that absolutely commodity essential for the American economy that is the Mexican avocado.
    0:53:39 Another commodity that has become central to the global economy, primarily for its use in batteries, is cobalt, which is a byproduct of copper mining.
    0:53:46 It’s estimated that more than 70% of the world’s cobalt comes from the DRC, the Democratic Republic of Congo.
    0:53:54 Congo is in a fascinating place at the moment in that it is this focus of this geopolitical struggle between the US and China.
    0:53:58 China has invested a lot there in the last 10, 15 years.
    0:54:04 It’s Chinese companies that have driven a lot of the growth in copper production, cobalt used in EV batteries.
    0:54:07 It’s a relatively difficult place to operate.
    0:54:08 It’s fairly corrupt.
    0:54:10 It’s in the middle of Africa and supply chains are difficult.
    0:54:18 There’s thousands of kilometres on trucks or rail and truck to get from the copper and cobalt mines in the middle of Congo to a port.
    0:54:27 From the Congolese government point of view, there’s a sense that the Congolese feel like they’re rather over-dependent on China.
    0:54:34 From the US point of view, Congo is one of the richest sources of minerals that we know about in the world.
    0:54:44 So there’s this attempt to do a minerals trade deal between the US and Congo, much like the deal that Trump is trying to do in Ukraine, what he wants to do in Greenland.
    0:54:54 At the same time, you have these commodity traders, people like Trafagura, Mercuria, Glencore, who are striking deals to buy copper from the Congolese government.
    0:54:58 And then the place that they’re taking it all to is the US.
    0:55:08 And the reason is one of these dislocations that’s been driven by Trump and by the trade war, because Trump has threatened to put tariffs on US copper imports, but he hasn’t actually done it yet.
    0:55:13 So you have a situation where because there’s a threat, the price of copper in the US has gone up.
    0:55:22 Usually the price of copper in the US is trading like $20, $30, $50 more than the price of copper in, I don’t know, China or London.
    0:55:28 At the moment, it’s trading $1,500, $2,000 more than the price of copper in China or London.
    0:55:31 So there’s $1,500, a tonne of opportunity for traders to make.
    0:55:34 The winners there are pretty obvious. Who are the losers?
    0:55:38 It’s very clear that the losers are US companies and US consumers.
    0:55:47 The price of copper in the US has been trading anywhere between 10% and 25% above the price of copper in the rest of the world, where usually it’s the same.
    0:55:50 The price of aluminium, the same. The price of steel, the same.
    0:55:53 Because of threatened or actual tariffs.
    0:55:58 It’ll take a while for that to feed through into very meaningful inflation for end users, but companies see it straight away.
    0:56:02 The companies will pay a copper price that’s based on the US copper contract.
    0:56:05 In fact, it’s now 20% more expensive than the rest of the world.
    0:56:12 So that’s a great example you just gave, but it’s really just one tiny example in the history of global trading.
    0:56:24 If you add it all up, how much do you feel that the inefficiencies or the arbitrage advantages, whatever you want to call them, in commodity trading accounts for inflation overall?
    0:56:26 I’m not sure I would see it like that.
    0:56:32 In that example, the driver of the inflation is the tariffs.
    0:56:35 The arbitrage is essentially bringing it down, right?
    0:56:42 The commodity traders in this example are buying copper at the cheap price and selling it at the more expensive US price.
    0:56:49 If you add all of their activities together, the impact of that is to bring up the price of copper outside of the US and bring it down inside the US.
    0:56:57 Now, if the US turns around and says, oh, actually, the tariff on copper is going to be 5%, not 25%, in that case, it will come down.
    0:57:08 But broadly speaking, moving material from where the price is cheap to where it’s expensive, both in location and in form and in time, that’s closing those price gaps at the margin.
    0:57:21 And so in a world where you have perfect commodity trading with unlimited capacity to trade and to finance trades and to take risks probably brings down inflation rather than pushes it up.
    0:57:36 Having read your book, I could make a pretty compelling argument, I think, that trading resources has shaped the world, the geopolitics, the national economics and societies of countries.
    0:57:41 For the past hundred years and probably a couple thousand years before that.
    0:57:53 So how do you assess the relationship between this practice, the trading of commodities and all those downstream political, economic and social effects?
    0:57:58 Commodity trading at this moment is as large as it has ever been.
    0:58:03 We are consuming record amounts of almost every natural resource.
    0:58:08 Even the resources that we think we are leaving behind, think about thermal coal.
    0:58:11 The global demand is an all-time high.
    0:58:18 The consumption of oil, the consumption of copper, the consumption of wheat, the consumption of rice, all of them are at the record.
    0:58:28 Therefore, you need commodity traders more than ever to arbitrage those flows, to buy from where those commodities are produced and sell where they are needed.
    0:58:37 At one time, I was criticizing the business to Deanne Taylor, who was the CEO of Beetle, the world’s largest oil trader.
    0:58:47 I suppose that I presented trading as something that it was easy, that they were taking money from the table under the noses of consumers and producers.
    0:58:55 And then he turned to me and said, well, Javier, if you think that this is so easy, why not everyone else is doing it?
    0:58:57 Why is only us who is doing it?
    0:58:59 This is a more difficult business than you think.
    0:59:02 This is not free money that we are taking from the table.
    0:59:07 This is not the big bully from high school taking the lunch from the children.
    0:59:10 We are putting our money at risk.
    0:59:17 And clearly, the global economy needs us because if not, they will have got rid of commodity traders a long time ago.
    0:59:19 But it’s not like you have to have all or nothing.
    0:59:24 Other products and services have well-established, transparent markets.
    0:59:29 And there are certainly trading markets and commodities that are similar to those markets I’m talking about.
    0:59:32 But this is a whole other layer.
    0:59:36 It could have been replaced by now by a more centralized clearinghouse.
    0:59:36 Couldn’t it have been?
    0:59:38 I suppose that the answer is no.
    0:59:47 If it was so easy to standardize commodity trading and make it, you know, the Amazon of commodity trading, it will have happened already.
    0:59:53 I suppose it’s a combination of the quantity and the differences of commodities.
    0:59:59 Also, the origins of where a lot of those commodities are coming and where they are going.
    1:00:02 And also, how politicized at times is the market?
    1:00:08 There’s a market where you need to navigate coup d’etat, civil wars, American sanctions.
    1:00:21 It just strikes me that the two of you have exposed a pretty large and foundational layer of the global economy that many people either don’t want to know about or don’t have the resources to find out about.
    1:00:28 But when it comes to the government, it still just surprises me that there’s so little appreciation for the depth and wealth of this industry.
    1:00:32 So do you see that changing in the U.S. and U.K. at least?
    1:00:44 I think there’s been a vast amount of complacency from governments in the West about commodities thinking that’s the past, that’s the old economy, the market will sort it out.
    1:00:46 We don’t need to worry about that.
    1:00:49 We don’t need to have lots of policy to do with that.
    1:00:53 Leave it to some technical specialist and probably don’t fund that technical specialist very well.
    1:01:03 There’s not an awful lot of consideration to commodity markets because they maybe don’t affect ordinary voters quite so directly as other things of the economy.
    1:01:04 But I think it’s a mistake.
    1:01:06 The last few years has borne that out.
    1:01:21 Suddenly, you know, we’ve woken up in Europe to how being complacent about commodity supplies and commodity security has suddenly left Europe extremely vulnerable and is essentially in the process of killing a lot of the heavy industry of Europe through high energy prices.
    1:01:26 Governments need to pay much more attention to this and need to think much more strategically and more long term about that.
    1:01:36 I don’t necessarily think that everything that the current U.S. administration is doing is a good idea, but commodities have risen up the list of political priorities, and I think that’s probably a good thing.
    1:01:41 Do you feel your book has changed the way commodities are traded or will be traded in the future?
    1:01:47 I think that the book has helped to bring a bit of transparency to the industry.
    1:01:52 We find more policymakers that are aware of who these companies are.
    1:02:04 It really concerns me that from time to time, a government may invite Jack or me to speak to them as if we were the source of expertise in the industry.
    1:02:14 While it’s very flattering, I’m thinking, geez, if the governments are calling us as the experts, they really have no clue what’s going on.
    1:02:26 That is really the level of understanding of the industry, where basically the world for sale has become the de facto, if you are interested into commodity trading, you need to read the book.
    1:02:31 Are the traders changing the behavior because of our book?
    1:02:46 I don’t know, but we know that an oil trader from Betel, which is the world’s largest oil trader, was recorded by the FBI on a secret wiretap, and he was talking about us.
    1:02:57 He was talking about our questions and the fact that we were writing stories about commodity trading, and he said that the company that employed him was a bit nervous, so they needed to keep a bit of a low profile.
    1:03:10 So, in so many ways, when we saw our names on the FBI wiretap, and then, you know, he did call us an idiot, but it was quite good because we thought, well, maybe we do have a bit of an impact.
    1:03:17 Javier Blas and Jack Farchi have certainly had an impact on me.
    1:03:19 I hope you as well.
    1:03:21 Their book is called The World for Sale.
    1:03:23 Let us know what you think.
    1:03:26 Our email is radio at Freakonomics.com.
    1:03:41 Coming up next time, the economist Austin Goolsby, a repeat guest on this show, is now president and CEO of the Federal Reserve Bank of Chicago, which puts him at the center of some important debates.
    1:03:44 From the beginning, they started asking, are you a dove?
    1:03:45 Are you a hawk?
    1:03:47 I don’t even know if I like birds.
    1:03:49 I just want to be a data dog.
    1:03:52 And what does it take to be a data dog?
    1:03:54 There are two main rules.
    1:03:57 There’s a time for walking and there’s a time for sniffing.
    1:04:00 And the first rule is know the difference.
    1:04:02 The second rule is you never throw anything away.
    1:04:07 The diet of the data dog is eat anything that hits the floor.
    1:04:13 We asked Goolsby to walk us through the Fed’s data and tell us what it means for the U.S. economy.
    1:04:15 That’s next time on the show.
    1:04:17 Until then, take care of yourself.
    1:04:19 And if you can, someone else too.
    1:04:24 Freakonomics Radio is produced by Stitcher and Renbud Radio.
    1:04:33 You can find our entire archive on any podcast app, also at Freakonomics.com, where we publish complete transcripts and show notes.
    1:04:36 This episode was produced by Tao Jacobs.
    1:04:40 It was mixed by Jasmine Klinger with help from Jeremy Johnston.
    1:04:44 Thanks to Michael Haberkorn for the original book recommendation.
    1:04:51 Thanks also to Ivo Saryanovich, Jonathan Kingsman, and Scott Irwin for their good insights on commodity trading.
    1:05:03 The Freakonomics Radio Network staff also includes Alina Coleman, Augusta Chapman, Delvin Abouaji, Eleanor Osborne, Ellen Frankman, Elsa Hernandez, Gabriel Walth, Greg Rippon, Morgan Levy, Sarah Lilly, and Zach Lipinski.
    1:05:08 Our theme song is Mr. Fortune by the Hitchhikers, and our composer is Luis Guerra.
    1:05:11 As always, thank you for listening.
    1:05:18 Oh, Jesus Christ, hold on one second.
    1:05:20 That I need to check because I cannot remember.
    1:05:25 Jack, do you remember how much oil these guys controlled in the 1970s?
    1:05:32 The Freakonomics Radio Network.
    1:05:34 The hidden side of everything.
    1:05:38 Stitcher.

    Just beneath the surface of the global economy, there is a hidden layer of dealmakers for whom war, chaos, and sanctions can be a great business opportunity. Javier Blas and Jack Farchy, the authors of The World for Sale, help us shine a light on the shadowy realm of commodity traders.

     

    • SOURCES:
      • Javier Blas, opinion columnist at Bloomberg News.
      • Jack Farchy, energy and commodities senior reporter at Bloomberg News.

     

     

  • Most Replayed Moment: How to Know If You’re Being Gaslit by a Narcissist And What to Do About It: Dr Ramani Durvasula

    中文
    Tiếng Việt
    AI transcript
    0:00:03 What’s better than a well-marbled ribeye sizzling on the barbecue?
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    0:00:26 Service fees, exclusions, and terms apply.
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    0:00:39 You spend time, even today, dealing with patients who are the victim of a narcissistic relationship, or the victim of a narcissist.
    0:00:46 Every week. Every week. I mean, it’s probably one of the, if not the most gratifying part of my week.
    0:00:50 I’m a big believer that if you’re a mental health practitioner, you practice mental health.
    0:00:54 So that’s a privilege, to be able to be in that room and to work with clients.
    0:01:07 But it would be so easy when you’re dealing at a macro level, large populations going on YouTube, writing books, to get distanced from what is happening to individual people’s lives.
    0:01:10 One of the tricky bits with research is we study populations.
    0:01:11 We study samples, right?
    0:01:12 We study hundreds of people.
    0:01:15 What happens in the room is something very different.
    0:01:23 And you start to recognize, A, how badly these relationships harm people, their schemas of the world, their schemas of themselves.
    0:01:37 And B, how much potential for intervention there is with these clients through very, very simple approaches around education about narcissism, validation of their experience, breaking through self-blame, and teaching them to trust themselves.
    0:01:43 So how many patients do you think you’ve seen that have been victims of narcissists?
    0:01:45 I mean, hundreds, hundreds, really.
    0:01:46 And I even use the word survivor.
    0:01:49 I hate to call them victims because I don’t even think they’re that passive.
    0:01:51 I mean, I think that they just weren’t.
    0:01:53 No one ever taught anyone this, right?
    0:01:54 I’ll give you the example.
    0:02:00 When people are in a relationship with somebody who’s living with addiction, it’s very clear what they’re dealing with, right?
    0:02:08 You have a person, they’re using a substance that’s altering them, that’s altering their behavior, that’s taking them away from who they are in person.
    0:02:11 People in relationships with addicts will say, I’m in two relationships.
    0:02:19 I’m in a relationship with a sober person, and I’m in a relationship with somebody who’s using or intoxicated or denying or defending their use, right?
    0:02:20 Two people.
    0:02:22 And it breaks the people in those relationships.
    0:02:23 And we’re willing to call it that.
    0:02:27 The experience people have in narcissistic relationships in a way is no different.
    0:02:32 With the added bit, though, that at least with addiction, people can say, I see what the behavior is.
    0:02:34 I see what the issue is.
    0:02:36 Addiction’s a disease, and we know it’s treatable.
    0:02:39 Narcissism, not so much.
    0:02:46 And on top of that, the narcissistic person has this very well-developed, very successful behavioral repertoire.
    0:02:54 They can go out in the world, and they’re able to be charming and charismatic and confident and smart and the center of attention and running companies.
    0:03:08 And behind closed doors, they psychologically eviscerate the people they’re with, spouses, partners, family members, close friends, maybe people who are below them in an organization, people where they can kind of get away with it.
    0:03:11 So the people they’re harming, the world thinks this person’s fantastic.
    0:03:15 At least the person who’s in a relationship with an addict, people say, okay, I get it.
    0:03:15 They’re using.
    0:03:16 This is hard.
    0:03:23 But for the folks in narcissistic relationships, a lot of people say, aren’t you lucky that you’re married to that guy?
    0:03:26 And the person’s like, oh my gosh, are these people out of their mind?
    0:03:27 Like, so what do they do?
    0:03:28 They blame themselves.
    0:03:31 Okay.
    0:03:35 What is narcissism?
    0:03:42 I’ve heard the word used so often, but I couldn’t tell you the definition of it.
    0:03:44 And I feel like I’d butcher the definition of what it is.
    0:03:54 So I’m almost curious to ask you, what just, before I almost contaminate you with what my definition is, what’s your working definition?
    0:03:57 What’s your working model of what narcissism is?
    0:04:02 Delusions of grandeur, someone that thinks they’re like super important and that they are better than everybody else.
    0:04:03 Arrogance.
    0:04:06 And they’re cruel.
    0:04:06 Okay.
    0:04:07 All right.
    0:04:12 So I would give you probably like a C plus, B minus if you’re a student in my class.
    0:04:15 I mean, I cut students a lot of slack back in the day.
    0:04:17 So I’ll give you a C plus, B minus.
    0:04:19 Because you’re in the neighborhood, right?
    0:04:24 The grandiosity, the arrogance, the meanness.
    0:04:29 But that to me is even more sort of a manifestation of the traits, like the grandiosity, the arrogance.
    0:04:33 They have variable empathy and typically have low empathy.
    0:04:34 They’re deeply entitled.
    0:04:40 They truly think they’re more special than everyone else and that the rules should apply to them very differently.
    0:04:46 They have a excessive need for admiration and validation.
    0:04:47 They’re very superficial.
    0:04:53 They don’t really have the capacity for deep, sustained, intimate relationships.
    0:04:57 They’re very much referential to the world outside of them to set goals.
    0:05:00 They don’t have a good internal sense of like what matters to me.
    0:05:01 What do I want to do?
    0:05:04 They just want to do what they do, again, to get that admiration and validation.
    0:05:09 There’s a shallowness, a real emotional shallowness to narcissism.
    0:05:11 Those are the patterns and traits.
    0:05:18 We sort of see they’re very, very self-centered, very preoccupied with themselves, the good parts of themselves, the bad parts of themselves.
    0:05:23 It’s very rare for them to sort of lift their heads up and genuinely notice the experience of another person.
    0:05:25 That’s what narcissism is.
    0:05:26 How does it show up?
    0:05:32 It shows up as devaluation, dismissiveness, manipulation, gaslighting.
    0:05:37 They get angry very quickly, especially when they’re frustrated or disappointed.
    0:05:42 And that can show up as overt rage or overt anger, yelling, screaming, or even violence.
    0:05:46 That can show up as passive aggression, withholding, and withdrawing.
    0:05:49 They are prone to betrayal.
    0:05:50 They lie.
    0:05:51 They cheat.
    0:05:54 They make promises about the future they never keep.
    0:05:56 But they do that to keep people around so they won’t leave them.
    0:05:59 So it’s part of a larger sort of a manipulation.
    0:06:01 They will dominate people.
    0:06:03 They have to get the last word.
    0:06:04 They will shift blame onto other people.
    0:06:09 They will rarely take responsibility for their misdeeds, even when they’re clearly caught in them.
    0:06:12 And if they do, they’ll still blame the other person.
    0:06:15 They’re very neglectful and careless in relationships.
    0:06:18 That is narcissism.
    0:06:25 How can you tell the difference between someone having a bad day, an asshole, and a narcissist?
    0:06:28 Because some of those things there, I thought, Joe, on a bad day, I might do that.
    0:06:29 Yeah.
    0:06:32 You know, the whole collection together, no?
    0:06:35 But on a bad day, when I haven’t slept, okay, do you know what?
    0:06:38 I might blame someone or whatever else.
    0:06:39 What’s the distinction?
    0:06:43 When a person has a bad day, and we all have bad days, and on those bad days,
    0:06:49 we might look, if all the, if the only tape someone had of us was of that day, ooh, right?
    0:06:51 But here’s the piece.
    0:06:57 When people are not narcissistic and they have bad days, they will take accountability,
    0:07:02 they will make amends, and they will change their behavior and say, I’m not doing this again.
    0:07:03 This is not okay.
    0:07:04 Why wasn’t it okay?
    0:07:06 Because it was none of those people’s fault.
    0:07:07 You didn’t get enough sleep.
    0:07:12 And whether that means we reach deeper to be as kind as we can to the people, in some cases,
    0:07:16 especially if it’s people we know or we see, again, you may not know the random person at
    0:07:21 the gym, but if we, someone we know or work with, we step, we step out of ourselves to
    0:07:25 say, the way I conducted myself yesterday wasn’t okay, and I’m really sorry about that.
    0:07:30 And so that they’re having that experience of you taking accountability.
    0:07:33 That’s where I know we’re not dealing with a narcissistic person.
    0:07:34 We’re dealing with a bad day.
    0:07:37 And a bad day is just that, a day.
    0:07:38 It’s not every day.
    0:07:42 With a narcissistic person, many days, I’m not going to say all.
    0:07:48 But many days are characterized by these machinations, these manipulations, and these invalidations.
    0:07:53 The person in a relationship with a narcissistic person feels like they’re constantly on their
    0:07:54 back foot, that they can’t be themselves.
    0:07:56 They can’t express a need.
    0:07:57 They can’t express a want.
    0:08:01 They can’t even express a feeling for fear of it being shut down.
    0:08:05 So there’s your not narcissistic person.
    0:08:06 What about an asshole?
    0:08:13 I do think assholery and narcissism are pretty, we use the terms interchangeably.
    0:08:19 I think, though, that here’s my asshole belief, since this is something, I think the construct
    0:08:23 validation on asshole is probably still needing to be done.
    0:08:26 I think assholes tend to be pretty consistently assholes.
    0:08:35 So whereas narcissistic people can really, they have a much wider behavioral repertoire to be
    0:08:36 absolutely charming.
    0:08:41 This is a person who can be absolutely charming on the golf course with the CEO of their company.
    0:08:48 Like charming, nice, warm, remembering the ages of their kids, and asking about the wife, and
    0:08:50 remembering that their grandmother is sick, and all this stuff.
    0:08:52 And get home.
    0:08:54 Forget it was his anniversary.
    0:08:56 Scream at their partner.
    0:08:58 Why does the house look like this?
    0:09:00 Why do I have to put up with this?
    0:09:02 Make those damn kids shut up.
    0:09:04 But they were Mr.
    0:09:09 I remember that your little girl’s birthday is February 6th when they were on the golf course.
    0:09:10 That is not assholery.
    0:09:12 That’s narcissism.
    0:09:15 Can you cure narcissism, in your opinion?
    0:09:16 No, I don’t.
    0:09:19 Because I think that would imply changing a personality, which I don’t think we can do.
    0:09:23 Is there any evidence?
    0:09:30 Have you ever seen in your 20 years of working with narcissists and their survivors, any sign
    0:09:34 of a narcissist becoming a not-narcissist or a non-narcissist?
    0:09:36 I’ve not seen them become a not-narcissist.
    0:09:42 I’ve seen them make micro-changes, because I measure and monitor and make my notes in therapy.
    0:09:44 So I’ll see, interesting.
    0:09:48 They’re no longer trying to mess with coming in 10 minutes later and asking me to keep them
    0:09:48 for the whole hour.
    0:09:52 They are honoring the therapeutic frame.
    0:09:55 They’re paying the bill when they decide not to show up at the last minute.
    0:09:56 I’ll see tiny tweaks.
    0:10:02 I’ll see people who’ll come in and say, I screamed at my girlfriend again last night and that wasn’t
    0:10:03 cool.
    0:10:05 So I was like, oh, whoa, that’s in sight.
    0:10:06 Like, I’ll run with it.
    0:10:08 But here’s the rub, okay?
    0:10:09 These micro-changes.
    0:10:12 And they are micro-changes, but they are changes.
    0:10:13 And they’re in the right direction.
    0:10:19 That much water under the bridge for the family members and partners and other people that have
    0:10:20 been harmed.
    0:10:23 They’re saying, you want me to stay in this relationship because this dude remembered to
    0:10:25 say thank you once this week?
    0:10:26 I think not.
    0:10:27 To me, the thank you is progress.
    0:10:32 To the people in their lives who’ve been harmed, that one thank you is not going to be enough.
    0:10:33 I heard this word, gaslighting.
    0:10:37 Again, it’s a word I’ve heard a lot, but I’m not necessarily really clear on what the definition
    0:10:38 of gaslighting is.
    0:10:42 But from reading your work, I hear that narcissists gaslight people a lot.
    0:10:43 A lot, right.
    0:10:44 What is gaslighting?
    0:10:47 So gaslighting, at its simplest, it’s a power play.
    0:10:48 It’s a form of emotional abuse.
    0:10:49 And it’s a tactic.
    0:10:55 Gaslighting is predicated on a relationship that’s ostensibly characterized by trust.
    0:10:59 So that’s why strangers can’t gaslight you in the same way as an intimate partner,
    0:11:02 a trusted colleague, a family member.
    0:11:06 Even a person with expertise, like an attorney or a physician, could gaslight you, right?
    0:11:09 Because there’s a presumption of trust.
    0:11:10 So you’re going to listen to the gaslighter.
    0:11:17 Initially, what the gaslighter will do is they will doubt the gaslighted person’s perceptions,
    0:11:20 experiences, memories, even reality.
    0:11:21 That never happened.
    0:11:23 I never said that.
    0:11:24 You’re making that up.
    0:11:27 We never went there.
    0:11:32 So now this person’s a little confused because their reality is saying, yeah, we did.
    0:11:33 Yeah, we did.
    0:11:37 So initially, a person will fight back against the gaslighter.
    0:11:39 They’ll say, we absolutely went there.
    0:11:41 Do you want me to show you the pictures on my phone?
    0:11:44 Then we go to the next step of gaslighting.
    0:11:47 The gaslighter doesn’t want to see the pictures on your phone.
    0:11:48 They just want to overpower you.
    0:11:50 This isn’t about evidence.
    0:11:52 This is about them overpowering you.
    0:11:54 So they’ll say, look, here’s the pictures on my phone.
    0:11:57 And then the gaslighter won’t say, well, you’re right.
    0:11:58 We did go there.
    0:12:03 Instead, they’ll say, oh my gosh, you are the most petty human being I’ve ever met.
    0:12:04 Is this what it is?
    0:12:08 You’re just going to go in your phone to find the pictures to prove something to me?
    0:12:10 Is that what this relationship is?
    0:12:13 I don’t know that I want to even be in a relationship like this.
    0:12:17 Now, this poor person who’s being gaslighted is thinking, I just showed them the pictures
    0:12:17 to prove a point.
    0:12:19 And now I’m the bad one.
    0:12:22 And so they trust this person.
    0:12:24 So they think, well, maybe I am doing something bad.
    0:12:25 Maybe I am being petty.
    0:12:28 But gaslighting doesn’t happen once.
    0:12:31 It happens over and over and over again.
    0:12:38 It’s an indoctrination process that leaves the gaslighted person utterly confused, completely
    0:12:40 out of their mind, doubting themselves.
    0:12:42 And they start to believe the critiques.
    0:12:45 The gaslighter will tell them things like, you’re crazy.
    0:12:46 You’re stupid.
    0:12:48 You don’t remember things right.
    0:12:49 Maybe you have dementia.
    0:12:50 Do you think you should be in therapy?
    0:12:52 You might need to be on medication.
    0:12:57 By the time the gaslighter is done with someone, they have lost all sense of, they don’t trust
    0:12:58 themselves at all.
    0:13:03 And so if they don’t leave the relationship, and some people don’t, they are then sort of
    0:13:07 in this, again, this form of servitude with the narcissistic person, a gaslighting person,
    0:13:11 almost relying on them to lead them through reality.
    0:13:16 So it’s almost like utter submission at that point, that the gaslighter gets to dictate reality.
    0:13:23 And then, over time, there’s this tactic that narcissistic and other abusive people use called
    0:13:24 DARVO.
    0:13:31 DARVO stands for deny, attack, reverse, victim, and offender.
    0:13:33 It’s a construct that was developed by Dr. Jennifer Fried.
    0:13:38 Deny, attack, reverse, victim, and offender.
    0:13:46 So what the narcissistic person will in a very skilled, I mean, in a cruelly skillful way do
    0:13:53 is if the person, the gaslighted person ever attempts to push back on something that the
    0:13:58 narcissist does, done, like you came, you said you were going to be home by nine o’clock last
    0:13:58 night.
    0:14:00 You didn’t get home till one in the morning.
    0:14:03 The narcissistic person will deny said, that’s not true.
    0:14:07 I came, yeah, I didn’t get home at nine, but I didn’t come home at any one in the morning.
    0:14:10 But again, like, what is your problem?
    0:14:10 Like, what do you do?
    0:14:14 Like, you read the ADT guide all day to see what time I come in the door?
    0:14:15 And you know what?
    0:14:18 Like, I can’t believe that this is my life.
    0:14:21 I work so hard to keep us in this fabulous house.
    0:14:24 I work so hard so you can stay home.
    0:14:26 And I’m the bad guy?
    0:14:28 Like, I can’t even believe that this is the issue.
    0:14:29 Like, you put me through so much.
    0:14:31 Reverse, victim, and offender.
    0:14:34 He was out till one in the morning, and he knows it.
    0:14:37 But now he’s shut down the conversation.
    0:14:40 It is an insidious dynamic.
    0:14:45 Because done enough, you literally strip another person of the reality.
    0:14:47 And that is unacceptable to me.
    0:14:48 That’s absolute abuse.
    0:14:49 Do you see this a lot?
    0:14:50 All the time.
    0:14:52 All the time.
    0:14:55 It is the dynamic that once it had name to it.
    0:14:57 When the word is used right, most people use this word wrong.
    0:15:00 That whole process I described is gaslighting.
    0:15:03 When the word is used correctly, it’s powerful.
    0:15:09 It captures a unique interpersonal dynamic that really eats people from the inside out.
    0:15:09 I hear it.
    0:15:11 I see it all the time.
    0:15:17 By family members, by partners, in the workplace, you name it.
    0:15:20 And it really messes people up because they feel like they’ve lost their minds.
    0:15:22 And they feel like they can’t trust themselves.
    0:15:25 And I think that’s a terrible thing to do to someone.
    0:15:28 What should you do if you’re being gaslit?
    0:15:34 When you know what it is and someone starts to gaslight you, they literally deny your reality,
    0:15:34 right?
    0:15:39 You have to take a step back and say, that’s not what happened.
    0:15:40 But you don’t say it to them.
    0:15:44 The importance with gaslighting is you don’t engage with the gaslighter.
    0:15:46 You now know you’re being gaslighted.
    0:15:52 Which means the other person in that interaction has the capacity to gaslight you.
    0:15:56 So what that means is, from your side, you need to shut it down.
    0:15:59 And that means no longer engaging.
    0:15:59 Does that make…
    0:16:03 So you cannot keep engaging with them because they’re going to pull you down.
    0:16:04 Further and further.
    0:16:08 Yeah, it’s almost like they’re going to pull you down into being drowned or pull you into
    0:16:09 the quicksand.
    0:16:12 So when they start gaslighting, I never said that.
    0:16:17 One playback could be, we’re having a different experience then.
    0:16:18 And leave it at that.
    0:16:20 Don’t go down that slippery slope.
    0:16:21 Don’t go down the slope.
    0:16:24 Don’t say, don’t show them the text message.
    0:16:25 Don’t pull out the email.
    0:16:27 Don’t try to prove them wrong.
    0:16:29 Don’t engage with them.
    0:16:32 It’s funny you’re asking me this because I was recently gaslighted.
    0:16:35 I was relatively recently in a professional situation.
    0:16:38 And I’m thinking, not me.
    0:16:40 Like, I don’t know much, but I know this.
    0:16:40 So don’t…
    0:16:40 But they did.
    0:16:41 I was.
    0:16:44 And I got very upset.
    0:16:49 And in this particular situation, it was actually, I understand why I got…
    0:16:52 It was like, think of it as a corporate structure that was gaslighting me.
    0:16:58 So sometimes very nice people who work in corporate systems gaslight because they’re trying to prop
    0:17:01 up the narcissism of the corporation, but they’re decent human beings.
    0:17:02 It was very clear to me.
    0:17:03 I’ve seen that happen.
    0:17:05 But in this particular case, I was being gaslighted.
    0:17:06 I got upset though.
    0:17:13 Knowing all I know, knowing all the tactics, it’s very dehumanizing to have your reality
    0:17:15 completely doubted.
    0:17:20 And so I did feel a sense of upset, but I confronted the person.
    0:17:23 I said, this is gaslighting and it’s not okay.
    0:17:25 And I know you’re better than this.
    0:17:26 And they happened to be.
    0:17:30 This was a lucky case where the gaslighter was not narcissistic.
    0:17:32 So we came to a conclusion.
    0:17:38 But when I’ve been gaslighted by narcissistic people, I just disengage.
    0:17:41 And I file it away and say, this person is capable of this.
    0:17:43 There’s really not much juice here.
    0:17:45 This can only go so deep.
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    Bạn vẫn đang dành thời gian, ngay cả hôm nay, để giải quyết các bệnh nhân là nạn nhân của một mối quan hệ quá tự mãn, hoặc nạn nhân của một người tự mãn. Mỗi tuần. Mỗi tuần. Ý tôi là, đó có lẽ là một trong những điều đáng hài lòng nhất trong tuần của tôi. Tôi là một người rất tin rằng nếu bạn là một chuyên gia sức khỏe tâm thần, bạn thực hành sức khỏe tâm thần. Vì vậy, đó là một đặc ân, được ở trong căn phòng đó và làm việc với những khách hàng. Nhưng thật dễ dàng để khi làm việc với quy mô lớn, những quần thể lớn lên YouTube, viết sách, bạn sẽ xa rời những gì đang xảy ra trong cuộc sống của các cá nhân. Một trong những điều khó khăn với nghiên cứu là chúng ta nghiên cứu các quần thể. Chúng ta nghiên cứu mẫu, đúng không? Chúng ta nghiên cứu hàng trăm người. Những gì xảy ra trong phòng là điều rất khác. Và bạn bắt đầu nhận ra, A, những mối quan hệ này tổn hại con người như thế nào, các cách nhìn của họ về thế giới, cách nhìn về bản thân họ. Và B, có bao nhiêu khả năng can thiệp với những khách hàng này thông qua những cách tiếp cận rất đơn giản như giáo dục về sự tự mãn, xác thực trải nghiệm của họ, phá vỡ sự tự buộc tội và dạy họ tin tưởng vào bản thân mình.
    Vậy bạn nghĩ có bao nhiêu bệnh nhân mà bạn đã gặp là nạn nhân của những người tự mãn? Tôi nghĩ là hàng trăm, thực sự là hàng trăm. Và tôi thậm chí còn dùng từ ‘người sống sót’. Tôi ghét gọi họ là nạn nhân vì tôi không nghĩ họ thụ động đến vậy. Ý tôi là, tôi nghĩ họ chỉ đơn giản là không biết. Không ai đã dạy cho ai điều này, đúng không? Tôi sẽ đưa ra ví dụ. Khi mọi người trong một mối quan hệ với ai đó sống với chứng nghiện, điều đó rất rõ ràng về những gì họ đang đối mặt, đúng không? Bạn có một người, họ đang sử dụng một chất nào đó làm thay đổi họ, làm thay đổi hành vi của họ, dẫn họ xa rời con người thật của họ. Những người trong mối quan hệ với những người nghiện sẽ nói, tôi đang ở trong hai mối quan hệ. Tôi đang ở trong một mối quan hệ với một người tỉnh táo, và tôi đang ở trong một mối quan hệ với ai đó đang sử dụng, hoặc say xỉn, hoặc phủ nhận hoặc biện minh cho việc sử dụng của họ, đúng không? Hai người. Và điều đó đã phá vỡ những người trong các mối quan hệ đó. Và chúng ta sẵn sàng gọi nó như vậy. Trải nghiệm mà mọi người có trong các mối quan hệ tự mãn về cơ bản không khác biệt. Với điểm cộng là, ít nhất với nghiện, mọi người có thể nói, tôi thấy hành vi của họ. Tôi thấy vấn đề là gì. Nghiện là một căn bệnh, và chúng ta biết nó có thể điều trị được. Còn sự tự mãn thì không phải như vậy. Và không chỉ vậy, người tự mãn có một bộ kỹ năng hành vi rất phát triển và thành công. Họ có thể ra ngoài thế giới, và họ rất có sức quyến rũ, lôi cuốn, tự tin, thông minh và là trung tâm của sự chú ý, điều hành các công ty. Và sau cánh cửa đóng kín, họ tâm lý tước đoạt người đang ở bên họ, vợ chồng, đối tác, thành viên gia đình, bạn bè gần gũi, có thể là những người dưới họ trong một tổ chức, những người mà họ có thể dễ dàng kiểm soát. Vì vậy, những người mà họ đang làm tổn thương, thế giới nghĩ rằng người này thật tuyệt vời. Ít nhất đối với người đang trong mối quan hệ với một người nghiện, mọi người sẽ nói, được rồi, tôi hiểu. Họ đang sử dụng. Điều này thật khó khăn. Nhưng đối với những người trong các mối quan hệ tự mãn, nhiều người sẽ nói, bạn thật may mắn khi kết hôn với người đó? Và người đó sẽ nghĩ, ôi Chúa ơi, mấy người này có bị điên không? Thế thì họ làm gì? Họ tự trách bản thân mình.
    Được rồi. Sự tự mãn là gì? Tôi đã nghe từ này được sử dụng rất nhiều, nhưng tôi không thể nói cho bạn định nghĩa của nó. Và tôi cảm thấy như tôi sẽ làm hỏng định nghĩa của nó. Vì vậy, tôi gần như tò mò hỏi bạn, trước khi tôi làm ảnh hưởng đến bạn bằng định nghĩa của tôi, định nghĩa làm việc của bạn là gì? Mô hình làm việc của bạn về sự tự mãn là gì? Ảo tưởng về sự vĩ đại, ai đó nghĩ rằng họ rất quan trọng và rằng họ tốt hơn mọi người khác. Kiêu ngạo. Và họ tàn nhẫn. Được rồi. Vì vậy, tôi có thể cho bạn điểm C cộng, B trừ nếu bạn là sinh viên trong lớp học của tôi. Ý tôi là, tôi đã rất thoải mái với sinh viên trong quá khứ. Vì vậy, tôi sẽ cho bạn điểm C cộng, B trừ. Bởi vì bạn đang ở gần đúng, phải không? Sự vĩ đại, sự kiêu ngạo, sự ác độc. Nhưng điều đó đối với tôi, thậm chí còn hơn thế là một cách thể hiện của các đặc điểm như sự vĩ đại, sự kiêu ngạo. Họ có lòng đồng cảm không ổn định và thường có lòng đồng cảm rất thấp. Họ cảm thấy quá đỗi có quyền. Họ thực sự nghĩ rằng họ đặc biệt hơn mọi người khác và rằng các quy tắc nên áp dụng cho họ rất khác. Họ có nhu cầu quá mức về sự ngưỡng mộ và xác thực. Họ rất nông cạn. Họ thực sự không có khả năng xây dựng mối quan hệ sâu sắc, bền vững và thân mật. Họ thường tham chiếu đến thế giới bên ngoài để đặt ra mục tiêu. Họ không có ý thức tốt về những gì quan trọng với họ. Tôi muốn làm gì? Họ chỉ muốn làm những gì họ đang làm, một lần nữa, để nhận được sự ngưỡng mộ và xác thực đó. Có một sự nông cạn, một sự nông cạn thật sự trong cảm xúc đối với sự tự mãn. Đó là những mẫu hình và đặc điểm. Chúng tôi thấy họ rất tự kỷ, rất lo âu về bản thân, những phần tốt đẹp của bản thân, những phần tệ hại của bản thân. Thật hiếm khi họ ngẩng đầu lên và chân thành nhận thấy trải nghiệm của một người khác. Đó là sự tự mãn. Nó biểu hiện như thế nào? Nó biểu hiện như sự đánh giá thấp, coi thường, thao túng, lừa dối. Họ nổi giận rất nhanh, đặc biệt khi họ cảm thấy thất vọng hoặc bị tổn thương. Và điều đó có thể biểu hiện như cơn thịnh nộ công khai hoặc sự tức giận công khai, la hét, gào thét, hoặc thậm chí là bạo lực.
    Điều đó có thể xuất hiện dưới dạng sự thụ động, sự giấu giếm và rút lui.
    Họ dễ có hành vi phản bội.
    Họ nói dối.
    Họ lừa gạt.
    Họ hứa hẹn về tương lai mà không bao giờ giữ lời.
    Nhưng họ làm vậy để giữ người bên mình để họ không rời bỏ họ.
    Vì vậy, đó là một phần của một kiểu thao túng lớn hơn.
    Họ sẽ thống trị người khác.
    Họ phải có lời nói cuối cùng.
    Họ sẽ đổ lỗi cho người khác.
    Họ hiếm khi nhận trách nhiệm về những hành vi sai trái của mình, ngay cả khi họ rõ ràng bị bắt gặp.
    Và nếu họ có thừa nhận, họ vẫn sẽ đổ lỗi cho người khác.
    Họ rất thiếu quan tâm và cẩu thả trong các mối quan hệ.
    Đó chính là chủ nghĩa tự yêu bản thân.
    Làm thế nào bạn có thể phân biệt giữa một người có một ngày tồi tệ, một kẻ đáng ghét và một người tự yêu bản thân?
    Bởi vì một trong những điều đó, tôi đã nghĩ, Joe, vào một ngày tồi tệ, tôi có thể làm như vậy.
    Vâng.
    Bạn biết đấy, tất cả mọi thứ gộp lại, không phải sao?
    Nhưng vào một ngày tồi tệ, khi tôi chưa ngủ đủ giấc, được không, bạn biết không?
    Tôi có thể đổ lỗi cho ai đó hoặc bất cứ điều gì khác.
    Sự phân biệt là gì?
    Khi một người có một ngày tồi tệ, và tất cả chúng ta đều có những ngày tồi tệ, và vào những ngày tồi tệ đó,
    chúng ta có thể trông như vậy nếu toàn bộ băng ghi hình mà ai đó có về chúng ta chỉ là của ngày hôm đó, ooh, đúng không?
    Nhưng đây là điểm mấu chốt.
    Khi những người không phải là kẻ tự yêu bản thân có một ngày tồi tệ, họ sẽ chịu trách nhiệm,
    họ sẽ làm hòa, và họ sẽ thay đổi hành vi của mình và nói, tôi sẽ không làm điều này nữa.
    Điều này là không thể chấp nhận.
    Tại sao lại không thể chấp nhận?
    Bởi vì không phải là lỗi của những người đó.
    Bạn đã không ngủ đủ giấc.
    Và cho dù điều đó có nghĩa là chúng ta tìm cách sâu hơn để trở nên tử tế nhất có thể với mọi người, trong một số trường hợp,
    đặc biệt nếu đó là những người chúng ta biết hoặc chúng ta gặp, một lần nữa, bạn có thể không biết người ngẫu nhiên nào tại
    phòng tập thể dục, nhưng nếu còn là ai đó chúng ta biết hoặc làm việc cùng, chúng ta tự bước ra khỏi bản thân mình để
    nói, cách tôi cư xử ngày hôm qua là không ổn, và tôi thật sự xin lỗi về điều đó.
    Để họ có được trải nghiệm về bạn đang chịu trách nhiệm.
    Đó là lúc tôi biết chúng ta không đang đối phó với một người tự yêu bản thân.
    Chúng ta đang đối phó với một ngày tồi tệ.
    Và một ngày tồi tệ chỉ là vậy, một ngày.
    Nó không phải là mỗi ngày.
    Với một người tự yêu bản thân, nhiều ngày, tôi sẽ không nói là tất cả.
    Nhưng nhiều ngày được đặc trưng bởi những âm mưu, những thao túng và những sự vô giá trị này.
    Người trong một mối quan hệ với một người tự yêu bản thân cảm thấy như họ luôn ở trong thế bị động, rằng họ không thể là chính mình.
    Họ không thể bày tỏ một nhu cầu.
    Họ không thể bày tỏ một mong muốn.
    Họ thậm chí không thể bày tỏ một cảm xúc vì sợ nó sẽ bị dập tắt.
    Vậy thì đó là một người không phải là người tự yêu bản thân.
    Nhưng còn một kẻ đáng ghét thì sao?
    Tôi nghĩ rằng có sự phân biệt giữa việc trở thành kẻ đáng ghét và tự yêu bản thân.
    Tôi nghĩ, tuy nhiên, rằng đây là niềm tin về kẻ đáng ghét của tôi, vì đây là điều mà tôi nghĩ rằng cấu trúc
    xác nhận về kẻ đáng ghét có lẽ vẫn cần được thực hiện.
    Tôi nghĩ rằng kẻ đáng ghét có xu hướng là những người đáng ghét một cách nhất quán.
    Vì vậy, trong khi những người tự yêu bản thân thực sự, họ có một kho tàng hành vi rộng lớn hơn để trở nên
    hoàn toàn quyến rũ.
    Đó là một người có thể hoàn toàn cuốn hút trên sân golf với Giám đốc điều hành công ty của họ.
    Như là quyến rũ, tốt bụng, ấm áp, nhớ tuổi của con cái họ, hỏi về vợ và
    nhớ rằng bà của họ đang bị ốm, và tất cả những điều đó.
    Và về nhà.
    Quên đi kỷ niệm ngày cưới của mình.
    Quát mắng đối tác của họ.
    Tại sao nhà lại trông như thế này?
    Tại sao tôi phải chịu đựng điều này?
    Bắt những đứa trẻ chết tiệt đó im đi.
    Nhưng họ đã là ông.
    Tôi nhớ rằng sinh nhật của cô con gái nhỏ của bạn là ngày 6 tháng 2 khi họ ở trên sân golf.
    Đó không phải là sự đáng ghét. Đó là tự yêu bản thân.
    Bạn có thể chữa trị cho chủ nghĩa tự yêu bản thân, theo ý kiến của bạn không?
    Không, tôi không.
    Bởi vì tôi nghĩ rằng điều đó sẽ đồng nghĩa với việc thay đổi một tính cách, điều mà tôi không nghĩ là chúng
    ta có thể làm.
    Có bằng chứng nào không?
    Bạn đã bao giờ thấy trong 20 năm làm việc với những người tự yêu bản thân và những người sống sót sau họ,
    dấu hiệu nào về một người tự yêu bản thân trở thành không phải là người tự yêu bản thân hoặc một người không tự yêu
    bản thân chưa?
    Tôi chưa thấy họ trở thành không phải là người tự yêu bản thân.
    Tôi đã thấy họ tạo ra những thay đổi vi mô, vì tôi đo và theo dõi và ghi chép trong liệu pháp.
    Vì vậy, tôi sẽ thấy, thú vị.
    Họ không còn cố gắng làm mất trật tự khi đến muộn 10 phút và yêu cầu tôi giữ họ trong suốt cả giờ.
    Họ đang tôn trọng khuôn khổ trị liệu.
    Họ đang trả hóa đơn khi họ quyết định không xuất hiện vào phút cuối.
    Tôi sẽ thấy những điều chỉnh nhỏ.
    Tôi sẽ thấy những người đến và nói, tôi đã quát mắng bạn gái của mình một lần nữa tối qua và điều đó không ổn.
    Vì vậy, tôi đã nghĩ, ôi, điều đó thật sự đáng suy nghĩ.
    Giống như, tôi sẽ phát triển từ đó.
    Nhưng đây là chuyện, được không?
    Những thay đổi vi mô này.
    Và chúng là những thay đổi vi mô, nhưng chúng là những thay đổi.
    Và chúng đang đi đúng hướng.
    Rằng đã có rất nhiều điều diễn ra đối với các thành viên gia đình và đối tác và những người khác đã bị tổn thương.
    Họ đang nói, bạn muốn tôi ở lại trong mối quan hệ này vì người đàn ông này đã nhớ nói cảm ơn một lần trong tuần này?
    Tôi nghĩ là không.
    Đối với tôi, việc nói cảm ơn là một sự tiến bộ.
    Đối với những người trong cuộc sống của họ đã bị tổn thương, một lời cảm ơn đó sẽ không đủ.
    Tôi đã nghe thấy từ này, gaslighting.
    Một lần nữa, đó là một từ mà tôi đã nghe rất nhiều, nhưng tôi không thực sự rõ về định nghĩa của gaslighting là gì.
    Nhưng từ việc đọc tác phẩm của bạn, tôi nghe rằng những người tự yêu bản thân thường gaslight người khác rất nhiều.
    Rất nhiều, đúng không?
    Gaslighting là gì?
    Vì vậy, gaslighting, ở mức đơn giản nhất, đó là một trò chơi quyền lực.
    Đó là một hình thức lạm dụng cảm xúc.
    Và đó là một chiến thuật.
    Gaslighting dựa trên một mối quan hệ mà rõ ràng được đặc trưng bởi sự tin tưởng.
    Vì vậy đó là lý do tại sao những người xa lạ không thể gaslight bạn theo cách giống như một người yêu thân thiết, một đồng nghiệp đáng tin cậy, một thành viên gia đình.
    Ngay cả một người có chuyên môn, như một luật sư hoặc bác sĩ, cũng có thể gaslight bạn, phải không?
    Bởi vì có một sự giả định về lòng tin.
    Vì vậy, bạn sẽ lắng nghe kẻ gaslight.
    Ban đầu, điều mà kẻ gaslight sẽ làm là họ sẽ nghi ngờ những cảm nhận, trải nghiệm, ký ức, thậm chí cả thực tế của người bị gaslight.
    Điều đó không bao giờ xảy ra.
    Tôi chưa bao giờ nói như vậy.
    Bạn đang bịa đặt.
    Chúng tôi chưa bao giờ đến đó.
    Vì vậy, giờ người này hơi bối rối vì thực tế của họ đang nói, đúng vậy, chúng tôi đã đến đó.
    Vâng, chúng tôi đã đến đó.
    Vì vậy, ban đầu, một người sẽ chống lại kẻ thao túng tâm lý. Họ sẽ nói, chúng ta chắc chắn đã đến đó. Bạn có muốn tôi cho xem những bức ảnh trên điện thoại không?
    Sau đó, chúng tôi bước vào giai đoạn tiếp theo của việc thao túng tâm lý. Kẻ thao túng không muốn xem những bức ảnh trên điện thoại của bạn. Họ chỉ muốn áp đảo bạn. Đây không phải là về bằng chứng. Đây là về việc họ áp đảo bạn.
    Nên họ sẽ nói, nhìn này, đây là những bức ảnh trên điện thoại của tôi. Và sau đó kẻ thao túng sẽ không nói, ồ, đúng rồi, chúng ta đã đến đó. Thay vào đó, họ sẽ nói, ôi trời, bạn thật sự là người nhỏ nhen nhất mà tôi từng gặp. Đây có phải là điều đang diễn ra không? Bạn chỉ việc tìm kiếm trong điện thoại để tìm những bức ảnh để chứng minh điều gì với tôi? Đó có phải là mối quan hệ này không? Tôi không biết liệu tôi có muốn ở trong một mối quan hệ như thế này hay không.
    Giờ đây, người tội nghiệp đang bị thao túng tâm lý nghĩ rằng, tôi vừa cho họ xem những bức ảnh để chứng minh một điểm nào đó. Và giờ tôi là người xấu. Vậy nên họ tin tưởng người này. Họ nghĩ, có thể tôi đang làm điều gì đó sai trái. Có thể tôi đang nhỏ nhen. Nhưng thao túng tâm lý không chỉ xảy ra một lần. Nó xảy ra đi xảy ra lại nhiều lần. Đây là một quá trình giáo dục indoctrination khiến cho người bị thao túng hoàn toàn bối rối, hoàn toàn mất kiểm soát, nghi ngờ chính mình. Và họ bắt đầu tin vào những lời chỉ trích. Kẻ thao túng sẽ nói những điều như, bạn điên rồi. Bạn ngu ngốc. Bạn không nhớ mọi thứ đúng. Có thể bạn bị sa sút trí tuệ. Bạn có nghĩ rằng bạn nên đi trị liệu không? Có lẽ bạn cần dùng thuốc.
    Đến thời điểm kẻ thao túng kết thúc với một người nào đó, họ hoàn toàn mất đi cảm giác, họ không còn tin tưởng vào chính mình chút nào. Và nếu họ không rời bỏ mối quan hệ, và một số người không làm vậy, họ thực sự rơi vào một dạng phục vụ cho người có tính cách narcissistic, một người thao túng tâm lý, gần như phụ thuộc vào họ để dẫn dắt họ qua thực tại. Nên lúc này gần như là sự khuất phục hoàn toàn, rằng kẻ thao túng có thể xác định thực tế. Và rồi, theo thời gian, có một chiến thuật mà những người narcissistic và những người lạm dụng khác sử dụng gọi là DARVO.
    DARVO có nghĩa là từ chối, tấn công, đảo ngược, nạn nhân và thủ phạm. Đây là một khái niệm được phát triển bởi Tiến sĩ Jennifer Fried. Từ chối, tấn công, đảo ngược, nạn nhân và thủ phạm. Vậy nên những người narcissistic sẽ thực hiện điều này một cách rất khéo léo, ý tôi là một cách rất tàn nhẫn, nếu người bị thao túng sẽ cố gắng phản kháng lại điều gì đó mà người narcissistic đã làm, như là bạn đã đến và bạn nói rằng bạn sẽ về nhà lúc chín giờ tối qua. Bạn đã không về nhà cho đến một giờ sáng. Người narcissistic sẽ từ chối nói rằng, điều đó không đúng. Tôi đã đến, vâng, tôi không về lúc chín giờ, nhưng tôi không về lúc một giờ sáng. Nhưng lại như kiểu, vấn đề của bạn là gì? Bạn đang làm gì? Bạn đọc hướng dẫn ADT cả ngày để xem tôi về nhà lúc nào? Và bạn biết không? Tôi không thể tin rằng đây là cuộc sống của tôi. Tôi làm việc chăm chỉ để giữ cho chúng ta trong ngôi nhà tuyệt vời này. Tôi làm việc chăm chỉ để bạn có thể ở nhà. Và tôi lại là người xấu? Như vậy, tôi không thể tin rằng đây là vấn đề. Như bạn đã đặt tôi vào rất nhiều điều.
    Đảo ngược, nạn nhân và thủ phạm. Anh ta đã ở ngoài cho đến một giờ sáng, và anh ta biết điều đó. Nhưng bây giờ anh ta đã ngăn chặn cuộc trò chuyện. Đây là một động thái tàn nhẫn. Vì nếu lặp đi lặp lại đủ nhiều, bạn sẽ hoàn toàn tước đoạt thực tại của một người khác. Và điều đó đối với tôi là không thể chấp nhận. Đó là sự lạm dụng tuyệt đối. Bạn có thấy điều này thường xuyên không?
    Luôn luôn. Luôn luôn. Đây là động lực mà một khi có tên gọi, khi từ được sử dụng đúng cách, hầu hết mọi người dùng từ này sai. Toàn bộ quy trình tôi đã mô tả là thao túng tâm lý. Khi từ đó được sử dụng chính xác, nó rất mạnh mẽ. Nó nắm bắt một động lực giao tiếp đặc thù thực sự ăn mòn con người từ bên trong ra bên ngoài. Tôi nghe thấy điều đó. Tôi thấy điều đó mọi lúc. Bởi các thành viên trong gia đình, bởi các đối tác, trong nơi làm việc, bạn kể tên nó. Và điều đó thực sự làm cho mọi người bị tổn thương vì họ cảm thấy như họ đã mất đi lý trí của mình. Và họ cảm thấy như họ không thể tin tưởng vào chính mình. Và tôi nghĩ đó là một điều tồi tệ để làm với ai đó.
    Bạn nên làm gì nếu bạn đang bị thao túng tâm lý? Khi bạn biết đó là gì và ai đó bắt đầu thao túng bạn, họ thực sự từ chối thực tại của bạn, đúng không? Bạn phải bước lùi lại và nói, đó không phải là điều đã xảy ra. Nhưng bạn không nói điều đó với họ. Điều quan trọng trong thao túng tâm lý là bạn không tham gia vào cuộc trò chuyện với kẻ thao túng. Bạn giờ đã biết rằng bạn đang bị thao túng. Điều đó có nghĩa là người khác trong tương tác đó có khả năng thao túng bạn. Vậy nên điều đó có nghĩa là, từ phía bạn, bạn cần phải chấm dứt điều đó. Và điều đó có nghĩa là không tham gia nữa. Điều đó có nghĩa là… Vì vậy, bạn không thể tiếp tục tham gia với họ vì họ sẽ kéo bạn xuống. Cao hơn và cao hơn. Vâng, nó gần như như thể họ đang kéo bạn xuống để bạn chết chìm hoặc kéo bạn vào cát lún. Vì vậy, khi họ bắt đầu thao túng tâm lý, tôi không bao giờ nói điều đó. Một cách để phản pháo có thể là, chúng ta đang có một trải nghiệm khác nhau thì sao. Và giữ nó ở đó. Đừng đi xuống con dốc trơn đó. Đừng đi xuống dốc. Đừng nói, đừng cho họ xem tin nhắn. Đừng rút email ra. Đừng cố chứng minh họ sai. Đừng tham gia với họ.
    Thật buồn cười khi bạn hỏi tôi điều này vì gần đây tôi đã bị thao túng tâm lý. Tôi đã khá gần đây trong một tình huống chuyên môn. Và tôi nghĩ, không phải tôi. Như, tôi không biết nhiều, nhưng tôi biết điều này. Vậy nên đừng… Nhưng họ đã làm. Tôi đã bị. Và tôi đã rất tức giận. Và trong tình huống này, thực sự, tôi hiểu tại sao tôi đã… Hãy nghĩ về nó như một cấu trúc doanh nghiệp đang thao túng tôi. Vì vậy, đôi khi những người rất tốt làm việc trong hệ thống doanh nghiệp thao túng vì họ đang cố gắng duy trì tính narcissistic của công ty, nhưng họ là những con người tử tế. Điều đó rất rõ ràng với tôi. Tôi đã thấy điều đó xảy ra. Nhưng trong trường hợp cụ thể này, tôi đã bị thao túng. Tuy nhiên, tôi đã rất tức giận.
    Biết tất cả những gì tôi biết, biết tất cả các chiến thuật, thật sự rất phi nhân tính khi thực tại của bạn bị nghi ngờ hoàn toàn. Vì vậy, tôi cảm thấy khó chịu, nhưng tôi đã đối mặt với người đó. Tôi nói, đây là hành vi thao túng tâm lý và nó không ổn. Và tôi biết bạn tốt hơn điều này. Và họ đã đúng như vậy. Đây là một trường hợp may mắn khi người thao túng không phải là người có tính cách kiêu ngạo. Vì vậy, chúng tôi đã đi đến một kết luận. Nhưng khi tôi bị thao túng bởi những người có tính cách kiêu ngạo, tôi thường chỉ ngắt kết nối. Và tôi ghi nhớ điều đó và nói, người này có khả năng như vậy. Thực sự không có gì nhiều ở đây. Điều này chỉ có thể đi sâu đến một mức độ nhất định.
    在燒烤上嗆嗆作響的優質紋理肋眼牛排,有什麼比這更好呢?
    一份經過 Instacart 購物者精心挑選並送到你家門口的優質紋理肋眼牛排。
    一份你甚至不需要離開小孩游泳池就能訂購的優質紋理肋眼牛排。
    無論你的夏天需要什麼食材,Instacart 都能滿足你的需求。
    下載 Instacart 應用程式,享受前三個訂單的 $0 送貨費。
    服務費、排除項目和條款適用。
    Instacart。超越期望的雜貨。
    你今天也在花時間處理那些受虐於自戀關係的病人,或是自戀者的受害者。
    每週。每週。我是說,這可能是我每週中,若不是最令人滿意的部分之一。
    我深信,如果你是一位心理健康工作者,你就應該實踐心理健康。
    所以能夠在那個房間裡與客戶一起工作,是一種特權。
    但當你處理的是宏觀層面的問題,像是龐大的人口去 YouTube 上撰寫書籍時,與個人生活中實際發生的事情保持距離是非常容易的。
    研究的一個棘手之處在於,我們研究的是人群。
    我們研究的是樣本,對吧?
    我們研究的是數百個人。
    在房間裡發生的事情卻是截然不同的情況。
    你開始認識到,A,這些關係對人們的傷害有多麼嚴重,影響他們對世界的認知,影響他們對自己的認知。
    B,對這些客戶的介入潛力有多麼巨大,透過一些非常簡單的教育、自戀的經驗驗證、打破自責以及教他們學會信任自己。
    那麼你認為你看過多少個受虐於自戀者的病人?
    我想,數以百計,真的。
    我甚至使用「生存者」這個詞。
    我不喜歡稱他們為受害者,因為我不認為他們是那麼被動。
    我的意思是,他們只是沒有被教導過這一切,對吧?
    我舉個例子。
    當一個人和一個有成癮問題的人在一起時,他們面對的問題是非常明顯的,對吧?
    你面對的那個人正在使用某種改變他們的物質,這改變了他們的行為,讓他們遠離真實的自己。
    與成癮者在關係中的人會說,”我在兩段關係中”。
    “我有一段與清醒的人的關係,還有一段與正在使用酒精或毒品的人,或是在否認或保護自己使用的人”對吧?
    兩個人。
    這段關係會摧毀那些人。
    我們願意這麼說。
    人們在自戀關係中的經歷在某種程度上並沒有不同。
    不過多了一點,有成癮的關係中,人們可以說,我清楚他們的行為是什麼。
    我清楚問題是什麼。
    成癮是一種疾病,我們知道是可以治療的。
    但自戀就不太一樣。
    而且,這些自戀者有著非常成熟、非常成功的行為作為表現。
    他們能走進世界,變得迷人、自信、聰明,成為注意的中心,管理企業。
    但在封閉的空間裡,他們卻會心理上剝奪與他們在一起的人,配偶、伴侶、家庭成員、親密朋友,甚至是那些在某個組織中低於他們的人,讓他們能夠逃避責任。
    所以,受害者們,外界卻認為這個人很了不起。
    至少與成癮者陷入關係的人,人們會說,好吧,我明白。
    他們在使用。
    這很困難。
    但對於那些在自戀關係中的人,許多人會說,你真幸運,能嫁給那個人?
    而那個人會想,哦,我的天,這些人是不是瘋了?
    那麼他們做什麼呢?
    他們開始自責。
    那麼,自戀究竟是什麼?
    我聽過這個詞很多次,但我無法告訴你它的定義。
    我覺得自己會把它說得不淩駕其上。
    所以我幾乎想問你,在我幾乎用我的定義污染你之前,你的工作定義是什麼?
    你對自戀的工作模型是什麼?
    妄想自己很偉大,覺得自己非常重要,並且比其他人都好。
    傲慢。
    而且他們是殘酷的。
    好吧。
    那我會給你一個大約 C+ 或 B- 的成績,如果你是我班上的學生。
    我過去對學生很寬容。
    所以我會給你 C+ 或 B-。
    因為你走在正確的方向,對吧?
    自大、傲慢、刻薄。
    但對我來說,這些更像是特質的表徵,例如自大、傲慢。
    他們的同理心很不穩定,通常同理心很低。
    他們極度自我感覺良好。
    他們真的認為自己比其他人特別,規則應該對他們適用得非常不同。
    他們對讚美和驗證有過度的需求。
    他們非常膚淺。
    他們沒有能力維持持久深厚的親密關係。
    他們非常依賴外部世界來設立目標。
    他們沒有一個良好的內在感覺,例如什麼對我重要。
    我想做什麼?
    他們只想做他們想做的事情,再次尋求讚美和驗證。
    自戀有一種膚淺,真正的情感膚淺。
    這些是模式和特質。
    我們看到他們非常自我為中心,對自己所好的部分和壞的部分都非常專注。
    他們非常少會抬起頭來,真正關注他人經歷的情況。
    這就是自戀的本質。
    它是如何顯現的?
    它表現為貶值、輕視、操控和煤氣燈效應。
    他們很快就會生氣,尤其是在沮喪或失望的時候。
    這可能表現為明顯的憤怒或者過度的憤怒,大喊大叫,甚至是暴力。
    這可以表現為被動攻擊、壓抑和撤退。
    他們容易背叛。
    他們說謊。
    他們作弊。
    他們對未來的承諾從不兌現。
    但這樣做是為了留住別人,讓他們不會離開自己。
    因此這是更大操控的一部分。
    他們會主宰他人。
    他們必須要有最後一言。
    他們會將責任推卸給他人。
    他們很少為自己的不當行為負責,即使他們明顯被抓住。
    即使他們有時這樣做,他們仍會責怪別人。
    他們在關係中非常忽視和粗心。
    這就是自戀。
    你怎樣區分一個人只是度過了糟糕的一天、壞人和自戀者?
    因為這裡的一些情況,我想,喬,在糟糕的一天,我可能也會這樣。
    是的。
    你知道,所有那些綜合在一起,不是嗎?
    但在糟糕的一天,當我沒睡好時,好吧,你知道嗎?
    我可能會責怪某人或其他什麼。
    區別是什麼?
    當一個人度過糟糕的一天,而我們都有過糟糕的一天,在那些糟糕的一天裡,
    我們可能會看,如果別人對我們的唯一印象正是那一天,哦,對吧?
    但這就是重點。
    當人們不是自戀的人而度過糟糕的一天時,他們會承擔責任,
    他們會和解,並改變自己的行為,說,我不會再這樣做了。
    這是不可以的。
    為什麼不可以?
    因為這些人沒有錯。
    你沒有得到充足的睡眠。
    而這可能意味著我們更深入地對他人表現出我們能夠的善良,在某些情況下,
    特別是如果是我們認識或看到的人,無論如何,你可能不認識健身房的隨機人,
    但是如果是我們認識的或合作的人,我們會走出自己來
    說,昨天我行為不當,我真的很抱歉。
    因此他們會體驗到你承擔責任的狀態。
    這就是我知道我們不是在對一個自戀者。
    我們是在處理一個糟糕的一天。
    而糟糕的一天,僅僅就是一天。
    這並不是每天。
    與自戀者相處,很多天,我不會說每一天。
    但很多天都是以這些操控、這些操縱和這些無效化為特徵。
    與自戀者在關係中的人感覺自己不斷處於不利地位,無法做自己。
    他們無法表達需求。
    他們無法表達想要的東西。
    他們甚至無法表達感受,因為害怕被壓制。
    所以這就是你不是自戀者的標誌。
    那壞人呢?
    我確實認為壞人和自戀者非常相似,我們經常交換使用這兩個詞。
    不過,我的壞人觀點是,因為這是一個構造,
    我認為對壞人的驗證可能仍然需要進行。
    我認為壞人往往會一貫地表現得像壞人。
    而自戀者真的,他們有更寬廣的行為範疇,能夠表現得非常迷人。
    這是一個在高爾夫球場上可以與他們公司的CEO非常迷人的人。
    像迷人、友善、溫暖,記得他們孩子的年齡,詢問妻子的狀況,還記得他們的祖母生病了,還有這些事情。
    然後回家。
    忘了那是他的紀念日。
    對伴侶大吼。
    為什麼房子看起來像這樣?
    為什麼我必須忍受這些?
    讓那些該死的孩子閉嘴。
    但他們在高爾夫球場上記得你小女孩的生日是2月6日那位。
    這不是壞行為。
    這是自戀。
    你認為自戀可以治療嗎?
    不,我不這麼認為。
    因為我認為這意味著改變一個人的性格,而這我不認為我們能做到。
    有任何證據嗎?
    在你20年的時間裡與自戀者及其倖存者相處的經驗中,有沒有看到自戀者變成非自戀者的跡象?
    我沒有看到他們變成非自戀者。
    我看到他們有微小的改變,因為我會在治療中進行測量和監測,並做筆記。
    所以我會看到,有趣的是。
    他們不再嘗試故意遲到10分鐘並要求我保留他們整個小時。
    他們正在尊重治療的框架。
    當他們決定最後一分鐘不出席時,會把費用支付了。
    我會看到微小的調整。
    我會看到有人進來,說,我昨晚又對我女朋友大吼,那樣是不酷的。
    所以我會說,哦,哇,那真是有洞察力。
    我會順勢而為。
    但這裡有個問題,好嗎?
    這些微小的改變。
    而且這些都是微小的改變,但它們確實是改變。
    而且方向是正確的。
    對於那些受到傷害的家庭成員和伴侶以及其他人來說,這樣的變化已經過了很多水到橋頭。
    他們說,你想讓我留在這段關係裡,因為這個家伙這周只記得說了一次謝謝?
    我覺得不行。
    對我來說,謝謝是進步。
    但對那些在他們生活中受到傷害的人來說,那一次的謝謝是不夠的。
    我聽到了這個詞,煤氣燈效應。
    再說一次,這是我聽過很多的詞,但我對煤氣燈效應的定義不太清楚。
    但從閱讀你的作品中,我聽說自戀者經常煤氣燈操縱他人。
    很多,對吧。
    那麼煤氣燈效應是什麼呢?
    從最簡單的角度看,煤氣燈效應是一種權力遊戲。
    這是一種情感虐待。
    這是一種策略。
    煤氣燈效應的基礎是一種貌似建立在信任上的關係。
    這就是為什麼陌生人無法以與親密伴侶、可信的同事或家庭成員相同的方式煤氣燈操控你。
    即使是擁有專業知識的人,比如律師或醫生,也可能會煤氣燈操縱你,對吧?
    因為有信任的預設。
    所以你會聽從煤氣燈操縱者的話。
    最初,煤氣燈操縱者會懷疑被煤氣燈操縱者的感知、經歷、記憶,甚至現實感。
    那從未發生過。
    我從未說過這些。
    你在編造這些故事。
    我們從來沒有去過那裡。
    所以現在這個人有點困惑,因為他們的現實在說:“是的,我們去了。”
    “是的,我們去過。”
    最初,這個人會反抗這種氣體燒灼的行為。他們會說,“我們確實去過那裡。你想要我給你看我手機上的照片嗎?”
    然後我們進入了下一步氣體燒灼的行為。氣體燒灼者不想看到你手機上的照片。他們只是想要壓倒你。這與證據無關。而是關於他們壓倒你的事情。
    所以他們會說,“看,這裡是我手機上的照片。”而氣體燒灼者不會說,“好吧,你是對的。我們確實去過那裡。”相反,他們會說,“哦,我的天啊,你真是我見過的最小氣的人。這就是你的意思嗎?你只是要在你的手機裡尋找照片來證明什麼嗎?這就是這段關係的樣子嗎?我不知道我是否想要進入這樣的關係。”
    現在,這個可憐的被氣體燒灼的人在想,“我只是給他們看了照片以證明一個觀點。現在卻是我錯了。”於是他們信任這個人。他們想,“也許我確實在做一些不好的事情。也許我確實在小氣。”
    但氣體燒灼並不是一次性的。它會一而再、再而三地發生。這是一個洗腦過程,使得被氣體燒灼的人感到完全困惑,完全失去理智,開始懷疑自己。他們開始相信那些批評。氣體燒灼者會告訴他們:“你瘋了。你傻了。你記錯了事情。也許你有癡呆症。你覺得你應該去看心理治療嗎?你可能需要吃藥。”
    當氣體燒灼者對某人做完這些時,他們已經失去了所有的自我認知,根本不再信任自己。因此,如果他們不離開這段關係,而有些人不會,那麼他們就在這種情況下,與那個自戀的人、氣體燒灼的人形成了一種近乎依賴的關係,依賴他們來引導自己度過現實。
    所以在那一刻幾乎是完全的屈從,氣體燒灼者可以決定現實。然後,隨著時間的推移,這種自戀者和其他施虐者所使用的策略叫做DARVO。DARVO代表否認、攻擊、反轉、受害者和加害者。這是一個由詹妮弗·弗里德博士所發展的概念。
    否認、攻擊、反轉、受害者和加害者。所以自戀的人以一種非常高明的—我說的是殘酷高明的方式—如果被氣體燒灼的人試圖反駁自戀者所做的任何事情,就像你來了,你說你昨晚要在九點回家。你直到凌晨一點才回到家。自戀的人會否認並說那不是真的。“我來了,是的,我沒有在九點回家,但我並沒有凌晨一點回來。但是,你到底有什麼問題?你一天都在看ADT指導,看看我什麼時候進門?”然後你知道嗎?“我真不敢相信這是我的生活。我這麼努力地維持我們住在這個美好的家裡。我這麼努力讓你可以呆在家裡。然後我竟然是壞人?”“我都無法相信這居然是個問題。你讓我受了這麼多的折磨。”
    反轉、受害者和加害者。他今晚出門到凌晨一點,然後他心裡知道。而現在他已經結束了對話。這是一種不懈的動態。因為如果這樣不停地做下去,你真的會剝奪另一個人的現實。對我來說,這是不可接受的。這是絕對的虐待。
    你經常看到這種情況嗎?時常。時常。這種動態一旦有了名稱。當這個詞用得正確時,大多數人都會錯誤使用這個詞。我所描述的整個過程就是氣體燒灼。當這個詞正確使用時,它是強大的。它捕捉了一種獨特的人際關係動態,真的是從內部腐蝕著人們。我聽過這些情況。我隨時隨地都看到這種情況。無論是家庭成員、伴侶、工作場所,無論你能想到什麼。這真的讓人感到困擾,因為他們感覺自己失去了理智。他們覺得自己無法信任自己。我認為這對一個人來說是一件可怕的事情。
    如果你被氣體燒灼,你應該怎麼做?當你知道這是什麼並且某人開始對你進行氣體燒灼時,他們實際上否認你的現實,對嗎?你必須退一步,然後說,“這不是發生的事情。”但是你不需要對他們這麼說。與氣體燒灼最重要的是你不要和氣體燒灼者繼續Engage。你現在知道自己正在被氣體燒灼。這意味著在這次互動中,另一個人有能力對你進行氣體燒灼。因此,這意味著從你的方面來看,你需要將其關閉。這意味著不再參與。
    這樣理解嗎……所以你不能繼續與他們交往,因為他們會把你拖下去。越來越深。是的,這幾乎就像他們要把你拖進淹死或拉進流沙。因此,當他們開始氣體燒灼時,我從來沒有說過那樣的話。有一種回應可以說,“那麼我們有不同的經歷。”然後就這樣離開。不要走下那條滑坡。不用說,不要給他們發短信。不要提出電子郵件。不要試圖證明他們錯了。不要參與。
    你問我這個問題是有趣的,因為我最近被氣體燒灼。在最近一個專業情況中,我會想,不是我。就像我不太了解很多事情,但我知道這件事。所以不要……但他們做到了。我確實被氣體燒灼了。我非常生氣。而在這個特定情況下,我實際上理解了我為什麼會……就像想像這是一種氣體燒灼我的企業結構。因此,當然,某些非常有素養的人在企業系統中因為試圖支撐企業的自戀而進行氣體燒灼,但他們是正直的人。這對我來說非常明顯。我曾經見過這樣的情況。但在這個特定的例子中,我確實在被氣體燒灼。但是我依然生氣。
    了解我所知道的一切,了解所有的策略,當你的現實完全被懷疑時,是非常非人化的。因此我感到不快,但我面對了那個人。我說,這是精神操控,這是不可以接受的。我知道你能做到更好。幸運的是,他們的確有所改變。這是一個幸運的案例,那個精神操控者並不是自戀型的。所以我們達成了一個結論。但當我被自戀型的人精神操控時,我會選擇退出。我將這些事情放在一旁,並且說,這個人是有能力做到這樣的。這真的沒有太多意義。這種情況能發展到的深度也有限。

    Dr. Ramani Durvasula explains the toxic and insidious nature of narcissistic abuse and gaslighting. In this powerful conversation, learn the psychological tactics narcissists use, from denying your reality to invalidating your experiences, and how to reclaim your sense of self in the face of manipulation.

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  • What Is an AI Agent?

    AI transcript
    0:00:08 Today, we’re discussing one of the busiest and most confusing terms in AI right now, agents.
    0:00:15 Are they just fancy wrappers around LLMs, full-blown autonomous workers, or something in between?
    0:00:28 A16Z Info Partners Guido Appenzeller, Matt Bornstein, and Yoko Lee break down the technical definitions, pricing models, use cases, and why the term agent means so many different things to different people.
    0:00:34 If you’re building, buying, or just curious about what agents are and aren’t, this episode is for you.
    0:00:36 Let’s get into it.
    0:01:14 So I think there’s some things which are probably kind of easy to say, which is that, A, there’s a good amount of disagreement.
    0:01:14 What is an agent?
    0:01:26 We’ve heard a lot of different definitions of it, both on the technical side as well, I’d say, on the marketing and sales side in some cases, because there’s some sales models associated with it.
    0:01:29 So let’s start with the technical side.
    0:01:32 I think there’s sort of a continuum here.
    0:01:41 You know, the simplest thing that I’ve heard being called an agent is basically just a clever prompt on top of some kind of knowledge base or some kind of context that has this sort of a chat type interface.
    0:01:45 So from a user’s perspective, this looks like a human agent would look like, right?
    0:01:50 So, for example, I ask it, hey, I have a technical problem with my product X, Y, Z.
    0:01:53 It looks at the knowledge base and comes back with a canned response.
    0:01:57 Well, there doesn’t have to be a knowledge base, right?
    0:01:59 It doesn’t even have to be a knowledge base.
    0:01:59 I see.
    0:01:59 Got it.
    0:02:00 Okay.
    0:02:01 So maybe it’s just a trained model.
    0:02:02 It’s all in the model weights, the knowledge.
    0:02:03 So it’s even simpler.
    0:02:06 So an agent could just be an LLM.
    0:02:06 Right.
    0:02:09 But the chat interface or something like that, by some definition, right?
    0:02:18 I think on the other end of the spectrum, there are some people who basically say for something to be a real agent, it has to be something fairly close to AGI, right?
    0:02:20 It needs to persist over long periods of time.
    0:02:21 It needs to be able to learn.
    0:02:22 It needs to have a knowledge base.
    0:02:25 It needs to work independently on problems.
    0:02:29 If you take the most extensive definition, is it fair to say that doesn’t work yet?
    0:02:31 I think so.
    0:02:31 It doesn’t work yet.
    0:02:35 Will it ever work?
    0:02:37 That’s a philosophical question.
    0:02:38 All right.
    0:02:38 Fair.
    0:02:39 Very fair.
    0:02:40 Very fair.
    0:02:50 So if we take that continuum in between, is there at least a way to chop that up into a couple of categories of maybe degrees of agentic behavior?
    0:02:53 And different types of agent.
    0:02:59 There’s some artsy agent that help artists to come up with new bezier curves.
    0:03:03 There’s coding agent, which we like to talk about as the agent of the day.
    0:03:03 Which we use, yeah.
    0:03:05 Yeah, which we use.
    0:03:08 There’s agent that’s just a wraparound type of LLMs.
    0:03:09 That’s right, yeah.
    0:03:12 I may be the contrarian in this group.
    0:03:12 All right.
    0:03:17 Look, I kind of think agent is just a word for AI applications, right?
    0:03:20 Anything that uses AI kind of can be an agent.
    0:03:28 Now, before we started this talk, I actually went online just to refresh myself about some of the more interesting AI agent perspectives out there.
    0:03:34 I found a really cool talk from Karpathy that he gave a couple of years ago about agents, which I can describe a little bit.
    0:03:38 But the really funny part was on the YouTube recommended videos to watch next.
    0:03:58 The cleanest definition I’ve seen of an agent is just something that does complex planning and something that interacts with outside systems.
    0:04:03 The problem with that definition is all LLMs now do both of those things, right?
    0:04:05 They have built-in planning in many cases.
    0:04:13 And they at least consume information, you know, at least from the internet, maybe from some servers that expose information through MCP or some other protocol.
    0:04:15 So the line really is very blurry.
    0:04:26 And, you know, what was so interesting about the Karpathy talk is he basically, he related to autonomous vehicles and said, AI agents are a real problem, but it’s like a 10-year problem.
    0:04:28 It’s like a decade problem that we need to work on.
    0:04:33 And I think most of what we’re seeing in the market now is like, is not the decade version of this problem.
    0:04:36 It’s like the weekend demo version of this problem.
    0:04:38 And this is why we sort of generate so much confusion.
    0:04:42 You have this kind of poorly defined nebulous thing that LLMs are kind of consuming themselves over time.
    0:04:49 And so I don’t think anything we have are actually agents is kind of an agent itself may be a poorly defined and kind of overloaded term.
    0:04:59 But if someone’s willing to do the hard work and define exactly what it’s like to kind of be a human, but in digital form and spend 10 years to make it actually work, you know, that’s sort of what I’m excited to see.
    0:05:00 Okay.
    0:05:02 So defining agents is a difficult job.
    0:05:08 Maybe it’s easier to talk about how people use the tools they call agents and what are the differing degrees of agentic behavior.
    0:05:12 I wonder if part of a conversation is redefining agents.
    0:05:16 Because we all know that agent as a term is just not a great term.
    0:05:18 It means so many things to so many people.
    0:05:21 If it’s interesting to dissect, like, what do we mean?
    0:05:23 What do different people mean when they say agents?
    0:05:24 What are different ways?
    0:05:27 We could utilize this process we call agents.
    0:05:37 So it seems to me that if we’re trying to define agents or maybe even degrees of agentic behavior, which might be a little easier, there’s something like a user interface aspect to it, right?
    0:05:47 Where something that’s a pure copilot, but basically user goes back and forth with an LM to work on a particular task that’s often not called an agent.
    0:05:48 Is that fair?
    0:05:52 There’s a little bit of the copilots versus agents UI models.
    0:05:59 Yeah, I guess, like, what are the elements we would think that goes into agentic behavior?
    0:06:02 Like, Matt mentioned planning could be one.
    0:06:04 There could be decisions made by the agent.
    0:06:06 There has to be an LM somewhere.
    0:06:08 But curious about your take.
    0:06:17 So I think another definition we heard from Anthropic recently was this idea that an agent is an LLM running in a loop with tool use, right?
    0:06:19 Which there’s two important parts of it.
    0:06:26 One is this notion that it’s not just a single prompt and not even just a single static sequence of prompts, right?
    0:06:34 But something where the LLM takes the output of a prompt, feeds it back into itself, and based on that, makes decisions on what the next prompt and likely also went to abort.
    0:06:36 You went to complete a task.
    0:06:43 I think that for the real agents or the more agentic behaviors, I think that’s a reasonably good definition.
    0:06:44 And I think the other thing…
    0:06:51 But just by that definition, isn’t every chatbot effectively an agent then in this world, right?
    0:07:04 Like, if I go just to chatgpt.com and use their latest reasoning model with web search, right, isn’t it using tools and, like, feeding its outputs into a new prompt in order to do kind of chain of thought?
    0:07:06 Chain of thought is a little bit in between.
    0:07:14 If it’s just a single prompt that comes back with a result, then it wouldn’t have this notion of planning and doing a more long-term concept and deciding itself when it is complete, right?
    0:07:19 If you have a chain of thought reasoning where I’m giving a more complex task, that’s starting to look agentic, I agree.
    0:07:26 I just think it’s really tough to define a system based on what someone says to it, right?
    0:07:29 Because these are, by design, unstructured inputs.
    0:07:31 These systems will accept literally anything.
    0:07:36 And so, sure, if you tell it, you know, what’s today’s weather, I would agree that’s not agentic, right?
    0:07:38 That’s just fetching, you know, from an API.
    0:07:43 If you ask it to define a new philosophy of weather, right, it’ll happily go do it, right?
    0:07:47 So, it’s like an agent if you ask it one thing, but not an agent if you ask it another thing.
    0:07:50 I think that’s kind of a lot of the confusion in the market around this.
    0:07:58 And, you know, if we spoke in the terms that you’re talking about, Guido, of like, hey, this is an LLM in a loop with a tool, like, that’s actually a much more productive way to talk about it, I think.
    0:08:06 I mean, that said, it seems like we’re seeing to some degree a specialization of user interfaces in sort of two directions, right?
    0:08:15 There’s, let’s say, a cursor or something like that, which really emphasizes the tight loop between the user, the tight feedback loop between the user and the LLM and the thing I’m working on, right?
    0:08:20 So, I want immediate gratification when I do something, you know, and sort of response time matters.
    0:08:33 Then there’s sort of more the back-end, you know, source code management system type plugins, where it’s more about throwing something over the wall by maybe answering a couple of questions, and then you try to maximize the amount of time the agent can work independently.
    0:08:42 So, it seems like, I think you’re right that there’s no clean system, like, definition split between the two, but there seems to be a little bit of user interface specialization.
    0:08:42 Is that a fair statement?
    0:08:51 It almost felt like for all the use cases we’ve described, there’s one element that all agents have, which is reasoning and decision.
    0:08:57 Would you call, just a call to LLM to say, translate this text to JSON?
    0:08:58 That’s probably not an agent.
    0:09:08 But then if you ask LLM to say, hey, decide where, you know, this response goes and route it for me, it feels more like an agent than before.
    0:09:13 So, it almost felt like planning, I’m actually not sure, does the agent need to plan or does it need to decide?
    0:09:14 Maybe both.
    0:09:19 I actually feel like it’s a multi-step LLM chain with a decision tree.
    0:09:20 A dynamic decision tree.
    0:09:21 A dynamic decision tree.
    0:09:22 Yeah, I think that’s fair.
    0:09:24 I think we’ve all just been nerd sniped.
    0:09:34 I just think, you know, it’s like humanities people love classifying and, you know, they draw kind of like fine distinctions between different types of things, entities, whatever.
    0:09:39 We’re computer scientists, like, you know, none of there’s anything wrong with humanities, but we’re just not that.
    0:09:45 So, I think we’re not well equipped when it’s a bit isn’t just zero or one, it’s maybe something in between, and we just talk about it a lot.
    0:09:49 We, like, try to, like, coerce it to one value or the other.
    0:09:49 Yeah.
    0:09:52 Of course, agents are more than pure technology.
    0:09:56 They’re also becoming products, which means they need to be marketed.
    0:10:01 And how someone positions their product has a major effect on how they price it.
    0:10:12 What’s more, the ultimate value of any given agent, which is still to be determined for the vast majority of them, is to what degree they can actually replace or simply augment human workers.
    0:10:17 There is an interesting point, which is, I think there is a marketing angle to agents, right?
    0:10:24 I’ve heard this narrative from a couple of startups that they’re basically saying, like, hey, you know, we can price the software that we’re building much, much higher because this is an agent.
    0:10:28 So, we can go to a company and say, you’re replacing a human worker with this agent.
    0:10:34 The human worker makes, I don’t know, $50,000 a year, and therefore, this agent you can get for only $30,000 a year.
    0:10:36 This sounds really compelling from a first glance.
    0:10:46 And actually, I mean, there’s some value to it in the very early days because it essentially, it’s very easy to understand comparative pricing for somebody who has to make a buying decision, right?
    0:10:52 Now, on the flip side, we all know that the cost of a product over time converges towards the marginal cost of production, right?
    0:10:57 And so, today, if I used to use a translator, maybe to translate a page of text, today you use ChatGPT.
    0:11:00 I do not pay ChatGPT like I paid my translator.
    0:11:06 I paid a tiny fraction of a cent, right, which is the, via the API, which is the actual cost.
    0:11:10 So, I sort of wonder how much of the agent debate is driven by marketing and pricing.
    0:11:12 I just actually think this is a really interesting topic.
    0:11:20 What fields can you think of that are actually suffering complete replacement from AI or AI agent?
    0:11:21 And this is a setup, I’ll warn you.
    0:11:24 I have another extreme point of view that I’ll say afterward.
    0:11:26 But can you think of fields where this is actually happening?
    0:11:35 Not completely, but definitely partially, because there’s a lot of, for example, voice agents that replace receptionists.
    0:11:39 I don’t know if we should name, replace people who would, you know, get back to customers.
    0:11:45 So, there’s definitely a lot of workloads that have been offloaded from the folks who traditionally did the job.
    0:11:49 But I don’t think they’re, you know, 100% replaced.
    0:11:51 They can, you know, they can do something else.
    0:11:55 But we are seeing headcount growth in some areas are slowing.
    0:11:58 So, it’s not that existing jobs are being replaced.
    0:12:02 It’s more like they’re hiring net new humans slower.
    0:12:03 I think it’s exactly right.
    0:12:07 I mean, I think in few cases, humans will get replaced by AI.
    0:12:13 In most cases, you know, two humans will get replaced by one human that’s more productive with AI.
    0:12:16 Or, yeah, or maybe they keep the two employees.
    0:12:18 Maybe they go to three employees because now they’re more productive.
    0:12:19 Yeah, right, right.
    0:12:20 It’s just a really interesting question.
    0:12:30 And the reason I think it’s really relevant to agents is I think part of the ethos and part of the confusion around agents is this idea that we actually will develop human replacements, right?
    0:12:34 And that this thing we called an agent, which, by the way, is a name for a person, right?
    0:12:37 Before we had AI, we had people called agents.
    0:12:38 And we still have all kinds of people called agents.
    0:12:41 And it just doesn’t seem like that’s happening, right?
    0:12:43 Not in the replacement sense, right?
    0:12:45 You mentioned Yoko with agents.
    0:12:48 We’ve always had, you know, customer support automation.
    0:12:51 You know, we’ve had 1-800 numbers where you like press one for sales.
    0:12:55 Plus, you know, if that’s existed for a long time, this is a much better form of that, obviously.
    0:12:57 Translation is a great example too, Guido.
    0:12:59 These systems can perform translation extremely well.
    0:13:05 But you’re probably not going to just stick something to ChatGPT and then publish it on your website, right?
    0:13:06 There is actually work that needs to take place.
    0:13:13 And I think the reason for this is there’s just fundamental creative work in most things that humans do, right?
    0:13:22 I think from our kind of perch in Silicon Valley, we can forget that sometimes, that people all over the country and doing all sorts of jobs actually have hard jobs.
    0:13:33 And not just hard in the sense of someone’s got to do it jobs, but hard in the sense of it does take thinking and human decision making, which I just don’t know that AI kind of has what we would think of as decision making or intent, right?
    0:13:36 It’s a system that still, somebody has to push the button, right?
    0:13:41 It may be running somewhere, it may do a great job of whatever, but someone still has to give it a prompt and hit go.
    0:13:44 And to me, that’s a lot of the confusion around agents.
    0:13:49 We’re all thinking at some point, a human person with intent and creativity and thinking is going to be replaced.
    0:13:51 I’m just not sure that even is theoretically possible, right?
    0:13:56 It’s almost just like a catch-22 to say an AI system is thinking for itself, right?
    0:13:57 Because somebody has to have sort of created it.
    0:14:03 You know, this is old sci-fi philosophy I’m getting into now, but like, I actually do think it’s a big reason for the confusion that, you know, we sort of experienced.
    0:14:07 It’s interesting because there’s two types of agent we’re already talking about.
    0:14:13 There’s one type where the agent is replacing humans, work with humans, do things humans can do.
    0:14:17 There’s the other type of agents that’s more low-level system processes.
    0:14:20 They work with each other, they hand off tasks to each other.
    0:14:27 To some extent, agents are like technical details in the system in that way, but we mean both when we talk about agents.
    0:14:30 In that case, is there actually a difference between an agent and a function?
    0:14:31 I think so.
    0:14:35 I think agent will be multiple functions with LLMs in the middle.
    0:14:43 If you have a low-level agent and I’m giving this low-level agent a task and I get back a task result, it looks a little bit like a classic API call.
    0:14:47 But with the LLM in the middle to make decisions on what to do for that API call.
    0:14:51 So, but I understood, but that’s sort of how this function works internally?
    0:14:51 Yes.
    0:14:52 To some degree?
    0:14:52 Yes.
    0:14:53 Right?
    0:14:53 Yeah.
    0:14:55 So, from the outside, would I care?
    0:14:56 You wouldn’t care.
    0:15:13 It’s like most of the time when we see AISDRs, when we talk about AISDR agents, what we mean by that is when the agent can go to the CRM, pull something out, and then filter the list, draft an email, and send the email.
    0:15:18 So, that feels very process level instead of human level.
    0:15:18 Yeah.
    0:15:19 So, that’s what I meant.
    0:15:25 If you don’t know how this thing works internally, a classic function and an agent become indistinguishable.
    0:15:26 Totally.
    0:15:27 I absolutely agree.
    0:15:34 But when you, as a programmer, when you find, right, the function, you will define agent, that that’s this thing.
    0:15:36 Implementation.
    0:15:37 We’ll get back to pricing shortly.
    0:15:46 But first, let’s dive a little deeper into this discussion of how interacting with an agent is different than, or similar to, traditional software-based functions.
    0:15:50 So, here’s one interesting thing to think about on that topic.
    0:15:56 I totally agree with you, Guido, and I think you sort of agreed, too, that it’s really a function if you kind of just look at it that way.
    0:16:01 Shareable, reproducible functions have never really been a thing.
    0:16:09 This has been one of these long-time goals that people in the market have tried to say, oh, I can just write a function and then anybody on Earth can use it, right?
    0:16:14 Like, you know, we have packages, right, that you can download a whole package with various functionality, but literally just one function you can share.
    0:16:20 If you kind of squint a little bit, that kind of exists now with AI, right, because you have these models that’s trained by somebody.
    0:16:26 Somebody else may download it, fine-tune it, train a LoRa, package it up into some new and interesting way.
    0:16:31 And then it’s actually immediately available for someone else to use on hosting services or hugging face or something like that.
    0:16:41 So, while it does seem to be just an implementation detail, whether you’re using an LLM or not, there is this interesting thing where the model itself takes up so much of that functionality in the function.
    0:16:44 And it’s just a different kind of animal compared to normal code.
    0:16:50 It’s actually more, it’s kind of shared by default in a way, because nobody’s going in and training their own model every time they’re writing code.
    0:16:52 You know, it’s obviously heavy, right?
    0:16:53 It’s harder to move around.
    0:16:57 There are all these different characteristics from normal functions, some of which are actually very desirable.
    0:17:00 Some are kind of, you know, bad, right?
    0:17:06 But many of them are kind of interesting, and I think we’ll actually see new infrastructure, new dev tools kind of built around this in the long run.
    0:17:07 I think it would make sense.
    0:17:16 I mean, if we go back in time, the last time we sort of invented a major new component for building systems, which was probably networking, right?
    0:17:20 How we thought about calling a function before networking afterwards changed a lot, right?
    0:17:21 Totally, totally.
    0:17:25 The complexities of APIs and the infrastructure around it is completely different today.
    0:17:29 This is such a good point, because now I think about it, I feel like humans are just functions, too.
    0:17:41 Like, if you have a thought experiment and then replace LLMs in the program to a human, like, how the kind of answers we’ll give to the program is not that different from what the LLM will give to the program.
    0:17:50 So if we actually all get hooked up to servers one day and can be called as a function from Lambda, then I will agree that agents have been created.
    0:17:51 That’s what an agent is.
    0:17:54 Isn’t Mechanical Turk exactly that?
    0:17:55 Or maybe even your email inbox?
    0:18:01 There’s an Amazon Go supermarket a while back in Soma.
    0:18:08 I think they were advertising that it’s computer vision models behind the scenes, identifying what you took from the supermarket.
    0:18:15 But then people found that they hire a lot of people behind the scenes to actually label the data in real time.
    0:18:19 So the humans, in that case, are the functions that today may be…
    0:18:20 Secret agents.
    0:18:20 Right.
    0:18:22 Replaced by LLMs with…
    0:18:23 Well, but this was exactly my point, though, right?
    0:18:26 There actually is important creative work.
    0:18:29 Even in a grocery store checkout clerk, right?
    0:18:31 You could naively think, oh, this is an easy job.
    0:18:33 Actually, it’s not an easy job at all, right?
    0:18:37 And so you can take this work and kind of shift it, right?
    0:18:41 And you can squeeze it down with automation and stuff, but it never really goes away.
    0:18:42 Oh, yeah, absolutely.
    0:18:42 Yeah.
    0:18:43 All right.
    0:18:50 So given all of this, how should companies think about pricing their agents per seat, per token, per task?
    0:18:54 Hint, it might be too early to truly tell.
    0:19:02 Usually, if you introduce a brand-new product category, right, you often initially put a pricing that prices against the status quo, right?
    0:19:05 Whatever you replace or augment in some cases.
    0:19:07 But let’s assume we have a direct replacement, right?
    0:19:11 So that’s, I think, where this idea from, oh, this replaces a human, which it doesn’t.
    0:19:15 But if it would, right, then you could charge, you know, X amount for it, right?
    0:19:23 Usually, over time, competition kicks in, right, and you’re effectively priced by how much your competitors are charging, right?
    0:19:25 And you start sort of an erosion.
    0:19:27 Then it depends on many things, like how much of a mode do you have?
    0:19:29 Do you have customer lock-in, right, and so on?
    0:19:35 Long-term, converge against the marginal cost of production, right?
    0:19:40 Which, I mean, look, if I look at most agents today, it’s probably very low, right?
    0:19:46 Any agent you can purely model in software with a couple of LLMs calls, you can run at a very low cost.
    0:19:48 And the cost is decreasing over time.
    0:19:56 And I would sort of argue that’s kind of already what’s happening, that in practice, most AI applications,
    0:20:02 and in particular, if we want to call them AI agent applications, you know, they have their sales pitch around,
    0:20:05 you should pay us X because we’re saving you.
    0:20:07 You know, it’s like a classic ROI calculation.
    0:20:07 Established value.
    0:20:08 Yeah, exactly.
    0:20:10 Value-based pricing, you know.
    0:20:15 But in practice, I think most buyers are actually pretty sophisticated about what’s going on under the hood.
    0:20:17 And to your point, they know it’s pretty simple stuff happening.
    0:20:20 And so it’s like, hey, what does it cost you to run all these GPUs?
    0:20:22 And we’ll pay you some premium over that.
    0:20:25 And I think that’s how a lot of vendors are pricing in practice these days.
    0:20:29 I mean, long-term, you’d expect pretty healthy margins, just like in SaaS, right?
    0:20:32 Which software traditionally has very good margins.
    0:20:40 It’s so funny because we always advise companies to not price based on the margin, but price based on the value you add, whatever that could be.
    0:20:43 It could be compared to other vendors on the market.
    0:20:46 It could be compared to just, you know, what it is building in-house.
    0:20:54 And traditionally for infra, a rule of thumb, not always the case, is that if a service is used by a human, it’s a per-seat pricing.
    0:20:59 And if it’s a service that’s used by other machines, it’s a usage-based pricing.
    0:21:02 And I actually don’t know where to put agent here.
    0:21:05 Well, it could be used by either, right?
    0:21:07 It could be used by either, right?
    0:21:10 Look, I think your analysis is exactly right.
    0:21:14 And the reality is most AI companies don’t know what value they’re generating.
    0:21:20 Yet this is so new and so nascent that it’s like, hey, we’re just going to charge something that we’re not going to lose money on.
    0:21:24 And, you know, in the case of OpenAI, they have how many millions of users?
    0:21:27 They probably don’t have a very strong sense of what they’re all using it for.
    0:21:31 And once they do, right, and you see this more, they’re trying to verticalize a bit more
    0:21:36 and have kind of specific products for specific use cases, code obviously being the big one.
    0:21:39 You know, then you’ll be able to see the pricing kind of catch up is kind of my hypothesis.
    0:21:43 This reminds me of the OpenAI point you brought up.
    0:21:49 I was thinking about AI companions because that’s the closest to per-seat human pricing.
    0:21:55 Like you can’t charge someone every sentence they talk to their companion, although some of the foundational models do.
    0:21:58 There are services that will charge you per response.
    0:22:01 I haven’t used them, but they do exist.
    0:22:02 I see.
    0:22:03 Wow.
    0:22:03 Okay.
    0:22:10 So usually it’s kind of weird to charge someone, like buy tokens of how much they talk to the companion,
    0:22:12 rather than like a flat monthly fee.
    0:22:14 It doesn’t feel like a true friend.
    0:22:14 Right.
    0:22:14 Exactly.
    0:22:16 It’s very transactional.
    0:22:19 This is, look, this is all theory, right?
    0:22:27 People love sitting around and talking, oh, we’re going to charge per person, per task, per, you know, world economy that we rescue.
    0:22:29 You know, it’s like, it’s all made up, right?
    0:22:31 I think Guido’s thing was exactly right.
    0:22:34 Let’s look at the actual technology underlying what we’re calling agents right now.
    0:22:35 Where are they being deployed and why?
    0:22:40 And honestly, the pricing, the marketing, the sales tactic, all of this kind of follows from what they’re actually selling.
    0:22:50 If I’m selling something that looks like an agent, but I haven’t truly figured out the value I’m providing to my users, how do I justify the jump to a higher price point when I do figure out that value?
    0:22:53 You just need to be selling a solution rather than a product, right?
    0:22:58 This is really well-worn expertise in enterprise go-to-market code.
    0:23:03 You can somewhat see the decoupling of price from the underlying technology now because it really works.
    0:23:06 There’s a very clear ROI to people who use it.
    0:23:13 And so as a VP of engineering or a CTO, you can look at this and say, okay, I’m actually saving a lot of money and my guys are getting a lot more productive.
    0:23:14 I can value, I can do a normal ROI.
    0:23:14 Are they happier?
    0:23:17 Yeah, so you’re kind of buying a solution, right?
    0:23:22 You’re buying from a vendor something that solves a problem for you, which, again, Microsoft, Oracle, Salesforce, people have been doing forever.
    0:23:28 Once we start to see more of that, it’s going to be these things that become real products and kind of decouple pricing and look kind of like real businesses, I think.
    0:23:31 I think it’s dictated by the high-level application.
    0:23:33 So I’ll give you an example.
    0:23:35 So I’m a Pokemon Go player.
    0:23:41 So for those who have played Pokemon Go, once you collect enough Pokemons, you are out of storage in your pocket.
    0:23:48 So you need to pay extra to buy a new bag, virtual bag, that you can put more Pokemon in.
    0:23:52 And as an infrastructure investor, I invest in storage businesses.
    0:24:00 And then when I look at how much I need to pay for like 30 extra Pokemon, it was thousands of times more expensive than what storage is.
    0:24:02 So it actually reminded me.
    0:24:03 I’m surprised it sounded like thousands.
    0:24:06 But if it gets 10 to the 15 or so.
    0:24:09 There’s a whole price curve on Pokemon storage, it turns out.
    0:24:12 Because this is one JSON blob.
    0:24:12 Right.
    0:24:14 It’s one JSON blob.
    0:24:14 I know.
    0:24:16 And they charge you like $5.
    0:24:20 And then the Pokemon, normal Pokemon players, they wouldn’t think about this.
    0:24:22 Like how much do storage costs, right?
    0:24:25 Like a normal Pokemon player would be like, oh, this capability.
    0:24:31 I would be happily paying thousands more than I were to have an S3 bucket somewhere.
    0:24:33 So one of it is monopoly.
    0:24:38 So it’s an application layer monopoly that you wouldn’t have been able to store the Pokemon anywhere else.
    0:24:40 And two, it’s a use cases.
    0:24:41 It’s for a different audience.
    0:24:43 They wouldn’t be asking these questions.
    0:24:46 They would be thinking about what is the net new value?
    0:24:51 What’s the net new cost I will be willing to, you know, for the bill for if I were to get this value?
    0:24:52 Is it a fun game?
    0:24:53 It’s a fun game.
    0:24:54 Take a hundred more dollars.
    0:24:55 Yeah.
    0:24:56 I think that’s exactly right.
    0:25:02 And implicit is what you’re saying is this idea that the product or the solution has to actually work for them, right?
    0:25:08 For a less technical person who’s, you know, the person who’s not going to try to provision their own storage bucket to self-host their Pokemon.
    0:25:16 And it’s quite defensible, differentiated too, because, you know, Pokemon Go is not open source.
    0:25:18 There’s no other replacement of Pokemon Go.
    0:25:20 There’s only one Pokemon Go.
    0:25:25 So there’s only one place where you would be willing to pay so much money for Pokemon storage.
    0:25:26 Plus very strong brand.
    0:25:28 Plus you have a little bit of network effect because you can play together.
    0:25:28 Yeah.
    0:25:31 And then we’ll see the AI agent version of this.
    0:25:34 I can’t wait to see the AI companion version of this.
    0:25:37 Playing storage for AI companions wardrobe.
    0:25:43 As the AI market continues to shake out and evolve, where will agent capabilities ultimately live?
    0:25:48 For example, can they live inside LLMs or must they call external tools?
    0:25:51 And who’s ultimately in the best position to influence this?
    0:25:53 Super interesting question, right?
    0:25:56 What’s the systems perspective of how an agent is built?
    0:26:06 And I personally think that architecturally, there really is no difference between your typical SaaS software today and agent in terms of how you build it, right?
    0:26:07 And let me explain why, right?
    0:26:14 So an agent, we said you have sort of an overall loop with an LLM and prompts that feeds into itself plus external tool use.
    0:26:19 The LLM itself, you probably want to run a separate infrastructure just because it’s highly specialized.
    0:26:24 You need these vast GPU farms, you can’t easily run today’s large LLMs in a single GPU.
    0:26:26 So that’s a very specialized infrastructure, that’s externally.
    0:26:29 So the LLM call is external.
    0:26:36 The state management, well, today in SaaS applications, we do all the state management externally in databases or something like that.
    0:26:38 So you probably also want to externalize that, right?
    0:26:41 And then what remains is fairly lightweight logic, right?
    0:26:50 Where I basically, I’m taking context that I retrieve somehow from databases, I assemble that into a prompt, I run the prompt, and then I occasionally invoke tools.
    0:26:53 Maybe I do that with MCP or something like that with an external server.
    0:26:56 But the core loop is actually pretty lightweight, right?
    0:26:59 And I can run a gazillion agents on a single server.
    0:27:01 Not a gazillion, but many agents on a single server.
    0:27:04 I don’t need a lot of compute performance for that.
    0:27:05 Does that sound about right?
    0:27:06 Yeah, yeah, I totally agree.
    0:27:13 The interesting architectural question for me has always been, how do you handle the kind of non-determinism that may come?
    0:27:21 Many of these successful AI applications that we all use and love really just spit model outputs back out to the user, right?
    0:27:23 Like a chatbot or image generator.
    0:27:26 It’s like, hey, I called the LLM, here’s what I got, you know, good luck.
    0:27:34 When you try to actually incorporate the output from an LLM into the control flow of your program, that is actually a very hard, very unsolved problem.
    0:27:37 That, you know, to your point, there are relatively minor architectural differences today.
    0:27:40 But this may actually drive more significant changes in the future.
    0:27:45 I actually think the winners will be the specialists, not the foundational models.
    0:27:50 It’s the people who will build on top of the foundational models or fine-tune the foundational models.
    0:27:58 So like a very artistic example of this is that I’ve been spending the last two weeks just prompting GPT-40, their image model.
    0:28:00 It’s very good at cartooning.
    0:28:01 So it’s very good at manga.
    0:28:03 It can spell.
    0:28:04 So it has a storyline.
    0:28:09 But then I realized that there’s only top two or three styles it’s good at.
    0:28:10 So it’s good at Ghibli.
    0:28:11 It’s good at manga.
    0:28:14 And then there’s variations of the style in that realm.
    0:28:20 So now where art comes in is that the market likes out-of-distribution art.
    0:28:26 Everyone doesn’t want to see the same things over and over again because that’s how they value art, something that’s different.
    0:28:28 Ideally, maybe.
    0:28:33 Did somebody recently define art as out-of-distribution samples?
    0:28:34 Yeah.
    0:28:38 Art can be in-distribution as pop art, right?
    0:28:41 It could also be out-of-distribution.
    0:28:44 That’s like when impressionism came up many years ago.
    0:28:46 Everyone was drawing impressionism.
    0:28:50 And then at the time, the painters before, they were like, what’s wrong with your eyes?
    0:28:51 Why are you drawing blurry images?
    0:28:53 So styles come and go.
    0:28:57 But because of that, I think it’s a pushing distribution question.
    0:29:01 How the foundational model will never cover 100% of everything.
    0:29:10 So it’s really up to the humans and specialists of the next wave to come up with the new data, new workflows, new aesthetics to push that distribution.
    0:29:16 Of course, at the end of the day, agents are only as useful as the tools and data to which they have access.
    0:29:21 So what happens if major web platforms decide they want to keep agents from accessing their data?
    0:29:27 It seems like one of the hardest things about agents today are data modes, right?
    0:29:30 In some cases, just because they’re technically difficult, I’m trying to access data.
    0:29:33 An agent’s trying to access data, and it’s just very hard to integrate with that system.
    0:29:36 In some cases, it’s very deliberate, right?
    0:29:41 My iPhone, the photos are not accessible via any API because it’s a walled garden.
    0:29:43 So it’s sort of data silos you’re talking about.
    0:29:43 Data silos, right?
    0:29:48 So is that something that’s holding back agents or is making them more difficult?
    0:29:59 Or to make it even stronger, consumer companies traditionally often were opposed to offering automated access to their services because they want their user engagement.
    0:30:01 They want the time to advertise to the user.
    0:30:03 Will that limit how much we can deploy agents?
    0:30:09 And would that be changed once we have the browser-native agents that can browse the web and browse on the phone?
    0:30:10 Great question, yes.
    0:30:14 I think that I think Yoko is totally right.
    0:30:24 You know, it’s like there’s strong incentives for people who own data about, you know, physical entities, you know, people, businesses, et cetera, to keep to themselves, right?
    0:30:27 Especially because they may be scared what AI is going to do to them, by the way.
    0:30:29 So they’re kind of clinging tight to what they have.
    0:30:37 And these problems are rarely solved by defining a new protocol and just saying, hey, if we make it easy for people to give away their core assets, they’ll just do it.
    0:30:39 You know, obviously, you know, that’s very unlikely to work.
    0:30:44 But someone eventually will solve this by saying, hey, if your data is publicly visible, we’re going to get it.
    0:30:47 You know, it’s like, by the way, it’s not actually your data.
    0:30:48 It’s data about me.
    0:30:49 So why should you be holding on to it?
    0:30:55 Actually, I feel like the new advancement in models may just change the data mode.
    0:30:59 Kind of to the point of today, web browsing using an agent doesn’t work super well.
    0:31:00 It’s very slow.
    0:31:01 It’s very clunky.
    0:31:04 You have to try it multiple times for it to do any task.
    0:31:12 But imagine if we have foundational model capability of giving an agent ability to go to any website, logging as a human.
    0:31:13 We’ll table that one.
    0:31:15 I don’t know how agent identity works yet.
    0:31:28 Or go, you know, go SSH into a server, like execute certain commands or like spin up a virtual machine for a mobile or access a device farm, devising a device farm to play Pokemon Go.
    0:31:36 Like maybe those are the data traditionally only available to humans under that account now may be available to agents.
    0:31:38 There’s also the opposite that could happen, right?
    0:31:49 That basically all the consumer sites are starting with more and more complex anti-agent captures trying to keep out the agents because they only want the humans that have attention to come to those sites.
    0:31:53 I mean, I recently did use one of these deep research tools, one of the major LLMs.
    0:32:00 And one of the steps, if you look through it, all the steps I went through was like, you know, trying to see how I can get around a capture mechanism for a site.
    0:32:01 That was an actual reasoning step, right?
    0:32:05 It knew what information it wanted and it was blocked from accessing it.
    0:32:09 So is that, you know, how dystopian is the future going to be here?
    0:32:10 It solved it, actually.
    0:32:13 I mean, it’s so interesting.
    0:32:15 So here’s a really early machine learning example of this.
    0:32:19 I don’t know if you guys remember when Gmail first implemented ads.
    0:32:27 It was a big controversy because they basically said, okay, we are not going to read your emails, but our algorithms are going to read your emails.
    0:32:31 And we’re going to suggest ads that you should watch, you know, click on based on that.
    0:32:33 We all sort of, I think, just forgot and got used to it.
    0:32:36 I still think we don’t love the idea, but we kind of lived with it.
    0:32:41 But some of the data providers reacted by removing data from email, right?
    0:32:46 So Amazon famously now, when you order something, they send you a confirmation email that says, hey, you just ordered something.
    0:32:51 Click here to find out what you ordered, when it’s going to arrive or any information you might want to know.
    0:32:57 And so that actually did happen in practice in that example that the major data holders kind of found ways to withhold it.
    0:32:59 It’ll be interesting to see whether that’s possible now or not.
    0:33:05 But that same data is scraped on the client side from the ad networks that install.
    0:33:06 Oh, sure.
    0:33:07 Yeah, yeah, yeah.
    0:33:08 Yeah, there’s always some other way.
    0:33:08 Yeah, some, yeah.
    0:33:11 Yeah, not maybe exactly the same, but pretty good proxy.
    0:33:20 It may be that it’s much harder to tell the difference between an LLM and a human than a classic, you know, API call mechanism and a human.
    0:33:22 That may change the dynamics.
    0:33:29 Finally, Guido, Matt, and Yoko answer an obvious question on the longest timeline into which we might have clear visibility.
    0:33:35 What needs to happen to make agents a truly game-changing innovation within the next, say, two years?
    0:33:44 I think the positive vision is that in two years we figured out how an agent working on my behalf can use most of the tools that I have access to.
    0:33:48 I think it’s also clear what are all the pieces that are missing for that, right?
    0:33:53 We have not figured out security, authentication, access control for agents working on my behalf yet, right?
    0:34:02 We have not figured out how data retention works, you know, we have not figured out the relationship with consumer websites that potentially want to block that agent.
    0:34:06 But if you had that, it could make many tasks much, much easier, right?
    0:34:18 Today, if I have data sitting, say, my Google Drive or so, right, how easy I can reason about that data versus other data that’s in more fragmented sources, it makes an incredible difference, right?
    0:34:27 So I think that’s the bold case, right, where you have agents that can take all the data that you can access, they can access it on your behalf and perform tasks on your behalf, right, and save you a ton of time.
    0:34:31 It could make you, depending on what you do, like, you know, multiple times as productive as you are today.
    0:34:35 My answer to that is actually different modalities on the foundational model.
    0:34:41 Today is still very much text-based, and that worked really well for coding and text-based tests.
    0:34:45 But then for more visual-first tests, there’s just no one-to-one mapping.
    0:34:52 Even for web browsing, it’s like a very clunky experience of take a screenshot every couple seconds and send it back to the foundational model.
    0:35:06 So I will actually bet on multimodality when it comes to if we train the model with different traces of clicking on buttons on the website, navigating the web, using different devices, drawing, producing vector art.
    0:35:10 I think there will be new things that the model could unlock on the agent level.
    0:35:12 You can probably guess my answer.
    0:35:16 If we don’t use the word agent two years from now or five years from now, I think that’s a huge win.
    0:35:23 There’s actually a fun paper put out by some folks at Columbia, I think, called AI as Normal Technology.
    0:35:27 And they sort of make the argument that there’s a false dichotomy out there.
    0:35:35 It’s like AI is either going to bring about utopia or dystopia, meaning everything’s going to be amazing because we have AI or everything’s going to be terrible.
    0:35:36 This is kind of the national discourse.
    0:35:44 But if you just think of it as normal, right, like water or electricity or the internet or things like that, I think that’s the world we’re kind of headed towards.
    0:35:48 An agent is this kind of way to help us get there.
    0:35:49 And so that’s my goal.
    0:35:51 I mean, this stuff is just incredibly powerful.
    0:35:52 We understand how to use it.
    0:35:53 We understand how to use cases.
    0:35:55 And we’re kind of, you know, we’re kind of putting it to use for us.
    0:36:00 Thanks for listening to the A16Z podcast.
    0:36:06 If you enjoyed the episode, let us know by leaving a review at ratethispodcast.com slash A16Z.
    0:36:08 We’ve got more great conversations coming your way.
    0:36:09 See you next time.
    0:36:15 you

    What exactly is an AI agent — and does anyone actually agree?

    In this episode, taken from of AI + a16z, General Partner Guido Appenzeller and partners Matt Bornstein and Yoko Li break down one of the most hyped- and most hotly debated 0 concepts in AI right now: agents.

    Are agents just clever wrappers around LLMs? Tools that can reason and act? Or simply a fresh label for familiar tech?

    Whether you’re building, investing, or just trying to make sense of the buzz, this episode is for you.

    Resources:
    Find Guido on X: https://x.com/appenz

    Find Yoko on X: https://x.com/stuffyokodraws

    Find Matt on X: https://x.com/BornsteinMatt

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    Please note that the content here is for informational purposes only; should NOT be taken as legal, business, tax, or investment advice or be used to evaluate any investment or security; and is not directed at any investors or potential investors in any a16z fund. a16z and its affiliates may maintain investments in the companies discussed. For more details please see a16z.com/disclosures.

  • 673: Reddit Marketing: How to Drive Traffic from Reddit

    AI transcript
    0:00:07 If your traffic has been eroded by AI snippets and Reddit in the search results, this episode
    0:00:10 is going to show you how to fight back and tap into the power of Reddit.
    0:00:15 Now it feels a little bit like if you can’t beat them, join them kind of strategy, but
    0:00:19 there’s no ignoring that Reddit, the self-proclaimed front page of the internet, has found itself
    0:00:22 on the front page of just about every Google search.
    0:00:26 Stick around in this one, we’re breaking down how to get some of that traffic flowing back
    0:00:31 to you, the Reddit research and content best practices to be aware of, and some common
    0:00:33 mistakes to avoid.
    0:00:37 Now to help out, I’ve enlisted a professional content marketer who’s been helping businesses
    0:00:44 and brands take advantage of this brave new Reddit-dominated search world from redvisible.com,
    0:00:46 red with two Ds, Amy Aitman.
    0:00:47 Welcome to the Side Hustle Show.
    0:00:49 Hi, I’m so excited.
    0:00:52 I love this show and I’m really excited to get into this.
    0:00:53 So much fun.
    0:00:57 And me as well, I’ve got some big Reddit news to share coming up, but maybe you can
    0:01:03 kick us off with an example of what is possible from a publishing standpoint of, well, maybe
    0:01:08 my own site is having a hard time ranking anymore, but I could publish the same or similar content
    0:01:11 on Reddit and have it jump to the first page almost immediately.
    0:01:14 So case study, really fun.
    0:01:19 I was looking at one of our clients today and in SaaS, I guess a SaaS tool.
    0:01:20 Okay.
    0:01:21 Software product.
    0:01:27 And we have a website that we publish, reviews, comparisons, been around for a long time.
    0:01:35 We still do publish on our third party publishers, but we will publish a full scale article, blog,
    0:01:42 and then we’ll share something in Reddit and either a subreddit that we own and that we built out and we’ll share.
    0:01:47 Often Reddit content is quite different than a full blog.
    0:01:53 It’ll often be sort of a share and, you know, it has to fit the Reddit world and the Reddit narrative and the Reddit site.
    0:01:58 But if you go the next day, you’ll see the ranking for our content.
    0:02:06 And what’s really fun now is we’re seeing that because all roads lead to Reddit, it’s informing AI overviews.
    0:02:09 We’re seeing results in chat GPT search.
    0:02:11 We’re seeing results in Bing.
    0:02:13 Reddit has their own AI search tool.
    0:02:15 So you can show up there.
    0:02:20 You can show up in people also asking, show up in what people are saying.
    0:02:25 Everything can show up all over the place because all roads do sort of lead to Reddit.
    0:02:25 Yeah.
    0:02:37 From kind of late 2023 helpful content update to late 2024, like 12 months later, where so many publishers got hit by a series of algorithm updates, starting with helpful content.
    0:02:43 Reddit was like 10x, like 10 times the traffic that it used to get.
    0:02:46 It’s like, oh, there’s this giant sucking sound.
    0:02:49 And how do we, you know, get in front of that audience?
    0:02:51 You mentioned there’s going to be some nuance to it.
    0:02:53 So I want to get into the best practices here.
    0:02:57 It’s not just copying and pasting the content that I used to publish on my website.
    0:03:03 They’re like, maybe I still want to publish there because there’s hopefully down the road, like an opportunity to double, maybe triple dip.
    0:03:04 Maybe I create the video.
    0:03:10 Like I could take up potentially a lot of real estate on that first page of Google if I do it right.
    0:03:19 But you mentioned, okay, I’ve got my own subreddit that I own and moderate and manage, but then like tapping into potentially others that could be relevant.
    0:03:29 Maybe it would be helpful to have an example of like a product review type of article or like a roundup, like best, you know, 10 best toaster ovens or like that kind of traditional affiliate content.
    0:03:30 Maybe we’ll start there.
    0:03:30 Yeah, that’s great.
    0:03:35 Well, 10 best toaster ovens, let’s say that we’re working on getting that ranking.
    0:03:37 Obviously, we still have our publication.
    0:03:42 And I feel like that’s, to me, it’s like one spoke in this internet realm right now.
    0:03:46 And it’s an important spoke, but it used to be like the hub.
    0:03:50 And that’s where like all roads led to our publications.
    0:03:55 And now I look at it as one part in this entire landscape.
    0:03:59 Publication meaning like a website, like your domain that you have full control over.
    0:04:00 Yeah, okay.
    0:04:01 That you own, yeah.
    0:04:05 And that you do want to lead people to eventually, which is nice.
    0:04:09 But it’s only one spoke and that’s the reality of it.
    0:04:15 And posting a best toaster roundup in Reddit is not just copying and pasting your blog.
    0:04:22 For example, like Redditors really, I think they’re really suspicious generally of brands and of affiliates.
    0:04:25 And they know that kind of game things.
    0:04:26 Like people squeeze in there.
    0:04:27 We see it all the time.
    0:04:33 There’s a lot of Reddit rules and best practices that you have to engage in.
    0:04:36 But I would say generally be helpful.
    0:04:41 And a lot of times when we’re sharing those types of best of in ours, it’s, you know,
    0:04:44 we could take an angle of like, we’re looking into this, like we genuinely care.
    0:04:47 We come at it through the side of like, we’re the users.
    0:04:52 We are the curious people that are actually in their kitchen looking at toasters and,
    0:04:55 and comparing them and, you know, like UGC.
    0:04:59 But that’s how I would probably approach that in a Reddit list.
    0:05:04 Like I’m looking at these and can you add some recommendations or have you tried these?
    0:05:08 So that’s the kind of content I think that does really well in Reddit.
    0:05:13 And if you want to publish in your own subreddit, that’s great.
    0:05:15 I think it’s a great distribution play.
    0:05:20 And I think all publishers, at the very least, if you are intimidated with Reddit,
    0:05:23 create your own subreddit and start distributing your content.
    0:05:25 That’s where we really started.
    0:05:30 We would just distribute our content in Reddit and start to see some natural engagement.
    0:05:36 I mean, you can use the sidebar, you can link back to your site, you can add, you can add links back to your site.
    0:05:41 You can give them little teasers, like the full review is on my site, which is really great.
    0:05:42 That’s a great technique to Reddit.
    0:05:44 Like, you know, I’ve been looking into this.
    0:05:46 These are three things I learned.
    0:05:53 Not just straight copy and paste syndication, but a little teaser summary and, hey, the full review is back on my domain.
    0:05:57 Yeah, there are subreddits that let you distribute your content.
    0:06:06 And I see a lot of news driven content or if you have that type of a site where it’s like, you know, breaking news or breaking like entertainment.
    0:06:11 So there are some subreddits that will do just that and you can engage in that as well.
    0:06:12 That can be a strategy.
    0:06:18 But for a lot of my, like for our type of publishing or for review sites or affiliate sites,
    0:06:26 I think kind of crafting something that is valuable and answers a question or shares and then you can bring them back to your site.
    0:06:30 So that’s a really good baseline strategy for publishers out there.
    0:06:39 OK, and this is this is very timely because we like just as of literally yesterday got control of the Side Hustle Nation subreddit.
    0:06:40 Somebody had been squatting.
    0:06:43 I was wondering that I was looking at us.
    0:06:46 It’s like, wondered if you had control of that.
    0:06:53 Squatting is probably an aggressive term, but somebody was using that trademark term as their own subreddit in promoting who knows what.
    0:06:54 But it had kind of been abandoned.
    0:06:55 Yeah.
    0:07:00 And so we submitted a trademark request, submitted like a moderator takeover request.
    0:07:00 I don’t know what it was.
    0:07:04 And was able to get on board with that.
    0:07:12 And so now it’s like the question mark of why, you know, obviously we can invite the audience to come be members and contribute to the conversation and the content there.
    0:07:24 But from a publishing standpoint, like do we start with like the archive, like the dozens and dozens of posts in the archive that like start to drip those out as threads in this community or in this subreddit?
    0:07:30 Oh, I mean, that is definitely one strategy that you can do and, you know, figure out what kind of works.
    0:07:36 The great thing about Reddit, I would say, one, it’s great that you got your subreddit back.
    0:07:47 So for all the publishers out there, if you do anything right now, it’s like, you know, get your Reddit subreddit name because anybody can create any subreddit for any brand.
    0:07:48 There’s no, there’s no rules.
    0:07:52 It’s the wild, wild west of the world, Reddit.
    0:07:55 So it’s nice when you can recover that and you can take it over.
    0:07:59 So, yes, I would generally say have that distribution strategy.
    0:08:04 But think if you if your goal is a traffic arbitrage, there’s things that you might want to do.
    0:08:13 If your goal is to build a community there, there’s definitely a lot of community building things that you can do, you know, questions and engagement.
    0:08:14 Like you said, bring your audience back there.
    0:08:17 And what could that really look like?
    0:08:26 I would spend a few minutes actually strategizing what you want your group to look like and what it’s going to lead back to and what you want people to do.
    0:08:36 OK, but there’s a lot of opportunity there for for you to repurpose your tips, build some excitement, get some more views, ideas.
    0:08:46 Yeah. I mean, one thing that’s that’s top of mind is looking at some of the highest performing articles, historically highest performing articles that have lost traffic and then saying, well, why?
    0:08:50 You know, they’re still they’re still on the first page, but they’re just lower down.
    0:09:03 Right. And so it’s like, how could we create, you know, the Reddit thread or the red, you know, some sort of post around that in an attempt to sure, hopefully this still exists on the site and maybe we update it, make it more relevant and timely.
    0:09:08 Sure. But also, like, could we leapfrog that with some sort of Reddit in the search results?
    0:09:17 Like, do you see people going after that or trying to create, you know, some other little compelling little tentacle out into the Internet world to like draw people back in?
    0:09:22 Oh, yeah. I mean, it’s great. I love the feedback loop that can come from that, too.
    0:09:36 So if you have an old listicle article that has done well and you can share some of that and ask people to, you know, weigh in on are these great choices or do you agree with this advice or any other advice, you can update the article and you can actually share and write it.
    0:09:39 We’ve updated the article. We’ve updated the guide.
    0:09:43 There’s so many things you can do with your subreddit as a community as well.
    0:09:51 And for brands, I think, and for publishers, having that branded publisher subreddit is really great.
    0:09:59 But you can expand your footprint as well and have like affinity subreddits, which are more like topical.
    0:10:06 So you can, you know, just like just like a topical content map, you can have a subreddit for almost anything.
    0:10:12 And I feel like it’s almost like the old days of SEO and there’s like exact match.
    0:10:20 The more topical and the more niche the subreddit is, I feel like the easier it is to rank for certain things as well.
    0:10:29 So sometimes having those brand new subreddits that are really, really topical, like wedding flower arrangements, let’s say.
    0:10:32 And that’s all you talk about in that subreddit.
    0:10:38 And it becomes a place where people can ask questions, but also where you can share really topical things.
    0:10:41 And I feel like that also helps you rank.
    0:10:43 It all will depend on the landscape.
    0:10:49 Just looking at if you, you know, do a deep dive and look at what’s in the SERPs for anything.
    0:10:54 There’s certain subreddits that are just dominant, like moving is a dominant subreddit.
    0:10:59 A lot of business groups, you know, like project management, business, there’s a lot of that.
    0:11:02 So like the broad terms have kind of been taken over.
    0:11:03 Okay.
    0:11:13 So going a little bit nichier and having those little mini affinity groups, you don’t need to have a ton of content.
    0:11:19 You don’t need to have a hundred pieces, a hundred posts in your subreddit to start ranking and start seeing results.
    0:11:25 The thing that people don’t really talk about Reddit a lot is that Reddit will serve your content right away.
    0:11:36 The very first post, you create a new subreddit, you create a post, a welcome post or a new post, and it gets served to other editors right away.
    0:11:44 Yeah, it’s getting indexed and everything, spending a lot of computing power, indexing all this content, user-generated content here.
    0:11:51 We’ve built a lot of websites from scratch, and we know that it takes months to see those early results.
    0:11:55 And you’re in Ahrefs and you’re like, okay, are we getting every indexed?
    0:11:55 Are we getting some rankings?
    0:11:56 Are we doing that?
    0:12:03 It takes months to see if your original strategy is working, and Reddit, it takes days.
    0:12:05 Yeah, yeah, you get the quick feedback loop.
    0:12:08 Let’s go back to this, you know, best toasters example.
    0:12:12 So maybe I put the list on my site and it’s, you know, bestkitchengadgets.com or something.
    0:12:18 And I also have the best kitchen gadgets subreddit, sure, and I can post, you know, the teaser of it there.
    0:12:23 And then I’m going to r slash kitchens, r slash cooking.
    0:12:27 Am I, like, treading carefully not to, you know, get in trouble for self-promotion?
    0:12:35 Or does it make sense to make, like, the best toaster, like, to create a completely separate subreddit, like, only for that day?
    0:12:38 Or to piggyback on the brands themselves?
    0:12:41 Like, oh, you know, KitchenAid was, you know, one of the…
    0:12:48 So, I mean, that probably already exists, but, like, you know, if it’s an up-and-coming brand, like, if it doesn’t exist, like, you could be the first, you could be the creator of this thing.
    0:12:51 And this is the exciting thing about Reddit right now.
    0:13:01 And when we even start to work with partners and work with clients or even do a Reddit strategy for one of our sites, it’s, like, that’s part of the strategy is figuring out…
    0:13:06 It’s, like, kind of, like, choosing your own adventure in Reddit and where you want to go.
    0:13:13 And it is really just, like, evaluating the landscape and saying, okay, the brands, that’s, like, that’s already out there.
    0:13:14 There’s already…
    0:13:17 There might even be, like, a best toaster subreddit.
    0:13:19 So maybe we take a different approach.
    0:13:20 And, like, where can we kind of see?
    0:13:28 And also kind of evaluate the titles and the kind of thing that is ranking but also is getting engagement from Redditors.
    0:13:36 Because I think that’s another factor in getting your Reddit post up is comments and engagement as well.
    0:13:39 And we really like to have great content.
    0:13:41 I’m a content purist, a content nerd.
    0:13:43 I don’t want to have a bunch of…
    0:13:44 Oh, no bots.
    0:13:47 But I don’t have a bunch of people just upvoting things to upvote.
    0:13:51 I want great content that gets natural engagement.
    0:13:57 And knowing that Reddit serves your content, if it’s good, people will like it and comment and engage in it, too.
    0:14:01 So that’s another factor as well to keep in mind when you’re creating these strategies.
    0:14:08 But there is a lot of initial put things out there, put a few Reddit posts together, see what’s working.
    0:14:11 And then you can adjust the strategy.
    0:14:13 Yeah, isn’t it?
    0:14:14 In a way, it’s just nuts.
    0:14:20 Like, I miss the EAT, whatever, you know, expertise and authority and trust.
    0:14:25 It’s like, no, any old Joe Schmo can now create this thing and it ranks instantly.
    0:14:28 It’s like, well, what happened to building domain authority?
    0:14:34 I’ve been part of editorial and I’ve been a big EAT champion for many years.
    0:14:38 And the goalpost for content quality, it kept moving and moving and moving.
    0:14:44 And that was something like my editorial got tougher and tougher and we kept hiring more and more experts.
    0:14:45 And we still do that.
    0:14:49 I still hire the real deal experts, the real deal nerds.
    0:14:49 Yeah.
    0:14:54 But the Reddit thing coming up, it was like, that was my first kind of like gut.
    0:14:57 It was like, oh, these people are may or may not be experts.
    0:15:03 And I kind of had to like take a step back and embrace it.
    0:15:11 Because if you think about with AI overviews and AI content creation and all the things that are happening, content is a bit of a commodity.
    0:15:15 But at least with Reddit, as for the most part, it’s real.
    0:15:16 It is real people.
    0:15:20 I’m not saying they’re all experts, but they are real people.
    0:15:28 And the more that I spend time in Reddit, the more I kind of get it and kind of respect the ecosystem that is there.
    0:15:31 And I can’t believe the things that people are willing to share.
    0:15:32 Yeah.
    0:15:35 It’s a lot of anonymous usernames.
    0:15:37 It’s like, well, who’s to say?
    0:15:41 I mean, I guess you’re speaking from personal experience in a lot of cases as a commenter.
    0:15:43 But, you know, who’s behind it?
    0:15:43 I don’t know.
    0:15:45 I can see the pros and cons to that.
    0:15:49 But I think the anonymity really does help people express themselves.
    0:15:51 Let’s just like say that.
    0:15:54 Express, share things that they might not share.
    0:15:57 Even like horror stories with work or insights.
    0:16:04 Things that, you know, like even when you’re doing a podcast, there’s always going to be this thing where you’re holding back.
    0:16:06 But on Reddit, someone might not hold back.
    0:16:08 They might tell everything.
    0:16:09 And they often do.
    0:16:18 So I think that anonymity, it’s almost a tradeoff, but it could almost bring out more expertise and more insights than without it, to be fair.
    0:16:19 Okay.
    0:16:29 More with Amy in just a moment, including encouraging that engagement, building your community, and how you might do keyword research to figure out what kind of content to post in the first place.
    0:16:30 Coming up right after this.
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    0:18:52 There’s still a lot to unpack here.
    0:18:57 You mentioned that comments and engagement seem to be a positive signal, right?
    0:19:05 Like if this is getting a lot of upvotes and comments, like that may be more likely to get more eyeballs to both on the Reddit platform and potentially through Google later.
    0:19:10 Do anything specific to encourage that feedback, to encourage commenting?
    0:19:16 I would say create good content and learn what works when you get it served.
    0:19:18 Like I said, you create a post in Reddit.
    0:19:21 It gets served to other people in Reddit.
    0:19:23 You’ll see what’s kind of ranking.
    0:19:26 And once people are there, are they actually clicking through?
    0:19:27 Are they actually engaging?
    0:19:28 Are they actually upvoting?
    0:19:34 Those signals are really great and you can work on the editorial from there.
    0:19:35 You can kind of make adjustments.
    0:19:41 And do you have an example or two of a post or a thread that did get that level of engagement you were looking for?
    0:19:55 One of the things that we did in the beginning was we started just a subreddit for one of our websites and it naturally got a lot of engagement and people joining in and saying, OK, can you look into this tool?
    0:19:59 Can you look into this review or I don’t agree with you on this?
    0:20:04 So like sometimes even having like really strong opinions will get engagement, which is great.
    0:20:10 And I was looking at a post today and someone said, I don’t agree with your list for CFOs.
    0:20:14 I think these are not really great recommendations and it’s a talking point.
    0:20:15 It’s great.
    0:20:18 And they’re making my post have more engagement.
    0:20:21 I can always edit the post if I agree with them.
    0:20:23 I can always disagree with them.
    0:20:27 And I think that back and forth is actually a really good starting point for Reddit.
    0:20:33 So, I mean, just like sometimes you can, if you have a strong opinion, people are going to agree or disagree with you.
    0:20:38 It’s not about giving everything away like in a full blog.
    0:20:43 It’s about sharing a strong opinion, showing your expertise, having a side.
    0:20:45 I think that works really well to get engagement.
    0:20:52 I mean, is this any different than blog comments, you know, back in the day or is this just, you know, nobody’s nobody’s reading the blog anymore.
    0:20:53 So you got to go where the people are.
    0:20:54 Yeah.
    0:20:55 And that’s a really good point.
    0:21:00 I feel like everything I’ve done for the past decade or more has led me to this.
    0:21:09 It’s the way we’ve done editorial, like even just like how to get engagement, how to like improve a title, what to look for and what works.
    0:21:11 It’s just we’re on a different platform, right?
    0:21:15 It’s just a different place to put content and, you know, slightly different way.
    0:21:24 Is there anything proactive that you’re doing to build your own subreddit community on the platform?
    0:21:28 It’s like, I’m like such a newbie user.
    0:21:29 It’s like, does it just happen organically?
    0:21:32 People search side hustles and they find it?
    0:21:32 Like, how does it work?
    0:21:37 It can happen organically, but also like we do old fashioned community building.
    0:21:46 So we do reach out if somebody comments on one of our posts, I will reach out through the mod mail and say, thank you so much for your comment.
    0:21:47 Can you join our community?
    0:21:52 Can invite other mods and other people to contribute to your community?
    0:21:54 That’s that’s another thing that you can do.
    0:21:57 You can do cross posting on Reddit.
    0:22:02 I think Reddit is more friendly to cross post and sharing those kind of things.
    0:22:07 Self promotion is you have to kind of play it a little bit safe.
    0:22:12 But I think if you bring something valuable and it makes sense and it’s not all that you do.
    0:22:19 Remember, every single Reddit profile that we that you have, you can see in the entire history of what someone’s done.
    0:22:23 So every single thing you’ve done is a cross post promotion.
    0:22:31 You’ve mentioned the same brand or same publication everywhere you go or that’s all you talk about is the AI tool that you love.
    0:22:37 It’s very obvious to other writers that you’re not there to contribute to this Reddit community.
    0:22:38 OK, yeah, no shortcuts there.
    0:22:41 You got to be a part, be a good steward of the community.
    0:22:42 Can you explain cross posting really quick?
    0:22:47 This is like taking something from your subreddit into another subreddit.
    0:22:52 And sharing and it’s like there is a way that you can actually cross post and share.
    0:22:53 Yes.
    0:22:57 And that’s also you can also cross post a question into more than one.
    0:23:03 If you ask a question in another subreddit, you can cross post the question if you feel like you need more answers.
    0:23:05 So there is that, too.
    0:23:09 But yes, you can cross post your content into other subreddits.
    0:23:14 And again, every subreddit has their own rules, their own ecosystem, their own guidelines.
    0:23:22 So I just caution before you do any promotion, make sure you read the full subreddit rules.
    0:23:25 And when you control your subreddit, you get to control that, too.
    0:23:27 You can you can literally say no cross posting.
    0:23:28 You can say anything.
    0:23:30 You can say no cross posting, no brand promotions.
    0:23:35 You have to start every post with a Yahoo to get approved.
    0:23:36 Like it’s wild, wild.
    0:23:41 Let’s say I’m coming to you as a new client or new prospective client.
    0:23:52 Like talk to me about the like keyword research strategy, if that’s even the right term here, like to figure out where to go, what to post, what kind of keywords to target.
    0:24:03 It’s a similar type of conversations working with, you know, creating a content plan or working with just like an SEO type of content strategy, depending on the client goals, like figuring out what they want to do first.
    0:24:07 Do they want, is it going to be sort of a traffic arbitrage?
    0:24:09 Is it going to be an awareness play?
    0:24:12 Is it going to be a brand reputation management play?
    0:24:18 Is it going to be there’s a lot of different things that you can do with Reddit?
    0:24:23 But we start like literally looking at the search landscape, like where is Reddit coming up?
    0:24:26 Where are their brand terms coming up?
    0:24:29 What their brand terms are important to them?
    0:24:34 Obviously, like review comparisons, all those commercial intent terms are really important.
    0:24:44 We also look at AI overviews because Reddit’s being informed, like using Reddit’s in AI overviews now, which has only been for a few months, to be fair.
    0:24:57 So that’s really interesting to see like what kind of what are they pulling and then determine the content strategy and keyword strategy and what type of content where we put it from there.
    0:25:02 Any tools or tech that you like on this?
    0:25:14 I’m just trying to think of, well, in Ahrefs, I could pull up like a competitor report or like a content gap type of report and say, oh, you know, these 10 similar sites are ranking for these keywords.
    0:25:19 If you haven’t covered that, you might consider it because clearly there’s interest in that.
    0:25:22 Well, in Ahrefs, you can look up everything in Reddit.
    0:25:32 I feel like it’s a little bit behind still, like because there’s so much Reddit results that Ahrefs can be a little behind and displaying all the terms and the keywords that are actually ranking in Reddit.
    0:25:33 But that’s a good place to start.
    0:25:43 Like just look up Reddit, you know, look up your brand, look up your keywords, see it and also see like look up the keywords with your brand and then append Reddit.
    0:25:46 So like, you know, Nike review Reddit.
    0:25:47 So look to see that.
    0:26:01 So kind of like look at that landscape, like digging into those Reddit results and and seeing if it’s major subreddits that are coming up, if it’s if it’s a geo play, because a lot of times it could be something where it’s a lot of geographical locations.
    0:26:09 Like, you know, ask in Toronto or in Canada or in North Carolina or in L.A. and those kind of things, too.
    0:26:15 And seeing some of the terms that come up, a lot of times for brands, we see things like is Brand X legit?
    0:26:19 That’s a very something that comes up in Reddit a lot, as you can imagine.
    0:26:19 Yes.
    0:26:25 If you have a review of that brand, would you title that the three, you know, is Brand X legit here?
    0:26:26 I tested this out.
    0:26:28 I found these results.
    0:26:28 Yes or no?
    0:26:30 Like, here’s here’s the link to my full review.
    0:26:31 Yeah.
    0:26:38 I mean, for our blog, we might our third party, we might do a full review and that might be a subheading for a Reddit post.
    0:26:40 That might be the title of a Reddit post is blah, blah, blah legit.
    0:26:44 If we’re seeing that, if we’re seeing that people are asking that or is it worth it?
    0:26:45 Is it legit?
    0:26:46 Those kind of things.
    0:26:56 And you can see the type of questions that people are asking in Reddit results already and deciding what to do with the information is like the next step in the strategy for sure.
    0:26:57 But yeah, legit’s a good one.
    0:26:58 Worth it’s a good one.
    0:27:01 Would you create a new thread in that case?
    0:27:03 Like kind of with that same title?
    0:27:04 Or would you just comment on it?
    0:27:06 Like, yes, it’s legit.
    0:27:06 No, it’s not.
    0:27:08 Like whatever your results finding was.
    0:27:17 So a lot of times I evaluate sentiment of for the reviews that are coming up currently when we first start working with a client.
    0:27:30 And if it’s negative sentiment, if something’s definitely negative sentiment, one thing you don’t want to kind of do is like add to the fire because comments and upvotes make that post better.
    0:27:32 Give it more, give it more juice.
    0:27:43 So we kind of have an approach of like love bombing around the negative sentiments, at least having more of an editorial approach or creating things around that.
    0:27:48 I wouldn’t go and engage with a fully negative review and hoping to like turn the brain.
    0:27:50 And that’s what brands have done.
    0:27:51 They’re like, oh, I have a negative.
    0:28:01 Someone said something and it’s and it could be for something 10 years ago that happened and somebody was upset and it’s actually we could be a post from 10 years ago and write it like this is what we’re dealing with now.
    0:28:08 And so they’ll go and they’ll comment on that right at their head and just give it more juice and that it can stay in the ranking.
    0:28:14 But we like to kind of love bomb, let’s say, around those and to shift the sentiment.
    0:28:16 Sorry, I’m not sure if I’m clear on that.
    0:28:22 Are you saying like don’t jump on that overwhelmingly negative thread with a positive spin?
    0:28:23 You’re just like you’re just adding more fuel.
    0:28:27 And the consensus is still like we want to bury this thing.
    0:28:29 Like we don’t want this to have any more visibility than it already does.
    0:28:32 Starting something else that, you know, has a clean slate.
    0:28:33 It could be more positive.
    0:28:43 Yes, I would say the exception would be if it’s something that’s in your own branded subreddit and it’s a customer service type of question that’s genuine.
    0:28:46 I think then brands need to address it and need to comment.
    0:28:49 And I think that’s, you know, that’s a different strategy.
    0:28:52 That’s more of like a customer service strategy.
    0:29:01 But as far as like if you’re for the ranking, remember, like the more you engage in a post and read it, the more it’s going to surface to the top.
    0:29:01 Okay.
    0:29:02 Yeah.
    0:29:07 So maybe not adding more visibility to something that you don’t want people to read or you don’t want people to see.
    0:29:13 Or even if you’re just an affiliate partner, it’s like we don’t necessarily want that to be front and center.
    0:29:17 But I think evaluating that sentiment as content creators is really important.
    0:29:22 And I think that’s part of the research and part of what I tell our writers as well.
    0:29:34 Because if we’re talking about brands or products or things that we like and every single thing in Reddit is negative and we come across as this overly positive, which we would never do.
    0:29:41 Because we have a real editorial UGC approach to this, but it’s also doesn’t fly and it stands out.
    0:29:52 So like I think digging into what’s there and seeing what other people think is really important to create honest and genuine editorial and making recommendations as well.
    0:29:52 Yeah.
    0:29:54 Be upfront.
    0:29:56 Like, hey, here’s what we liked about it.
    0:29:56 Here’s what’s good.
    0:29:58 Here were some of the downsides.
    0:30:03 Or here’s, you know, here’s what some of the detractors say, you know, just to be aware of both sides.
    0:30:14 Yeah, it’s like we posted a post the other day and that said, I see a lot, just as many Reddit posts love this mattress versus just as many Reddit people don’t love this mattress.
    0:30:15 And here’s why.
    0:30:16 And that’s how we kind of approached it.
    0:30:23 But to completely ignore that there’s like people that are like, I, this is a way too soft of a mattress and I don’t like it.
    0:30:26 I think doesn’t play well on Reddit either.
    0:30:26 Yeah.
    0:30:28 I mean, I don’t think it’s a great editorial either.
    0:30:31 I think I like the balanced kind of approach.
    0:30:32 Okay.
    0:30:38 So that would be maybe how to approach some of the review content looking like, is this brand legit?
    0:30:39 Is this brand worth it?
    0:30:40 Is this product worth it?
    0:30:48 Imagine you could do similar for like this product versus this product, kind of like bottom of the funnel, you know, high buyer intent type of keywords.
    0:31:01 And then even going, you know, the 10 best toasters, like something a little bit higher in a buyer’s decision and kind of teasing that, hey, we’ve just undergone this, you know, month long intensive testing process.
    0:31:07 And I can’t wait to share all the results, you know, here, here on our site, but I’ll tease, you might be surprised who won or something.
    0:31:15 And I think if you want to embrace the Reddit values of things, you’ll be opinionated, you’ll share something.
    0:31:22 And overall, I think what’s gotten me really excited about doing editorial already is that it does feel fresh.
    0:31:24 It does feel a little different.
    0:31:31 And it does feel more human for a long time in SEO, in content websites, in affiliate websites.
    0:31:34 I feel like we were creating very similar types of content.
    0:31:40 And there was a lot of people in the industry saying the top 10 results all look the same.
    0:31:43 The top 20 results all look the same.
    0:31:45 And then we were just competing on content quality.
    0:31:47 We’re competing on a lot of different things.
    0:31:50 But to be fair, that was the landscape for a while.
    0:31:58 Yeah, authority, domain age, everybody plugs it into a phrase or something and says, well, this is what, you know, is already on the first page.
    0:32:00 Make sure you include that in your article.
    0:32:01 Make sure you include that.
    0:32:09 And even when we had these, like, you know, really underground reviews for, like, indie games on our sites that would get to it.
    0:32:17 Once something started getting searchable, once something started having enough search volume, one of the bigger publications would pick it up and destroy us.
    0:32:23 Because they would do, you know, a content pack of, you know, 200 articles or 50 articles to our three, right?
    0:32:24 Yeah.
    0:32:37 And now I think Reddit is giving other people a way to, you know, have those discussions, share those insights in the SERPs that the publishers, you know, competing with the publishers, yes.
    0:32:39 But it can be really refreshing and exciting, too.
    0:32:47 More with Amy in just a moment, including mistakes to avoid and how to get more mileage out of the content you’re already creating right after this.
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    0:34:04 One strategy I didn’t fully embrace or maybe wasn’t fully aware of when I was starting out was this idea of the piggyback principle.
    0:34:07 In the startup phase, that means you don’t have to start completely from scratch,
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    0:35:17 Is it primarily text written content versus, you know, people sharing videos or trying to get more juice to their YouTube channel or to their short form content?
    0:35:20 Yeah, I think there’s all sorts of things.
    0:35:24 Video content right now is really another exciting avenue.
    0:35:26 I see video in tons of SERPs.
    0:35:28 A lot more short videos.
    0:35:32 I see, like, obviously YouTube, TikTok, all of those channels being promoted.
    0:35:35 But yeah, you can use video in Reddit as well.
    0:35:36 And you can do all that.
    0:35:40 I don’t think we do a lot of video in Reddit, but we have.
    0:35:52 Okay, so what I’m hearing, own your community, own your subreddit as a place where hopefully nobody can, like, ban you for, like, dropping links or, like, you know, being self-promotional.
    0:35:53 Like, hey, of course I want to promote my stuff.
    0:35:54 This is my subreddit.
    0:35:58 But treading really, really carefully in others.
    0:36:03 Like, if there is, you know, r slash cooking and you come in, well, here’s my best, 10 best toasters.
    0:36:08 It’s like, ah, it’s a recipe to get the post deleted at best or get yourself banned at worst.
    0:36:15 Well, I would say even with your own subreddit, there’s no guarantee that you cannot be, that you won’t be suspended or banned.
    0:36:17 Reddit is a risky platform in that way.
    0:36:22 So I would say, like, give, and I call it paying the Reddit tax.
    0:36:25 Go in, give, share valuable information.
    0:36:29 I would never, ever start a new subreddit and start adding affiliate links.
    0:36:33 In fact, I, like, kind of don’t want to share any affiliate links.
    0:36:34 I think it’s a red flag.
    0:36:35 I think Redditors hate it.
    0:36:38 I think it’s sad because that’s how people, obviously, we’re…
    0:36:39 Yeah, Amy, we’re trying to make money.
    0:36:40 Come on.
    0:36:42 We are trying to make money.
    0:36:47 So you have to take a few extra steps and you have to, you know, you know, give till it hurts.
    0:36:48 Follow the rules.
    0:36:49 Share.
    0:36:53 You can share links to your own site and have affiliate links there.
    0:36:55 Yes, it’s another step that people have to take.
    0:36:58 But I think it’s worth it.
    0:37:10 I think it’s not worth the risk and, you know, just losing people, like, losing the Redditors’ kind of trust by, you know, just having a bunch of spammy, kind of linky kind of things.
    0:37:10 So.
    0:37:11 All right.
    0:37:15 So that’s helpful to be, like, I don’t know, to hear you say, like, I wouldn’t put any affiliate links.
    0:37:18 Like, okay, just tread, tread super carefully.
    0:37:21 Any other risks or mistakes that we should know about?
    0:37:25 I mean, it does feel, this is my beef with all these platforms.
    0:37:28 It’s like, yeah, you got to go where the eyeballs are, but you’re still playing in somebody else’s sandbox.
    0:37:31 They could take their ball and go home at any time.
    0:37:34 And you’re like, I feel like I’m building on borrowed land here.
    0:37:35 It’s really tough.
    0:37:36 I feel like that, too.
    0:37:41 I mean, the advice that I would have given five years ago is not what we’re doing now.
    0:37:46 In fact, like, being publishing and we publish a lot on YouTube.
    0:37:47 We publish on our own site.
    0:37:48 We publish in Reddit.
    0:37:52 We publish in Medium and TikTok and Quora and other forms.
    0:37:55 I would have said before, don’t do that.
    0:37:56 Don’t spread yourself thin.
    0:37:58 The editorial is different.
    0:38:01 It takes a lot more effort to get into all these things.
    0:38:05 And you’re, you know, going on rent to land and Reddit does have its risks.
    0:38:08 But it’s such a huge platform.
    0:38:10 There’s so much visibility.
    0:38:12 You almost have no choice.
    0:38:16 If you’re not on Reddit, you’re missing out on a lot of opportunities to be in the SERPs.
    0:38:21 And so we had to, our motto was like, we’re going to figure it out.
    0:38:23 No matter what, we’re going to figure it out.
    0:38:25 And so that was like, challenge accepted.
    0:38:26 We’ll do it.
    0:38:26 Yeah.
    0:38:30 Tell me about the Medium and Quora strategies.
    0:38:31 It’s like the same type of content.
    0:38:35 You know, we started a thread or somebody asked this question or a very similar question.
    0:38:37 So we could answer it over there as well.
    0:38:38 Yeah, I would say similar.
    0:38:41 They’re a little bit more edit friendly.
    0:38:46 You can edit a Quora question after it’s been asked a little bit easier.
    0:38:48 You can edit your Reddit questions too.
    0:38:54 But I think the etiquette is to say edited because I added this and it has to be valuable.
    0:38:55 Okay.
    0:38:55 Okay.
    0:39:01 I think Quora and Medium are obviously a little less risky as far as like you can publish what you want.
    0:39:05 And depending on the SERP, sometimes Quora outranks Reddit.
    0:39:13 So I think just evaluating that landscape again and seeing and also asking questions that people will answer is really important.
    0:39:15 Knowing how to ask the question.
    0:39:17 Quora has their own kind of etiquette as well.
    0:39:21 Like they ask you, don’t ask questions that have already been asked.
    0:39:23 So that kind of thing.
    0:39:28 So all these different things, they all have their own little quirks, let’s say, that you have to figure out.
    0:39:35 I mean, do you give any weight to like, you know, back in the day, it would be like, oh, that would be considered duplicate content to publish the same stuff on your site.
    0:39:40 And to paste it on Medium or paste it in, you know, syndicate to MSN.
    0:39:43 It’s like, or publish it on Substack.
    0:39:51 Like there’s lots of different channels where like, okay, on the plus side, it’s like, well, I have the potential to take up half of the first page if all of these somehow get ranking.
    0:39:56 But, you know, maybe only one of them is going to get indexed if it’s the same.
    0:39:56 Well, that’s the thing.
    0:40:02 We might have the same topic, but the approach to every single different platform is going to be different.
    0:40:06 And it’s different content for every single platform that we create.
    0:40:07 It might be remixed.
    0:40:08 Sounds like a lot of work.
    0:40:09 It is a lot of work.
    0:40:12 And I feel like maybe that’s why there’s bad sentiment.
    0:40:17 Like scaling up these teams, these editorial teams.
    0:40:28 But I have a great team of writers, creators that do video, will create a blog post, will create a Reddit share, will create a Quora, will create a Medium.
    0:40:32 And it is very, it is different for every single approach.
    0:40:34 And they will do fresh content for every single thing.
    0:40:36 So it is a lot of work.
    0:40:43 But it’s worth it because we have a client that I was doing a report for, and we were ranking in seven spots on the first page of Google.
    0:40:44 Yeah.
    0:40:46 For seven different things.
    0:40:47 Yeah, that’s what’s possible.
    0:40:51 They just completely dominate the front page real estate if done right.
    0:40:51 Yeah.
    0:40:57 Are there any rules of thumb in terms of, you know, publishing cadence where it’s like, well, every Monday I got to have a new thread?
    0:41:02 Is there any rules like that or just kind of like as you see fit or as you see necessary?
    0:41:06 With Reddit, I think starting off, don’t publish a 50 or a 100.
    0:41:09 I wouldn’t publish, mass publish anything.
    0:41:11 I wouldn’t, I would have a human approach to it.
    0:41:14 So I would start with publishing one thing, publishing two.
    0:41:21 And like I said before, you don’t need to have a ton of content to start seeing some results and start seeing what works.
    0:41:25 I’ve seen friends of mine, I think that’s their mistake because they put a lot,
    0:41:31 they invest a lot of their team’s energy and effort into their subreddit and they start to like, you know,
    0:41:36 I’m going to publish a hundred things, 150 things and put a ton of effort into it.
    0:41:41 One, the risk is if something happens and you lose that subreddit, which can happen.
    0:41:43 I hope it doesn’t.
    0:41:44 You’ve lost 150.
    0:41:53 But two, you can get enough data and validation and review from a few posts and then see what kind of works.
    0:41:55 But I also think just like be human.
    0:41:58 Like I think too much cadence, kind of maybe like a tripwire.
    0:42:00 So I would space it out a little bit.
    0:42:01 Okay.
    0:42:01 Yeah.
    0:42:10 So if, so if other publishers are in the same boat as me, they’ve, you know, been running their sites for five or 10 years, they’ve got like this huge library of content.
    0:42:13 The strategy is not to go and try to dump that all at once, even every single day.
    0:42:16 It’s just like, take a, take a metered approach.
    0:42:28 And if you want to publish more, I would say create those affinity subreddits as well that you can publish more and to different things like expand it that way instead of just expanding.
    0:42:35 But once your subreddit is established and you have members and you have engagement and all the good things that come from that, it’s a little bit more solid.
    0:42:40 And you can do, you can do a lot more and you can publish on more of a regular cadence.
    0:42:50 And of course, ideally people are publishing on your subreddit, they’re publishing questions and you have moderators and it can, you know, become this humongous thing eventually.
    0:42:51 Yeah, it can be its own.
    0:42:57 So it’s another touch point for the brand is kind of how I’ve traditionally viewed the Sino Salvation Facebook group.
    0:43:02 It’s like, hey, you know, wherever you are, if you’re in the car, hey, listen to the podcast.
    0:43:06 If you’re scrolling through your feed, make sure you see our stuff in the Facebook group.
    0:43:14 So there’s, I guess I could see another touch point here with people being engaged with the brand and fueling future content through their questions.
    0:43:26 Like, yeah, hey, anybody ever tried this particular side business or this particular money making app or whatever and try and gather feedback on that or like, sure, I never heard of that.
    0:43:27 I won’t test it out.
    0:43:28 Yeah.
    0:43:31 And then you can create a podcast or find somebody by an expert.
    0:43:39 And a lot of great things can happen with that kind of community and that feedback loop that I think is really fun for something like this, for sure.
    0:43:46 And remember, like, Reddit is not like a Facebook or like another social because it’s just so prevalent in the SERPs as well.
    0:43:53 So people that may even tell us that they’re not Reddit users, like my husband says he isn’t on Reddit, but he’s on Reddit.
    0:43:53 Sure.
    0:43:57 Because when he does any kind of Google search, Reddit will show up.
    0:43:58 He’ll be on it.
    0:44:00 You know, he might not realize it.
    0:44:01 Okay.
    0:44:02 Personal question.
    0:44:08 Like, you’ve talked a lot about, like, the affiliate type of content, which, you know, okay, there’s an extra step.
    0:44:09 Hopefully I draw people back to the site.
    0:44:11 Maybe they eventually click the affiliate link.
    0:44:18 If I want to promote an episode of the show and say, hey, we just had this really interesting guest on.
    0:44:24 She was getting paid to create short form videos for brands, you know, two, three hundred bucks a video, sometimes more.
    0:44:28 I genuinely think it’s like a super creative business, like a really cool story.
    0:44:31 Hey, I made a hundred grand on the side from my day job.
    0:44:37 You know, just trying to get the word out there, but not be like, hey, come listen to my stuff.
    0:44:45 Like, what’s, how do you, I don’t know, how do you tread lightly or, you know, figure out the best way to promote something like that or like that story based type of content?
    0:44:47 Oh, yeah, that’s really interesting.
    0:44:53 Because I think that there is a case for having more of a cadence then because you have real things that you want to share.
    0:45:02 And maybe there is like, maybe you share it in your brand and subreddit, maybe you have your own like, like subreddit for the podcast only.
    0:45:08 And this is where you get updates and it can be kind of a feed, but you can engage in other subreddits as well.
    0:45:13 And if you are genuinely excited, and I see a lot of people promoting themselves like that.
    0:45:16 But again, it’s like where it’s kind of like the approach.
    0:45:22 So, you know, it’s like this is such a really interesting story and I think you’re going to really get good tips.
    0:45:24 I think that can, that can work.
    0:45:31 I just think it’s when, I think it’s just when brands are almost lazy and too self-promotionals when they get into trouble.
    0:45:31 All right.
    0:45:31 All right.
    0:45:39 But I think if you’re a genuine content creator and you generally do what you do on Reddit, it does translate.
    0:45:39 It can.
    0:45:41 Not perfect, but it can.
    0:45:50 To what extent are you using AI to spin up, you know, different intros or different ways to say the same type of thing and like to make it unique and different?
    0:45:55 Well, we have like a no AI policy in our content.
    0:46:09 And to be fair, I don’t really know if our writers have used AI in their brainstorming process and their, but I don’t want it to look like AI, feel like AI, sound like AI.
    0:46:12 Even if they haven’t used AI to create it, if that makes sense.
    0:46:13 You can kind of sense it.
    0:46:16 I want them to, I want it to be a little imperfect.
    0:46:18 I want it to be, you know, opinionated.
    0:46:24 I want it to be, for Reddit especially, I think anything that feels computer generated.
    0:46:29 But yeah, for testing, I think that’s something that you could do.
    0:46:29 I don’t know.
    0:46:31 We don’t, we don’t really do that right now.
    0:46:32 All right.
    0:46:33 Fair enough.
    0:46:45 The people that are creating our editorial or creating our post are real experts, real nerds, full of like, you know, humor, edginess, opinions that I want to pull that out of them.
    0:46:49 I don’t want to figure out a formula for, you know, testing.
    0:46:50 Mass, mass producing.
    0:46:51 Okay.
    0:46:52 Fair.
    0:46:53 What’s next?
    0:46:55 Where do you see Red Visible going?
    0:46:58 Where, I mean, what’s got you excited this year?
    0:47:12 Well, the first thing is, I feel like it’s really exciting to survive in this new landscape when AI reviews are, you know, at the forefront, taking up half the listing on Google right now.
    0:47:16 When our publications, when the traffic changed, there was a huge shift.
    0:47:26 All of the things that have happened in publishing and digital, to be still here and to be excited and to be in content is a really big win for me and still gets me really motivated.
    0:47:36 And to be able to work with people that I love and creatives and, you know, and do the thing I love, that is really what’s kept me going for the past year, year and a half, two years.
    0:47:37 It’s been a roller coaster.
    0:47:50 Looking forward, I feel like because we’ve figured out how to distribute content, create content on different platforms, I feel like it’s a moat around our business, around what we do.
    0:47:54 Because no matter how the SERPs change, I feel like we have a stake somewhere.
    0:48:01 Whether it’s if Reddit completely disappeared from the SERPs, we still have our third party, but we still have our publishers.
    0:48:04 We still have, there’s still Quora Medium.
    0:48:06 There’s still video, which is really exciting.
    0:48:21 So, moving into that and just embracing search for what it is right now and for how people are discovering us and for where people are living online has been really what’s kept me motivated and what I look forward to doing.
    0:48:23 And every day is a new day.
    0:48:29 And in one year, I may be talking about something else, but for right now, that’s what keeps me going.
    0:48:32 Yeah, the change is the only constant.
    0:48:40 You never know what’s coming, but for the time being, a lot of that traffic and attention is certainly flowing towards Reddit.
    0:48:44 So, you might as well figure out how to take advantage of that, whatever that means for your brand.
    0:48:47 Redvisible.com is where you can find Amy.
    0:48:51 Let’s wrap this thing up with your number one tip for Side Hustle Nation.
    0:48:53 Embrace your side hustle.
    0:49:01 Like, I feel like everybody needs to have a side hustle, no matter how busy you are, and I feel like it’s a great way to test new things.
    0:49:03 I still have my little side hustles out there.
    0:49:11 You don’t necessarily have to make a lot of money right away, but the things that you learn, you never know where it’s going to come into play.
    0:49:20 So, I would say one of my side hustles is I love to play around with AI and play around with AI tools and things like that and create things.
    0:49:22 But have I put anything out into the orbit yet?
    0:49:23 No.
    0:49:24 But I’m learning a lot.
    0:49:29 Yeah, but you learn from that, like, just messing around time, like the tinkering time.
    0:49:30 But, I mean, I love it.
    0:49:37 I listened to the interview you did on UGC and how amazing that is and how much freedom someone gets.
    0:49:43 And I love hiring UGC creators and I love finding people and it can fit into your life.
    0:49:51 And these kind of things that people are discovering now and doing now, there’s going to be different opportunities in two years and three years.
    0:50:01 So, if you have a passion to do that and I have a 14-year-old and he’s done some videos with us and I was really hoping he would really get into it and be a creator.
    0:50:02 But it’s funny.
    0:50:07 Like, some of those episodes that you’re like, I know the perfect person for this.
    0:50:09 And you send it to them and they’re like, eh.
    0:50:11 I was like, man, I really thought that was going to hit.
    0:50:14 But when the student is ready, the teacher will appear.
    0:50:15 So, maybe they’ll come back to it.
    0:50:21 I think listening and hearing other people’s stories and getting inspired, you never know what’s going to be.
    0:50:22 And just, like, tinker around.
    0:50:23 It’s fun.
    0:50:25 Like, I think that’s my advice.
    0:50:29 I am in the very early stages of my Reddit tinkering.
    0:50:30 I hope you’ll come by and join.
    0:50:33 If you’re listening to this, it’s r slash side hustle nation.
    0:50:34 Come and come by.
    0:50:38 Help us out and build a helpful community for side hustlers on the internet.
    0:50:41 A couple of takeaways from me before we wrap.
    0:50:42 Like Amy said, no shortcuts.
    0:50:44 You got to be a member of the community.
    0:50:45 It’s real work.
    0:50:46 It’s real effort.
    0:50:51 And, you know, you can’t come in guns blazing and just spamming up a place with your affiliate links.
    0:50:52 You got to be there for the long haul.
    0:50:57 And the second thing is to build that subreddit that you are the moderator of, that you have some ownership over.
    0:51:00 It could be a distribution channel for your content.
    0:51:05 It could be a place to gather community feedback and questions that fuels future content.
    0:51:12 It could be just another touchpoint for your brand if people are going about their day-to-day lives and they see you pop up in their feed there.
    0:51:20 So those are kind of the highlights for me and I’ll probably update as we go forward with our newfound reddit journey here.
    0:51:24 But big news, the Side Hustle Show just had its 12th birthday.
    0:51:31 So whether this is your first time listening or you’ve been around since the beginning, I appreciate you spending some time with us in your earbuds today.
    0:51:39 If you are new or newer to the show and you want to dig a little bit deeper, you can actually get a personalized playlist at hustle.show.
    0:51:48 You just answer a few short, multiple-choice questions and it’ll recommend 8 to 10 of our greatest hits to start out with based on your answers.
    0:51:48 Totally free.
    0:51:51 Hustle.show for your personalized playlist.
    0:51:53 Big thanks to Amy for sharing her insight.
    0:51:57 Big thanks to our sponsors for helping make this content free for everyone.
    0:52:02 SideHustleNation.com slash deals is where you can find all the latest offers from our sponsors in one place.
    0:52:05 Thank you for supporting the advertisers that support the show.
    0:52:07 It really does make a difference.
    0:52:08 That is it for me.
    0:52:10 Thank you so much for tuning in.
    0:52:14 If you’re finding value in the show, the greatest compliment is to share it with a friend.
    0:52:15 So fire off that text message.
    0:52:19 Maybe somebody that you know who had their traffic hit in the last year or two.
    0:52:22 Say, hey, maybe here’s a path forward like we talked about at the beginning.
    0:52:24 If you can’t beat them, join them.
    0:52:27 Until next time, let’s go out there and make something happen.
    0:52:30 And I’ll catch you in the next edition of the Side Hustle Show.

    If you notice that your traffic is dominated with AI snippets and Reddit results, here’s how you can take advantage of that and learn how to drive traffic from Reddit.

    It really does feel like an “if you can’t beat ’em, join ’em” situation, but we can’t ignore that Reddit, the self-proclaimed front page of the internet, now shows up on the first page of almost every Google search.

    To help me out is Amy Aitman from ReddVisible.com, a professional content marketer who’s been helping businesses and brands take advantage of this new Reddit-dominated search world.

    Tune in to Episode 673 of the Side Hustle Show to learn:

    • how to get some Reddit traffic flowing back to you
    • the reddit research and content best practices to be aware of
    • and common mistakes to avoid

    Full Show Notes: Reddit Marketing: How to Drive Traffic from Reddit

    New to the Show? Get your personalized money-making playlist here!

    Sponsors:

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  • Was Biden’s Decline a Cover-Up? — with Jake Tapper & Alex Thompson

    AI transcript
    0:00:02 Support for Prop 3 comes from Viore.
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    0:00:31 Viore.com slash Prop G.
    0:00:35 That’s V-U-O-R-I dot com slash Prop G.
    0:00:37 Exclusions apply.
    0:00:40 Visit the website for full terms and conditions.
    0:00:47 In every company, there’s a whole system of decision makers,
    0:00:48 challenges, and strategies,
    0:00:51 shaping the future of business at every level.
    0:00:52 That’s why we’re running a special
    0:00:54 three-part Decoder Thursday series,
    0:00:56 looking at how some of the biggest companies in the world
    0:00:59 are adapting, innovating, and rethinking their playbooks.
    0:01:01 We’re asking enterprise leaders
    0:01:02 about some of the toughest questions
    0:01:03 they’re facing today,
    0:01:06 revealing the tensions, risks, and breakthroughs
    0:01:07 happening behind closed doors.
    0:01:10 Check out Decoder, wherever you get your podcasts.
    0:01:12 This special series from The Verge
    0:01:13 is presented by Adobe Express.
    0:01:16 What’s up, y’all?
    0:01:17 It’s Kenny Beach, and we are currently watching
    0:01:19 the best playoff basketball since,
    0:01:21 since I can’t even remember when.
    0:01:24 This is what we’ve been waiting for all season long.
    0:01:25 And on my show, Small Ball,
    0:01:27 I’ll be breaking down the series matchups,
    0:01:28 major performances,
    0:01:29 in-game coaching decisions,
    0:01:31 and game strategy,
    0:01:32 and so much more
    0:01:35 for the most exciting time of the NBA calendar.
    0:01:36 New episodes through the playoffs
    0:01:37 available on YouTube
    0:01:38 and wherever you get your podcasts.
    0:01:40 Subscribe to Small Ball with Kenny Beach
    0:01:41 so you don’t miss a thing.
    0:01:45 Episode 349.
    0:01:47 349 is the area code
    0:01:48 serving the Mexican state of Jalisco.
    0:01:51 In 1949, NATO was formed.
    0:01:52 What does a Scotsman say
    0:01:55 when he loses a digit on his foot?
    0:01:57 NATO.
    0:02:04 Yeah, we’re reaching.
    0:02:07 Go, go, go!
    0:02:16 Welcome to the 349th episode
    0:02:18 of the Prop G-Pod.
    0:02:18 What’s happening?
    0:02:20 Okay, in today’s episode,
    0:02:22 wow, is this blown up
    0:02:23 into something we weren’t thinking?
    0:02:24 Jake Tapper,
    0:02:26 anchor of the lead on CNN
    0:02:28 and the network chief Washington correspondent
    0:02:29 and Alex Thompson,
    0:02:31 national political correspondent for Axios
    0:02:33 and CNN contributor on the pod.
    0:02:34 They’re the co-authors of a new book,
    0:02:35 Original Sin,
    0:02:38 which unpacks what they call
    0:02:40 the defining mistake of the 2024 election,
    0:02:41 President Biden’s decision
    0:02:42 to run for re-election
    0:02:43 followed by a concerted effort
    0:02:45 to hide his cognitive decline.
    0:02:47 Let’s talk about the timeline
    0:02:48 and what’s going on here.
    0:02:48 I find this fascinating.
    0:02:50 Biden officially dropped out of the race
    0:02:51 on July 21st, 2024.
    0:02:54 I want to say I’m the original ageist.
    0:02:55 I said I’m Bill Maher
    0:02:56 where he responded,
    0:02:56 you’re an ageist,
    0:02:58 and I said, yeah, so is biology.
    0:02:58 I called,
    0:03:00 I said that it was fucking ridiculous
    0:03:02 that Biden was running for re-election
    0:03:02 and also ridiculous
    0:03:03 that Donald Trump
    0:03:04 was running for election.
    0:03:06 Our prefrontal cortex
    0:03:08 begins to degrade
    0:03:09 at the age of 40
    0:03:11 and we take driver’s licenses
    0:03:12 away from people.
    0:03:13 We don’t let them be pilots.
    0:03:14 Most CEOs
    0:03:16 and most of Western nations
    0:03:17 are asked to retire at 65
    0:03:19 and yet we’ve decided
    0:03:21 that people who are even past
    0:03:22 what is the life expectancy
    0:03:23 in the United States
    0:03:25 can have their finger on the button.
    0:03:27 This is a very taxing button.
    0:03:28 We absolutely need age limits
    0:03:29 on the top end
    0:03:31 as we do on the bottom end.
    0:03:32 But anyways,
    0:03:34 here is some receipts
    0:03:37 from me being the original ageist.
    0:03:37 What a thrill!
    0:03:41 On July 11th,
    0:03:42 I said on this very podcast
    0:03:43 that it was time
    0:03:44 for him to step down.
    0:03:45 And let’s be honest,
    0:03:47 America is the most impressive
    0:03:47 country in the world.
    0:03:49 We need to mature
    0:03:50 the most impressive person
    0:03:52 in the party
    0:03:54 to lead the Democratic Party
    0:03:56 and be the front line
    0:03:57 and that is not the president.
    0:03:59 OK, then again on Pivot
    0:04:00 with Kara Swisher
    0:04:01 just days before he exited the race.
    0:04:03 A few weeks ago,
    0:04:05 there was a general sense
    0:04:08 that the destabilization
    0:04:11 and the risks of removing Biden
    0:04:12 for a lot of people
    0:04:13 were not worth it.
    0:04:14 And then as there was
    0:04:15 additional scrutiny
    0:04:16 and he was forced to go
    0:04:18 off teleprompter
    0:04:19 and do live stuff,
    0:04:20 quite frankly,
    0:04:21 it just cemented,
    0:04:22 confirmed, validated
    0:04:24 everyone’s worst fears.
    0:04:25 And I wrote about it
    0:04:26 even earlier
    0:04:27 in our newsletter,
    0:04:28 No Mercy, No Malice
    0:04:28 on July 5th.
    0:04:31 I believe President Biden
    0:04:32 will announce
    0:04:33 he is withdrawing
    0:04:34 from the 2024 race
    0:04:35 imminently.
    0:04:39 Anyway,
    0:04:40 the book has really
    0:04:41 stirred controversy,
    0:04:42 not because of what
    0:04:42 the book reveals,
    0:04:43 but because of when
    0:04:44 it was released,
    0:04:45 just days after the news
    0:04:46 broke about
    0:04:47 Biden’s cancer diagnosis.
    0:04:48 So,
    0:04:50 this conversation
    0:04:51 with Jake and Alex
    0:04:51 was recorded
    0:04:52 before this kind of
    0:04:53 controversy hit it.
    0:04:54 I think a lot of this
    0:04:55 is that people feel
    0:04:56 that Jake and Alex
    0:04:57 accidentally are sort of
    0:04:57 dancing on the grave
    0:04:59 or the early grave
    0:05:01 of a man who has
    0:05:01 devoted his life
    0:05:02 to the U.S.
    0:05:03 I think a lot of this
    0:05:04 is that people are
    0:05:05 just upset about
    0:05:06 the fact that
    0:05:07 Democrats lost
    0:05:09 to an insurrectionist
    0:05:10 and are looking
    0:05:11 for a target
    0:05:11 for their anger.
    0:05:12 And I think
    0:05:13 Jake and Alex
    0:05:13 got in the way.
    0:05:15 But this was an honest
    0:05:17 and thoughtful conversation.
    0:05:18 There’s also criticism,
    0:05:19 especially toward Jake,
    0:05:20 that he knew about
    0:05:21 Biden’s decline
    0:05:21 and is now trying
    0:05:22 to profit from it
    0:05:23 with his book.
    0:05:24 Look,
    0:05:25 they’re trying to make
    0:05:26 it sound more scandalous
    0:05:27 than it probably was.
    0:05:28 I don’t think
    0:05:29 cover-up is the right term.
    0:05:30 If they were truly
    0:05:30 trying to cover
    0:05:32 Biden’s cognitive decline,
    0:05:33 they would have never
    0:05:34 allowed him to debate.
    0:05:36 Trump decided not to debate
    0:05:37 after it was clear
    0:05:37 he didn’t have
    0:05:38 the cognitive abilities
    0:05:40 to go toe-to-toe
    0:05:41 with Vice President Harris.
    0:05:42 He looked stupid,
    0:05:42 flat-footed,
    0:05:43 and quite frankly old.
    0:05:44 And they decided
    0:05:45 to hide him.
    0:05:48 They let President Biden out.
    0:05:50 So we all knew this.
    0:05:50 I mean,
    0:05:51 this was a kind
    0:05:51 of an open secret.
    0:05:54 And if you have
    0:05:54 aging parents,
    0:05:55 you know that you’re
    0:05:56 not covering up for them,
    0:05:57 but you’re accidental
    0:05:58 co-conspirators.
    0:05:59 This was naive.
    0:05:59 It was stupid.
    0:06:00 It was irresponsible
    0:06:01 for the people around him
    0:06:02 and his family
    0:06:03 and him, quite frankly,
    0:06:04 to let this go
    0:06:05 as long as it did.
    0:06:06 I believe that
    0:06:07 it had the primary process,
    0:06:08 which is this
    0:06:09 unbelievable process
    0:06:09 that matures
    0:06:10 not only the right person,
    0:06:11 but the right person
    0:06:11 for the moment.
    0:06:13 I think we would have
    0:06:14 handed Trump his ass
    0:06:14 and we wouldn’t have
    0:06:15 an insurrectionist
    0:06:16 who is engaging
    0:06:17 in the greatest grift
    0:06:17 in the history
    0:06:19 of a Western economy
    0:06:20 right now.
    0:06:21 But the reason we have
    0:06:22 a quote-unquote person
    0:06:22 who is found guilty
    0:06:24 on 34 counts
    0:06:25 of sexual abuse
    0:06:26 by a jury of his peers,
    0:06:27 which includes
    0:06:28 many Republicans,
    0:06:29 the reason why
    0:06:30 that person won
    0:06:32 is because of
    0:06:33 not this cover-up,
    0:06:34 but this naivete,
    0:06:34 this ignorance,
    0:06:35 and this poor judgment
    0:06:37 of President Biden
    0:06:39 and his family.
    0:06:40 And we have to
    0:06:41 reckon with that.
    0:06:42 And also the Democratic Party
    0:06:43 who decided not to have,
    0:06:44 my recommendation
    0:06:46 was that we have
    0:06:47 a compressed sort of
    0:06:48 all-hands shark tank
    0:06:50 like primary
    0:06:51 with multiple debates
    0:06:52 and try and mature
    0:06:52 the best person
    0:06:54 because no one had heard
    0:06:55 of Barack Obama
    0:06:56 or Bill Clinton,
    0:06:58 but the primary process
    0:06:58 on both sides
    0:06:59 tends to mature
    0:07:00 amazing candidates.
    0:07:01 And we decided
    0:07:01 that we were going
    0:07:02 to stick our heads
    0:07:02 in the sand
    0:07:04 and believe
    0:07:04 that someone
    0:07:05 who didn’t make it
    0:07:06 to Iowa
    0:07:08 was in the previous election
    0:07:09 was the right person
    0:07:11 to take the mantle
    0:07:13 after basically Biden
    0:07:13 was threatened
    0:07:14 with getting embarrassed
    0:07:15 day by day
    0:07:15 when it became
    0:07:16 very obvious
    0:07:18 that he was
    0:07:18 in no shape
    0:07:19 whatsoever
    0:07:21 to run for president again.
    0:07:21 So this is
    0:07:23 this is something
    0:07:24 that we all engage in
    0:07:25 because we all love
    0:07:27 our aging parents
    0:07:27 and our family.
    0:07:28 we see them
    0:07:29 at their best
    0:07:30 so you can
    0:07:31 absolutely understand
    0:07:32 how they would
    0:07:33 make excuses.
    0:07:34 This is a guy
    0:07:34 who was pushing
    0:07:35 back on Russia
    0:07:36 who stood up
    0:07:37 to send
    0:07:38 immediately deployed
    0:07:39 aircraft carrier
    0:07:40 strike forces
    0:07:40 to the Mediterranean
    0:07:41 and told Iran
    0:07:42 to sit the fuck down.
    0:07:43 I don’t think
    0:07:43 he gets enough
    0:07:44 credit for that.
    0:07:45 Passed a ton
    0:07:46 of meaningful
    0:07:48 legislation.
    0:07:49 I mean,
    0:07:49 this guy,
    0:07:50 you could see
    0:07:51 why people would say,
    0:07:52 look,
    0:07:53 he’s lost a step
    0:07:53 but he surrounds himself
    0:07:55 with really talented people
    0:07:55 and he’s the best
    0:07:56 thing for the country.
    0:07:57 You can absolutely
    0:07:58 see that argument.
    0:07:59 And again,
    0:08:01 we all engage in this
    0:08:02 if you have aging parents
    0:08:04 in what is not a cover-up
    0:08:06 but a tendency
    0:08:06 to enable,
    0:08:07 rationalize,
    0:08:08 and not see
    0:08:09 the forest for the trees.
    0:08:10 When you’re inside
    0:08:11 of the bottle,
    0:08:12 it’s really hard
    0:08:14 to read the label.
    0:08:15 What’s the recommendation here?
    0:08:16 What’s the learning?
    0:08:17 The learning is
    0:08:18 we need age limits, folks.
    0:08:19 We have decided
    0:08:20 a 34-year-old
    0:08:21 doesn’t have the judgment
    0:08:22 or the experience
    0:08:22 to run for the land’s
    0:08:23 highest office
    0:08:24 than someone at 75
    0:08:25 probably doesn’t have
    0:08:27 the cognitive faculty
    0:08:28 or the judgment
    0:08:29 or, quite frankly,
    0:08:30 it’s just not as robust
    0:08:31 and presents too much
    0:08:32 of a health risk.
    0:08:33 What if President Biden
    0:08:34 was president right now?
    0:08:36 My guess is
    0:08:37 he would probably still,
    0:08:38 he probably wouldn’t
    0:08:39 handle the reins,
    0:08:39 hand the reins over
    0:08:40 to Vice President Harris.
    0:08:41 He’d still think
    0:08:42 that he could handle everything
    0:08:43 and we would have
    0:08:44 a nation that is somewhat
    0:08:45 in chaos
    0:08:46 or a little bit leaderless
    0:08:47 than Pennsylvania Avenue.
    0:08:48 I still think that would be
    0:08:49 better than what we have
    0:08:51 but that’s absolutely
    0:08:52 what we shouldn’t do.
    0:08:53 We need age limits also.
    0:08:54 It’s the kinder thing to do.
    0:08:56 It’s the kindest thing to do
    0:08:58 because a lot of these people
    0:08:59 feel like when they give up
    0:08:59 their profession
    0:09:00 that they’re essentially
    0:09:01 going home to die.
    0:09:02 And actually,
    0:09:03 there’s some truth to that,
    0:09:04 that mortality rates increase
    0:09:05 when you stop working.
    0:09:06 But when you have
    0:09:08 a mandatory retirement age
    0:09:09 as they do for the Supreme Court
    0:09:09 in the UK
    0:09:10 and they do across
    0:09:11 many corporations
    0:09:13 and in many government positions
    0:09:14 around the world,
    0:09:15 it creates,
    0:09:18 it gets rid of the anxiety.
    0:09:19 It’s the kind thing to do.
    0:09:19 It’s the right thing to do.
    0:09:20 It’s the best thing
    0:09:20 for the nation.
    0:09:21 So rather than playing
    0:09:22 in a blame game
    0:09:23 and getting angry
    0:09:24 for Jake and Alex
    0:09:26 for trying to promote their book,
    0:09:27 rather than blaming
    0:09:28 the Biden family,
    0:09:29 we can absolutely,
    0:09:29 or the people around them,
    0:09:30 we can absolutely,
    0:09:31 in my opinion,
    0:09:32 see how this happened.
    0:09:33 Anyways, with that,
    0:09:34 here’s our conversation
    0:09:35 with Jake Tapper
    0:09:36 and Alex Thompson.
    0:09:48 Jake, where does this podcast find you?
    0:09:49 I am at Penn Law School
    0:09:51 where my dad and C.J. Rice
    0:09:52 and I just did a seminar
    0:09:54 on criminal justice.
    0:09:55 I don’t know if you know
    0:09:56 the C.J. Rice story,
    0:09:56 but my dad
    0:09:59 and then slightly me
    0:10:01 helped get an innocent man
    0:10:01 out of prison.
    0:10:03 Oh, that’s nice.
    0:10:04 That must be rewarding
    0:10:05 to be able to work
    0:10:05 with your father.
    0:10:07 Yeah, it was pretty cool.
    0:10:09 That’s great.
    0:10:09 And Alex,
    0:10:11 where does this podcast find you?
    0:10:12 I’m in D.C.
    0:10:12 in my apartment.
    0:10:14 That’s not nearly
    0:10:15 as cool a story.
    0:10:16 Jake wins.
    0:10:17 Jake is winning so far.
    0:10:18 I didn’t get anyone
    0:10:19 out of prison,
    0:10:21 didn’t do anything.
    0:10:23 Just my apartment
    0:10:24 with too many books.
    0:10:25 All right,
    0:10:26 let’s bust right into it.
    0:10:27 Your new book,
    0:10:28 Original Sin,
    0:10:29 explores what you call
    0:10:31 the original sin
    0:10:32 of the 2024 election,
    0:10:33 President Biden’s decision
    0:10:35 to seek re-election,
    0:10:36 followed by a full-scale effort
    0:10:38 to conceal his cognitive decline
    0:10:39 throughout the campaign.
    0:10:41 I’ll start with a bunch
    0:10:42 of theses because Alex,
    0:10:42 Jake knows this,
    0:10:43 but Alex doesn’t.
    0:10:44 This podcast is just basically
    0:10:45 an excuse for me
    0:10:46 to talk about me
    0:10:46 and my views.
    0:10:48 My sense is that
    0:10:49 I read this book
    0:10:51 called What It Takes,
    0:10:52 and it covered,
    0:10:53 I think,
    0:10:54 like the 84 election
    0:10:55 and all the candidates,
    0:10:56 and it basically wrote
    0:10:57 a 100-page biography
    0:10:57 on all the candidates.
    0:10:58 One of them was Biden.
    0:11:00 88, but yeah.
    0:11:01 It was 88.
    0:11:01 Thank you, Jake.
    0:11:02 Jake,
    0:11:04 it’s my fucking podcast.
    0:11:05 Don’t correct me.
    0:11:08 You may be a big
    0:11:09 swinging dick at CNN,
    0:11:10 but I don’t put up
    0:11:10 with that shit here.
    0:11:11 So look,
    0:11:13 after reading that book,
    0:11:14 the takeaway I had
    0:11:15 from Biden
    0:11:16 was that he was
    0:11:17 a raging narcissist.
    0:11:19 And when I look
    0:11:21 at Dianne Feinstein
    0:11:23 or Ruth Bader Ginsburg,
    0:11:24 you know,
    0:11:26 this has really plagued us,
    0:11:27 was this narcissism
    0:11:28 that these people
    0:11:28 don’t want to acknowledge
    0:11:30 that maybe they aren’t
    0:11:31 up to the job.
    0:11:33 your thoughts on,
    0:11:33 I mean,
    0:11:34 at the end of the day,
    0:11:36 he decided to stay in.
    0:11:37 Wasn’t this,
    0:11:38 wasn’t he infected
    0:11:39 with narcissism?
    0:11:40 I’ve even heard now
    0:11:41 that he’s reflecting,
    0:11:42 but he’s not reflecting
    0:11:43 on his mistake.
    0:11:44 He’s reflecting on
    0:11:45 whether he would have won.
    0:11:46 Biden,
    0:11:47 narcissism that was
    0:11:48 bad for the country,
    0:11:50 put himself before the country.
    0:11:51 Dots.
    0:11:52 You know,
    0:11:53 it’s interesting
    0:11:54 that you reference
    0:11:54 what it takes
    0:11:56 because Joe Biden
    0:11:58 liked his portrayal
    0:11:58 in what it takes.
    0:11:59 In fact,
    0:12:01 he had the research
    0:12:02 of what it takes
    0:12:03 to write both
    0:12:04 of his memoirs,
    0:12:05 ghostwrite both
    0:12:05 of his memoirs.
    0:12:07 I agree with you
    0:12:07 that he didn’t
    0:12:08 totally understand
    0:12:10 the portrayal
    0:12:11 and some of the
    0:12:12 damning parts of it.
    0:12:13 And I do think
    0:12:14 that Joe Biden,
    0:12:17 especially in 2022,
    0:12:17 early 2023,
    0:12:19 sort of saw himself
    0:12:21 as an indispensable man,
    0:12:22 right?
    0:12:23 The world’s on fire,
    0:12:25 Putin’s on the march,
    0:12:28 and he can save it
    0:12:29 in its own way.
    0:12:30 It’s his own version
    0:12:31 of I alone can fix it.
    0:12:33 I’m curious,
    0:12:34 Jake,
    0:12:34 what you think
    0:12:37 when I have the receipts here,
    0:12:38 but very early on,
    0:12:38 I’m like,
    0:12:39 this guy’s too old
    0:12:41 and that also
    0:12:42 that Vice President Harris
    0:12:43 would make a great
    0:12:44 Supreme Court justice
    0:12:45 and a terrible candidate.
    0:12:45 This is someone
    0:12:46 who didn’t make it to Iowa
    0:12:49 in the previous campaign.
    0:12:50 And I started getting
    0:12:52 text messages
    0:12:53 from some of the people
    0:12:54 we both know
    0:12:55 saying,
    0:12:55 Scott,
    0:12:57 do you not understand
    0:12:58 the assignment here?
    0:12:59 You’re about to get
    0:13:00 Trump reelected.
    0:13:02 And quite frankly,
    0:13:03 and I’m not proud of this,
    0:13:04 I acquiesced.
    0:13:07 I signed up
    0:13:08 because I was so scared
    0:13:09 of a Trump re-election
    0:13:10 and everyone convinced me
    0:13:12 this was the only path forward.
    0:13:12 I’m curious
    0:13:15 what your experience was
    0:13:15 with that.
    0:13:16 A,
    0:13:16 did you register
    0:13:17 that same kind of pressure?
    0:13:18 And what was the
    0:13:19 behind-the-scenes
    0:13:21 kind of arm-twisting
    0:13:22 across the media
    0:13:23 powerful or elite?
    0:13:25 You’re right
    0:13:25 that there is
    0:13:26 this huge pressure
    0:13:29 of what’s wrong
    0:13:29 with you.
    0:13:31 Do you want Trump
    0:13:32 in this Manichean world
    0:13:33 like the Manichean world,
    0:13:34 the idea that we’re
    0:13:35 supposed to be
    0:13:36 on one side
    0:13:36 or the other?
    0:13:38 And if you are
    0:13:39 criticizing Joe Biden
    0:13:40 for anything,
    0:13:42 you obviously are MAGA.
    0:13:44 I went through that
    0:13:46 in 2020,
    0:13:49 more in 2021
    0:13:51 when I provided
    0:13:52 very critical coverage
    0:13:53 of the withdrawal
    0:13:54 from Afghanistan.
    0:13:57 And I think
    0:13:58 they just always
    0:13:58 thought I was
    0:13:59 a pain in the ass
    0:14:00 that it didn’t
    0:14:01 bother me as much,
    0:14:03 which is not to say
    0:14:03 that I covered
    0:14:04 in retrospect
    0:14:05 the aging
    0:14:06 and cognition issue
    0:14:07 as much as I wish
    0:14:08 I had,
    0:14:09 knowing now
    0:14:10 what Alex and I
    0:14:12 were able to learn
    0:14:13 after the election,
    0:14:14 interviewing more than
    0:14:16 200 mostly Democratic
    0:14:17 insiders
    0:14:18 on stuff that they
    0:14:19 wouldn’t talk to us
    0:14:20 about until the election
    0:14:21 was over.
    0:14:22 I do think that there
    0:14:23 is a degree of media
    0:14:24 complicity that we
    0:14:25 can talk about,
    0:14:28 but the bottom line
    0:14:29 really is
    0:14:31 that President Biden,
    0:14:32 his family,
    0:14:33 and his top aides
    0:14:35 lied.
    0:14:36 They lied to the press.
    0:14:38 They lied to the public.
    0:14:39 They lied to their own
    0:14:39 cabinet secretaries.
    0:14:40 They lied to
    0:14:41 White House staffers.
    0:14:43 They lied to Democratic
    0:14:44 elected officials
    0:14:47 and it was a lie
    0:14:48 made evident
    0:14:49 to the world.
    0:14:51 Well, first of all,
    0:14:52 I mean, as you know,
    0:14:53 the public was
    0:14:54 long skeptical
    0:14:55 of his ability
    0:14:56 to do this job,
    0:14:57 but it was a lie
    0:14:57 that was
    0:15:00 almost unrefutable,
    0:15:01 irrefutable
    0:15:04 after the June 27th debate.
    0:15:05 So,
    0:15:06 while I can
    0:15:08 point to any number
    0:15:08 of individuals,
    0:15:10 including myself
    0:15:11 and every single
    0:15:11 human being
    0:15:12 outside the White House
    0:15:13 who wasn’t
    0:15:14 constantly shouting
    0:15:14 about this,
    0:15:15 the emperor
    0:15:16 has no clothes,
    0:15:17 I do think
    0:15:18 at the end of the day
    0:15:19 the man that you
    0:15:20 called a narcissist
    0:15:23 and his support network,
    0:15:24 his inner circle,
    0:15:26 are chiefly responsible
    0:15:29 for this lie’s strength
    0:15:31 as long as it existed.
    0:15:33 Alex, I’m curious.
    0:15:34 I remember thinking,
    0:15:36 where’s his wife?
    0:15:38 It just,
    0:15:39 you know,
    0:15:40 when you think
    0:15:41 about your family
    0:15:42 and their role,
    0:15:44 you trust them,
    0:15:45 you know they have
    0:15:45 your best interests
    0:15:46 at heart.
    0:15:47 I’m curious
    0:15:48 if you have any
    0:15:49 inside,
    0:15:50 you know,
    0:15:52 information or knowledge
    0:15:53 here or reporting
    0:15:54 around
    0:15:56 what First Lady
    0:15:57 Biden’s role
    0:15:58 was or was not
    0:15:59 in this process.
    0:16:00 You know,
    0:16:01 Jill Biden used to be
    0:16:01 a reluctant
    0:16:02 political spouse.
    0:16:03 You know,
    0:16:04 in 2004,
    0:16:06 she has this story
    0:16:07 where she literally
    0:16:08 walked into
    0:16:09 a political meeting
    0:16:10 that was about
    0:16:11 Biden running
    0:16:11 for president
    0:16:12 in 2004
    0:16:14 with a no
    0:16:15 and a sharpie
    0:16:16 written on her stomach
    0:16:17 while she was
    0:16:17 in a bikini.
    0:16:18 She just like
    0:16:19 strode through
    0:16:19 the meeting.
    0:16:21 who hasn’t done
    0:16:21 that?
    0:16:22 Yeah.
    0:16:25 That changes
    0:16:27 and starting in like
    0:16:27 2017,
    0:16:28 2018,
    0:16:29 2019,
    0:16:30 she becomes
    0:16:31 not just,
    0:16:32 you know,
    0:16:32 an unwilling
    0:16:33 political spouse.
    0:16:34 She becomes
    0:16:34 an enthusiastic
    0:16:37 and in a huge part
    0:16:38 of his political
    0:16:39 decision-making
    0:16:40 and operation,
    0:16:41 her chief aide
    0:16:43 becomes a deputy
    0:16:44 campaign manager
    0:16:45 on the 2020
    0:16:45 effort.
    0:16:46 Very unusual
    0:16:48 for the aide
    0:16:48 to a spouse
    0:16:49 to have that
    0:16:49 sort of role.
    0:16:50 He then also
    0:16:51 becomes one of
    0:16:52 the most powerful
    0:16:53 people in the
    0:16:54 White House.
    0:16:55 He’s vetting
    0:16:56 certain aides.
    0:16:57 He’s often
    0:16:57 vetting people
    0:16:58 for loyalty.
    0:17:00 He had enormous
    0:17:01 control over the
    0:17:02 schedule and would
    0:17:03 often, you know,
    0:17:05 say, oh, you know,
    0:17:05 the first lady’s not
    0:17:06 going to like this.
    0:17:07 They would throw
    0:17:08 that around a lot
    0:17:09 of the time.
    0:17:09 So the combination
    0:17:10 of the two of them
    0:17:12 had enormous power
    0:17:13 in the White House
    0:17:14 and there was
    0:17:15 this feeling that
    0:17:16 even though he was
    0:17:17 80 and was about
    0:17:18 to run for
    0:17:18 re-election,
    0:17:20 none of the
    0:17:21 senior people in
    0:17:22 the White House
    0:17:22 got in his face
    0:17:24 and said,
    0:17:25 maybe we shouldn’t
    0:17:25 do this.
    0:17:27 And part of the
    0:17:27 reason, now that
    0:17:29 I think speaks to
    0:17:30 their own
    0:17:31 lack of courage,
    0:17:33 but part of the
    0:17:33 reason was that
    0:17:34 this environment
    0:17:35 had been set up,
    0:17:36 and I think Jill
    0:17:37 was an indispensable
    0:17:38 part of this,
    0:17:40 of where loyalty
    0:17:41 was the first
    0:17:42 virtue
    0:17:43 and most
    0:17:44 important virtue.
    0:17:45 And if you
    0:17:46 questioned,
    0:17:47 then it
    0:17:48 automatically got
    0:17:48 to the First
    0:17:49 Lady and then
    0:17:50 that would get
    0:17:51 back to Joe.
    0:17:51 So I think
    0:17:52 that was part
    0:17:54 of how she
    0:17:55 pushed.
    0:17:55 And I think
    0:17:56 if you watch
    0:17:57 his appearance
    0:17:58 on The View
    0:17:59 the other week,
    0:18:00 I think you can
    0:18:02 see how she
    0:18:03 took her role
    0:18:03 as a loving
    0:18:04 spouse and protector
    0:18:06 and how it
    0:18:08 went to lengths
    0:18:09 that eventually
    0:18:10 became, you
    0:18:12 know, covering
    0:18:13 up for his
    0:18:14 deficiencies.
    0:18:15 Well, somebody
    0:18:15 close to the
    0:18:17 family told
    0:18:19 us that
    0:18:20 of all the
    0:18:20 mottos, you
    0:18:21 hear about my
    0:18:21 word is a
    0:18:22 Biden, et
    0:18:23 cetera, et
    0:18:23 cetera, but
    0:18:24 there’s one that
    0:18:24 Joe Biden
    0:18:26 doesn’t share
    0:18:26 on the stump.
    0:18:27 It’s crude.
    0:18:29 It’s never
    0:18:29 call a fat
    0:18:30 person fat.
    0:18:32 And what
    0:18:33 it means is
    0:18:34 not please
    0:18:35 be polite.
    0:18:36 It’s don’t
    0:18:37 point out ugly
    0:18:38 truths.
    0:18:39 And this is a
    0:18:41 family motto
    0:18:41 that might not
    0:18:42 be on the
    0:18:43 Biden family
    0:18:44 crest, but it
    0:18:45 explains a lot.
    0:18:48 It explains why
    0:18:49 they lied to
    0:18:51 the public about
    0:18:52 Beau and his
    0:18:54 health, why
    0:18:55 they were in
    0:18:56 denial about
    0:18:58 Hunter’s
    0:18:59 condition and
    0:19:00 their daughter’s
    0:19:01 condition.
    0:19:02 both of them
    0:19:03 struggling with
    0:19:03 addiction.
    0:19:05 It’s the
    0:19:07 lie of Joe
    0:19:08 Biden cares
    0:19:08 about his
    0:19:08 family more
    0:19:09 than he cares
    0:19:10 about his
    0:19:10 own ambition.
    0:19:11 It’s not
    0:19:12 true.
    0:19:13 Probably not
    0:19:15 true for most
    0:19:15 presidents, if
    0:19:16 not all
    0:19:16 presidents, but
    0:19:20 there is a
    0:19:21 belief in the
    0:19:22 mythology of
    0:19:23 Joe Biden that
    0:19:24 for his
    0:19:24 family and
    0:19:25 closest aides
    0:19:27 becomes not
    0:19:27 just a
    0:19:28 mythology, it
    0:19:29 becomes a
    0:19:29 theology.
    0:19:30 and like
    0:19:31 any
    0:19:31 theology,
    0:19:33 skeptics are
    0:19:34 not welcome.
    0:19:35 And that’s
    0:19:36 one of the
    0:19:36 ways that they
    0:19:37 got to the
    0:19:38 place where
    0:19:38 they were
    0:19:40 putting Joe
    0:19:42 Biden ahead of
    0:19:43 everything.
    0:19:45 They believed
    0:19:45 that he was the
    0:19:46 singular man who
    0:19:47 could save NATO
    0:19:49 and protect Ukraine,
    0:19:50 protect the
    0:19:50 country from
    0:19:51 Donald Trump.
    0:19:53 Just such a
    0:19:54 denial of
    0:19:55 realities.
    0:19:56 Don’t call a
    0:19:57 fat person fat.
    0:19:58 money.
    0:19:58 To the point
    0:19:59 that ultimately
    0:20:01 the whole
    0:20:01 country was
    0:20:02 like, okay,
    0:20:03 this can’t go
    0:20:04 on anymore.
    0:20:04 We’ve never
    0:20:05 seen anything
    0:20:05 like this
    0:20:05 before.
    0:20:07 So you
    0:20:08 talked to
    0:20:09 200 people.
    0:20:09 What were
    0:20:10 some of the,
    0:20:10 give us a few
    0:20:11 of the most
    0:20:12 surprising findings
    0:20:13 that were sort
    0:20:14 of like, whoa.
    0:20:15 There’s so
    0:20:16 many.
    0:20:16 I mean,
    0:20:19 the fact that
    0:20:20 in December
    0:20:21 2022,
    0:20:23 he couldn’t
    0:20:24 come up with
    0:20:24 the name,
    0:20:25 in the middle
    0:20:25 of the day,
    0:20:27 he couldn’t
    0:20:27 come up with
    0:20:27 the name
    0:20:28 of his
    0:20:29 national security
    0:20:29 advisor,
    0:20:30 Jake Sullivan,
    0:20:31 or his
    0:20:31 communications
    0:20:32 director,
    0:20:33 Kate Bedingfield.
    0:20:33 He didn’t,
    0:20:34 he called
    0:20:36 Jake Steve,
    0:20:36 and he called
    0:20:37 Kate Press.
    0:20:39 The fact that
    0:20:39 behind the
    0:20:40 scenes,
    0:20:43 as far
    0:20:43 back as
    0:20:44 April
    0:20:44 2023,
    0:20:46 he was
    0:20:47 having moments
    0:20:47 where
    0:20:48 Democratic
    0:20:49 Congressman
    0:20:50 Mike Quigley
    0:20:50 of Illinois
    0:20:51 saw him
    0:20:52 and it
    0:20:53 reminded him
    0:20:53 of his
    0:20:54 father who
    0:20:54 had passed
    0:20:54 away from
    0:20:55 Parkinson’s.
    0:20:56 That’s to
    0:20:56 the extent
    0:20:57 of how
    0:20:58 debilitated
    0:20:58 he seemed.
    0:21:00 I mean,
    0:21:01 the fact that
    0:21:02 they had
    0:21:03 the last
    0:21:03 cabinet meeting
    0:21:04 that they
    0:21:04 had in
    0:21:05 almost a
    0:21:05 year in
    0:21:05 October
    0:21:06 2023,
    0:21:06 and then
    0:21:07 cabinet
    0:21:07 secretaries
    0:21:08 told us
    0:21:08 that the
    0:21:09 White House
    0:21:11 kept them
    0:21:11 at bay,
    0:21:13 didn’t allow
    0:21:14 them to see
    0:21:14 him,
    0:21:16 and that
    0:21:18 in the
    0:21:19 intervening
    0:21:19 time,
    0:21:19 one of
    0:21:19 the
    0:21:19 cabinet
    0:21:20 secretaries
    0:21:20 had a
    0:21:20 meeting
    0:21:21 with him
    0:21:22 and he
    0:21:22 seemed
    0:21:23 disoriented
    0:21:23 and not
    0:21:24 with it.
    0:21:26 Other
    0:21:26 cabinet
    0:21:26 secretaries
    0:21:27 told us
    0:21:27 that,
    0:21:27 you know,
    0:21:28 that legendary
    0:21:29 test of a
    0:21:29 president,
    0:21:30 can he
    0:21:31 manage the
    0:21:31 emergency
    0:21:32 2 a.m.
    0:21:33 phone call?
    0:21:34 No.
    0:21:35 They didn’t
    0:21:35 think he
    0:21:36 could by
    0:21:36 the end
    0:21:36 of his
    0:21:37 presidency.
    0:21:37 All of
    0:21:37 this.
    0:21:38 But honestly,
    0:21:39 like literally,
    0:21:40 when I was
    0:21:41 doing the
    0:21:41 audio book,
    0:21:42 after every
    0:21:43 chapter,
    0:21:43 I would just
    0:21:43 say,
    0:21:44 holy shit,
    0:21:44 I still
    0:21:45 can’t believe
    0:21:45 this.
    0:21:45 Alex and
    0:21:46 I reported
    0:21:46 this and
    0:21:46 I still
    0:21:47 can’t
    0:21:47 believe it.
    0:21:49 I mean,
    0:21:49 I would
    0:21:50 also just
    0:21:50 add to
    0:21:51 that he
    0:21:51 didn’t
    0:21:52 recognize
    0:21:52 George
    0:21:52 Clooney.
    0:21:54 One of
    0:21:54 the most
    0:21:55 famous people
    0:21:55 in the
    0:21:55 world,
    0:21:56 someone also
    0:21:56 that he
    0:21:56 had a
    0:21:57 relationship
    0:21:57 with,
    0:21:57 who had,
    0:21:59 when he
    0:21:59 was in
    0:22:00 the Senate
    0:22:01 as chair
    0:22:02 of the
    0:22:02 Senate
    0:22:03 Foreign
    0:22:03 Relations
    0:22:04 Committee,
    0:22:04 you know,
    0:22:05 Clooney was
    0:22:05 involved in
    0:22:05 that.
    0:22:06 They’d
    0:22:06 known each
    0:22:06 other for a
    0:22:07 long time.
    0:22:08 at that
    0:22:08 fundraiser
    0:22:09 in June
    0:22:10 of 2024,
    0:22:11 and an
    0:22:12 aide had
    0:22:12 to be like,
    0:22:13 you remember
    0:22:13 George?
    0:22:14 And he’s
    0:22:14 like, yeah,
    0:22:15 yeah, yeah.
    0:22:15 And then
    0:22:16 George Clooney.
    0:22:17 And that
    0:22:18 moment is
    0:22:19 the seed to
    0:22:20 eventually George
    0:22:21 Clooney writing
    0:22:21 that op-ed.
    0:22:23 And I
    0:22:24 think that
    0:22:24 was just
    0:22:25 sort of a
    0:22:26 stunning
    0:22:27 revelation
    0:22:29 and the
    0:22:29 fact that
    0:22:30 it’s what
    0:22:31 sort of
    0:22:31 compelled
    0:22:32 Clooney to
    0:22:32 speak out.
    0:22:34 I’m hearing
    0:22:35 from all
    0:22:35 of these
    0:22:36 senior-level
    0:22:37 people or
    0:22:37 governors,
    0:22:38 many of
    0:22:38 whom,
    0:22:39 some served
    0:22:40 in the
    0:22:40 administration,
    0:22:40 and when
    0:22:41 people reach
    0:22:41 out to
    0:22:41 me,
    0:22:44 and they
    0:22:44 quote-unquote,
    0:22:44 they say,
    0:22:45 I’d love to
    0:22:45 get your
    0:22:46 views on
    0:22:46 something,
    0:22:46 which is
    0:22:47 Latin for
    0:22:47 I’m running
    0:22:48 for president
    0:22:48 and want
    0:22:48 to come
    0:22:48 on your
    0:22:49 podcast.
    0:22:51 And it
    0:22:52 strikes me
    0:22:53 that one
    0:22:53 of the
    0:22:53 biggest
    0:22:54 missed
    0:22:54 opportunities
    0:22:56 was in
    0:22:56 as elegant
    0:22:57 and kind
    0:22:58 a way
    0:22:58 possible
    0:22:58 for
    0:22:59 someone
    0:22:59 like
    0:22:59 Governor
    0:23:00 Newsom
    0:23:00 or
    0:23:01 Secretary
    0:23:02 Buttigieg to
    0:23:02 say,
    0:23:03 look,
    0:23:04 I adore
    0:23:05 the man,
    0:23:06 but I’m
    0:23:06 running for
    0:23:06 president.
    0:23:08 And it
    0:23:09 just struck
    0:23:09 me that
    0:23:11 nobody did.
    0:23:11 Well,
    0:23:12 Dean Phillips
    0:23:12 did,
    0:23:13 but yeah,
    0:23:13 no major
    0:23:14 character did.
    0:23:14 I had
    0:23:15 Representative
    0:23:15 Phillips
    0:23:15 on the
    0:23:16 pod,
    0:23:16 I think a
    0:23:16 lot of
    0:23:17 him,
    0:23:17 and I
    0:23:17 think he’s
    0:23:17 going to
    0:23:18 be,
    0:23:18 I think
    0:23:18 he’s a
    0:23:18 great
    0:23:19 representative.
    0:23:19 I just
    0:23:20 don’t
    0:23:20 think he
    0:23:20 had much
    0:23:21 of a
    0:23:22 shot
    0:23:22 there.
    0:23:22 I don’t
    0:23:23 think he
    0:23:23 was much
    0:23:23 of a,
    0:23:23 I don’t
    0:23:24 think he
    0:23:24 was a
    0:23:24 credible
    0:23:24 candidate.
    0:23:26 I mean,
    0:23:26 I don’t
    0:23:26 want to
    0:23:27 say they’re
    0:23:28 to blame,
    0:23:29 but didn’t
    0:23:29 they,
    0:23:30 it just
    0:23:31 struck me,
    0:23:31 it got so
    0:23:32 bad at the
    0:23:32 end.
    0:23:33 And what
    0:23:34 was it?
    0:23:34 Was it
    0:23:35 they thought
    0:23:35 they would
    0:23:36 immediately
    0:23:38 render their
    0:23:39 future ambitions
    0:23:42 less likely
    0:23:42 because a
    0:23:42 democratic
    0:23:43 machine would
    0:23:44 remember their
    0:23:45 lack of
    0:23:45 loyalty?
    0:23:46 It just
    0:23:46 felt like
    0:23:47 there was
    0:23:47 such a
    0:23:48 vacuum for
    0:23:49 someone to
    0:23:49 just raise
    0:23:50 their hand
    0:23:50 and say,
    0:23:51 love the
    0:23:51 guy,
    0:23:52 we’ll
    0:23:52 support him
    0:23:53 if he’s
    0:23:53 a nominee,
    0:23:54 but I’m
    0:23:54 throwing my
    0:23:55 hat in the
    0:23:55 ring.
    0:23:55 How come
    0:23:56 that didn’t
    0:23:56 happen?
    0:23:57 It’s a
    0:23:57 great
    0:23:58 question.
    0:23:58 I think
    0:23:59 that first
    0:23:59 of all,
    0:23:59 he was
    0:24:00 incumbent
    0:24:00 president,
    0:24:01 and that’s
    0:24:02 very
    0:24:02 difficult
    0:24:03 to do.
    0:24:04 And usually
    0:24:05 when you
    0:24:05 do that,
    0:24:06 whether you
    0:24:07 are Pat
    0:24:08 Buchanan
    0:24:09 or Ted
    0:24:09 Kennedy,
    0:24:10 you are
    0:24:11 tarred with
    0:24:11 the
    0:24:12 disloyal
    0:24:13 label.
    0:24:14 That said,
    0:24:16 there were
    0:24:17 efforts to
    0:24:17 try to
    0:24:19 get a
    0:24:20 Pritzker
    0:24:21 or a
    0:24:21 Whitmer
    0:24:21 or a
    0:24:22 Newsom
    0:24:23 to run.
    0:24:24 Bill
    0:24:24 Daley,
    0:24:25 the former
    0:24:26 Obama
    0:24:26 White House
    0:24:27 chief of
    0:24:27 staff,
    0:24:28 tried to
    0:24:29 get them
    0:24:29 to.
    0:24:30 Dean
    0:24:31 Phillips
    0:24:32 tried to
    0:24:32 get them
    0:24:33 to before
    0:24:33 he became
    0:24:34 a nominee.
    0:24:34 We have
    0:24:35 a whole
    0:24:35 chapter on
    0:24:36 Congressman
    0:24:36 Phillips.
    0:24:39 And the
    0:24:39 truth of
    0:24:39 the matter
    0:24:40 is, you
    0:24:40 know, you
    0:24:41 read this
    0:24:42 book, there
    0:24:42 is not a
    0:24:42 lot of
    0:24:43 courage.
    0:24:45 There’s not
    0:24:46 a lot of
    0:24:46 risk.
    0:24:47 And it’s
    0:24:48 a risky
    0:24:48 venture to
    0:24:49 say I’m
    0:24:49 going to
    0:24:49 challenge the
    0:24:50 incumbent
    0:24:51 president.
    0:24:51 What I
    0:24:52 wonder more
    0:24:53 than that
    0:24:54 is where
    0:24:56 was the
    0:24:58 group of
    0:24:59 Democrats.
    0:25:01 Parties are
    0:25:01 so weak
    0:25:02 these days.
    0:25:02 But where
    0:25:03 was the
    0:25:05 DNC chair,
    0:25:06 Democratic
    0:25:06 leader of
    0:25:06 the Senate,
    0:25:07 Democratic
    0:25:07 leader of
    0:25:08 the House
    0:25:09 to say,
    0:25:10 look, you
    0:25:11 are historically
    0:25:12 unpopular.
    0:25:13 And beyond
    0:25:14 that, you’re
    0:25:15 having moments
    0:25:17 that I
    0:25:18 think that you
    0:25:18 should think
    0:25:19 about retiring
    0:25:21 and going
    0:25:21 out on top.
    0:25:23 But they
    0:25:23 didn’t do
    0:25:24 that either.
    0:25:24 And in
    0:25:25 fact, even
    0:25:25 towards the
    0:25:27 end, the
    0:25:27 only person
    0:25:28 we could find
    0:25:29 who directly
    0:25:31 told President
    0:25:31 Biden, I
    0:25:32 don’t think
    0:25:32 he should run
    0:25:34 again, was
    0:25:34 Chuck Schumer
    0:25:35 at the very,
    0:25:37 very end, one
    0:25:37 week before he
    0:25:38 dropped out.
    0:25:41 Even the Nancy
    0:25:41 Pelosi’s and
    0:25:42 Barack Obama’s
    0:25:43 Hakeem Jeffries
    0:25:44 did not directly
    0:25:45 say it.
    0:25:45 They would say
    0:25:46 things like,
    0:25:47 we just want to
    0:25:47 make sure you
    0:25:48 have all the
    0:25:48 access to all
    0:25:49 the information.
    0:25:49 You need all
    0:25:49 the polling
    0:25:50 information.
    0:25:52 I don’t know
    0:25:53 that Joe Biden
    0:25:53 would have ever
    0:25:54 dropped out.
    0:25:54 no matter
    0:25:54 what.
    0:25:55 I think he
    0:25:56 only dropped
    0:25:56 out at the
    0:25:56 very, very
    0:25:57 end because
    0:25:58 he had to.
    0:25:58 It would have
    0:25:59 been a disaster.
    0:25:59 It would have
    0:25:59 been a bloody
    0:26:00 convention.
    0:26:02 But that said,
    0:26:03 yeah, nobody
    0:26:04 really acquits
    0:26:04 themselves very
    0:26:05 well in this.
    0:26:07 I was under
    0:26:07 the impression
    0:26:08 the relationship
    0:26:08 between him
    0:26:09 and Obama
    0:26:09 was very
    0:26:10 strained,
    0:26:11 in that Obama
    0:26:13 saw the writing
    0:26:13 on the wall,
    0:26:15 but President
    0:26:15 Biden had
    0:26:15 already sort
    0:26:16 of shut
    0:26:16 him out.
    0:26:17 Is that
    0:26:18 true?
    0:26:20 yes, and
    0:26:21 Obama is
    0:26:22 very aware
    0:26:22 of that,
    0:26:23 which is
    0:26:24 why, despite
    0:26:25 I think some
    0:26:26 of the narrative
    0:26:27 that Obama
    0:26:27 was the one
    0:26:28 that pushed
    0:26:29 Biden out,
    0:26:30 he was involved,
    0:26:31 but he was
    0:26:31 aware enough
    0:26:32 of Biden’s
    0:26:33 resentments
    0:26:35 that he was
    0:26:37 wary of seeming
    0:26:38 involved because
    0:26:38 he knew it would
    0:26:39 just make Biden
    0:26:40 dig in more.
    0:26:41 And the reason
    0:26:41 the relationship
    0:26:42 is strained,
    0:26:42 there’s two
    0:26:43 reasons.
    0:26:43 One’s political,
    0:26:44 one’s personal.
    0:26:45 One is that
    0:26:46 Biden and the
    0:26:47 people around him
    0:26:48 have never
    0:26:48 gotten over
    0:26:49 that Obama
    0:26:50 favored Hillary
    0:26:51 as the successor
    0:26:51 rather than
    0:26:53 Biden in 2016.
    0:26:54 He wrote about
    0:26:54 it in his
    0:26:55 memoir, but
    0:26:56 it’s still
    0:26:56 something that
    0:26:58 enrages them
    0:26:59 that Obama
    0:26:59 never took me
    0:27:00 seriously,
    0:27:02 never gave me
    0:27:03 the full credit.
    0:27:04 And there’s
    0:27:05 a personal one
    0:27:05 too, and
    0:27:07 Hunter Biden’s
    0:27:08 ex-wife,
    0:27:08 now ex-wife,
    0:27:10 is very good
    0:27:10 friends with
    0:27:11 Michelle Obama.
    0:27:12 It’s why
    0:27:13 Michelle Obama
    0:27:14 resisted
    0:27:15 campaigning for
    0:27:15 Joe Biden
    0:27:16 in 2020.
    0:27:17 It didn’t get
    0:27:18 much noticed
    0:27:19 because of
    0:27:20 COVID, and
    0:27:21 it’s also why
    0:27:22 she was
    0:27:23 resistant to
    0:27:23 campaigning for
    0:27:24 him in
    0:27:25 2024.
    0:27:26 That
    0:27:28 relationship,
    0:27:29 there is a
    0:27:30 rift there.
    0:27:31 Now, the
    0:27:31 Obama people
    0:27:32 will be like,
    0:27:33 we like Joe,
    0:27:34 we don’t have
    0:27:34 any resentments.
    0:27:35 The resentments
    0:27:36 mostly seem to
    0:27:38 be on the
    0:27:39 Biden side
    0:27:40 toward the
    0:27:40 Obama’s.
    0:27:42 Give us
    0:27:42 some insight
    0:27:42 into the
    0:27:43 relationship.
    0:27:44 My thesis
    0:27:45 has always
    0:27:45 been that
    0:27:48 competition and
    0:27:48 politics make
    0:27:49 strange bedfellows,
    0:27:51 but I’ve
    0:27:51 always felt that
    0:27:51 the reason
    0:27:52 Vice President
    0:27:53 Harris, who
    0:27:53 was an
    0:27:54 immensely qualified
    0:27:55 person, but the
    0:27:55 reason she got the
    0:27:56 nod to be the
    0:27:56 vice president was
    0:27:57 because she
    0:27:57 called the
    0:27:58 President Biden
    0:27:59 a racist on a
    0:27:59 debate stage, so
    0:28:00 they thought of
    0:28:00 her as a
    0:28:00 fighter.
    0:28:02 I don’t think
    0:28:02 so.
    0:28:04 I think that
    0:28:05 almost cost her
    0:28:05 the nomination
    0:28:06 because Jill
    0:28:07 Biden was
    0:28:08 so resentful
    0:28:09 of it.
    0:28:10 At the end
    0:28:11 of the day,
    0:28:12 he had promised
    0:28:13 he would pick a
    0:28:13 woman vice
    0:28:14 president.
    0:28:14 He never
    0:28:15 promised he
    0:28:15 would pick an
    0:28:16 African-American
    0:28:17 woman vice
    0:28:17 president.
    0:28:17 He said he’d
    0:28:18 pick an
    0:28:18 African-American
    0:28:19 woman Supreme
    0:28:20 Court justice,
    0:28:20 but it kind of
    0:28:21 became this
    0:28:23 thing after
    0:28:24 George Floyd
    0:28:25 and the
    0:28:26 protests there
    0:28:26 that he felt
    0:28:27 like he had
    0:28:27 to pick a
    0:28:28 black woman.
    0:28:29 It really,
    0:28:30 at the end of
    0:28:30 the day,
    0:28:31 truly came
    0:28:31 down to
    0:28:33 Kamala Harris,
    0:28:34 who had been
    0:28:35 in the view
    0:28:35 of the Biden
    0:28:37 team vetted
    0:28:37 on a national
    0:28:38 stage because
    0:28:39 she had been
    0:28:40 a candidate
    0:28:40 for president,
    0:28:41 even though,
    0:28:41 as you point
    0:28:41 out, she
    0:28:42 didn’t even
    0:28:42 make it to
    0:28:44 2020, much
    0:28:44 less Iowa.
    0:28:45 And even
    0:28:46 though they
    0:28:47 were publicly
    0:28:48 talking about
    0:28:49 people like
    0:28:50 Congresswoman
    0:28:52 Karen Bass,
    0:28:52 who’s now the
    0:28:53 mayor of Los
    0:28:53 Angeles, and
    0:28:54 Congresswoman
    0:28:55 Val Demings
    0:28:55 from Florida,
    0:28:56 those two
    0:28:57 weren’t really
    0:28:57 in the final
    0:28:58 two.
    0:28:59 It was Gretchen
    0:28:59 Whitmer of
    0:28:59 Michigan,
    0:29:01 and Kamala
    0:29:02 Harris.
    0:29:03 Biden liked
    0:29:04 Whitmer more.
    0:29:05 He had more
    0:29:05 affection for
    0:29:06 her, saw
    0:29:07 her as more
    0:29:08 of a Biden
    0:29:09 Democrat type
    0:29:11 from a gritty
    0:29:14 Midwestern state.
    0:29:15 But at the
    0:29:15 end of the
    0:29:16 day, just
    0:29:19 the image
    0:29:20 of him
    0:29:22 with Kamala
    0:29:22 Harris, who
    0:29:23 was of the
    0:29:24 progressive left
    0:29:25 at that point,
    0:29:26 even though she
    0:29:27 really previously
    0:29:28 had been more
    0:29:29 of a moderate
    0:29:30 in California,
    0:29:32 African-American
    0:29:33 woman,
    0:29:34 vetted, had
    0:29:35 gone after him
    0:29:36 in the debate.
    0:29:37 And so there
    0:29:37 were people on
    0:29:38 the staff who
    0:29:38 thought, well,
    0:29:39 this shows that
    0:29:40 he’s like bigger
    0:29:41 than that sort
    0:29:41 of thing.
    0:29:43 But Jill Biden
    0:29:44 really, really
    0:29:45 resented her.
    0:29:46 And while
    0:29:47 President Biden
    0:29:48 and Kamala
    0:29:49 Harris, I think,
    0:29:50 developed a
    0:29:51 genuine warmth,
    0:29:53 theirs was not
    0:29:54 the partnership
    0:29:55 of a Bush
    0:29:56 and Cheney,
    0:29:57 or a Clinton
    0:29:58 and Gore,
    0:29:59 or an Obama
    0:29:59 and Biden,
    0:30:01 she was
    0:30:02 relegated to
    0:30:03 lesser tasks.
    0:30:04 The team
    0:30:04 never really
    0:30:05 thought of her
    0:30:07 as the
    0:30:07 heir apparent
    0:30:08 until the
    0:30:09 very end.
    0:30:09 In fact,
    0:30:10 they would use
    0:30:10 her as an
    0:30:11 excuse as to
    0:30:11 why Biden
    0:30:12 couldn’t step
    0:30:12 down.
    0:30:13 You want
    0:30:13 Kamala to be
    0:30:14 the nominee?
    0:30:15 She’s less
    0:30:16 popular than
    0:30:16 Biden.
    0:30:19 which enraged
    0:30:19 other Democrats
    0:30:21 because it was
    0:30:21 like, you
    0:30:22 picked her.
    0:30:23 Some people
    0:30:24 in the Biden
    0:30:24 world have
    0:30:26 quipped, you
    0:30:26 know, actually
    0:30:27 the original
    0:30:27 sin was picking
    0:30:28 her because,
    0:30:30 you know, they
    0:30:31 felt that she
    0:30:32 was not ready
    0:30:33 or was not
    0:30:33 electable.
    0:30:35 But at the
    0:30:36 end of the
    0:30:36 day, that was
    0:30:37 their choice.
    0:30:37 And it was,
    0:30:38 you know, picking
    0:30:39 a vice president
    0:30:39 is one of the
    0:30:40 most consequential
    0:30:42 choices, you
    0:30:42 know, a
    0:30:42 presidential
    0:30:43 candidate faces.
    0:30:44 What color
    0:30:45 insight can you
    0:30:46 provide on the
    0:30:47 relationship between
    0:30:47 President Biden
    0:30:48 and Vice
    0:30:49 President Harris
    0:30:49 so the public
    0:30:50 may not have
    0:30:51 that nuance?
    0:30:52 You know, there
    0:30:53 was a little bit
    0:30:54 of strain.
    0:30:54 You know, Jake
    0:30:56 spoke to some
    0:30:56 of this, but,
    0:30:57 you know, the
    0:30:58 way that Biden
    0:30:58 would call her
    0:31:00 a kid, right?
    0:31:01 Like, I think
    0:31:01 Kamala Harris,
    0:31:02 according to
    0:31:03 people around
    0:31:04 her, they
    0:31:04 thought, she
    0:31:05 thought of
    0:31:05 herself as a
    0:31:06 peer.
    0:31:07 And Biden
    0:31:09 saw her as,
    0:31:10 you know, a
    0:31:11 kid and someone
    0:31:11 that had been
    0:31:12 really good friends
    0:31:13 with his late
    0:31:14 son, Beau
    0:31:15 Biden, when
    0:31:15 they were both
    0:31:16 state attorneys
    0:31:16 general.
    0:31:18 And even
    0:31:19 on the staff
    0:31:20 level is where
    0:31:21 the tension
    0:31:22 really was,
    0:31:23 where the
    0:31:24 Biden team
    0:31:25 didn’t think
    0:31:27 she was very
    0:31:28 good, thought
    0:31:29 she was creating
    0:31:30 headaches for
    0:31:30 them all the
    0:31:31 time, was
    0:31:34 not, and also
    0:31:34 didn’t think she
    0:31:35 was, like, a
    0:31:35 very nice person.
    0:31:37 And to Jake’s
    0:31:37 point, they
    0:31:39 used that dim
    0:31:41 view of her to
    0:31:43 rationalize, you
    0:31:43 know, running
    0:31:44 for re-election.
    0:31:46 which is
    0:31:47 twisted, because
    0:31:47 as you know,
    0:31:48 it’s got the,
    0:31:49 they could have
    0:31:49 made her a
    0:31:50 Supreme Court
    0:31:51 justice, right?
    0:31:52 They could have
    0:31:52 said at some
    0:31:54 point, when that
    0:31:54 position came
    0:31:56 open, we’re
    0:31:56 going to make
    0:31:56 you a Supreme
    0:31:57 Court justice,
    0:31:58 and, you
    0:31:59 know, if you
    0:32:00 want to resign
    0:32:01 from the court
    0:32:02 and run for
    0:32:03 president in the
    0:32:03 future, that’s
    0:32:04 on you, but,
    0:32:05 you know, we
    0:32:06 got to put
    0:32:07 somebody who
    0:32:08 we think can
    0:32:08 actually be
    0:32:09 vice president
    0:32:10 and actually be
    0:32:11 president, if
    0:32:11 need be.
    0:32:12 And she
    0:32:13 probably, let’s
    0:32:14 be honest, I
    0:32:15 mean, she’s
    0:32:16 certainly not the
    0:32:17 legal mind that
    0:32:18 Ketanji Brown-Jackson
    0:32:19 is, but she
    0:32:19 would have been
    0:32:20 confirmed.
    0:32:21 She’s a senator.
    0:32:21 She’s a former
    0:32:23 attorney general of
    0:32:23 California.
    0:32:24 The U.S.
    0:32:25 Senate is a
    0:32:27 fairly, they love
    0:32:28 to sniff each
    0:32:28 other.
    0:32:29 I mean, you
    0:32:31 know, a senator is
    0:32:31 good enough for any
    0:32:33 position, so I
    0:32:33 think she would
    0:32:33 have been confirmed.
    0:32:34 This is all
    0:32:36 Earth-2 stuff, but
    0:32:36 if they really
    0:32:37 didn’t think she
    0:32:38 was qualified, there
    0:32:39 was an out right
    0:32:39 there.
    0:32:41 We’ll be right
    0:32:42 back after a
    0:32:42 quick break.
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    0:35:06 Listen, I get it.
    0:35:07 Naming a streaming
    0:35:08 service is hard.
    0:35:09 There’s a lot to
    0:35:09 choose from.
    0:35:10 Most of the words
    0:35:11 are nonsensical.
    0:35:12 But there is simply
    0:35:13 no excuse for the
    0:35:14 fact that Warner
    0:35:15 Brothers Discovery
    0:35:16 got rid of the
    0:35:17 name HBO, one of
    0:35:18 the best brands in
    0:35:20 television, only to
    0:35:21 decide a few years
    0:35:22 later that, oh,
    0:35:22 actually, it should
    0:35:23 have been called
    0:35:24 HBO Max all along.
    0:35:25 This week on the
    0:35:26 Vergecast, we talk
    0:35:27 about how this
    0:35:28 branding disaster at
    0:35:30 HBO came to be and
    0:35:31 what might happen
    0:35:31 next.
    0:35:32 Plus, everything
    0:35:33 happening at ESPN,
    0:35:34 the future of Fox,
    0:35:36 and what happens if
    0:35:37 you get ants in your
    0:35:38 Sonos speaker.
    0:35:39 All that and more on
    0:35:40 the Vergecast, wherever
    0:35:41 you get podcasts.
    0:35:52 try and put us in the
    0:35:52 room.
    0:35:53 Like, what was the
    0:35:56 moment that you
    0:35:57 said, okay, it’s
    0:35:58 over?
    0:36:00 I mean, what was, to
    0:36:01 me, it sounded, you
    0:36:02 said, a threat of a
    0:36:03 chaotic election.
    0:36:04 I was under the
    0:36:05 impression that
    0:36:07 Speaker Pelosi or
    0:36:08 somebody had said,
    0:36:09 every day I’m going
    0:36:10 to have Democrats
    0:36:12 come out against you
    0:36:13 and it’s going to be
    0:36:14 humiliating for you.
    0:36:14 That didn’t happen.
    0:36:16 No, so it’s very
    0:36:17 complicated.
    0:36:19 So, I mean, there is
    0:36:20 this impression that it
    0:36:23 was this grand plan
    0:36:25 with Schumer,
    0:36:26 Jeffries, Pelosi, and
    0:36:27 Obama pulling strings
    0:36:30 and deciding things.
    0:36:32 But no, it was much
    0:36:33 more organic than
    0:36:33 that.
    0:36:34 Pelosi and Schumer
    0:36:36 both got members of
    0:36:38 their caucus to hold
    0:36:39 off on calling for
    0:36:40 him to step down at
    0:36:41 different times.
    0:36:43 And wielded those
    0:36:46 public, the threat of
    0:36:47 more public calls for
    0:36:49 him to step down as
    0:36:50 a threat to get
    0:36:51 things.
    0:36:53 To get, that’s how
    0:36:54 Schumer got a meeting
    0:36:57 with the Biden White
    0:36:58 House and campaign
    0:36:59 leadership.
    0:37:00 by saying, if you
    0:37:02 don’t do this, I
    0:37:03 got six senators who
    0:37:04 are ready to come out
    0:37:04 right now.
    0:37:05 And so they did that
    0:37:06 meeting.
    0:37:09 But at the very end,
    0:37:11 after a drumbeat of
    0:37:13 House Democrats on
    0:37:15 their own coming out,
    0:37:17 and by the end, I
    0:37:17 think it was like
    0:37:18 something like 40,
    0:37:19 which is really kind
    0:37:20 of a small number
    0:37:20 when you think about
    0:37:21 how many of them
    0:37:22 actually wanted him
    0:37:22 to step down.
    0:37:25 And it was pretty
    0:37:26 organic.
    0:37:27 The Biden people were
    0:37:29 still in denial.
    0:37:30 But what I think
    0:37:31 changed the equation
    0:37:34 was you have Chuck
    0:37:36 Schumer goes to visit
    0:37:38 the president in
    0:37:38 Delaware.
    0:37:42 He has to threaten
    0:37:42 that he’s going to
    0:37:43 call for the meeting
    0:37:44 if they don’t give it
    0:37:45 to him publicly.
    0:37:46 So they say, if you
    0:37:47 don’t give it to me,
    0:37:47 I’m going to call for
    0:37:48 it and you’re going to
    0:37:48 have to give it to me.
    0:37:49 So let me come and
    0:37:49 visit him.
    0:37:51 He goes and visits him.
    0:37:53 This is after Pelosi
    0:37:54 and Jeffries have both
    0:37:56 made it clear to Biden
    0:37:57 the House Democratic
    0:37:59 Caucus doesn’t want him
    0:37:59 to be the nominee
    0:38:01 anymore and they think
    0:38:02 they’re going to lose
    0:38:03 – they’re not going to
    0:38:04 be able to recapture
    0:38:07 the House and that
    0:38:08 they’re worried that he’s
    0:38:09 not getting the polling
    0:38:09 data that they’re
    0:38:10 getting.
    0:38:12 Schumer goes there and
    0:38:14 he says – he tells
    0:38:15 that – he tells Biden
    0:38:15 about the meeting that
    0:38:18 the House – the Senate
    0:38:19 Democrats have had with
    0:38:20 the campaign leadership.
    0:38:21 What Schumer had told
    0:38:23 Biden’s top aides,
    0:38:25 Mike Donilon and Steve
    0:38:27 Ruschetti, tell the
    0:38:28 president every detail
    0:38:29 of this and then it
    0:38:30 got back to Schumer
    0:38:31 that they hadn’t.
    0:38:32 So that’s why he called
    0:38:33 for the private meeting.
    0:38:34 He went there and he
    0:38:37 basically said, of the
    0:38:40 51-member Senate
    0:38:42 Democratic caucus, there
    0:38:44 are five who want you
    0:38:45 to stay as the nominee.
    0:38:46 And that meant a lot to
    0:38:47 Joe Biden personally
    0:38:49 because at that point,
    0:38:51 by the way, I think
    0:38:53 only one had publicly
    0:38:55 called for him to not
    0:38:55 be the nominee anymore.
    0:38:56 I think Senator
    0:38:57 Welch from Vermont.
    0:38:59 They were all holding
    0:39:00 back.
    0:39:02 But a number of them
    0:39:03 were very worried,
    0:39:04 especially the ones up
    0:39:04 for re-election.
    0:39:07 So that was a deciding
    0:39:07 factor.
    0:39:10 Also, one week later,
    0:39:13 when Biden was very
    0:39:13 sick with COVID,
    0:39:16 and I can’t imagine
    0:39:17 what it was like for
    0:39:18 an 81-year-old man
    0:39:19 who’s insisting on his
    0:39:21 health and vigor to
    0:39:22 have been laid up with
    0:39:23 COVID in isolation,
    0:39:25 Ruschetti and Donilon
    0:39:25 meet with him and
    0:39:27 they tell him something
    0:39:28 that hasn’t been
    0:39:30 reported until this book,
    0:39:32 which is the woman
    0:39:33 running the Democratic
    0:39:34 National Convention,
    0:39:35 which was about
    0:39:36 three weeks away,
    0:39:38 was a woman named
    0:39:38 Mignon Moore,
    0:39:39 longtime respected
    0:39:40 Democratic operative.
    0:39:41 When she got the job
    0:39:43 in 2023, she formed
    0:39:44 an ad hoc committee
    0:39:45 called the What If
    0:39:46 Committee.
    0:39:47 Not on the books,
    0:39:48 but it was just a group
    0:39:49 of maybe a dozen
    0:39:50 or so people involved
    0:39:51 in the convention,
    0:39:52 and it was,
    0:39:55 what if the protests
    0:39:57 in Chicago turn out
    0:39:59 to be like the protests
    0:40:00 in the 68 convention?
    0:40:02 What if Joe Biden’s
    0:40:03 no longer the nominee?
    0:40:04 What if this?
    0:40:04 What if that?
    0:40:05 After the debate,
    0:40:07 they started regularly
    0:40:07 reaching out to the
    0:40:09 delegates, and they
    0:40:11 were hearing from the
    0:40:12 delegates how much
    0:40:13 bleeding there was
    0:40:14 going on.
    0:40:15 And the What If
    0:40:16 Committee told
    0:40:17 Ruschetti and Donilon,
    0:40:19 if you go to the
    0:40:20 convention, if the
    0:40:21 president takes this
    0:40:21 to the convention,
    0:40:23 he can still win,
    0:40:26 but it will be ugly
    0:40:27 and it will be close.
    0:40:29 So all of this data,
    0:40:31 you don’t have the
    0:40:32 support of the senators,
    0:40:33 it’s going to be an
    0:40:34 ugly battle.
    0:40:36 Schumer had also told
    0:40:39 Biden what Donilon
    0:40:40 and Ruschetti had not,
    0:40:40 which is,
    0:40:42 your own pollsters
    0:40:43 don’t think you can win.
    0:40:45 They think there’s a
    0:40:46 5% chance that you can win.
    0:40:49 And that is not what
    0:40:50 Donilon
    0:40:53 had been telling
    0:40:54 the president.
    0:40:55 Donilon was the,
    0:40:57 the pollsters never
    0:40:58 talked to Biden.
    0:40:59 They would talk to
    0:41:00 Donilon and Ruschetti
    0:41:01 and Donilon would
    0:41:02 interpret the information
    0:41:04 and he’s still
    0:41:04 interpreting it out there.
    0:41:05 You hear him at
    0:41:06 Harvard, the Harvard
    0:41:07 Institute of Politics
    0:41:08 talking about it was
    0:41:09 only a two-point race,
    0:41:10 et cetera, et cetera.
    0:41:11 Just absolute nonsense.
    0:41:13 Anyway, I think at the
    0:41:14 end of the day,
    0:41:16 a very sick Biden
    0:41:17 saw the writing on the
    0:41:19 wall, saw that the
    0:41:20 only way he was going
    0:41:21 to win the nomination
    0:41:22 was with a hideous
    0:41:23 convention.
    0:41:25 None of the Democrats
    0:41:26 in the House,
    0:41:27 none of the Democrats
    0:41:28 in the Senate,
    0:41:30 I’m using none loosely,
    0:41:31 but few,
    0:41:32 few in the Democrats
    0:41:32 in the House,
    0:41:33 few in the Democrats
    0:41:33 in the Senate
    0:41:34 wanted him to be the
    0:41:35 nominee and he just saw
    0:41:36 the writing on the wall.
    0:41:37 But it took three
    0:41:38 excruciating weeks.
    0:41:41 Just from a spectator
    0:41:42 standpoint,
    0:41:43 it sounds like it would
    0:41:43 have been such great
    0:41:46 theater if he’d said,
    0:41:47 stuck up the middle
    0:41:47 finger and said,
    0:41:48 no, I’m going to the
    0:41:48 convention, I’m going
    0:41:49 to be the nominee.
    0:41:51 All hell breaks loose
    0:41:52 at the convention.
    0:41:54 And let’s assume
    0:41:55 he didn’t get it.
    0:41:56 I’m curious,
    0:41:57 so with the two of you
    0:41:58 just speculating,
    0:41:59 trying to game theory
    0:42:00 it out,
    0:42:01 who do you think
    0:42:02 were the likely,
    0:42:03 who would have emerged
    0:42:07 from a contested
    0:42:07 convention or a
    0:42:08 bloody convention,
    0:42:09 who do you think
    0:42:10 most likely would have
    0:42:11 emerged victorious
    0:42:12 if Biden had decided
    0:42:13 to go the distance
    0:42:14 but didn’t end up
    0:42:15 the nominee?
    0:42:16 It’s such an
    0:42:16 interesting question
    0:42:17 because how does
    0:42:19 Biden brawling,
    0:42:20 how does it affect
    0:42:20 Kamala Harris?
    0:42:22 And does Kamala
    0:42:23 Harris stick with him
    0:42:24 completely until the
    0:42:25 end, when does she
    0:42:27 break, if at all?
    0:42:28 And does that
    0:42:29 sour her chances?
    0:42:30 Now, you know,
    0:42:31 Black woman is a
    0:42:31 demographic of the
    0:42:32 most loyal voting
    0:42:33 bloc in the
    0:42:34 Democratic Party.
    0:42:36 And it was made
    0:42:37 very clear, we have
    0:42:37 some reporting,
    0:42:39 that many of the
    0:42:40 Black leaders of the
    0:42:41 party were like,
    0:42:42 you are not going
    0:42:45 to pass over the
    0:42:46 first Black woman
    0:42:46 vice president.
    0:42:47 So she had the
    0:42:48 inside track, but
    0:42:49 given the connection
    0:42:50 to Biden, if he
    0:42:50 went to the
    0:42:52 convention, it would
    0:42:53 have been, that
    0:42:53 could have
    0:42:54 actually sunk her.
    0:42:56 After that, you
    0:42:57 have to look, you
    0:42:57 know, there was
    0:42:59 already sort of
    0:43:01 what I called in
    0:43:03 2023 the just-in-case
    0:43:03 primary.
    0:43:05 You know, Newsom,
    0:43:06 J.B.
    0:43:08 Pritzker, Gretchen
    0:43:10 Whitmer were all
    0:43:13 very subtly, you
    0:43:14 know, laying track
    0:43:15 just-in-case.
    0:43:16 I think J.B.
    0:43:17 Pritzker, given the
    0:43:18 fact that the
    0:43:19 convention was in
    0:43:20 Chicago, the fact
    0:43:21 that he had, that
    0:43:21 he’s a billionaire
    0:43:22 and has a ton of
    0:43:23 money and would
    0:43:24 have said, I’m
    0:43:24 going to spend a
    0:43:25 billion dollars to
    0:43:26 beat Trump, I
    0:43:27 guess, in my
    0:43:28 Aaron Sorkin, I
    0:43:29 actually somehow
    0:43:30 think that he
    0:43:31 could have pulled
    0:43:31 it off.
    0:43:32 Now, Newsom is
    0:43:33 like a great
    0:43:34 political athlete.
    0:43:35 You know, it would
    0:43:36 have been interesting
    0:43:36 to see if he could
    0:43:37 rally enough
    0:43:38 delegates, but I
    0:43:39 think the
    0:43:40 combination of it
    0:43:40 being Chicago and
    0:43:42 the fear of
    0:43:43 Trump would have
    0:43:44 made them go with
    0:43:45 a little bit of a
    0:43:46 less risky option.
    0:43:47 So your money
    0:43:48 would have been on
    0:43:48 Pritzker.
    0:43:49 Yes.
    0:43:50 That’s really
    0:43:51 interesting.
    0:43:53 So this is a
    0:43:56 corpus that, you
    0:43:57 know, that through
    0:43:58 their machination and
    0:43:59 process and
    0:44:01 infrastructure decided
    0:44:02 to keep Biden, and
    0:44:02 that’s the
    0:44:03 Democratic Party.
    0:44:04 What does this say
    0:44:06 about the
    0:44:06 shortcomings of the
    0:44:07 Democratic Party?
    0:44:09 And if they engage
    0:44:10 the two of you, and
    0:44:10 I’m sure they’ve
    0:44:11 asked you this
    0:44:12 question, what
    0:44:13 needs to change
    0:44:13 about the
    0:44:15 Democratic Party in
    0:44:15 terms of its
    0:44:16 responsibility to
    0:44:18 mature or
    0:44:19 gestate the best
    0:44:21 candidate to win
    0:44:22 the election?
    0:44:24 What changes, what
    0:44:25 does this reflect about
    0:44:25 the Democratic
    0:44:26 machinery and what
    0:44:27 needs to change?
    0:44:30 The last election that
    0:44:32 I can think of, the
    0:44:33 last primary election
    0:44:34 that I can think of
    0:44:35 where Democrats
    0:44:36 actually allowed the
    0:44:39 Democratic voters to
    0:44:42 pick the nominee was
    0:44:45 2008 when they picked
    0:44:46 Barack Obama.
    0:44:48 And remember, the
    0:44:49 consensus, the
    0:44:50 Democratic leadership
    0:44:51 consensus was kind of
    0:44:52 Hillary Clinton, but
    0:44:53 there were a number of
    0:44:54 Democratic candidates that
    0:44:55 were strong, and
    0:44:56 ultimately, Iowa voters
    0:44:58 picked Obama, New
    0:44:59 Hampshire voters picked
    0:45:00 Hillary, and then South
    0:45:01 Carolina voters picked
    0:45:02 Obama, and, you know,
    0:45:03 but it was a very
    0:45:04 competitive primary, and
    0:45:05 it was legit.
    0:45:06 It was a legitimate
    0:45:06 primary.
    0:45:08 It was contested, it
    0:45:09 was ugly, they had to
    0:45:12 have a meeting of the
    0:45:13 two candidates when it
    0:45:14 was over, et cetera,
    0:45:14 et cetera.
    0:45:16 2012, obviously, the
    0:45:17 incumbent Democrat wins.
    0:45:21 2016, the DNC is all
    0:45:24 in for Hillary, and
    0:45:25 they’re not fair to
    0:45:25 Bernie Sanders.
    0:45:28 And, in fact, Tulsi
    0:45:30 Gabbard resigns as a
    0:45:30 member of the Democratic
    0:45:31 National Committee
    0:45:33 because the DNC is
    0:45:34 being so unfair to
    0:45:34 Bernie.
    0:45:36 2020, there are all
    0:45:37 these machinations
    0:45:39 because they wanted to
    0:45:40 stop Bernie again.
    0:45:42 Obama redeeming
    0:45:43 himself with Biden to
    0:45:44 a degree, perhaps, by
    0:45:45 helping to convince
    0:45:47 others to drop out of
    0:45:48 the race so Democrats
    0:45:49 could rally against
    0:45:50 Biden to stop Bernie.
    0:45:52 And then, of course,
    0:45:54 what happened in
    0:45:56 2020, which is the
    0:45:57 Democratic Party
    0:46:00 leaning on state
    0:46:01 parties to not even
    0:46:03 permit primaries.
    0:46:04 I mean, the Dean
    0:46:05 Phillips campaign had
    0:46:07 to sue the Wisconsin
    0:46:08 Democratic Party all the
    0:46:09 way up to the
    0:46:09 Wisconsin Supreme
    0:46:11 Court to even put him
    0:46:11 on the ballot.
    0:46:13 And as you note, he
    0:46:14 wasn’t like a real
    0:46:14 threat.
    0:46:17 So I would say, well,
    0:46:18 I’ve heard people like
    0:46:19 Ezra Klein talk about
    0:46:22 the weakness of the
    0:46:23 Democratic Party.
    0:46:24 This is about the
    0:46:25 weakness of the
    0:46:26 Democratic Party or the
    0:46:27 weakness of parties in
    0:46:28 general, that the
    0:46:29 Democratic Party is
    0:46:31 built around, was built
    0:46:31 around Biden, and the
    0:46:32 Republican Party is
    0:46:33 built around Trump.
    0:46:34 And to a degree, I
    0:46:36 think that’s fair.
    0:46:38 But I will say, the
    0:46:39 Republicans had a
    0:46:40 primary, and they had
    0:46:41 strong candidates, and
    0:46:42 they were on the ballot,
    0:46:43 and they had debates.
    0:46:44 Trump didn’t participate,
    0:46:45 but they had debates.
    0:46:47 And Republican voters
    0:46:48 picked who they picked,
    0:46:51 probably aided by Alvin
    0:46:52 Bragg and Letitia James
    0:46:52 in ways.
    0:46:55 But, I mean, I think one
    0:46:55 of the biggest problems,
    0:46:57 and Democrats have not
    0:46:58 asked my advice, I don’t
    0:46:59 know about Alex, I don’t
    0:47:00 think that I’m going to be
    0:47:01 getting any invitations to
    0:47:03 speak anytime soon.
    0:47:06 But, letting voters
    0:47:08 decide, having open
    0:47:10 primaries, I mean, whatever
    0:47:10 you think of Robert F.
    0:47:12 Kennedy Jr., and I don’t
    0:47:14 think much of him, in
    0:47:16 terms of his views on
    0:47:19 vaccines, I mean, why was
    0:47:21 he not allowed to be a
    0:47:22 candidate, you know, or
    0:47:23 Marianne Williamson?
    0:47:25 Why was it such a
    0:47:27 transgression to allow
    0:47:28 them to be on a ballot
    0:47:30 or to have a debate?
    0:47:31 What’s so crazy about
    0:47:32 that?
    0:47:33 Dean Phillips, as you
    0:47:34 know, Scott, he says the
    0:47:35 main reason he ran was he
    0:47:37 wanted to force Biden on a
    0:47:38 debate stage so people
    0:47:39 could see what he had been
    0:47:40 seeing behind the scenes.
    0:47:42 Would that really have been
    0:47:43 such an awful idea in
    0:47:43 retrospect?
    0:47:47 And I would just add, you
    0:47:48 know, the Democrats, the
    0:47:51 Democratic Party, I think,
    0:47:52 truly believe with a sincere
    0:47:54 conviction that Trump is an
    0:47:55 existential threat to
    0:47:55 democracy.
    0:47:57 And if you believe that,
    0:47:59 it’s easy to rationalize
    0:48:01 anything, including, in
    0:48:03 some ways, doing things
    0:48:04 that are anti-democratic,
    0:48:05 which is what they did,
    0:48:07 and basically rigging the
    0:48:09 2024 primary to ensure
    0:48:10 that Biden would stay the
    0:48:10 nominee.
    0:48:11 It’s so interesting because
    0:48:13 it’s the opposite, isn’t
    0:48:13 it?
    0:48:15 I remember in 1992, I was a
    0:48:16 second year in business
    0:48:17 school, and a friend of
    0:48:20 mine, her father was a
    0:48:21 wealthy developer in
    0:48:22 Sacramento, and she knew I
    0:48:24 was into politics and said,
    0:48:25 I was, I was, I had a big
    0:48:28 do caucus for president sign in
    0:48:29 my window, remember him?
    0:48:32 And she said, my father’s
    0:48:35 hosting a fundraiser for this
    0:48:36 unknown governor from
    0:48:38 Arkansas, and he’s got no
    0:48:41 shot whatsoever, no shot.
    0:48:43 But we’re thinking about him
    0:48:44 for 96 or 2000.
    0:48:46 And I went and met this guy.
    0:48:50 And back then, it’s reported
    0:48:51 he had a photographic memory,
    0:48:53 and he would get a cue card on
    0:48:55 everyone in the room.
    0:48:57 And I’m in a room, second
    0:48:58 year of business school, bad
    0:49:00 suit, intimidated, in a room
    0:49:02 of 100 people, and he yells,
    0:49:04 he throws up his arm, and he
    0:49:04 yells, Scott!
    0:49:09 And it comes over to me, and
    0:49:11 the guy goes, I heard you, like
    0:49:13 me, were raised by a single
    0:49:13 mother.
    0:49:15 And he looks me in the eye, and
    0:49:17 he takes my hand, and he goes,
    0:49:19 it wasn’t easy, was it?
    0:49:22 And I remember thinking, and I’ve
    0:49:24 gone on to raise money and
    0:49:25 canvas for the Clintons.
    0:49:27 Like, at that moment, I was all
    0:49:28 in for any, Roger Clinton could
    0:49:29 have run for something, and I
    0:49:31 was gonna, I was gonna support
    0:49:31 him.
    0:49:33 And the primary process, and
    0:49:36 that, that, it really is just
    0:49:38 such an incredible process,
    0:49:41 when it’s let, when it’s let
    0:49:44 loose, of not only maturing the
    0:49:46 right person, but maturing the
    0:49:47 right man or woman for that
    0:49:48 moment.
    0:49:50 I mean, it, I think we
    0:49:52 underestimate just how powerful
    0:49:54 a process it is when we let it
    0:49:54 run.
    0:49:56 And anything we do to get in the
    0:49:58 way of that, it’s just, it’s not
    0:49:59 only not democratic, it’s just
    0:49:59 stupid.
    0:50:02 It’s an amazing means of vetting
    0:50:05 the right person at the right
    0:50:05 moment.
    0:50:10 It’s been my great privilege to be a
    0:50:10 campaign reporter.
    0:50:13 And the two moments that mean the
    0:50:16 most to me, just as a campaign
    0:50:18 reporter, was one, covering John
    0:50:21 McCain in 2000, and watching that.
    0:50:22 And one of the things that was so
    0:50:24 interesting about it is he went from
    0:50:28 being a very conservative guy, except
    0:50:29 on campaign finance.
    0:50:31 He was a very experiential guy, like,
    0:50:33 what he experienced informed his life.
    0:50:35 And that campaign changed him, not
    0:50:38 just the Bush machine bullying him and
    0:50:41 all that, but he just became much more
    0:50:43 open-minded about different things.
    0:50:44 And he started teaming up with
    0:50:46 Democrats on, on bipartisan
    0:50:47 legislation.
    0:50:48 It was just interesting watching a
    0:50:51 person mature, as you just noted, and
    0:50:55 seeing the same thing on the Obama
    0:50:55 side.
    0:50:58 In 2007, he was a shitty candidate.
    0:51:01 I’d see him in these, like, high
    0:51:03 school gymnasiums on a Friday night
    0:51:06 in, you know, armpit Iowa, and he was
    0:51:08 awful, he was listless, he was mad that
    0:51:10 he was there, he missed his wife, he
    0:51:11 missed his daughters.
    0:51:13 And, like, Axelrod and those guys,
    0:51:16 Plough, they would kick the shit out
    0:51:17 of him, like, what are you doing?
    0:51:18 Do you want to be president or do you
    0:51:18 not?
    0:51:20 And he grew.
    0:51:22 He grew and became the Barack Obama
    0:51:24 that got elected president.
    0:51:28 And seeing that close-up is an
    0:51:29 incredible thing.
    0:51:32 And I don’t think that we’ve, I’m
    0:51:33 trying to think, I mean, there was a
    0:51:36 Republican primary this last election,
    0:51:37 but, you know, Donald Trump was
    0:51:39 essentially an incumbent running.
    0:51:42 But watching the process really is
    0:51:42 just great.
    0:51:44 And Democrats are so fearful.
    0:51:47 They’re so terrified that the party’s
    0:51:49 going to nominate Bernie Sanders or
    0:51:49 whatever.
    0:51:51 And it’s just like, let the party
    0:51:52 nominate who they want.
    0:51:54 We’ll be right back.
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    0:54:55 We’re back with more from Jake Tapper and
    0:54:55 Alex Thompson.
    0:54:59 So just going back to this notion that we
    0:55:02 have a tendency or this narcissism gets in
    0:55:02 the way.
    0:55:05 I’ll put forward a thesis on what you guys
    0:55:06 to respond to it.
    0:55:06 And I can’t help.
    0:55:08 I’ve got two great political minds.
    0:55:10 So I want to talk about a little bit about
    0:55:11 our current situation.
    0:55:17 I’m upset that we have this emerging
    0:55:18 kleptocracy,
    0:55:19 kakistocracy,
    0:55:20 whatever-ocracy you want to call it.
    0:55:23 And what I think is worse
    0:55:26 is I feel like
    0:55:28 we’re feckless and neutered in terms of our
    0:55:28 resistance to it.
    0:55:31 I feel there’s a total lack of leadership on
    0:55:32 the Democratic side.
    0:55:34 And arguably,
    0:55:35 arguably,
    0:55:36 you know,
    0:55:37 the leader of the Democratic Party,
    0:55:38 I don’t know if you’d agree with this,
    0:55:39 is Senator Schumer.
    0:55:42 And I think some of that same narcissism
    0:55:44 and age is coming to fruition there.
    0:55:47 Do you think there needs to be a process
    0:55:50 for essentially saying,
    0:55:50 okay,
    0:55:52 are these the right people,
    0:55:52 distinct to tenure,
    0:55:54 to put up,
    0:55:55 to represent our party
    0:55:56 and put up a fight?
    0:55:57 If the election,
    0:55:58 my understanding is the election
    0:55:59 we’re held today,
    0:56:00 despite everything we know
    0:56:02 about this kind of mob family
    0:56:03 approach to governance,
    0:56:05 Donald Trump would be re-elected again.
    0:56:07 So,
    0:56:08 Senator Schumer
    0:56:09 and some of the other people
    0:56:10 in the Democratic Party,
    0:56:11 do we still suffer
    0:56:13 from the same narcissism
    0:56:13 and inability
    0:56:14 to put the best people forward
    0:56:15 to put up the fight?
    0:56:17 I mean,
    0:56:18 I think Chuck Schumer,
    0:56:19 I mean,
    0:56:20 you talk to many,
    0:56:21 many Democrats,
    0:56:22 a lot of people believe
    0:56:22 Chuck Schumer
    0:56:23 has lost a few steps.
    0:56:25 That being said,
    0:56:25 you know,
    0:56:26 there is a vacuum
    0:56:28 and I think the party
    0:56:29 is going through
    0:56:31 a process
    0:56:32 of reckoning
    0:56:33 with what just happened.
    0:56:35 And sometimes
    0:56:36 those processes
    0:56:37 take a while.
    0:56:37 I mean,
    0:56:38 the Republican Party
    0:56:40 was in a complete state
    0:56:41 of catastrophe
    0:56:42 after 2008.
    0:56:44 And it wasn’t clear
    0:56:46 if there was
    0:56:46 any sort of leader
    0:56:47 that was emerging
    0:56:48 and eventually
    0:56:49 you did have
    0:56:50 people come forward
    0:56:51 and I think
    0:56:51 that’s what’s happening
    0:56:52 with the Democratic Party.
    0:56:53 Now,
    0:56:55 amidst that vacuum,
    0:56:55 to your point,
    0:56:57 a lot of,
    0:56:58 there’s a lot of things
    0:56:59 happening
    0:57:00 and there is not really
    0:57:01 an effective opposition.
    0:57:02 I mean,
    0:57:03 it’s up to the Democratic
    0:57:04 senators
    0:57:05 and House members
    0:57:06 to pick their leaders.
    0:57:07 And,
    0:57:07 you know,
    0:57:08 I don’t have advice
    0:57:10 for Democrats
    0:57:10 and I don’t have advice
    0:57:11 for Republicans.
    0:57:15 I personally think
    0:57:17 that
    0:57:20 what Democrats,
    0:57:21 that all of Democrats
    0:57:22 right now
    0:57:24 are being blamed
    0:57:24 for
    0:57:26 the Biden
    0:57:27 fiasco.
    0:57:27 And by that,
    0:57:28 I mean his decision
    0:57:29 to run for re-election
    0:57:30 and his decision
    0:57:32 to hide
    0:57:33 his deterioration.
    0:57:35 Because no one
    0:57:36 is coming out
    0:57:36 and saying,
    0:57:38 as our reporting suggests,
    0:57:39 this was the fault
    0:57:40 of President Biden,
    0:57:41 his wife,
    0:57:43 and his son,
    0:57:44 and like a number,
    0:57:45 a few top aides.
    0:57:47 But this isn’t necessarily
    0:57:49 something that could be
    0:57:50 laid on the feet
    0:57:50 of every single
    0:57:51 elected Democrat
    0:57:52 in the country.
    0:57:53 People saw things,
    0:57:54 but ultimately
    0:57:55 they were being lied to
    0:57:57 by a small group of people.
    0:57:59 My personal view
    0:58:00 is that until
    0:58:00 the Democratic Party
    0:58:02 reckons with that,
    0:58:03 people are going to have
    0:58:04 a very difficult time
    0:58:05 trusting them
    0:58:06 on anything.
    0:58:08 And I think that
    0:58:09 in the same way
    0:58:10 the Republican Party
    0:58:11 had to reckon
    0:58:13 with the Iraq War
    0:58:15 until it became,
    0:58:15 I mean,
    0:58:16 it took years,
    0:58:18 years before,
    0:58:20 I guess it was 2016
    0:58:21 when Donald Trump
    0:58:22 became a nominee
    0:58:23 who was willing
    0:58:24 to say that was a mistake.
    0:58:25 But until then,
    0:58:26 it was heresy
    0:58:28 for a Republican
    0:58:29 to acknowledge that.
    0:58:30 I don’t know
    0:58:31 how long it’s going to take
    0:58:34 for a Gretchen Whitmer
    0:58:35 or a Josh Shapiro
    0:58:37 or a Gavin Newsom
    0:58:37 or whatever
    0:58:38 to say,
    0:58:39 you know,
    0:58:39 we got lied to
    0:58:41 and I didn’t do enough
    0:58:41 as a governor
    0:58:43 or as a Democratic leader
    0:58:44 to push on this,
    0:58:45 but we need,
    0:58:46 we can’t ever
    0:58:47 let this happen again
    0:58:49 and this is my position
    0:58:49 on this,
    0:58:49 X, Y, Z.
    0:58:51 I think that this is
    0:58:52 the true cross
    0:58:53 they have to bear
    0:58:54 because,
    0:58:55 I mean,
    0:58:56 I just see it
    0:58:58 with family and friends
    0:58:59 who are Democrats.
    0:59:00 I’m,
    0:59:00 you know,
    0:59:01 I’m a member
    0:59:01 of the Bull Moose Party,
    0:59:02 but family and friends
    0:59:03 who are Democrats
    0:59:06 who are furious
    0:59:08 with the Democratic Party
    0:59:10 and it can be triggered
    0:59:11 just by,
    0:59:11 you know,
    0:59:12 they see Chris Van Hollen
    0:59:13 going down to El Salvador
    0:59:14 to meet with
    0:59:16 an undocumented immigrant
    0:59:17 who’s a wife beater
    0:59:19 and yes,
    0:59:20 he should be afforded
    0:59:20 due process
    0:59:21 as anybody in this country
    0:59:22 should be afforded
    0:59:22 due process.
    0:59:23 It’s set and yes,
    0:59:24 the Trump administration
    0:59:26 should abide by the law
    0:59:27 and all that,
    0:59:31 but they see energy
    0:59:32 being directed
    0:59:32 towards things
    0:59:34 that are not helpful
    0:59:34 to them
    0:59:36 that they don’t understand
    0:59:37 and on a hair trigger
    0:59:39 they can get mad about it
    0:59:41 and when I poke and prod
    0:59:42 with these friends
    0:59:43 and family members
    0:59:44 and I’m using a,
    0:59:46 not a hypothetical,
    0:59:47 this is an example
    0:59:48 that happened with somebody,
    0:59:49 ultimately,
    0:59:50 they’re still mad
    0:59:50 about Biden.
    0:59:52 They just think
    0:59:53 Democrats are liars
    0:59:54 and they don’t even,
    0:59:55 like,
    0:59:55 I mean,
    0:59:56 it is,
    0:59:57 I think,
    0:59:58 to a lot of people
    0:59:59 and a lot of Democrats
    1:00:01 like finding out
    1:00:03 that the wizard
    1:00:04 is behind the curtain
    1:00:06 or your entire religion
    1:00:07 is based on,
    1:00:08 you know,
    1:00:10 a lie that somebody concocted
    1:00:10 or,
    1:00:11 I mean,
    1:00:11 it’s,
    1:00:12 I think it is a very
    1:00:13 debilitating thing.
    1:00:14 You,
    1:00:15 a lot of people are raised,
    1:00:16 you’re a Democrat,
    1:00:17 you’re a Republican
    1:00:18 and then you find out that,
    1:00:19 let’s say,
    1:00:20 that you’re a
    1:00:22 never Trump Republican,
    1:00:22 you find out
    1:00:23 that it actually isn’t about
    1:00:26 a strong international relation
    1:00:27 and free trade
    1:00:28 and respect for authority
    1:00:29 and,
    1:00:29 you know,
    1:00:30 that it’s just actually
    1:00:31 about Donald Trump.
    1:00:31 And in this case,
    1:00:33 it’s just like,
    1:00:35 you were raised as a Democrat
    1:00:36 and it turns out that
    1:00:37 it wasn’t about
    1:00:39 anything other than
    1:00:41 preserving this old man’s ego
    1:00:41 and his desperate
    1:00:42 cling to power.
    1:00:43 I mean,
    1:00:44 I think that that is
    1:00:46 just severely traumatic.
    1:00:48 I want to put forward
    1:00:48 a thesis,
    1:00:49 something we think about
    1:00:50 a lot here
    1:00:53 in the Prof G
    1:00:54 universe of podcasts
    1:00:55 and that is,
    1:00:56 and granted,
    1:00:57 you know,
    1:00:59 I’m a hammer
    1:00:59 so everything
    1:01:01 I see is a nail,
    1:01:02 but my thesis
    1:01:03 around how we
    1:01:04 elected
    1:01:06 a Fallon
    1:01:07 and an insurrectionist
    1:01:08 is that
    1:01:09 if you look at the groups
    1:01:10 that pivoted hardest
    1:01:12 from blue to red
    1:01:13 2020 to 2024,
    1:01:15 Latinos,
    1:01:16 and my thesis there
    1:01:16 is they don’t even
    1:01:17 want to be identified
    1:01:17 as a group
    1:01:19 to people
    1:01:20 under the age of 40
    1:01:21 who for the first time
    1:01:22 aren’t doing as well
    1:01:23 as his or her parents
    1:01:25 were at 40 or 30.
    1:01:27 So the country’s
    1:01:27 not working for them.
    1:01:28 They want to change.
    1:01:29 And then women
    1:01:30 45 to 64.
    1:01:32 And my thesis is
    1:01:32 that’s the mothers
    1:01:33 of young men.
    1:01:34 And at the Democratic
    1:01:35 National Convention,
    1:01:36 I saw a parade
    1:01:37 of special interest groups
    1:01:38 addressing the very real
    1:01:39 concerns and issues
    1:01:40 still facing a lot
    1:01:41 of these groups
    1:01:42 that I didn’t see
    1:01:43 one person talk about
    1:01:44 or even acknowledge
    1:01:45 the struggle
    1:01:45 of the group
    1:01:46 I believe
    1:01:46 has fallen furthest
    1:01:47 fastest in America
    1:01:48 and that’s young men.
    1:01:50 Four times likely
    1:01:50 to kill themselves,
    1:01:51 three times likely
    1:01:51 to be addicted,
    1:01:52 12 times likely
    1:01:53 to be incarcerated.
    1:01:56 I believe
    1:01:57 that the Democratic Party
    1:01:59 may have lost
    1:01:59 the election
    1:02:01 because they refused
    1:02:02 to acknowledge
    1:02:04 because of a purity test
    1:02:05 or not meeting
    1:02:06 a purity test
    1:02:07 addressing the issues
    1:02:08 facing young men
    1:02:09 in this country
    1:02:10 and that we drastically
    1:02:11 need to move away
    1:02:12 from identity politics
    1:02:14 and focus
    1:02:15 on the folks
    1:02:16 that are really
    1:02:18 facing the most
    1:02:18 headwinds
    1:02:19 in our society
    1:02:19 right now.
    1:02:22 And I’m just curious,
    1:02:23 the Democratic Party’s
    1:02:24 ability to even
    1:02:25 acknowledge the struggles
    1:02:26 that young men
    1:02:27 are facing in this country
    1:02:27 and if it played
    1:02:28 a role in the election.
    1:02:33 the party has a big problem
    1:02:34 with young men
    1:02:35 who feel that the party
    1:02:36 doesn’t care about them
    1:02:39 or sees their struggles
    1:02:40 as lesser
    1:02:42 than other people’s struggles.
    1:02:43 Now,
    1:02:44 I would also say
    1:02:45 one of the things
    1:02:45 that’s very hard
    1:02:47 about this last election
    1:02:48 is it’s very difficult
    1:02:49 to draw
    1:02:51 hard and fast lessons
    1:02:51 from it
    1:02:53 because the Democratic Party
    1:02:54 sort of like,
    1:02:55 you know,
    1:02:57 sort of forfeited.
    1:02:57 You know,
    1:02:59 they dropped their nominee
    1:03:00 with 107 days to go
    1:03:01 and then ran
    1:03:03 and then only,
    1:03:03 you know,
    1:03:04 she had a lot of money
    1:03:06 but she only had 107 days.
    1:03:06 So,
    1:03:08 I think that’s,
    1:03:09 and Democrats I talk to,
    1:03:10 it’s like the single
    1:03:11 hardest thing
    1:03:12 for them
    1:03:13 to reckon with
    1:03:13 is
    1:03:15 drawing lessons
    1:03:15 because
    1:03:17 it was such a chaotic
    1:03:18 process.
    1:03:20 so I think
    1:03:21 your point
    1:03:21 is well taken
    1:03:22 but I also think
    1:03:24 what’s making
    1:03:24 a lot of Democrats
    1:03:25 struggle
    1:03:26 to figure out
    1:03:27 why they lost
    1:03:27 is because
    1:03:29 you had such
    1:03:30 a weird process
    1:03:31 and didn’t have
    1:03:32 like a full,
    1:03:33 a nominee
    1:03:35 with a full runway
    1:03:36 to make their case.
    1:03:36 Jake?
    1:03:37 So,
    1:03:39 we talked about this
    1:03:40 last time we talked
    1:03:41 and I actually love
    1:03:42 talking to you
    1:03:42 about this
    1:03:43 because it’s a conversation
    1:03:46 that I’ve only had
    1:03:46 with you
    1:03:48 and Peter Hamby
    1:03:50 from Puck
    1:03:52 who covers
    1:03:52 a lot of this stuff.
    1:03:54 My son is now
    1:03:55 15 years old
    1:03:57 and he’s a gamer,
    1:03:58 he’s a football fan,
    1:04:00 starting linebacker
    1:04:02 on his
    1:04:03 varsity football team.
    1:04:05 The Democratic Party
    1:04:07 has no way
    1:04:08 of communicating
    1:04:08 with him.
    1:04:11 They have no entree
    1:04:11 into his world
    1:04:13 and in fact
    1:04:13 it’s interesting
    1:04:16 I went on a
    1:04:17 left-leaning
    1:04:19 podcast
    1:04:20 that shall remain
    1:04:20 nameless
    1:04:21 and we were talking
    1:04:22 about my kids
    1:04:23 because I think
    1:04:24 they were both people
    1:04:24 without kids
    1:04:26 and they asked me
    1:04:27 about my son
    1:04:27 and I said
    1:04:27 he was,
    1:04:28 you know,
    1:04:30 he’s a football player
    1:04:31 and he wants
    1:04:32 to be a policeman
    1:04:34 and their joke was
    1:04:35 about my 15-year-old son,
    1:04:35 oh,
    1:04:36 how does he feel
    1:04:37 about minorities?
    1:04:37 Like the idea
    1:04:38 that he wants
    1:04:38 to be a policeman
    1:04:40 therefore he’s racist,
    1:04:40 my son.
    1:04:41 And like,
    1:04:42 you know,
    1:04:42 that was the big laugh
    1:04:43 and then I got dragged
    1:04:44 in the comments
    1:04:45 and all that stuff
    1:04:47 and I thought
    1:04:48 to myself,
    1:04:48 this is why
    1:04:49 you fuckers
    1:04:50 are losing elections.
    1:04:52 Like,
    1:04:53 my football-playing son
    1:04:58 who has no
    1:04:59 political views,
    1:05:00 he’s 15,
    1:05:01 he thinks about
    1:05:03 World War II
    1:05:04 and gaming
    1:05:07 and playing linebacker.
    1:05:08 That’s his world.
    1:05:10 you’re deciding
    1:05:11 he’s a racist
    1:05:13 because he wants
    1:05:13 to be a cop
    1:05:14 and why does he
    1:05:15 want to be a cop?
    1:05:15 He wants to be a cop
    1:05:16 because he wants
    1:05:17 to help people,
    1:05:17 you know,
    1:05:19 and he thinks
    1:05:19 that’s the best way
    1:05:20 he can help people
    1:05:22 and that’s how
    1:05:23 the Democratic Party
    1:05:25 talks to men,
    1:05:26 not just white men,
    1:05:27 but men
    1:05:29 and I mean,
    1:05:30 I get the idea
    1:05:31 that they thought
    1:05:31 Tim Walz
    1:05:33 could,
    1:05:34 what’s the term?
    1:05:36 He used code switch
    1:05:36 or something?
    1:05:37 He thought that he could
    1:05:39 translate the Democratic Party
    1:05:40 values because he
    1:05:42 hunts and fishes
    1:05:43 and owns a gun
    1:05:44 and was in the army
    1:05:45 and drinks a beer.
    1:05:46 I mean,
    1:05:47 at least there was
    1:05:47 an attempt
    1:05:50 but I find it
    1:05:50 just insane
    1:05:52 that,
    1:05:53 you know,
    1:05:54 the party,
    1:05:54 I mean,
    1:05:55 look,
    1:05:56 I’m 56 now
    1:05:57 so,
    1:05:58 you know,
    1:05:58 but I remember
    1:06:00 when,
    1:06:01 I mean,
    1:06:01 I grew up
    1:06:03 in a Queen village
    1:06:03 which is
    1:06:04 on the border
    1:06:05 of South Philadelphia
    1:06:06 and like,
    1:06:07 those were all
    1:06:07 Democrats,
    1:06:09 these beer-drinking
    1:06:10 union guys
    1:06:12 and probably
    1:06:12 a lot of them
    1:06:13 still are
    1:06:14 just because
    1:06:14 Philadelphia
    1:06:15 is such a one
    1:06:16 party town
    1:06:19 but if you made,
    1:06:19 if there was
    1:06:20 this thriving
    1:06:21 Republican Party
    1:06:22 in Philadelphia,
    1:06:24 they’d lose
    1:06:25 a lot of elections.
    1:06:26 So,
    1:06:27 I don’t get
    1:06:28 what they’re doing
    1:06:28 but I think
    1:06:29 it’s a lot
    1:06:29 of what you’re saying
    1:06:30 like,
    1:06:33 toxic masculinity
    1:06:35 and white privilege
    1:06:36 and these are
    1:06:37 the things
    1:06:38 that my son
    1:06:39 hears when people
    1:06:40 are talking to him.
    1:06:41 He’s 15,
    1:06:42 you know,
    1:06:43 he doesn’t,
    1:06:45 of course he has
    1:06:45 privilege,
    1:06:45 he has privilege
    1:06:46 because he’s
    1:06:46 white,
    1:06:47 because he’s
    1:06:47 male,
    1:06:47 because he’s
    1:06:48 my son,
    1:06:48 all that,
    1:06:49 but like,
    1:06:50 that’s not how
    1:06:51 he sees the world,
    1:06:51 he’s 15.
    1:06:53 So,
    1:06:54 we’ve got to wrap up here
    1:06:54 because I know
    1:06:55 you guys are busy
    1:06:56 but I’m going to use
    1:06:56 this as a segue
    1:06:57 to talk about
    1:06:58 media and its impact
    1:06:59 on elections
    1:07:00 moving forward.
    1:07:01 Just a quick stat
    1:07:03 with respect to Rogan,
    1:07:04 the 40 million
    1:07:06 views on YouTube
    1:07:07 and the 15 million
    1:07:08 audio downloads
    1:07:09 for Harris to have
    1:07:09 gotten the same
    1:07:10 number of impressions
    1:07:11 she would have had
    1:07:11 to have gone on CNN,
    1:07:12 MSNBC,
    1:07:13 and Fox
    1:07:14 every night for three
    1:07:15 hours for two weeks.
    1:07:17 And that’s a lead
    1:07:17 into my question.
    1:07:18 Jake,
    1:07:18 I think you’re
    1:07:21 the king of all media.
    1:07:21 You know,
    1:07:23 you’re a pilot
    1:07:24 for Pan Am Airlines
    1:07:24 but it’s Pan Am
    1:07:25 in the 70s.
    1:07:27 Traditional media
    1:07:27 is,
    1:07:28 I mean,
    1:07:29 enjoy it,
    1:07:29 date a lot of
    1:07:30 stewardesses,
    1:07:30 you know,
    1:07:32 give kids wings
    1:07:34 but that industry.
    1:07:35 I think the sun is
    1:07:36 passing midday.
    1:07:37 I think the average
    1:07:37 age of cable news
    1:07:38 viewers is 70.
    1:07:40 And I think one
    1:07:41 of the big errors
    1:07:42 of the Democratic
    1:07:43 Party not figuring
    1:07:43 out a way to speak
    1:07:44 to people via podcast,
    1:07:45 the average age
    1:07:45 of a podcast listener
    1:07:46 is 34.
    1:07:47 And a 70-year-old
    1:07:48 woman watching
    1:07:49 MSNBC,
    1:07:51 she knows who
    1:07:52 she’s voting for.
    1:07:53 Whereas 34-year-old
    1:07:54 males tend to focus
    1:07:55 on economics.
    1:07:58 And that is a swing issue
    1:08:00 because no party owns it.
    1:08:01 Sometimes Democrats
    1:08:02 are seen as better
    1:08:03 for the economy
    1:08:03 and Republicans
    1:08:04 are seen as better
    1:08:04 for the economy
    1:08:06 which makes no fucking sense
    1:08:07 given Democrats
    1:08:08 have created 40 million jobs
    1:08:09 in the last 40 years
    1:08:10 and Republicans 1 million.
    1:08:11 But be that as it may,
    1:08:12 it’s a swing issue.
    1:08:14 I’m curious
    1:08:16 how you guys see
    1:08:18 as CNN and Axios
    1:08:19 how you personally
    1:08:20 are responding
    1:08:21 or trying to meet
    1:08:22 the moment
    1:08:24 around
    1:08:26 transitioning media
    1:08:27 or your platforms.
    1:08:27 How are you guys
    1:08:28 personally thinking
    1:08:29 about your message?
    1:08:30 Are you trying
    1:08:31 to get into podcasting?
    1:08:32 What do you think
    1:08:32 traditional media?
    1:08:33 Just thoughts
    1:08:34 on the media ecosystem
    1:08:35 moving forward.
    1:08:36 Obviously we’re
    1:08:37 in a tremendous
    1:08:38 time of disruption.
    1:08:40 Sir Mark Thompson,
    1:08:41 the head of CNN
    1:08:42 right now,
    1:08:42 is the guy
    1:08:44 who helped bring
    1:08:45 the New York Times
    1:08:47 from a newspaper
    1:08:48 with a website
    1:08:48 to a website
    1:08:49 with a newspaper
    1:08:50 and making it profitable
    1:08:51 and making it sustainable.
    1:08:52 So hopefully
    1:08:53 he will figure out
    1:08:53 what to do
    1:08:54 and obviously
    1:08:55 we know
    1:08:56 that it’s not
    1:08:58 just cable news
    1:08:58 that’s going
    1:08:58 through this.
    1:08:59 It’s everything.
    1:09:00 Movies,
    1:09:01 entertainment,
    1:09:02 on TV,
    1:09:03 books.
    1:09:05 You know,
    1:09:06 when I’ve
    1:09:07 now written
    1:09:08 seven books
    1:09:09 and, you know,
    1:09:11 the first few,
    1:09:11 like,
    1:09:12 all they cared
    1:09:13 about was
    1:09:14 hardback sales
    1:09:15 and now
    1:09:16 there’s an
    1:09:16 acknowledgement
    1:09:17 that Kindle
    1:09:19 and audiobook
    1:09:21 are thriving
    1:09:22 ways that people
    1:09:22 are consuming
    1:09:23 information.
    1:09:23 so
    1:09:24 all of which
    1:09:25 is to say
    1:09:26 I don’t know
    1:09:26 where this
    1:09:27 ends up
    1:09:28 but CNN
    1:09:29 and every
    1:09:30 media organization
    1:09:32 needs to figure
    1:09:32 out a way
    1:09:33 to get to
    1:09:33 where people
    1:09:34 are
    1:09:35 on their
    1:09:36 phones
    1:09:36 or on their
    1:09:36 streaming
    1:09:37 services
    1:09:38 and,
    1:09:39 I mean,
    1:09:40 I agree
    1:09:41 with everything
    1:09:41 you’re saying.
    1:09:43 I do not
    1:09:43 have a podcast.
    1:09:45 The notion
    1:09:45 that I
    1:09:46 would have…
    1:09:46 Oh, you will.
    1:09:48 This is the easiest
    1:09:51 prediction in history.
    1:09:52 Jake Tapper
    1:09:52 will have a
    1:09:52 podcast.
    1:09:53 Yeah, I don’t
    1:09:54 doubt it.
    1:09:54 I don’t doubt
    1:09:55 that someday
    1:09:55 I will have
    1:09:56 a podcast.
    1:09:56 I mean,
    1:09:57 right now,
    1:09:58 every day,
    1:09:58 I make sure
    1:09:59 that I put
    1:10:00 something on
    1:10:01 TikTok,
    1:10:02 Instagram,
    1:10:03 Facebook,
    1:10:04 Twitter,
    1:10:06 Substack,
    1:10:06 everything.
    1:10:07 I have no idea
    1:10:08 what’s going to
    1:10:08 live and what’s
    1:10:09 going to die,
    1:10:09 but I want to
    1:10:10 make sure
    1:10:10 that I’m
    1:10:11 part of it.
    1:10:12 And I do,
    1:10:13 I have to
    1:10:14 believe that
    1:10:14 there will
    1:10:15 always be
    1:10:17 an audience
    1:10:18 and a desire
    1:10:19 for people
    1:10:20 who can just
    1:10:20 give the news
    1:10:21 and give
    1:10:21 analysis
    1:10:22 without being
    1:10:22 part of a
    1:10:23 team,
    1:10:24 without being
    1:10:24 a Democrat,
    1:10:25 without being
    1:10:25 a Republican,
    1:10:26 who are willing
    1:10:27 to write a book
    1:10:28 critical of Joe
    1:10:29 Biden while also
    1:10:29 going on air
    1:10:30 and providing
    1:10:31 critical analysis
    1:10:32 of Donald Trump.
    1:10:33 I got to believe
    1:10:34 that that’s
    1:10:34 sustainable,
    1:10:36 but how do we
    1:10:36 get there?
    1:10:37 I don’t know.
    1:10:38 Alex?
    1:10:40 I’m,
    1:10:41 the one thing
    1:10:41 that makes me
    1:10:42 optimistic
    1:10:43 optimistic is
    1:10:45 people are
    1:10:45 always going
    1:10:46 to want
    1:10:47 to get
    1:10:47 new
    1:10:48 information
    1:10:49 that
    1:10:49 they
    1:10:49 can
    1:10:50 trust.
    1:10:51 But to your
    1:10:52 point,
    1:10:52 how they
    1:10:53 get that
    1:10:54 is changing
    1:10:56 so rapidly.
    1:10:58 And even
    1:10:59 with the,
    1:10:59 you know,
    1:11:00 we’re bringing
    1:11:00 in AI,
    1:11:01 so like
    1:11:02 commodity news
    1:11:03 can just be
    1:11:03 written up
    1:11:04 by a program,
    1:11:05 which obviously
    1:11:05 is going to
    1:11:06 change our
    1:11:07 jobs too
    1:11:08 in huge
    1:11:09 ways by
    1:11:10 2028.
    1:11:11 But I just
    1:11:12 think you have
    1:11:12 to meet
    1:11:13 the audience
    1:11:13 where they
    1:11:13 are because
    1:11:14 I think
    1:11:16 people will
    1:11:16 always want
    1:11:18 new information
    1:11:19 that they can
    1:11:19 trust.
    1:11:20 And so that’s
    1:11:21 the one thing
    1:11:21 that makes me
    1:11:22 optimistic because
    1:11:22 as long as
    1:11:23 you sort of
    1:11:23 keep that
    1:11:24 North Star
    1:11:25 and just
    1:11:25 figure out
    1:11:26 the different
    1:11:27 ways to
    1:11:27 get them
    1:11:28 the information,
    1:11:28 I think
    1:11:29 things will
    1:11:29 be okay.
    1:11:29 Yeah,
    1:11:30 well,
    1:11:30 this is the
    1:11:30 easiest.
    1:11:31 I’ve been
    1:11:31 in business
    1:11:32 my whole life
    1:11:32 and an
    1:11:32 operator.
    1:11:34 Some rip
    1:11:34 off the rest
    1:11:35 is politics
    1:11:35 with Jake
    1:11:36 Tapper and
    1:11:37 Alex Thompson.
    1:11:37 Boom,
    1:11:38 I got a
    1:11:38 10% royalty.
    1:11:39 Gentlemen,
    1:11:41 Jake Tapper
    1:11:42 anchors the
    1:11:42 lead on
    1:11:43 CNN and
    1:11:44 serves as
    1:11:44 the network’s
    1:11:45 chief Washington
    1:11:45 correspondent.
    1:11:46 Alex Thompson
    1:11:47 is a national
    1:11:47 political correspondent
    1:11:48 for Axios
    1:11:49 and a CNN
    1:11:49 contributor.
    1:11:50 You’re both
    1:11:51 great at what
    1:11:51 you do,
    1:11:52 but I know
    1:11:52 enough about
    1:11:53 media.
    1:11:53 Whenever I
    1:11:54 read or
    1:11:55 watch you
    1:11:55 guys,
    1:11:56 the thing I
    1:11:57 appreciate
    1:11:57 and people
    1:11:58 don’t,
    1:12:00 I know
    1:12:00 enough about
    1:12:00 this business
    1:12:01 to be
    1:12:01 dangerous.
    1:12:02 You guys
    1:12:02 do the
    1:12:03 work.
    1:12:03 Jake
    1:12:03 doesn’t
    1:12:04 just show
    1:12:04 up and
    1:12:05 read off a
    1:12:05 teleprompter.
    1:12:06 He does
    1:12:06 the work
    1:12:07 off camera.
    1:12:08 Alex,
    1:12:09 I love
    1:12:10 some of the
    1:12:11 analysis you
    1:12:11 do.
    1:12:13 I can tell
    1:12:14 every time you
    1:12:14 write something
    1:12:15 you’re asking
    1:12:16 yourself,
    1:12:16 what is the
    1:12:17 inside here?
    1:12:18 And you
    1:12:18 spend real
    1:12:19 time.
    1:12:20 So you
    1:12:20 guys do
    1:12:20 the work.
    1:12:22 I’m fans
    1:12:22 of you
    1:12:22 both and
    1:12:23 really
    1:12:24 appreciate
    1:12:24 your time
    1:12:24 and your
    1:12:25 good work
    1:12:25 in this
    1:12:25 important
    1:12:26 moment.
    1:12:27 Thank you
    1:12:27 and thank
    1:12:27 you for
    1:12:28 doing what
    1:12:28 you do.
    1:12:28 And thank
    1:12:30 you for
    1:12:31 focusing on
    1:12:31 young men
    1:12:32 in this
    1:12:32 country because
    1:12:33 it is so
    1:12:33 important.
    1:12:33 It’s a
    1:12:34 conversation
    1:12:35 that we
    1:12:35 as a
    1:12:35 society
    1:12:36 just don’t
    1:12:36 have
    1:12:36 enough.
    1:12:37 Thanks
    1:12:38 very much,
    1:12:38 Jake.
    1:12:38 Thanks,
    1:12:38 gentlemen.
    1:12:39 Thank
    1:12:40 you.
    1:12:49 This episode
    1:12:49 was produced
    1:12:50 by Jennifer
    1:12:50 Sanchez.
    1:12:51 Our intern
    1:12:51 is Dan
    1:12:52 Shallon.
    1:12:53 Drew Burrows
    1:12:53 is our
    1:12:54 technical
    1:12:54 director.
    1:12:55 Thank you
    1:12:55 for listening
    1:12:55 to the
    1:12:55 Prop G
    1:12:56 pod from
    1:12:56 the Vox
    1:12:57 Media Podcast
    1:12:57 Network.
    1:12:58 We will
    1:12:58 catch you
    1:12:59 on Saturday
    1:13:00 for No
    1:13:00 Mercy,
    1:13:01 No Malice
    1:13:01 as read
    1:13:02 by George
    1:13:02 Hahn.
    1:13:03 And please
    1:13:03 follow our
    1:13:04 Prop G
    1:13:04 Markets pod
    1:13:05 wherever you
    1:13:05 get your
    1:13:06 pods for new
    1:13:07 episodes every
    1:13:08 Monday and
    1:13:08 Thursday.

    Scott has a conversation with Jake Tapper, anchor of “The Lead” on CNN and the network’s chief Washington correspondent, and Alex Thompson, national political correspondent for Axios and a CNN contributor. 

    They discuss their new book, Original Sin: President Biden’s Decline, Its Cover-Up, and His Disastrous Choice to Run Again

    Scott also opens the episode by addressing the controversy surrounding the book.

    Learn more about your ad choices. Visit podcastchoices.com/adchoices

  • Essentials: Maximize Productivity, Physical & Mental Health With Daily Tools

    中文
    Tiếng Việt
    AI transcript
    0:00:02 – Welcome to Huberman Lab Essentials,
    0:00:04 where we revisit past episodes
    0:00:07 for the most potent and actionable science-based tools
    0:00:10 for mental health, physical health, and performance.
    0:00:13 I’m Andrew Huberman,
    0:00:15 and I’m a professor of neurobiology and ophthalmology
    0:00:17 at Stanford School of Medicine.
    0:00:20 I decided that we would hold office hours.
    0:00:22 Office hours in the university setting
    0:00:25 are when students come to the professor’s office
    0:00:28 or you meet outdoors on campus or in the classroom
    0:00:31 to review the material and questions from lecture
    0:00:33 in more detail.
    0:00:35 Now, unfortunately, we don’t have the opportunity
    0:00:38 to meet face-to-face in real life,
    0:00:41 but nonetheless, you’ve been sending your questions,
    0:00:45 putting them in the comments section on YouTube, et cetera,
    0:00:47 and I’ve prepared a number of answers
    0:00:50 to the questions that have shown up most frequently.
    0:00:53 Now, in order to provide context and structure
    0:00:56 to the way that we will address these questions,
    0:01:00 I’ve arranged the science and science-based protocols
    0:01:02 that relate to various aspects of life,
    0:01:06 such as mood, exercise, sleep, waking, anxiety, creativity,
    0:01:10 et cetera, into the context of a day.
    0:01:13 Selecting the unit of a day in order to deliver
    0:01:16 this science information and protocols
    0:01:19 is not a haphazard decision on my part.
    0:01:21 It’s actually the case that every cell in our body,
    0:01:25 every organ in our body and our brain is modulated
    0:01:27 or changes across the 24-hour day
    0:01:31 in a very regular and predictable rhythm.
    0:01:33 And so selecting the unit of the day
    0:01:34 is not just a practical one,
    0:01:37 but it’s one that’s related to our deeper biology.
    0:01:39 So let’s talk about how to apply quality,
    0:01:41 peer-reviewed science to your day
    0:01:45 and how to optimize everything from sleep to learning,
    0:01:47 creativity, meal timing, et cetera.
    0:01:50 I’m going to do this in the context of my day
    0:01:51 and what I typically do.
    0:01:54 I tend to wake up sometime around 6:00 AM, 6:30.
    0:01:57 The first thing I do after I wake up
    0:01:59 is I take the pen that’s on my nightstand
    0:02:01 and the pad of paper on my nightstand,
    0:02:04 and I write down the time in which I woke up.
    0:02:08 The reason for writing down what time I wake up
    0:02:11 is because I want to know what’s called my temperature minimum.
    0:02:14 I don’t care what my actual temperature is.
    0:02:17 I care when my lowest temperature is.
    0:02:19 And I know that that lowest temperature
    0:02:23 is approximately two hours before my average wake-up time.
    0:02:25 The second thing I do after I wake up
    0:02:28 is to get into forward ambulation,
    0:02:31 which is just nerd speak for taking a walk.
    0:02:34 There’s a phenomenon whereby when we generate
    0:02:37 our own forward motion, forward ambulation,
    0:02:42 visual images pass by us on our eyes, so-called optic flow.
    0:02:47 Experiencing visual flow has a powerful effect
    0:02:49 on the nervous system.
    0:02:52 The effect it has is essentially to quiet
    0:02:54 or reduce the amount of neural activity
    0:02:57 in this brain structure called the amygdala.
    0:03:00 And many of you have probably heard about the amygdala
    0:03:03 for its role in anxiety and fear and threat detection.
    0:03:07 And indeed, the amygdala is part of the network in the brain
    0:03:10 that generates feelings of fear and threat and anxiety.
    0:03:11 It does a bunch of other things too,
    0:03:13 but that’s one of its primary functions.
    0:03:17 Forward ambulation, walking or biking or running,
    0:03:20 and generating optic flow in particular,
    0:03:23 has this incredible property of lowering activity
    0:03:26 and the amygdala and thereby reducing levels of anxiety.
    0:03:29 That walk is a particularly important protocol each day
    0:03:33 because it really serves to push my neurology
    0:03:34 in the direction that I’d like it to go,
    0:03:37 which is alert, but not anxious.
    0:03:40 I want to have a high degree of focus and alertness
    0:03:43 because I’m soon going to move into a bout of work.
    0:03:45 I need to lean into the day.
    0:03:47 So in order to do that,
    0:03:51 I make sure that the walking is done outdoors.
    0:03:54 I do it outdoors because I also want sunlight in my eyes.
    0:03:57 Getting sunlight in your eyes first thing in the morning
    0:04:00 is absolutely vital to mental and physical health.
    0:04:02 Even if there’s cloud cover,
    0:04:04 more photons, light information
    0:04:05 are coming through that cloud cover
    0:04:08 than would be coming from a very bright indoor bulb.
    0:04:12 So getting outside for a 10 minute walk or a 15 minute walk
    0:04:15 will basically ensure that you’re getting adequate stimulation
    0:04:16 of these neurons in the eye
    0:04:18 that are called the melanopsin,
    0:04:20 intrinsically photosensitive ganglion cells.
    0:04:22 These are neurons that convey to the brain
    0:04:25 that it’s daytime and it’s time to be alert.
    0:04:29 And it sets in motion a huge number of biological cascades
    0:04:31 within every cell and organ of your body,
    0:04:34 from your liver, to your gut, to your heart, to your brain.
    0:04:38 Early in the day, we experience a natural and healthy bump
    0:04:42 in a hormone called cortisol and promotes wakefulness.
    0:04:45 It actually promotes a healthy immune system.
    0:04:47 It’s very important that that pulse of cortisol
    0:04:50 arrive early in the day.
    0:04:53 That pulse of cortisol is going to happen once every 24 hours,
    0:04:55 no matter what.
    0:04:57 It’s going to happen and you get to time it.
    0:04:58 How do you time it?
    0:05:01 Primarily by when you view bright sunlight.
    0:05:02 You can combine it with the forward ambulation,
    0:05:06 with the walk and the optic flow that I talked about before.
    0:05:08 And that’s what I do each morning
    0:05:11 to generate a sense of alertness in my body and brain
    0:05:14 to generate a sense of calm yet alert.
    0:05:16 So now we have our first protocol,
    0:05:18 which is to write down the time of day that you wake up.
    0:05:21 The second protocol is to take a walk first thing
    0:05:22 in the morning.
    0:05:25 And the third protocol is woven in with that walk,
    0:05:30 at least for me, which is to get that sunlight exposure.
    0:05:34 I’m a big believer based on quality peer review data,
    0:05:37 that hydration is essential for mental performance.
    0:05:41 As many of you know, neurons require ionic flow.
    0:05:44 What that means is neurons need sodium.
    0:05:45 They need magnesium and they need potassium
    0:05:47 in order to function.
    0:05:50 We do tend to get dehydrated at night.
    0:05:52 I try and make sure that I’m hydrated early in the day
    0:05:54 before I begin any work.
    0:05:58 So I make myself drink this water with a little bit
    0:05:59 of sea salt.
    0:06:01 How much sea salt, if you really want to get detailed,
    0:06:03 I suppose it’s about half a teaspoon.
    0:06:04 It’s not much.
    0:06:06 At that point, I start craving caffeine,
    0:06:09 but I don’t drink that caffeine yet.
    0:06:13 I purposely delay my caffeine intake to 90 minutes
    0:06:16 to 120 minutes after I wake up.
    0:06:20 The reason I delay caffeine is because one of the factors
    0:06:25 that induces a sense of sleepiness is the buildup of adenosine.
    0:06:30 The buildup of adenosine accumulates the longer we are awake.
    0:06:31 When you wake up in the morning,
    0:06:35 your adenosine levels are likely to be very low.
    0:06:39 However, caffeine is an adenosine blocker.
    0:06:42 It’s actually a competitive antagonist for you aficionados.
    0:06:44 It sort of parks in the receptor
    0:06:46 that adenosine normally would park at
    0:06:50 and prevents adenosine from acting on that receptor.
    0:06:51 That’s why you feel more alert.
    0:06:53 The reason for delaying caffeine intake 90 minutes
    0:06:57 to two hours after waking is I want to make sure
    0:06:59 that I don’t have a late afternoon
    0:07:03 or even early afternoon crash from caffeine.
    0:07:06 One of the best ways to ensure a caffeine crash
    0:07:08 is to drink a bunch of caffeine,
    0:07:10 block all those adenosine receptors.
    0:07:13 And then by early or late afternoon,
    0:07:15 when that caffeine starts to wear off
    0:07:17 and gets dislodged from the receptors,
    0:07:21 a lower level of adenosine is able to create
    0:07:23 a greater level of sleepiness.
    0:07:25 Delaying caffeine in 90 minutes to two hours
    0:07:28 optimizes this relationship between adenosine
    0:07:30 and wakefulness and sleepiness in a way
    0:07:34 that really provides a nice consistent arc of energy
    0:07:36 throughout the day and brings energy down
    0:07:39 as I’m headed toward sleep and falling asleep.
    0:07:40 I’d like to take a quick break
    0:07:43 and acknowledge our sponsor Eight Sleep.
    0:07:45 Eight Sleep makes smart mattress covers
    0:07:47 with cooling, heating, and sleep tracking capacity.
    0:07:50 One of the best ways to ensure a great night’s sleep
    0:07:51 is to make sure that the temperature
    0:07:53 of your sleeping environment is correct.
    0:07:56 And that’s because in order to fall and stay deeply asleep,
    0:07:57 your body temperature actually has to drop
    0:07:59 by about one to three degrees.
    0:08:02 And in order to wake up feeling refreshed and energized,
    0:08:04 your body temperature actually has to increase
    0:08:05 by about one to three degrees.
    0:08:08 Eight Sleep automatically regulates the temperature
    0:08:09 of your bed throughout the night,
    0:08:11 according to your unique needs.
    0:08:13 I’ve been sleeping on an Eight Sleep mattress cover
    0:08:16 for over four years now, and it has completely transformed
    0:08:18 and improved the quality of my sleep.
    0:08:20 Eight Sleep has just launched their latest model,
    0:08:22 the Pod 5, and the Pod 5 has several
    0:08:24 new important features.
    0:08:26 One of these new features is called Autopilot.
    0:08:29 Autopilot is an AI engine that learns your sleep patterns
    0:08:31 to adjust the temperature of your sleeping environment
    0:08:33 across different sleep stages.
    0:08:35 It also elevates your head if you’re snoring,
    0:08:37 and it makes other shifts to optimize your sleep.
    0:08:40 The base on the Pod 5 also has an integrated speaker
    0:08:41 that syncs to the Eight Sleep app
    0:08:44 and can play audio to support relaxation and recovery.
    0:08:47 The audio catalog includes several NSDR,
    0:08:49 non-sleep deep rest scripts,
    0:08:51 that I worked on with Eight Sleep to record.
    0:08:52 If you’re not familiar,
    0:08:54 NSDR involves listening to an audio script
    0:08:57 that walks you through a deep body relaxation
    0:09:00 combined with some very simple breathing exercises.
    0:09:02 And that combination has been shown in peer reviewed studies
    0:09:04 to restore your mental and physical vigor.
    0:09:06 And this is great because while we would all like
    0:09:08 to get to bed on time and get up
    0:09:09 after a perfect night’s sleep,
    0:09:12 oftentimes we get to bed a little late or later.
    0:09:14 Sometimes we have to get up early and charge into the day
    0:09:16 because we have our obligations.
    0:09:18 NSDR can help offset some of the negative effects
    0:09:20 of slight sleep deprivation.
    0:09:23 And NSDR gets you better at falling back asleep
    0:09:25 should you wake up in the middle of the night.
    0:09:26 It’s an extremely powerful tool
    0:09:29 that anyone can benefit from the first time and every time.
    0:09:31 If you’d like to try Eight Sleep,
    0:09:36 go to eightsleep.com/huberman to get up to $350 off the new pod five.
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    0:09:40 including Mexico and the UAE.
    0:09:46 Again, that’s eightsleep.com/huberman to save up to $350.
    0:09:50 My primary objective early in the day is to get into a mode of being focused,
    0:09:52 yet alert so that I can get work done.
    0:09:57 I’ve found that the best way for me to achieve that state is through fasting.
    0:10:02 So I don’t eat anything until about 11:00 AM or 12:00 noon.
    0:10:08 Fasting increases levels of adrenaline, also called epinephrine in the brain and body.
    0:10:14 And when our levels of epinephrine and adrenaline are increased, we learn better, we can focus better.
    0:10:22 You don’t want epinephrine, aka adrenaline too high, that feels like stress and panic, you get jittery,
    0:10:31 you can’t focus, but in its optimal range, adrenaline really provides a heightened sense of focus and the ability to encode,
    0:10:34 meaning bring in and retain, remember information.
    0:10:37 Next, I want to talk about what I’m doing while I’m working.
    0:10:43 A couple of things for optimizing workspace that are grounded in neuroscience and physiology.
    0:10:48 I’ve talked before about the fact that when our eyes are directed upward,
    0:10:54 it creates a state of heightened alertness and this has a relationship to the brainstem neurons that
    0:11:01 create alertness and their control over the muscles of the eye and believe it or not, the eyelids.
    0:11:07 The point here is that you can optimize your workstation in a physical way
    0:11:12 that leverages this aspect of the visual system and your level of alertness.
    0:11:17 Try and position your screen or your tablet, whatever device you happen to be working on,
    0:11:21 at least at eye level and ideally slightly higher.
    0:11:24 Most people are looking down at their computer or tablet
    0:11:28 or are angling their eyes at their screen at about 30 degrees.
    0:11:32 When we look down, when our eyelids are slightly closed,
    0:11:36 it tends to decrease our levels of alertness and increase our levels of sleepiness.
    0:11:40 So we’re now at the description of my day and these protocols
    0:11:44 in which I would do a 90-minute bout of work.
    0:11:45 Now, why 90 minutes?
    0:11:49 Well, the brain is going through these 90-minute so-called ultradian cycles
    0:11:51 throughout the entire day and night.
    0:11:57 Every 90 minutes, we shift over from being very alert to being less alert and then back to alert again.
    0:11:58 Here’s how it works.
    0:12:01 At the start of one of these 90-minute ultradian cycles,
    0:12:09 my brain is not quite engaged in whatever it is I’m trying to do, but I set a timer for 90 minutes
    0:12:16 and I try and get a strong bout of work done inside of that 90 minutes with the full understanding
    0:12:20 that the entire 90 minutes is not going to be uniform in terms of my ability of focus.
    0:12:24 So the goal is to get into what I call the tunnel, to really get into a tunnel of quality work.
    0:12:29 The brain loves that state, but it’s very hard for many of us to access.
    0:12:32 My phone is absolutely off.
    0:12:33 It’s not on airplane mode.
    0:12:36 It’s absolutely off during this time.
    0:12:39 In addition, I use low-level white noise.
    0:12:42 White noise, which is essentially all frequencies of sound.
    0:12:46 We’re all frequencies of sound that we can perceive.
    0:12:49 Mixed up kind of randomly, there’s no structure to it.
    0:12:55 Turned on at a low volume, puts the brain into a state that’s optimal for learning and workflow.
    0:13:00 So everything about this 90-minute block from the low levels of white noise to the position of my computer,
    0:13:05 how I’m standing, where my eyes are positioned, is geared towards putting me in this tunnel of work.
    0:13:09 And I have to say that while it can be a challenge to try and achieve this state and this tunnel of work,
    0:13:12 some days you start to get kind of addicted to it.
    0:13:14 It feels really good.
    0:13:19 It’s like a workout for the mind, and it is something that as you exit that 90 minutes,
    0:13:23 you really feel like you’ve accomplished a lot, because often you have.
    0:13:25 And it just feels deeply satisfying.
    0:13:30 And I’m convinced that that’s because of the release of neuromodulators like dopamine and the norepinephrine
    0:13:32 that’s circulating in your system.
    0:13:35 And I want to be clear that I’m not perfect about this 90 minutes.
    0:13:41 Occasionally I get drawn away, but I really try and achieve this most, if not every day that I’m alive,
    0:13:45 because for me, that work session is kind of holy.
    0:13:50 There’s a powerful way in which you can place the timing of this 90-minute work bout in an optimal way.
    0:14:00 You have access to a very important piece of data that dictates when this bout should start, more or less, and when it should end.
    0:14:05 That piece of data is your temperature minimum.
    0:14:09 If you’re somebody who wakes up on average at 7:00 a.m., well, then your temperature minimum is 5:00 a.m.
    0:14:19 You can be reasonably sure that your best work is going to be done anywhere from four to six hours after your temperature minimum.
    0:14:20 How do I know this?
    0:14:24 How do I know this relationship between temperature minimum and focused cognition?
    0:14:33 Well, temperature minimum defines the trough, the nadir, as they say, of your temperature across the 24-hour cycle.
    0:14:36 And immediately after that, your temperature will start to rise.
    0:14:44 That temperature rise is actually what triggers the initial cortisol release that you experience and wakes you up further.
    0:14:49 And then, of course, that sunlight that you’re getting is going to further enhance that healthy release of cortisol.
    0:14:54 That cortisol will then provide fuel, if you will, for that increase in temperature.
    0:14:59 And your body will continue to increase in temperature throughout the day toward the afternoon.
    0:15:06 What you’re trying to do in this idea of optimizing this 90-minute work bout to a particular time of day
    0:15:10 is catch the portion of the steepest slope of that temperature rise.
    0:15:16 So if you’re somebody who wakes up at 8:00 a.m. each morning, your temperature minimum is 6:00 a.m.,
    0:15:23 chances are you’re going to want to start this work bout somewhere around 10:00 a.m. or 11:00 a.m.
    0:15:27 Now, some people wake up and feel very alert first thing in the morning.
    0:15:29 They can really do their best work first thing in the morning.
    0:15:32 Please, if that’s you, continue to do that.
    0:15:35 Leverage that time, use that time.
    0:15:42 But if you’re somebody who struggles to find focus, definitely let your physiology and this rise in your body
    0:15:48 temperature support your efforts to focus rather than trying to do your best work at times of day
    0:15:54 when your physiology is actually directing your body and your brain toward defocus and towards being
    0:15:55 more lethargic.
    0:16:02 It just is setting yourself up for success when you try and capture this rising phase of your temperature.
    0:16:09 Data going back to the 1990s supports the idea that physical movement of particular kinds
    0:16:13 can support brain health and brain function, both in the immediate term and in the long term.
    0:16:21 So after I’ve finished a bout of work, this 90-minute bout of work, I force myself to do some sort of
    0:16:27 physical exercise that is going to be supportive of my brain health and brain function and organ health and bodily
    0:16:32 function in general. Now, there are various forms of physical activity or what we call exercise,
    0:16:39 but those can generally be batched into two categories. First is strength and hypertrophy work.
    0:16:44 So physical movements that are designed to make you stronger and/or make your muscles larger.
    0:16:52 There’s also endurance work, physical exercise and movements that are designed to allow you to do
    0:16:59 more work over time or to extend the amount of time that you can do work of any kind, both physical and mental.
    0:17:04 The data all point to the fact that working out hard for longer than an hour can actually
    0:17:09 be detrimental because of the way that it raises cortisol and cortisol can be a good thing if it’s
    0:17:14 appropriately timed and in the appropriate low levels, but you don’t want to have your cortisol levels up
    0:17:19 throughout the day or have big spikes of cortisol repeatedly.
    0:17:22 So keeping workouts relatively short can definitely help with that.
    0:17:30 Endurance work and strength training or hypertrophy training done in combination, meaning not necessarily
    0:17:36 in the same workout, but done across the week is immensely beneficial for the production of things like
    0:17:44 brain-derived nootrophic factor, for limiting inflammatory cytokines like IL-6, for promoting anti-inflammatory
    0:17:51 cytokines like IL-10, provided that exercise is of the proper duration and that it’s not so intense that
    0:17:54 you’re actually creating damage to the various systems of the body.
    0:17:57 What about the structure of the actual workouts?
    0:18:03 Well, approximately 80% of the resistance training you do should be resistance training that doesn’t
    0:18:08 go to what they call failure, where you can’t actually move the resistance anymore.
    0:18:13 The other 20% can be of the higher intensity to failure type training.
    0:18:21 That 80-20 rule of less than failure and work to failure in the resistance exercise regime can be
    0:18:27 transported or translated to the endurance exercise portion by focusing on that thing that we’re familiar
    0:18:31 with which is the burn when we’re running hard or cycling hard, we’ll experience a kind of burning of
    0:18:38 the muscles that’s associated with the lactate system. And actually the lactate system is its own form of
    0:18:46 fuel for the brain. And so there’s increasing interest in generating the lactate or pushing past that lactate
    0:18:51 threshold for small portion, 20% or so of endurance work in order to support brain health and function.
    0:18:57 So on any given day I finished that work block and I train, I do some sort of resistance or endurance
    0:19:01 training. I put those on alternate days or different days rather.
    0:19:08 As many of you know, I’ve been taking AG1 daily for more than 13 years. However, I’ve now found an even
    0:19:16 better vitamin mineral probiotic drink. That new and better drink is the new and improved AG1, which just launched this month.
    0:19:22 This next-gen formula from AG1 is a more advanced clinically backed version of the product that I’ve
    0:19:28 been taking daily for years. It includes new bioavailable nutrients and enhanced probiotics.
    0:19:33 The next-gen formula is based on exciting new research on the effects of probiotics on the gut microbiome.
    0:19:37 And it now includes several specific clinically studied probiotic strains that have been shown to
    0:19:43 support both digestive health and immune system health, as well as to improve bowel regularity and to
    0:19:47 reduce bloating. As someone who’s been involved in research science for more than three decades,
    0:19:51 and in health and fitness for equally as long, I’m constantly looking for the best tools to improve
    0:19:58 my mental health, physical health, and performance. I discovered and started taking AG1 way back in 2012,
    0:20:04 long before I ever had a podcast, and I’ve been taking it every day since. I find that it greatly improves
    0:20:08 all aspects of my health. I just feel so much better when I take it, but with each passing year,
    0:20:13 and by the way, I’m turning 50 this September, I continue to feel better and better. And I
    0:20:18 attribute a lot of that to AG1. AG1 uses the highest quality ingredients in the right combinations,
    0:20:23 and they’re constantly improving their formulas without increasing the cost. So I’m honored to have
    0:20:30 them as a sponsor of this podcast. If you’d like to try AG1, you can go to drinkag1.com/huberman to
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    0:20:43 bottle of vitamin D3 K2. Again, go to drinkag1.com/huberman to claim the special welcome kit with
    0:20:50 five free travel packs and a free bottle of vitamin D3 K2. So we’ve now talked about the arc that spans
    0:20:56 all the way from waking to a morning bout of focused work to physical training.
    0:21:02 I have not mentioned ingesting anything or nutrients. One of the most common questions I
    0:21:07 get are what should I eat for my brain? Well, ironically enough, one of the best things you can
    0:21:12 do for your brain is to not eat. But of course, we all have to eat sooner or later. So let’s talk about
    0:21:18 food timing first. As I mentioned, I eat my first meal sometime around noon, plus or minus an hour. The
    0:21:25 volume of food is also important. If you eat a large volume of anything because it diverts
    0:21:31 blood to your gut, you will feel lethargic and you will have less blood going to your brain.
    0:21:37 That seems like a simple and trivial fact, but if you want to be able to think you can’t ingest large
    0:21:43 volumes of anything into your gut. So for lunch, I do emphasize slightly lower carbohydrate or low
    0:21:51 carbohydrate intake for the simple reason that adrenaline and dopamine and their associated
    0:21:58 neuromodulators are going to support alertness. So for me, I fast up until about noon, then I eat a
    0:22:05 lunch that consists of some sort of protein thing like some meat or some chicken or some salmon and some
    0:22:11 vegetables, et cetera. And if I’ve exercised previously, which I do, as I mentioned, five
    0:22:17 days a week, then I will ingest some starches. I’ll ingest some bread or bread, excuse me, or rice or
    0:22:23 oatmeal and butter and nuts and things like that. But I will keep the total amount of carbohydrate
    0:22:27 a little bit on the low side, or if I haven’t trained, I won’t have any carbohydrate at all.
    0:22:34 Not because I’m ketogenic, but because starches cause the release
    0:22:38 of serotonin in the brain and lend themselves to a state of sleepiness.
    0:22:44 Now, what about components of foods that are not about alertness, but are about mood? We did an entire
    0:22:51 episode on mood and food, and it’s very clear based on now dozens of studies that ingesting sufficient
    0:22:59 levels of omega-3 fatty acids is going to support healthy mood and even can act as an antidepressant.
    0:23:07 Ingesting at least 1,000 milligrams per day of the EPA form of essential fatty acid is as effective
    0:23:13 as prescription antidepressants in relieving depression. And if you’re somebody who requires
    0:23:20 prescription antidepressants, Prozac, Zoloft, etc., it can allow people to take lower doses of those
    0:23:29 medications. A key aspect to the midday meal, if you want that meal to benefit you, is to take a brief
    0:23:35 walk afterwards. It turns out that brief walks of five to 30 minutes after ingesting food can accelerate
    0:23:41 metabolism and actually can accelerate and improve nutrient utilization, which is essentially the same as
    0:23:47 metabolism. But nonetheless, that’s something that I do after I finish my noon meal. I do force myself to
    0:23:53 stand up and go outside and take a brief walk. That also gets me again into optic flow.
    0:23:59 It also has another benefit, which is that I am giving my brain and thereby my body more information
    0:24:04 about light and time of day, which is always better than less information about light and time of day.
    0:24:10 A key protocol for sleep health and wakefulness and metabolism and hormone health
    0:24:15 is viewing light in the afternoon. So here’s the reason for doing this.
    0:24:24 As we progress into the evening hours, there’s a phenomenon where our retina, our eyes become very
    0:24:32 sensitive to light such that if we view bright lights or even not so bright lights between the hours of
    0:24:41 10:00 p.m. and 4:00 a.m. That is strongly disruptive, very disruptive for our dopamine production. It can
    0:24:48 really screw up our sleep. But if you can get outside and see the sun as it arcs down, or if you can’t see
    0:24:55 the sun directly, get some sunlight in your eyes in the afternoon hours. So maybe 4:00 p.m. ish. What it does
    0:25:03 is it lowers the sensitivity of your retina in the late evening hours, which allows you to buffer yourself
    0:25:07 against the negative effects of bright light later at night. Now we haven’t talked too much about
    0:25:14 melatonin, but melatonin is a hormone that is inhibited by light. Melatonin is the hormone that
    0:25:19 allows you to fall asleep easily. Now I’m not talking about supplementing melatonin. I’m talking
    0:25:25 about melatonin that you naturally produce from your pineal. So the protocol is very simple. Get
    0:25:31 outside in the afternoon or evening for 10 to 30 minutes, take your sunglasses off. So get that
    0:25:38 afternoon light. So what you’ll probably notice is that the optimal protocols for optimizing your brain
    0:25:43 and body health and performance and sleep, et cetera, are actually really simple. But just because they’re
    0:25:49 simple does not mean that they are not powerful. In fact, they are very powerful because they leverage
    0:25:54 the most powerful technology that exists, which is your nervous system. What we are talking about today
    0:26:02 are really basic things that we can all do that can steer our neurology and our biology in the directions
    0:26:07 that are going to support workflow, that are going to support hormones, that are going to support brain
    0:26:13 function. So at some point in the evening, I eat that thing that we call dinner. And while it
    0:26:18 feels sort of strange to talk about my dinner, the reason I want to talk about my dinner and what
    0:26:24 I eat for dinner is that for me, dinner, of course, is about eating, but also about optimizing the
    0:26:30 transition to sleep. So my dinner generally is comprised of things that are going to support
    0:26:38 rest and deep sleep. And that means starchy carbohydrates. It’s absolutely clear that one of the major ways that we can
    0:26:45 increase serotonin, which helps in the transition to sleep is by ingesting starchy carbohydrates.
    0:26:50 So my dinner is carbohydrates and some protein. So maybe some chicken or fish or something like that,
    0:26:57 maybe some eggs, or sometimes just pasta or just rice and vegetables. And that’s because I enjoy those foods,
    0:27:04 but also because I want to increase the amount of serotonin in my brain so that I can actually fall asleep that night.
    0:27:09 Many people who are on low carbohydrate diets struggle with falling and staying asleep. And that’s because
    0:27:14 it’s hard to achieve heightened levels of serotonin, which are necessary to enter sleep.
    0:27:21 I should also mention that melatonin and serotonin fall in the same pathway. They are related hormones
    0:27:26 and neuromodulators. Essentially what we’re talking about is a system that’s biasing us towards rest and
    0:27:32 relaxation as opposed to wakefulness. You might ask, well, can’t I just take serotonin? Can’t I just take
    0:27:38 5-HTP or a precursor to serotonin or tryptophan? And indeed you can. However, many people, including
    0:27:44 myself, find that when they supplement with serotonin in the evening or at night, that can cause problems
    0:27:50 in the architecture or the structure of sleep. It can cause a lot of people, including me, to fall asleep
    0:27:54 very fast, sleep very deeply for three or four hours, and then wake up and have a terrible time
    0:28:00 falling back asleep. And that effect, at least for me, can last several days. It’s really disruptive.
    0:28:06 So I don’t like to supplement with anything that is directly dopamine or a precursor to dopamine
    0:28:11 at any time or directly serotonin or a precursor to serotonin. Rather, there are other things that can
    0:28:16 enhance the transition to sleep safely, which we will talk about in a few minutes. But the evening meal
    0:28:22 meal consists largely of carbohydrates for that specific purpose of generating a sense of calm.
    0:28:27 And of course, carbohydrates are delicious. And because I’m doing some physical training,
    0:28:31 and presumably you are as well, or I hope you are because it’s so beneficial to one’s health,
    0:28:38 that’s also going to replenish my glycogen stores, which is one of the primary fuel sources for moving
    0:28:43 one’s muscles and moving around and doing exercise, as well as for the brain and for cognitive function.
    0:28:48 I’d like to take a quick break and acknowledge one of our sponsors, Element. Element is an
    0:28:52 electrolyte drink that has everything you need and nothing you don’t. That means the electrolytes,
    0:28:57 sodium, magnesium, and potassium in the correct amounts, but no sugar. Proper hydration is critical
    0:29:02 for optimal brain and body function. Even a slight degree of dehydration can diminish cognitive and
    0:29:07 physical performance. It’s also important that you get adequate electrolytes. The electrolytes,
    0:29:12 sodium, magnesium, and potassium are vital for functioning of all the cells in your body,
    0:29:16 especially your neurons, or your nerve cells. Drinking Element dissolved in water makes it very
    0:29:20 easy to ensure that you’re getting adequate hydration and adequate electrolytes. To make
    0:29:25 sure that I’m getting proper amounts of hydration and electrolytes, I dissolve one packet of Element
    0:29:30 in about 16 to 32 ounces of water when I first wake up in the morning, and I drink that basically
    0:29:34 first thing in the morning. I’ll also drink Element dissolved in water during any kind of physical
    0:29:39 exercise that I’m doing, especially on hot days when I’m sweating a lot and losing water and electrolytes.
    0:29:44 Element has a bunch of great tasting flavors. I love the raspberry. I love the citrus flavor.
    0:29:49 Right now, Element has a limited edition lemonade flavor that is absolutely delicious. I hate to say
    0:29:54 that I love one more than all the others, but this lemonade flavor is right up there with my favorite
    0:29:59 other one, which is raspberry or watermelon. Again, I can’t pick just one flavor. I love them all.
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    0:30:15 that’s drinkelement.com/huberman to claim a free sample pack.
    0:30:21 So let’s talk about sleep and how to access sleep. One way to do that is to leverage the drop in
    0:30:28 temperature that’s necessary to fall and stay asleep. So they mentioned earlier in the early
    0:30:33 parts of the day after waking, our body temperature is rising and that continues throughout the day.
    0:30:38 And then sometime late in the afternoon, our temperature peaks, and then it starts to drop.
    0:30:44 That drop in temperature of one to three degrees is vitally important for us to be able to fall
    0:30:51 asleep easily. One way that we can decrease our transition time into sleep is to accelerate that
    0:30:57 drop in temperature. And one way to accelerate that drop in temperature, somewhat counterintuitively,
    0:31:04 is to use hot baths, hot showers, or if you have access to one, a sauna. Now this is counterintuitive,
    0:31:09 but actually, if you are to get into a sauna or a hot shower or a hot bath and then get out,
    0:31:16 your body is going to engage particular mechanisms for cooling itself off that are going to allow you to
    0:31:21 drop your temperature more quickly and fall asleep more easily. It is absolutely true that keeping the
    0:31:26 room very dark is beneficial. The other thing is keeping the room cool. The reason keeping the room
    0:31:33 cool is useful for getting into and staying asleep is that throughout the night, there are phases of
    0:31:38 sleep where you are paralyzed, so-called REM sleep, that’s a healthy paralysis, presumably so you can’t
    0:31:41 act out your dreams, but there are portions of the night where you can move. And one of the more
    0:31:47 important movements that you do in the middle of the night is put your hand out or your foot out,
    0:31:53 or you take your face out from under the covers as a means to cool yourself. You’re actually allowing
    0:32:01 cooling of the body through what are called AVAs. Arteriovenous astimoses is the technical name
    0:32:07 that are in the palms, the upper half of the face and the bottoms of the feet. Now, there are things that
    0:32:13 one can take to enhance the transition to sleep. Three compounds that can be very beneficial for aiding the
    0:32:18 transition to sleep and for which there are wide safety margins, although please do check with your
    0:32:25 physician before taking anything, are specific forms of magnesium, something called apigenin and theanine.
    0:32:31 Magnesium comes in many forms. Magnesium threonate, that’s T-H-R-E-O-N-A-T-E, threonate, and magnesium
    0:32:38 biglycinate have transporters that allow them to cross the blood-brain barrier more readily than other forms of
    0:32:44 magnesium. And there within the brain, they promote the release of a neurotransmitter called GABA,
    0:32:49 which is an inhibitory neurotransmitter, which shuts off the forebrain to some extent. It doesn’t
    0:32:53 shut off completely, but it essentially shuts down thinking, rumination, planning, and what we call
    0:33:01 executive function. So for many people taking 300 to 400 milligrams of magnesium biglycinate or magnesium
    0:33:07 threonate 30 to 60 minutes before sleep can aid them in falling asleep. When coupled with apigenin
    0:33:15 and theanine provide a sort of synergy or a sleep cocktail that seems to be very effective in aiding
    0:33:22 the transition to sleep. So apigenin is the substance that’s found in chamomile and 50 milligrams of
    0:33:29 apigenin taken 30 minutes before sleep can act as another way to shut off the forebrain and reduce
    0:33:35 rumination, reduce anxiety, and allow people to fall and stay asleep. And then the third compound is
    0:33:45 theanine, T-H-E-A-N-I-N-E. Theanine is a compound that can also increase GABA, but also increases
    0:33:50 activation of something called chloride channels. Chloride channels are another way in which neurons
    0:33:55 lower their levels of activity. So magnesium threonate or biglycinate, apigenin, and theanine
    0:34:01 in combination can be very effective for aiding the transition to sleep. Now, what if you wake up in
    0:34:07 the middle of the night? This is a very common occurrence and there are two general themes around
    0:34:13 waking up in the middle of the night that one can use tools to counteract. The first theme is if you’re
    0:34:20 somebody who is tired in the evenings and you’re kind of pushing yourself to stay awake. So you’re going to the
    0:34:26 party or you’re pushing yourself to study your work when in fact you’d like to get into bed at 8:30 or 9:00,
    0:34:30 and then you’re falling asleep around 10:30 or 11:00 and waking up at 2:30 or 3:00 in the morning,
    0:34:36 you can’t fall back asleep. Chances are that your melatonin pulse was initiated early in the night.
    0:34:44 So that melatonin pulse started probably around 8:30 or 9:00, but you’re staying up. You’re battling that
    0:34:48 melatonin. You may not like this advice, but one of the things that you can do to offset that is to
    0:34:53 simply go to bed earlier. The other thing is many people wake up in the middle of the night because
    0:34:58 of anxiety or because they have to use the restroom. It’s perfectly fine to flip on the lights, but keep the
    0:35:05 lights dim. But if you flip on those lights, try and flip them off as soon as possible and try and get back
    0:35:12 into bed. So now we’ve essentially traveled around the clock, so to speak, from the time where one wakes up
    0:35:17 until the time they get to sleep, maybe wake up, get back to sleep, etc.
    0:35:24 I want to emphasize that although people’s schedules vary, most people are doing more than one or two work
    0:35:30 bouts per day. And indeed, I’m doing more than one or two work bouts per day. I really emphasize that
    0:35:37 morning 90-minute work block because I think most people would agree that there’s a portion of each
    0:35:42 day in which we need to do the hardest thing or the most important thing or the thing that demands the
    0:35:49 most of our cognitive self. I position that early in the day and I position everything around that
    0:35:54 in order to ensure that it happens and that it happens with the highest degree of efficiency,
    0:36:01 even though that morning 90-minute work block is so vital. Of course, there’s a second work block.
    0:36:06 So combined, that’s just three hours of focused work, which may not seem like a lot. But if you were to
    0:36:12 dissect your day and kind of look at the arc and structure of your day, I’d be willing to bet that
    0:36:19 if we added up the total period of time in which you were in deep work, really focused, dedicated work,
    0:36:24 that it would probably amount to about three or four hours. And of course, throughout the day,
    0:36:29 there are other things happening outside of those 90-minute work blocks. I’m checking my text messages,
    0:36:36 I’m checking my email, I’m responding to various demands, I’m working and tending to life. So while I’ve
    0:36:42 carved some boundaries or delineated some boundaries around those work blocks, and I’m certain that if you do,
    0:36:49 too, you will benefit from them. Of course, please adapt and modify what I’ve described today in ways
    0:36:54 that best serve you and your schedule. What I’ve tried to do is provide you scientific support,
    0:37:00 specific protocols and regimens, because people are always asking me for more specificity and detail,
    0:37:07 and an example of one way, just one way, in which these various tools and protocols that are grounded
    0:37:12 in science could be leveraged in one’s own life. And last but not least, thank you for your interest
    0:37:17 in science.
    Chào mừng bạn đến với Huberman Lab Essentials, nơi chúng ta cùng nhìn lại những tập trước để tìm ra những công cụ khoa học mạnh mẽ và có thể áp dụng cho sức khỏe tâm thần, sức khỏe thể chất và hiệu suất. Tôi là Andrew Huberman, và tôi là giáo sư sinh lý học thần kinh và nhãn khoa tại Trường Y tế Stanford. Tôi đã quyết định rằng chúng tôi sẽ tổ chức giờ làm việc. Giờ làm việc trong môi trường đại học là khi sinh viên đến văn phòng của giáo sư hoặc gặp nhau ngoài trời trong khuôn viên trường hoặc trong lớp học để xem xét tài liệu và các câu hỏi từ bài giảng một cách chi tiết hơn.
    Thật không may, chúng ta không có cơ hội để gặp mặt trực tiếp trong đời thực, nhưng dù sao thì bạn vẫn đã gửi các câu hỏi của mình, để lại chúng trong phần bình luận trên YouTube, v.v., và tôi đã chuẩn bị một số câu trả lời cho những câu hỏi thường xuất hiện nhất. Để cung cấp ngữ cảnh và cấu trúc cho cách mà chúng ta sẽ trả lời những câu hỏi này, tôi đã sắp xếp các kiến thức khoa học và các giao thức dựa trên khoa học liên quan đến nhiều khía cạnh của cuộc sống, chẳng hạn như tâm trạng, tập thể dục, giấc ngủ, thức dậy, lo âu, sáng tạo, v.v., trong bối cảnh của một ngày.
    Việc chọn đơn vị một ngày để cung cấp thông tin khoa học và các giao thức này không phải là một quyết định ngẫu nhiên từ phía tôi. Thực tế là mỗi tế bào trong cơ thể chúng ta, mỗi cơ quan trong cơ thể và bộ não của chúng ta đều bị điều tiết hoặc thay đổi trong suốt 24 giờ của một ngày theo một nhịp điệu rất đều đặn và có thể dự đoán được. Vì vậy, việc chọn đơn vị là một ngày không chỉ là một quyết định thực tiễn, mà còn liên quan đến sinh học sâu sắc hơn của chúng ta.
    Vậy hãy cùng nói về cách áp dụng khoa học chất lượng, được đánh giá bởi các chuyên gia vào ngày của bạn và cách tối ưu hóa mọi thứ, từ giấc ngủ đến học tập, sáng tạo, thời gian ăn uống, v.v. Tôi sẽ làm điều này trong bối cảnh của một ngày của tôi và những gì tôi thường làm. Tôi thường thức dậy vào khoảng 6:00 sáng hoặc 6:30. Điều đầu tiên tôi làm sau khi thức dậy là tôi lấy cây bút trên bàn đầu giường và quyển giấy trên bàn đầu giường của mình, và tôi ghi lại thời gian mà tôi thức dậy. Lý do ghi lại thời gian tôi thức dậy là vì tôi muốn biết cái gọi là nhiệt độ tối thiểu của mình. Tôi không quan tâm đến nhiệt độ thực tế của mình. Tôi quan tâm đến thời điểm mà nhiệt độ thấp nhất của tôi xảy ra. Và tôi biết rằng nhiệt độ thấp nhất đó thường rơi vào khoảng hai giờ trước thời gian dậy trung bình của tôi.
    Điều thứ hai tôi làm sau khi thức dậy là bắt đầu di chuyển về phía trước, thực chất chỉ là một cách nói của việc đi bộ. Có một hiện tượng mà khi chúng ta tạo ra chuyển động về phía trước, hình ảnh thị giác trôi qua mắt chúng ta, cái được gọi là dòng ảnh. Trải nghiệm dòng hình ảnh có một tác động mạnh mẽ đến hệ thần kinh. Tác động của nó về cơ bản là làm dịu hoặc giảm lượng hoạt động thần kinh trong cấu trúc não gọi là hạch hạnh nhân (amygdala). Nhiều người trong số các bạn có thể đã nghe về hạch hạnh nhân vì vai trò của nó trong lo âu, sợ hãi và phát hiện mối đe dọa. Thực tế, hạch hạnh nhân là một phần của mạng lưới trong não tạo ra cảm giác sợ hãi, đe dọa và lo âu. Nó cũng thực hiện một số chức năng khác, nhưng đó là một trong những chức năng chính của nó.
    Việc di chuyển về phía trước, đi bộ, đạp xe hoặc chạy bộ, đặc biệt là tạo ra dòng ảnh, có tính chất tuyệt vời là giảm hoạt động trong hạch hạnh nhân và do đó giảm mức độ lo âu. Đó là lý do vì sao việc đi bộ mỗi ngày là một giao thức đặc biệt quan trọng, vì nó thực sự giúp điều chỉnh hệ thần kinh của tôi theo hướng mà tôi muốn, đó là tỉnh táo nhưng không lo âu. Tôi muốn có một mức độ tập trung và tỉnh táo cao, bởi vì tôi sẽ sớm bước vào giai đoạn làm việc. Tôi cần chuẩn bị cho cả ngày.
    Để làm điều đó, tôi đảm bảo rằng việc đi bộ được thực hiện ngoài trời. Tôi làm như vậy vì tôi cũng muốn ánh sáng mặt trời chiếu vào mắt mình. Nhận được ánh sáng mặt trời vào mắt ngay khi thức dậy là rất cần thiết cho sức khỏe tâm thần và thể chất. Ngay cả khi có mây, ánh sáng từ các photon vẫn xuyên qua lớp mây đó nhiều hơn so với ánh sáng từ một bóng đèn trong nhà rất sáng. Vì vậy, việc ra ngoài đi bộ khoảng 10 hay 15 phút sẽ đảm bảo rằng bạn đang nhận được sự kích thích đầy đủ cho các tế bào thần kinh trong mắt được gọi là melanopsin, các tế bào hạch nhạy cảm với ánh sáng tự nhiên. Đây là những tế bào thần kinh truyền đạt cho não biết rằng đó là ban ngày và đã đến lúc tỉnh táo. Điều này khởi động một loạt các chuỗi sinh học lớn bên trong mỗi tế bào và cơ quan trong cơ thể bạn, từ gan, ruột, tim đến não bộ của bạn.
    Sớm trong ngày, chúng ta trải qua một sự gia tăng tự nhiên và lành mạnh trong một hormone gọi là cortisol và thúc đẩy sự tỉnh táo. Nó thực sự thúc đẩy một hệ thống miễn dịch khỏe mạnh. Rất quan trọng là xung cortisol đó đến sớm trong ngày. Xung cortisol đó sẽ xảy ra một lần mỗi 24 giờ, bất kể điều gì. Nó sẽ xảy ra và bạn có thể định thời gian cho nó. Làm thế nào để bạn định thời gian cho nó? Chủ yếu là khi bạn nhìn thấy ánh sáng mặt trời sáng. Bạn có thể kết hợp nó với chuyển động về phía trước, với việc đi bộ và dòng ảnh mà tôi đã đề cập trước đó. Và đó là những gì tôi làm mỗi buổi sáng để tạo ra cảm giác tỉnh táo trong cơ thể và não bộ của mình, để tạo ra cảm giác bình tĩnh nhưng vẫn tỉnh táo.
    Vì vậy, chúng ta có giao thức đầu tiên, đó là ghi lại thời gian trong ngày bạn thức dậy. Giao thức thứ hai là đi bộ ngay khi thức dậy vào buổi sáng. Và giao thức thứ ba được kết hợp với việc đi bộ đó, ít nhất là đối với tôi, đó là nhận được ánh sáng mặt trời. Tôi hoàn toàn tin tưởng dựa trên dữ liệu đánh giá chất lượng, rằng sự hydrat hóa là thiết yếu cho hiệu suất tâm thần. Như nhiều bạn đã biết, tế bào thần kinh cần dòng ion. Điều đó có nghĩa là tế bào thần kinh cần natri. Chúng cần magnesi và cần kali để hoạt động. Chúng ta thường bị mất nước vào ban đêm. Tôi cố gắng đảm bảo rằng tôi được hydrat hóa vào đầu ngày trước khi bắt đầu bất kỳ công việc nào. Vì vậy, tôi tự làm cho mình uống nước với một chút muối biển.
    Dưới đây là bản dịch sang tiếng Việt:
    Bao nhiêu muối biển, nếu bạn thực sự muốn chi tiết, tôi nghĩ khoảng nửa thìa cà phê. Không nhiều lắm. Đến lúc đó, tôi bắt đầu thèm caffeine, nhưng tôi chưa uống caffeine. Tôi cố tình hoãn việc tiêu thụ caffeine từ 90 phút đến 120 phút sau khi thức dậy. Lý do tôi trì hoãn caffeine là vì một trong những yếu tố gây ra cảm giác buồn ngủ là sự tích tụ của adenosine. Sự tích tụ của adenosine càng tăng lên khi chúng ta thức lâu hơn. Khi bạn thức dậy vào buổi sáng, mức adenosine của bạn có thể rất thấp. Tuy nhiên, caffeine là một chất chặn adenosine. Thực tế, nó là một đối kháng cạnh tranh cho các bạn yêu thích. Nó ở lại vị trí tiếp nhận mà adenosine thường sẽ ở lại và ngăn cản adenosine không tác động lên vị trí tiếp nhận đó. Đó là lý do tại sao bạn cảm thấy tỉnh táo hơn. Lý do tôi trì hoãn việc tiêu thụ caffeine từ 90 phút đến 2 giờ sau khi thức dậy là tôi muốn chắc chắn rằng tôi không bị kiệt sức vào buổi chiều muộn hoặc thậm chí là buổi chiều sớm. Một trong những cách tốt nhất để đảm bảo bạn bị kiệt sức vì caffeine là uống một đống caffeine, chặn tất cả các thụ thể adenosine đó. Và rồi vào buổi chiều sớm hoặc muộn, khi caffeine bắt đầu giảm và bị rời khỏi các thụ thể, mức adenosine thấp hơn có thể tạo ra mức độ buồn ngủ cao hơn. Việc trì hoãn caffeine trong 90 phút đến 2 giờ tối ưu hóa mối quan hệ này giữa adenosine và sự tỉnh táo cũng như buồn ngủ theo một cách mà thực sự cung cấp một đường cong năng lượng nhất quán đẹp mắt suốt cả ngày và giảm năng lượng khi tôi tiến đến giấc ngủ và đang chìm vào giấc ngủ.
    Tôi muốn nghỉ ngơi một chút và ghi nhận nhà tài trợ của chúng tôi, Eight Sleep. Eight Sleep tạo ra các lớp đệm thông minh với khả năng làm mát, sưởi ấm và theo dõi giấc ngủ. Một trong những cách tốt nhất để đảm bảo có một giấc ngủ ngon là đảm bảo rằng nhiệt độ của môi trường ngủ của bạn là đúng. Và đó là vì để rơi vào giấc ngủ sâu và giữ giấc ngủ sâu, nhiệt độ cơ thể bạn thực sự phải giảm từ khoảng một đến ba độ. Và để thức dậy cảm thấy tỉnh táo và tràn đầy năng lượng, nhiệt độ cơ thể của bạn thực sự phải tăng từ khoảng một đến ba độ. Eight Sleep tự động điều chỉnh nhiệt độ của giường bạn suốt đêm, phù hợp với nhu cầu riêng của bạn. Tôi đã ngủ trên lớp đệm Eight Sleep trong hơn bốn năm, và nó đã hoàn toàn biến đổi và cải thiện chất lượng giấc ngủ của tôi. Eight Sleep vừa mới ra mắt mẫu mới nhất của họ, Pod 5, và Pod 5 có một số tính năng mới quan trọng. Một trong những tính năng mới này được gọi là Autopilot. Autopilot là một động cơ AI học các mô hình giấc ngủ của bạn để điều chỉnh nhiệt độ của môi trường ngủ của bạn qua các giai đoạn giấc ngủ khác nhau. Nó cũng nâng đầu bạn nếu bạn đang ngáy, và thực hiện các sự thay đổi khác để tối ưu hóa giấc ngủ của bạn. Cơ sở trên Pod 5 cũng có một loa tích hợp mà đồng bộ với ứng dụng Eight Sleep và có thể phát âm thanh để hỗ trợ thư giãn và phục hồi. Danh mục âm thanh bao gồm một số kịch bản NSDR, nghỉ ngơi sâu không ngủ, mà tôi đã làm việc cùng Eight Sleep để ghi lại. Nếu bạn chưa quen, NSDR liên quan đến việc lắng nghe một kịch bản âm thanh hướng dẫn bạn qua một sự thư giãn sâu của cơ thể kết hợp với một số bài tập thở rất đơn giản. Và sự kết hợp đó đã được chứng minh trong các nghiên cứu được bình duyệt là phục hồi năng lượng tinh thần và thể chất của bạn. Điều này thật tuyệt vời vì trong khi tất cả chúng ta đều muốn đi ngủ đúng giờ và thức dậy sau một giấc ngủ hoàn hảo, thường thì chúng ta đi ngủ muộn hơn một chút hoặc muộn hơn. Đôi khi chúng ta phải dậy sớm và lao vào ngày mới vì chúng ta có những nghĩa vụ của mình. NSDR có thể giúp bù đắp một số tác động tiêu cực của việc thiếu ngủ nhẹ. Và NSDR giúp bạn dễ dàng hơn trong việc quay lại giấc ngủ nếu bạn thức dậy giữa đêm. Đây là một công cụ cực kỳ mạnh mẽ mà bất kỳ ai cũng có thể hưởng lợi ngay lần đầu tiên và mỗi lần sau. Nếu bạn muốn thử Eight Sleep, hãy truy cập eightsleep.com/huberman để nhận tối đa $350 giảm giá cho chiếc Pod 5 mới. Eight Sleep giao hàng đến nhiều quốc gia trên toàn thế giới, bao gồm cả Mexico và UAE. Một lần nữa, đó là eightsleep.com/huberman để tiết kiệm tối đa $350.
    Mục tiêu chính của tôi vào buổi sáng là vào trạng thái tập trung, nhưng vẫn tỉnh táo để có thể hoàn thành công việc. Tôi đã tìm ra rằng cách tốt nhất để tôi đạt được trạng thái đó là qua việc nhịn ăn. Vì vậy, tôi không ăn gì cho đến khoảng 11:00 AM hoặc 12:00 giờ trưa. Nhịn ăn tăng cường mức độ adrenaline, còn gọi là epinephrine trong não và cơ thể. Và khi mức epinephrine và adrenaline của chúng ta được tăng cường, chúng ta học tốt hơn, chúng ta có thể tập trung tốt hơn. Bạn không muốn epinephrine, tức là adrenaline, quá cao, vì điều đó gây cảm giác căng thẳng và hoảng loạn, bạn sẽ cảm thấy run rẩy, không thể tập trung, nhưng trong phạm vi tối ưu của nó, adrenaline thực sự tạo ra cảm giác tập trung cao hơn và khả năng mã hóa, có nghĩa là tiếp nhận và lưu giữ thông tin. Tiếp theo, tôi muốn nói về những gì tôi đang làm khi làm việc. Một số điều để tối ưu hóa không gian làm việc được dựa trên thần kinh học và sinh lý học. Tôi đã nói trước đây về việc khi mắt chúng ta hướng lên trên, nó tạo ra một trạng thái cảnh giác cao hơn và điều này có mối liên quan đến các tế bào thần kinh ở thân não tạo ra sự tỉnh táo và khả năng kiểm soát các cơ của mắt và thật không thể tin được, cả mí mắt. Điểm ở đây là bạn có thể tối ưu hóa nơi làm việc của mình theo cách vật lý nhằm tận dụng khía cạnh này của hệ thống thị giác và mức độ tỉnh táo của bạn. Hãy cố gắng định vị màn hình hoặc máy tính bảng của bạn, bất kỳ thiết bị nào bạn đang làm việc, ít nhất ở mức ngang tầm mắt và lý tưởng hơn là hơi cao hơn một chút. Hầu hết mọi người đang nhìn xuống máy tính hoặc máy tính bảng của họ hoặc đang nghiêng mắt xuống màn hình ở khoảng 30 độ. Khi chúng ta nhìn xuống, khi mí mắt của chúng ta hơi khép lại, điều đó có xu hướng giảm mức độ tỉnh táo của chúng ta và tăng mức độ buồn ngủ. Vì vậy, giờ đây chúng ta đang ở mô tả của ngày của tôi và các quy trình mà tôi sẽ làm trong 90 phút làm việc.
    Bây giờ, tại sao lại là 90 phút?
    À, bộ não trải qua những chu kỳ siêu nhịp mà gọi là ultradian trong suốt cả ngày và đêm.
    Mỗi 90 phút, chúng ta chuyển từ trạng thái rất tỉnh táo sang trạng thái ít tỉnh táo hơn và rồi lại quay về trạng thái tỉnh táo.
    Đây là cách nó hoạt động.
    Ở đầu một trong những chu kỳ ultradian 90 phút này, bộ não của tôi không hoàn toàn tập trung vào những gì tôi đang cố gắng làm, nhưng tôi đặt một bộ đếm thời gian cho 90 phút và cố gắng hoàn thành một lượng công việc mạnh mẽ trong khoảng thời gian 90 phút đó với sự hiểu biết đầy đủ rằng toàn bộ 90 phút sẽ không đồng nhất về khả năng tập trung của tôi.
    Vì vậy, mục tiêu là đi vào trạng thái mà tôi gọi là “đường hầm”, thực sự tập trung vào một “đường hầm” của công việc chất lượng.
    Bộ não rất thích trạng thái đó, nhưng nhiều người trong chúng ta rất khó để đạt được.
    Điện thoại của tôi hoàn toàn tắt.
    Nó không ở chế độ máy bay.
    Nó hoàn toàn tắt trong suốt thời gian này.
    Ngoài ra, tôi sử dụng tiếng trắng ở mức thấp.
    Tiếng trắng, về cơ bản là tất cả các tần số âm thanh.
    Chúng ta đều nhận thức được các tần số âm thanh.
    Trộn lẫn một cách ngẫu nhiên, không có cấu trúc nào trong đó.
    Khi được bật ở âm lượng thấp, nó đưa bộ não vào trạng thái tối ưu cho việc học và làm việc.
    Vì vậy, tất cả mọi thứ về khoảng thời gian 90 phút này, từ mức tiếng trắng thấp đến vị trí của máy tính của tôi, cách tôi đứng, vị trí của đôi mắt của tôi, đều được thiết kế để đưa tôi vào “đường hầm” làm việc này.
    Và tôi phải nói rằng mặc dù có thể khó khăn để cố gắng đạt được trạng thái và “đường hầm” làm việc này, nhưng một số ngày bạn bắt đầu cảm thấy hơi nghiện nó.
    Cảm giác thật tuyệt vời.
    Nó giống như một bài tập cho tâm trí, và khi bạn thoát ra khỏi 90 phút đó, bạn thực sự cảm thấy mình đã hoàn thành nhiều việc, vì thường thì bạn có.
    Và nó cảm thấy thật sự thỏa mãn.
    Và tôi tin rằng điều đó là nhờ vào sự giải phóng các chất điều chỉnh thần kinh như dopamine và norepinephrine đang tuần hoàn trong hệ thống của bạn.
    Và tôi muốn làm rõ rằng tôi không hoàn hảo về 90 phút này.
    Thỉnh thoảng tôi bị lôi kéo ra ngoài, nhưng tôi thực sự cố gắng đạt được điều này hầu hết, nếu không phải mỗi ngày tôi còn sống, vì với tôi, phiên làm việc đó là khá thiêng liêng.
    Có một cách mạnh mẽ trong việc bạn có thể đặt thời điểm của phiên làm việc 90 phút này một cách tối ưu.
    Bạn có quyền truy cập vào một phần dữ liệu rất quan trọng quyết định khi nào phiên làm việc này nên bắt đầu, nhiều hay ít, và khi nào nó nên kết thúc.
    Phần dữ liệu đó là mức nhiệt độ tối thiểu của bạn.
    Nếu bạn là người thường dậy vào lúc 7:00 sáng, thì mức nhiệt độ tối thiểu của bạn là 5:00 sáng.
    Bạn có thể hoàn toàn chắc chắn rằng công việc tốt nhất của bạn sẽ được thực hiện từ bốn đến sáu giờ sau mức nhiệt độ tối thiểu của bạn.
    Làm thế nào tôi biết điều này?
    Làm thế nào tôi biết mối quan hệ này giữa mức nhiệt độ tối thiểu và khả năng tập trung?
    Chà, mức nhiệt độ tối thiểu xác định điểm thấp nhất, như người ta nói, của nhiệt độ của bạn trong suốt chu kỳ 24 giờ.
    Và ngay sau đó, nhiệt độ của bạn sẽ bắt đầu tăng.
    Sự tăng nhiệt độ đó thực sự là điều kích hoạt sự giải phóng cortisol ban đầu mà bạn trải nghiệm và đánh thức bạn thêm.
    Sau đó, tất nhiên, ánh nắng mà bạn nhận được sẽ tăng cường thêm sự giải phóng cortisol khỏe mạnh đó.
    Cortisol sẽ sau đó cung cấp năng lượng, nếu bạn muốn, cho sự tăng nhiệt độ đó.
    Và cơ thể của bạn sẽ tiếp tục tăng nhiệt độ trong suốt cả ngày đến chiều.
    Điều bạn đang cố gắng làm trong ý tưởng tối ưu hóa phiên làm việc 90 phút này đến một thời điểm cụ thể trong ngày là bắt kịp phần của độ dốc cao nhất của sự tăng nhiệt độ đó.
    Vì vậy, nếu bạn là người dậy vào lúc 8:00 sáng mỗi sáng, mức nhiệt độ tối thiểu của bạn là 6:00 sáng, có khả năng bạn sẽ muốn bắt đầu phiên làm việc này vào khoảng 10:00 hoặc 11:00 sáng.
    Bây giờ, một số người dậy và cảm thấy rất tỉnh táo ngay từ đầu buổi sáng.
    Họ thực sự có thể làm việc tốt nhất vào sáng sớm.
    Xin vui lòng, nếu bạn thuộc về nhóm đó, hãy tiếp tục làm điều đó.
    Tận dụng thời gian đó, sử dụng thời gian đó.
    Nhưng nếu bạn là người gặp khó khăn trong việc tìm kiếm sự tập trung, chắc chắn hãy để cho cơ thể và sự tăng nhiệt độ này hỗ trợ nỗ lực tập trung của bạn thay vì cố gắng làm việc tốt nhất vào những khoảng thời gian trong ngày mà cơ thể bạn thực sự đang hướng dẫn bạn và bộ não của bạn đến sự không tập trung và trở nên uể oải hơn.
    Nó chỉ đơn giản là đặt bạn vào một vị trí thành công khi bạn cố gắng bắt kịp giai đoạn tăng nhiệt độ này.
    Dữ liệu từ những năm 1990 hỗ trợ ý tưởng rằng hoạt động thể chất của những loại đặc biệt có thể hỗ trợ sức khỏe và chức năng não, cả trong ngắn hạn và dài hạn.
    Vì vậy, sau khi tôi hoàn thành một phiên làm việc, phiên làm việc 90 phút này, tôi buộc mình phải thực hiện một dạng bài tập thể chất nào đó có thể hỗ trợ sức khỏe và chức năng não của tôi cũng như sức khỏe cơ quan và chức năng cơ thể nói chung.
    Bây giờ, có nhiều hình thức hoạt động thể chất hoặc điều mà chúng ta gọi là tập thể dục, nhưng chúng có thể được nhóm vào hai loại.
    Đầu tiên là công việc sức mạnh và tăng trưởng cơ bắp.
    Vì vậy, những chuyển động thể chất được thiết kế để làm cho bạn mạnh mẽ hơn và/hoặc làm cho cơ bắp của bạn lớn hơn.
    Cũng có công việc bền bỉ, các bài tập thể dục và chuyển động được thiết kế để cho phép bạn làm nhiều việc hơn theo thời gian hoặc kéo dài thời gian mà bạn có thể làm việc bất kỳ loại nào, cả thể chất và tinh thần.
    Dữ liệu đều chỉ ra rằng tập luyện căng thẳng hơn một giờ thực sự có thể có hại do cách mà nó làm tăng cortisol và cortisol có thể là điều tốt nếu được thời gian phù hợp và ở mức thấp thích hợp, nhưng bạn không muốn có mức cortisol cao trong suốt cả ngày hoặc có những đợt tăng lớn cortisol liên tục.
    Vì vậy, giữ cho các buổi tập tương đối ngắn chắc chắn có thể giúp điều đó.
    Công việc sức bền và đào tạo sức mạnh hoặc đào tạo tăng cường cơ bắp khi kết hợp với nhau, có nghĩa là không nhất thiết phải trong cùng một buổi tập, nhưng được thực hiện trong suốt tuần sẽ rất có lợi cho việc sản xuất các yếu tố như yếu tố phát triển thần kinh có nguồn gốc từ não, để giới hạn các cytokine viêm như IL-6, và để thúc đẩy các cytokine chống viêm như IL-10, với điều kiện là bài tập có độ dài phù hợp và không quá cường độ để gây ra tổn thương cho các hệ thống khác nhau của cơ thể.
    Thế còn cấu trúc của các bài tập thực tế thì sao?
    Bạn nên làm khoảng 80% bài tập sức đề kháng của mình là những bài không đi đến điểm “thất bại”, tức là bạn không thể cử động sức đề kháng nữa. 20% còn lại có thể là các bài tập cường độ cao đến điểm thất bại. Quy tắc 80-20 về việc làm ít hơn điểm thất bại và làm đến điểm thất bại trong chế độ tập sức đề kháng có thể được áp dụng hoặc chuyển giao sang phần bài tập sức bền bằng cách tập trung vào điều mà chúng ta quen thuộc, đó là sự nóng rát khi chạy nhanh hoặc đạp xe nhanh, chúng ta sẽ trải nghiệm một cảm giác nóng rát ở cơ bắp liên quan đến hệ thống lactate. Và thực tế, hệ thống lactate là một dạng nhiên liệu riêng cho não. Do đó, đang có sự quan tâm ngày càng tăng trong việc tạo ra lactate hoặc vượt qua ngưỡng lactate cho một phần nhỏ, khoảng 20% công việc sức bền để hỗ trợ sức khỏe và chức năng của não.
    Vì vậy, vào bất kỳ ngày nào khi tôi hoàn thành khối công việc đó và tôi tập luyện, tôi sẽ thực hiện một loại đào tạo sức đề kháng hoặc sức bền. Tôi đặt chúng vào những ngày xen kẽ hoặc những ngày khác nhau.
    Như nhiều bạn biết, tôi đã uống AG1 hàng ngày hơn 13 năm. Tuy nhiên, giờ đây tôi đã tìm thấy một loại đồ uống vitamin, khoáng chất và probiotic thậm chí tốt hơn. Đồ uống mới và tốt hơn đó là AG1 phiên bản mới và cải tiến, vừa ra mắt tháng này. Công thức thế hệ tiếp theo từ AG1 là một phiên bản tiên tiến hơn, đã được lâm sàng chứng minh của sản phẩm mà tôi đã uống hàng ngày trong nhiều năm qua. Nó bao gồm các dưỡng chất sinh học mới và probiotics được cải tiến.
    Công thức thế hệ tiếp theo dựa trên nghiên cứu mới hấp dẫn về các tác động của probiotic lên hệ vi sinh vật đường ruột. Nó hiện bao gồm một vài chủng probiotic cụ thể đã được nghiên cứu lâm sàng cho thấy hỗ trợ cả sức khỏe tiêu hóa và sức khỏe hệ thống miễn dịch, cũng như cải thiện đều đặn đường ruột và giảm cảm giác đầy hơi. Là một người đã tham gia vào nghiên cứu khoa học hơn ba thập kỷ, và trong lĩnh vực sức khỏe và thể hình cũng lâu như vậy, tôi luôn tìm kiếm những công cụ tốt nhất để cải thiện sức khỏe tâm thần, sức khỏe thể chất và hiệu suất của mình. Tôi phát hiện và bắt đầu dùng AG1 từ năm 2012, lâu trước khi tôi có podcast, và tôi đã dùng mỗi ngày kể từ đó. Tôi nhận thấy rằng nó cải thiện rất nhiều mọi khía cạnh của sức khỏe của tôi. Tôi cảm thấy tốt hơn rất nhiều khi dùng nó, nhưng qua mỗi năm trôi qua, và nhân tiện, tôi sẽ bước sang tuổi 50 vào tháng 9 này, tôi vẫn cảm thấy ngày càng tốt hơn. Và tôi quy nhiều điều đó cho AG1. AG1 sử dụng các thành phần chất lượng cao nhất trong những sự kết hợp phù hợp, và họ liên tục cải thiện công thức của mình mà không tăng chi phí. Vì vậy, tôi rất vinh dự khi có họ là nhà tài trợ cho podcast này. Nếu bạn muốn thử AG1, bạn có thể truy cập drinkag1.com/huberman để nhận một ưu đãi đặc biệt. Hiện tại, AG1 đang tặng một bộ quà tặng chào mừng AG1 với năm gói đi du lịch miễn phí và một chai vitamin D3 K2 miễn phí. Một lần nữa, hãy truy cập drinkag1.com/huberman để nhận bộ quà tặng chào mừng đặc biệt với năm gói đi du lịch miễn phí và một chai vitamin D3 K2 miễn phí.
    Vì vậy, chúng ta đã nói về quá trình từ việc thức dậy đến một khoảng thời gian làm việc tập trung vào buổi sáng cho đến khi tập thể dục. Tôi chưa đề cập đến việc tiêu thụ bất cứ thứ gì hoặc các dưỡng chất. Một trong những câu hỏi thường gặp nhất mà tôi nhận được là tôi nên ăn gì cho não của mình? Thật mỉa mai, một trong những điều tốt nhất bạn có thể làm cho não của mình là không ăn. Nhưng tất nhiên, tất cả chúng ta đều phải ăn sớm hay muộn. Vậy thì hãy nói về thời gian ăn uống trước. Như tôi đã đề cập, tôi ăn bữa ăn đầu tiên vào khoảng giữa trưa, có thể sớm hơn hoặc muộn hơn một giờ. Khối lượng thực phẩm cũng rất quan trọng. Nếu bạn ăn một khối lượng lớn bất kỳ thứ gì vì nó sẽ làm máu chuyển sang dạ dày, bạn sẽ cảm thấy uể oải và lượng máu đến não sẽ giảm. Điều đó có vẻ như là một sự thật đơn giản và tầm thường, nhưng nếu bạn muốn có khả năng suy nghĩ, bạn không thể tiêu thụ khối lượng lớn bất kỳ thứ gì vào dạ dày của mình. Vì vậy, cho bữa trưa, tôi nhấn mạnh đến việc tiêu thụ carbohydrate hơi thấp hoặc ít carbohydrate vì lý do đơn giản rằng adrenaline và dopamine cùng với các modul thần kinh liên quan của chúng sẽ hỗ trợ sự tỉnh táo. Với tôi, tôi nhịn ăn cho đến khoảng giữa trưa, sau đó tôi ăn một bữa trưa bao gồm một số loại thực phẩm giàu protein như thịt, gà hoặc cá hồi và một số loại rau, v.v. Và nếu tôi đã tập thể dục trước đó, như tôi đã đề cập, năm ngày một tuần, thì tôi sẽ tiêu thụ một số tinh bột. Tôi sẽ ăn một ít bánh mì hoặc gạo hoặc bột yến mạch và bơ và các loại hạt. Nhưng tôi sẽ giữ tổng lượng carbohydrate ở mức hơi thấp, hoặc nếu tôi không tập luyện, tôi sẽ không ăn bất kỳ carbohydrate nào. Không phải vì tôi theo chế độ ketogenic mà vì các tinh bột gây ra sự giải phóng serotonin trong não và gây ra trạng thái buồn ngủ.
    Bây giờ, còn những thành phần của thực phẩm không liên quan đến sự tỉnh táo mà liên quan đến tâm trạng thì sao? Chúng tôi đã thực hiện một toàn bộ tập về tâm trạng và thực phẩm, và rất rõ ràng dựa trên hàng tá nghiên cứu rằng việc tiêu thụ đủ mức axit béo omega-3 sẽ hỗ trợ tâm trạng khỏe mạnh và thậm chí có thể hoạt động như một loại thuốc chống trầm cảm. Việc tiêu thụ ít nhất 1.000 miligam mỗi ngày dạng EPA của axit béo thiết yếu có tác dụng tương tự như thuốc chống trầm cảm theo toa trong việc làm giảm triệu chứng trầm cảm. Và nếu bạn là người cần thuốc chống trầm cảm theo toa, như Prozac, Zoloft, v.v., điều đó có thể cho phép mọi người sử dụng liều thấp hơn của các loại thuốc đó. Một khía cạnh quan trọng của bữa ăn giữa trưa, nếu bạn muốn bữa ăn đó mang lại lợi ích cho bạn, là đi dạo một chút sau đó.
    Hóa ra, những cuộc đi bộ ngắn từ năm đến ba mươi phút sau khi ăn có thể tăng tốc quá trình chuyển hóa và thực sự cải thiện việc sử dụng dinh dưỡng, về cơ bản là giống như quá trình chuyển hóa. Tuy nhiên, đó là điều mà tôi làm sau khi ăn trưa. Tôi buộc mình phải đứng dậy và ra ngoài đi bộ một chút. Việc này cũng giúp tôi có lại cảm giác dòng chảy thị giác.
    Nó cũng có một lợi ích khác, đó là tôi cung cấp cho não bộ và như vậy là cho cơ thể mình nhiều thông tin hơn về ánh sáng và thời gian trong ngày, điều này luôn tốt hơn so với việc có ít thông tin hơn về ánh sáng và thời gian trong ngày. Một giao thức quan trọng cho sức khỏe giấc ngủ, sự tỉnh táo, quá trình chuyển hóa và sức khỏe hormone là tiếp xúc với ánh sáng vào buổi chiều. Đây là lý do để làm điều này.
    Khi chúng ta tiến vào buổi tối, có một hiện tượng mà trong đó võng mạc, mắt của chúng ta trở nên rất nhạy cảm với ánh sáng, đến mức nếu chúng ta nhìn vào ánh sáng sáng hoặc thậm chí là ánh sáng không quá sáng vào khoảng thời gian từ 10:00 tối đến 4:00 sáng, điều đó sẽ gây rối loạn mạnh mẽ, rất rối cho quá trình sản xuất dopamine của chúng ta. Nó có thể thực sự làm rối loạn giấc ngủ của chúng ta. Nhưng nếu bạn có thể ra ngoài và nhìn thấy mặt trời khi nó lặn, hoặc nếu bạn không thể nhìn trực tiếp vào mặt trời, hãy để một chút ánh sáng mặt trời vào mắt trong những giờ buổi chiều. Có thể khoảng 4:00 chiều. Điều này giúp giảm độ nhạy cảm của võng mạc vào những giờ cuối buổi tối, giúp bạn tự bảo vệ trước các tác động tiêu cực của ánh sáng sáng vào ban đêm.
    Chúng ta chưa nói nhiều về melatonin, nhưng melatonin là một hormone bị ức chế bởi ánh sáng. Melatonin là hormone giúp bạn dễ dàng đi vào giấc ngủ. Tôi không nói về việc bổ sung melatonin. Tôi đang nói về melatonin mà bạn tự nhiên sản xuất từ tuyến tùng. Giao thức này rất đơn giản. Ra ngoài vào buổi chiều hoặc buổi tối trong khoảng từ 10 đến 30 phút, bỏ kính râm ra. Hãy nhận ánh sáng buổi chiều. Điều bạn sẽ nhận thấy là những giao thức tối ưu để tối ưu hóa sức khỏe và hiệu suất não bộ cùng cơ thể và giấc ngủ, v.v., thực sự rất đơn giản. Nhưng chỉ vì chúng đơn giản không có nghĩa là chúng không mạnh mẽ. Thực tế, chúng rất mạnh mẽ vì chúng tận dụng công nghệ mạnh mẽ nhất hiện có, đó chính là hệ thần kinh của bạn. Những điều chúng ta đang nói hôm nay thực sự là những điều cơ bản mà chúng ta đều có thể làm để điều chỉnh thần kinh học và sinh học của chúng ta theo những hướng sẽ hỗ trợ quy trình làm việc, hỗ trợ hormone, hỗ trợ chức năng não bộ.
    Vào một thời điểm nào đó trong buổi tối, tôi ăn thứ mà chúng ta gọi là bữa tối. Và dẫu nó có vẻ hơi kỳ lạ khi nói về bữa tối của mình, lý do tôi muốn nói về bữa tối và những gì tôi ăn là vì đối với tôi, bữa tối, tất nhiên, là về việc ăn uống, nhưng cũng là về việc tối ưu hóa chuyển tiếp vào giấc ngủ. Vì vậy, bữa tối của tôi thường bao gồm những thứ sẽ hỗ trợ sự nghỉ ngơi và giấc ngủ sâu. Điều đó có nghĩa là carbohydrate tinh bột. Rõ ràng rằng một trong những cách chính mà chúng ta có thể tăng cường serotonin – điều giúp trong việc chuyển giao vào giấc ngủ – là bằng cách tiêu thụ carbohydrate tinh bột.
    Vì vậy, bữa tối của tôi là carbohydrate và một số protein. Có thể là thịt gà hoặc cá hoặc thứ gì đó như vậy, có thể là trứng, hoặc đôi khi chỉ là mì ống hoặc chỉ là cơm và rau. Và đó là vì tôi thích những món ăn đó, nhưng cũng vì tôi muốn tăng lượng serotonin trong não mình để thực sự có thể đi vào giấc ngủ vào tối hôm đó. Nhiều người đang ăn kiêng ít carbohydrate gặp khó khăn trong việc ngủ ngon và duy trì giấc ngủ. Và đó là bởi vì khó khăn trong việc đạt được mức serotonin cao, điều cần thiết để đi vào giấc ngủ.
    Tôi cũng nên đề cập rằng melatonin và serotonin nằm trong cùng một con đường. Chúng là hormone và neuromodulator liên quan. Về cơ bản, những gì chúng ta đang nói đến là một hệ thống thiên về sự nghỉ ngơi và thư giãn thay vì tỉnh táo. Bạn có thể hỏi, vậy tại sao tôi không thể chỉ dùng serotonin? Tôi có thể chỉ dùng 5-HTP hoặc tiền chất của serotonin hoặc tryptophan? Và thực sự thì bạn có thể. Tuy nhiên, nhiều người, bao gồm cả tôi, nhận thấy rằng khi họ bổ sung serotonin vào buổi tối hoặc ban đêm, điều đó có thể gây ra vấn đề trong kiến trúc hoặc cấu trúc giấc ngủ. Nó có thể khiến nhiều người, bao gồm cả tôi, ngủ rất nhanh, ngủ rất sâu trong ba hoặc bốn giờ, và sau đó tỉnh dậy và gặp khó khăn trong việc ngủ lại. Và tác dụng đó, ít nhất đối với tôi, có thể kéo dài trong vài ngày. Nó thực sự gây rối.
    Vì vậy, tôi không thích bổ sung bất kỳ thứ gì trực tiếp là dopamine hoặc tiền chất của dopamine vào bất kỳ thời điểm nào hoặc trực tiếp serotonin hoặc tiền chất của serotonin. Thay vào đó, có những thứ khác có thể nâng cao việc chuyển tiếp vào giấc ngủ một cách an toàn, điều mà chúng ta sẽ nói tới trong vài phút tới. Nhưng bữa tối chủ yếu là carbohydrate cho mục đích cụ thể là tạo ra cảm giác bình tĩnh. Và dĩ nhiên, carbohydrate là rất ngon. Và vì tôi đang thực hiện một số bài tập thể chất, và có lẽ bạn cũng vậy, hoặc tôi hy vọng bạn cũng vậy vì điều đó rất có lợi cho sức khỏe, điều đó cũng sẽ bổ sung cho các kho glycogen của tôi, đó là một trong những nguồn nhiên liệu chính cho việc di chuyển cơ bắp và vận động và tập thể dục, cũng như cho não bộ và chức năng nhận thức.
    Tôi muốn tạm dừng nhanh và công nhận một trong những nhà tài trợ của chúng ta, Element. Element là một loại đồ uống điện giải có mọi thứ bạn cần và không có gì bạn không cần. Điều đó có nghĩa là các điện giải, natri, magie và kali với mức độ chính xác, nhưng không có đường. Việc cung cấp nước đúng cách rất quan trọng cho chức năng não bộ và cơ thể tối ưu. Ngay cả một mức độ mất nước nhẹ cũng có thể làm giảm hiệu suất nhận thức và thể chất. Cũng quan trọng là bạn nhận được đủ điện giải. Các điện giải, natri, magie và kali là rất quan trọng cho sự hoạt động của tất cả các tế bào trong cơ thể bạn, đặc biệt là các neuron của bạn, hay còn gọi là tế bào thần kinh.
    Uống Element hòa tan trong nước giúp bạn dễ dàng đảm bảo rằng bạn nhận đủ nước và điện giải. Để chắc chắn rằng mình nhận đủ lượng nước và điện giải, tôi hòa tan một gói Element trong khoảng 16 đến 32 ounce nước khi tôi thức dậy vào buổi sáng, và tôi uống ngay khi vừa thức dậy. Tôi cũng sẽ uống Element hòa tan trong nước trong bất kỳ loại hoạt động thể chất nào mà tôi thực hiện, đặc biệt là vào những ngày nóng khi tôi ra mồ hôi nhiều và mất nước cùng điện giải.
    Element có rất nhiều hương vị ngon. Tôi thích vị mâm xôi. Tôi thích vị chanh. Hiện tại, Element có một hương vị nước chanh phiên bản giới hạn rất ngon. Tôi không muốn nói rằng tôi thích một hương vị hơn tất cả các hương vị khác, nhưng hương vị nước chanh này ngang bằng với một hương vị yêu thích khác của tôi, đó là mâm xôi hoặc dưa hấu. Một lần nữa, tôi không thể chọn chỉ một hương vị. Tôi yêu tất cả chúng.
    Nếu bạn muốn thử Element, bạn có thể truy cập drinkelement.com/huberman, đánh vần là drinkelement.com/huberman, để nhận một gói mẫu Element miễn phí với bất kỳ đơn hàng nào của hỗn hợp đồ uống Element. Một lần nữa, đó là drinkelement.com/huberman để nhận gói mẫu miễn phí.
    Bây giờ hãy nói về giấc ngủ và cách để có được giấc ngủ. Một cách để làm điều đó là tận dụng sự giảm nhiệt độ cần thiết để ngủ và duy trì giấc ngủ. Như đã đề cập trước đó, trong những phần đầu của ngày, sau khi thức dậy, nhiệt độ cơ thể chúng ta tăng lên và điều đó tiếp tục trong suốt cả ngày. Và rồi, vào một lúc nào đó muộn trong buổi chiều, nhiệt độ sẽ đạt đỉnh và sau đó bắt đầu giảm xuống. Sự giảm nhiệt độ từ một đến ba độ rất quan trọng để chúng ta có thể dễ dàng đi vào giấc ngủ. Một cách để làm giảm thời gian chuyển tiếp sang giấc ngủ là thúc đẩy sự giảm nhiệt độ đó. Và một cách để tăng tốc sự giảm nhiệt độ, mặc dù có phần ngược lại với suy nghĩ thông thường, là sử dụng bồn tắm nóng, vòi sen nóng hoặc nếu có thể, là xông hơi. Bây giờ điều này có vẻ ngược lại, nhưng thực sự, nếu bạn bước vào xông hơi hoặc vòi sen nóng hoặc bồn tắm nóng rồi ra ngoài, cơ thể của bạn sẽ kích hoạt các cơ chế nhất định để làm mát bản thân, điều này sẽ cho phép bạn giảm nhiệt độ nhanh chóng hơn và dễ dàng đi vào giấc ngủ hơn. Điều hoàn toàn đúng là giữ cho phòng tối là có lợi. Điều khác là giữ cho phòng mát. Lý do việc giữ cho phòng mát là hữu ích cho việc đi vào ngủ và duy trì giấc ngủ là trong suốt đêm, có những giai đoạn giấc ngủ mà bạn bị tê liệt, gọi là giấc ngủ REM, đó là một dạng tê liệt lành mạnh, có lẽ là để bạn không thể hành động theo giấc mơ của mình, nhưng có những khoảng thời gian trong đêm mà bạn có thể cử động. Và một trong những chuyển động quan trọng mà bạn thực hiện giữa đêm là đưa tay hoặc chân ra ngoài, hoặc bạn đưa mặt ra khỏi chăn như một cách để làm mát cho bản thân. Bạn thực sự đang cho phép cơ thể làm mát thông qua những gì được gọi là AVAs. Hệ thống nối tĩnh mạch – động mạch là tên kỹ thuật của những chỗ này, nằm ở lòng bàn tay, nửa trên của khuôn mặt và dưới lòng bàn chân. Bây giờ, có những thứ mà ai đó có thể dùng để tăng cường quá trình chuyển tiếp vào giấc ngủ. Ba hợp chất có thể rất có lợi trong việc hỗ trợ chuyển tiếp vào giấc ngủ và có các khoảng an toàn rộng lớn, mặc dù xin hãy kiểm tra với bác sĩ của bạn trước khi dùng bất kỳ thứ gì, đó là các dạng cụ thể của magiê, một thứ được gọi là apigenin và theanine.
    Magiê có nhiều dạng. Magiê threonate, được viết là T-H-R-E-O-N-A-T-E, và magiê biglycinate có các vận chuyển cho phép chúng vượt qua hàng rào máu-não dễ dàng hơn so với các dạng khác của magiê. Và trong não, chúng thúc đẩy sự giải phóng một loại chất dẫn truyền thần kinh gọi là GABA, đây là một chất dẫn truyền thần kinh ức chế, giúp hạn chế não trước đến một mức độ nào đó. Nó không hoàn toàn đóng lại, nhưng về cơ bản nó giúp giảm suy nghĩ, tư duy, lập kế hoạch và những gì chúng ta gọi là chức năng điều hành. Vì vậy, với nhiều người, việc uống từ 300 đến 400 miligam magiê biglycinate hoặc magiê threonate 30 đến 60 phút trước khi ngủ có thể giúp họ dễ dàng đi vào giấc ngủ. Khi kết hợp với apigenin và theanine, nó tạo ra một loại hợp lực hoặc một “cocktail” cho giấc ngủ có vẻ rất hiệu quả trong việc hỗ trợ quá trình chuyển tiếp vào giấc ngủ. Vì vậy, apigenin là chất được tìm thấy trong hoa cúc và 50 miligam apigenin dùng 30 phút trước khi ngủ có thể hoạt động như một cách khác để hạn chế não trước và giảm lo âu, giúp mọi người có thể đi vào và duy trì giấc ngủ. Và hợp chất thứ ba là theanine, được viết là T-H-E-A-N-I-N-E. Theanine là một hợp chất có thể cũng tăng cường GABA, nhưng cũng tăng cường hoạt hóa của một cái gọi là kênh clorua. Kênh clorua là một cách khác mà các tế bào thần kinh giảm hoạt động của mình. Vì vậy, magiê threonate hoặc biglycinate, apigenin và theanine kết hợp có thể rất hiệu quả trong việc hỗ trợ quá trình chuyển tiếp vào giấc ngủ. Bây giờ, nếu bạn thức dậy giữa đêm thì sao? Đây là một hiện tượng rất phổ biến và có hai chủ đề chung xung quanh việc thức dậy giữa đêm mà người ta có thể sử dụng công cụ để đối phó. Chủ đề đầu tiên là nếu bạn là người cảm thấy mệt mỏi vào buổi tối và đang cố gắng giữ mình tỉnh táo. Bạn có thể đang tham gia một bữa tiệc hoặc đang cố gắng học bài khi thực tế bạn muốn đi ngủ lúc 8:30 hoặc 9:00, và sau đó bạn ngủ gật vào khoảng 10:30 hoặc 11:00 và thức dậy vào lúc 2:30 hoặc 3:00 sáng, và bạn không thể trở lại giấc ngủ. Có khả năng cao là nhịp melatonin của bạn đã bắt đầu sớm trong đêm. Vì vậy, nhịp melatonin đó có lẽ đã bắt đầu vào khoảng 8:30 hoặc 9:00, nhưng bạn vẫn thức. Bạn có thể không thích lời khuyên này, nhưng một trong những điều bạn có thể làm để bù đắp cho việc đó là đơn giản là đi ngủ sớm hơn. Điều khác là nhiều người thức dậy giữa đêm vì lo âu hoặc vì họ cần sử dụng nhà vệ sinh.
    Dưới đây là bản dịch sang tiếng Việt của đoạn văn bạn đã cung cấp:
    Việc bật đèn là hoàn toàn bình thường, nhưng hãy giữ cho ánh sáng mờ. Tuy nhiên, nếu bạn bật đèn, hãy cố gắng tắt chúng càng sớm càng tốt và cố gắng trở về giường. Bây giờ chúng ta đã đi qua một vòng trong ngày, để nói cách khác, từ khi ai đó thức dậy cho đến khi họ đi ngủ, có thể là thức dậy, trở lại ngủ, v.v.
    Tôi muốn nhấn mạnh rằng mặc dù lịch trình của mọi người khác nhau, nhưng hầu hết mọi người đều làm nhiều hơn một hoặc hai khoảng thời gian làm việc mỗi ngày. Thực sự, tôi cũng làm nhiều hơn một hoặc hai khoảng thời gian làm việc mỗi ngày. Tôi rất nhấn mạnh vào khoảng thời gian làm việc 90 phút vào buổi sáng vì tôi nghĩ rằng hầu hết mọi người sẽ đồng ý rằng có một phần trong mỗi ngày mà chúng ta cần phải làm việc khó nhất, việc quan trọng nhất hoặc việc đòi hỏi nhiều nhất từ bản thân trí tuệ của mình. Tôi sắp xếp điều đó ở đầu ngày và tất cả mọi thứ xung quanh để đảm bảo rằng nó xảy ra và xảy ra với mức độ hiệu quả cao nhất, mặc dù khoảng thời gian làm việc 90 phút vào buổi sáng là rất quan trọng. Tất nhiên, còn có một khoảng thời gian làm việc thứ hai. Vậy tổng cộng, đó chỉ là ba giờ làm việc tập trung, mà có thể không có vẻ là nhiều. Nhưng nếu bạn phân tích ngày của mình và xem xét quỹ đạo cũng như cấu trúc của nó, tôi sẵn sàng cá rằng nếu chúng ta cộng dồn tổng thời gian bạn ở trong trạng thái làm việc sâu, thực sự tập trung và tận tâm, thì tổng thời gian này có thể đạt khoảng ba hoặc bốn giờ. Và tất nhiên, trong suốt cả ngày, có nhiều việc khác xảy ra bên ngoài những khoảng thời gian làm việc 90 phút đó. Tôi đang kiểm tra tin nhắn, tôi đang kiểm tra email, tôi đang đáp ứng các yêu cầu khác nhau, tôi đang làm việc và chăm sóc cuộc sống. Vì vậy, trong khi tôi đã thiết lập một số ranh giới xung quanh những khoảng thời gian làm việc đó, và tôi chắc rằng nếu bạn cũng làm như vậy, bạn sẽ thu được lợi ích từ chúng. Tất nhiên, hãy điều chỉnh và sửa đổi những gì tôi đã mô tả hôm nay theo cách phục vụ tốt nhất cho bạn và lịch trình của bạn. Những gì tôi cố gắng làm là cung cấp cho bạn sự hỗ trợ khoa học, các giao thức và chế độ cụ thể, vì mọi người luôn yêu cầu tôi cung cấp thêm tính cụ thể và chi tiết, và một ví dụ về một cách, chỉ một cách, trong đó các công cụ và giao thức khác nhau dựa trên khoa học có thể được áp dụng trong cuộc sống của riêng bạn. Và cuối cùng nhưng không kém phần quan trọng, cảm ơn bạn đã quan tâm đến khoa học.
    – 歡迎來到 Huberman Lab Essentials,
    在這裡我們回顧過去的集數,
    尋找最有效且可行的科學工具,
    用以促進心理健康、身體健康和表現。
    我是 Andrew Huberman,
    我在史丹佛醫學院擔任神經生物學和眼科的教授。
    我決定舉辦辦公時間。
    在大學環境中,辦公時間是學生來到教授的辦公室,
    或在校園戶外或教室中見面,
    以更詳細地回顧課堂上的材料和問題。
    不幸的是,我們沒有機會
    在現實生活中面對面會面,
    但儘管如此,你們一直在發送問題,
    將它們放在 YouTube 的評論區等地方,
    而我準備了幾個對於最常出現的問題的回答。
    為了提供背景和結構
    來回答這些問題,我將科學和基於科學的協議
    關於生活的各個方面,如情緒、運動、睡眠、清醒、焦慮、創造力等,
    安排在一天的脈絡中。
    選擇一天作為單位來傳遞這些科學資訊和協議,
    並不是我任意的決定。
    實際上,我們身體中的每一個細胞、每一個器官和大腦
    都是在24小時的日夜中以非常規律和可預測的節奏調節或改變的。
    因此,選擇一天作為單位,不僅是實用的考量,
    而且與我們更深層的生物學相關。
    那麼,讓我們談談如何將高質量的同行評審科學應用到你的日常生活中,
    以及如何優化從睡眠到學習、創造力、進餐時間等各個方面。
    我將在我自己的日常生活脈絡中去實行這一點
    並分享我平時的做法。
    我通常在早上6:00或6:30左右醒來。
    我醒來後做的第一件事
    就是取下夜stand上的筆和紙墊,
    寫下我醒來的時間。
    之所以要寫下醒來的時間,
    是因為我想知道所謂的我的最低體溫。
    我不在乎我的實際體溫是什麼。
    我關心的是我的最低體溫什麼時候出現。
    我知道那個最低體溫大約是在我平均醒來時間的兩個小時之前。
    醒來後我做的第二件事
    是進行前進的步態,
    這只是行走的專業術語。
    當我們自己產生向前的運動時,
    可視的影像會在我們眼前流過,這被稱為視覺流。
    經歷視覺流對神經系統有很強的影響。
    它的效果實際上是減少
    或降低在大腦一個名為杏仁核的結構中的神經活動。
    許多人可能已經聽說過杏仁核
    在焦慮、恐懼和威脅檢測中的作用。
    的確,杏仁核是大腦中
    產生恐懼、威脅和焦慮感的網絡的一部分。
    它還有很多其他功能,
    但這是它的主要功能之一。
    進行前進步態,例如行走、騎自行車或跑步,
    特別是產生視覺流,
    有著降低杏仁核活動和減少焦慮水平的神奇特性。
    這個散步每天都很重要,
    因為它真的幫助我將神經系統
    推向我希望的方向,即保持警覺,但不焦慮。
    我希望有高度的專注和警覺,
    因為我將很快進入一段工作。
    我需要全力以赴迎接這一天。
    因此為了做到這一點,
    我確保在戶外進行散步。
    我之所以選擇戶外,是因為我還想讓陽光照射到我的眼睛。
    早上第一時間讓陽光進入你的眼睛
    對心理和身體健康至關重要。
    即使在陰雲密佈的天氣中,
    穿透雲層的光子和光信息
    比來自非常明亮的室內燈泡的光線要多。
    因此,外出散步10分鐘或15分鐘
    基本上會確保你獲得足夠的刺激
    來促使眼睛中的這些神經元工作,
    這些神經元被稱為黑色素視覺神經細胞,
    本質感光的神經節細胞。
    這些神經元向大腦傳遞
    現在是白天,該警覺了。
    這會在你身體的每一個細胞和器官內部啟動大量的生物連鎖反應,
    從你的肝臟到你的腸道,再到你的心臟和大腦。
    在一天之初,我們會自然地出現
    一種名為皮質醇的荷爾蒙的小高峰,
    它促進清醒和健康的免疫系統。
    這個皮質醇的脈衝在一天之內
    早些時候到達是非常重要的。
    不論如何,這個脈衝每24小時就會發生一次,
    只是時間是由你來把握。
    你怎麼把握時間呢?
    主要取決於你何時接觸明亮的陽光。
    你可以將其與之前提到的前進步態、散步和視覺流結合起來。
    這就是我每天早上所做的,
    以在我的身體和大腦中產生警覺感,
    同時又保持冷靜。
    所以現在我們有了第一個協議,
    就是記下你醒來的時間。
    第二個協議是早上第一件事就是散步。
    第三個協議與這次散步是相互關聯的,
    對我來說,就是要獲得陽光的暴露。
    根據高質量同行評審的數據,我堅信水合作用對心理表現至關重要。
    正如許多人所知道的,神經元需要離子流。
    這意味著神經元需要鈉。
    它們需要鎂和鉀
    才能正常運作。
    我們之所以在夜間容易脫水。
    我試著確保在一天開始之前
    我已經保持水分。
    所以我會喝加了一點海鹽的水。
    如果真的想詳細談談,你需要多少海鹽,我想大約是一茶匙的一半。這並不多。到了那時,我開始渴望咖啡因,但我目前還不喝咖啡因。為了故意延遲咖啡因的攝取,我會在早上醒來後等待90分鐘到120分鐘。推遲咖啡因的原因之一是引起困倦感的因素之一是腺苷的積累。腺苷的積累隨著我們清醒的時間延長而增加。當你早上醒來時,你的腺苷水平很可能是非常低的。然而,咖啡因是一種腺苷拮抗劑。對於喜愛咖啡因的人來說,它其實是一種競爭性拮抗劑。它會停留在腺苷通常會停留的受體上,並防止腺苷在該受體上發揮作用。這就是為什麼你會感覺更加清醒。推遲90分鐘到兩小時後攝取咖啡因的原因是,我想確保不會在下午晚些時候甚至早些時候經歷咖啡因的崩潰。確保咖啡因崩潰的最佳方法之一是喝大量的咖啡因,阻塞所有那些腺苷受體。然後到了下午早些時候或晚些時候,當那咖啡因開始消退並從受體上脫落時,較低的腺苷水準會產生更強烈的困倦感。在早上醒來後的90分鐘到兩小時內推遲咖啡因,優化了腺苷與警覺和困倦之間的關係,從而大大提供了一整天的穩定能量曲線,並隨著我走向入睡而降低能量。
    我想稍作休息,介紹我們的贊助商 Eight Sleep。Eight Sleep 生產智能床墊套,具備冷卻、加熱和睡眠跟踪的功能。確保良好睡眠的最佳方法之一是確保您的睡眠環境的溫度適宜。因為為了能進入並深度入睡,您的體溫實際上必須降低約一到三度。並且為了能夠在清晨醒來時感覺恢復和充滿活力,您的體溫實際上必須上升約一到三度。Eight Sleep 會根據您的獨特需求,自動調節整個夜間床鋪的溫度。我已經在 Eight Sleep 床墊套上睡了四年多,完全改變了我的睡眠品質。Eight Sleep 最近推出了他們的最新型號 Pod 5,Pod 5 具有幾個新的重要功能。其中一個新的功能叫做 Autopilot。Autopilot 是一個 AI 引擎,根據您的睡眠模式調整睡眠環境的溫度,涵蓋不同的睡眠階段。如果您在打鼾,它還會抬高您的頭部,並進行其他調整以優化您的睡眠。Pod 5 的底座也有一個集成揚聲器,可以與 Eight Sleep 應用同步,並播放音頻以支持放鬆和恢復。音頻目錄中包含幾段 NSDR(非睡眠深度休息)腳本,我與 Eight Sleep 合作錄製。如果您不熟悉,NSDR 涉及聆聽一段音頻腳本,帶您進行深度身體放鬆,結合一些非常簡單的呼吸練習。這種組合在同行評審的研究中已被證明能恢復您的心理和身體活力。而這非常棒,因為儘管我們都希望按時上床睡覺,並在完美的睡眠後醒來,但很多時候我們會晚點入睡或稍晚點睡覺。有時我們不得不早起,奔赴一天的工作,因為我們有責任。NSDR 可以幫助抵消輕微睡眠剝奪的一些負面影響。而且若您在半夜醒來,NSDR 可以幫助您更好地再次入睡。這是一個極其強大的工具,任何人都能從第一次到每次都受益。如果您想試試 Eight Sleep,請訪問 eightsleep.com/huberman,以獲得最高 350 美元的 Pod 5 創新優惠。Eight Sleep 向包括墨西哥和阿聯酋等多個國家發貨。再次提醒,請訪問 eightsleep.com/huberman,節省高達 350 美元。
    我在早上的主要目標是進入一種專注而清醒的狀態,以便能完成工作。我發現達到這種狀態的最佳方法是通過禁食。所以我直到大約上午11:00或12:00才吃東西。禁食會增加腎上腺素的水平,腦部和身體中也被稱為腎上腺素的物質。而當我們腎上腺素和腎上腺素的水平升高時,我們學習得更好,能更好地專注。你並不想讓腎上腺素(即腎上腺素)過高,那感覺像壓力和恐慌,會讓你感到不安,無法專注,但在其最佳範圍內,腎上腺素確實提供了更強烈的專注感和編碼能力,這意味著吸收和保留、記住信息。接下來,我想談談我在工作時做什麼。一些針對工作空間優化的事情,這些都是基於神經科學和生理學的。我之前談過的事是,當我們的眼睛向上移動時,會產生一種高度警覺的狀態,這與大腦幹神經元引發警覺的功能有關,它們控制著眼睛的肌肉,信不信由你,還有眼瞼。這裡的重點是,你可以在物理上優化你的工作站,以利用視覺系統的這一方面及你的警覺程度。儘量將你的螢幕或平板電腦,無論你正在使用什麼設備,擺放到與眼睛至少平行,最好稍微高一些的位置。大多數人都是低頭看著電腦或平板電腦,或者以大約 30 度的角度看著螢幕。當我們低頭看的時候,當我們的眼瞼稍微閉合時,這會減少我們的警覺程度,增加我們的困倦感。所以我們現在來到我的一天的描述,這些方案將我工作90分鐘。
    現在,為什麼是90分鐘呢?
    其實,大腦在整個白天和夜晚都在經歷這種所謂的90分鐘超日週期。
    每90分鐘,我們的警覺性從非常清醒轉變為較不清醒,然後再回到清醒狀態。
    這是怎麼運作的呢?
    在這90分鐘超日週期的開始時,我的腦子並沒有完全投入到我正在嘗試做的事情中,但我設置了一個90分鐘的計時器,
    並且努力在這90分鐘內集中精力完成一個強有力的工作,完全明白整個90分鐘的專注力不會是均勻的。
    所以目標就是進入我所謂的隧道,真正進入高品質工作的隧道。
    大腦非常喜歡這種狀態,但對於很多人來說,進入這種狀態非常困難。
    我的手機絕對關閉。
    它並不是處於飛行模式,這段時間手機是完全關閉的。
    此外,我還會使用低水平的白噪音。
    白噪音本質上是所有聲音頻率的混合。
    我們所有可以感知的聲音頻率被隨機混合,沒有特定的結構。
    調到低音量時,能將大腦置於最佳的學習和工作狀態。
    因此,這90分鐘工作區間中的一切,從白噪音的低音量到我的電腦位置、我站的姿勢、眼睛的位置,都是為了讓我進入這個工作隧道。
    我必須說,雖然試圖達到這種狀態和工作隧道可能是個挑戰,但有時候你會開始對此上癮。
    這種感覺真的很好。
    這就像是心智的鍛煉,而在你結束這90分鐘的時候,真的會感覺自己完成了很多,因為往往你確實完成了很多。
    這真的是令人感到非常滿足的。
    我深信這是因為神經調節物質如多巴胺和去甲腎上腺素在你體內循環的釋放。
    我想明確的是,對於這90分鐘我並不是十全十美。
    有時我會被分心,但我真的努力在我活著的每一天,盡量在這段時間內達到這一點,因為對我而言,這段工作時光有點神聖。
    有一個強大的方式可以讓你將這90分鐘工作時段的時間安排得最優。
    你可以接觸到一個非常重要的數據,這個數據決定了這個工作環節應該何時開始,或多或少,何時結束。
    這個數據就是你的最低體溫。
    如果你是一個平均在早上7:00醒來的人,那麼你的最低體溫就是早上5:00。
    你可以相當確信,你最佳的工作將在你的最低體溫會過後的四到六小時之內完成。
    我怎麼知道這一點?
    我怎麼知道最低體溫與專注思維之間的關係?
    其實,最低體溫定義了你在24小時週期內的最低點,正如他們所說的那樣。
    在這之後,你的體溫會開始上升。
    這個體溫的上升實際上觸發了你所經歷的初次皮質醇釋放,並進一步喚醒你。
    然後,當然,陽光會進一步增強這種健康的皮質醇釋放。
    那麼,皮質醇隨後將提供燃料,促使體溫上升。
    而且,隨著一天的推進,你的體溫會持續上升,直到下午。
    你所要在這個優化的90分鐘工作時段中做的,就是捕捉到體溫上升最陡峭的部分。
    所以如果你每天早上8:00起床,你的最低體溫就是早上6:00,
    那麼你大概想要在早上10:00或11:00左右開始這個工作時段。
    現在,有些人早上起床時感覺非常清醒。
    他們確實可以在早上第一件事情做出最佳的工作。
    請,如果你是這樣的人,繼續這樣做。
    充分利用這段時間,使用這段時間。
    但是如果你是一個在這器官上努力集中精神的人,絕對應該讓自身生理和體溫的上升支持你專注的努力,而不是在那些時候努力完成最佳工作,
    那時你的生理實際上是在引導你的身體和大腦放鬆,變得更加無精打采。
    試圖捕捉體溫上升這個階段,這樣能更有助於你的成功。
    回溯到1990年代的數據支持特定類型的身體運動能夠支持大腦的健康和功能,無論是短期還是長期。
    所以在我完成這90分鐘的工作之後,我強迫自己進行某種身體運動,以支持我的大腦健康和功能,以及器官健康和身體的整體功能。
    現在,有各種形式的身體活動或者我們稱之為的運動,但這些通常可以分為兩類。第一是力量和肌肉增長訓練。
    這是設計用來增強力量和/或增大肌肉的身體動作。
    還有耐力訓練,是設計用來長時間做更多工作或延長你能做任何工作(無論是身體還是心理)的時間的體育運動和動作。
    所有數據都指向這樣一個事實,即努力訓練超過一小時其實可能是有害的,因為它提升了皮質醇,而皮質醇如果在適當的時機和低水平下是好的,但你不想讓皮質醇整天保持在高水平,或者反覆出現大幅度的激增。
    因此,保持相對較短的鍛鍊肯定會有助於這一點。
    耐力運動和力量訓練或肥大訓練的結合進行,即使不一定在同一個訓練中,而是分配在一週當中,對於產生大腦衍生神經滋養因子、限制炎性細胞因子如 IL-6、促進抗炎細胞因子如 IL-10 等方面有著極大的好處,前提是運動的持續時間適當,且強度不至於對身體的各個系統造成損傷。
    那麼,實際的訓練結構呢?
    實際上,您進行的約 80% 的阻力訓練應該是未達所謂的“失敗”階段,即您無法再移動負重的階段。而其餘的 20% 可以是高強度到達失敗類型的訓練。這種 80-20 規則,即在阻力訓練中低於失敗和工作到失敗的比例,也可以轉換到耐力運動部分,通過注意我們熟悉的“燃燒感”來實現,當我們用力跑步或騎車時,會經歷一種與乳酸系統相關的肌肉燃燒感。其實,乳酸系統本身就是一種燃料,供應給大腦。因此,越來越多的人對於生成乳酸或超過乳酸閾值的興趣在增加,這佔耐力工作的 20% 左右,以支持大腦的健康和功能。
    在任何一天結束那段工作後,我會進行一些阻力訓練或耐力訓練。我將這些訓練安排在不同的日子或交替進行。
    正如你們所知,我已經每天服用 AG1 超過 13 年。然而,我最近發現了更好的維他命礦物質益生菌飲品。這款新改進的飲品就是本月推出的全新 AG1。
    這個來自 AG1 的新一代配方是我多年來每天服用的產品更先進、更具臨床支持的版本。它包含了新的生物可利用營養物質和增強的益生菌。
    新一代配方基於對益生菌對腸道微生物組影響的激動人心的新研究。它現在包含了幾種特定的臨床研究益生菌菌株,這些菌株已被證明能支持消化健康和免疫系統健康,並改善腸道規律性和減少腹脹。作為一名從事研究科學超過三十年,並在健康與健身方面同樣長期投入的人,我不斷尋找最佳工具來改善我的心理健康、身體健康和表現。我是在 2012 年偶然發現並開始服用 AG1 的,當時我連播客都還沒有,自那時起我天天服用。我發現它極大地改善了我健康的各個方面。服用後我感覺好多了,但每年都有所改善。順便提一下,這個九月我將滿 50 歲,我感覺自己變得越來越好。我把這歸功於 AG1。AG1 使用最高品質的成分並進行適當的組合,並且不斷改進他們的配方卻不提高價格。因此,我很榮幸能成為這個播客的贊助商。如果你想試試 AG1,可以訪問 drinkag1.com/huberman 來獲取特別優惠。現在,AG1 正在免費贈送一套 AG1 歡迎套件,內含五個免費旅行包和一瓶免費的維他命 D3 K2。再次訪問 drinkag1.com/huberman 來索取包含五個免費旅行包和一瓶免費維他命 D3 K2 的特別歡迎套件。
    我們現在已經談到了從清晨醒來到早上的專注工作再到體能訓練的整個過程。
    我沒有提到進食或營養。人們最常問我的一個問題是:我該吃什麼來對大腦有益?諷刺的是,你能為大腦做的最佳事情之一就是不吃東西。當然,我們終究得吃東西。那麼,首先讓我們談談進食時機。正如我提到的,我的第一餐通常在中午左右,正負一小時。進食的食量也很重要。如果你吃了大量的任何食物,因為它會使血液流向你的腸道,你會感到無精打采,並且大腦的血液供應會減少。這似乎是一個簡單而微不足道的事實,但如果你想思考,就不能往腸道中攝入大量食物。因此,對我而言,我會在中午之前禁食,然後吃一頓包含一些蛋白質的午餐,比如一些肉或雞肉或鮭魚和一些蔬菜等。如果我之前有運動,像我提到的那樣,每週五天,那麼我會攝入一些澱粉。我可能會吃一些麵包或米飯,或燕麥粥,加上黃油和堅果等東西。但我會保持碳水化合物的總量在較低水平,或者如果我沒有訓練,我將完全不吃碳水化合物。這不是因為我在實行生酮飲食,而是因為澱粉會促使大腦釋放血清素,導致昏昏欲睡的狀態。
    那麼,關於那些不涉及警覺性 但與情緒有關的食物成分呢?我們在一整集節目中討論了情緒與食物的關係,根據如今數十項研究的結果,攝取足夠的 ω-3 脂肪酸將能支持健康的情緒,甚至具有抗憂鬱的作用。每天攝入至少 1,000 毫克的 EPA 形式的必需脂肪酸與處方抗憂鬱藥物在緩解抑鬱症方面具有同樣的效果。如果你是需要處方抗憂鬱藥物的人,像是百憂解、佐賀特等,則這可以讓人們減少這些藥物的劑量。午餐的關鍵是,若要讓這頓餐對你有益,可以在餐後稍微散步一下。
    結果發現,在進食後進行五到三十分鐘的短暫散步可以加速新陳代謝,實際上也能加快並改善營養利用,這本質上與新陳代謝是相同的。儘管如此,我在午餐結束後會強迫自己站起來,走到外面稍微散步一下。這樣做也讓我再度進入視覺流動的狀態。另外還有一個好處,就是我給我的大腦,以及因此給我的身體,提供更多有關光線和時間的資訊,這總是比對光線和時間的資訊更少要好。
    對於睡眠健康、清醒狀態、新陳代謝和荷爾蒙健康,一個關鍵的協議是在下午看光。這就是為什麼要這麼做的原因。隨著晚上時光的推移,我們的視網膜、眼睛對光變得非常敏感,以至於如果我們在晚上十點到凌晨四點之間看到明亮的燈光或甚至不那麼明亮的燈光,這會強烈擾亂我們的多巴胺產生,甚至真的會搞砸我們的睡眠。但是如果你能走到戶外,看到陽光的下弓,或者如果你無法直接看到陽光,在下午的時段獲取陽光在你的眼睛中,或許是四點鐘左右。這樣做是降低你在晚上的視網膜敏感度,使你能夠抵抗夜間強光帶來的負面影響。
    我們還沒有詳細談到褪黑素,但褪黑素是一種受到光抑制的荷爾蒙。褪黑素是讓你容易入睡的荷爾蒙。這裡我所談的並不是補充褪黑素,而是你從腦下垂體自然產生的褪黑素。所以這個協議非常簡單。在下午或傍晚到戶外待10到30分鐘,把太陽眼鏡拿掉,讓陽光照射進來。你可能會注意到,優化你的大腦和身體健康、表現和睡眠等的最佳方案實際上非常簡單。但僅僅因為這些方案簡單並不意味著它們不強大。事實上,它們非常強大,因為它們利用了存在的最強大技術——你的神經系統。今天我們談論的其實是一些每個人都能做的基本事情,這能引導我們的神經學和生物學朝著支持工作流程、荷爾蒙和大腦功能的方向發展。
    在晚上某個時候,我會吃我們稱之為晚餐的東西。雖然談論我的晚餐似乎有點奇怪,但我想談論我的晚餐和我晚餐吃的東西的原因是,對我來說,晚餐當然是為了吃,但也是為了優化入睡的過渡。所以我的晚餐一般由支持休息和深度睡眠的食物組成,這意味著澱粉類碳水化合物。非常明確的一點是,我們可以增強血清素的主要方式之一,就是攝取澱粉類碳水化合物,這幫助我們過渡到睡眠。所以我的晚餐就是碳水化合物和一些蛋白質。可能有一些雞肉或魚,或其他類似的東西,可能是一些雞蛋,或有時只是意大利麵或米飯和蔬菜。這是因為我喜歡這些食物,但同時也因為我想增加大腦中的血清素含量,讓我能夠真正入睡。許多正在進行低碳水化合物飲食的人在入睡和保持睡眠方面會有困難,這是因為很難達到進入睡眠所需的高血清素水平。
    我還應該提到,褪黑素和血清素是同一路徑中的荷爾蒙。它們是相關的荷爾蒙和神經調節劑。基本上我們談論的是一個使我們偏向休息和放鬆的系統,而非保持清醒。你可能會問,我難道不能直接攝取血清素?難道我不能攝取5-HTP或血清素的前驅物或色氨酸?確實,你可以這樣做。然而,許多人,包括我自己,發現當他們在晚上或夜間補充血清素時,會對睡眠的結構或架構造成問題。這會讓很多人,包括我,快速入睡,深度睡眠三到四個小時,然後醒來後很難再入睡。對於我來說,這種影響可能會持續幾天,這真的很擾亂。所以我不喜歡在任何時間內補充直接的多巴胺或多巴胺的前驅物,或直接的血清素或血清素的前驅物。相反,還有其他一些安全地促進入睡過渡的方法,我們等會會談到。但晚餐的成分主要是碳水化合物,這是出於產生平靜感的具體目的。
    當然,碳水化合物是美味的。而且,因為我正在進行一些身體訓練,而希望你們也是,因為這對健康真的很有益,這也會補充我的肝醣儲備,這是活動肌肉、四處走動和進行鍛煉的主要燃料來源之一,以及對大腦和認知功能的支持。
    我想快速休息一下,感謝我們的一個贊助商,Element。Element是一款電解質飲料,包含你所需的一切,但沒有無用的成分。這意味著它包含正確比例的電解質,鈉、鎂和鉀,但沒有糖。適當的水合作用對優化大腦和身體功能至關重要。即使是輕微的脫水也會減少認知和身體表現。此外,獲得充足的電解質也很重要。電解質、鈉、鎂和鉀對你體內所有細胞的功能至關重要,特別是你的神經元或神經細胞。
    飲用溶解於水中的 Element 可以非常輕鬆地確保你獲得足夠的水分和電解質。為了確保我攝取到適量的水分和電解質,我每天早上起床時會將一包 Element 溶解於約 16 到 32 盎司的水中,並且基本上是早上的第一件事會喝這個。我還會在進行任何體力活動的時候,尤其是在炎熱的日子裡,大量出汗並失去水分和電解質時,喝溶解在水中的 Element。Element 有多種美味的口味。我喜歡覆盆子口味,也喜歡柑橘口味。目前,Element 還有一款限量版的檸檬水口味,絕對美味。雖然不想說我特別喜歡某一種口味,但這款檸檬水口味的確跟我最喜歡的口味——覆盆子或西瓜相當接近。我真的無法只選擇一種口味,我每種口味都喜歡。
    如果你想試試 Element,可以訪問 drinkelement.com/huberman,拼寫為 drinkelement.com/huberman,索取一個免費的 Element 試用包,前提是購買任意一種 Element 飲品混合粉。再次重申,請訪問 drinkelement.com/huberman 以索取免費試用包。
    現在讓我們來談談睡眠及如何獲得良好的睡眠。一個方法是利用入睡和保持入睡所需的溫度下降。他們之前提到,在早上的早期階段,我們的體溫會上升,這種上升會持續一整天。然後在下午的某個時間,我們的體溫會達到最高點,隨後開始下降。體溫下降一到三度對於我們能夠輕鬆入睡至關重要。我們可以縮短入睡過渡時間的一種方法是加速這個體溫的下降。而加速體溫下降的其中一個方法,則是使用熱水澡、熱淋浴,或者如果你有機會,使用桑拿。這雖然聽起來有些違反直覺,但實際上,如果你進入桑拿、熱淋浴或熱水澡,然後再出來,你的身體會啟動特定的機制來降溫,這會讓你能夠更快速地降低體溫並輕鬆入睡。保持房間非常黑暗是非常有益的,另一點是保持房間涼爽。保持房間涼爽對於入睡和保持睡眠是有用的,因為整個晚上,有一些睡眠階段你會被癱瘓,例如所謂的快速眼動(REM)睡眠,這是一種健康的癱瘓,估計是為了防止你在夢中動作,但在夜間某些時候你是可以移動的。而在深夜你可以做的其中一個重要動作就是把手伸出來或者把腳伸出來,或者把臉從被子下拿出來,以便讓自己降溫。你實際上是透過所謂的 AVAs 來實現身體的降溫。動脈靜脈吻合是技術名稱,存在於手掌、臉的上半部和腳底。現在,有一些可以幫助過渡到睡眠的補充品。三種能對入睡過渡非常有益且安全性範圍較大的化合物,雖然在開始服用任何東西之前請務必與醫生確認,分別是特定形式的鎂、被稱為 apigenin 的物質以及茶氨酸。鎂有多種形式。鎂蘇糖(magnesium threonate,拼作 T-H-R-E-O-N-A-T-E)和鎂雙甘氨酸(magnesium biglycinate)具有能夠比其他形式的鎂更容易穿越血腦屏障的運輸蛋白。在大腦中,它們促進了一種叫 GABA 的神經遞質的釋放,這是一種抑制性神經遞質,在某種程度上關閉前腦,雖然不會完全關閉,但基本上會讓思考、沉思、計畫以及我們所謂的執行功能下降。因此,對於許多人來說,在睡前 30 到 60 分鐘服用 300 到 400 毫克的鎂雙甘氨酸或鎂蘇糖可以幫助他們入睡。當和 apigenin 以及茶氨酸結合時,形成一種協同作用或睡眠雞尾酒,似乎對促進入睡非常有效。所以,apigenin 是在洋甘菊中發現的一種物質,睡前 30 分鐘服用 50 毫克的 apigenin 可以進一步關閉前腦,減少沉思,減少焦慮,並讓人輕鬆入睡。第三種化合物是茶氨酸(theanine,拼作 T-H-E-A-N-I-N-E)。茶氨酸是一種可以增加 GABA 的化合物,但也會增加一種叫氯通道的活性。氯通道是神經元降低其活動水平的另一種方式。因此,鎂蘇糖或雙甘氨酸、apigenin 和茶氨酸的結合對幫助入睡的過渡非常有效。
    那麼,如果你在半夜醒來怎麼辦呢?這是一種非常常見的情況,有兩個用工具來應對的主題。第一個主題是,如果你是晚上感到疲倦且逼自己保持清醒的人,像是去參加派對或逼自己學習工作,而實際上你希望在 8:30 或 9:00 上床,結果在 10:30 或 11:00 入睡,並於凌晨 2:30 或 3:00 醒來卻無法再次入睡,那麼你的褪黑激素脈衝很可能是在夜晚早期啟動的。這個褪黑激素脈衝很可能是在 8:30 或 9:00 開始的,但你卻一直保持清醒,和褪黑激素抗衡。雖然你可能不喜歡這個建議,但你可以做的其中一件事情就是提早上床。另一方面,許多人在半夜醒來是因為焦慮或因為他們需要上廁所。
    開燈是完全可以的,但請保持燈光柔和。但如果你開了那些燈,儘量儘快把它們關掉,然後再回到床上。現在,我們可以說從一個人醒來的時刻到他們入睡的時刻,甚至是醒來後再入睡,我們事實上已經圍繞著時鐘走了一圈。
    我想強調,雖然每個人的時間表不同,但大多數人每天都會進行不止一兩次的工作。我自己也確實每天會進行不止一兩次的工作。我非常強調早晨那段90分鐘的工作時間,因為我想大多數人都會同意,每天都有一段時間是我們需要完成最困難、最重要或最需要我們認知能力的工作。我把這段時間安排在一天的早期,並圍繞這段時間安排其他事情,以確保它的實現並以最高效率進行,即使這個早上的90分鐘工作區塊是如此重要。當然,還有第二個工作區塊。因此,加起來就是三小時的專注工作,這看起來可能不算很多。但如果你剖析你的一天,看看你的一天的走勢和結構,我敢打賭如果我們加總你在深度工作中,真正專注且投入的時間,可能會達到三到四小時。當然,在一天中,除了那90分鐘的工作區塊之外,還有其他事情發生。我在查看我的短信,檢查電子郵件,回應各種要求,工作和照顧生活。因此,雖然我已經為那些工作區塊劃定了一些界限,我相信如果你也這樣做,你會受益的。當然,請根據你的需求和時間表調整和修改我今天所描述的內容。我所試圖做的是提供科學支持、具體的策略和例行公事,因為人們總是詢問我更具體的細節,以及如何在自己生活中利用這些基於科學的各種工具和流程的例子,這只是一種可能的方式。最後但同樣重要的是,感謝你對科學的興趣。

    In this Huberman Lab Essentials episode, I provide a science-based daily protocol designed to enhance performance, mood and overall health by strategically timing simple yet powerful tools and behaviors.

    I explain how to increase energy and alertness in the morning, optimize your workspace and work sessions for maximum focus, and structure your day for sustained productivity. I also discuss the roles of fasting, meal and caffeine timing, and key nutrients, as well as how to leverage exercise to sharpen alertness and cognitive performance. Additionally, I describe evening practices and supplements that help you fall asleep quickly and promote quality sleep.

    Read the episode show notes at hubermanlab.com.

    Thank you to our sponsors

    AG1: https://drinkag1.com/huberman

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    Timestamps

    00:00:00 Office Hours, Example Daily Protocol

    00:01:48 Morning, Tools: Temperature Minimum, Walk, Sunlight
    & Cortisol

    00:05:30 Hydration, Electrolytes, Tool: Delay Caffeine

    00:07:39 Sponsor: Eight Sleep

    00:09:45 Morning Focus, Fasting

    00:10:34 Tools: Optimize Workspace, Screen Position, Work
    Bouts

    00:13:45 Tool: Timing Work Bouts, Temperature Minimum

    00:16:02 Exercise, Strength & Hypertrophy, Endurance
    Training, Tool: 80/20 Workouts

    00:19:01 Sponsor: AG1

    00:20:48 Afternoon, Meal Timing, Carbs, Omega-3s, Tool:
    Afternoon Walks & Light

    00:25:33 Dinner, Sleep Transition, Carbs, Serotonin

    00:28:44 Sponsor: LMNT

    00:30:16 Accelerate Sleep, Tool: Reduce Temperature &
    Hot Baths

    00:32:06 Sleep Supplements, Magnesium, Apigenin, Theanine;
    Waking at Night

    00:35:06 Example Daily Routine, Work Blocks

    Disclaimer & Disclosures

    Learn more about your ad choices. Visit megaphone.fm/adchoices

  • Addiction Doctor: Alcohol Rewires Your Brain! Alcohol Is The Reason You Feel Awful! This Many Glasses Of Wine Increases Cancer Risk By 40%!

    中文
    Tiếng Việt
    AI transcript
    0:00:04 The amount of alcohol it takes to begin to cause health-related problems is much lower than you think.
    0:00:07 Okay, so if I have this glass of wine every day…
    0:00:11 You’d be in what we call moderate risk, which is associated with pretty much every form of cancer.
    0:00:12 So say that I’m drinking…
    0:00:15 If you’re drinking two of those glasses, we’re talking like a 40% increase.
    0:00:19 But even drinking that amount, your risk of breast cancer would increase by about 5%.
    0:00:19 This amount?
    0:00:20 Mm-hmm.
    0:00:22 Which, for many people, is very normal.
    0:00:26 So there’s a lot of misinformation out there about how much should you drink, which I think people don’t know.
    0:00:29 But I can take you through everything, so…
    0:00:32 Dr. Sarah Wakeman is a Harvard professor and addiction expert.
    0:00:35 Leading the charge against one of the biggest public health crises of our time.
    0:00:36 Addiction.
    0:00:38 Bringing facts, empathy, and hard-earned truth.
    0:00:41 One in three people may have a problem with alcohol at some point in their lives.
    0:00:49 And globally, 2.6 million people every year die from alcohol-related causes because pretty much every organ in the body is impacted by it.
    0:00:57 You can see here, this is a 43-year-old person where their brain looks the way a 90-year-old with dementia would look because of that brain damage over time from alcohol use.
    0:00:58 But what drives people to use substances?
    0:01:00 Probably the most important question.
    0:01:04 And if we look at studies, one is about 40% to 60% genetics.
    0:01:06 And the other half of the equation is trauma.
    0:01:12 And so when you hear someone talk about alcohol gives them pain relief, whether that’s emotional or physical, that’s a very real thing.
    0:01:15 That’s because your sort of natural painkiller system is activated by drinking.
    0:01:18 It’s an anti-anxiety and a pain medication sort of all-in-one.
    0:01:21 So when you think about how we treat addiction, where are we going wrong?
    0:01:26 The biggest problem is that people haven’t been given the evidence and tools to understand addiction.
    0:01:30 But also many rehabs don’t offer the things that we know are actually effective.
    0:01:31 And what is it that people need?
    0:01:32 Great question.
    0:01:35 One of the most effective tools we teach people is something called…
    0:01:38 And they found that people drank much less after it.
    0:01:38 Wow.
    0:01:46 I find it incredibly fascinating that when we look at the back end of Spotify and Apple and our audio channels,
    0:01:53 the majority of people that watch this podcast haven’t yet hit the follow button or the subscribe button, wherever you’re listening to this.
    0:01:55 I would like to make a deal with you.
    0:02:02 If you could do me a huge favor and hit that subscribe button, I will work tirelessly from now until forever to make the show better and better and better and better.
    0:02:05 I can’t tell you how much it helps when you hit that subscribe button.
    0:02:11 The show gets bigger, which means we can expand the production, bring in all the guests you want to see and continue to do in this thing we love.
    0:02:16 If you could do me that small favor and hit the follow button, wherever you’re listening to this, that would mean the world to me.
    0:02:18 That is the only favor I will ever ask you.
    0:02:19 Thank you so much for your time.
    0:02:29 Dr. Sarah Wakeman, with all the work that you do, what is the mission that you are on?
    0:02:45 My mission is really to change the way people think about and understand alcohol and drug problems and also to give people the evidence and the facts, both to understand addiction, which are sort of problems related to alcohol and drug use, but also to just understand the science around, for example, how much should you drink?
    0:02:47 Is drinking healthy? Is it not healthy?
    0:02:52 There’s a lot of misinformation out there, and I want to give people the tools to make the right decision for them in their lives.
    0:02:57 And who are you and what is your sort of body of experience and education?
    0:03:08 So I’m a medicine doctor by training, so I still do some general medicine, like in the hospital, take care of pneumonia and heart failure, and in the outpatient setting, take care of people’s diabetes and depression.
    0:03:14 But I train especially in addiction medicine, so I’m board certified in addiction medicine, and that’s been kind of my life’s work.
    0:03:33 I work in a big academic medical center in Boston, Massachusetts, where I would say my kind of focus professionally has been thinking about how do we bring addiction care back into the medical system so that it’s not this separate and unequal and often very poorly done sort of siloed system, but actually just a part of the health care that people get.
    0:03:39 And then I train people, so I’m program director of our fellowship program, so I train doctors who want to be specialists in addiction medicine.
    0:03:44 When you think about how we treat addiction in the modern world, what are some of your gripes?
    0:03:46 Where are we going wrong?
    0:03:48 Oh, how much time do we have?
    0:03:49 I feel the last year.
    0:03:50 Where do we begin?
    0:04:10 I mean, I think at its core, the biggest problem is that we’ve all been taught and sort of infused in this idea that addiction is an issue of behaving badly, that it’s an issue of morality, that people really need to kind of knock it off and pull themselves up by their bootstraps, and that this is like a criminal legal issue, that it’s an issue of willpower.
    0:04:14 And so if you believe those things, then why would you think that someone should get medical care?
    0:04:18 Or why would you treat them with compassion and kindness if you think that they’re doing something wrong?
    0:04:30 And so really reframing how we think about addiction based on all of the science we have and what effective treatment looks like, which often is very different than what people may have experienced if they were trying to access care for themselves or a loved one.
    0:04:32 And what is an addiction?
    0:04:36 What falls into the bucket of addiction?
    0:04:38 You know, because I use my iPad a lot.
    0:04:39 I use my phone a lot.
    0:04:42 Is that an addiction?
    0:04:45 Yeah, it’s a great question because we use that term colloquially a lot.
    0:04:48 You know, I’m addicted to Netflix or whatever.
    0:04:51 So addiction is really defined by use despite consequences.
    0:04:55 So continuing to do something in your life despite bad things happening to you because of it.
    0:04:59 So we talk of addiction, we talk of the four Cs as a way to remember it.
    0:05:04 So one C is loss of control, meaning like you’ve tried to change and you haven’t been able to.
    0:05:07 So you’ve tried to cut back or you’ve tried to stop and you couldn’t.
    0:05:09 The other is compulsive use.
    0:05:14 So your use is like spiraling out of control that you’re kind of using in a way that isn’t really attached to your rational thinking.
    0:05:16 The next is consequence.
    0:05:22 So continued use despite negative consequences either in your life, your job, your relationships, your health.
    0:05:27 And then the last C is craving, which is this sort of strong psychological urge to want to use.
    0:05:29 Like you can’t get the idea of having a drink out of your mind.
    0:05:32 And so it’s really those four Cs that we think about.
    0:05:38 And then we make the definition based on how many criteria people meet out of this 11 list of different criteria.
    0:05:42 And then based on that, people can have a mild use disorder, moderate or severe.
    0:05:45 And so moderate, severe is really what we think of as addiction.
    0:05:47 But it’s that use despite bad things happening to you.
    0:05:50 And what things are capable of being addictive?
    0:05:52 Yeah, lots of things.
    0:05:54 I mean, I focus mostly on alcohol and drugs.
    0:05:58 So alcohol, obviously, probably most common.
    0:06:00 I think we’ll talk about that a lot today, which I’m excited about.
    0:06:06 And certainly when we look worldwide, 400 million people have an alcohol use disorder, meaning addiction to alcohol.
    0:06:08 It’s a lot of people.
    0:06:09 The other are drugs.
    0:06:13 So that can be opioids like heroin or pain pills or fentanyl.
    0:06:22 It can be cocaine or stimulants like methamphetamine or prescription stimulants, sedatives that people may take for anxiety like benzodiazepines, cannabis.
    0:06:26 And so there’s a whole sort of range of substances that can be addictive.
    0:06:31 And how addictive a substance is is really related to sort of how much dopamine is released in the brain.
    0:06:34 I know you’ve had a wonderful episode with Dr. Lemke about dopamine.
    0:06:36 So you’ve talked about that a bit.
    0:06:39 And there are different sort of addictive indices of different substances.
    0:06:43 So cannabis is less addictive than methamphetamine, for example.
    0:06:46 But all of those substances can cause addiction in people.
    0:06:51 Even beyond that, I wonder sometimes in my life if I’m addicted to other things like, I mean, I drink coffee every day.
    0:06:53 Certainly get a craving to drink it now.
    0:06:54 Yeah.
    0:06:57 Well, there’s, you know, a couple important pieces there.
    0:06:59 Is your coffee drinking causing harm in your life in any way?
    0:07:00 No.
    0:07:01 I think it helps.
    0:07:02 It may be helping you, right?
    0:07:03 Okay, so it’s not.
    0:07:04 Yeah, so it’s not addiction.
    0:07:09 So there’s a difference between physiologic dependence, meaning like if you don’t drink your cup of coffee, you’re going to get a headache.
    0:07:14 And addiction, meaning that you’re spending all your day and all your money buying more and more coffee.
    0:07:15 We don’t really see this.
    0:07:22 But buying more and more coffee despite, you know, your girlfriend nagging you about it and you’re late to work because you’re purchasing coffee.
    0:07:24 We don’t really see that so much with coffee.
    0:07:25 But that would be sort of addiction.
    0:07:26 And how big is the problem?
    0:07:29 So if you were to frame, like, why should we care?
    0:07:31 Why should the person listening to this care?
    0:07:38 Because I imagine it’s the case that many people here don’t have an addiction that fits into the category of having severe consequence for their life.
    0:07:43 I also imagine some people are under the impression that addiction is something that happens to other people.
    0:07:43 Yeah.
    0:07:52 So can you frame the situation for me and explain to me why we should all care about this and I guess the scale of the impact it’s having?
    0:07:57 Well, I guarantee you that many people listening have been touched by addiction either personally or in their lives.
    0:08:00 Because of stigma, we tend not to talk about that.
    0:08:01 But the scale is huge.
    0:08:06 So globally, 2.6 million people every year die from alcohol-related causes.
    0:08:10 So that’s 7,000 people today will die from an alcohol-related death.
    0:08:13 Another 600,000 people die from drug-related deaths annually.
    0:08:18 So that’s like 1,600 deaths today from drug-related causes.
    0:08:28 And then when we look at the criteria of sort of meeting criteria for a substance use disorder or addiction, it’s about 400 million people worldwide for alcohol and 80 million people for drug use.
    0:08:29 So it’s incredibly common.
    0:08:41 If you think about alcohol, some studies estimate that the lifetime prevalence, meaning over the course of your life, how likely are you to at some point develop alcohol addiction, somewhere between 15% and 30% in some studies.
    0:08:45 So one in three people may have a problem with alcohol at some point in their life.
    0:08:46 So this touches all of us.
    0:08:59 We just don’t talk about it because of stigma and because of these mental images of kind of othering that, you know, it’s only those people who are injecting heroin who have addiction or that person who, you know, has the shakes every morning and is drinking as soon as they wake up who has a problem with alcohol.
    0:09:01 In which direction are we going in as a society?
    0:09:04 Are we getting better or are we getting more addicted?
    0:09:06 Yeah, great question.
    0:09:08 The pandemic was not kind to addiction.
    0:09:16 So we saw rates of alcohol and drug use and deaths related to those increase significantly after the onset of the COVID pandemic.
    0:09:18 That has started to level out.
    0:09:26 So for drug use related deaths, we’re now back at the pre-pandemic levels, but there was a very significant increase during the time of the pandemic.
    0:09:32 And that’s really not surprising when we think about what are the things that drive people to use alcohol or drugs in a problematic way.
    0:09:39 I was looking at some of the life expectancy graphs and this one in particular I found quite shocking.
    0:09:40 I’ll throw it up on the screen.
    0:09:49 But it shows that obviously, you know, we would expect that there was a drop in life expectancy during the pandemic.
    0:09:52 But even when you compare it to other countries, it’s not as significant.
    0:09:58 So I’m wondering why, in your view, there was such a significant decline in life expectancy during the pandemic.
    0:09:59 Yeah.
    0:10:01 So obviously, COVID was one driver.
    0:10:04 One of the main other drivers was substance related deaths.
    0:10:12 So actually immediately following the onset of the pandemic, so beginning March, April of 2020, we saw a 23% increase in alcohol related mortality.
    0:10:16 And we saw the highest rates ever we’ve seen of drug related overdose deaths.
    0:10:19 And that actually impacted U.S. life expectancy up until this year.
    0:10:21 This is the first year that we’ve seen that change.
    0:10:29 At the essence of what’s actually going on there, because, you know, addiction is downstream from something else.
    0:10:31 What is actually going on?
    0:10:33 Yeah, so that’s a really great question.
    0:10:35 Like, what drives people to use substances?
    0:10:39 It’s actually probably the most important question, even in my work.
    0:10:45 You know, if you don’t understand what someone’s substance use is about or related to, how are you ever going to address it or help them address it?
    0:10:48 So trauma is probably the single biggest driver.
    0:10:51 So, you know, you often hear things like cannabis is the gateway drug.
    0:10:53 I would say trauma is the gateway drug.
    0:10:59 If we look at many, many studies, there are kind of two different things that drive someone’s risk of addiction.
    0:11:00 One is genetics.
    0:11:05 It’s about 40% to 60% genetic, similar to diabetes in terms of someone’s risk.
    0:11:07 That’s not a done deal, obviously.
    0:11:11 There are people with strong genetic risks who never develop addiction and people without that who do.
    0:11:15 The other half of the equation is based on kind of your exposures and your experiences.
    0:11:19 And one of the number one drivers is what we call adverse childhood experiences.
    0:11:25 So there are this famous study called the ACEs study, which stands for Adverse Childhood Experience, and it’s been replicated.
    0:11:31 There’s a recent one done actually in Europe as well that looks at the number of adverse childhood experiences you have,
    0:11:35 and it’s a linear track increase in terms of your risk of substance use disorder.
    0:11:44 So if you think about what’s happening in the brain with substances, you know, when we use alcohol or drugs, all sorts of feel-good hormones are released, right?
    0:11:48 Dopamine, your endogenous opioid system, which is literally your natural pain reliever.
    0:11:54 And if you take someone who’s experienced trauma, there’s great relief that people can find in substance use.
    0:11:56 And so we saw that in the pandemic, like what was going on in the pandemic.
    0:11:57 People were scared.
    0:11:58 They were bored.
    0:11:59 They were lonely.
    0:12:01 They were stuck at home.
    0:12:02 They didn’t have their usual routine.
    0:12:04 Some people were losing people that they loved.
    0:12:10 And so we saw all of this escalating substance use, and it was actually most pronounced in people who are frontline workers.
    0:12:12 So that could be a health care provider.
    0:12:19 It could also be someone working in a grocery store or a convenience store who had to work through the scariest times of the pandemic, and also people who are caregivers.
    0:12:23 So those are kind of the two groups that had the biggest increase in their substance use during the pandemic.
    0:12:25 What is going on in the brain?
    0:12:27 You referenced it a little bit there.
    0:12:29 You referenced that dopamine makes you feel good.
    0:12:34 So, you know, very naively, I would assume a case of if you feel bad, dopamine makes you feel good.
    0:12:35 You want more dopamine.
    0:12:38 But is it more complicated and nuanced than that?
    0:12:43 Yeah, well, alcohol is a really complicated one because alcohol has lots of different effects on the brain.
    0:12:47 So any drug or substance that can cause addiction is going to release dopamine.
    0:12:53 That’s sort of a primary driver of many things that we find rewarding, whether it’s sex or food or alcohol or drugs.
    0:13:00 But alcohol also, so it binds to the part of our brain, a system called GABA, which is sort of our anti-anxiety system.
    0:13:08 So it’s the same system that anxiety medications like people may have heard of Ativan or lorazepam or Xanax, these medications that are kind of sedatives and anxiety meds.
    0:13:10 Alcohol acts on that part of the brain.
    0:13:17 And it actually then causes a release of your endogenous opioids in your brain, so like your brain’s natural painkillers.
    0:13:25 So that’s actually why one of the medications that’s effective in helping people stop drink actually just blocks the opioid response in the brain, which doesn’t make sense when you first hear about it.
    0:13:32 Until you understand these neural mechanisms, that actually your sort of natural painkiller system is activated by drinking.
    0:13:38 So when you hear someone talk about alcohol gives them pain relief, whether that’s emotional or physical, that’s a very real thing.
    0:13:42 That’s a powerful system in our brain that gets activated when you’re drinking.
    0:13:43 Ah, okay.
    0:13:56 So if I’m having a stressful time at work and work is making me anxious and is crippling me, then I’m more likely to want to have a big blowout on the weekend because that’s effectively a pain medication.
    0:13:57 Totally.
    0:14:00 It’s an anti-anxiety and a pain medication sort of all in one.
    0:14:09 And I think often this is part of the area where I think just getting more awareness and education about alcohol is so important because we see that as a way of treating ourselves, right?
    0:14:12 And it’s very easy to have that get out of control.
    0:14:21 And I think especially if in your head you think, as long as I’m not, like, drinking in the morning or missing work because of drinking or, you know, having problems in my relationships, I’m fine.
    0:14:29 But actually there’s so many health problems and even life problems related to alcohol that people may make different decisions for themselves if they had that awareness earlier on.
    0:14:43 You know, I was thinking about a friend of mine who is fairly well known, passed away from issues related to his addiction.
    0:14:46 He had a lot of pressure on him when he was fairly young.
    0:14:53 He wasn’t necessarily a young child when he had a lot of pressure put on him, but he was young.
    0:15:00 And I was wondering, as you said, childhood experiences, what age that is.
    0:15:11 Is there like a certain age where those experiences, you know, if you experience a certain level of trauma at a certain age, it’s harder to recover from that and you’re more likely to be addicted?
    0:15:13 Yeah, so it’s a great question.
    0:15:15 Trauma at any time can put you at risk for addiction.
    0:15:20 The earlier that happens, the more sort of long-lasting the impact can be.
    0:15:26 So when we think about the brain, you know, your brain doesn’t really fully form until early to mid-20s.
    0:15:32 And so both in terms of trauma but also in terms of early substance exposure, you’re at much greater risk when you’re younger.
    0:15:37 But that doesn’t mean that trauma in later life doesn’t put you at risk for developing substance use as well.
    0:15:44 So I’ve seen people who, you know, their first trauma was in their 20s or 30s or 40s and they can still develop a substance use disorder.
    0:15:48 It’s just the risk is even greater when you experience those adversities as a child.
    0:15:52 And the interesting thing is, you know, trauma is not so much about the experience.
    0:15:57 It’s about often being left alone to grapple with that experience by yourself.
    0:16:01 And so what’s traumatizing to one person may not be traumatizing to someone else.
    0:16:03 And, you know, take the pandemic, for example.
    0:16:08 I’ve talked to people who, like, being stuck at home and alone and bored was deeply traumatic.
    0:16:10 Other people were fine.
    0:16:15 They, like, were in their living room, you know, doing whatever and found ways to connect and to live their lives and did okay.
    0:16:18 It was the same experience, but it was experienced very differently by different people.
    0:16:24 So it’s less about the actual experience and more about the impact on that human, how they’re left feeling.
    0:16:26 And often it’s about feeling disconnected.
    0:16:30 We often talk about the opposite of addiction is not sobriety.
    0:16:31 It’s actually connection.
    0:16:34 It’s how do you build that connection with other people again.
    0:16:39 My friend that I was referencing is Liam Payne, who’s from One Direction, the boy band who passed away.
    0:16:42 And he was on my podcast a few years before he passed away.
    0:16:51 And on the show, he said that much of what made his early life so difficult as a teenager was he was obviously thrust onto this big show.
    0:16:54 And then the way it worked was, you know, you’ve got all this public spotlight.
    0:17:00 And then they’d, like, put him up on a stage and he’d be in front of 100,000 people in Dubai.
    0:17:05 And then they, after that experience, he was then, like, driven back to a hotel room and, like, locked in a hotel room.
    0:17:09 Because obviously you can’t go out because you’re that famous that if you walk out on the street, the crowds are going to emerge.
    0:17:12 So he was then locked in that hotel room.
    0:17:16 And on the show, he said, I was locked in there with the minibar, which is full of alcohol.
    0:17:17 So I would drink.
    0:17:19 And that cycle would repeat itself.
    0:17:23 And he’d be like, stage, you know, car, hotel, locked, drink, stage, car.
    0:17:24 And that cycle repeated itself.
    0:17:35 So when you’re talking about isolation and loneliness as well, I never really considered the fact that connection and social relationships could play a role in creating an addiction in someone.
    0:17:37 But it tracks.
    0:17:38 Totally.
    0:17:43 I mean, it makes me think of a patient I saw this week who really wants to stop drinking and is able to go for a few weeks.
    0:17:44 But his life is pretty empty.
    0:17:46 Like, he’s not working right now.
    0:17:47 He doesn’t have a lot of relationships.
    0:17:51 So when he’s not drinking, he’s sitting at home, like, watching TV by himself.
    0:17:56 And it doesn’t take very long for him to think that, like, you know, the thing that’s going to give me relief is having a drink.
    0:18:01 And so then the question becomes less about the molecule of alcohol and more about, like, how do we fill up people’s lives?
    0:18:09 How do we form connection and build community and build a sense of identity and purpose and engagement outside of the relief of substance use?
    0:18:11 You’re clearly extremely smart.
    0:18:15 And when I meet people like you, I always think to myself, you could have committed your life to anything.
    0:18:20 You could have worked in pretty much any field and you would have been a success because you have what it takes to be successful.
    0:18:23 So why do you care so much about this?
    0:18:25 Yeah.
    0:18:28 I think like many people, I had kind of a personal threat.
    0:18:33 I had a family member who was impacted by addiction who actually died when I was in medical school.
    0:18:42 And so that was sort of a pivotal moment, I think, that coming at the same time that I was learning all of this science, I was realizing, like, wow, I wish I’d known this when I was younger.
    0:18:47 And dealing with family members and friends who were affected by this and that we’ve gotten it so wrong.
    0:18:51 And most people don’t have the kind of tools and knowledge to do things differently.
    0:18:54 And so, you know, you sort of, there’s that saying, when you know better, you do better.
    0:18:58 And I think I kind of wanted to put out into the world what I wished was there for other people.
    0:18:59 An immediate family member.
    0:19:00 Mm-hmm.
    0:19:02 And what age were you when you lost that person?
    0:19:05 Probably 24 or so.
    0:19:06 From addiction?
    0:19:06 Yep.
    0:19:17 When you’re dealing with a family member or someone close to you that has an addiction, so many people listening will be able to relate to that feeling.
    0:19:18 Yeah.
    0:19:24 Can you describe what they feel, I guess, in an attempt to make them feel seen?
    0:19:33 Because sometimes, especially in hindsight, if you end up losing that person, you can be filled with lots of feelings of guilt or misunderstanding and especially are thinking about how society’s moved on.
    0:19:38 So how do you put into words how it feels to be a family member with someone dealing with addiction?
    0:19:40 Yeah, I think you feel powerless.
    0:19:45 You feel like you want to do something and you either don’t know what to do or feel like everything you’ve tried hasn’t worked.
    0:19:54 I think, again, because people have been exposed to this idea that it’s an issue of willpower or choice, which really implies that if people wanted it bad enough, they could just stop.
    0:20:02 And so if you’re a family member, then that’s easy to feel like, oh, they don’t love me enough, you know, that they’re not choosing me over this substance.
    0:20:08 And so I think often people feel deeply hurt and they’ve, you know, been through experiences that have created trauma for themselves.
    0:20:11 There’s a lot of trauma within families who are experiencing this.
    0:20:19 And then they’re sometimes given really bad advice, you know, that you have to, like, kick someone out or this whole concept of kind of tough love and that people need to hit bottom.
    0:20:28 And so sometimes people, you know, either do that and then wrestle with the guilt of was that the right thing or not or they feel bad even like being kind or loving to their family member.
    0:20:31 So I think there’s a whole mix of feelings.
    0:20:34 And, of course, if you lose someone, you always wonder what if, like, could I have done something differently?
    0:20:37 Could something else have changed?
    0:20:40 And I think people can feel angry and sad and guilty and be left with that.
    0:20:46 What did those people in your life need that you lost that they didn’t get?
    0:20:51 I think they needed science-based treatment and compassion and empathy.
    0:21:01 And I think they needed a world where addiction was not seen as something to be ashamed of or something that we judge, but rather something that is a problem.
    0:21:06 You know, the shift from, like, you are the problem to, like, you have a problem and we can help you with this.
    0:21:09 And I think too often we have approached it as if, like, you the person are the problem.
    0:21:22 Do you sometimes think back and think, you know, if I’d done something differently, whether it was you or someone else around you or the system around that individual, they would still be here today?
    0:21:24 Because I think that was the first thing that sprung to mind.
    0:21:26 I played back all the decisions that I made.
    0:21:30 And I thought, okay, maybe that was bad advice that I was given.
    0:21:32 Maybe I should have been, you know, maybe I could have called more.
    0:21:34 Maybe I could have intervened here.
    0:21:37 Maybe, you know, maybe there’s something else I could have done.
    0:21:38 Absolutely.
    0:21:40 I mean, I think about that all the time.
    0:21:43 And, you know, I think, I mean, I think of a friend I lost an overdose.
    0:21:45 I think of the family member I lost alcohol.
    0:21:51 And not only things that I could have done differently, but also, you know, those people, they saw their doctor.
    0:21:52 They were in the hospital.
    0:22:02 They had all these touch points, all of these, like, reachable moments where someone could have engaged with them and offered them kindness and actual effective care that’s backed by science.
    0:22:03 And they weren’t.
    0:22:06 And so there are all of these, like, missed moments and missed opportunities.
    0:22:22 But the other thing I think about is, like, how much time I lost with them because I think often in this model of, like, tough love and kicking people out or thinking, like, I’m not going to see you until you stop using or stop drinking because I think that’s going to help make them make that change.
    0:22:27 You lose out on, like, all of these moments of time with people that you love and you can’t get those back.
    0:22:45 And so there is this problem, I think, in that binary model of, like, you’re either, like, sobering in recovery or you’re actively using and this is good and that is bad is that we lose the fact that, like, people who are struggling with addiction are amazing, funny, loving people who have a problem that they’re dealing with.
    0:22:49 But if someone was dealing with cancer, you wouldn’t, like, not want to spend time with them.
    0:22:51 You know, you miss all of that time.
    0:22:55 And, you know, both cases that I’m thinking about, like, I’ll never get that back, you know?
    0:23:05 There’s a phrase I had many years ago, which I’m now reconsidering, which is change happens when the pain of staying the same becomes greater than the pain of making a change.
    0:23:11 And that kind of dovetails into this idea that someone needs to hit their own rock bottom for them to change.
    0:23:24 I think the part of the reason why that idea prevails is because we hear so many stories, I hear them on this podcast, of someone’s family rejecting them, throwing them out on the street, and them having that eureka moment that, fuck, I need to change my life.
    0:23:30 And people always reference that, like, rock bottom moment where they took action because, you know, they weren’t at the very bottom of the well.
    0:23:33 And how does that phrase sit with you?
    0:23:37 Change happens when the pain of making a change becomes greater than the pain of making a change.
    0:23:40 I think that there are those times, for sure.
    0:23:41 It’s not to discount that.
    0:23:43 And I hear those stories, too.
    0:23:53 But I think there are, from evidence, what we know, there are probably more times where people just endure the pain again and again and again until they never change.
    0:24:07 And I think the part that we don’t see are the folks who change happens when they begin to get enough hope that things could be better for them, that, you know, someone loves them, someone cares enough that they’re reaching out a hand in the darkness, that there actually is a path forward.
    0:24:16 I think people stay stuck when they feel hopeless, when they feel like nothing could ever, that they’re never going to get this, they’re never going to be able to change, their life would never get better.
    0:24:18 And so, you know, take the example.
    0:24:24 I’ll often hear from family members when their loved one is in jail that they’re like, thank heavens.
    0:24:26 You know, they’re in a safe place at least.
    0:24:27 Like, there’s actually this sense of relief.
    0:24:30 There’s even a term for it called a rescued that people feel.
    0:24:36 I think it just goes to the desperation that families are dealing with, but this idea that, like, that’s a safe intervention.
    0:24:40 And you hear these stories, right, of someone who they get locked up and, like, that’s their eureka moment.
    0:24:55 And yet, if imprisonment were an effective intervention for addiction, for example, we wouldn’t see that actually the time after getting released from prison, there’s 130 times increased risk of dying from a drug-related cause after people leave prison.
    0:25:00 And that your risk of dying ever from addiction is much, much higher if you’ve ever been imprisoned.
    0:25:04 And so I think there are those stories, but we tend to elevate those, like, amazing narratives.
    0:25:10 And we miss the fact that so many other people are going to die in pain and alone and isolated because they have no hope.
    0:25:13 And so it’s not to discount those moments.
    0:25:20 And some people are incredibly resilient and against all odds, even with the most trauma, they can, you know, make it through.
    0:25:21 And that’s incredible.
    0:25:26 But that doesn’t mean that we should, like, create a system that makes it as hard as possible on people.
    0:25:35 So would you say that if we are trying to help someone change, really, it’s about hope, it’s about the strength of their why, and it’s about love and empathy and connection?
    0:25:36 Absolutely.
    0:25:37 Is there anything else missing?
    0:25:39 And it’s about effective treatment.
    0:25:40 And treatment, okay.
    0:25:43 Which is subjective, right?
    0:25:45 Which could be, depending on the situation they’re in.
    0:25:52 It depends on the type of addiction and their situation, but in most cases, it’s some combination of psychotherapy medication.
    0:25:54 So alcohol.
    0:25:54 Yes.
    0:25:57 There’s, I mean, alcohol’s been on a journey.
    0:25:58 Yes.
    0:26:01 It’s been on a journey in terms of society’s opinion about it.
    0:26:04 Can you take me on that journey and tell me where we are now?
    0:26:10 And when I’m saying that, I’m talking about society’s opinion on its health benefits and what it is.
    0:26:14 And then also what we’re getting wrong now about alcohol.
    0:26:14 Yeah.
    0:26:15 Yeah.
    0:26:17 So, I mean, the journey of alcohol is fascinating.
    0:26:27 So first, I think we think of this as a relatively modern thing, but, you know, archaeologists have discovered, like, beer-making equipment in hunter-gatherers’ cave dwellings from 13,000 years ago.
    0:26:28 That’s wild.
    0:26:28 Wow.
    0:26:31 Like, 13,000 years of people figuring out how to make beer.
    0:26:34 You know, you look at China 9,000 years ago.
    0:26:37 It was really about, like, a spiritual journey or a social thing.
    0:26:39 It was never really about health.
    0:26:42 At some point, we started talking about this as something that is good for your health.
    0:26:43 Like, drink red wine.
    0:26:44 It’s going to improve your health.
    0:26:47 And that’s where I think we got wrong.
    0:26:50 And the reason why was actually from how we were looking at the data.
    0:26:56 So first, if you look at only one health condition, there are some health conditions where a moderate amount of alcohol actually improves your health.
    0:26:59 But it was also how people were conducting the studies.
    0:27:07 So in most of those studies, what people do is they take, like, a massive population, tens of thousands of people, where we have some data where they’re reporting how much alcohol they used.
    0:27:09 And then we look at health risks over time.
    0:27:15 And scientists would lump people into sort of non-drinkers versus light drinkers, moderate drinkers, or heavy drinkers.
    0:27:21 And what they were finding is that people who were drinking even up to the moderate level were actually doing better than the people who weren’t drinking at all.
    0:27:25 And so that was where that concept that drinking is good for your health came from.
    0:27:32 And so people talk about this, like, J-shaped curve, meaning that moderate drinkers actually have lower risks of health problems.
    0:27:38 And then it’s really only when you start drinking very high levels that you start having more risk of health problems than people who don’t drink at all.
    0:27:44 What they realized was wrong with that is that in the people who don’t drink at all, many of those people are not drinking because they’re actually really unhealthy.
    0:27:49 For another reason, like, they might have heart failure, and they, like, don’t want to drink because they don’t want it to mix with their medication.
    0:27:53 Or they might have had a history of alcohol use disorder, and they’re actually in recovery.
    0:27:57 So they’ve already had some damage from alcohol, and they are not drinking because of that.
    0:28:04 And so when you change the reference group, you actually make the sort of group that you compare people to, to people who very rarely drink.
    0:28:08 So it’s not that they’re not drinkers at all, but they drink, you know, very, very light levels.
    0:28:14 Then you start to see that those, like, health benefits of alcohol go away, especially if you look across all conditions.
    0:28:19 Are you telling me that there’s no healthy level of alcohol consumption?
    0:28:20 Yes.
    0:28:23 I would never say drinking alcohol is good for your health.
    0:28:29 That doesn’t mean that drinking at what we call low-risk levels can’t be a part of a healthy lifestyle.
    0:28:36 So it’s a slight shift that, like, don’t fool yourself into thinking that drinking that glass of wine is, like, going to exercise for 30 minutes.
    0:28:38 Like, it’s not something that’s going to promote your health.
    0:28:43 I think of it more like having dessert, eating bacon, going out in the sun.
    0:28:44 There are risks associated with all those activities.
    0:28:50 It doesn’t mean that I would say you can never do any of that, but you need to understand what the risks are and then make choices for yourself.
    0:28:55 So I look at this glass of wine here and this pint of beer.
    0:28:55 Yep.
    0:29:02 If I drank one of these a day, not a huge amount, I think what people tend to think is they think, well, it’s only one.
    0:29:07 So my body will just flush it out and there’ll be no adverse health consequences.
    0:29:07 Yep.
    0:29:10 Is that true?
    0:29:13 Well, so part of the challenge is what we think of as one drink.
    0:29:21 So I think much like, you know, if you learn to read the serving size on a food, you realize that, like, oh, a serving of ice cream is like a half a scoop.
    0:29:23 It’s not like a giant ice cream sundae.
    0:29:24 The same is true with alcohol.
    0:29:32 So in the U.K., the kind of low-risk drinking limits talk about units of alcohol, which is the equivalent of eight grams of alcohol.
    0:29:35 So how much of a drink has eight grams of alcohol?
    0:29:38 And to be in that low-risk category, you have to be below 14 units.
    0:29:43 The problem is that glass of wine, just eyeballing it, has several units of alcohol.
    0:29:51 So it is not a, even though we think of it as a single drink, it’s probably, I mean, I have to guess, but it’s probably like three units of alcohol.
    0:29:56 So if I have a glass of wine every day, I’ll be over that limit then?
    0:29:57 You’d be right at that limit.
    0:30:00 The problem is most people don’t drink just one glass.
    0:30:09 If you, you know, if you have two glasses one day and then one glass one day and then three glasses one day because you’re at a social function, all of a sudden you’re actually quite a lot over that limit.
    0:30:12 So if you said that this is roughly three units, roughly.
    0:30:13 And you get 14 a week.
    0:30:14 You get 14 a week.
    0:30:14 Mm-hmm.
    0:30:16 So three times seven.
    0:30:16 Mm-hmm.
    0:30:17 21.
    0:30:17 Yeah.
    0:30:20 So yes, you’re over if you’re drinking that size.
    0:30:20 Yeah.
    0:30:26 Okay, so if I have this glass of wine every day, then I’d be over the UK limit of?
    0:30:27 Lower risk drinking.
    0:30:28 Lower risk drinking.
    0:30:30 So I’d be medium risk drinking.
    0:30:36 You’d be in what we call moderate risk, which is associated with pretty much every form of cancer, which I think people don’t know.
    0:30:38 Okay.
    0:30:42 Because I was wondering why cancer has been increasing.
    0:30:43 Yes.
    0:30:45 A variety of different forms of cancer have been increasing.
    0:30:48 You know, breast cancer is one of the ones we always hear about that’s increasing.
    0:30:55 So you’re saying, what is the data in terms of low or moderate risk of drinking and cancer?
    0:30:56 Yeah.
    0:31:00 So the data is growing and really worrisome.
    0:31:06 So for breast cancer, so there’s really, there’s a few cancers that even at low risk limits, you see the risk begin to increase.
    0:31:10 So where we would say there’s kind of no healthy, or there’s no even like low risk amount.
    0:31:13 So breast and esophageal cancer, two examples of that.
    0:31:17 So breast cancer, if you were to drink below those low risk limits.
    0:31:24 So in the U.S. that would be fewer than seven drinks, but a drink in the U.S. is five ounces of wine, which is smaller than that.
    0:31:29 Or in the U.K. is below that 14 units, so it would be, you know, fewer than seven of that size glass of wine.
    0:31:32 We still see a slight increase in the risk of breast cancer.
    0:31:33 It’s about a 5% increase.
    0:31:37 So that means your risk of breast cancer would increase by about 5%.
    0:31:38 And that’s not huge.
    0:31:41 So I think, you know, percent increase is kind of hard to do the math on.
    0:31:47 But if you think in the U.S., for example, the average woman has a 13% likelihood of getting breast cancer in their lifespan.
    0:31:49 13% likelihood?
    0:31:50 Really?
    0:31:50 Yeah.
    0:31:51 Wow.
    0:31:51 Really high.
    0:31:55 So 5% increase would increase that to like 13.6 or so.
    0:32:04 So that means that if there’s nine women in this room, one of them is going to get breast cancer probabilistically?
    0:32:04 In their life.
    0:32:05 Yep.
    0:32:07 Damn.
    0:32:07 Yeah.
    0:32:08 Why is it?
    0:32:09 And it’s increasing.
    0:32:10 Yeah.
    0:32:14 And so the reasons for that are likely environmental because your genes don’t change over that time period.
    0:32:18 So the risk factors, you know, if you think about breast cancer, it’s alcohol.
    0:32:19 It’s obesity.
    0:32:25 It’s, you know, age when you have children or don’t have children because it’s a really hormonally driven cancer.
    0:32:27 Same thing if you think about colon cancer.
    0:32:30 That’s a really scary one where we’re seeing more and more cases in younger people.
    0:32:33 Some of the drivers of that, eating meat.
    0:32:36 So processed meats increase your risk of colon cancer.
    0:32:38 So, you know, these very sort of normal behaviors.
    0:32:44 There’s probably other environmental things, honestly, that we’re not yet measuring or able to measure.
    0:32:51 Just given the rate of acceleration, when I talk to my colleagues who are oncologists, you know, things like plastics or other things that we don’t yet know.
    0:32:56 It’s clearly something in the environment that is driving these increased cancer risks.
    0:33:01 So even at this sort of level, if I’m drinking, that might be one unit, right?
    0:33:02 Yes.
    0:33:03 So that would be one unit.
    0:33:05 So that would be fewer than 14 of that.
    0:33:10 So you could see like, you know, if you had double that, it would be a decent pour of wine.
    0:33:13 You could not have more than seven of those in a week to be in low risk.
    0:33:16 But even drinking that amount, your risk of breast cancer would go up a little bit.
    0:33:17 Even this amount?
    0:33:18 Mm-hmm.
    0:33:22 There’s really sort of no safe amount of alcohol when it comes to breast cancer.
    0:33:24 Is it just breast cancer?
    0:33:27 So that low risk category.
    0:33:34 So when we, these big cancer studies categorize people as sort of low risk or light drinkers, moderate or heavy.
    0:33:38 And for pretty much every cancer, once you get to the moderate category, we start seeing increases.
    0:33:41 And there’s what we call a dose-response relationship.
    0:33:43 So the more you drink, the higher your risk of cancer.
    0:33:47 There’s only a few cancers that the risk seems to increase even at that very low level.
    0:33:49 And breast cancer is one of those.
    0:33:51 And then esophageal cancer is one of those.
    0:33:55 So there are certain cancers where even a small amount of alcohol will increase your risk.
    0:34:00 Does it have an impact on thinking about cancers that are prominent in men?
    0:34:00 Yeah.
    0:34:04 So colon cancer, we’re seeing that in a lot of young men.
    0:34:06 Liver cancer.
    0:34:07 Yeah.
    0:34:12 Prostate cancer, which is obviously a male cancer, we don’t think of as much as being sort of an alcohol-sensitive cancer.
    0:34:19 But most cancers, because the way alcohol impacts your risk of cancer is not really on a specific organ outside of the liver.
    0:34:21 It’s really about how it changes our DNA.
    0:34:30 So it’s about inflammation and what are called reactive oxygen species that sort of change our cells and increase the risk over time of the mutations that lead to cancer.
    0:34:31 So yeah, can you drill down on that?
    0:34:42 So if I’m a heavy drinker, so say that I’m drinking, let’s say I’m drinking two glasses of wine a day consistently, which I guess would, like if I was drinking two of those a day.
    0:34:43 If you were drinking two of those glasses, yeah, you’d be in the heavy category.
    0:34:45 So two of those a day puts me in the heavy drinker category.
    0:34:48 Yeah, which would surprise most people, right?
    0:34:51 Like that, for many people, is very normal.
    0:34:53 It is very normal, yeah.
    0:34:58 I think it’s somewhat more difficult for younger people to understand because younger people drink less.
    0:35:03 But if I think about the generation above me, having two glasses of wine a day is quite normal.
    0:35:06 After work, on the weekends, with every meal that you have.
    0:35:08 So that would make me a heavy drinker.
    0:35:15 And then what are the stats saying in terms of my cancer risk profile?
    0:35:21 Yeah, so it varies by cancer, but roughly we’re talking like a 40% increase in cancer depending on the cancer type.
    0:35:23 And the more you drink, the more that’s going to go up.
    0:35:27 So, you know, these are scientific studies where it’s not precise to you as an individual.
    0:35:28 They’re based on large populations.
    0:35:31 But definitely, the more you drink, the greater the risk.
    0:35:35 And then if I have other sort of, do they call them comorbidities?
    0:35:36 Yeah, exactly.
    0:35:41 So other illnesses, other diseases in my body, my probability is going to go up further if I’m obese, if I’m overweight.
    0:35:43 Exactly, if you smoke.
    0:35:49 So one of the main drivers of alcohol, too, and cancer is that it actually makes you more susceptible to the cancer-causing effects of tobacco.
    0:35:53 So if you drink and smoke, your risk of cancer is going to be even higher.
    0:35:56 How does that work?
    0:36:05 The thought is, like, if you take esophageal cancer at, like, the cellular level, it makes you more susceptible of the carcinogens, which are kind of the cancer-causing compounds in tobacco.
    0:36:10 And so rather than just seeing, like, an additive risk, you actually almost get a multiplied risk in terms of the risk of cancer.
    0:36:14 So smoking and then obesity is the other big one.
    0:36:19 So a lot of cancers, your risk goes up if you’re, you know, have an increase in your body mass.
    0:36:20 What’s going on in the body, then?
    0:36:23 If I drink alcohol, how is that leading to cancer?
    0:36:32 You referenced it slightly there, but I want to make sure I’m super clear in my brain as to, like, what the knock-on effects are and how that ends up as cancer.
    0:36:34 Yeah, I mean, there’s lots of different mechanisms.
    0:36:37 So, I mean, maybe starting just with, like, what does alcohol do in your body?
    0:36:39 So you ingest alcohol.
    0:36:40 The, like, fancy name for that is ethanol.
    0:36:41 It’s a molecule.
    0:36:45 And it basically gets absorbed pretty quickly from your stomach.
    0:36:49 And so, you know, it hits your bloodstream usually within 10 minutes or so of having a drink.
    0:36:53 And how much it hits your bloodstream depends on how much water you have in your body.
    0:36:55 So alcohol doesn’t penetrate into your fat.
    0:36:58 It just kind of diffuses into the water parts of your body.
    0:37:05 So that’s actually why, for many women, they will get more sort of drunk or more of an effect from alcohol at a lower level than men because women have more body fat than men.
    0:37:07 But that’s going to depend on you as an individual.
    0:37:09 If you have more body fat, you’re going to have a different impact.
    0:37:11 So alcohol gets in your bloodstream.
    0:37:15 Alcohol can instantly cross across what we call your blood-brain barrier.
    0:37:17 So it impacts your brain instantly.
    0:37:25 And that’s where you feel the initially pleasurable effects for many people of feeling a little relaxed, feeling more social, feeling a little bit, you know, less anxiety.
    0:37:30 If you keep drinking and that level keeps going up, then you start having impaired judgment.
    0:37:33 You might have motor – lack of motor coordination.
    0:37:36 So we’ve all seen this and many people have probably experienced it.
    0:37:39 You know, you may be stumbling, not able to drive safely.
    0:37:42 You’re not going to make the same decisions you would make if you weren’t drinking.
    0:37:46 And then if you keep drinking, then you get – you can actually lose consciousness.
    0:37:48 So pass out and people have experienced that.
    0:37:51 Your body is going to try to break down alcohol as quickly as it’s able to.
    0:37:55 Like anything, we want to kind of excrete any abnormality and get back to our normal functioning.
    0:37:59 And so that process happens mostly in your liver, which is why the liver is so sensitive to alcohol.
    0:38:02 Because your body sees ethanol as poison.
    0:38:03 Yes.
    0:38:08 I mean, you know, I know you talked about this, Dr. Lemke, but your body always wants to restore what’s called homeostasis.
    0:38:12 Your body is always going to fight to get back to what it feels its normal is.
    0:38:15 And so ethanol is not something that belongs in your bloodstream.
    0:38:17 Your body is going to try to excrete it as fast as it can.
    0:38:20 And then it converts it into something called acetate.
    0:38:22 And then you can pee that out and breathe that out and get rid of it.
    0:38:26 So to eliminate the alcohol in your body, you have to go through this process.
    0:38:32 And part of that process includes this toxic molecule that’s going to be floating around and causing damage to your cells.
    0:38:35 So that’s one way that alcohol can cause cancer.
    0:38:38 The other is just general sort of inflammation.
    0:38:43 People have probably heard that inflammation is just not good for the body and increases the risk of cancer.
    0:38:48 And alcohol generates a lot of that inflammation in the process of getting eliminated.
    0:38:52 And so it can actually change your cells that over time that can lead to cancer.
    0:39:05 So I also found this graph, which shows for anyone that can’t see what we’re describing at the moment, it shows the acceleration in liver disease, death rates and general liver disease compared to other parts of the body.
    0:39:06 Yeah.
    0:39:07 Other organs in the body, I believe it shows.
    0:39:08 Yeah.
    0:39:10 What impact does alcohol have on the liver?
    0:39:12 And we have our little mannequin here of the human body.
    0:39:13 Where is the liver?
    0:39:14 Yeah.
    0:39:15 Great question.
    0:39:17 So here’s our little mannequin.
    0:39:19 So just to orient people to the body.
    0:39:20 So we’re looking at the inside of the body.
    0:39:22 So like the ribs are gone.
    0:39:23 The outside of the skin is gone.
    0:39:25 These two pink things are the lungs.
    0:39:26 They kind of encase the heart.
    0:39:28 You can see the heart’s behind the lungs pumping your blood.
    0:39:31 The liver is this brownish organ.
    0:39:34 It’s on the right side of your body, right under your ribs.
    0:39:35 It’s quite large.
    0:39:35 It’s big.
    0:39:36 And it’s an amazing organ.
    0:39:37 It is quite big.
    0:39:46 It processes much of what any kind of toxins that we take in, things that we eat, your glucose, alcohol.
    0:39:48 90% of it’s metabolized by the liver.
    0:39:53 So the liver is sort of the clearinghouse getting rid of byproducts in your body.
    0:39:57 The other are the kidneys, but the liver plays a huge role, especially in alcohol.
    0:39:58 So it sits right here.
    0:40:00 It almost looks like it’s as big as the lung, as one lung.
    0:40:00 Yeah.
    0:40:02 Yeah, it is.
    0:40:02 Really?
    0:40:02 Yeah.
    0:40:03 It’s a giant organ.
    0:40:05 And it’s an amazing organ.
    0:40:09 So you could actually cut out 80% of the liver and it would regrow itself.
    0:40:13 So kind of like, you know, those lizards that you cut off their tail and they regenerate a tail.
    0:40:14 The liver is fascinating.
    0:40:16 It’s why we can do living liver transplant.
    0:40:21 So I could take half of your liver and give it to someone who needed a liver.
    0:40:25 You would still be able to live and they would get a second chance at life from that part of your liver.
    0:40:28 So it’s this really cool organ that can regenerate.
    0:40:31 But it can only regenerate up to a point.
    0:40:40 So once you get to a level where you have a lot of scar tissue in your liver, we call that cirrhosis, you sort of reach a point of no return where at that point the liver can’t heal itself.
    0:40:51 So I sort of think of it like, to use a baking analogy, if you’re making muffins or a cake, you’re going along, you’re mixing all your ingredients, and you realize before you put things in the oven, like, oh, I forgot the eggs.
    0:40:54 You can still add the eggs in and, like, whisk it all together and it’s going to be okay.
    0:40:59 If the muffins are baking in the oven and you forgot the eggs, you can’t, like, pour the eggs on top and make the batter the same.
    0:41:09 And the liver is sort of like that, that up to a certain degree, you can actually completely repair the effects of things like alcohol or obesity, other things.
    0:41:13 But once you pass that point into scar tissue, the liver can’t regenerate anymore.
    0:41:22 And so when you think about that graph or just the rising rates of liver disease, the main drivers of liver disease are obesity and, too, is alcohol.
    0:41:26 And so those are the leading causes of liver transplant.
    0:41:35 And the thing that is, you know, so sad is, I mean, I see this all the time working in the hospital is, first of all, we’re seeing younger and younger people coming in and liver failure.
    0:41:41 So people in their 20s coming in and fulminant liver failure from alcohol and then dying in the hospital.
    0:41:46 And the terrible thing is that they often didn’t even know that this was causing a problem in their health.
    0:41:49 And by the time they get to the hospital, they’re so sick, it’s too late.
    0:41:53 And yet all of that could have been prevented or even repaired if it was caught sooner.
    0:41:58 And so that’s where I think this education of understanding, like, what really are the health harms of alcohol?
    0:42:04 And that we have normalized binge drinking on many occasions, especially in young people, as being totally normal.
    0:42:06 And yet there are very serious health consequences.
    0:42:10 So I’ve got a bunch of questions around the liver.
    0:42:15 Does that mean that my liver can take a bit of a beating before there’s any real problems?
    0:42:18 Should I, you know, someone like me, I don’t drink alcohol.
    0:42:20 I’m not engaging in anything too bad.
    0:42:27 But sometimes I do wonder if I could have like a blowout weekend and then my liver would just recover to normal again and I’d be fine.
    0:42:28 Yeah.
    0:42:30 I mean, so first, every person is different.
    0:42:32 One blowout weekend, you probably would be fine.
    0:42:33 Anyone would probably be fine.
    0:42:36 The challenge is one blowout weekend then leads to like multiple blowout weekends.
    0:42:40 And then over time, that can actually accelerate the damage to your liver.
    0:42:46 You said that my liver regenerates though, so I’m thinking this thing will just pop back to normal again.
    0:42:48 As long as you haven’t gotten to that scarring phase.
    0:42:53 So once you get too far down that path, even if you were to stop drinking, your liver won’t recover.
    0:42:58 The hard thing is that we don’t totally understand who and why that happens so young to.
    0:43:05 So this is an active area investigation because there are people who’ve been drinking for 60 years and their livers don’t show signs of scarring.
    0:43:09 And then we’re seeing these young people at 25 who come in and die in the hospital.
    0:43:17 And so there are individual factors that you don’t have any way of knowing that are going to impact your risk of developing liver inflammation and scar tissue.
    0:43:22 And so the safest way to prevent that is to not drink in these really high ways that we know are going to lead to harm.
    0:43:29 The other way is to get medical care because often we do detect these things through blood tests and we can do ultrasounds.
    0:43:34 And when we see those early phases, so what happens first is you actually get fat deposition in your liver.
    0:43:35 That’s the first step.
    0:43:38 And then we see inflammation in fatty liver.
    0:43:45 And if you don’t stop the thing that’s driving those changes, over time we see the development of what’s called fibrosis, which is like scar tissue.
    0:43:52 And then that scar tissue gets more and more advanced to the point that your liver stops functioning and you either die or you need a liver transplant.
    0:43:58 What activities outside of alcohol cause great stress on our liver that we might not see as obvious?
    0:43:59 Yeah.
    0:44:00 So obesity.
    0:44:02 Food does.
    0:44:02 Yeah, food.
    0:44:05 So your liver is very involved in glucose metabolism.
    0:44:10 So our diet and our body weight impact our liver health.
    0:44:21 And the other medications, so acetaminophen or Tylenol, which is a very common over-the-counter pain reliever, above a certain threshold can cause serious liver damage.
    0:44:27 So sometimes we’ll see cases where someone didn’t realize that, like, their cold medicine plus the Tylenol they were taking both had that ingredient.
    0:44:28 And then they go out and drink heavily.
    0:44:31 And that kind of combination effect can cause liver damage.
    0:44:40 How much do you think – this might be a bit of an unclear question – but how much alcohol is going to cause liver damage?
    0:44:43 So, again, it varies person to person.
    0:44:48 For liver damage, it does tend to be the moderate to higher amounts that cause damage.
    0:44:58 One thing is that, you know, that having these big surges, like these massive binge episodes, is probably more harmful than drinking, like, at a moderate level for a long period of time.
    0:45:04 Those, like, big surges cause a big buildup of that toxic byproduct that your body has to clear.
    0:45:14 And so, you know, if you have several years of binge drinking heavily, that actually probably is going to cause more damage than a longer period of time of just drinking above the risk limit.
    0:45:19 So, really trying to minimize and avoid those very heavy drinking episodes is incredibly important.
    0:45:27 And then keeping it to those low-risk guidelines, which we just learned, are kind of eye-opening in how low-risk they are, is going to reduce the risk of liver damage.
    0:45:29 And does alcohol just impact the liver?
    0:45:30 No.
    0:45:33 I mean, alcohol has effects across our body.
    0:45:36 So, many parts of the body can be affected by alcohol.
    0:45:38 So, kind of starting from the top, your brain.
    0:45:40 And we can look at this with pictures, like an MRI.
    0:45:41 Oh, I’ve got one actually.
    0:45:42 Yeah, I think.
    0:45:45 This is, by the way, shocking for me.
    0:45:51 So, when we do an MRI of someone’s brain, we basically, this is like a cross slice.
    0:45:55 So, it’s almost like you’re facing me and I’m cutting your face off and looking at your brain onwards.
    0:45:58 Healthy brain tissue is the gray and white matter.
    0:46:04 And you want it to be as plump and, like, taking up as much space as possible because that’s where all of your brain activity is.
    0:46:10 When people get really old or have dementia, one thing we see is more and more of the black space is essentially water.
    0:46:15 So, we see the brain starts shrinking and shrinking and there’s more water and less active, healthy brain tissue.
    0:46:19 That process is accelerated with heavy alcohol use.
    0:46:30 And so, you can see here, this is a 43-year-old person with severe alcohol use disorder where their brain looks the way, you know, a 90-year-old with dementia would look because of that brain damage over time from alcohol use.
    0:46:33 And so, we can actually, a form of dementia is related to alcohol use.
    0:46:36 And so, your brain can be hugely impacted with alcohol.
    0:46:38 What is going on there?
    0:46:42 Like, what’s causing the brain to deteriorate in such a way because of alcohol?
    0:46:47 Yeah, well, remember I said ethanol, which is the molecule, crosses the blood-brain barrier.
    0:46:53 And so, especially when you’re having these high levels of blood alcohol, that ethanol is sort of bathing your brain.
    0:47:00 And if you think about what we talked about, inflammation and changes to cells and to DNA and proteins that is happening at the brain level.
    0:47:05 The other thing that can cause, accelerate the brain damage we see with alcohol is actually nutritional deficiencies.
    0:47:10 So, people may be drinking a lot and they’re actually not getting really crucial nutrients in their diet.
    0:47:13 And that can accelerate the process of brain damage.
    0:47:21 We can even see a very, like, sudden onset amnesia from heavy alcohol use in the setting of not getting enough nutrients in your diet.
    0:47:24 Okay, so that’s the brain.
    0:47:24 That’s the brain.
    0:47:26 So, the brain, for sure.
    0:47:28 The next is the mouth and your esophagus.
    0:47:30 So, obviously, you’re drinking alcohol.
    0:47:31 It’s bathing your mouth.
    0:47:33 It’s bathing your esophagus and your stomach.
    0:47:37 So, we do see an increase in cancer, like we talked about, and that’s accelerated by smoking.
    0:47:44 But we also see, like, benign but annoying and problematic health conditions, most notably acid reflux, so heartburn.
    0:47:47 So, if you notice, like, I’m, like, always having heartburn.
    0:47:49 I’m having to pop all these, like, antacids and take this medicine.
    0:47:52 You might want to think, like, how much am I drinking?
    0:47:53 Is that contributing to my heartburn?
    0:47:55 So, that’s a very common thing.
    0:47:57 The heart is affected by alcohol.
    0:48:02 So, you know, the heart is an organ where at low risk levels there doesn’t seem to be harm from alcohol.
    0:48:05 But once you get into the moderate and high, we see harms.
    0:48:07 And the harms can be a couple folds.
    0:48:13 One is something called atrial fibrillation, which is basically where your heart starts beating really irregularly.
    0:48:18 So, in your heart, there’s four chambers, the two chambers at the top.
    0:48:20 So, this is really showing the ventricles and the atrium.
    0:48:23 So, there’s two chambers that blood flows through.
    0:48:29 And in a normal heart, your electrical activity comes from the top of your heart, goes down to the bottom of your heart, and tells the heart to pump.
    0:48:36 And so, you get a single impulse that goes to the bottom of the heart, says pump, and that pumps blood out to your brain and your body and your organs and your liver.
    0:48:41 In atrial fibrillation, the top of the heart is just kind of quivering with this abnormal electrical activity.
    0:48:43 And so, the heart can’t pump in a normal way.
    0:48:53 We actually, there’s a term in medicine called holiday heart because we see sometimes people drink a ton over the holidays and will end up in this abnormal rhythm just from that binge drinking pattern.
    0:49:06 And then, over time, if you’re drinking at high levels, your heart actually dilates and you can end up with congestive heart failure from a cardiomyopathy, which means the heart muscle gets kind of weak and thin and floppy and can’t pump the way that it needs to.
    0:49:07 Oh, damn.
    0:49:13 Sometimes we think that if we’re good at handling our beer or our alcohol, then it’s having less harm on us.
    0:49:17 So, for whatever reason, I’ve always been good at drinking quite a lot.
    0:49:28 When I used to drink, I don’t drink anymore, but when I used to drink and being less affected than my friend, who was a little bit bigger than me, had a little bit more body fat, which is really interesting because you pointed out an association there that I was never aware of.
    0:49:30 Just to pause on that for a second.
    0:49:33 You’re saying that if someone has more body fat, they’re more likely to get drunk?
    0:49:37 Yeah, because they have less body water and alcohol doesn’t go into your body fat.
    0:49:43 So, essentially, it’s like if you took, you know, a glass of water and you dropped red dye in it, you’re going to diffuse into that water.
    0:49:48 So, the more water you have, the more diffuse it’ll be and the lower your blood alcohol content.
    0:49:51 So, if you have very low body fat, you probably have more body water.
    0:49:55 And so, you know, two drinks for you is going to diffuse into a larger amount of water.
    0:49:56 That explains a lot.
    0:49:58 Because I always wondered, he was so much bigger than me.
    0:50:03 At the time, he had much more body fat and he would get drunk very, very quickly.
    0:50:07 And you always think, oh, a big guy, they can handle their beer or whatever, but he’d get drunk very quickly.
    0:50:13 So, I used to wonder, I used to think, well, alcohol isn’t harming me as much because I’m not having, I’m not as drunk as he is.
    0:50:15 But that’s not true.
    0:50:22 No, I mean, so first of all, I think the interesting story there, one, is not just the body fat, but also that people metabolize alcohol at different rates.
    0:50:27 You probably, I don’t know if you found this feature, you probably had fewer hangovers than your friend.
    0:50:31 Because hangover does seem to be related to the amount, how high that your blood alcohol level gets.
    0:50:35 So, people who don’t metabolize alcohol as quickly tend to have worse hangovers.
    0:50:37 So, that may have been something you experienced.
    0:50:46 But it doesn’t protect you from the other health harms of alcohol, like liver damage, like cancer, like over time, you know, heart problems or esophageal problems.
    0:50:47 What is a hangover?
    0:50:53 Yeah, hangover is a fascinating thing that people are, you know, there’s a lot of emerging evidence about it and trying to understand what happens.
    0:51:01 It seems to be most related to how high the ethanol concentration in your brain gets because they’ve actually done a ton of studies with mice and with people.
    0:51:08 It was initially thought to be due to the byproducts of alcohol, like that acetyl aldehyde molecule we talked about, but it doesn’t seem to be related to that.
    0:51:10 It seems to be related to ethanol.
    0:51:20 But essentially, it’s this syndrome where after you drink, once your blood alcohol content comes down to zero, you feel sort of apathetic, you’re tired, you have a headache, you often feel nauseous.
    0:51:25 And so, it’s sort of that sequelae of your brain essentially being bathed in this ethanol.
    0:51:28 And then as it leaves, you just feel totally crappy.
    0:51:31 Because people think of it sometimes as just being dehydrated.
    0:51:34 Yeah, it is not just being dehydrated.
    0:51:37 There’s actual sort of effects of ethanol on your brain that lead to the hangover.
    0:51:46 I think if you are drinking at an amount that you’re getting a hangover, it is a good sign that you’re drinking above a limit that would be considered okay for your body.
    0:51:55 Because sometimes, I remember back in the day, if I had a big glass of water before I went to bed, if I’d been drinking, I felt better in the morning.
    0:51:57 There is some element of dehydration, don’t get me wrong.
    0:52:01 And that’s partly because, right, if you think, again, alcohol is diffused in water.
    0:52:06 So, if your total body water is contracted because you’re dehydrated, your ethanol level is going to be higher.
    0:52:10 So, drinking is going to help you sort of flush it out and feel better.
    0:52:11 I’m drinking water.
    0:52:13 But it’s not only because of dehydration.
    0:52:15 There’ll be people listening to this now.
    0:52:16 I doubt they would have got this far.
    0:52:20 Because if they did, they probably wouldn’t think this.
    0:52:28 But there’ll be some people who would have gotten this far in the conversation and be thinking, yes, but alcohol helps me socialize.
    0:52:29 And socializing is really important.
    0:52:35 And I can’t socialize very easily because of the design of the modern world without having a drink.
    0:52:37 Or I have great times when I drink.
    0:52:40 So, I don’t want to quit my alcohol use.
    0:52:46 And, you know, in some cases that they will be high and medium consumption alcohol drinkers.
    0:52:48 What do you say to those people?
    0:52:50 Well, first, like, there’s no judgment here.
    0:52:54 So, a molecule of ethanol is not more moral or immoral than a molecule of glucose.
    0:52:56 You could say the same thing about diet.
    0:53:01 We have lots of awareness now about processed foods and white flour and white sugar.
    0:53:05 That doesn’t mean that everyone’s going to live this, like, ascetic lifestyle where they never eat dessert.
    0:53:12 So, I think it really is, like, you need to go in with eyes wide open and understand what are the risks, what matters to you, and how do you make that calculus.
    0:53:16 So, if you decide it’s a choice you want to make, you want to set yourself up for success.
    0:53:30 So, if you decide, like, I want to cut back on how much I’m drinking, but I’m going to go to happy hour every night with my friends and just try to, like, not drink while I’m there, you’re probably not going to be very successful because you’re going to be in a situation that’s constantly, like, reminding you of alcohol use and everyone around you is using alcohol.
    0:53:36 So, try to make some different sort of structural changes in how you set up your life and your week and your day.
    0:53:46 And you may find that, actually, you don’t miss it that much, that you could cut out three or four days of drinking and still get that social pleasure two days out of the week and your overall health risk is going to go down significantly.
    0:53:55 In terms of treating someone with alcohol abuse disorder, rehab is often the most widely known form of treatment.
    0:54:05 One of my friends who struggled with addiction really, really badly with alcohol addiction, but also drug addiction, said to me multiple times, he said, I’ve been to rehab three or four times now and it’s just not working.
    0:54:05 Yeah.
    0:54:12 And I think when the most popular or the most well-known treatment doesn’t work for you, you kind of develop an even greater sense of hopelessness.
    0:54:13 Are you a fan of rehab?
    0:54:15 Generally, no.
    0:54:22 So, you know, rehab is this idea that you go away somewhere for a week, a couple weeks, and then you’re kind of cured, right?
    0:54:27 It’s almost like people have thought of addiction as an infection where you need, like, two weeks of antibiotics and then you’re done.
    0:54:35 What we really understand is that for many people, addiction is more like a chronic illness or even like cancer where you need a lot of treatment up front for the first few years.
    0:54:41 And then over time, you get into stability and remission and you’re almost like a cancer survivor.
    0:54:42 You’re in long-term recovery.
    0:54:48 And so this idea that you go somewhere for a couple weeks and then you come out and you’re all better really doesn’t match what we know of addiction.
    0:54:53 The other problem is that much of what happens in rehab is not all that therapeutic most of the time.
    0:54:59 So the things that we know are most effective for addiction, one are medications, which there’s a lot of stigma and misunderstanding about.
    0:55:02 And then two are, like, evidence-based psychotherapies.
    0:55:08 So things like cognitive behavioral therapy, motivational enhancement therapy, you know, working on your underlying trauma.
    0:55:14 Often in rehabs, the model is really built around this idea of, like, you remove yourself from this environment.
    0:55:17 You do some groups while you’re there.
    0:55:20 Sometimes often they’re based on more of, like, a peer support model.
    0:55:23 Sometimes the therapies that are offered are, frankly, not very evidence-based.
    0:55:25 Like, we actually did this study.
    0:55:30 It was a secret shopper study where we called rehab programs across the country to, like, ask about what they offered.
    0:55:39 And many of them offer things like, you know, horse therapy or, like, dolphin-assisted therapy, which, like, I’m sure it’s very nice to swim with dolphins and to work with horses.
    0:55:42 But it’s not something that’s been, like, studied and effective.
    0:55:50 And many places don’t offer the things that we know are actually effective, which are, you know, trained clinicians during evidence-based treatments or medication treatments.
    0:55:56 So it’s a combination of, like, this short-term fix for a long-term problem and not actually getting the treatment that you need.
    0:55:59 So what does work, like, for alcohol use disorder, most people don’t know.
    0:56:04 We have very effective medications that can help you, even if you just want to not drink as much.
    0:56:09 So there’s this medication I mentioned at the beginning that actually blocks your opioid receptors.
    0:56:09 Yeah.
    0:56:11 Which seems kind of funny that it works on alcohol.
    0:56:21 But the reason it does is that for people who part of the thing that drives them to drink is that they drink, they feel this, like, pain relief pleasure sensation from the release of opioids in their brain.
    0:56:23 And that makes them want to drink more.
    0:56:27 That if you block that, people don’t get sick if they drink, but they just don’t find it as rewarding.
    0:56:32 And so someone named Sinclair, actually, in Europe did some fascinating experiments of even just using it as needed.
    0:56:41 So rather than taking it as an everyday medication, if you know that when you go to, like, a holiday event, you’re going to drink way more than you want to drink, you take it, like, 30 minutes before you go.
    0:56:44 And then what people find is they have, like, one drink, and they’re like, ah, I’m good.
    0:56:50 I don’t have that same urge to want to drink more and more because I didn’t get the same sort of tickle of feeling better and feeling relief.
    0:56:56 What do you think about psychedelics as a way to counteract addictive behaviors like the ones we’ve described?
    0:56:57 Yeah.
    0:57:02 One of the most, like, groundbreaking trials in the last couple of years for alcohol use disorder was psilocybin.
    0:57:08 So there’s a big study of psilocybin-assisted psychotherapy for alcohol use disorder, which showed really remarkable effects.
    0:57:19 So people took psilocybin, actually compared it, folks came in, and they either got a big dose of Benadryl or psilocybin, and then they sat with a therapist for, like, eight hours for this guided psilocybin journey.
    0:57:24 And they found that people drank much less after it, so it does seem to have some effect.
    0:57:33 And the thought is that part of the way psychedelics work is they increase neuroplasticity, meaning the ability for the brain to form new pathways and kind of retrain itself.
    0:57:36 And so it does seem to be a potential therapeutic for alcohol use disorder.
    0:57:39 Psilocybin is the active compound in magic mushrooms.
    0:57:40 Yes, exactly.
    0:57:40 Have you heard of Ibogaine?
    0:57:42 I have, yeah.
    0:57:47 Which is often associated, which is another psychedelic often associated with addiction.
    0:57:47 Yes.
    0:57:52 People have looked at Ibogaine for opioid use disorder.
    0:57:58 Those studies have been less promising than psilocybin, although it hasn’t been tested in the same kind of rigorous ways recently.
    0:58:06 Partly for opioid use disorder, we have really effective medications that have been shown to improve recovery and reduce death, and so it’s sort of hard to be better than that.
    0:58:13 One really interesting, like, new whole class of medications for alcohol is medications that are being used for weight loss that people have probably heard of.
    0:58:21 So, like, Wagovi, Ozempic, that whole class of GLP-1 medications seems to also reduce alcohol use, which is kind of interesting.
    0:58:21 Really?
    0:58:22 Yeah.
    0:58:23 Have they studied that?
    0:58:24 Yeah.
    0:58:34 So they, well, first of all, there’s, I mean, there’s whole, like, Reddit threads and online communities about this where people were prescribed it for diabetes or for weight loss, and they all of a sudden were like, I don’t really want to smoke or drink.
    0:58:36 Like, that kind of urge has gone away entirely.
    0:58:40 And for some people, they really describe it as being, like, miraculous.
    0:58:45 They’ve been trying to stop drinking for, you know, years and years, and for the first time, they don’t feel that sense of, like, craving and urge.
    0:58:54 And there recently have been some actual clinical trials where they’ve done, you know, placebo-controlled blinded studies and have shown that it does reduce drinking.
    0:59:02 And so it’s a really interesting area where it seems like those medications kind of reset craving and appetite more globally and not just for food.
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    1:00:06 One of the ways that many of us understand addiction, if we haven’t experienced it directly in our own lives, is we look up at role models on TV and in sort of celebrity pop culture.
    1:00:12 And we see these role models who, you know, we see on stages start to deteriorate and deteriorate in the public eye.
    1:00:19 And ultimately, it seems often like it’s inevitable that someday the TMZ headline is going to ring out and say that this person has passed away.
    1:00:21 And that happens all too often.
    1:00:28 We think about, you know, Whitney Houston or I guess Michael Jackson’s even been associated with dying from an addiction.
    1:00:30 I think it was painkillers or something.
    1:00:34 Prince Elvis Presley, Mac Miller, who a lot of people will know as well.
    1:00:36 And then Nicole Smith.
    1:00:42 And even now in the public eye, there are certain individuals where we’re starting to see this sort of erratic behavior.
    1:00:43 They’re posting on their Instagrams.
    1:00:47 They’re showing up in society in a slightly different way.
    1:00:53 When you see that in the line of work that you operate in, what is your natural reaction?
    1:01:00 How does it make you feel when, you know, because there’s a couple of people I’m thinking about at the moment who the world are talking about that, you know, we think they have an addiction.
    1:01:01 We think they need help.
    1:01:04 What is your natural reaction to that?
    1:01:06 And what is it that those people need?
    1:01:07 Yeah.
    1:01:13 When I read the headlines of someone dying, I mean, to me, it’s gutting and heartbreaking.
    1:01:21 One, because obviously it’s a human life that with someone’s mother and sister or brother and people cared about a public figure that people looked up to and cared about.
    1:01:23 But mostly that it was a totally preventable death.
    1:01:26 Like really no one should die from a substance related death.
    1:01:28 We have tools to treat addiction.
    1:01:32 We know how to prevent the harms of, you know, drug overdose, for example.
    1:01:43 And so the fact that someone can die, especially someone that everyone has watched for so long, is I think just like a tragic example of how what the mismatch is between what we do around addiction and what science says is actually helpful.
    1:01:54 I think, you know, when I see someone who actively is showing signs, like it’s just sad to see that happen so publicly without people being able to support that person.
    1:01:56 And it’s not a magic fix.
    1:01:59 It’s not going to be like, you know, you have an intervention.
    1:02:01 The person goes to treatment, gets better forever.
    1:02:03 That I think is often in people’s minds.
    1:02:06 It is a process, a journey, like any change.
    1:02:15 And so really it is around where we began, that idea of how do you begin to understand with this person, how is their substance use getting in the way of what they want for themselves?
    1:02:22 And how might their life be better for them based on whatever they believe better is if they were to make changes to their substance use?
    1:02:29 I remember I had this one particular friend who had an addiction and I remember always the life of the party.
    1:02:41 And I remember this one day he came up to me at an event and he’d sat down in front of me and said to me, he said, he like whispered to me, I’m in so much pain.
    1:02:45 And he told me about rehab and how it failed him, etc.
    1:02:55 But it just, it almost sounded unbelievable that someone with such a big smile on their face would whisper to me, especially a man, because men don’t really talk much about their emotions.
    1:02:57 I’m in so much pain.
    1:03:03 And then funnily, I then see how the world treats that individual, him having whispered that to me one day.
    1:03:09 And the world, how the world responds to his behavior and attacks him and criticizes him.
    1:03:10 But I was privy to the whisper.
    1:03:11 Yeah.
    1:03:19 And that one whisper helped me to kind of reframe how to treat that person, but also really what was at the heart of what was going on.
    1:03:21 And probably give you so much empathy, you know.
    1:03:22 A huge amount of empathy.
    1:03:23 Because I would have been like the rest of the world.
    1:03:24 I would have just thought, oh, what an idiot.
    1:03:25 What a dickhead.
    1:03:25 Like, what’s he doing that?
    1:03:26 That’s strange behavior.
    1:03:27 Yeah.
    1:03:31 And you said something really important that was a slight shift in words.
    1:03:32 You didn’t say he failed treatment.
    1:03:34 You said the treatment failed him.
    1:03:38 And that matters so much because I think too often we’ve made it seem as if people are failing.
    1:03:42 Like, if they go to rehab and they don’t get well, it’s their problem, you know.
    1:03:45 And actually, the treatment wasn’t right for them.
    1:03:50 If someone had cancer and their cancer came back or didn’t get treated by chemotherapy, we wouldn’t say, like, oh, they failed.
    1:03:52 You know, we would say, well, what’s the next treatment?
    1:03:53 How do we get them to the right doctor?
    1:04:02 And so there is this, like, personal blaming, and that gets at stigma, which is one of the main reasons that people don’t share that they’re struggling with substances, that they don’t seek treatment.
    1:04:05 And so we have tremendous stigma towards drug and alcohol addiction.
    1:04:08 It’s one of the most stigmatized kind of social conditions globally.
    1:04:12 And so, of course, then, if you’re a person who starts to think, like, oh, maybe I do have a problem.
    1:04:20 Like, maybe my alcohol use is getting in the way of things, it’s really hard to then say anything because you worry that you’re going to be judged, you’re going to be labeled, you’re going to be misunderstood.
    1:04:22 In some cases, terrible things could happen to you.
    1:04:25 You might get your children taken away by, you know, child welfare.
    1:04:27 You could lose your housing or lose your job.
    1:04:32 And so that stigma has, like, played into this terrible cycle where people, you know, have to whisper it to someone.
    1:04:39 It shows how much he trusted you to even be able to say honestly what he was going through because there’s so much stigma about the condition itself.
    1:04:41 You must have had many cases that broke your heart.
    1:04:42 Yeah.
    1:04:45 Can you tell me about one that changed you?
    1:04:49 Oh, goodness, so many.
    1:05:01 You know, so one gentleman in particular, he was – struggled with heroin addiction for a long time and had been – like we talked about, had been kind of a chronic illness for him.
    1:05:02 He’d had periods where he’d done really well.
    1:05:07 He’d had periods where he had struggled and had always stayed safe through all of that.
    1:05:15 And he actually – his, like, one really meaningful relationship in his life that kind of kept him together was a relationship with his mom, and he lived with her.
    1:05:18 And they lived in public housing.
    1:05:21 And they were, you know, dealing with economic insecurity like many people.
    1:05:26 And someone found out that he was staying with her, and it would have put her at risk for her housing.
    1:05:29 And so he didn’t want her to lose her housing, so he left, but he was newly homeless.
    1:05:36 And all of a sudden, because of just social barriers, was dealing with the stress of homelessness and being alone.
    1:05:45 And even with kind of all of the connection he’d had with his mom and with treatment, he was found dead between two parked cars.
    1:05:46 It overdosed alone in the street.
    1:05:49 And I always think, like, if –
    1:05:49 And you knew him.
    1:05:50 Oh, yeah.
    1:05:54 The cascading effects that, you know, that it didn’t have to be that way.
    1:05:58 And I think there are so many deaths like that where I just think it doesn’t have to be like this.
    1:06:00 You know, really no one should die like this.
    1:06:05 And there are so many things that, you know, in the moment feel so out of our control.
    1:06:15 And I think that’s part of what generates my passion for this work is I can’t always save the person in front of me or change issues around homelessness or housing policy.
    1:06:20 But I can try to work on a broader scale to make things different for the next person.
    1:06:26 And I think that kind of – that, for me, counteracts some of the distress of losing people that I care about.
    1:06:43 If you were president of the United States, for example, let’s just use this country as an example, and you had to make upstream changes to the way society was designed in order to mitigate the downstream symptom of addiction and addictive behaviors, etc.
    1:06:47 What are those things that you would change about the way that our society is designed?
    1:06:48 You could change anything.
    1:06:49 Yeah.
    1:06:55 I mean, starting upstream, the biggest thing would be building resilience and building connection early on.
    1:07:02 So, you know, I think these things that feel so not related to addiction per se are actually deeply related when we think about adverse childhood experiences.
    1:07:09 So when we think about prevention for children, you know, often people have looked at, like, education, like, you know, telling people – telling kids that drugs are bad.
    1:07:10 That doesn’t work.
    1:07:13 What does work is actually building resilience among young people.
    1:07:15 So building resilience, building connection.
    1:07:16 So what does that look like?
    1:07:17 That looks like affordable housing.
    1:07:22 That looks like parks where people can get outside and play sports and exercise and build relationships.
    1:07:30 That looks like, you know, supporting families so that families can stay together and so those early relationships and attachment can be well-formed.
    1:07:40 That’s, like, the true prevention work is trying to break the cycles of intergenerational trauma, poverty, substance use, and actually supporting families, communities at the very start.
    1:07:42 It reminds me of Rat Park.
    1:07:42 Yes.
    1:07:45 Yeah, Rat Park is a great example of that.
    1:07:47 What is Rat Park for those that don’t know?
    1:07:47 Yeah.
    1:07:56 So Rat Park was a series of experiments that were done where essentially they took – they’re trying to understand kind of drivers of addiction using rat models.
    1:08:03 And so they took rats and they had one model where rats were isolated in their own cage with nothing to do and no human connection.
    1:08:09 And they had access to a substance like morphine or cocaine where they could push a lever and get more of it.
    1:08:15 And those animals, when they were deprived of connection and isolation, anything to do, used more of the drug.
    1:08:16 It gave them relief.
    1:08:17 It gave them pleasure.
    1:08:26 They took those same animals and they put them in this amazing cage with, you know, areas to play and, like, wheels to climb on and lots of friends and other rats.
    1:08:31 And all of a sudden they saw the same animals were no longer kind of pushing the lever and trying to get more of the drug.
    1:08:37 And so, you know, it’s a somewhat simplified model that there’s lots of – it’s probably oversimplified.
    1:08:51 But it demonstrates that so much of addiction really is around this idea of connection, restoring sort of the world around us, the community, the interrelatedness that we all have, the opportunities and purpose and meaning and hope.
    1:08:52 So I think that’s the real prevention.
    1:08:56 And then there’s how do we actually address folks who are having a problem.
    1:09:02 And I think, you know, what I would do there is first make addiction treatment widely available immediately when people need it.
    1:09:17 So the minute you walk into your general practitioner’s office or an emergency room, you get treated with compassion, with science, with people asking you what can they do to help and offering you effective care the same way they would if you had a new cancer diagnosis or a new diagnosis of a heart problem.
    1:09:21 And that we really reframe treatment entirely to look like the way it looks for any other health condition.
    1:09:32 And that we stop punishing people who use substances where, you know, a lot of times people are still sent to jail for substance use, which, you know, is a confusing mixed message.
    1:09:39 If we’re saying this is a health problem on the one hand, but we’re going to put you in prison or jail at the same time, those two things don’t necessarily align.
    1:09:42 Many of us are living in the first model of Rat Park.
    1:09:43 Yeah.
    1:09:44 We’re living alone.
    1:09:45 We’re living in these big cities.
    1:09:47 We’re more sedentary than ever before.
    1:09:54 Maybe, you know, we’ve moved to a big city because we don’t have, which means we don’t have our family around.
    1:09:56 We might be doing a job.
    1:09:57 That’s incredibly challenging.
    1:10:15 So it’s no wonder when we think about addiction and alcohol and some of these other behaviors, but more broadly beyond alcohol as a substance, other addictive behaviors, whether it’s social media or it’s what we eat or pornography or in the sort of inverse,
    1:10:23 the good habits, the healthy food, the working out, the exercise, the productive behaviors, why we’re struggling so much.
    1:10:30 And I’ve often wondered if we should all just like go to like communes and live, do you know what I mean?
    1:10:31 Yeah.
    1:10:32 In groups.
    1:10:36 I mean, I don’t think human beings were meant to live this way.
    1:10:37 And it’s a relatively new thing, right?
    1:10:40 We often lived in a village or a community.
    1:10:42 We lived in these multi-generational households.
    1:10:54 I mean, I have little kids, and I think having kids was such an eye-opener of that, of like, well, that makes sense why people live with their parents and their grandparents and have these big families to create, you know, community and a sort of extended family around you.
    1:10:56 And we have lost that in a lot of ways.
    1:11:03 And I think the ways that we used to get that, like religion, maybe not – maybe that still resonates for some people, but for others it may not.
    1:11:09 And so finding other ways of engagement, of meaning, of purpose, that can be through lots of different things.
    1:11:11 You know, I think people are finding creative ways of doing that.
    1:11:17 It can be through like, you know, finding a volunteer activity, finding some other type of social group.
    1:11:18 Some people do it through sports.
    1:11:25 You know, they find connection and engagement with people they don’t really know over the shared love around an activity or a team.
    1:11:29 But really sort of seeing that as a priority the same way you’d prioritize other things in your life and your health.
    1:11:34 And are you a fan of therapy as an approach to aim at the early childhood trauma?
    1:11:35 Absolutely, yeah.
    1:11:41 I mean, I think one of the problems is that too often therapy has been like forced on people.
    1:11:49 I think that I’m much more of the approach of like we need to make treatment available and welcoming and high quality so that people get value out of it.
    1:11:50 And therapy is a huge part of that.
    1:11:52 You know, it’s about a lot of things.
    1:11:52 It’s about connection.
    1:11:58 It’s about figuring out those reasons why people are using in the first place, addressing and healing those traumas.
    1:12:02 It also matters that we have good, well-trained, empathetic therapists.
    1:12:10 So there’s been a lot of interesting studies looking at actually how empathetic your therapist is, is probably the strongest predictor of whether you stop, make changes to your alcohol or drug use.
    1:12:11 Really?
    1:12:16 Which is so interesting because we often think like, you know, you’ve probably heard someone say like, I don’t really like my therapist.
    1:12:19 And I think someone’s reaction to that is like, oh, like you’re not that into therapy.
    1:12:28 But they’ve actually done a lot of studies showing that a therapist who is less empathetic, their client is more likely to use more substances at the end of that course of treatment.
    1:12:34 So actually having a really well-trained, compassionate, evidence-based workforce is hugely important too.
    1:12:36 And I guess the same applies for family and friends.
    1:12:36 Yeah.
    1:12:37 Yeah.
    1:12:38 I think empathy is really powerful.
    1:12:42 Those kind of things that we think of as soft skills actually matter tremendously.
    1:12:45 Is it possible to prop somebody up?
    1:12:54 I, you know, because I was talking to, I think it was talking to Dr. Anna Lenke about this, about the idea that you can play a role in someone’s addiction.
    1:12:55 Yeah.
    1:12:59 I want to help my friend who’s addicted.
    1:13:01 And so I, I’m there for them.
    1:13:02 I’m comforting them.
    1:13:11 But I’m actually in some way reinforcing that addictive behavior because I’m, I’m positively reinforcing it because I’m supporting them so much and I’m loving them so much.
    1:13:16 And I’m showing them so much empathetic attention that actually I’m playing a role in continuing that addiction.
    1:13:18 Is that possible?
    1:13:18 Yeah.
    1:13:21 I mean, this is this concept of like enabling, which I think is nuanced.
    1:13:28 I would say at its core, it’s really deeply problematic that for the most part, love and support are never going to be harmful.
    1:13:34 And when I talk to patients, often the thing that caused them to ultimately engage in treatment was not some terrible consequence.
    1:13:44 It was the idea that someone cared enough about them in a moment where they didn’t love themselves very much and felt hopeless that someone was willing to sort of lift them up and believe in them.
    1:13:46 And it’s these small moments of kindness.
    1:13:52 Like I’ll tell you a story of a patient that we took care of in the hospital who was there for a really life-threatening infection related to their drug use.
    1:14:02 And a year to the date after he was hospitalized, he wrote a letter to our team and he said, you know, I’ll never forget the moments you guys came in and just sat with me and talked to me.
    1:14:06 And he now sends an email every single year on the anniversary of when he got out of the hospital.
    1:14:19 And it’s those moments of humanity, of connection, again, that connection idea that often are the catalyst for change, the kind of hope and belief that your life could be better somehow, as opposed to this idea of, like, increasing someone’s pain and suffering.
    1:14:21 And that plays out in different ways.
    1:14:28 So in families, one of the most effective tools we teach people is something called CRAFT, which stands for Community Reinforcement and Family Training.
    1:14:35 And it’s very different than the, like, people may have seen, like, shows where you’re supposed to, like, stage an intervention and, you know, tell someone all or nothing.
    1:14:37 But CRAFT is very different.
    1:14:40 It teaches people, first, how do you understand the science of addiction, family members?
    1:14:42 Second, how do you get support for yourself?
    1:14:45 Because it’s really tough to deal with addiction in a family.
    1:14:48 And then how do you start to learn about consequences in a different way?
    1:14:56 That, you know, if you’re a parent and your kid is missing school because they’re using, you don’t want to cover for them and sort of reinforce their pattern.
    1:15:02 But you also don’t need to kick them out of your house, that there are sort of gradations of consequence that can actually help people change.
    1:15:07 And one of the biggest sort of motivators for change is actually positive reinforcement of the behaviors you want to see.
    1:15:12 So that’s been called contingency management in the kind of treatment world.
    1:15:15 And, you know, health insurance companies, lots of companies have figured this out, right?
    1:15:22 So if you get money back because you join a gym or you get those, you know, you get reimbursements for doing something that people want to see, people do more of it.
    1:15:23 It’s true in human behavior.
    1:15:24 It’s very true with addiction.
    1:15:26 But we often do the opposite.
    1:15:34 We try to punish people into getting well instead of reinforcing kind of the healthy behavior that what we want to see more of, if that makes sense.
    1:15:41 Yeah, I guess I’m trying to represent the audience member that’s listening to this right now that knows someone in their life that was addictive.
    1:15:44 And they tried to be empathetic.
    1:15:45 They tried to offer support.
    1:15:50 They tried to give the person help and still nothing changed.
    1:15:51 Yeah.
    1:16:01 In that situation, maybe the person that was struggling with the addiction didn’t accept the support, didn’t go to the meetings, didn’t speak to the therapist.
    1:16:01 Yeah.
    1:16:09 In such a situation where you’re offering help to someone and they’re not taking it, they’re not willing to investigate different medical treatments.
    1:16:12 They’re living at your house, they’re living at your house, they’re in your business, whatever.
    1:16:16 Is there a point where you say enough is enough?
    1:16:17 Yeah.
    1:16:21 Well, first, like, it is just so hard to be there as a family member or friend.
    1:16:25 So for anyone listening, I’ve been there, it’s incredibly impossible.
    1:16:27 So have grace with yourself.
    1:16:33 I think that’s a different decision you’re talking about is at some point you have to make a decision to protect yourself.
    1:16:43 So let’s say you have someone in your home who’s dealing with addiction who, you know, gets aggressive or is stealing money or is, you know, causing trauma to the people living in the house.
    1:16:48 At some point you may need to decide that for my well-being, for the rest of the family’s well-being, I can’t have this in my life right now.
    1:16:52 That’s very different than saying kicking them out is going to make them better.
    1:16:55 So the distinction there is that it’s okay to protect ourselves.
    1:16:56 Sometimes we have to do that.
    1:16:59 And sometimes there’s only so much you can do.
    1:17:04 But to not sort of fool yourself into thinking that the action is to help the other person, and that’s okay.
    1:17:09 I think the other piece is, you know, at the end of the day, first of all, it’s easier to be a treater.
    1:17:10 So I’ve been a family member.
    1:17:11 I’ve been a clinician.
    1:17:13 As a clinician, I can truly be unconditional.
    1:17:18 So I’m going to be someone’s doctor whether they continue to use heroin or continue to drink or don’t.
    1:17:19 And there’s something really beautiful in that.
    1:17:24 Like my engagement with someone is not premised on whether they make changes or not.
    1:17:30 As a family member, that’s harder, especially if you’re a kid dependent on someone or you’re in a marriage or a relationship.
    1:17:32 So you may have to make different choices.
    1:17:37 But I think at the end of the day, people don’t change because of why we think they should change.
    1:17:40 They change because they think their life is going to get better in some way.
    1:17:46 So the key then becomes figuring out, like, why might this person’s life get better if they were to make changes to their alcohol or drug use?
    1:17:53 So it’s a shift where you become sort of on their team instead of trying to drag them towards water, you know, drag the horse towards water.
    1:17:58 And there’s this fascinating kind of human instinct that none of us like being told what to do.
    1:18:02 So there’s something called the writing reflex, which is it’s really hard for caregivers.
    1:18:09 It’s hard for parents because we love to tell people, like, our great advice and why what they’re doing is wrong and they should take our, like, brilliant doctor advice.
    1:18:12 And this can be, like, telling someone, like, don’t you see what you’re doing is causing harm?
    1:18:13 You should make changes.
    1:18:15 It can also be subtler.
    1:18:17 It can be, like, lecturing someone or trying to educate them.
    1:18:21 But when someone shoves something down your throat, your instinct is to resist.
    1:18:24 It’s just, like, natural human behavior, even if it’s a great idea.
    1:18:26 If someone’s, like, shoving an ice cream cone in your face and, like, eat it.
    1:18:30 Even if you like ice cream, you might be like, wait, wait, I don’t know if I want this ice cream.
    1:18:33 And so the key then is not to sort of tell someone what to do.
    1:18:35 It’s to understand why might they want to make changes.
    1:18:39 And so once you do that, then you all of a sudden realize, like, it just feels better.
    1:18:42 You’re not trying to drag someone towards something.
    1:18:46 It doesn’t – you don’t have, like, personal skin in the game about what choice they make.
    1:18:57 But you’re really a partner with them and figuring out how is this thing causing problems to you and why might your life get better if you were to make changes to your alcohol use or your drinking or your substance use.
    1:19:00 What’s the difference in delivery there in terms of delivering that message?
    1:19:03 Because they’re both ultimately getting to the same outcome.
    1:19:06 But it sounds like the language might be slightly different.
    1:19:07 Yeah, very different.
    1:19:15 So in kind of, like, medical speak and therapy speak, we talk about something called motivational interviewing, which is – it becomes almost like a mind trick.
    1:19:22 But it is basically a way of trying to identify from the person their reasons for change and reflecting it back to them.
    1:19:29 And so it’s not you telling them you think they should change, but you are trying to elicit their motivation and amplify it.
    1:19:31 And then at the end of the day, you’re turning over the power back to them.
    1:19:34 So that might look like something someone says, you know –
    1:19:36 I’ll be your patient.
    1:19:39 So, yeah, I do drink a lot.
    1:19:41 I drink a couple of times a day, especially in the mornings.
    1:19:42 But it’s fine.
    1:19:45 You know, I’m still managing to get to work every day.
    1:19:48 Obviously, I have a couple of misconduct issues at work.
    1:19:51 But other than that, you know, and my partner’s left me.
    1:19:53 But other than that, everything else is fine.
    1:19:54 And I can manage this.
    1:19:58 It sounds like your alcohol use is causing some problems at work and in your relationships.
    1:19:59 It is, yeah.
    1:20:01 Yeah, I lost – my partner’s left me.
    1:20:08 And I keep getting these misconduct notifications at work and disciplinaries because I sometimes get there late.
    1:20:10 And when I’m there, sometimes I fall asleep, et cetera.
    1:20:12 And I’ve – obviously, I work with big machinery.
    1:20:14 So there’s a little bit of a risk there.
    1:20:15 But otherwise, it’s okay.
    1:20:21 It sounds like you’re worried about your safety at work and also how your drinking is starting to affect your job and your relationships.
    1:20:22 That’s true, yeah.
    1:20:23 I am, you know.
    1:20:25 I’ve been on the crane in particular.
    1:20:30 Being intoxicated on the crane in particular has caused a few incidences.
    1:20:35 And, you know, I sometimes do worry that one day it’ll go a little bit too far, yeah.
    1:20:42 Yeah, it sounds like that’s really scary that you’re really worried your alcohol use could cause even, like, a serious or life-threatening accident at work.
    1:20:50 Yeah, and then what am I going to do for work, you know, because if you get something like that on your file, then I’m never going to be able to be a machine operator ever again.
    1:20:52 Yeah, and your job sounds really important to you.
    1:20:52 It’s so important.
    1:20:54 Alcohol’s starting to get in the way of that.
    1:20:55 Yeah, 100%.
    1:20:55 Yeah.
    1:20:59 And so what are your goals looking forward around your job or your relationship?
    1:21:06 Well, I know I really should, I really should fix this alcohol issue that I have.
    1:21:10 And I would love to find a partner.
    1:21:12 That’s really important to me because I want to have a family.
    1:21:16 So, you know, obviously prerequisite of having a family is finding a partner, really.
    1:21:18 So, yeah.
    1:21:26 Yeah, it sounds like you’re really committed to thinking about making a change to your drinking and that you’re looking forward to finding a partner and family and you’re worried that alcohol might get in the way of that.
    1:21:33 So what you’re doing there is you’re not leading me, you’re kind of pushing me, if that makes sense.
    1:21:43 There’s like a little bit of like a Jedi mind trick thing where you’re – so essentially, it’s actually really – it’s a little tricky when you’re first learning how to do it because what I’m trying to do is I’m listening for what’s called change talk.
    1:21:46 So any little nugget you’re giving me about making a change.
    1:21:49 So you’re saying like, oh, I’m starting to get this misconduct.
    1:21:51 I’m worried about this thing with safety at work.
    1:21:52 I want a partner.
    1:21:55 Those are like – it’s a goldmine of little kernels of change.
    1:21:58 And I’m ignoring all of your sustained talk.
    1:22:01 So anything where you’re arguing for the status quo, it’s not a big deal.
    1:22:02 Drinking is not that big a deal.
    1:22:03 I can’t make a change.
    1:22:05 I don’t even acknowledge it or address it.
    1:22:08 And that’s actually hard because I think most of us pay attention to the negative stuff.
    1:22:18 So if you think about like a performance review at work or someone telling you any kind of feedback, we tend to amplify and remember like the one bad thing that someone said to us and forget the millions of good things.
    1:22:23 So you have to change – you have to like train yourself to do the opposite, to hear those little kernels of change talk.
    1:22:25 And then I’m basically being a mirror, but I’m amplifying it.
    1:22:27 So I’m taking these little kernels of change talk.
    1:22:30 I’m reflecting back to your own words.
    1:22:32 So I’m not telling you that you should stop drinking because it’s unsafe at work.
    1:22:37 I’m reflecting to you like you’re starting to get worried that you might have an accident at work, and that’s really serious.
    1:22:40 And that’s kind of guiding the conversation forward.
    1:22:49 The other key is that if you meet a point of resistance, you want to pivot because once you start arguing, whether it’s about politics or anything, people dig in.
    1:22:52 So if you start arguing with someone, you’ve got to find another way.
    1:22:58 You’ve just got to pivot and roll to a different tactic because the more you argue, the more people dig in on their point of view.
    1:23:01 And it’s more about like winning the argument than it is about moving forward.
    1:23:03 What if you want to change yourself?
    1:23:13 Is there a process, a system, a methodology to help you discover what your ideal behaviors are, what your why is, and to implement change?
    1:23:14 That’s why I say all the time, what’s your why?
    1:23:16 I think that’s so exciting.
    1:23:19 Like we all want to live our best lives, whatever that means to us.
    1:23:23 And so having a purpose, having a goal is probably the most important thing.
    1:23:25 Motivation is important.
    1:23:26 We talk a lot about motivation.
    1:23:28 But motivation is fleeting.
    1:23:31 It can slip and slide over the course of one day.
    1:23:33 So you may, you know, take kind of a mundane example.
    1:23:36 You want to get in shape and you’re feeling super motivated one day.
    1:23:42 And then the next morning, your alarm clock goes off at like 5 in the morning and you’re tired and it’s cozy in your bed.
    1:23:44 And maybe you stayed up a little too late.
    1:23:46 Your motivation is going to be flagging, right?
    1:23:52 So if you don’t have a goal or a reason or a why or a purpose, it’s going to be really hard to actually get up the energy to get up.
    1:23:57 And so figuring out what that purpose is and then trying to find ways to enjoy the process.
    1:24:01 Because if you’re always working towards a future goal, some people are very goal-oriented and that works for them.
    1:24:04 But finding joy in the process will help you.
    1:24:05 So I’ll take alcohol, for example.
    1:24:07 Like not an addiction issue.
    1:24:09 Just like making changes to your drinking in your life.
    1:24:12 So if you’re just like, oh, I should stop drinking because drinking is bad for me.
    1:24:15 That’s like a relatively vague goal, right?
    1:24:18 It’s not really about anything that matters specifically to you.
    1:24:20 And it’s going to be hard to stick to that.
    1:24:25 If instead you think, okay, I, you know, I’ve started to realize that when I drink every single night,
    1:24:29 I don’t get the work done that I want to get done because I’m too tired and I fall asleep.
    1:24:31 I don’t feel refreshed in the morning because I’m not sleeping very well.
    1:24:35 I’m not getting up early to exercise and that’s something that really matters to me.
    1:24:38 I’m not like as present with my family as I wanted to be.
    1:24:42 Then it’s all these little micro goals that make it much easier to make a change.
    1:24:44 So you may decide, you know, I’m not going to drink.
    1:24:46 I’m only going to drink two days out of the week.
    1:24:48 And when I do drink, I’m going to keep it to this amount.
    1:24:51 But the reason why is not some vague recommendation from some doctor.
    1:24:55 It’s because like you’re working really hard at work and it feels good to be productive after dinner.
    1:24:58 And you’re training for a race and you want to get up in the morning and run.
    1:25:02 And so you actually notice those little steps like, wow, it feels great.
    1:25:03 I woke up this morning and I feel so refreshed.
    1:25:06 Like you’re reinforcing your goal right there.
    1:25:09 You’re not working towards some abstract thing that doesn’t really matter to you.
    1:25:16 So you want to make these like really focused, personalized goals and really anchoring it on what is your why.
    1:25:19 And your why may be very different than my why or someone else’s why.
    1:25:22 So it may be, you know, sleep really matters to you.
    1:25:25 Or, you know, you may have a different relationship with alcohol.
    1:25:29 So the other kind of example I’d give is people are different, right?
    1:25:30 We respond differently to things.
    1:25:33 So some people can open a bag of like potato chips and eat two and walk away.
    1:25:36 Some people like they open the bag, they’re going to eat all of the chips.
    1:25:38 And so it’s just easier not to open the bag.
    1:25:40 And alcohol is like that too.
    1:25:45 Some people may find if they open a bottle of wine or they have alcohol in the house, they’re going to drink all of it.
    1:25:49 And the idea of like trying to keep to these small amounts of alcohol is actually really hard.
    1:25:54 And it’s simpler and easier to just avoid it completely or to only drink at a restaurant or something.
    1:26:01 So you do have to understand like how your goals, your why, your purpose interacts with your response to whatever it is that you’re working on.
    1:26:02 And that’s going to be different for everyone.
    1:26:08 Are there any other things, any other habits that we should be thinking about when we’re trying to overcome an addiction?
    1:26:15 So if we think about alcohol as being at like the bottom of the stream, is there anything else upstream that I should be thinking about?
    1:26:17 So we talked about social connections and relationships.
    1:26:19 So I need to be making sure that I’m surrounded by people.
    1:26:27 I’m socializing because that’s going to be an insulator to like stress and loneliness, which is going to cause me discomfort, which is going to lead me to alcohol.
    1:26:27 Yeah.
    1:26:33 But are there any other things that I should be thinking about when I’m setting off to make a change in my life?
    1:26:33 Yeah.
    1:26:34 Yeah.
    1:26:35 There’s a bunch.
    1:26:43 I think first, any behavior change, whether it’s alcohol or other, if you’re feeling like depleted and tired and not your best self, it’s going to be harder to make a change.
    1:26:55 So if you think about like any big decision you made to change your job, to start an exercise routine, to leave your partner, you probably didn’t choose like the day that you’re exhausted and feeling anxious and stressed and not your best self to make that change.
    1:26:56 Like change is hard.
    1:27:05 So you want to try to boost up other things in your life, eat well, you know, get enough rest, try to exercise, things that are going to help you feel healthy and your best self when you’re trying to make a change.
    1:27:07 Is that linked to dopamine?
    1:27:13 Yeah, because I mean, so our natural reward system, the thing that triggers it is exercise, food, sex, connection.
    1:27:19 So, you know, trying to have healthy other ways of positive dopamine release.
    1:27:25 And so I think for many people, alcohol or substances can feel like a way of doing something nice for ourselves.
    1:27:29 Like I’m going to, this is going to help me reduce my stress after a bad day at work.
    1:27:34 So the goal then is not that you just like white knuckle it all night and feel really stressed after work.
    1:27:37 It’s that you figure out like, what are some other things that help me reduce stress after work?
    1:27:39 Maybe it’s going to a yoga class with a friend.
    1:27:42 Maybe it is, you know, spending time with my family.
    1:27:46 Maybe it’s getting massage or meditating or watching a show I like.
    1:27:49 So you want to, it’s not just you’re removing the thing that you’re trying to change.
    1:27:52 You want to fill up the empty space with other things.
    1:27:58 So what if I fill it up with like Haagen-Dazs ice cream and burgers?
    1:28:00 Because that will cause a dopamine here.
    1:28:08 So presumably if I just eat loads of sweets and candy, then that’s going to stop me from engaging in addictive behavior.
    1:28:10 But we see that all the time.
    1:28:12 So that’s like replacing things.
    1:28:19 And, you know, I was reading an article, people probably heard of dry January, this idea of like not drinking for the month of January to rethink your relationship with alcohol.
    1:28:24 I was reading an article that dry January has become high January because people are just smoking a ton of weed instead of drinking.
    1:28:32 And so it’s very, I think you want to be cautious that you’re not just replacing the thing that you’re trying to change with something that’s also going to cause health problems.
    1:28:36 Now, having dessert once in a while for this, you know, you’re not getting calories from alcohol.
    1:28:43 And having a nice ice cream cone once a week is a way of sort of treating yourself that’s healthier and maybe more aligned with your goals.
    1:28:44 That’s fine.
    1:28:53 I think thinking about these things, actually thinking about alcohol the way we think about dessert, sunbathing, eating processed meats, all of these things have risk and benefit in our lives.
    1:29:01 I think where we’ve gone so wrong with alcohol is this idea that it’s like a health promoting behavior, that you shouldn’t be drinking for your health.
    1:29:02 It’s not going to make you healthier.
    1:29:12 And also, much like many things we do that are not health promoting activities, there are ways of reducing the health harms of that activity so that it’s OK in small amounts in your life.
    1:29:16 I think B2B marketers keep making this mistake.
    1:29:18 They’re chasing volume instead of quality.
    1:29:24 And when you try to be seen by more people instead of the right people, all you’re doing is making noise.
    1:29:26 But that noise rarely shifts the needle.
    1:29:27 And it’s often quite expensive.
    1:29:32 And I know, as there was a time in my career where I kept making this mistake, that many of you will be making it too.
    1:29:37 Eventually, I started posting ads on our show sponsor’s platform, LinkedIn.
    1:29:39 And that’s when things started to change.
    1:29:41 I put that change down to a few critical things.
    1:29:49 One of them being that LinkedIn was then, and still is today, the platform where decision makers go to, not only to think and learn, but also to buy.
    1:29:55 And when you market your business there, you’re putting it right in front of people who actually have the power to say yes.
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    1:30:15 That’s linkedin.com slash diary.
    1:30:25 Just thinking about something we said earlier about how early childhood trauma causes the brain to change and then results in addictive behaviors.
    1:30:39 If I went through an early childhood trauma and my brain has changed because of that, and then I get into, I become addicted to alcohol as a young man, and then I manage to find my way off the alcohol, my brain is still addicted, right?
    1:30:43 My brain still has that addictive sort of predisposition.
    1:30:47 So isn’t it the case that I’ll just end up being addicted to something else that gives me a dopamine hit?
    1:30:52 So it turns out the brain is amazingly plastic, meaning it can change.
    1:30:53 We see that over time.
    1:30:57 So the first thing is even adverse childhood experiences are not a done deal.
    1:30:58 So we talk a lot about ACEs.
    1:31:09 We don’t talk a lot about P.C.E.s or P.C.E., positive childhood experiences, but actually you can reduce the risk that someone develops addiction by increasing the number of positive childhood experiences.
    1:31:11 So take someone who’s experienced some terrible adversity.
    1:31:16 Their parent has died or they have a parent who’s in prison or they have addiction in their family.
    1:31:22 If that kid has one single adult figure that they believe cares about them, that reduces their risk of addiction.
    1:31:28 So there are a lot of positive ways that we can actually change the trajectory, even in the midst of terrible trauma.
    1:31:36 When you think about someone who’s had a substance use disorder, we actually have good data on this, that after five years of recovery, and often that is fits and starts.
    1:31:43 So most people think of, like, this is one fell swoop that you, like, decide to stop drinking, and then success is that you never drink again.
    1:31:46 For most people, what we find is that’s actually, like, a series of steps.
    1:31:55 So I always like to think of progress, not perfection, and not have this kind of all-or-nothing mindset that for many people, they may early on have a month where they go without alcohol.
    1:31:58 And then maybe next time it’s three months, and then maybe it’s a year.
    1:32:03 And these recurrences happen, but ultimately they get to this place where they go into long-term recovery.
    1:32:09 After five years of recovery, a person’s risk of subsequently developing addiction is no higher than the general public.
    1:32:10 So your brain actually does change.
    1:32:12 And we see this on functional imaging.
    1:32:15 We see this in longitudinal studies that follow people over time.
    1:32:21 So you actually can overwhelm those things and get to a place where you don’t have a higher risk than other people.
    1:32:24 Because some people say, I’ve got an addictive personality.
    1:32:24 Yeah.
    1:32:28 They sort of self-label and self-identify as having an addictive personality.
    1:32:31 Sometimes they even reference their brain as being easily addictive.
    1:32:33 Is there truth in that?
    1:32:35 Is it possible to have an addictive personality?
    1:32:38 It’s not so much about personality, but we do respond differently to substances.
    1:32:43 So, you know, take alcohol or opioids, anything.
    1:32:45 People feel differently the first time they ever use it.
    1:32:52 So often if you talk to someone who then develops addiction, they tell you that first time they used the substance, it was like this amazing feeling.
    1:32:58 It felt like I’ve had people describe it as falling in love or, you know, a warm hug or like a relaxing bath.
    1:33:00 These like incredible comforting experiences.
    1:33:03 Other people, they get prescribed like an opioid for a tooth extraction.
    1:33:07 They feel nauseous and kind of like not like themselves, and they don’t like the feeling.
    1:33:13 So how we respond to substances is definitely based on our neurobiology and is different for different people.
    1:33:20 So some people are both from a genetic reason and their own brain are just more wired to be at risk of addiction.
    1:33:23 And that’s important to know about yourself because then you can make different choices.
    1:33:29 You may decide, you know, never to keep alcohol in the house or not to drink because the risk is too great.
    1:33:32 How much do you think about other things that are taking hold of society?
    1:33:35 Some of the other things that are non-substance related.
    1:33:41 So social media addictions and pornography addictions and what else are some of the big ones?
    1:33:41 Food addictions.
    1:33:43 Food, sex, gambling.
    1:33:45 I think there are a lot of similarities.
    1:33:49 It’s not my particular area of focus, but I think there are a lot of overlaps.
    1:33:53 I mean, I think many of the things you just listed, you could talk about one, dopamine, obviously.
    1:34:08 But two, this idea of needing to fill yourself with something else, either, you know, thinking about trauma, thinking about untreated mental illness, thinking about just kind of the deficit of connection and of meaning and reward and reaching to these external solutions.
    1:34:22 Can you tell me about a time where you’ve worked with a patient who, through the process of working with them and understanding their trauma, you discovered something unexpected about the root cause of their addictive behavior?
    1:34:30 Yeah, yeah, I can think of many patients, but one in particular who, you know, I had this, I knew that he’d experienced hard things in his life.
    1:34:33 He’d been in prison, for example, which is a traumatizing experience.
    1:34:35 He’d lost his parents, another thing.
    1:34:50 I never truly understood the depth of his trauma and had, he had struggled his whole life with substance use disorder and using lots of things, mostly opioids, but also alcohol and cocaine and just had had a really, really hard time.
    1:34:56 And after, I mean, years of knowing him, one day he broke down my office and shared that he’d actually been molested as a young kid.
    1:35:05 And so sometimes there is that, like, that thing that people have never felt like they could share with anyone that really is at the root of so much of what they’ve been dealing with.
    1:35:18 And like the person who whispered to you, I think the pain of keeping that inside, not only the trauma of experiencing that as a child, but then holding that secret and feeling like you somehow are damaged or, you know, that this thing inside you is there.
    1:35:26 And not being able to heal it, talk about it, share it with people, I think, is just this, like, this well of pain that lives inside people.
    1:35:26 Did he recover?
    1:35:28 He actually passed away.
    1:35:31 From substance abuse?
    1:35:33 From substance use, yeah.
    1:35:44 You must carry a lot of this stuff with you, because your line of work sounds like you’re dealing with bad news quite often, more so than the average person.
    1:35:47 And the news you’re dealing with is a different type of news.
    1:35:56 You’re dealing with somebody sort of reaching the end of their life through something that you also have said many times you believe is preventable in many cases.
    1:36:00 How do you manage that?
    1:36:03 Yeah, I mean, I think a couple things.
    1:36:08 One, there are so many stories of hope that I think counterbalance that for me.
    1:36:16 So I think, you know, the other stories in my mind are, you know, I carry with me and still care for and are in touch with people who are living these amazing, vibrant lives and recovery.
    1:36:20 And, I mean, in the U.S. alone, there’s 24 million people living in recovery.
    1:36:25 So there are these stories of people who have overcome just trauma, tragedy, hardship, and are doing awesome.
    1:36:27 They’re parenting, they’re working.
    1:36:29 You probably don’t even know they’re around you.
    1:36:31 You know, they don’t tell people necessarily that they’re in recovery.
    1:36:48 And getting to be sort of a part of that process with someone and watching, you know, there’s nothing in medicine where I can actually see as dramatic of a change as with addiction, where someone can be, you know, in a moment where they’re dealing with all of these health consequences and relationship challenges, and then they get better.
    1:36:51 And it’s just like the most beautiful thing to be a part of.
    1:36:55 And so I think the hope from that, the sort of positivity of it is what keeps me going every day.
    1:37:00 Obviously, finding ways to care for myself through that and family and connection, exercise.
    1:37:01 I run, I write.
    1:37:04 You know, you have to keep yourself whole through it all, too.
    1:37:10 But I think I get tremendous purpose and mostly, like, a lot of hope from working with people and seeing them recover.
    1:37:13 What is the most important thing we didn’t talk about that we should have talked about?
    1:37:15 I think one thing is language.
    1:37:17 It’s like this subtle thing.
    1:37:22 I sort of mentioned an example where you did it really well, where instead of saying someone failed treatment, you said the treatment failed them.
    1:37:28 But a lot of the language that we use with addiction actually subtly and not so subtly worsens stigma.
    1:37:34 And sometimes it sounds like I’m being politically correct or it’s like an issue of semantics, but there’s actually really good data on this.
    1:37:38 So if you think about words we use for addiction, one is substance abuse, right?
    1:37:40 So the term abuse, what does abuse refer to?
    1:37:44 So it actually comes from an old English word that means, like, a willful act of misconduct.
    1:37:48 And it’s a word that we use for child abuse, for sexual abuse, for domestic abuse.
    1:37:55 Like, it’s only for these, like, terribly violent acts of commission that are very stigmatized because they’re, like, terrible things.
    1:37:59 And yet we use it for this thing that we’re saying is a health condition, that you’re, like, a substance abuser or you have substance abuse.
    1:38:10 And so there have actually been these elegant studies that took, like, PhD-level psychologists, really highly trained clinicians, and they described a person as either a substance abuser or as a person with a substance use disorder.
    1:38:16 And the clinician was actually more likely to recommend a punitive intervention for the person described as a substance abuser.
    1:38:16 What does that mean?
    1:38:19 So in this case, they were given, like, an option.
    1:38:24 You read this paragraph about, like, a fictional patient, and they don’t really know what the researchers are testing.
    1:38:26 And they’re given a bunch of different options for intervention.
    1:38:30 And one is this, like, send them to drug court or send them to jail.
    1:38:33 One is, like, offer them, you know, outpatient effective treatment.
    1:38:35 There’s a bunch of different choices.
    1:38:40 When they hear someone described as a substance abuser, they’re actually more likely to recommend the, like, jail-based intervention.
    1:38:46 So words actually, like, very – they influence how we think, even how we make clinical decisions.
    1:38:47 They’ve also done this to the public.
    1:38:53 So if you describe someone as a drug addict, the public has a more negative view of them than if you describe them as a person with addiction.
    1:39:01 So there are these subtle ways – there’s been this shift in addiction to really using what we call person-first language, which has been true across medicine.
    1:39:03 So, like, we used to use terrible words.
    1:39:08 Like, we’d refer to someone as, like, the schizophrenic, you know, or really labeling them as their health condition.
    1:39:13 And thankfully, there’s been a change from that to realize that people are people-first who have an illness or not defined by it.
    1:39:17 So I would never say, like, I’m going to go see the lung cancer in room 204.
    1:39:20 I’d say I’m going to see, you know, Mr. Smith who has lung cancer.
    1:39:22 And so with addiction, too, like, people are more than that.
    1:39:27 So to say, you know, person with addiction, person with alcohol use disorder rather than saying they’re an addict or an alcoholic.
    1:39:32 And then even terms like clean and dirty, which are commonly used when we talk about addiction.
    1:39:34 So, you know, take the word clean.
    1:39:35 It sounds really positive.
    1:39:36 Like, you’re saying, oh, you’re clean.
    1:39:37 But, like, what are you really saying?
    1:39:41 So you’re saying, like, if you’re clean now, when you were actively struggling, what were you?
    1:39:42 You were dirty.
    1:39:49 And so I always remember an example, a friend of mine who’s in recovery was interviewing for jobs in the recovery space.
    1:39:53 And so people on the interview trail would say to him, like, how long have you been clean for?
    1:39:55 And he would say, well, I’ve been bathing since I was a newborn.
    1:39:57 So I’ve been clean my whole life.
    1:39:59 And I’ve been in recovery for five years or whatever.
    1:40:05 So I think these little things actually matter that we should use terminology that we’d use for another health condition.
    1:40:15 If we’re labeling, you know, people with active addiction as dirty or, you know, people with addiction as the same as child abusers with that sort of language, we’re really sort of subtly increasing stigma.
    1:40:20 So that’s a small thing that we can all do is just try to use language that’s a bit more humanizing.
    1:40:25 It’s so interesting because I was aware of this, but I still found myself accidentally using the word abuse.
    1:40:25 Yeah.
    1:40:27 And I’d stumble into it.
    1:40:28 I go, fuck it, I’ll see you mentioned.
    1:40:31 I tried to avoid the use of the word addict.
    1:40:37 Yeah, it’s hard to change, but, you know, like everything, you just want to be humble, curious, and keep trying.
    1:40:39 I mean, there’s lots of language that we’ve changed.
    1:40:49 Like, think about so many terms we use for, you know, for, you know, people who are born with different abilities or for people of different races or other identities that we’re really stigmatizing.
    1:40:53 And we’ve, like, learned to use different language, even if it feels a little awkward when you’re first learning it.
    1:40:58 I think understanding the science and the data behind the impact it has to use certain language, I think, is really useful.
    1:40:59 Yeah.
    1:41:04 Because that’s helped me to understand, just because now I understand the first principles of it, I need to make sure I describe people as a person first.
    1:41:04 Yeah.
    1:41:09 So a person with addiction is much better than calling someone an addict.
    1:41:10 Yeah, exactly.
    1:41:13 And one thing people ask me, we’ll say, well, what if someone refers to themselves that way?
    1:41:15 Because people may do that.
    1:41:17 And that’s fine.
    1:41:19 People can use whatever language they want for themselves.
    1:41:26 But I think as a healthcare professional, for sure, or someone who’s trying to help combat stigma, like, we can choose to use different language.
    1:41:31 And I’ve actually had patients sort of ask me, like, well, why do you use that terminology when they use a different language?
    1:41:35 And it actually can be sort of empowering to be like, oh, yeah, I’m actually a person in recovery.
    1:41:37 I’m a person with addiction.
    1:41:47 Something I’ve been really curious about just in my life generally, because in conversation, I’ll often, I said something yesterday when we were at dinner with the team here.
    1:42:00 I said, I can’t remember the exact phrase, but it was words to the effect of, I’m not good at that, or I’m not that type of person, or I’m not organized.
    1:42:04 And I stopped myself, and the team will remember, and I go, actually, I shouldn’t say that.
    1:42:08 I should say, right now, what sort of…
    1:42:13 You’re, like, defining yourself as incapable of doing something instead of being like, I’m working on organization right now.
    1:42:29 Yeah, I think it’s so important, and we don’t think about it, how casually we create an identity for ourself that is, like, fundamentally limiting, or puts us in a box, or frames us as having a deficit, or captures our whole identity in some kind of deficiency we have, often in the case of the habits I’m referring to.
    1:42:34 Does a similar thing take effect when we’re talking about calling someone an addict?
    1:42:38 Yeah, you’re sort of labeling them as that it’s the only thing that they are, and that they will be that forever.
    1:42:43 And, you know, a friend of mine is a journalist who is in recovery and writes a lot about addiction.
    1:42:57 Maya Solovitz wrote this great New York Times piece that addiction doesn’t always last a lifetime, because I think there’s this idea in our head that, like, you know, people with addiction will always have addiction, and it’s this, like, incurable thing, and that actually people have lots of different journeys.
    1:43:02 And for some people, you know, that becomes something they deal with, and then they move on in their lives.
    1:43:13 For other people, it’s something that they actively manage, but this idea that you sort of boil things down to, like, the only thing I am in this world as a person with addiction, you really limit everything else about yourself.
    1:43:19 We have a closing tradition on this podcast where the last guest leaves a question for the next, not knowing who they’re going to be leaving it for.
    1:43:33 So, and the question that’s been left for you is, if you could redo or revise one thing that you have successfully accomplished, what would that be and why?
    1:43:46 I guess I would say, and I could think of lots of successful accomplishments I’d apply this to, but I’ll take the example of medical training, which is a successful accomplishment.
    1:43:53 I think I would be more present that we are always, like, rushing to the accomplishment, to the finish line, to sort of getting to the next goal.
    1:43:59 And I think back and wish I had realized what an amazing journey it was in that moment.
    1:44:11 And, I mean, even things with medical training that I was never going to be a heart surgeon, but to stand in an operating room and look inside someone’s chest and watch a beating heart is an experience that I’ll never get again.
    1:44:18 And I think in this journey to always achieve and move forward and get to the next exam and the next thing, we sometimes miss, like, the miracle that’s right in front of us.
    1:44:21 And so I think I would have been even more present.
    1:44:24 That applies to all of us.
    1:44:26 I felt like I was being called out.
    1:44:31 True for parenting, true for everything.
    1:44:33 Thank you so much.
    1:44:40 I’m so grateful for the work that you’re doing because there’s so much conflicting information, especially as it relates to alcohol.
    1:44:46 There’s been so much information over the last five, ten years about the impact alcohol has on us.
    1:44:53 And I’ve sat here and had conversations with people who are pretty convinced that even, you know, moderate levels of alcohol are good for us.
    1:44:57 And having read your work, I’m now clear on what the truth there is.
    1:44:59 Thank you for doing what you do.
    1:45:00 It’s incredibly important.
    1:45:17 And I actually think it’s going to become increasingly important, unfortunately, because the way that the world is heading, the loneliness epidemic that we’re experiencing and the access we now have to digital devices and to low cost consumption of addictive substances is terrifying for me.
    1:45:21 I know you’ve got a book on the way, which I’m extremely excited about, which is due in autumn.
    1:45:21 Next autumn?
    1:45:22 Spring of 27.
    1:45:23 So we have some time.
    1:45:24 Okay.
    1:45:25 And what’s that book about?
    1:45:26 Can you give me a clue?
    1:45:27 I’m going to guess.
    1:45:43 It is going to be about changing the narrative around addiction and about really reframing how people think about it, to see it as a treatable, good prognosis illness, and using some of the stories of people I’ve had the privilege of knowing to hopefully help people see things in a different way.
    1:45:46 Where do people find you if they want to reach out or learn more?
    1:45:47 Yes.
    1:45:50 They can find me on LinkedIn, on Instagram.
    1:45:51 They can email me.
    1:45:52 Yeah.
    1:45:55 Happy to connect and would love to come back after the book is out, too.
    1:45:56 I look forward to that.
    1:45:57 I’d love to.
    1:46:00 So your Instagram, your LinkedIn, I’ll put those details below.
    1:46:11 I’m sure you’ll probably get a lot of messages because these issues in particular are incredibly potent issues in people’s lives and very emotional issues as well.
    1:46:15 So thank you for, on behalf of all my audience, thank you for your generosity today, but also thank you for your wisdom.
    1:46:16 Really, really appreciate it.
    1:46:18 And I would love to speak to you again soon when the book is out.
    1:46:19 Thank you.
    1:46:20 Thank you for having me.
    1:46:35 I find it incredibly fascinating that when we look at the back end of Spotify and Apple and our audio channels, the majority of people that watch this podcast haven’t yet hit the follow button or the subscribe button wherever you’re listening to this.
    1:46:37 I would like to make a deal with you.
    1:46:44 If you could do me a huge favor and hit that subscribe button, I will work tirelessly from now until forever to make the show better and better and better and better.
    1:46:47 I can’t tell you how much it helps when you hit that subscribe button.
    1:46:54 The show gets bigger, which means we can expand the production, bring in all the guests you want to see and continue to doing this thing we love.
    1:46:58 If you could do me that small favor and hit the follow button, wherever you’re listening to this, that would mean the world to me.
    1:47:00 That is the only favor I will ever ask you.
    1:47:01 Thank you so much for your time.
    1:47:26 I’ll see you next time.
    Lượng rượu cần thiết để bắt đầu gây ra các vấn đề sức khỏe thực sự thấp hơn nhiều so với những gì bạn nghĩ.
    Vậy nếu tôi uống một ly rượu vang mỗi ngày…
    Bạn sẽ nằm trong cái mà chúng tôi gọi là rủi ro vừa phải, điều này liên quan đến hầu như mọi loại ung thư.
    Giả sử tôi uống…
    Nếu bạn uống hai ly rượu đó, chúng ta đang nói đến việc tăng khoảng 40%.
    Nhưng ngay cả khi uống lượng đó, nguy cơ mắc ung thư vú của bạn cũng sẽ tăng khoảng 5%.
    Lượng này?
    Ừm-hm.
    Điều này, với nhiều người, là rất bình thường.
    Nên có rất nhiều thông tin sai lệch về việc bạn nên uống bao nhiêu, điều mà tôi nghĩ là mọi người không biết.
    Nhưng tôi có thể hướng dẫn bạn mọi thứ, vì vậy…
    Bác sĩ Sarah Wakeman là giáo sư tại Harvard và là chuyên gia về nghiện thuốc.
    Dẫn đầu cuộc chiến chống lại một trong những cuộc khủng hoảng sức khỏe cộng đồng lớn nhất của thời đại chúng ta.
    Nghiện.
    Mang lại sự thật, sự đồng cảm và những sự thật mà chúng tôi đã phải nỗ lực để có được.
    Một trên ba người có thể gặp vấn đề với rượu vào một thời điểm nào đó trong cuộc sống.
    Và trên toàn cầu, 2,6 triệu người mỗi năm chết vì các nguyên nhân liên quan đến rượu, vì hầu như mọi cơ quan trong cơ thể đều bị ảnh hưởng bởi nó.
    Bạn có thể thấy ở đây, đây là một người 43 tuổi mà não của họ trông giống như não của một người 90 tuổi bị mất trí nhớ do tổn thương não theo thời gian từ việc sử dụng rượu.
    Nhưng điều gì khiến mọi người sử dụng chất kích thích?
    Có lẽ đó là câu hỏi quan trọng nhất.
    Nếu chúng ta xem xét các nghiên cứu, một trong số đó khoảng 40% đến 60% là di truyền.
    Và nửa còn lại của phương trình là chấn thương.
    Và khi bạn nghe ai đó nói rằng rượu giúp họ giảm đau, bất kể đó là đau về mặt cảm xúc hay thể chất, đó là một điều rất thực tế.
    Điều đó là vì hệ thống giảm đau tự nhiên của bạn được kích hoạt khi uống rượu.
    Nó là một loại thuốc giảm lo âu và giảm đau, tất cả trong một.
    Vì vậy, khi bạn nghĩ về cách chúng tôi điều trị nghiện, chúng tôi đã sai ở đâu?
    Vấn đề lớn nhất là mọi người chưa được cung cấp bằng chứng và công cụ để hiểu về nghiện.
    Nhưng cũng có nhiều cơ sở cai nghiện không cung cấp những thứ mà chúng tôi biết là thực sự hiệu quả.
    Và mọi người cần gì?
    Đó là câu hỏi tuyệt vời.
    Một trong những công cụ hiệu quả nhất mà chúng tôi dạy mọi người là một cái gì đó gọi là…
    Và họ đã phát hiện ra rằng mọi người uống ít hơn nhiều sau khi làm điều đó.
    Wow.
    Tôi thấy thật thú vị khi nhìn vào số liệu thống kê phía sau của Spotify và Apple và các kênh âm thanh của chúng tôi,
    hầu hết mọi người xem podcast này vẫn chưa nhấn nút theo dõi hoặc nút đăng ký, bất kể bạn đang nghe điều này ở đâu.
    Tôi muốn đề nghị một thỏa thuận với bạn.
    Nếu bạn có thể làm cho tôi một ân huệ lớn và nhấn nút đăng ký đó, tôi sẽ làm việc không mệt mỏi từ giờ cho đến mãi mãi để làm cho chương trình tốt hơn và tốt hơn và tốt hơn nữa.
    Tôi không thể nói với bạn rằng việc bạn nhấn nút đăng ký đó giúp ích nhiều như thế nào.
    Chương trình ngày càng lớn, điều này có nghĩa là chúng tôi có thể mở rộng sản xuất, mời tất cả những vị khách bạn muốn gặp và tiếp tục làm những điều mà chúng tôi yêu thích.
    Nếu bạn có thể làm cho tôi một ân huệ nhỏ đó và nhấn nút theo dõi, bất kể bạn đang nghe điều này ở đâu, điều đó sẽ có ý nghĩa rất lớn đối với tôi.
    Đó là ân huệ duy nhất mà tôi sẽ từng yêu cầu bạn.
    Cảm ơn bạn rất nhiều vì thời gian của bạn.
    Bác sĩ Sarah Wakeman, với tất cả công việc mà bạn đang làm, mục tiêu của bạn là gì?
    Mục tiêu của tôi thực sự là thay đổi cách mọi người suy nghĩ về và hiểu các vấn đề liên quan đến rượu và thuốc, và cũng để cung cấp cho mọi người bằng chứng và sự thật, cả để hiểu về nghiện, đó là những vấn đề liên quan đến việc sử dụng rượu và thuốc, nhưng cũng để hiểu về khoa học xung quanh, chẳng hạn như nên uống bao nhiêu?
    Uống có tốt cho sức khỏe không? Hay là không tốt cho sức khỏe?
    Có rất nhiều thông tin sai lệch ngoài kia, và tôi muốn cung cấp cho mọi người các công cụ để đưa ra quyết định đúng đắn cho họ trong cuộc sống của họ.
    Và bạn là ai và kinh nghiệm cũng như trình độ học vấn của bạn ra sao?
    Tôi là bác sĩ y học theo đào tạo, vì vậy tôi vẫn làm một số công việc y tế tổng quát, như trong bệnh viện, chăm sóc bệnh viêm phổi và suy tim, và trong môi trường ngoại trú, chăm sóc bệnh tiểu đường và trầm cảm của mọi người.
    Nhưng tôi chuyên đào tạo về y học nghiện, vì vậy tôi được chứng nhận về y học nghiện, và đó là công việc cả cuộc đời tôi.
    Tôi làm việc tại một trung tâm y tế học thuật lớn ở Boston, Massachusetts, nơi mà tôi sẽ nói rằng trọng tâm nghề nghiệp của tôi là suy nghĩ về cách chúng ta đưa chăm sóc nghiện trở lại vào hệ thống y tế để không trở thành một hệ thống tách biệt và bất bình đẳng, và thường rất kém hiệu quả, nhưng thực sự chỉ là một phần của dịch vụ chăm sóc sức khỏe mà mọi người nhận được.
    Và sau đó tôi đào tạo mọi người, vì vậy tôi là giám đốc chương trình đào tạo chuyên khoa của chúng tôi, vì vậy tôi đào tạo các bác sĩ muốn trở thành chuyên gia trong y học nghiện.
    Khi bạn nghĩ về cách chúng tôi điều trị nghiện trong thế giới hiện đại, có những điều gì bạn không hài lòng?
    Chúng tôi đã sai ở đâu?
    Ôi, chúng ta có bao nhiêu thời gian?
    Tôi cảm thấy trong năm qua.
    Chúng ta bắt đầu từ đâu?
    Ý tôi là, tôi nghĩ vấn đề lớn nhất là chúng ta đã được dạy và cảm nhận trong ý tưởng rằng nghiện là một vấn đề về hành vi xấu, rằng đó là một vấn đề về đạo đức, rằng mọi người thực sự cần phải kiểm soát bản thân và tự đứng lên từ khó khăn, và rằng đây giống như một vấn đề pháp lý hình sự, rằng đây là một vấn đề về sức mạnh ý chí.
    Vì vậy, nếu bạn tin vào những điều đó, thì tại sao bạn nghĩ rằng ai đó nên nhận được sự chăm sóc y tế?
    Hoặc tại sao bạn lại đối xử với họ bằng lòng thương cảm và sự tử tế nếu bạn cho rằng họ đang làm một việc sai trái?
    Cách thực sự thay đổi cách chúng ta suy nghĩ về nghiện dựa trên tất cả dữ liệu khoa học mà chúng tôi có và những gì điều trị hiệu quả trông như thế nào, điều này thường rất khác so với những gì mọi người có thể đã trải nghiệm nếu họ cố gắng tiếp cận chăm sóc cho bản thân hoặc một người thân yêu.
    Và nghiện là gì?
    Điều gì nằm trong định nghĩa của nghiện?
    Bạn biết đấy, vì tôi sử dụng iPad của mình rất nhiều.
    Tôi sử dụng điện thoại của mình rất nhiều.
    Điều đó có phải là nghiện không?
    Vâng, đó là một câu hỏi hay vì chúng ta thường sử dụng thuật ngữ đó một cách thông tục.
    Bạn biết đấy, tôi bị nghiện Netflix hay bất cứ điều gì.
    Vì vậy, nghiện thực sự được định nghĩa là việc sử dụng bất chấp hậu quả.
    Tiếp tục làm một điều gì đó trong cuộc sống của bạn mặc dù có những điều xấu xảy ra với bạn vì điều đó. Vì vậy, chúng ta nói về nghiện, chúng ta nói về bốn C như là một cách để ghi nhớ nó. Một C là mất kiểm soát, có nghĩa là bạn đã cố gắng thay đổi nhưng không thể. Bạn đã cố gắng giảm bớt hoặc đã cố gắng dừng lại nhưng không thể. Còn lại là việc sử dụng cưỡng chế. Việc sử dụng của bạn như tăng vọt ra khỏi kiểm soát, bạn đang sử dụng theo cách mà không thực sự kết nối với suy nghĩ hợp lý của mình. Cái tiếp theo là hậu quả. Vì vậy, tiếp tục sử dụng mặc dù có những hậu quả tiêu cực trong cuộc sống của bạn, công việc của bạn, các mối quan hệ của bạn, sức khỏe của bạn. Và C cuối cùng là cơn thèm thuốc, đây là sự thôi thúc tâm lý mạnh mẽ muốn sử dụng. Như bạn không thể gạt ý định uống một ly ra khỏi đầu. Và vì vậy, thực sự có bốn C mà chúng ta nghĩ đến. Sau đó, chúng ta định nghĩa dựa trên số lượng tiêu chuẩn mà mọi người đáp ứng trong danh sách 11 tiêu chí khác nhau này. Và dựa trên điều đó, mọi người có thể gặp rối loạn sử dụng nhẹ, trung bình hoặc nặng. Và vì vậy, trung bình, nặng thực sự là những gì chúng tôi coi là nghiện. Nhưng đó là việc sử dụng mặc dù có những điều xấu xảy ra với bạn. Và những điều nào có khả năng gây nghiện? Có rất nhiều thứ. Ý tôi là, tôi chủ yếu tập trung vào rượu và ma túy. Vì vậy, rượu, rõ ràng, có lẽ là phổ biến nhất. Tôi nghĩ chúng ta sẽ nói về điều đó nhiều hôm nay, điều mà tôi rất hào hứng. Và chắc chắn khi chúng ta nhìn trên toàn cầu, có 400 triệu người có rối loạn sử dụng rượu, có nghĩa là nghiện rượu. Đó là rất nhiều người. Còn ma túy thì sao? Có thể là opioid như heroin hoặc thuốc giảm đau hoặc fentanyl. Nó có thể là cocaine hoặc các chất kích thích như methamphetamine hoặc các chất kích thích theo toa, thuốc an thần mà mọi người có thể dùng cho lo âu như benzodiazepines, cần sa. Và vì vậy có một loạt các chất có thể gây nghiện. Và mức độ gây nghiện của một chất liên quan đến cách mà dopamine được giải phóng trong não. Tôi biết bạn đã có một tập phim tuyệt vời với Tiến sĩ Lemke về dopamine. Vì vậy, bạn đã nói về điều đó một chút. Và có các chỉ số gây nghiện khác nhau của các chất khác nhau. Vì vậy, cần sa ít gây nghiện hơn methamphetamine, chẳng hạn. Nhưng tất cả những chất đó đều có thể gây nghiện cho mọi người. Ngay cả hơn thế, đôi khi tôi tự hỏi trong cuộc sống của mình nếu tôi nghiện những thứ khác như, ý tôi là, tôi uống cà phê mỗi ngày. Chắc chắn tôi có cơn thèm để uống nó ngay bây giờ. Vâng. Vậy có một vài yếu tố quan trọng ở đó. Việc uống cà phê của bạn có gây hại cho cuộc sống của bạn theo cách nào không? Không. Tôi nghĩ nó hữu ích. Nó có thể đang giúp bạn, đúng không? Được rồi, vậy nó không phải. Vâng, vậy nó không phải là nghiện. Vì vậy, có sự khác biệt giữa sự phụ thuộc sinh lý, có nghĩa là nếu bạn không uống tách cà phê của mình, bạn sẽ bị đau đầu. Và nghiện, có nghĩa là bạn đang dành cả ngày và toàn bộ tiền bạc của mình để mua thêm nhiều cà phê. Chúng tôi không thực sự thấy điều này. Nhưng việc mua thêm nhiều cà phê mặc dù, bạn biết đấy, bạn gái của bạn cứ nhắc nhở bạn về điều đó và bạn muộn làm vì bạn đang mua cà phê. Chúng tôi không thực sự thấy điều đó nhiều với cà phê. Nhưng điều đó sẽ là một dạng nghiện. Và vấn đề lớn như thế nào? Nếu bạn định hình, như, tại sao chúng ta nên quan tâm? Tại sao người nghe điều này nên quan tâm? Bởi vì tôi tưởng tượng rằng nhiều người ở đây không có một nghiện nào phù hợp vào loại có hậu quả nặng nề cho cuộc sống của họ. Tôi cũng tưởng tượng rằng một số người có thể nghĩ rằng nghiện là điều gì đó xảy ra với những người khác. Vâng. Vậy bạn có thể định hình tình huống cho tôi và giải thích cho tôi tại sao tất cả chúng ta nên quan tâm về điều này và tôi đoán là quy mô ảnh hưởng mà nó gây ra? Vâng, tôi bảo đảm với bạn rằng rất nhiều người nghe đã bị ảnh hưởng bởi nghiện, dù là cá nhân hay trong cuộc sống của họ. Vì sự kỳ thị, chúng ta thường không nói về điều đó. Nhưng quy mô thì rất lớn. Vì vậy, trên toàn cầu, 2,6 triệu người mỗi năm chết vì các nguyên nhân liên quan đến rượu. Vì vậy, có 7.000 người hôm nay sẽ chết vì cái chết liên quan đến rượu. Một 600.000 người khác chết vì cái chết liên quan đến ma túy hàng năm. Vì vậy, đó là khoảng 1.600 cái chết hôm nay do nguyên nhân liên quan đến ma túy. Và sau đó khi chúng ta nhìn vào các tiêu chí đáp ứng cho rối loạn sử dụng chất hoặc nghiện, có khoảng 400 triệu người trên toàn cầu cho rượu và 80 triệu người cho ma túy. Vì vậy, nó cực kỳ phổ biến. Nếu bạn nghĩ về rượu, một số nghiên cứu ước lượng rằng tỷ lệ mắc phải trong suốt cuộc đời, có nghĩa là trong suốt cuộc đời bạn, khả năng bạn phát triển nghiện rượu ở một thời điểm nào đó, dao động giữa 15% và 30% trong một số nghiên cứu. Vì vậy, một trong ba người có thể gặp vấn đề với rượu tại một thời điểm nào đó trong cuộc đời của họ. Vì vậy, điều này ảnh hưởng đến tất cả chúng ta. Chúng ta chỉ không nói về nó vì sự kỳ thị và vì những hình ảnh tâm lý về việc khác biệt hóa rằng, bạn biết đấy, chỉ có những người đó đang tiêm heroin mới có nghiện hoặc người đó, bạn biết đấy, có triệu chứng run rẩy mỗi sáng và uống ngay khi họ thức dậy mới có vấn đề với rượu. Cuộc sống xã hội của chúng ta đang đi theo hướng nào? Chúng ta có đang trở nên tốt hơn hay đang ngày càng nghiện hơn? Vâng, câu hỏi tuyệt vời. Đại dịch đã không có lợi cho nghiện. Vì vậy, chúng ta đã thấy tỷ lệ sử dụng rượu và ma túy và cái chết liên quan đến chúng tăng đáng kể sau khi bắt đầu đại dịch COVID. Điều đó đã bắt đầu ổn định. Vì vậy, đối với cái chết liên quan đến sử dụng ma túy, chúng ta hiện đã trở lại mức trước đại dịch, nhưng đã có một sự gia tăng rất đáng kể trong thời gian đại dịch. Và điều đó thực sự không có gì ngạc nhiên khi chúng ta nghĩ về những điều gì đã khiến mọi người sử dụng rượu hoặc ma túy một cách có vấn đề. Tôi đã nhìn vào một số biểu đồ về tuổi thọ và biểu đồ này mà tôi thấy khá sốc. Tôi sẽ đưa nó lên màn hình. Nhưng nó cho thấy rằng rõ ràng, bạn biết đấy, chúng ta sẽ mong đợi rằng sẽ có một sự giảm sút về tuổi thọ trong thời gian đại dịch.
    Nhưng ngay cả khi so sánh với các quốc gia khác, sự khác biệt cũng không đáng kể. Vậy tôi tự hỏi, theo bạn, tại sao lại có sự sụt giảm rõ rệt về tuổi thọ trong thời kỳ đại dịch? Vâng. Rõ ràng, COVID là một trong những nguyên nhân. Một trong những nguyên nhân chính khác là tỷ lệ tử vong liên quan đến chất kích thích. Thực tế, ngay sau khi đại dịch bắt đầu, vào khoảng tháng 3 và tháng 4 năm 2020, chúng tôi đã thấy tỷ lệ tử vong liên quan đến rượu gia tăng 23%. Và chúng tôi đã thấy tỷ lệ tử vong do quá liều ma túy cao nhất từ trước đến nay. Điều này thực sự đã ảnh hưởng đến tuổi thọ của Mỹ cho đến năm nay. Đây là năm đầu tiên chúng ta thấy sự thay đổi đó. Cốt lõi của những gì thực sự đang diễn ra ở đây là, bạn biết đấy, nghiện là hệ quả từ một điều gì khác. Vậy thực sự có điều gì đang xảy ra? Vâng, đó là một câu hỏi rất hay. Như vậy, điều gì khiến mọi người sử dụng chất kích thích? Thực sự có thể đó là câu hỏi quan trọng nhất, ngay cả trong công việc của tôi. Bạn biết đấy, nếu bạn không hiểu về việc sử dụng chất kích thích của một người và nó liên quan đến điều gì, thì bạn sẽ chữa trị nó bằng cách nào hay giúp họ giải quyết nó ra sao? Vì vậy, chấn thương có lẽ là động lực lớn nhất. Bạn biết đấy, bạn thường nghe rằng cần sa được coi là chất gây nghiện đầu tiên. Tôi sẽ nói rằng chấn thương chính là chất gây nghiện đầu tiên. Nếu chúng ta nhìn vào rất nhiều nghiên cứu, có hai điều khác nhau gây ra nguy cơ nghiện của một người. Một là di truyền. Khoảng 40% đến 60% là di truyền, tương tự như nguy cơ mắc bệnh tiểu đường. Điều đó rõ ràng không phải là một điều đã xong. Có những người có nguy cơ di truyền mạnh nhưng không bao giờ phát triển nghiện, và những người không có mà vẫn mắc phải. Nửa còn lại của phương trình dựa trên loại hình trải nghiệm và kinh nghiệm mà bạn phải trải qua. Và một trong những động lực số một chính là những trải nghiệm khó khăn trong thời thơ ấu. Có một nghiên cứu nổi tiếng gọi là nghiên cứu ACEs, viết tắt của trải nghiệm khó khăn thời thơ ấu, và nó đã được nhân rộng. Có một nghiên cứu gần đây được thực hiện ở châu Âu cũng xem xét số lượng trải nghiệm khó khăn thời thơ ấu mà bạn có, và có mối liên hệ tỷ lệ thuận với nguy cơ mắc rối loạn sử dụng chất kích thích của bạn. Nếu bạn nghĩ về những gì xảy ra trong não bộ khi sử dụng chất kích thích, bạn biết đấy, khi chúng ta sử dụng rượu hoặc ma túy, rất nhiều hormone mang lại cảm giác tốt được tiết ra, đúng không? Dopamine, hệ thống opioid nội sinh của bạn, mà thực sự là thuốc giảm đau tự nhiên của bạn. Và nếu bạn lấy một người đã trải qua chấn thương, thì việc tìm thấy sự nhẹ nhõm trong việc sử dụng chất kích thích là rất lớn. Và chúng ta đã thấy điều đó trong thời kỳ đại dịch, như những gì đã xảy ra trong đại dịch. Mọi người đều bị sợ hãi. Họ buồn chán. Họ cảm thấy cô đơn. Họ bị mắc kẹt ở nhà. Họ không có thói quen hàng ngày như bình thường. Một số người đang mất đi những người họ yêu thương. Vì vậy, chúng ta đã thấy tất cả sự gia tăng việc sử dụng chất kích thích, và điều này thực sự nổi bật nhất ở những người làm việc ở tuyến đầu. Điều đó có thể là một nhà cung cấp dịch vụ chăm sóc sức khỏe. Nó cũng có thể là một người làm việc trong cửa hàng tạp hóa hoặc cửa hàng tiện lợi, những người phải làm việc trong những thời điểm đáng sợ nhất của đại dịch, và cũng là những người chăm sóc người khác. Vì vậy, đó là hai nhóm có sự gia tăng lớn nhất trong việc sử dụng chất kích thích trong thời kỳ đại dịch. Vậy điều gì đang xảy ra trong não bộ? Bạn đã đề cập đến một chút ở đó. Bạn đã đề cập rằng dopamine khiến bạn cảm thấy tốt. Vì vậy, bạn biết đấy, một cách rất ngây thơ, tôi sẽ giả định rằng nếu bạn cảm thấy không tốt, dopamine sẽ khiến bạn cảm thấy tốt hơn. Bạn muốn có nhiều dopamine hơn. Nhưng có phải nó phức tạp và tinh vi hơn thế không? Vâng, thật vậy, rượu là một trong những thứ phức tạp vì rượu có nhiều ảnh hưởng khác nhau đến não bộ. Vì vậy, bất kỳ loại thuốc hoặc chất nào có thể gây nghiện đều sẽ giải phóng dopamine. Đó là động lực chính của nhiều thứ mà chúng ta thấy có giá trị, bất kể đó là tình dục hay thực phẩm hay rượu hay ma túy. Nhưng rượu cũng vậy, nó liên kết với một phần của não bộ của chúng ta, một hệ thống gọi là GABA, mà là hệ thống chống lo âu của chúng ta. Đó cũng là hệ thống mà các loại thuốc chống lo âu như bạn có thể đã nghe đến như Ativan hoặc lorazepam hoặc Xanax, các loại thuốc này về cơ bản là thuốc an thần và thuốc chống lo âu. Rượu hoạt động trên phần đó của não bộ. Và nó thực sự kích thích việc giải phóng các opioid nội sinh trong não của bạn, giống như những loại thuốc giảm đau tự nhiên của não bạn. Vì vậy, đó thực sự là lý do tại sao một trong những loại thuốc hiệu quả trong việc giúp mọi người ngừng uống rượu thực sự chỉ chặn phản ứng opioid trong não, điều này có thể không hợp lý khi bạn lần đầu nghe về nó. Cho đến khi bạn hiểu các cơ chế thần kinh này, rằng thực sự hệ thống giảm đau tự nhiên của bạn được kích hoạt khi uống rượu. Vì vậy, khi bạn nghe ai đó nói rằng rượu mang lại cho họ cảm giác giảm đau, dù đó là tinh thần hay thể chất, đó là một điều rất thực. Đó là một hệ thống mạnh mẽ trong não bộ của chúng ta được kích hoạt khi bạn uống rượu. À, được rồi. Vậy nếu tôi đang trải qua một thời gian căng thẳng tại nơi làm việc và công việc khiến tôi lo âu và bị tê liệt, thì tôi có khả năng cao hơn để muốn có một buổi tiệc tùng vào cuối tuần vì đó thực sự là một loại thuốc giảm đau. Hoàn toàn đúng. Nó là một loại thuốc giảm lo âu và giảm đau, gần như là tất cả trong một. Và tôi nghĩ thường thì đây là một phần trong lĩnh vực mà tôi nghĩ rằng việc nâng cao nhận thức và giáo dục về rượu là rất quan trọng vì chúng ta thấy rằng đó là một cách để tự điều trị bản thân phải không? Và thật dễ dàng để điều đó trở nên mất kiểm soát. Và tôi nghĩ đặc biệt nếu trong đầu bạn nghĩ, miễn là tôi không uống rượu vào buổi sáng hoặc không nghỉ làm vì uống rượu hoặc, bạn biết đấy, không gặp vấn đề trong các mối quan hệ của mình, thì tôi ổn. Nhưng thực tế có rất nhiều vấn đề sức khỏe và thậm chí cả vấn đề cuộc sống liên quan đến rượu mà mọi người có thể đưa ra những quyết định khác cho chính mình nếu họ có nhận thức đó sớm hơn. Bạn biết đấy, tôi đã nghĩ đến một người bạn của tôi, người khá nổi tiếng, đã qua đời vì những vấn đề liên quan đến nghiện. Anh ấy đã chịu rất nhiều áp lực khi còn khá trẻ. Anh ấy không nhất thiết là một đứa trẻ nhỏ khi bị đặt nhiều áp lực, nhưng anh ấy còn trẻ.
    Và tôi đang tự hỏi, như bạn đã nói, những trải nghiệm thời thơ ấu, độ tuổi đó là bao nhiêu. Có phải có một độ tuổi nhất định mà những trải nghiệm đó, bạn biết đấy, nếu bạn trải qua một mức độ chấn thương nhất định ở một độ tuổi nhất định, thì sẽ khó khăn hơn để hồi phục và bạn có khả năng cao hơn bị nghiện không? Vâng, đó là một câu hỏi tuyệt vời. Chấn thương ở bất kỳ thời điểm nào cũng có thể đặt bạn vào rủi ro bị nghiện. Càng xảy ra sớm thì tác động của nó càng kéo dài. Khi chúng ta nghĩ về não bộ, bạn biết đấy, não của bạn thực sự không phát triển hoàn toàn cho đến đầu hoặc giữa những năm 20 tuổi. Vì vậy, cả về mặt chấn thương và cả về việc tiếp xúc sớm với chất kích thích, bạn có nguy cơ cao hơn khi bạn còn trẻ. Nhưng điều đó không có nghĩa là chấn thương ở giai đoạn sau trong cuộc đời không đặt bạn vào rủi ro phát triển tình trạng nghiện các chất cũng vậy. Tôi đã thấy mọi người mà, bạn biết đấy, chấn thương đầu tiên của họ xảy ra khi họ ở độ tuổi 20, 30 hoặc 40 và họ vẫn có thể phát triển rối loạn sử dụng chất. Chỉ là rủi ro càng lớn hơn khi bạn trải qua những khó khăn đó khi còn là một đứa trẻ. Và điều thú vị là, bạn biết đấy, chấn thương không chỉ đơn thuần là trải nghiệm. Nó thường là việc bị bỏ lại một mình để vật lộn với trải nghiệm đó. Và vậy nên điều gì đó gây chấn thương cho một người thì có thể không gây chấn thương cho người khác. Lấy ví dụ về đại dịch. Tôi đã trò chuyện với những người mà, như, việc bị mắc kẹt ở nhà một mình và cảm thấy chán ngắt đã gây ra chấn thương sâu sắc. Những người khác thì không sao cả. Họ, như, ở trong phòng khách của mình, bạn biết đấy, làm bất cứ việc gì và tìm cách kết nối và sống cuộc sống của họ và ổn thôi. Đó là một trải nghiệm giống nhau, nhưng được trải nghiệm rất khác nhau bởi những người khác nhau. Vì vậy, nó ít hơn về trải nghiệm thực tế và nhiều hơn về tác động lên con người đó, cảm giác mà họ để lại. Và thường là cảm giác bị ngắt kết nối. Chúng ta thường nói rằng điều trái ngược với nghiện không phải là sự tỉnh táo. Thực tế, đó là sự kết nối. Đó là làm thế nào bạn xây dựng lại kết nối với những người khác. Người bạn mà tôi đang nhắc đến là Liam Payne, người từ One Direction, ban nhạc đã qua đời. Anh ấy đã tham gia podcast của tôi vài năm trước khi qua đời. Và trong chương trình, anh ấy nói rằng nhiều điều đã làm cho cuộc sống đầu đời của anh ấy trở nên khó khăn khi còn là một thiếu niên là vì anh ấy rõ ràng bị cuốn vào một chương trình lớn. Và sau đó cách hoạt động là, bạn biết đấy, bạn có tất cả ánh đèn công khai. Và sau đó họ lại đưa anh ấy lên một sân khấu và anh ấy đứng trước 100.000 người ở Dubai. Và sau đó, sau trải nghiệm đó, anh ấy được đưa trở lại một phòng khách sạn và bị khóa trong đó. Bởi vì rõ ràng là bạn không thể ra ngoài vì bạn nổi tiếng đến mức nếu bạn bước ra đường, đám đông sẽ xuất hiện. Vì vậy, anh ấy bị khóa trong phòng khách sạn đó. Và trong chương trình, anh ấy nói, tôi bị khóa ở đó với minibar, nơi có đầy rượu. Vì vậy, tôi sẽ uống. Và vòng lặp đó sẽ lặp lại. Và anh ấy sẽ như, sân khấu, bạn biết đấy, xe, khách sạn, bị khóa, uống, sân khấu, xe. Và vòng lặp đó đã lặp lại. Vì vậy, khi bạn đang nói về sự cô lập và cô đơn, tôi chưa bao giờ thực sự xem xét thực tế rằng sự kết nối và các mối quan hệ xã hội có thể đóng vai trò trong việc tạo ra một người nghiện. Nhưng nó cũng đúng. Hoàn toàn. Ý tôi là, nó làm tôi nghĩ đến một bệnh nhân mà tôi đã gặp tuần này, người thực sự muốn ngừng uống và có thể đi được vài tuần. Nhưng cuộc sống của anh ấy khá trống rỗng. Như, anh ấy không đang làm việc bây giờ. Anh ấy không có nhiều mối quan hệ. Vì vậy, khi anh ấy không uống, anh ấy ở nhà, như, xem TV một mình. Và không mất quá lâu để anh ấy nghĩ rằng, như, điều mà sẽ mang lại cho tôi sự giải tỏa là uống một ly. Và vì vậy câu hỏi trở thành ít hơn về phân tử rượu và nhiều hơn về việc, như, làm thế nào chúng ta có thể lấp đầy cuộc sống của mọi người? Làm thế nào chúng ta có thể hình thành kết nối, xây dựng cộng đồng và xây dựng cảm giác bản sắc, mục đích và sự tham gia ngoài việc giải tỏa bằng việc sử dụng chất? Bạn rõ ràng là rất thông minh. Và khi tôi gặp những người như bạn, tôi luôn nghĩ với bản thân rằng, bạn có thể cống hiến cuộc đời mình cho bất cứ điều gì. Bạn có thể làm việc trong hầu hết mọi lĩnh vực và bạn đã thành công vì bạn có những gì cần thiết để thành công. Vậy tại sao bạn lại quan tâm đến điều này đến vậy? Vâng. Tôi nghĩ như nhiều người khác, tôi có một mối đe dọa cá nhân. Tôi có một thành viên trong gia đình bị ảnh hưởng bởi nghiện và thực sự đã qua đời khi tôi đang học y. Vì vậy, đó là một khoảnh khắc then chốt, tôi nghĩ, khi nó đến cùng lúc mà tôi đang học tất cả những khoa học này, tôi nhận ra, như, wow, tôi ước gì tôi biết điều này khi tôi còn trẻ. Và đối phó với những thành viên trong gia đình và bạn bè bị ảnh hưởng bởi điều này và rằng chúng ta đã sai rất nhiều. Và hầu hết mọi người không có những công cụ và kiến thức để làm mọi thứ khác đi. Và vì vậy, bạn biết đấy, có một câu nói, khi bạn biết tốt hơn, bạn làm tốt hơn. Và tôi nghĩ tôi muốn đem đến thế giới những gì tôi ước là có sẵn cho những người khác. Một thành viên trong gia đình ngay lập tức. Ừm-hứ. Và bạn bao nhiêu tuổi khi bạn mất người đó? Có lẽ khoảng 24 tuổi. Vì nghiện? Vâng. Khi bạn đối phó với một thành viên trong gia đình hoặc người gần gũi với bạn có vấn đề nghiện, rất nhiều người đang lắng nghe có thể đồng cảm với cảm giác đó. Vâng. Bạn có thể mô tả những gì họ cảm thấy, tôi đoán, trong nỗ lực làm cho họ cảm thấy được nhìn nhận? Bởi vì đôi khi, đặc biệt là khi nhìn lại, nếu bạn cuối cùng mất người đó, bạn có thể đầy những cảm xúc về tội lỗi hoặc hiểu lầm và đặc biệt là suy nghĩ về cách mà xã hội đã tiến lên. Vậy làm thế nào bạn diễn đạt cảm giác trở thành một thành viên trong gia đình với người đang phải đối mặt với nghiện? Vâng, tôi nghĩ bạn cảm thấy bất lực. Bạn cảm thấy như bạn muốn làm điều gì đó nhưng bạn không biết phải làm gì hoặc cảm giác như mọi thứ bạn đã thử đều không hiệu quả. Tôi nghĩ, một lần nữa, vì mọi người đã tiếp xúc với ý tưởng rằng đây là vấn đề của sức mạnh ý chí hoặc sự lựa chọn, điều đó thực sự gợi ý rằng nếu mọi người muốn điều đó đủ, họ chỉ có thể dừng lại.
    Và vì vậy, nếu bạn là thành viên trong gia đình, thì rất dễ dàng để cảm thấy, ôi, họ không yêu thương tôi đủ, bạn biết đấy, rằng họ không chọn tôi hơn chất gây nghiện này. Và vì vậy, tôi nghĩ thường thì mọi người cảm thấy bị tổn thương sâu sắc và họ đã trải qua những kinh nghiệm tạo ra chấn thương cho chính họ. Có rất nhiều chấn thương trong các gia đình đang trải qua điều này. Và sau đó, đôi khi họ nhận được những lời khuyên rất tệ, bạn biết đấy, rằng bạn phải đuổi một ai đó ra ngoài hoặc toàn bộ khái niệm về tình thương cứng rắn và rằng mọi người cần phải chạm đáy. Và vì vậy, đôi khi, bạn biết đấy, mọi người either làm điều đó và sau đó đấu tranh với cảm giác tội lỗi liệu đó có phải là điều đúng đắn hay không, hoặc họ cảm thấy tồi tệ ngay cả khi đối xử tốt hoặc yêu thương với thành viên trong gia đình của họ. Vì vậy, tôi nghĩ có một sự pha trộn toàn bộ của những cảm giác. Và, tất nhiên, nếu bạn mất một ai đó, bạn luôn tự hỏi nếu, như, liệu tôi có thể đã làm điều gì đó khác đi không? Liệu có điều gì khác có thể đã thay đổi không? Và tôi nghĩ rằng mọi người có thể cảm thấy tức giận và buồn bã và tội lỗi và bị bỏ lại với điều đó. Những người đó trong cuộc sống của bạn cần gì mà bạn đã mất mà họ không nhận được? Tôi nghĩ họ cần một phương pháp điều trị dựa trên khoa học và lòng trắc ẩn và sự đồng cảm. Và tôi nghĩ họ cần một thế giới nơi nghiện không được coi là một điều đáng xấu hổ hoặc điều gì mà chúng ta phán xét, mà là một vấn đề. Bạn biết đấy, sự chuyển mình từ, như, bạn là vấn đề đến, như, bạn có một vấn đề và chúng tôi có thể giúp bạn với điều này. Và tôi nghĩ quá thường xuyên chúng ta đã tiếp cận nó như thể, như, bạn là người gây ra vấn đề. Bạn có bao giờ nghĩ lại và nghĩ, bạn biết đấy, nếu tôi đã làm điều gì đó khác đi, dù là bạn hay một người khác quanh bạn hoặc hệ thống xung quanh cá nhân đó, họ sẽ vẫn ở đây hôm nay? Bởi vì tôi nghĩ đó là điều đầu tiên xuất hiện trong tâm trí tôi. Tôi đã xem lại tất cả những quyết định mà tôi đã đưa ra. Và tôi nghĩ, được rồi, có thể đó là lời khuyên tệ mà tôi đã nhận được. Có thể tôi nên, bạn biết đấy, có lẽ tôi có thể đã gọi nhiều hơn. Có thể tôi đã có thể can thiệp ở đây. Có thể, bạn biết đấy, có lẽ có điều gì khác tôi có thể đã làm. Chắc chắn rồi. Tôi nghĩa rằng tôi nghĩ về điều đó mọi lúc. Và, bạn biết đấy, tôi nghĩ, tôi nghĩ về một người bạn mà tôi đã mất vì quá liều. Tôi nghĩ về một thành viên trong gia đình mà tôi đã mất vì rượu. Và không chỉ là những điều mà tôi có thể đã làm khác đi, mà còn, bạn biết đấy, những người đó, họ đã gặp bác sĩ của họ. Họ đã ở trong bệnh viện. Họ có tất cả những điểm tiếp xúc này, tất cả những khoảnh khắc mà ai đó có thể đã tương tác với họ và cung cấp cho họ sự tử tế và sự chăm sóc hiệu quả thực sự được hỗ trợ bởi khoa học. Và họ đã không được như vậy. Và vì vậy có tất cả những khoảnh khắc bị bỏ lỡ và những cơ hội không được tận dụng. Nhưng điều khác mà tôi nghĩ đến là, như, bao nhiêu thời gian tôi đã mất với họ vì tôi nghĩ rằng thường trong mô hình này, như, tình thương cứng rắn và đuổi người ra ngoài hoặc suy nghĩ, như, tôi sẽ không gặp bạn cho đến khi bạn ngừng sử dụng hoặc ngừng uống vì tôi nghĩ rằng điều đó sẽ giúp họ thay đổi. Bạn mất đi tất cả những khoảnh khắc thời gian với những người mà bạn yêu thương và bạn không thể lấy lại những điều đó. Và vì vậy có một vấn đề này, tôi nghĩ, trong mô hình nhị phân của, như, bạn hoặc là đang hồi phục hoặc bạn đang sử dụng và đây là tốt và đó là xấu là chúng ta mất đi sự thật rằng, như, những người đang vật lộn với nghiện là những người tuyệt vời, hài hước, yêu thương có một vấn đề mà họ đang đối mặt. Nhưng nếu ai đó đang đối phó với ung thư, bạn sẽ không, như, không muốn dành thời gian với họ. Bạn biết đấy, bạn đã bỏ lỡ tất cả thời gian đó. Và, bạn biết đấy, cả hai trường hợp mà tôi đang nghĩ đến, như, tôi sẽ không bao giờ lấy lại được điều đó, bạn biết không? Có một câu nói mà tôi đã có nhiều năm trước đây, mà giờ đây tôi đang xem xét lại, đó là thay đổi xảy ra khi nỗi đau của việc giữ nguyên trạng trở nên lớn hơn nỗi đau của việc thay đổi. Và điều đó liên kết với ý tưởng rằng ai đó cần phải chạm đáy của chính họ để họ thay đổi. Tôi nghĩ một phần lý do tại sao ý tưởng đó tồn tại là vì chúng ta nghe quá nhiều câu chuyện, tôi nghe thấy chúng trong podcast này, về gia đình của ai đó từ chối họ, đuổi họ ra đường, và họ có khoảnh khắc eureka đó rằng, chết tiệt, tôi cần phải thay đổi cuộc sống của mình. Và người ta luôn đề cập đến Khoảnh khắc chạm đáy đó nơi họ hành động vì, bạn biết đấy, họ không ở dưới đáy của giếng. Và cụm từ đó có ý nghĩa gì với bạn? Thay đổi xảy ra khi nỗi đau của việc thay đổi trở nên lớn hơn nỗi đau của việc thay đổi. Tôi nghĩ rằng chắc chắn có những lúc như vậy. Không phải để đánh giá thấp điều đó. Và tôi cũng nghe những câu chuyện đó. Nhưng tôi nghĩ rằng từ chứng cứ, những gì chúng ta biết, có thể có nhiều lần mà mọi người chỉ chịu đựng nỗi đau một lần nữa và một lần nữa và một lần nữa cho đến khi họ không bao giờ thay đổi. Và tôi nghĩ rằng phần mà chúng ta không thấy là những người mà việc thay đổi xảy ra khi họ bắt đầu có đủ hy vọng rằng mọi thứ có thể cải thiện cho họ, rằng, bạn biết đấy, có ai đó yêu họ, có ai đó quan tâm đủ để đưa tay ra trong bóng tối, rằng thực sự có một con đường phía trước. Tôi nghĩ rằng mọi người bị mắc kẹt khi họ cảm thấy tuyệt vọng, khi họ cảm thấy như không có gì có thể, rằng họ sẽ không bao giờ có được điều này, họ sẽ không bao giờ có thể thay đổi, cuộc sống của họ sẽ không bao giờ tốt hơn. Và vì vậy, bạn biết đấy, hãy lấy ví dụ. Tôi thường nghe từ các thành viên gia đình khi người thân của họ ở trong tù rằng họ như, cảm ơn Chúa. Bạn biết đấy, ít nhất họ đang ở một nơi an toàn. Như, thực sự có một cảm giác nhẹ nhõm. Thậm chí còn có một thuật ngữ cho điều đó gọi là được cứu mà mọi người cảm thấy. Tôi nghĩ rằng điều đó chỉ cho thấy sự tuyệt vọng mà các gia đình đang phải đối mặt, nhưng ý tưởng rằng, như, đó là một can thiệp an toàn. Và bạn nghe những câu chuyện này, đúng không, về ai đó mà họ bị khóa lại và, như, đó là khoảnh khắc eureka của họ.
    Và thế nhưng, nếu việc bỏ tù là một biện pháp can thiệp hiệu quả cho sự nghiện ngập, chẳng hạn, thì chúng ta sẽ không thấy rằng thực sự, thời gian sau khi được thả ra khỏi tù, có nguy cơ tử vong do nguyên nhân liên quan đến ma túy tăng gấp 130 lần sau khi những người đó rời khỏi tù.
    Và nguy cơ tử vong vì nghiện của bạn sẽ cao hơn nhiều, nhiều lần nếu bạn từng bị bỏ tù.
    Và vì vậy tôi nghĩ rằng có những câu chuyện như vậy, nhưng chúng ta có xu hướng nâng cao những câu chuyện, những tự sự tuyệt vời đó.
    Và chúng ta bỏ lỡ thực tế rằng rất nhiều người khác sẽ chết trong đau đớn và cô đơn và bị cách ly vì họ không còn hy vọng.
    Và vì vậy không phải là để giảm giá trị những khoảnh khắc đó.
    Và một số người thực sự có sức bền phi thường và bất chấp mọi thử thách, ngay cả với những chấn thương lớn nhất, họ có thể, bạn biết đấy, vượt qua.
    Và điều đó thật tuyệt vời.
    Nhưng điều đó không có nghĩa là chúng ta nên tạo ra một hệ thống mà khiến mọi thứ trở nên khó khăn nhất có thể đối với mọi người.
    Vậy bạn có nói rằng nếu chúng ta đang cố gắng giúp ai đó thay đổi, thì thực sự, đó là về hy vọng, về sức mạnh của lý do họ, và về tình yêu, sự đồng cảm và kết nối không?
    Hoàn toàn chính xác.
    Có điều gì khác thiếu không?
    Và đó còn là về việc điều trị hiệu quả.
    Và điều trị, được rồi.
    Điều này là chủ quan, phải không?
    Điều này có thể phụ thuộc vào tình huống mà họ đang ở.
    Nó phụ thuộc vào loại nghiện và tình huống của họ, nhưng trong hầu hết các trường hợp, đó là một sự kết hợp nào đó của liệu pháp tâm lý và thuốc.
    Vậy rượu.
    Đúng.
    Có, ý tôi là, rượu đã trải qua một hành trình.
    Đúng vậy.
    Nó đã trải qua một hành trình về ý kiến của xã hội về nó.
    Bạn có thể dẫn tôi đi qua hành trình đó và cho tôi biết chúng ta đang ở đâu bây giờ không?
    Và khi tôi nói điều đó, tôi đang nói về ý kiến của xã hội về lợi ích sức khỏe của nó và nó là gì.
    Và sau đó cũng là những gì mà chúng ta đang hiểu sai về rượu bây giờ.
    Đúng vậy.
    Vậy, ý tôi là, hành trình của rượu thật hấp dẫn.
    Đầu tiên, tôi nghĩ chúng ta nghĩ về điều này như một điều tương đối hiện đại, nhưng, bạn biết đấy, các nhà khảo cổ học đã phát hiện ra, như là, thiết bị làm bia trong những nơi ở của thợ săn hái lượm cách đây 13.000 năm.
    Thật điên rồ.
    Wow.
    Như là, 13.000 năm của con người tìm ra cách làm bia.
    Bạn biết đấy, nếu bạn nhìn vào Trung Quốc 9.000 năm trước.
    Nó thực sự liên quan đến, như là, một hành trình tâm linh hoặc một điều xã hội.
    Nó chưa bao giờ thực sự về sức khỏe.
    Vào một thời điểm nào đó, chúng ta bắt đầu nói về điều này như một thứ gì đó tốt cho sức khỏe của bạn.
    Như là, uống rượu vang đỏ. Nó sẽ cải thiện sức khỏe của bạn.
    Và đó là nơi mà tôi nghĩ chúng ta đã hiểu sai.
    Và lý do thực sự là vì cách mà chúng ta đã nhìn vào dữ liệu.
    Vì vậy, trước tiên, nếu bạn chỉ xem xét một tình trạng sức khỏe, thì có một số tình trạng sức khỏe mà một lượng rượu vừa phải thực sự cải thiện sức khỏe của bạn.
    Nhưng nó cũng là cách mà mọi người thực hiện các nghiên cứu.
    Vì vậy, trong hầu hết các nghiên cứu đó, những gì mọi người làm là họ lấy một dân số khổng lồ, hàng chục nghìn người, nơi chúng ta có một số dữ liệu mà họ báo cáo về việc họ đã sử dụng bao nhiêu rượu.
    Và sau đó chúng ta xem xét các rủi ro sức khỏe theo thời gian.
    Và các nhà khoa học sẽ nhóm người vào các loại không uống, uống nhẹ, uống vừa phải hoặc uống nhiều.
    Và những gì họ đã tìm thấy là những người uống thậm chí ở mức độ vừa phải thực sự đang làm tốt hơn so với những người không uống một chút nào.
    Và vì vậy đó là nơi mà khái niệm rằng uống rượu là tốt cho sức khỏe của bạn xuất phát.
    Và vì vậy mọi người nói về điều này, như là, đường cong hình chữ J, có nghĩa là những người uống vừa phải thực sự có nguy cơ sức khỏe thấp hơn.
    Và sau đó chỉ khi bạn bắt đầu uống ở mức rất cao, bạn mới bắt đầu có nhiều rủi ro về các vấn đề sức khỏe hơn so với những người không uống một chút nào.
    Những gì họ nhận ra là sai lầm trong điều đó là ở những người không uống chút nào, nhiều người trong số họ không uống vì họ thực sự rất không khỏe.
    Vì một lý do khác, như là, họ có thể bị suy tim, và họ không muốn uống vì họ không muốn nó pha trộn với thuốc của họ.
    Hoặc họ có thể đã từng có tiền sử về rối loạn sử dụng rượu, và họ thực sự đang trong quá trình phục hồi.
    Vì vậy họ đã bị tổn thương từ rượu trước đó, và họ không uống vì điều đó.
    Và vì vậy khi bạn thay đổi nhóm tham chiếu, bạn thực sự làm cho nhóm mà bạn so sánh mọi người là những người hiếm khi uống.
    Vì vậy không phải là họ không phải là người uống rượu chút nào, nhưng họ uống, bạn biết đấy, ở mức rất, rất thấp.
    Sau đó, bạn bắt đầu thấy rằng những lợi ích sức khỏe của rượu biến mất, đặc biệt nếu bạn nhìn trên tất cả các điều kiện.
    Bạn đang nói với tôi rằng không có mức tiêu thụ rượu nào là lành mạnh?
    Đúng.
    Tôi sẽ không bao giờ nói rằng uống rượu là tốt cho sức khỏe của bạn.
    Điều đó không có nghĩa là uống ở những gì chúng ta gọi là mức độ rủi ro thấp không thể là một phần của lối sống lành mạnh.
    Vì vậy, đó là một sự thay đổi nhỏ rằng, như là, đừng tự lừa dối mình vào việc nghĩ rằng uống một ly rượu đó giống như việc tập thể dục trong 30 phút.
    Như là, nó không phải là một điều gì đó sẽ thúc đẩy sức khỏe của bạn.
    Tôi nghĩ về nó giống như việc ăn món tráng miệng, ăn thịt xông khói, ra ngoài ánh nắng mặt trời.
    Có những rủi ro liên quan đến tất cả những hoạt động đó.
    Điều đó không có nghĩa là tôi sẽ nói rằng bạn không bao giờ được làm bất kỳ điều nào trong số đó, nhưng bạn cần hiểu những rủi ro là gì và sau đó đưa ra lựa chọn cho chính mình.
    Vì vậy tôi nhìn vào ly rượu này và cốc bia này.
    Đúng.
    Nếu tôi uống một trong số này mỗi ngày, không phải là một lượng lớn, tôi nghĩ những gì mà mọi người có xu hướng nghĩ là họ nghĩ, ồ, chỉ có một thôi.
    Vì vậy, cơ thể tôi sẽ tự thải ra và sẽ không có hậu quả sức khỏe tiêu cực nào.
    Đúng.
    Điều đó có đúng không?
    Vậy, một phần của thách thức là những gì chúng ta nghĩ đến như là một ly rượu.
    Vì vậy tôi nghĩ tương tự như, bạn biết đấy, nếu bạn học cách đọc kích cỡ phần ăn trên thực phẩm, bạn nhận ra rằng, ôi, một phần kem là khoảng một nửa muỗng.
    Nó không phải là một ly kem khổng lồ.
    Điều tương tự cũng đúng với rượu.
    Vì vậy ở Vương quốc Anh, các giới hạn uống rượu có rủi ro thấp nói về đơn vị rượu, tương đương với tám gram rượu.
    Vậy thì một đồ uống có tám gram rượu là bao nhiêu?
    Và để nằm trong danh mục rủi ro thấp, bạn phải dưới 14 đơn vị.
    Vấn đề là ly rượu vang đó, chỉ nhìn bằng mắt, có vài đơn vị rượu.
    Vậy nên đó không phải là, mặc dù chúng ta nghĩ về nó như một đồ uống đơn lẻ, nhưng có lẽ, tôi phải đoán, nhưng có lẽ nó giống như ba đơn vị rượu.
    Vậy nếu tôi uống một ly rượu vang mỗi ngày, thì tôi sẽ vượt qua giới hạn đó phải không?
    Bạn sẽ đúng ở giới hạn đó.
    Vấn đề là hầu hết mọi người không chỉ uống một ly.
    Nếu bạn, bạn biết đấy, nếu bạn uống hai ly một ngày và sau đó một ly một ngày và sau đó ba ly một ngày vì bạn đang ở một sự kiện xã hội, bỗng nhiên bạn đang thực sự vượt qua giới hạn đó khá nhiều.
    Vậy nếu bạn nói rằng đây là khoảng ba đơn vị, khoảng thế.
    Và bạn có 14 trong một tuần.
    Bạn có 14 trong một tuần.
    Ừm.
    Vậy ba nhân bảy.
    Ừm.
    21.
    Vâng.
    Vậy bạn sẽ vượt qua nếu bạn uống đến kích thước đó.
    Vâng.
    Được rồi, vậy nếu tôi có ly rượu vang này mỗi ngày, thì tôi sẽ vượt qua giới hạn ở Vương quốc Anh của?
    Uống với rủi ro thấp.
    Uống với rủi ro thấp.
    Vậy tôi sẽ nằm trong mức rủi ro trung bình.
    Bạn sẽ ở trong cái mà chúng tôi gọi là rủi ro vừa phải, điều này liên quan đến hầu hết mọi hình thức ung thư, mà tôi nghĩ là mọi người không biết.
    Được rồi.
    Bởi vì tôi đang tự hỏi tại sao ung thư lại gia tăng.
    Vâng.
    Nhiều hình thức ung thư khác nhau đã tăng lên.
    Bạn biết đấy, ung thư vú là một trong những thứ mà chúng ta luôn nghe thấy đang gia tăng.
    Vậy bạn đang nói, dữ liệu về mức độ rủi ro thấp hoặc vừa phải của việc uống rượu và ung thư là gì?
    Vâng.
    Vì vậy, dữ liệu này đang phát triển và thực sự đáng lo ngại.
    Đối với ung thư vú, có thực sự có một vài loại ung thư mà ngay cả ở mức rủi ro thấp, bạn thấy rủi ro bắt đầu gia tăng.
    Vậy nơi mà chúng tôi sẽ nói rằng không có lượng nào là lành mạnh, hoặc không có ngay cả lượng rủi ro thấp nào.
    Vậy ung thư vú và ung thư thực quản, là hai ví dụ về điều đó.
    Vậy ung thư vú, nếu bạn uống dưới những mức rủi ro thấp đó.
    Vậy ở Mỹ, đó sẽ là ít hơn bảy đồ uống, nhưng một đồ uống ở Mỹ là năm ounce rượu vang, cái mà nhỏ hơn so với điều đó.
    Hoặc ở Vương quốc Anh là dưới 14 đơn vị, nên sẽ là, bạn biết đấy, ít hơn bảy ly rượu vang kích thước đó.
    Chúng tôi vẫn thấy có một chút gia tăng rủi ro ung thư vú.
    Điều đó khoảng 5% gia tăng.
    Điều đó có nghĩa là rủi ro ung thư vú của bạn sẽ tăng khoảng 5%.
    Và điều đó không lớn.
    Vậy tôi nghĩ rằng, bạn biết đấy, việc tính toán phần trăm tăng là có phần khó khăn.
    Nhưng nếu bạn nghĩ ở Mỹ, chẳng hạn, phụ nữ trung bình có 13% khả năng mắc ung thư vú trong suốt cuộc đời của họ.
    Khả năng 13%?
    Thật sao?
    Vâng.
    Gần như quá cao.
    Vậy thì 5% gia tăng sẽ đưa nó lên khoảng 13,6 hay như vậy.
    Vậy có nghĩa là nếu có chín phụ nữ trong căn phòng này, một trong số họ sẽ có khả năng bị ung thư vú?
    Trong cuộc đời của họ.
    Đúng vậy.
    Chết tiệt.
    Vâng.
    Tại sao lại như vậy?
    Và nó đang gia tăng.
    Vâng.
    Và lý do cho điều đó có khả năng là do môi trường vì gen của bạn không thay đổi trong khoảng thời gian đó.
    Vậy những yếu tố rủi ro, bạn biết đấy, nếu bạn nghĩ về ung thư vú, đó là rượu.
    Đó là béo phì.
    Đó là, bạn biết đấy, tuổi khi bạn có con hoặc không có con vì đây là một loại ung thư chủ yếu do hormone điều khiển.
    Cũng như khi bạn nghĩ về ung thư ruột kết.
    Đó là một điều thực sự đáng sợ khi chúng ta thấy ngày càng nhiều trường hợp ở những người trẻ tuổi.
    Một số yếu tố gây ra điều đó, ăn thịt.
    Vậy các loại thịt chế biến sẵn gia tăng rủi ro của bạn với ung thư ruột kết.
    Vậy nên, bạn biết đấy, những hành vi rất bình thường.
    Chắc chắn có thể có những yếu tố môi trường khác, thành thật mà nói, mà chúng tôi vẫn chưa đo lường hoặc có thể đo lường.
    Chỉ khi xem xét tỷ lệ gia tăng, khi tôi nói chuyện với các đồng nghiệp của tôi là các nhà ung thư học, bạn biết đấy, những thứ như nhựa hoặc những thứ khác mà chúng tôi vẫn chưa biết.
    Rõ ràng có điều gì đó trong môi trường đang thúc đẩy những rủi ro ung thư gia tăng này.
    Vậy ngay cả ở mức độ như vậy, nếu tôi uống, điều đó có thể là một đơn vị, đúng không?
    Vâng.
    Vậy đó sẽ là một đơn vị.
    Vậy sẽ ít hơn 14 đơn vị đó.
    Vậy bạn có thể thấy như, bạn biết đấy, nếu bạn có gấp đôi điều đó, nó sẽ là một lượng rượu vang hợp lý.
    Bạn không thể có hơn bảy ly đó trong một tuần để ở mức rủi ro thấp.
    Nhưng ngay cả khi uống số lượng đó, rủi ro ung thư vú của bạn sẽ tăng lên một chút.
    Thậm chí số lượng này?
    Ừm.
    Thực sự không có lượng rượu nào là an toàn khi nói đến ung thư vú.
    Chỉ có ung thư vú không?
    Vậy danh mục rủi ro thấp đó.
    Vậy khi chúng tôi, những nghiên cứu lớn về ung thư này phân loại mọi người là rủi ro thấp hoặc người uống nhẹ, vừa phải hoặc nặng.
    Và đối với hầu hết mọi loại ung thư, ngay khi bạn đến danh mục vừa phải, chúng tôi bắt đầu thấy gia tăng.
    Và có cái mà chúng tôi gọi là mối quan hệ liều – phản ứng.
    Vậy càng uống nhiều, rủi ro ung thư của bạn càng cao.
    Chỉ có một vài loại ung thư mà rủi ro dường như tăng lên ngay cả ở mức độ rất thấp đó.
    Và ung thư vú là một trong số đó.
    Và sau đó ung thư thực quản cũng là một trong số đó.
    Vậy có một số loại ung thư mà ngay cả một lượng nhỏ rượu cũng sẽ tăng rủi ro của bạn.
    Có ảnh hưởng gì đến việc suy nghĩ về những loại ung thư phổ biến ở nam giới không?
    Vâng.
    Vậy ung thư ruột kết, chúng ta thấy điều đó ở nhiều nam giới trẻ.
    Ung thư gan.
    Vâng.
    Ung thư tuyến tiền liệt, mà rõ ràng là một loại ung thư nam giới, chúng ta không nghĩ rằng nó là một loại ung thư nhạy cảm với rượu.
    Nhưng hầu hết các loại ung thư, vì cách mà rượu ảnh hưởng đến rủi ro ung thư của bạn không thực sự liên quan đến một cơ quan cụ thể nào ngoài gan.
    Nó thực sự liên quan đến cách nó thay đổi DNA của chúng ta.
    Vậy nó liên quan đến viêm và cái mà được gọi là các loại oxy phản ứng, thứ thay đổi các tế bào của chúng ta và tăng rủi ro theo thời gian với các đột biến dẫn đến ung thư.
    Vậy nên, bạn có thể giải thích kỹ hơn về điều đó không?
    Vậy nếu tôi là người uống rượu nặng, giả sử tôi uống, hãy tưởng tượng tôi uống hai ly rượu vang mỗi ngày một cách nhất quán, mà tôi đoán sẽ, như nếu tôi uống hai ly như vậy một ngày.
    Nếu bạn uống hai ly như vậy, đúng vậy, bạn sẽ nằm trong danh mục người uống rượu nặng.
    Vâng, điều này có thể làm ngạc nhiên hầu hết mọi người, đúng không? Đối với nhiều người, điều đó rất bình thường. Nó rất bình thường, đúng vậy. Tôi nghĩ điều này có phần khó hơn đối với những người trẻ tuổi để hiểu vì họ uống ít hơn. Nhưng nếu tôi nghĩ về thế hệ lớn hơn mình, việc uống hai ly rượu mỗi ngày là điều khá bình thường. Sau giờ làm việc, vào cuối tuần, với mỗi bữa ăn bạn có. Vì vậy, điều đó sẽ khiến tôi trở thành một người uống rượu nặng. Và những số liệu thống kê cho thấy gì về hồ sơ rủi ro ung thư của tôi? Vâng, điều đó thay đổi tùy theo loại ung thư, nhưng đại khái chúng ta đang nói về khoảng 40% gia tăng nguy cơ ung thư tùy thuộc vào loại ung thư. Và bạn uống càng nhiều, nguy cơ đó sẽ càng tăng. Vì vậy, bạn biết đấy, đây là những nghiên cứu khoa học mà không chính xác cho từng cá nhân. Chúng dựa trên các dân số lớn. Nhưng chắc chắn rằng, bạn uống càng nhiều, nguy cơ càng cao. Và nếu tôi có những loại bệnh khác, họ gọi đó là bệnh đồng mắc? Vâng, chính xác. Vì vậy, những căn bệnh khác, nếu cơ thể tôi có những bệnh khác, khả năng của tôi sẽ tăng lên hơn nữa nếu tôi thừa cân, nếu tôi béo phì. Chính xác, nếu bạn hút thuốc. Vì vậy, một trong những yếu tố chính của rượu và ung thư là nó thực sự khiến bạn dễ mắc phải những tác động gây ung thư của thuốc lá. Vì vậy, nếu bạn vừa uống rượu vừa hút thuốc, nguy cơ ung thư của bạn sẽ còn cao hơn. Điều đó hoạt động như thế nào? Suy nghĩ là, như nếu bạn xem ung thư thực quản ở cấp độ tế bào, nó làm cho bạn dễ bị ảnh hưởng hơn bởi các chất gây ung thư, là những hợp chất gây ung thư trong thuốc lá. Vì vậy, thay vì chỉ thấy rủi ro gia tăng, bạn thực sự gần như có rủi ro được nhân lên về nguy cơ ung thư. Vì vậy, hút thuốc và béo phì là những yếu tố lớn khác. Nên nhiều loại ung thư, nguy cơ của bạn sẽ tăng lên nếu bạn có sự gia tăng khối lượng cơ thể. Thì điều gì đang xảy ra trong cơ thể, khi tôi uống rượu, điều đó dẫn đến ung thư như thế nào? Bạn đã đề cập đến điều này một chút, nhưng tôi muốn chắc chắn rằng mình rất rõ ràng về những tác động kéo theo và cách mà điều đó dẫn đến ung thư. Vâng, có rất nhiều cơ chế khác nhau. Vì vậy, có thể bắt đầu với việc rượu làm gì trong cơ thể bạn? Bạn uống rượu. Tên gọi fancy cho điều đó là ethanol. Nó là một phân tử. Và nó chủ yếu được hấp thụ khá nhanh từ dạ dày của bạn. Vì vậy, bạn biết đấy, nó sẽ vào dòng máu của bạn thường trong vòng 10 phút sau khi bạn uống. Và lượng rượu vào dòng máu của bạn phụ thuộc vào lượng nước bạn có trong cơ thể. Vì vậy, rượu không đi vào chất béo của bạn. Nó chỉ khuếch tán vào những phần có nước trong cơ thể bạn. Vì vậy, đó là lý do tại sao, đối với nhiều phụ nữ, họ sẽ cảm thấy say hoặc cảm thấy tác động từ rượu ở mức thấp hơn so với nam giới vì phụ nữ có nhiều chất béo cơ thể hơn nam giới. Nhưng điều này sẽ phụ thuộc vào từng cá nhân. Nếu bạn có nhiều chất béo cơ thể, bạn sẽ có một tác động khác. Vì vậy, rượu vào trong dòng máu của bạn. Rượu có thể ngay lập tức vượt qua cái mà chúng tôi gọi là hàng rào máu-não của bạn. Vì vậy, nó ảnh hưởng ngay lập tức đến não của bạn. Và đây là nơi bạn cảm thấy những tác động thú vị ban đầu của việc cảm thấy một chút thư giãn, cảm thấy xã hội hơn, cảm thấy ít lo âu hơn. Nếu bạn tiếp tục uống và mức đó tiếp tục tăng lên, thì bạn bắt đầu có sự phán đoán kém. Bạn có thể thiếu sự phối hợp vận động. Chúng ta đã thấy điều này và nhiều người có thể đã trải nghiệm điều đó. Bạn biết đấy, có thể bạn sẽ vấp ngã, không thể lái xe một cách an toàn. Bạn sẽ không đưa ra những quyết định giống như khi bạn không uống. Và nếu bạn tiếp tục uống, bạn có thể – thực sự mất ý thức. Vậy thì, mọi người đã trải nghiệm điều đó. Cơ thể bạn sẽ cố gắng phân hủy rượu nhanh nhất có thể. Như bất cứ thứ gì, chúng ta muốn loại bỏ bất kỳ điều gì bất thường và quay trở lại chức năng bình thường của mình. Vì vậy, quá trình đó chủ yếu diễn ra ở gan của bạn, lý do mà gan rất nhạy cảm với rượu. Bởi vì cơ thể bạn coi ethanol như một chất độc. Có. Tôi có nghĩa là, bạn biết đấy, tôi biết bạn đã nói về điều này, Tiến sĩ Lemke, nhưng cơ thể của bạn luôn muốn khôi phục cái gọi là trạng thái cân bằng. Cơ thể của bạn luôn chiến đấu để quay trở lại trạng thái bình thường mà nó cảm thấy là bình thường. Vì vậy, ethanol không phải là thứ thuộc về dòng máu của bạn. Cơ thể bạn sẽ cố gắng loại bỏ nó nhanh nhất có thể. Và sau đó nó chuyển đổi nó thành một cái gọi là acetate. Và sau đó bạn có thể tiểu ra và thở ra và tống khứ nó đi. Vì vậy, để loại bỏ rượu trong cơ thể bạn, bạn phải trải qua quy trình này. Và một phần của quy trình đó bao gồm một phân tử độc hại sẽ nổi trong cơ thể và gây hại cho các tế bào của bạn. Vì vậy, đó là một cách mà rượu có thể gây ung thư. Cách khác là chỉ là viêm chung. Có lẽ nhiều người đã nghe rằng viêm không tốt cho cơ thể và tăng nguy cơ ung thư. Và rượu sinh ra rất nhiều viêm trong quá trình được loại bỏ. Vì vậy, nó thực sự có thể thay đổi các tế bào của bạn theo thời gian, điều đó có thể dẫn đến ung thư. Tôi cũng thấy biểu đồ này, cho bất kỳ ai không thể thấy những gì chúng tôi đang mô tả tại thời điểm này, nó cho thấy sự gia tăng trong bệnh gan, tỷ lệ tử vong và bệnh gan chung so với các bộ phận khác của cơ thể. Vâng. Tôi tin rằng nó cho thấy các cơ quan khác trong cơ thể. Vâng. Rượu có tác động như thế nào đến gan? Và chúng ta có con mô hình nhỏ của cơ thể con người ở đây. Gan nằm ở đâu? Vâng. Câu hỏi tuyệt vời. Vì vậy, đây là mô hình nhỏ của chúng tôi. Để định vị mọi người trong cơ thể. Vì vậy, chúng ta đang nhìn vào bên trong cơ thể. Vì vậy, như xương sườn đã biến mất. Bên ngoài của làn da đã biến mất. Hai thứ màu hồng này là phổi. Chúng bao quanh tim. Bạn có thể thấy trái tim nằm phía sau phổi bơm máu của bạn. Gan là cơ quan màu nâu này. Nó nằm ở bên phải cơ thể bạn, ngay dưới xương sườn. Nó khá lớn. Nó to.
    Dưới đây là bản dịch tiếng Việt của đoạn văn bạn cung cấp:
    Và đó là một cơ quan đáng kinh ngạc. Nó khá lớn. Nó xử lý phần lớn các loại độc tố mà chúng ta tiếp nhận, những thứ mà chúng ta ăn, glucose của bạn, rượu. 90% trong số đó được chuyển hóa bởi gan. Vì vậy, gan giống như một trung tâm lọc bỏ các sản phẩm phụ trong cơ thể bạn. Các cơ quan khác là thận, nhưng gan đóng vai trò rất lớn, đặc biệt là trong việc xử lý rượu. Nó nằm ngay đây. Nó gần như trông có vẻ to như phổi, như một lá phổi. Đúng vậy. Thực sự là như vậy. Thật không? Đúng vậy. Đó là một cơ quan khổng lồ. Và đó là một cơ quan tuyệt vời. Vì vậy, bạn thực sự có thể cắt bỏ 80% gan và nó sẽ tự tái tạo. Nó giống như, bạn biết đấy, những con thằn lằn mà bạn cắt đuôi của chúng và chúng tái tạo lại đuôi. Gan thật thú vị. Đó là lý do tại sao chúng ta có thể thực hiện cấy ghép gan từ người sống. Vì vậy, tôi có thể lấy một nửa gan của bạn và tặng cho một người cần gan. Bạn vẫn có thể sống bình thường và họ sẽ có một cơ hội sống thứ hai từ phần gan của bạn. Vì vậy, đó là một cơ quan rất tuyệt vời có thể tái tạo. Nhưng nó chỉ có thể tái tạo đến một mức độ nhất định. Vì vậy, một khi bạn đạt đến mức mà bạn có nhiều mô sẹo trong gan, chúng tôi gọi đó là xơ gan, bạn giống như đã đến điểm không quay lại được, tại thời điểm đó gan không thể tự chữa lành. Tôi nghĩ về điều đó giống như việc, sử dụng phép ẩn dụ nướng bánh, nếu bạn đang làm bánh muffin hoặc bánh sinh nhật, bạn đang trộn tất cả các nguyên liệu của mình, và bạn nhận ra trước khi cho vào lò, như, ôi, tôi quên không cho trứng. Bạn vẫn có thể thêm trứng vào và, giống như, đánh tan tất cả lại với nhau và nó sẽ ổn. Nếu bánh muffin đang nướng trong lò và bạn quên trứng, bạn không thể, như, đổ trứng lên trên và làm cho bột giống nhau. Và gan cũng giống như vậy, rằng đến một mức độ nhất định, bạn thực sự có thể hoàn toàn sửa chữa các tác động của những thứ như rượu hoặc béo phì, những thứ khác. Nhưng một khi bạn vượt qua điểm đó đến mô sẹo, gan không thể tái tạo nữa. Và vì vậy khi bạn nghĩ về đồ thị đó hoặc chỉ tỉ lệ gia tăng của bệnh gan, những nguyên nhân chính gây ra bệnh gan là béo phì và, cũng là rượu. Và vì vậy đó là những nguyên nhân hàng đầu của việc cấy ghép gan. Và điều đáng buồn là, ý tôi là, tôi thấy điều này mọi lúc khi làm việc trong bệnh viện là, trước hết, chúng tôi đang thấy những người ngày càng trẻ tuổi nhập viện và suy gan. Vì vậy, những người trong độ tuổi 20 nhập viện và suy gan cấp tính từ rượu và rồi chết trong bệnh viện. Và điều tồi tệ là họ thường không biết rằng điều này đang gây ra vấn đề cho sức khỏe của họ. Và khi họ đến được bệnh viện, họ đã quá ốm, đã quá muộn. Và tất cả điều đó có thể đã được ngăn chặn hoặc thậm chí sửa chữa nếu được phát hiện sớm hơn. Và vì vậy đó là lý do tại sao tôi nghĩ rằng việc giáo dục hiểu biết, như, những tác hại sức khỏe thực sự của rượu là gì? Và rằng chúng ta đã điều chỉnh việc uống rượu say xỉn trong nhiều dịp, đặc biệt là trong giới trẻ, như là điều hoàn toàn bình thường. Và thế nhưng, có những hậu quả sức khỏe rất nghiêm trọng. Vì vậy, tôi có một loạt câu hỏi xung quanh gan. Điều đó có nghĩa là gan của tôi có thể chịu đựng một chút trước khi có bất kỳ vấn đề thực sự nào không? Tôi nên, bạn biết đấy, một người như tôi, tôi không uống rượu. Tôi không tham gia vào bất cứ điều gì quá xấu. Nhưng đôi khi tôi tự hỏi nếu tôi có thể có một cuối tuần thật “hoành tráng” và rồi gan của tôi chỉ cần phục hồi lại như bình thường và tôi sẽ ổn. Đúng vậy. Ý tôi là, trước hết, mỗi người là khác nhau. Một cuối tuần “hoành tráng”, có lẽ bạn sẽ ổn. Ai cũng có thể sẽ ổn. Thách thức là một cuối tuần “hoành tráng” rồi dẫn đến nhiều cuối tuần “hoành tráng”. Và theo thời gian, điều đó thực sự có thể tăng tốc độ tổn thương cho gan của bạn. Bạn đã nói rằng gan của tôi tái tạo, vì vậy tôi nghĩ rằng cái gì đó sẽ tự quay lại bình thường. Miễn là bạn chưa đến giai đoạn hình thành mô sẹo. Vì vậy, một khi bạn đi quá xa trên con đường đó, ngay cả khi bạn ngừng uống, gan của bạn sẽ không phục hồi. Điều khó khăn là chúng tôi không hoàn toàn hiểu ai và tại sao điều đó xảy ra lại quá trẻ. Vì vậy, đây là một lĩnh vực đang được điều tra tích cực bởi vì có những người đã uống rượu trong 60 năm và gan của họ không có dấu hiệu bị sẹo. Và rồi chúng tôi thấy những người trẻ tuổi 25 nhập viện và chết trong bệnh viện. Và vì vậy có những yếu tố cá nhân mà bạn không có cách biết sẽ ảnh hưởng đến nguy cơ phát triển viêm gan và mô sẹo của bạn. Và vì vậy cách an toàn nhất để ngăn chặn điều đó là không uống những cách thật cao mà chúng tôi biết sẽ dẫn đến tổn hại. Cách khác là tìm kiếm sự chăm sóc y tế vì thường chúng tôi phát hiện những điều này thông qua xét nghiệm máu và chúng tôi có thể thực hiện siêu âm. Và khi chúng tôi thấy những giai đoạn sớm đó, điều xảy ra trước tiên là bạn thực sự có sự lắng đọng mỡ trong gan. Đó là bước đầu tiên. Và sau đó chúng tôi thấy sự viêm ở gan nhiễm mỡ. Và nếu bạn không ngừng điều gì đang thúc đẩy những thay đổi đó, theo thời gian chúng tôi thấy sự phát triển của những gì gọi là xơ hóa, giống như mô sẹo. Và sau đó mô sẹo đó trở nên ngày càng tiến triển đến mức gan của bạn ngừng hoạt động và bạn sẽ chết hoặc bạn cần một ca cấy ghép gan. Những hoạt động nào ngoài rượu gây căng thẳng lớn cho gan của chúng ta mà chúng ta có thể không thấy rõ ràng? Vâng. Vì vậy, béo phì. Thức ăn cũng vậy. Vâng, thức ăn. Vì vậy, gan của bạn rất liên quan đến chuyển hóa glucose. Vì vậy, chế độ ăn uống và cân nặng của chúng ta ảnh hưởng đến sức khỏe gan của chúng ta. Và những loại thuốc khác, như acetaminophen hoặc Tylenol, một loại thuốc giảm đau rất phổ biến không kê đơn, vượt quá một ngưỡng nhất định có thể gây tổn thương gan nghiêm trọng. Vì vậy, đôi khi chúng tôi sẽ thấy những trường hợp mà ai đó không nhận ra rằng, như, thuốc cảm lạnh của họ cộng thêm Tylenol mà họ đang dùng đều có thành phần đó. Và sau đó họ ra ngoài và uống rượu nặng. Và hiệu ứng kết hợp đó có thể gây tổn hại cho gan. Bạn nghĩ rằng bao nhiêu – có thể đây là một câu hỏi hơi không rõ ràng – nhưng bao nhiêu rượu sẽ gây tổn thương cho gan? Vì vậy, một lần nữa, điều đó thay đổi tùy người.
    Đối với tổn thương gan, thường thì những lượng rượu từ trung bình đến cao sẽ gây ra thiệt hại. Một điều cần nhớ là, những cú sốc lớn, như những đợt uống rượu say sưa, có thể có hại hơn nhiều so với việc uống ở mức độ vừa phải trong một khoảng thời gian dài. Những cú sốc lớn như vậy sẽ tạo ra một lượng lớn các sản phẩm độc hại mà cơ thể bạn phải xử lý. Vì vậy, nếu bạn có nhiều năm uống rượu say sưa nặng, điều đó thực sự có thể gây tổn thương nhiều hơn so với việc chỉ uống ở mức độ vượt quá giới hạn rủi ro trong một khoảng thời gian dài. Do đó, việc cố gắng tối thiểu hóa và tránh những đợt uống rượu nặng là vô cùng quan trọng. Và việc giữ cho mình trong các hướng dẫn rủi ro thấp mà chúng ta vừa tìm hiểu, thật sự gây bất ngờ khi thấy chúng có mức rủi ro thấp như thế nào, sẽ giúp giảm thiểu nguy cơ tổn thương gan.
    Và có phải rượu chỉ ảnh hưởng đến gan không? Không. Ý tôi là, rượu có tác động đến toàn bộ cơ thể chúng ta. Rất nhiều bộ phận trong cơ thể có thể bị ảnh hưởng bởi rượu. Bắt đầu từ trên, chính là não của bạn. Chúng ta có thể nhìn điều này bằng hình ảnh, như hình chụp MRI. À, tôi có một cái ở đây. Đây thực sự là một điều gây sốc đối với tôi. Khi chúng ta thực hiện một hình chụp MRI não của ai đó, điều cơ bản là chúng ta đang nhìn cắt ngang. Nó giống như bạn đang đối diện với tôi và tôi cắt bỏ mặt bạn để nhìn vào não bạn từ bên trong. Mô não khỏe mạnh là chất xám và chất trắng. Bạn muốn nó đầy đặn và chiếm càng nhiều không gian càng tốt vì đó là nơi tất cả hoạt động não của bạn diễn ra. Khi mọi người lớn tuổi hơn hoặc bị chứng mất trí nhớ, một điều chúng ta thấy là ngày càng nhiều không gian đen, thực chất là nước. Vì vậy, não bắt đầu co lại và co lại, có nhiều nước hơn và ít mô não khỏe mạnh hoạt động hơn. Quá trình này diễn ra nhanh hơn khi sử dụng rượu nặng. Và vì vậy, bạn có thể thấy ở đây, đây là một người 43 tuổi với rối loạn sử dụng rượu nặng, nơi não của họ trông giống như não của một người 90 tuổi bị mất trí nhớ, do tổn thương não theo thời gian từ việc sử dụng rượu. Và do đó, một hình thức chứng mất trí nhớ có liên quan đến việc sử dụng rượu. Và như vậy, não của bạn có thể bị ảnh hưởng rất nhiều bởi rượu.
    Điều gì đang diễn ra ở đây? Tại sao não lại bị suy giảm theo cách như vậy do rượu? Vâng, hãy nhớ rằng tôi đã nói ethanol, phân tử đó, vượt qua hàng rào máu-não. Vì vậy, đặc biệt là khi bạn có nồng độ rượu trong máu cao, ethanol giống như đang ngâm não bạn. Và nếu bạn nghĩ về những gì chúng ta đã nói, viêm và những thay đổi ở tế bào và DNA và protein đang diễn ra ở cấp độ não. Một điều khác có thể gây ra, đẩy nhanh tổn thương não mà chúng ta thấy với rượu thực sự là sự thiếu hụt dinh dưỡng. Vì vậy, mọi người có thể uống rất nhiều nhưng thực sự không nhận được những chất dinh dưỡng quan trọng trong chế độ ăn uống của họ. Và điều này có thể đẩy nhanh quá trình tổn thương não. Chúng ta thậm chí có thể thấy sự mất trí nhớ khởi phát đột ngột do sử dụng rượu nặng trong hoàn cảnh không nhận đủ chất dinh dưỡng trong chế độ ăn uống của bạn.
    Đó là về não. Tiếp theo là miệng và thực quản của bạn. Rõ ràng, bạn đang uống rượu. Nó ngâm miệng bạn. Nó ngâm thực quản và dạ dày của bạn. Vì vậy, chúng tôi thấy có sự gia tăng ung thư, như chúng ta đã nói, và điều đó được đẩy nhanh bởi việc hút thuốc. Nhưng chúng tôi cũng thấy, như tình trạng sức khỏe lành tính nhưng khó chịu và gây rắc rối, đặc biệt là trào ngược axit, hay ợ nóng. Vì vậy, nếu bạn nhận thấy, như là: “Tôi luôn bị ợ nóng. Tôi phải dùng tất cả loại thuốc kháng axit và uống thuốc này”. Bạn có thể muốn nghĩ, “Tôi đang uống bao nhiêu? Liệu điều đó có góp phần vào ợ nóng của tôi không?” Đó là một vấn đề rất phổ biến.
    Tim cũng bị ảnh hưởng bởi rượu. Vì vậy, bạn biết đấy, tim là một cơ quan mà ở mức rủi ro thấp dường như không có tác hại từ rượu. Nhưng khi bạn vào mức độ vừa phải và cao, chúng ta thấy có tác hại. Và các tác hại có thể là một vài điều. Một trong số đó là cái gọi là rung tâm nhĩ, điều này thực chất là khi tim của bạn bắt đầu đập không đều. Vì vậy, trong tim của bạn, có bốn ngăn, hai ngăn ở trên. Điều này thực sự cho thấy các tâm thất và tâm nhĩ. Vì vậy, có hai ngăn mà máu chảy qua. Và trong một trái tim bình thường, hoạt động điện của bạn xuất phát từ phần trên của tim, đi xuống phần dưới của tim và ra lệnh cho tim bơm. Và vì vậy, bạn nhận được một xung đơn đi xuống dưới cùng của tim, nói bơm, và điều đó bơm máu ra não, cơ thể và các cơ quan của bạn, và cả gan. Trong rung tâm nhĩ, phần trên của tim chỉ rung rinh với hoạt động điện bất thường này. Và vì vậy, tim không thể bơm theo cách bình thường. Thực sự, có một thuật ngữ trong y học gọi là “tim nghỉ lễ”, vì chúng tôi thấy đôi khi mọi người uống rất nhiều trong những ngày lễ và sẽ kết thúc trong nhịp bất thường này chỉ từ mô hình uống say đó. Và sau đó, theo thời gian, nếu bạn uống ở mức cao, tim của bạn thực sự sẽ giãn ra và bạn có thể mắc suy tim sung huyết do một chứng bệnh cơ tim, điều này có nghĩa là cơ tim trở nên yếu và mỏng và không thể bơm đúng cách.
    Ôi không. Đôi khi chúng ta nghĩ rằng nếu chúng ta giỏi trong việc xử lý bia hoặc rượu, thì nó sẽ ít gây hại cho chúng ta hơn. Vậy, vì lý do nào đó, tôi luôn giỏi trong việc uống khá nhiều. Khi tôi từng uống, tôi không uống nữa, nhưng khi tôi đã từng uống và ít bị ảnh hưởng hơn so với bạn của tôi, người lớn hơn một chút và có một ít mỡ cơ thể hơn, điều này thực sự rất thú vị vì bạn đã chỉ ra một mối liên hệ mà tôi chưa bao giờ biết đến. Chỉ để dừng lại một chút tại đó. Bạn đang nói rằng nếu ai đó có nhiều mỡ cơ thể hơn, thì họ có nhiều khả năng say hơn? Vâng, vì họ có ít nước trong cơ thể hơn và rượu không đi vào mỡ cơ thể của bạn.
    Vậy thì, về cơ bản, nó giống như nếu bạn lấy một ly nước và đổ thuốc nhuộm đỏ vào đó, nó sẽ khuếch tán vào trong nước. Càng nhiều nước thì nó sẽ càng được khuếch tán nhiều, và nồng độ cồn trong máu của bạn sẽ càng thấp. Nếu bạn có lượng mỡ cơ thể rất thấp, có thể bạn sẽ có lượng nước trong cơ thể cao hơn. Vì vậy, hai ly đối với bạn có thể sẽ khuếch tán vào một lượng nước lớn hơn. Điều đó giải thích rất nhiều điều. Bởi vì tôi luôn thắc mắc, anh ấy lớn hơn tôi rất nhiều. Vào thời điểm đó, anh ấy có nhiều mỡ cơ thể hơn và sẽ say rất nhanh. Và bạn luôn nghĩ, ôi, một người lớn, họ có thể chịu đựng bia hoặc bất cứ thứ gì, nhưng anh ấy sẽ say rất nhanh. Vì vậy, tôi từng tự hỏi, tôi từng nghĩ, ôi, rượu không làm tôi say nhiều như vậy vì tôi không say như anh ấy. Nhưng đó không phải là sự thật. Không, ý tôi là, đầu tiên tôi nghĩ câu chuyện thú vị ở đây không chỉ là mỡ cơ thể mà còn là mọi người trao đổi chất rượu với tốc độ khác nhau. Có lẽ bạn, tôi không biết bạn có nhận thấy điều này không, có thể bạn đã ít bị say rượu hơn bạn của mình. Bởi vì hội chứng say rượu dường như liên quan đến lượng rượu trong máu của bạn cao như thế nào. Vì vậy, những người không trao đổi chất rượu nhanh chóng thường có triệu chứng say rượu tồi tệ hơn. Điều đó có thể là điều bạn đã trải qua. Nhưng điều đó không bảo vệ bạn khỏi những tác hại khác đối với sức khỏe do rượu gây ra, như tổn thương gan, ung thư, và theo thời gian, bạn biết đấy, các vấn đề về tim hoặc thực quản.
    Cơn say rượu là gì?
    Ừ, cơn say rượu là một điều thú vị mà mọi người đang, bạn biết đấy, có rất nhiều bằng chứng mới nổi về nó và đang cố gắng hiểu điều gì xảy ra. Nó dường như liên quan đến mức độ nồng độ ethanol trong não bạn cao như thế nào vì họ thực sự đã làm rất nhiều nghiên cứu với chuột và con người. Ban đầu, người ta nghĩ rằng nó do các sản phẩm phụ của rượu, như phân tử acetaldehyde mà chúng tôi đã nói đến, nhưng có vẻ như không liên quan đến điều đó. Nó có vẻ liên quan đến ethanol. Nhưng về cơ bản, đó là hội chứng mà sau khi bạn uống, khi nồng độ cồn trong máu của bạn giảm xuống bằng không, bạn cảm thấy loại vô cảm, bạn thấy mệt mỏi, bạn bị đau đầu, bạn thường cảm thấy buồn nôn. Vì vậy, đó là một phần của chuỗi sự kiện mà não của bạn về cơ bản đã được ngâm trong ethanol. Và sau đó khi nó rời khỏi, bạn chỉ cảm thấy rất tệ. Bởi vì mọi người đôi khi nghĩ rằng đó chỉ là bị mất nước. Ừ, nó không chỉ đơn giản là mất nước. Thực sự có những tác động của ethanol lên não bạn dẫn đến cơn say rượu. Tôi nghĩ nếu bạn đang uống với một lượng mà bạn bị say rượu, đó là một dấu hiệu tốt rằng bạn đang uống vượt quá giới hạn mà cơ thể bạn có thể chấp nhận. Bởi vì đôi khi, tôi nhớ lại thời đó, nếu tôi uống một ly nước lớn trước khi đi ngủ, nếu tôi đã uống rượu, tôi cảm thấy tốt hơn vào buổi sáng. Có một yếu tố nào đó của việc mất nước, đừng hiểu sai nghĩa tôi. Và điều đó một phần là vì, đúng, nếu bạn nghĩ rằng, một lần nữa, rượu được khuếch tán trong nước. Vì vậy, nếu tổng lượng nước trong cơ thể bạn bị co lại vì bạn mất nước, thì mức độ ethanol trong cơ thể bạn sẽ cao hơn. Do đó, việc uống nước sẽ giúp bạn loại bỏ và cảm thấy tốt hơn. Tôi đang uống nước. Nhưng không chỉ vì bị mất nước. Sẽ có những người đang nghe điều này bây giờ. Tôi nghi ngờ rằng họ sẽ đi đến được phần này. Bởi vì nếu họ đã làm vậy, có lẽ họ sẽ không nghĩ như này. Nhưng sẽ có những người đã đi đến phần này của cuộc trò chuyện và đang nghĩ, vâng, nhưng rượu giúp tôi giao tiếp xã hội. Và việc giao tiếp xã hội là rất quan trọng. Và tôi không thể giao tiếp xã hội một cách dễ dàng vì thiết kế của thế giới hiện đại mà không uống rượu. Hoặc tôi có những khoảng thời gian tuyệt vời khi tôi uống. Vì vậy, tôi không muốn ngừng sử dụng rượu của mình. Và, bạn biết đấy, trong một số trường hợp, họ sẽ là những người uống rượu với mức độ tiêu thụ cao và trung bình. Bạn sẽ nói gì với những người đó? Vâng, trước tiên, không có sự phán xét ở đây. Vì vậy, một phân tử ethanol không có đạo đức nhiều hơn hay ít hơn một phân tử glucose. Bạn có thể nói điều tương tự về chế độ ăn kiêng. Chúng ta hiện có nhiều nhận thức về thực phẩm chế biến và bột trắng cũng như đường trắng. Điều đó không có nghĩa là mọi người sẽ sống theo lối sống khổ hạnh, nơi họ không bao giờ ăn món tráng miệng. Vì vậy, tôi nghĩ thực sự là, bạn cần phải vào cuộc với đôi mắt mở to và hiểu rõ những rủi ro, điều gì quan trọng đối với bạn, và làm thế nào để bạn đưa ra quyết định đó. Vì vậy, nếu bạn quyết định đó là một lựa chọn bạn muốn thực hiện, bạn nên chuẩn bị cho mình để thành công. Nếu bạn quyết định, như tôi muốn giảm bớt lượng rượu mình uống, nhưng tôi sẽ đi đến giờ hạnh phúc mỗi tối với bạn bè và chỉ cố gắng không uống khi tôi ở đó, có lẽ bạn sẽ không thành công lắm vì bạn sẽ có mặt trong một tình huống luôn nhắc nhở về việc sử dụng rượu và mọi người xung quanh bạn đều sử dụng rượu. Vì vậy, hãy cố gắng thực hiện một số thay đổi cấu trúc trong cách bạn thiết lập cuộc sống và tuần và ngày của bạn. Và bạn có thể thấy rằng, thực sự, bạn không thiếu nó nhiều đến vậy, rằng bạn có thể cắt giảm ba hoặc bốn ngày uống rượu và vẫn nhận được niềm vui xã hội trong hai ngày trong tuần và rủi ro sức khỏe tổng thể của bạn sẽ giảm xuống đáng kể. Trong việc điều trị ai đó có vấn đề lạm dụng rượu, phục hồi chức năng thường là hình thức điều trị được biết đến nhiều nhất. Một trong những người bạn của tôi đã đấu tranh với chứng nghiện rượu rất nghiêm trọng, nhưng cũng là nghiện ma túy, đã nói với tôi nhiều lần, anh ấy đã từng nói, tôi đã đi phục hồi chức năng ba hoặc bốn lần rồi mà vẫn không có hiệu quả. Vâng. Và tôi nghĩ rằng khi phương pháp điều trị phổ biến nhất hoặc nổi tiếng nhất không hiệu quả với bạn, bạn sẽ có cảm giác tuyệt vọng lớn hơn. Bạn có phải là fan của phục hồi chức năng không? Nói chung, không.
    Dịch đoạn văn sau sang tiếng Việt:
    Vì vậy, bạn biết đấy, phục hồi chức năng là ý tưởng rằng bạn đi đâu đó trong một tuần, hai tuần, rồi bạn như được chữa khỏi, đúng không? Nó gần như là mọi người đã nghĩ rằng nghiện là một loại nhiễm trùng mà bạn cần, như, hai tuần kháng sinh rồi xong. Những gì chúng ta thực sự hiểu là đối với nhiều người, nghiện giống như một bệnh mãn tính hoặc thậm chí như ung thư, nơi bạn cần rất nhiều điều trị ngay từ đầu trong vài năm đầu tiên. Và theo thời gian, bạn đạt được sự ổn định và vào thời kỳ thuyên giảm, gần như bạn trở thành một người sống sót sau ung thư. Bạn đang trong quá trình phục hồi lâu dài. Và vì vậy, ý tưởng rằng bạn đi đâu đó trong vài tuần và sau đó bạn trở ra và hoàn toàn khỏe mạnh thực sự không phù hợp với những gì chúng ta biết về nghiện.
    Vấn đề khác là nhiều điều xảy ra trong quá trình phục hồi thực sự không có giá trị trị liệu trong hầu hết thời gian. Vì vậy, những thứ mà chúng ta biết là hiệu quả nhất cho nghiện, một là thuốc, mà có rất nhiều sự kỳ thị và sự hiểu lầm về chúng. Và sau đó, thứ hai là, như, liệu pháp tâm lý dựa trên bằng chứng. Những thứ như liệu pháp hành vi nhận thức, liệu pháp tăng cường động lực, bạn biết, làm việc về chấn thương tiềm ẩn của bạn. Thường thì trong các cơ sở phục hồi, mô hình thực sự được xây dựng quanh ý tưởng, như, bạn tách mình khỏi môi trường này. Bạn tham gia vào một số nhóm trong khi bạn ở đó. Đôi khi, thường thì chúng dựa trên mô hình hỗ trợ đồng đẳng hơn. Đôi khi, các liệu pháp được cung cấp, thành thật mà nói, không phải là rất dựa trên bằng chứng. Như là, chúng tôi thực sự đã thực hiện một nghiên cứu này. Đó là một nghiên cứu người mua bí mật, nơi chúng tôi gọi đến các chương trình phục hồi trên toàn quốc để hỏi về những gì họ cung cấp. Và nhiều trong số đó cung cấp những điều như, bạn biết đấy, liệu pháp cưỡi ngựa hoặc liệu pháp hỗ trợ cá heo, mà, như, tôi chắc chắn là rất tuyệt vời khi bơi với cá heo và làm việc với ngựa. Nhưng đó không phải là điều đã được nghiên cứu và hiệu quả. Và nhiều nơi không cung cấp những điều mà chúng ta biết là thực sự hiệu quả, là, bạn biết đấy, các nhà trị liệu được đào tạo trong các liệu pháp dựa trên bằng chứng hoặc liệu pháp thuốc.
    Vì vậy, nó là sự kết hợp của, như, một giải pháp ngắn hạn cho một vấn đề dài hạn và không thực sự nhận được điều trị mà bạn cần. Vậy những gì thực sự hoạt động, như, cho rối loạn sử dụng rượu, hầu hết mọi người không biết. Chúng tôi có những loại thuốc rất hiệu quả có thể giúp bạn, ngay cả khi bạn chỉ muốn không uống nhiều hơn. Vì vậy, có một loại thuốc mà tôi đã đề cập ở đầu, thực sự chặn các thụ thể opioid của bạn. Vâng. Điều đó có vẻ hơi buồn cười rằng nó hoạt động với rượu. Nhưng lý do nó hoạt động là vì đối với những người mà phần nào trong lý do khiến họ uống là họ uống, họ cảm nhận được cảm giác giảm đau từ sự giải phóng opioid trong não. Và điều đó khiến họ muốn uống nhiều hơn. Nếu bạn chặn điều đó, mọi người không cảm thấy bị ốm khi uống, nhưng họ chỉ không thấy nó thú vị nữa. Và có một người tên là Sinclair, thực sự, ở châu Âu đã thực hiện một số thí nghiệm thú vị bằng cách sử dụng nó khi cần. Vì vậy, thay vì uống nó như một loại thuốc hàng ngày, nếu bạn biết rằng khi bạn tham gia một sự kiện nghỉ lễ, bạn sắp uống nhiều hơn những gì bạn muốn uống, bạn uống nó, như, 30 phút trước khi bạn đi. Và sau đó điều mà mọi người nhận ra là họ có, như, một ly, và họ sẽ như, ah, tôi ổn. Tôi không có cảm giác muốn uống thêm nữa vì tôi đã không cảm nhận được cảm giác tốt đẹp và giảm bớt.
    Bạn nghĩ gì về các loại psychedelics như một cách để chống lại các hành vi nghiện như những điều chúng ta đã mô tả? Vâng. Một trong những thử nghiệm quan trọng nhất trong vài năm qua cho rối loạn sử dụng rượu là psilocybin. Vì vậy, có một nghiên cứu lớn về liệu pháp tâm lý hỗ trợ psilocybin cho rối loạn sử dụng rượu, đã cho thấy hiệu quả thực sự đáng chú ý. Vì vậy, mọi người uống psilocybin, thực sự so sánh, mọi người đến và họ nhận được một liều lớn của Benadryl hoặc psilocybin, và sau đó họ ngồi với một nhà trị liệu trong khoảng tám giờ cho cuộc hành trình psilocybin có hướng dẫn này. Và họ phát hiện rằng mọi người uống ít hơn nhiều sau đó, vì vậy thực sự có vẻ như nó có hiệu quả nào đó. Và suy nghĩ là rằng một phần cách mà các chất gây ảo giác hoạt động là chúng tăng cường độ linh hoạt của não, có nghĩa là khả năng của não để hình thành các con đường mới và kiểu tái đào tạo chính nó. Vì vậy, nó thực sự có vẻ như là một liệu pháp tiềm năng cho rối loạn sử dụng rượu. Psilocybin là hợp chất hoạt động trong những chiếc nấm ma thuật. Vâng, chính xác. Bạn đã nghe nói về Ibogaine chưa? Tôi đã nghe, vâng. Thường được liên kết, đó là một loại psychedelic khác thường liên kết với nghiện. Vâng. Mọi người đã xem xét Ibogaine cho rối loạn sử dụng opioid. Những nghiên cứu đó ít hứa hẹn hơn so với psilocybin, mặc dù nó chưa được kiểm tra theo những cách nghiêm ngặt tương tự gần đây. Một phần là cho rối loạn sử dụng opioid, chúng tôi có những loại thuốc rất hiệu quả đã được chứng minh là cải thiện khả năng phục hồi và giảm tỷ lệ tử vong, vì vậy thật khó để tốt hơn điều đó. Một điều rất thú vị, như, một loại thuốc hoàn toàn mới cho rượu là những loại thuốc đang được sử dụng cho việc giảm cân mà mọi người có lẽ đã nghe nói. Vì vậy, như, Wagovi, Ozempic, toàn bộ lớp thuốc GLP-1 đó dường như cũng giảm việc sử dụng rượu, điều này khá thú vị. Thật sao? Vâng. Họ đã nghiên cứu điều đó chưa? Vâng. Vì vậy, họ, tốt, trước hết, có, nghĩa là, có những chủ đề Reddit và cộng đồng trực tuyến toàn bộ về điều này nơi mọi người đã được kê đơn cho tiểu đường hoặc để giảm cân, và họ đột nhiên nói, tôi không thực sự muốn hút thuốc hoặc uống nữa. Như, cảm giác thúc đẩy đó đã biến mất hoàn toàn. Và đối với một số người, họ thực sự mô tả nó như là, như, kỳ diệu. Họ đã cố gắng ngừng uống trong nhiều năm và lần đầu tiên, họ không cảm thấy cảm giác thèm muốn và khát khao đó. Và gần đây đã có một số thử nghiệm lâm sàng thực sự nơi họ đã thực hiện, bạn biết đấy, các nghiên cứu mù ngẫu nhiên có kiểm soát giả dược và đã cho thấy rằng nó giảm việc uống rượu.
    Và vì vậy, đây là một lĩnh vực rất thú vị, nơi mà dường như những loại thuốc đó có thể làm tái khởi động cơn thèm thuốc và cảm giác thèm ăn một cách toàn diện và không chỉ dành riêng cho thực phẩm.
    Cái quái gì thế này?
    Tôi sẽ cho bạn biết.
    Tất cả các bạn có lẽ đều biết rằng tôi dành một lượng lớn thời gian trong năm, khoảng 50 tuần một năm, để đi du lịch khắp thế giới.
    Và một trong những mẹo tuyệt vời mà tôi luôn chia sẻ khi đi du lịch là hãy đóng gói thật nhẹ nhàng có thể.
    Bởi nếu bạn làm vậy, tôi thấy rằng mình có thể tiết kiệm hàng giờ đồng hồ bằng cách không phải kiểm tra hành lý và sau đó phải chờ đợi chúng ở bên kia.
    Vì vậy, tôi luôn mang theo một chiếc túi nhỏ, xinh xắn có thể để trên đầu trong máy bay.
    Bất cứ nơi nào tôi đi, ngay cả cho những chuyến đi kéo dài hàng tuần, đó là một mẹo du lịch cực kỳ hữu ích.
    Và đó là lý do tại sao tôi phải nói với bạn về nhà tài trợ cho chương trình hôm nay, Exeter.
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    Bạn có thể tìm hiểu thêm tại exeter.com.
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    Đó là exeter.com với mã DOAC.
    Một trong những cách mà nhiều người trong chúng ta hiểu về nghiện, nếu chúng ta chưa trải nghiệm nó trực tiếp trong cuộc sống của chính mình, là chúng ta nhìn lên các hình mẫu trên ti vi và trong nền văn hóa người nổi tiếng.
    Và chúng ta thấy những hình mẫu này, những người mà chúng ta thấy trên sân khấu bắt đầu suy yếu và deteriorating trong mắt công chúng.
    Và cuối cùng, dường như thường xuyên là điều không thể tránh khỏi rằng một ngày nào đó tiêu đề của TMZ sẽ vang lên và nói rằng người đó đã qua đời.
    Và điều đó xảy ra quá thường xuyên.
    Chúng ta nghĩ về, bạn biết đấy, Whitney Houston hoặc tôi đoán Michael Jackson cũng đã được liên kết với cái chết do nghiện.
    Tôi nghĩ đó là thuốc giảm đau hay cái gì đó.
    Prince, Elvis Presley, Mac Miller, người mà rất nhiều người cũng biết đến.
    Và rồi Nicole Smith.
    Và ngay cả bây giờ trong mắt công chúng, có một số cá nhân mà chúng ta bắt đầu thấy hành vi thất thường này.
    Họ đang đăng bài trên Instagram của họ.
    Họ xuất hiện trong xã hội theo một cách hơi khác.
    Khi bạn thấy điều đó trong lĩnh vực công việc mà bạn hoạt động, phản ứng tự nhiên của bạn là gì?
    Nó khiến bạn cảm thấy như thế nào khi, bạn biết đấy, vì có một vài người mà tôi đang nghĩ đến lúc này mà thế giới đang nói về, bạn biết đấy, chúng ta nghĩ họ có một căn bệnh nghiện.
    Chúng ta nghĩ họ cần giúp đỡ.
    Phản ứng tự nhiên của bạn với điều đó là gì?
    Và những người đó cần gì?
    Vâng.
    Khi tôi đọc tiêu đề về một người đã qua đời, tôi có nghĩa là, đối với tôi, điều đó thật đau lòng và xé lòng.
    Một phần, bởi vì rõ ràng đó là một sinh mạng của con người, với một người mẹ, một người chị hoặc một người anh và những người đã chăm sóc một nhân vật công chúng mà mọi người đã ngưỡng mộ và quan tâm.
    Nhưng phần lớn đó là một cái chết hoàn toàn có thể ngăn chặn được.
    Thật sự thì không ai nên chết vì một cái chết liên quan đến chất kích thích.
    Chúng ta có các công cụ để điều trị nghiện.
    Chúng ta biết cách ngăn chặn những tác hại của, bạn biết đấy, quá liều thuốc, chẳng hạn.
    Và vì vậy sự thực rằng ai đó có thể chết, đặc biệt là ai đó mà mọi người đã theo dõi từ rất lâu, tôi nghĩ chỉ là một ví dụ bi thảm về sự mismatch giữa những gì chúng ta làm xung quanh nghiện và những gì khoa học nói là thực sự hữu ích.
    Tôi nghĩ, bạn biết đấy, khi tôi thấy ai đó đang có dấu hiệu nghiện, thật buồn khi thấy điều đó xảy ra quá công khai mà không ai có thể hỗ trợ người đó.
    Và điều đó không phải là một phép diệu kỳ.
    Nó sẽ không giống như, bạn biết đấy, bạn có một cuộc can thiệp.
    Người đó đi điều trị, và trở nên tốt hơn mãi mãi.
    Điều đó tôi nghĩ thường có trong tâm trí mọi người.
    Đó là một quá trình, một hành trình, giống như bất kỳ sự thay đổi nào.
    Và vì vậy thực sự nó xoay quanh nơi chúng ta bắt đầu, ý tưởng về cách bạn bắt đầu hiểu với người này, cách mà việc sử dụng chất của họ cản trở những gì họ muốn cho chính họ?
    Và cuộc sống của họ có thể trở nên tốt hơn thế nào dựa trên những gì họ tin rằng điều tốt hơn là nếu họ thực hiện những thay đổi đối với việc sử dụng chất của họ?
    Tôi nhớ có một người bạn đặc biệt đã nghiện, và tôi nhớ luôn là linh hồn của bữa tiệc.
    Và tôi nhớ một ngày nọ, anh ấy đến gặp tôi tại một sự kiện và ngồi xuống trước mặt tôi và nói với tôi, anh ấy thì thầm với tôi, anh ấy nói, anh ấy rất đau đớn.
    Và anh ấy kể cho tôi về việc điều trị phục hồi và cách mà nó đã thất bại với anh ấy, v.v.
    Nhưng điều đó gần như nghe có vẻ không thể tin được rằng một người với nụ cười lớn như vậy lại thì thầm với tôi, đặc biệt là một người đàn ông, vì đàn ông không thực sự nói nhiều về cảm xúc của họ.
    Tôi đang trong rất nhiều cơn đau.
    Và sau đó hài hước là tôi thấy cách mà thế giới đối xử với cá nhân đó, việc anh ấy đã thì thầm điều đó với tôi một ngày.
    Và thế giới, cách mà thế giới đáp ứng với hành vi của anh ấy và tấn công anh và chỉ trích anh.
    Nhưng tôi đã được nghe thì thầm đó.
    Vâng.
    Và cái thì thầm đó đã giúp tôi tái định hình cách đối xử với người đó, nhưng cũng thực sự là những gì nằm ở trung tâm của những gì đang diễn ra.
    Và có thể mang lại cho bạn rất nhiều sự đồng cảm, bạn biết đấy.
    Rất nhiều sự đồng cảm.
    Bởi vì tôi sẽ giống như phần còn lại của thế giới.
    Tôi đã chỉ nghĩ, ồ, thật là một tên ngốc.
    Thật là một kẻ ngu ngốc.
    Như, tại sao anh ấy lại làm như vậy? Đó là hành vi kỳ lạ.
    Vâng.
    Và bạn đã nói một điều thực sự quan trọng đó là một sự chuyển biến nhẹ trong ngôn từ.
    Bạn không nói anh ấy thất bại trong việc điều trị.
    Bạn nói rằng việc điều trị đã thất bại với anh ấy.
    Và điều đó rất quan trọng bởi vì tôi nghĩ quá thường xuyên, chúng ta đã khiến nó dường như mọi người đang thất bại.
    Như, nếu họ đi đến phục hồi mà họ không khỏi bệnh, thì đó là vấn đề của họ, bạn biết đấy.
    Và thực sự, việc điều trị đã không đúng với họ.
    Nếu ai đó bị ung thư và bệnh ung thư của họ quay lại hoặc không được điều trị bằng hóa trị, chúng ta sẽ không nói, giống như, ôi, họ đã thất bại.
    Bạn biết đấy, chúng ta sẽ nói, ừ, điều trị tiếp theo là gì?
    Làm thế nào chúng ta có thể đưa họ đến bác sĩ phù hợp?
    Và vì vậy có một sự đổ lỗi cá nhân này, và điều đó gây ra sự kỳ thị, mà là một trong những lý do chính mà mọi người không chia sẻ rằng họ đang gặp khó khăn với các chất, rằng họ không tìm kiếm điều trị.
    Và vì vậy, chúng ta có rất nhiều sự kỳ thị đối với sự nghiện ma túy và rượu. Đây là một trong những điều kiện xã hội bị kỳ thị nhiều nhất trên toàn cầu. Và vì vậy, tất nhiên, nếu bạn là một người bắt đầu nghĩ rằng, ôi, có thể tôi thực sự có vấn đề. Chẳng hạn, có thể việc sử dụng rượu của tôi đang cản trở mọi thứ, thì thật khó để nói gì vì bạn lo lắng rằng mình sẽ bị đánh giá, bị gán nhãn hoặc bị hiểu lầm. Trong một số trường hợp, điều khủng khiếp có thể xảy ra với bạn. Bạn có thể bị tước quyền nuôi con bởi, bạn biết đấy, cơ quan bảo vệ trẻ em. Bạn có thể mất nhà ở hoặc mất việc làm. Và vì vậy, sự kỳ thị đó đã góp phần vào một vòng luẩn quẩn khủng khiếp nơi mà mọi người, bạn biết đấy, phải thì thầm với ai đó. Nó cho thấy anh ấy đã tin tưởng bạn đến mức nào để có thể thành thật nói về những gì anh ấy đã trải qua vì có quá nhiều sự kỳ thị về chính tình trạng này. Bạn chắc chắn đã có nhiều trường hợp khiến bạn đau lòng. Đúng. Bạn có thể kể cho tôi một trường hợp đã thay đổi bạn không? Ôi trời, nhiều quá. Bạn biết đấy, có một người đàn ông đặc biệt, ông ấy đã chiến đấu với sự nghiện heroin trong một thời gian dài và đã như chúng ta đã nói, đó là một căn bệnh mãn tính đối với ông. Ông đã có những khoảng thời gian mà ông đã làm rất tốt. Ông đã có những khoảng thời gian mà ông đã gặp khó khăn và luôn đảm bảo an toàn trong suốt thời gian đó. Và thực sự – một trong những mối quan hệ có ý nghĩa nhất trong đời ông ấy đã giữ ông ấy bên nhau là mối quan hệ với mẹ ông, và ông sống cùng bà. Họ sống trong nhà ở công cộng. Họ đã, bạn biết đấy, đang đối phó với sự bất ổn về kinh tế như nhiều người khác. Và ai đó đã phát hiện ra rằng ông đang ở cùng bà, và điều đó sẽ đặt bà vào rủi ro về nhà ở của bà. Vì vậy, ông không muốn bà mất nhà, nên ông đã rời đi, nhưng ông đã trở thành người vô gia cư mới. Và đột nhiên, chỉ vì những rào cản xã hội, ông đã phải đối mặt với áp lực của việc vô gia cư và cảm giác cô đơn. Và ngay cả khi có tất cả những liên kết mà ông đã có với mẹ ông và với việc điều trị, ông đã được tìm thấy đã chết giữa hai chiếc xe đậu. Ông đã sử dụng ma túy quá liều một mình trên đường phố. Và tôi luôn nghĩ, như thể – và bạn đã biết ông ấy. Ôi, đúng rồi. Những tác động dây chuyền mà, bạn biết đấy, không nhất thiết phải như vậy. Và tôi nghĩ có rất nhiều cái chết như vậy mà tôi chỉ nghĩ là không nhất thiết phải như thế này. Bạn biết đấy, thực sự không ai nên chết như thế này. Và có rất nhiều điều mà, bạn biết đấy, trong khoảnh khắc cảm thấy như không nằm trong tầm kiểm soát của chúng ta. Và tôi nghĩ đó là một phần lý do tạo động lực cho niềm đam mê của tôi với công việc này là tôi không thể luôn cứu được người trước mặt mình hoặc thay đổi vấn đề về vô gia cư hoặc chính sách nhà ở. Nhưng tôi có thể cố gắng làm việc ở quy mô rộng hơn để tạo ra sự khác biệt cho người tiếp theo. Và tôi nghĩ rằng điều đó – điều đó, đối với tôi, cân bằng lại một phần sự đau khổ khi mất đi những người mà tôi quan tâm. Nếu bạn là tổng thống Hoa Kỳ, chẳng hạn, hãy sử dụng đất nước này như một ví dụ, và bạn phải thực hiện những thay đổi ở thượng nguồn đối với cách mà xã hội được thiết kế nhằm giảm thiểu triệu chứng nghiện và hành vi nghiện. Những điều nào bạn sẽ thay đổi về cách mà xã hội của chúng ta được thiết kế? Bạn có thể thay đổi bất cứ điều gì. Đúng. Ý tôi là, bắt đầu từ ở thượng nguồn, điều lớn nhất sẽ là xây dựng sức bền và xây dựng mối liên kết từ sớm. Vì vậy, bạn biết đấy, tôi nghĩ những điều này mà cảm thấy không liên quan đến nghiện bản thân lại thực sự có liên hệ sâu sắc khi chúng ta nghĩ về những trải nghiệm khó khăn trong thời thơ ấu. Vì vậy, khi chúng ta nghĩ về việc phòng ngừa cho trẻ em, bạn biết đấy, thường người ta đã nhìn vào, như giáo dục, như việc nói với mọi người – nói với trẻ em rằng ma túy là xấu. Điều đó không hiệu quả. Điều thực sự hiệu quả là xây dựng sức bền cho giới trẻ. Vì vậy, xây dựng sức bền, xây dựng mối liên kết. Vậy điều đó trông như thế nào? Nó trông như nhà ở hợp lý. Nó trông như những công viên nơi mọi người có thể ra ngoài và chơi thể thao, tập thể dục và xây dựng các mối quan hệ. Nó trông như việc hỗ trợ các gia đình để các gia đình có thể ở bên nhau và như vậy những mối quan hệ và sự gắn bó ban đầu có thể được hình thành tốt. Đó là công việc phòng ngừa thực sự là cố gắng phá vỡ chu kỳ của chấn thương giữa các thế hệ, nghèo đói, sử dụng chất và thực sự hỗ trợ các gia đình, cộng đồng ngay từ đầu. Nó làm tôi nhớ đến Rat Park. Đúng. Ừ, Rat Park là một ví dụ tuyệt vời về điều đó. Rat Park là gì đối với những ai không biết? Đúng. Vì vậy, Rat Park là một loạt các thí nghiệm mà đã được thực hiện, nơi mà họ thực chất đã lấy – họ đang cố gắng hiểu những tác nhân gây nghiện bằng cách sử dụng mô hình chuột. Và vì vậy, họ đã đưa chuột và có một mô hình trong đó chuột bị cô lập trong chuồng của chính chúng với không có gì để làm và không có kết nối với con người. Và chúng có thể tiếp cận một chất như morphine hoặc cocaine và chúng có thể ấn một cần gạt để có thêm. Và những con vật đó, khi bị thiếu kết nối và bị cô lập, không có gì để làm, đã sử dụng nhiều hơn chất đó. Nó cho chúng cảm giác dễ chịu. Chúng đã sử dụng nhiều hơn chất đó. Họ đã đưa những con vật đó vào một chiếc chuồng tuyệt vời, với nhiều khu vực để chơi, như những cái bánh xe để leo trèo và nhiều bạn bè và chuột khác. Và đột nhiên, họ thấy rằng những con vật đó không còn ấn cần gạt và cố gắng lấy thêm chất đó. Và bạn biết đấy, đây là một mô hình hơi đơn giản, có lẽ là quá đơn giản. Nhưng nó cho thấy rằng rất nhiều sự nghiện thực sự liên quan đến ý tưởng kết nối này, khôi phục lại kiểu thế giới xung quanh chúng ta, cộng đồng, sự liên kết mà chúng ta có, những cơ hội và mục đích và ý nghĩa và hy vọng. Vì vậy, tôi nghĩ đó là phòng ngừa thực sự. Và sau đó là cách chúng ta thực sự giải quyết những người đang gặp vấn đề. Và tôi nghĩ, bạn biết đấy, điều tôi sẽ làm ở đó là trước tiên làm cho việc điều trị nghiện trở nên sẵn có rộng rãi ngay khi mọi người cần đến nó.
    Khi bạn bước vào văn phòng của bác sĩ đa khoa hoặc ở phòng cấp cứu, bạn được tiếp đãi với lòng từ bi, với sự khoa học, với những người hỏi bạn họ có thể làm gì để giúp đỡ và cung cấp cho bạn sự chăm sóc hiệu quả như cách họ làm nếu bạn vừa nhận được chẩn đoán ung thư mới hoặc một chẩn đoán mới về vấn đề tim mạch.
    Và chúng ta hoàn toàn phải định hướng lại điều trị để nó giống với cách mà chúng ta nhìn nhận bất kỳ vấn đề sức khỏe nào khác.
    Và chúng ta cần dừng lại việc trừng phạt những người sử dụng chất kích thích, nơi mà, bạn biết đấy, nhiều lúc người ta vẫn bị gửi vào tù vì việc sử dụng chất kích thích, điều này, bạn biết đấy, tạo ra một thông điệp hỗn loạn.
    Nếu chúng ta nói đây là một vấn đề sức khỏe ở một khía cạnh, nhưng cùng lúc đó chúng ta lại đưa bạn vào tù, thì hai điều này không nhất thiết phải phù hợp với nhau.
    Nhiều người chúng ta đang sống trong mô hình đầu tiên của Rat Park.
    Đúng vậy.
    Chúng ta sống một mình.
    Chúng ta sống ở những thành phố lớn này.
    Chúng ta đang ít vận động hơn bao giờ hết.
    Có thể, bạn biết đấy, chúng ta chuyển đến một thành phố lớn vì chúng ta không có, có nghĩa là chúng ta không có gia đình xung quanh.
    Chúng ta có thể đang làm một công việc.
    Thật sự thách thức.
    Vì vậy, không có gì ngạc nhiên khi khi nghĩ về nghiện và rượu và một số hành vi khác, nhưng rộng hơn ngoài rượu như một chất kích thích, những hành vi nghiện khác, cho dù là mạng xã hội hay thứ chúng ta ăn uống hay khiêu dâm hay trong những thói quen tốt, thực phẩm lành mạnh, tập thể dục, những hành vi có năng suất, tại sao chúng ta lại đang gặp khó khăn đến thế.
    Và tôi thường tự hỏi liệu chúng ta nên đến như những nơi cộng đồng và sống, bạn biết đấy?
    Đúng vậy.
    Trong các nhóm.
    Tôi có ý rằng tôi không nghĩ con người được sinh ra để sống như thế này.
    Và đây là một điều tương đối mới, đúng không?
    Chúng ta thường sống trong một làng hoặc một cộng đồng.
    Chúng ta sống trong những hộ gia đình đa thế hệ.
    Tôi có những đứa trẻ nhỏ và tôi nghĩ việc có con thật sự mở mang mắt của tôi về điều đó, như kiểu, ôi, điều đó có lý do vì sao mọi người sống với cha mẹ và ông bà của họ và có những gia đình lớn để tạo ra, bạn biết đấy, cộng đồng và một dạng gia đình mở rộng xung quanh mình.
    Và chúng ta đã mất mát điều đó theo nhiều cách.
    Và tôi nghĩ những cách mà chúng ta từng có được điều đó, như tôn giáo, có thể không – có thể điều đó vẫn còn đọng lại với một số người, nhưng với những người khác thì có thể không.
    Và vì vậy, tìm kiếm những cách khác để gắn bó, để tìm kiếm ý nghĩa và mục đích, có thể qua rất nhiều điều khác nhau.
    Bạn biết đấy, tôi nghĩ mọi người đang tìm kiếm những cách sáng tạo để làm điều đó.
    Nó có thể là qua việc tìm kiếm một hoạt động tình nguyện, tìm kiếm một loại nhóm xã hội khác nào đó.
    Một số người làm điều đó qua thể thao.
    Bạn biết đấy, họ tìm thấy sự kết nối và tham gia với những người mà họ không thực sự quen biết qua tình yêu chung quanh một hoạt động hoặc một đội nhóm.
    Nhưng thực sự, nhìn nhận điều đó như một ưu tiên cũng giống như bạn sẽ ưu tiên những điều khác trong cuộc sống và sức khỏe của bạn.
    Và bạn có phải là một người ủng hộ liệu pháp như một phương pháp để giải quyết các chấn thương thời thơ ấu không?
    Chắc chắn rồi, vâng.
    Tôi nghĩ một trong những vấn đề là quá nhiều lần liệu pháp đã bị áp đặt lên mọi người.
    Tôi nghĩ rằng tôi chủ trương nhiều hơn vào việc chúng ta cần làm cho việc điều trị có sẵn, thân thiện và chất lượng cao để mọi người có thể hưởng lợi từ nó.
    Và liệu pháp là một phần rất lớn trong đó.
    Bạn biết đấy, nó liên quan đến rất nhiều điều.
    Nó liên quan đến sự kết nối.
    Nó liên quan đến việc tìm hiểu những lý do tại sao mọi người sử dụng ngay từ đầu, giải quyết và chữa lành những chấn thương đó.
    Điều đó cũng quan trọng rằng chúng ta có những nhà trị liệu tốt, được đào tạo tốt, có lòng đồng cảm.
    Vì vậy, đã có rất nhiều nghiên cứu thú vị xem xét thực sự xem một nhà trị liệu có lòng đồng cảm như thế nào, có lẽ là yếu tố dự đoán mạnh mẽ nhất về việc bạn có ngừng sử dụng, thay đổi việc sử dụng rượu hoặc ma túy hay không.
    Thật sao?
    Điều này thật sự thú vị bởi vì chúng ta thường nghĩ rằng, bạn biết đấy, bạn có thể đã nghe ai đó nói rằng, tôi không thực sự thích nhà trị liệu của mình.
    Và tôi nghĩ phản ứng của ai đó về điều đó là như, ôi, như bạn không thực sự thích liệu pháp.
    Nhưng họ thực sự đã làm rất nhiều nghiên cứu cho thấy rằng một nhà trị liệu kém đồng cảm, khách hàng của họ có khả năng sử dụng nhiều chất kích thích hơn vào cuối khóa điều trị đó.
    Vì vậy, thực sự có một lực lượng lao động được đào tạo tốt, đầy lòng nhân ái và dựa trên bằng chứng là cực kỳ quan trọng.
    Và tôi đoán điều đó cũng áp dụng cho gia đình và bạn bè.
    Vâng.
    Vâng.
    Tôi nghĩ lòng đồng cảm thực sự mạnh mẽ.
    Những thứ kiểu như vậy mà chúng ta nghĩ là kỹ năng mềm thực sự rất quan trọng.
    Có thể kéo ai đó đứng lên được không?
    Tôi, bạn biết đấy, bởi vì tôi đã nói chuyện với, tôi nghĩ là đã nói chuyện với Tiến sĩ Anna Lenke về điều này, về ý tưởng rằng bạn có thể đóng vai trò trong sự nghiện của ai đó.
    Đúng vậy.
    Tôi muốn giúp một người bạn của tôi đang nghiện.
    Và vì vậy tôi ở đó với họ.
    Tôi đang an ủi họ.
    Nhưng thực tế là theo một cách nào đó tôi đang củng cố hành vi nghiện đó bởi vì tôi, tôi đang củng cố tích cực nó bởi vì tôi đang hỗ trợ họ rất nhiều và tôi yêu họ rất nhiều.
    Và tôi đang cho họ rất nhiều sự chú ý đồng cảm mà thực tế tôi đang đóng vai trò trong việc tiếp tục sự nghiện đó.
    Có phải điều đó là khả thi không?
    Vâng.
    Ý tôi là, đây là khái niệm như kích thích, mà tôi nghĩ là tinh tế.
    Tôi sẽ nói rằng về cốt lõi, điều đó thực sự có vấn đề rất lớn rằng hầu hết, tình yêu và sự hỗ trợ sẽ không bao giờ gây hại.
    Và khi tôi nói chuyện với bệnh nhân, thường điều đã khiến họ cuối cùng tham gia vào điều trị không phải là một hậu quả tồi tệ nào đó.
    Nó là ý tưởng rằng ai đó quan tâm đến họ đủ trong một khoảnh khắc mà họ không yêu bản thân mình rất nhiều và cảm thấy tuyệt vọng rằng ai đó sẵn lòng nâng đỡ họ và tin vào họ.
    Và đó là những khoảnh khắc nhỏ của sự tử tế.
    Như tôi sẽ kể cho bạn một câu chuyện về một bệnh nhân mà chúng tôi đã chăm sóc trong bệnh viện, người đã ở đó vì một loại nhiễm trùng đe dọa đến tính mạng liên quan đến việc sử dụng thuốc của họ.
    Và một năm đúng ngày sau khi anh ấy nhập viện, anh ấy đã viết một bức thư cho đội ngũ của chúng tôi và anh ấy đã nói, bạn biết đấy, tôi sẽ không bao giờ quên những khoảnh khắc mà các bạn đến và chỉ ngồi cùng tôi và nói chuyện với tôi.
    Và giờ đây, anh ấy gửi một email mỗi năm vào ngày kỷ niệm khi anh ấy xuất viện khỏi bệnh viện. Và chính những khoảnh khắc nhân văn, sự kết nối, lại là ý tưởng kết nối thường là chất xúc tác cho sự thay đổi, loại hy vọng và niềm tin rằng cuộc sống của bạn có thể trở nên tốt đẹp hơn theo cách nào đó, thay vì ý tưởng như là làm tăng thêm nỗi đau và sự khổ sở của ai đó. Và điều đó diễn ra theo nhiều cách khác nhau. Trong các gia đình, một trong những công cụ hiệu quả nhất mà chúng tôi dạy cho mọi người là một cái gọi là CRAFT, viết tắt của Tăng cường Cộng đồng và Đào tạo Gia đình. Nó rất khác với, như, những gì mọi người có thể đã thấy, như là các chương trình mà bạn phải dàn dựng một buổi can thiệp và nói với ai đó tất cả hoặc không có gì. Nhưng CRAFT thì rất khác. Nó dạy cho mọi người, trước tiên, làm thế nào để hiểu về khoa học của nghiện, các thành viên trong gia đình? Thứ hai, làm thế nào để bạn nhận được sự hỗ trợ cho bản thân? Bởi vì thật sự rất khó để đối phó với nghiện trong một gia đình. Và sau đó bạn bắt đầu học về hậu quả theo một cách khác? Như là, nếu bạn là một bậc phụ huynh và đứa trẻ của bạn nghỉ học vì chúng đang sử dụng, bạn không muốn bao che cho chúng và củng cố hành vi của chúng. Nhưng bạn cũng không cần phải đuổi chúng ra khỏi nhà, rằng có những mức độ hậu quả khác nhau thực sự có thể giúp người khác thay đổi. Một trong những động lực lớn nhất cho sự thay đổi thực sự là sự củng cố tích cực những hành vi mà bạn muốn thấy. Điều đó đã được gọi là quản lý điều kiện trong thế giới điều trị. Và, bạn biết đấy, các công ty bảo hiểm sức khỏe, nhiều công ty đã nhận ra điều này, đúng không? Nếu bạn nhận lại tiền vì tham gia một phòng tập thể dục hoặc bạn nhận được các khoản hoàn tiền cho việc làm điều mà mọi người muốn thấy, họ sẽ làm nhiều hơn nữa. Điều đó đúng trong hành vi con người. Nó rất đúng với nghiện. Nhưng chúng ta thường làm điều trái ngược. Chúng ta cố gắng trừng phạt mọi người để họ khỏe hơn thay vì củng cố loại hành vi lành mạnh mà chúng ta muốn thấy nhiều hơn, nếu điều đó có ý nghĩa. Vâng, tôi đoán tôi đang cố gắng đại diện cho một thành viên khán giả đang lắng nghe điều này ngay bây giờ, người biết ai đó trong cuộc sống của họ đã có hành vi nghiện. Và họ đã cố gắng thể hiện sự đồng cảm. Họ đã cố gắng cung cấp sự hỗ trợ. Họ đã cố gắng giúp đỡ người đó nhưng mọi thứ vẫn không thay đổi. Vâng. Trong tình huống đó, có thể người gặp khó khăn với nghiện không chấp nhận sự hỗ trợ, không tham gia các cuộc họp, không nói chuyện với nhà trị liệu. Vâng. Trong một tình huống như vậy, khi bạn đang cung cấp sự giúp đỡ cho ai đó và họ không nhận, họ không sẵn lòng khám phá các phương pháp điều trị y tế khác nhau. Họ sống trong nhà của bạn, họ sống trong nhà của bạn, họ can thiệp vào cuộc sống của bạn, bất kể là gì. Liệu có điểm nào bạn nói rằng đủ là đủ? Vâng. Trước tiên, thật sự rất khó để ở đó như một thành viên trong gia đình hoặc bạn bè. Vì vậy, đối với bất kỳ ai đang lắng nghe, tôi đã ở đó, điều đó cực kỳ khó khăn. Hãy có lòng nhân hậu với bản thân bạn. Tôi nghĩ rằng quyết định khác mà bạn đang nói đến là vào một thời điểm nào đó bạn phải đưa ra quyết định để bảo vệ bản thân mình. Giả sử bạn có ai đó trong nhà của bạn đang đối mặt với nghiện, người mà, bạn biết, trở nên hung dữ hoặc đang ăn cắp tiền hoặc, bạn biết đấy, gây ra chấn thương cho những người sống trong nhà. Vào một thời điểm nào đó, bạn có thể cần phải quyết định rằng vì sức khỏe của mình, vì sức khỏe của cả gia đình, tôi không thể có điều này trong cuộc sống của tôi ngay bây giờ. Điều đó khác hoàn toàn với việc nói rằng đuổi họ đi sẽ làm cho họ khá hơn. Vì vậy, sự khác biệt ở đây là bảo vệ bản thân là điều hoàn toàn đúng. Đôi khi, chúng ta cần phải làm điều đó. Và đôi khi có những thứ chỉ có thể làm đến thế. Nhưng đừng đánh lừa bản thân rằng hành động đó là để giúp người khác, và điều đó cũng không sao cả. Tôi nghĩ rằng một phần khác là, bạn biết đấy, vào cuối ngày, trước tiên, thật dễ dàng hơn khi là một người điều trị. Vì vậy, tôi đã là một thành viên trong gia đình. Tôi đã là một nhà trị liệu. Là một nhà trị liệu, tôi thực sự có thể không điều kiện. Vì vậy, tôi sẽ là bác sĩ của ai đó cho dù họ tiếp tục sử dụng heroin hay tiếp tục uống rượu hay không. Và có điều gì đó thật đẹp trong điều đó. Như là sự gắn kết của tôi với ai đó không phụ thuộc vào việc họ có thay đổi hay không. Là một thành viên trong gia đình, điều đó khó hơn, đặc biệt nếu bạn là một đứa trẻ phụ thuộc vào ai đó hoặc bạn đang trong một cuộc hôn nhân hoặc một mối quan hệ. Vì vậy, bạn có thể phải đưa ra những lựa chọn khác. Nhưng tôi nghĩ rằng vào cuối ngày, mọi người không thay đổi chỉ vì lý do mà chúng ta nghĩ họ nên thay đổi. Họ thay đổi vì họ nghĩ cuộc sống của họ sẽ tốt đẹp hơn theo một cách nào đó. Vì vậy, chìa khóa trở thành việc tìm ra, như, tại sao cuộc sống của người này có thể tốt hơn nếu họ thực hiện thay đổi đối với việc sử dụng rượu hoặc ma túy của họ? Vì vậy, đó là một sự thay đổi mà bạn trở thành một phần của đội của họ thay vì cố gắng kéo họ đến nước, bạn biết đấy, kéo ngựa đến nước. Và có một loại bản năng con người thú vị là không ai trong chúng ta thích bị bảo phải làm gì. Vì vậy, có một cái gọi là phản xạ viết, mà thật sự rất khó cho những người chăm sóc. Thật khó cho các bậc phụ huynh bởi vì chúng tôi thích nói với mọi người, như, những lời khuyên tuyệt vời của chúng tôi và tại sao những gì họ đang làm là sai và họ nên nghe lời khuyên tuyệt vời của bác sĩ của chúng tôi. Và điều này có thể, như, nói với ai đó, như, bạn không thấy điều bạn đang làm đang gây hại sao? Bạn nên thay đổi. Nó cũng có thể tinh tế hơn. Nó có thể giống như, giảng giải cho ai đó hoặc cố gắng giáo dục họ. Nhưng khi ai đó nhét cái gì đó vào miệng bạn, bản năng của bạn là phản kháng. Đó chỉ là, hành vi tự nhiên của con người, ngay cả khi đó là một ý tưởng hay. Nếu ai đó, như, nhét một cái kem vào mặt bạn và bảo ăn đi. Ngay cả khi bạn thích kem, bạn có thể sẽ nói, chờ đã, tôi không chắc tôi muốn ăn kem này. Và vì vậy, chìa khóa là không cho ai đó biết phải làm gì. Mà là hiểu lý do tại sao họ muốn thay đổi. Và khi bạn làm điều đó, thì đột nhiên bạn nhận ra rằng, như, cảm giác tốt hơn.
    Bạn không cố kéo ai đó về phía nào. Nó không – bạn không có, kiểu như, lợi ích cá nhân trong quyết định mà họ đưa ra. Nhưng bạn thật sự là một đối tác với họ và cùng nhau tìm ra điều gì đang gây ra vấn đề cho bạn và tại sao cuộc sống của bạn có thể sẽ tốt hơn nếu bạn thay đổi cách sử dụng rượu hoặc cách uống rượu hoặc sử dụng chất kích thích. Sự khác biệt trong việc truyền đạt thông điệp đó là gì? Bởi vì cả hai cuối cùng đều hướng đến cùng một kết quả. Nhưng có vẻ như ngôn ngữ có thể khác nhau một chút. Vâng, rất khác. Trong ngôn ngữ y tế và ngôn ngữ trị liệu, chúng tôi nói về một khái niệm gọi là phỏng vấn động lực, đó là – nó trở thành giống như một trò chơi tâm trí. Nhưng về cơ bản, đó là cách cố gắng nhận diện từ người đó lý do của họ cho sự thay đổi và phản ánh lại cho họ. Vì vậy, không phải bạn nói với họ rằng bạn nghĩ họ nên thay đổi, mà bạn đang cố gắng khơi dậy động lực của họ và khuếch đại nó. Và cuối cùng, bạn đang trao lại quyền lực cho họ. Điều đó có thể trông giống như điều ai đó nói, bạn biết đấy – Tôi sẽ là bệnh nhân của bạn. Vậy, vâng, tôi thực sự uống nhiều. Tôi uống vài lần một ngày, đặc biệt là vào buổi sáng. Nhưng không sao cả. Bạn biết đấy, tôi vẫn quản lý để đến văn phòng mỗi ngày. Rõ ràng, tôi gặp một vài vấn đề kỷ luật tại nơi làm việc. Nhưng ngoài điều đó ra, bạn biết đấy, và bạn tôi đã rời bỏ tôi. Nhưng ngoài điều đó ra, tất cả mọi thứ vẫn ổn. Và tôi có thể quản lý điều này. Có vẻ như việc sử dụng rượu của bạn đang gây ra một số vấn đề tại nơi làm việc và trong các mối quan hệ của bạn. Đúng vậy, đúng vậy. Vâng, tôi đã mất – bạn tôi đã bỏ tôi. Và tôi vẫn liên tục nhận được những thông báo vi phạm kỷ luật ở công ty và kỷ luật vì đôi khi tôi đến trễ. Và khi tôi ở đó, đôi khi tôi ngủ gật, v.v. Và tôi – rõ ràng, tôi làm việc với máy móc lớn. Vì vậy có một chút rủi ro ở đó. Nhưng ngoài điều đó ra, thì cũng ổn. Có vẻ như bạn đang lo lắng về sự an toàn của mình tại nơi làm việc và cũng như việc uống rượu của bạn đang bắt đầu ảnh hưởng đến công việc và các mối quan hệ của bạn. Điều đó đúng, vâng. Tôi, bạn biết đấy. Tôi đã làm việc trên cần cẩu đặc biệt. Bị say xỉn trên cần cẩu đặc biệt đã gây ra một vài sự cố. Và, bạn biết đấy, đôi khi tôi rất lo lắng rằng một ngày nào đó điều đó sẽ đi quá xa, vâng. Vâng, có vẻ như điều đó thực sự đáng sợ là bạn rất lo lắng rằng việc sử dụng rượu của bạn có thể gây ra một tai nạn nghiêm trọng hay đe dọa đến tính mạng tại nơi làm việc. Vâng, và sau đó tôi sẽ làm gì để kiếm sống, bạn biết đấy, bởi vì nếu bạn có một điều như vậy trong hồ sơ của mình, thì tôi sẽ không bao giờ có thể trở thành một người vận hành máy móc nữa. Vâng, và công việc của bạn nghe có vẻ thật sự quan trọng đối với bạn. Nó rất quan trọng. Rượu đang bắt đầu cản trở điều đó. Vâng, 100%. Vâng. Vậy, những mục tiêu của bạn trong tương lai liên quan đến công việc hoặc mối quan hệ của bạn là gì? À, tôi biết tôi thực sự nên, tôi thực sự nên giải quyết vấn đề rượu này mà tôi có. Và tôi rất muốn tìm một người bạn đời. Điều đó thật sự quan trọng với tôi vì tôi muốn có một gia đình. Vì vậy, bạn biết đấy, rõ ràng điều kiện tiên quyết để có một gia đình là tìm một người bạn đời, thật sự. Vậy, vâng. Vâng, có vẻ như bạn thật sự cam kết suy nghĩ về việc thay đổi cách uống rượu của mình và bạn mong muốn tìm một người bạn đời và gia đình và bạn lo lắng rằng rượu có thể cản trở điều đó. Vì vậy, những gì bạn đang làm ở đó là bạn không đang dẫn dắt tôi, bạn đang kiểu như xô tôi, nếu điều đó có nghĩa. Có một chút như là một trò chơi tâm trí Jedi mà bạn đang – vì vậy thực chất, thực sự là – nó có chút khó khăn khi bạn lần đầu học cách làm điều đó vì điều tôi đang cố gắng làm là lắng nghe những gì được gọi là “thay đổi lời nói”. Vì vậy, bất kỳ thông tin nhỏ nào bạn cung cấp cho tôi về việc thay đổi. Vì vậy bạn đang nói như, “ồ, tôi bắt đầu nhận được những vi phạm này”. Tôi lo lắng về điều này liên quan đến an toàn nơi làm việc. Tôi muốn có một người bạn đời. Đó là như – đó là một kho vàng của những hạt nhỏ của sự thay đổi. Và tôi đang phớt lờ tất cả những lời nói duy trì của bạn. Vì vậy, bất kỳ điều gì mà bạn đang biện minh cho hiện trạng, không phải là vấn đề lớn. Uống rượu không phải là một vấn đề lớn. Tôi không thể thay đổi. Tôi thậm chí không thừa nhận nó hay đề cập đến nó. Và điều đó thực sự khó khăn vì tôi nghĩ hầu hết chúng ta chú ý đến những điều tiêu cực. Vì vậy, nếu bạn nghĩ về một cuộc đánh giá hiệu suất tại nơi làm việc hoặc ai đó cung cấp cho bạn bất kỳ loại phản hồi nào, chúng ta thường có xu hướng khuếch đại và nhớ như là một điều tồi tệ mà ai đó đã nói với chúng ta và quên đi hàng triệu điều tốt đẹp khác. Vì vậy, bạn phải thay đổi – bạn phải kiểu như đào tạo bản thân để làm điều ngược lại, để nghe những hạt nhỏ của “thay đổi lời nói”. Và sau đó, về cơ bản, tôi đang trở thành một chiếc gương, nhưng tôi đang khuếch đại nó. Vì vậy, tôi lấy những hạt nhỏ của “thay đổi lời nói”. Tôi phản ánh lại cho lời của chính bạn. Vì vậy, tôi không nói với bạn rằng bạn nên ngừng uống rượu vì nó không an toàn tại nơi làm việc. Tôi đang phản ánh lại cho bạn như là bạn đang bắt đầu lo lắng rằng bạn có thể gặp một tai nạn ở nơi làm việc, và điều đó thật sự nghiêm trọng. Và đó là một cách dẫn dắt cuộc trò chuyện tiến lên. Một điểm chính khác là nếu bạn gặp phải sự kháng cự, bạn muốn chuyển hướng vì khi bạn bắt đầu tranh luận, bất kể đó là về chính trị hay bất cứ điều gì, mọi người sẽ cố thủ. Vì vậy, nếu bạn bắt đầu tranh cãi với ai đó, bạn phải tìm một cách khác. Bạn chỉ cần phải chuyển hướng và chuyển sang một chiến thuật khác vì càng tranh luận, mọi người càng cố thủ trong quan điểm của họ. Điều đó rất quan trọng hơn là thắng cuộc tranh luận hơn là tiến lên. Thế còn nếu bạn muốn thay đổi chính mình thì sao? Có một quy trình, một hệ thống, một phương pháp nào đó để giúp bạn khám phá những hành vi lý tưởng của bạn, lý do của bạn là gì, và thực hiện sự thay đổi không? Đó là lý do tại sao tôi thường nói, lý do của bạn là gì? Tôi nghĩ điều đó thật hấp dẫn. Giống như tất cả chúng ta đều muốn sống cuộc sống tốt nhất của mình, bất kể điều đó có nghĩa là gì đối với chúng ta. Và vì vậy có một mục đích, có một mục tiêu có thể là điều quan trọng nhất. Động lực là quan trọng. Chúng ta nói rất nhiều về động lực.
    Nhưng động lực thì có thể phai nhạt. Nó có thể trượt qua và thay đổi trong suốt một ngày. Vì vậy, bạn có thể lấy một ví dụ khá bình thường. Bạn muốn có được vóc dáng đẹp và cảm thấy rất có động lực vào một ngày. Nhưng sáng hôm sau, đồng hồ báo thức của bạn kêu lúc 5 giờ sáng, và bạn cảm thấy mệt mỏi, trong khi nằm ấm áp trong chăn. Có thể là bạn thức khuya một chút. Lúc này, động lực của bạn sẽ giảm sút, đúng không? Nếu bạn không có một mục tiêu hay một lý do hay một đích đến, thì sẽ rất khó để thực sự có năng lượng để đứng dậy.
    Vì vậy, việc tìm ra mục đích của bản thân và cố gắng tìm cách tận hưởng quá trình rất quan trọng. Bởi vì nếu bạn luôn làm việc hướng tới một mục tiêu trong tương lai, một số người rất có định hướng mục tiêu và điều đó có hiệu quả với họ. Nhưng tìm ra niềm vui trong quá trình sẽ giúp bạn. Hãy để tôi lấy ví dụ về rượu. Không phải vấn đề nghiện ngập đâu. Chỉ là việc thay đổi thói quen uống rượu trong cuộc sống của bạn. Nếu bạn chỉ nghĩ, “Ôi, tôi nên ngừng uống rượu vì uống là xấu cho tôi.” Điều đó giống như một mục tiêu khá mơ hồ, đúng không? Nó không thực sự liên quan đến điều gì đó quan trọng với bạn.
    Và sẽ khó để tuân thủ điều đó. Nếu thay vào đó, bạn nghĩ, “Được rồi, tôi đã bắt đầu nhận ra rằng khi tôi uống mỗi đêm, tôi không hoàn thành công việc mà tôi muốn vì tôi quá mệt và ngủ thiếp đi. Tôi không cảm thấy tỉnh táo vào buổi sáng vì tôi không ngủ ngon. Tôi không dậy sớm để tập thể dục, và đó là điều thật sự quan trọng với tôi. Tôi không có mặt bên gia đình như tôi muốn.” Vậy thì tất cả những mục tiêu nhỏ này sẽ giúp bạn dễ dàng hơn để thay đổi. Có thể bạn quyết định, “Tôi sẽ không uống rượu.” “Tôi chỉ uống hai ngày trong tuần.” Và khi tôi uống rượu, tôi sẽ giữ ở mức đó. Nhưng lý do không phải là một khuyến nghị mơ hồ nào từ bác sĩ. Mà là vì bạn đang làm việc rất chăm chỉ, và cảm thấy tuyệt vời khi có năng suất làm việc sau bữa tối. Bạn đang tập luyện cho một cuộc đua và bạn muốn dậy vào buổi sáng để chạy. Và bạn thực sự nhận thấy những bước nhỏ đó, giống như, “Wow, thật tuyệt. Hôm nay tôi đã dậy và cảm thấy rất tỉnh táo.” Như vậy, bạn đang củng cố mục tiêu của mình ngay từ đó. Bạn không đang hướng tới một điều gì đó trừu tượng không thực sự quan trọng với bạn.
    Vì vậy, bạn muốn đặt ra những mục tiêu thật sự tập trung, cá nhân hóa và gắn chặt nó với lý do của bạn. Và lý do của bạn có thể rất khác so với lý do của tôi hay của người khác. Có thể là, như bạn biết đấy, giấc ngủ rất quan trọng với bạn. Hoặc, bạn có thể có một mối quan hệ khác với rượu. Một ví dụ khác mà tôi sẽ đưa ra là mọi người thì khác nhau, đúng không? Chúng ta phản ứng khác nhau với mọi thứ. Một số người có thể mở một túi khoai tây chiên và ăn hai cái rồi đi ra. Một số người khác thì khi họ mở túi, họ sẽ ăn hết tất cả. Và vì vậy, đơn giản hơn là không mở túi ra.
    Và rượu cũng giống như vậy. Một số người có thể thấy rằng nếu họ mở một chai rượu vang hay có rượu trong nhà, họ sẽ uống hết. Và ý tưởng về việc cố gắng giữ ở mức uống nhỏ thật ra rất khó. Thay vào đó, sẽ đơn giản và dễ dàng hơn nhiều nếu bạn hoàn toàn tránh xa hoặc chỉ uống khi ở nhà hàng hoặc gì đó. Vì vậy, bạn thực sự phải hiểu cách mà mục tiêu của bạn, lý do của bạn, mục đích của bạn tương tác với phản ứng của bạn đối với bất kỳ điều gì mà bạn đang làm việc. Và điều đó sẽ khác nhau với từng người.
    Có điều gì khác, những thói quen khác mà chúng ta nên nghĩ tới khi cố gắng vượt qua một cơn nghiện không? Nếu chúng ta coi rượu như ở đáy dòng suối, có điều gì khác ở thượng nguồn mà tôi nên suy nghĩ không? Chúng ta đã nói về các kết nối xã hội và mối quan hệ. Vì vậy, tôi cần đảm bảo rằng tôi được bao quanh bởi những người. Tôi đang giao lưu vì điều đó sẽ là một cách cách ly khỏi căng thẳng và cô đơn, điều sẽ gây khó chịu cho tôi, dẫn tôi đến rượu.
    Nhưng còn điều gì khác mà tôi nên suy nghĩ khi quyết định thay đổi trong cuộc sống của mình không? Có. Có rất nhiều điều. Tôi nghĩ rằng đầu tiên, bất kỳ sự thay đổi hành vi nào, dù là rượu hay cái khác, nếu bạn cảm thấy kiệt sức, mệt mỏi và không phải là phiên bản tốt nhất của chính mình, thì sẽ khó khăn hơn để thực hiện một sự thay đổi. Vì vậy, nếu bạn nghĩ về bất kỳ quyết định lớn nào mà bạn đã đưa ra để thay đổi công việc, bắt đầu một thói quen thể dục, hoặc rời bỏ một mối quan hệ, bạn có thể không chọn ngày mà bạn cảm thấy kiệt sức, lo âu, căng thẳng và không phải là phiên bản tốt nhất của mình để thực hiện sự thay đổi đó.
    Sự thay đổi thì khó khăn. Vì vậy, bạn muốn cố gắng cải thiện những điều khác trong cuộc sống của mình, ăn uống lành mạnh, ngủ đủ giấc, cố gắng tập thể dục, những điều sẽ giúp bạn cảm thấy khỏe mạnh và là phiên bản tốt nhất của mình khi bạn cố gắng thực hiện một sự thay đổi. Điều đó có liên quan đến dopamine không? Vâng, bởi vì có nghĩa là hệ thống thưởng tự nhiên của chúng ta, điều kích hoạt nó là thể dục, thực phẩm, tình dục, kết nối. Vì vậy, cố gắng có những cách lành mạnh khác để giải phóng dopamine. Và vì vậy, tôi nghĩ rằng đối với nhiều người, rượu hoặc các chất khác có thể cảm thấy như một cách để làm điều gì đó tốt cho bản thân. Vậy nên, bạn sẽ cảm thấy như, “Tôi sẽ, điều này sẽ giúp tôi giảm căng thẳng sau một ngày làm việc tồi tệ.”
    Vì vậy, mục tiêu không phải là bạn chỉ như kiểu cố gắng chịu đựng suốt cả đêm và cảm thấy rất căng thẳng sau công việc. Mà là bạn tìm ra, “Những điều khác nào giúp tôi giảm căng thẳng sau công việc?” Có thể là đi đến lớp yoga với một người bạn. Có thể là, bạn biết đấy, dành thời gian bên gia đình. Có thể là đi mát xa, thiền hoặc xem một chương trình bạn thích. Vì vậy, bạn cần không chỉ là loại bỏ điều mà bạn muốn thay đổi. Bạn cần lấp đầy khoảng trống đó bằng những điều khác. Vậy nếu tôi lấp đầy nó bằng kem Haagen-Dazs và burger thì sao? Bởi vì điều đó sẽ gây ra dopamine, đúng không?
    Dưới đây là bản dịch tiếng Việt của đoạn văn bạn đã cung cấp:
    Chắc chắn rằng nếu tôi chỉ ăn nhiều đồ ngọt và kẹo, thì điều đó sẽ ngăn tôi không tham gia vào các hành vi nghiện. Nhưng chúng ta thấy điều đó diễn ra mọi lúc. Đó giống như việc thay thế những thứ. Và, bạn biết đấy, tôi đã đọc một bài báo, mọi người có thể đã nghe về việc “tháng Giêng khô,” ý tưởng không uống rượu trong tháng Một để suy nghĩ lại về mối quan hệ của bạn với rượu. Tôi đã đọc một bài báo nói rằng “tháng Giêng khô” đã trở thành “tháng Giêng cao,” bởi vì mọi người đang hút rất nhiều cần sa thay vì uống rượu. Và vì vậy, tôi nghĩ rằng bạn nên cẩn thận để không chỉ thay thế điều mà bạn đang cố gắng thay đổi bằng một thứ cũng gây ra các vấn đề về sức khỏe. Giờ thì, thỉnh thoảng ăn dessert thì, bạn biết đấy, bạn không nhận calo từ rượu. Và một chiếc kem ốc quế ngon một lần mỗi tuần là một cách để tự thưởng cho bản thân mà lành mạnh hơn và có thể phù hợp hơn với mục tiêu của bạn. Điều đó cũng không sao. Tôi nghĩ rằng khi nghĩ về những điều này, thực sự nghĩ về rượu theo cách mà chúng ta nghĩ về dessert, tắm nắng, ăn thịt chế biến, tất cả những thứ này đều có rủi ro và lợi ích trong cuộc sống của chúng ta. Tôi nghĩ rằng nơi mà chúng ta đã sai lầm với rượu là ý tưởng rằng nó giống như một hành vi thúc đẩy sức khỏe, rằng bạn không nên uống vì sức khỏe của bạn. Nó sẽ không làm bạn khỏe hơn. Và cũng giống như nhiều thứ mà chúng ta làm không phải là hoạt động thúc đẩy sức khỏe, có những cách giảm thiểu tác hại sức khỏe của hoạt động đó để nó vẫn ổn với mức nhỏ trong cuộc sống của bạn. Tôi nghĩ các nhà tiếp thị B2B vẫn mắc phải sai lầm này. Họ đang theo đuổi khối lượng thay vì chất lượng. Và khi bạn cố gắng được nhiều người hơn nhìn thấy thay vì những người phù hợp, tất cả những gì bạn đang làm là tạo ra tiếng ồn. Nhưng tiếng ồn đó hiếm khi thay đổi được điều gì. Và nó thường khá tốn kém. Tôi biết, đã có thời điểm trong sự nghiệp của tôi khi tôi cũng liên tục mắc phải sai lầm này, và nhiều người trong số các bạn có thể cũng vậy. Cuối cùng, tôi đã bắt đầu quảng cáo trên nền tảng của nhà tài trợ chương trình của chúng tôi, LinkedIn. Và đó là khi mọi thứ bắt đầu thay đổi. Tôi quy đổi sự thay đổi đó cho một vài yếu tố quan trọng. Một trong số đó là LinkedIn khi đó, và vẫn vậy cho đến hôm nay, là nền tảng mà các nhà quyết định đến đó, không chỉ để suy nghĩ và học hỏi, mà còn để mua sắm. Và khi bạn tiếp thị doanh nghiệp của mình trên đó, bạn đang đặt nó ngay trước mặt những người thực sự có quyền nói có. Và bạn có thể nhắm đến họ theo chức vụ, ngành nghề và kích thước công ty. Đó thực sự là một cách thông minh hơn để sử dụng ngân sách tiếp thị của bạn. Và nếu bạn chưa thử nó, tại sao không thử? Hãy thử quảng cáo trên LinkedIn, và tôi sẽ tặng bạn 100 đô la tín dụng quảng cáo để bạn bắt đầu. Nếu bạn truy cập linkedin.com slash diary, bạn có thể yêu cầu điều đó ngay bây giờ. Đó là linkedin.com slash diary. Chỉ cần suy nghĩ về điều gì đó mà chúng tôi đã nói trước đó về cách chấn thương thời thơ ấu gây ra sự thay đổi trong não và sau đó dẫn đến hành vi nghiện. Nếu tôi trải qua một chấn thương thời thơ ấu và não của tôi đã thay đổi vì điều đó, và sau đó tôi trở thành nghiện rượu khi còn trẻ, và rồi tôi tìm cách thoát khỏi rượu, não của tôi vẫn nghiện, đúng không? Não của tôi vẫn có sự thiên lệch nghiện. Vậy có phải tôi sẽ kết thúc bằng việc nghiện một thứ khác mang lại cho tôi cảm giác dopamine không? Hóa ra não bộ cực kỳ dẻo dai, nghĩa là nó có thể thay đổi. Chúng ta thấy điều đó theo thời gian. Vậy điều đầu tiên là những trải nghiệm khó khăn thời thơ ấu thậm chí còn không phải là điều chắc chắn. Chúng ta nói rất nhiều về ACEs. Chúng ta không nói nhiều về P.C.E.s hoặc P.C.E, những trải nghiệm tích cực trong thời thơ ấu, nhưng thực tế là bạn có thể làm giảm nguy cơ một ai đó phát triển nghiện bằng cách tăng số lượng trải nghiệm tích cực thời thơ ấu. Hãy tưởng tượng một người đã trải qua một nghịch cảnh khủng khiếp. Cha mẹ của họ đã qua đời hoặc họ có một người cha mẹ đang ở trong tù hoặc họ có gia đình có người nghiện. Nếu đứa trẻ đó có một người lớn duy nhất mà họ tin tưởng rằng quan tâm đến họ, điều đó làm giảm nguy cơ nghiện của chúng. Do đó, có rất nhiều cách tích cực mà chúng ta thực sự có thể thay đổi quỹ đạo, ngay cả trong bối cảnh chấn thương khủng khiếp. Khi bạn nghĩ về một người có rối loạn sử dụng chất gây nghiện, chúng ta thực sự có dữ liệu tốt về điều này, rằng sau năm năm phục hồi, và thường thì đó là những bước khởi đầu và thất bại. Vì vậy, hầu hết mọi người nghĩ rằng, đây là một quyết định lớn mà bạn quyết định ngừng uống, và sau đó thành công là bạn không bao giờ uống lại nữa. Đối với hầu hết mọi người, những gì chúng ta tìm thấy là thực sự, như là một chuỗi các bước. Vì vậy, tôi luôn thích nghĩ về sự tiến bộ, không phải sự hoàn hảo, và không có tâm lý “mọi thứ hoặc không có gì” này mà đối với nhiều người, họ có thể sớm có một tháng không uống rượu. Và sau đó có thể lần sau là ba tháng, và có thể là một năm. Và những lần tái phát này xảy ra, nhưng cuối cùng họ đến được nơi mà họ bước vào phục hồi lâu dài. Sau năm năm phục hồi, nguy cơ phát triển nghiện của một người không cao hơn so với công chúng nói chung. Vì vậy, não của bạn thực sự thay đổi. Và chúng ta thấy điều này qua hình ảnh chức năng. Chúng ta thấy điều này trong các nghiên cứu dọc theo thời gian theo dõi mọi người. Vì vậy, bạn thực sự có thể vượt qua những điều đó và đạt đến một nơi mà bạn không có nguy cơ cao hơn so với những người khác. Bởi vì một số người nói, tôi có tính cách nghiện. Vâng. Họ thường tự gán nhãn và tự xác định mình có tính cách nghiện. Đôi khi họ thậm chí còn đề cập đến não của họ như là dễ bị nghiện. Có đúng không nhỉ? Liệu có khả thi để có một tính cách nghiện hay không? Không phải là tính cách, nhưng chúng ta thực sự phản ứng khác nhau với các chất. Vì vậy, bạn biết đấy, hãy lấy rượu hoặc opioid, bất cứ điều gì. Mọi người cảm nhận khác nhau ngay lần đầu tiên họ sử dụng nó. Vì vậy, thường thì nếu bạn trò chuyện với ai đó đã phát triển nghiện, họ sẽ kể rằng lần đầu tiên họ sử dụng chất đó, đó giống như một cảm giác tuyệt vời. Nó cảm giác như tôi đã thấy một số người mô tả là yêu đương hoặc, bạn biết đấy, một cái ôm ấm áp hoặc như là một buổi tắm thư giãn.
    Những trải nghiệm như vậy thật sự an ủi.
    Những người khác, họ được kê thuốc như opioid cho việc nhổ răng.
    Họ cảm thấy buồn nôn và như không phải chính mình, và họ không thích cảm giác đó.
    Vì vậy, cách chúng ta phản ứng với các chất là do sinh học thần kinh của chúng ta và khác nhau giữa từng người.
    Một số người có lý do di truyền và bộ não của họ chỉ đơn giản là dễ bị nguy cơ nghiện hơn.
    Điều này quan trọng để hiểu về bản thân mình, vì vậy bạn có thể đưa ra những lựa chọn khác nhau.
    Bạn có thể quyết định, biết rằng bạn không bao giờ giữ rượu trong nhà hoặc không uống vì rủi ro quá lớn.
    Bạn có nghĩ về những vấn đề khác đang chiếm lĩnh xã hội?
    Một số vấn đề khác không liên quan đến chất kích thích.
    Nghiện mạng xã hội và nghiện khiêu dâm, còn gì khác là những vấn đề lớn?
    Nghiện thực phẩm.
    Thực phẩm, sex, cờ bạc.
    Tôi nghĩ có nhiều điểm tương đồng.
    Đây không phải là lĩnh vực chính của tôi, nhưng tôi nghĩ có nhiều chồng chéo.
    Ý tôi là, tôi nghĩ nhiều điều bạn vừa liệt kê, bạn có thể nói về một điều, dopamin, rõ ràng.
    Nhưng hai, ý tưởng này về việc cần phải lấp đầy bản thân bằng điều gì đó khác, hoặc, bạn biết đấy, suy nghĩ về chấn thương, suy nghĩ về các bệnh tâm thần chưa được điều trị, suy nghĩ về sự thiếu kết nối và ý nghĩa và phần thưởng và tìm đến những giải pháp bên ngoài.
    Bạn có thể kể cho tôi về một lần bạn làm việc với một bệnh nhân mà qua quá trình làm việc với họ và hiểu về chấn thương của họ, bạn phát hiện điều gì đó bất ngờ về nguyên nhân gốc rễ của hành vi nghiện của họ không?
    Vâng, vâng, tôi có thể nghĩ đến nhiều bệnh nhân, nhưng có một người đặc biệt, bạn biết đấy, tôi biết rằng anh ấy đã trải qua những điều khó khăn trong cuộc sống.
    Anh ấy đã từng ở trong tù, ví dụ, đó là một trải nghiệm gây chấn thương.
    Anh ấy đã mất cả cha mẹ, một điều khác.
    Tôi chưa bao giờ thực sự hiểu sâu sắc về chấn thương của anh ấy và anh ấy đã đấu tranh cả đời với chứng rối loạn sử dụng chất và sử dụng nhiều thứ, chủ yếu là opioid, nhưng cũng có rượu và cocaine, và chỉ có một khoảng thời gian rất khó khăn.
    Và sau, có nghĩa là, sau nhiều năm biết anh ấy, một ngày nọ anh ấy đã bật khóc trong văn phòng của tôi và chia sẻ rằng thực ra anh ấy đã từng bị lạm dụng khi còn nhỏ.
    Và vì vậy đôi khi có điều đó, một thứ mà người ta chưa bao giờ cảm thấy có thể chia sẻ với ai đó, thực sự nằm ở gốc rễ của rất nhiều thứ mà họ đã trải qua.
    Và như người đã thì thầm với bạn, tôi nghĩ rằng nỗi đau khi giữ điều đó bên trong, không chỉ là chấn thương khi trải qua điều đó khi còn là một đứa trẻ, mà còn là việc giữ bí mật đó và cảm thấy rằng bạn như bị tổn thương hoặc, bạn biết đấy, rằng cái điều đó bên trong bạn vẫn tồn tại.
    Và không thể chữa lành, nói về nó, chia sẻ nó với người khác, tôi nghĩ, thực sự là một giếng sâu của nỗi đau sống bên trong mọi người.
    Anh ấy đã hồi phục chưa?
    Thực ra, anh ấy đã qua đời.
    Do sử dụng chất kích thích?
    Do việc sử dụng chất, vâng.
    Bạn chắc chắn mang theo rất nhiều điều này bên mình, bởi vì nghề nghiệp của bạn nghe có vẻ như bạn thường xuyên phải đối mặt với những tin xấu, nhiều hơn cả người bình thường.
    Và tin tức bạn đang phải xử lý là một loại tin khác.
    Bạn đang đối diện với ai đó dường như đang ở cuối cuộc đời của họ qua một điều mà bạn cũng đã nói nhiều lần bạn tin rằng trong nhiều trường hợp có thể phòng ngừa được.
    Bạn quản lý điều đó như thế nào?
    Vâng, ý tôi là, tôi nghĩ có một vài điều.
    Một, có rất nhiều câu chuyện hy vọng mà tôi nghĩ sẽ cân bằng điều đó với tôi.
    Vì vậy, tôi nghĩ, bạn biết đấy, những câu chuyện khác trong đầu tôi là, bạn biết đấy, tôi vẫn chăm sóc và giữ liên lạc với những người đang sống những cuộc đời tuyệt vời, đầy sức sống và đang phục hồi.
    Và, ý tôi là, chỉ riêng ở Mỹ thôi, có 24 triệu người đang sống trong quá trình phục hồi.
    Vì vậy, có những câu chuyện về những người đã vượt qua chấn thương, bi kịch, khó khăn, và họ đang làm rất tốt.
    Họ đang nuôi dạy con cái, họ đang làm việc.
    Có thể bạn thậm chí không biết họ đang ở xung quanh bạn.
    Bạn biết đấy, họ không nhất thiết phải nói cho mọi người rằng họ đang trong quá trình phục hồi.
    Và việc được tham gia vào quá trình đó với ai đó và chứng kiến, bạn biết đấy, không có gì trong y học mà tôi thực sự có thể thấy sự thay đổi kịch tính như với nghiện, nơi ai đó có thể, bạn biết đấy, đang ở trong một khoảnh khắc khi họ đang phải đối mặt với tất cả những hậu quả sức khỏe và thách thức trong mối quan hệ, và rồi họ trở nên tốt hơn.
    Và đó thực sự là điều đẹp nhất mà tôi được tham gia.
    Vì vậy, tôi nghĩ hy vọng từ đó, sự tích cực từ nó là điều giữ tôi tiếp tục mỗi ngày.
    Rõ ràng, tìm cách để chăm sóc cho bản thân thông qua điều đó và gia đình và sự kết nối, tập thể dục.
    Tôi chạy, tôi viết.
    Bạn biết đấy, bạn cũng phải giữ cho bản thân mình được trọn vẹn trong mọi thứ.
    Nhưng tôi nghĩ tôi nhận được mục đích to lớn và chủ yếu, như, nhiều hy vọng từ việc làm việc với mọi người và thấy họ phục hồi.
    Điều quan trọng nhất mà chúng ta chưa nói đến mà tôi nên nói là gì?
    Tôi nghĩ một điều là ngôn ngữ.
    Đó là một điều tinh tế.
    Tôi đã đề cập một ví dụ mà bạn đã làm rất tốt, nơi thay vì nói ai đó thất bại trong điều trị, bạn đã nói điều trị đã thất bại đối với họ.
    Nhưng rất nhiều ngôn ngữ mà chúng ta sử dụng với nghiện thực sự một cách tinh tế và không quá tinh tế làm trầm trọng thêm sự kỳ thị.
    Và đôi khi nghe như tôi đang đúng chính trị hoặc đó là một vấn đề ngữ nghĩa, nhưng thực sự có dữ liệu rất tốt về điều này.
    Vì vậy, nếu bạn nghĩ về những từ mà chúng ta sử dụng cho nghiện, một là lạm dụng chất, đúng không?
    Vì vậy, thuật ngữ lạm dụng, lạm dụng ám chỉ điều gì?
    Nó thực sự đến từ một từ tiếng Anh cổ có nghĩa là, như, một hành động vi phạm cố ý.
    Và đó là một từ mà chúng ta sử dụng cho lạm dụng trẻ em, lạm dụng tình dục, lạm dụng gia đình.
    Giống như, chỉ dành cho những hành vi bạo lực khủng khiếp mà rất bị kỳ thị vì đó là những điều tồi tệ.
    Và tuy nhiên, chúng ta lại sử dụng nó cho điều mà chúng ta nói là một tình trạng sức khỏe, rằng bạn như là một người lạm dụng chất hoặc bạn có lạm dụng chất.
    Và thực sự đã có những nghiên cứu tinh tế mà lấy những nhà tâm lý học có trình độ tiến sĩ, những chuyên gia lâm sàng được đào tạo bài bản, và họ mô tả một người là người lạm dụng chất hoặc là người có rối loạn sử dụng chất. Và thực tế, chuyên gia lâm sàng có khả năng cao hơn để đề xuất một can thiệp trừng phạt cho người được mô tả là người lạm dụng chất. Điều đó có nghĩa là gì? Trong trường hợp này, họ được đưa ra một lựa chọn. Họ đọc một đoạn văn về một bệnh nhân hư cấu, và họ không thực sự biết các nhà nghiên cứu đang thử nghiệm gì. Và họ được đưa ra một loạt lựa chọn khác nhau cho can thiệp. Một trong số đó là, như kiểu, gửi họ đến tòa án ma túy hoặc gửi họ vào tù. Một cái khác là, như kiểu, đề nghị họ, bạn biết đấy, điều trị ngoại trú hiệu quả. Có rất nhiều lựa chọn khác nhau. Khi họ nghe ai đó được mô tả là người lạm dụng chất, họ có khả năng cao hơn để đề xuất can thiệp dựa vào tù. Vì vậy, từ ngữ thực sự, như, rất – nó ảnh hưởng đến cách chúng ta suy nghĩ, ngay cả trong cách chúng ta đưa ra quyết định lâm sàng. Họ cũng đã làm điều này với công chúng. Vì vậy, nếu bạn mô tả ai đó là một kẻ nghiện, công chúng có cái nhìn tiêu cực hơn về họ so với việc nếu bạn mô tả họ là một người có chứng nghiện. Vậy nên có những cách tinh tế – đã có một sự thay đổi trong việc nghiện để thực sự sử dụng cái mà chúng ta gọi là ngôn ngữ đặt con người lên hàng đầu, điều này đã đúng trong y học. Chúng ta từng sử dụng những từ khủng khiếp. Chúng ta đã gọi ai đó như, như kiểu, người mắc bệnh tâm thần phân liệt, bạn biết đấy, hoặc thực sự gán nhãn họ theo tình trạng sức khỏe của họ. Và may mắn là đã có sự thay đổi từ đó để nhận ra rằng mọi người là những con người trước tiên, những người có bệnh tật nhưng không được định nghĩa bởi bệnh tật đó. Vì vậy, tôi sẽ không bao giờ nói, như kiểu, tôi sẽ đi gặp bệnh nhân ung thư phổi trong phòng 204. Tôi sẽ nói tôi sẽ gặp, bạn biết đấy, ông Smith người có ung thư phổi. Và với nghiện cũng vậy, như, mọi người còn hơn thế nữa. Vì vậy, để nói, bạn biết đấy, người có nghiện, người có rối loạn sử dụng rượu thay vì nói họ là người nghiện hay người nghiện rượu. Và sau đó ngay cả những thuật ngữ như sạch và dơ, những từ thường được dùng khi chúng ta nói về nghiện. Vì vậy, bạn biết đấy, hãy lấy từ sạch. Nó nghe có vẻ rất tích cực. Như kiểu, bạn đang nói, ôi, bạn sạch. Nhưng, như, bạn thực sự đang nói gì? Vì vậy, bạn đang nói, như, nếu bạn sạch bây giờ, khi bạn đang vật lộn, thì bạn đã là gì? Bạn đã dơ. Và tôi luôn nhớ một ví dụ, một người bạn của tôi đang trong quá trình phục hồi đã phỏng vấn xin việc trong lĩnh vực phục hồi. Và nhiều người trong cuộc phỏng vấn đã hỏi anh ấy, như kiểu, bạn đã sạch trong bao lâu? Và anh ấy đã nói, ồ, tôi đã tắm từ khi tôi chào đời, nên tôi đã sạch cả đời mình. Và tôi đã trong quá trình phục hồi được năm năm hay gì đó. Vì vậy, tôi nghĩ những điều nhỏ bé này thực sự quan trọng mà chúng ta nên sử dụng các thuật ngữ mà chúng ta sẽ dùng cho một tình trạng sức khỏe khác. Nếu chúng ta gán nhãn, bạn biết đấy, những người đang nghiện tích cực là dơ hoặc, bạn biết đấy, những người có nghiện giống như những kẻ lạm dụng trẻ em với kiểu ngôn ngữ đó, chúng ta thực sự đang theo cách tinh tế gia tăng sự kỳ thị. Vì vậy, đó là điều nhỏ mà tất cả chúng ta có thể làm là chỉ cần cố gắng sử dụng ngôn ngữ nhân văn hơn một chút. Thật thú vị vì tôi đã nhận thức được điều này, nhưng tôi vẫn thấy bản thân vô tình sử dụng từ lạm dụng. Đúng vậy. Và tôi đã vấp phải điều đó. Tôi nói, kệ đi, tôi sẽ coi như bạn nhắc đến. Tôi đã cố gắng tránh sử dụng từ nghiện. Đúng vậy, thật khó để thay đổi, nhưng, bạn biết đấy, như mọi thứ, bạn chỉ muốn khiêm tốn, tò mò và tiếp tục cố gắng. Ý tôi là, có rất nhiều ngôn ngữ mà chúng ta đã thay đổi. Như, nghĩ về rất nhiều thuật ngữ mà chúng ta sử dụng cho, bạn biết đấy, những người sinh ra với những năng lực khác nhau hoặc cho những người thuộc các chủng tộc hoặc những danh tính khác mà chúng ta thực sự đang kỳ thị. Và chúng ta đã học để sử dụng ngôn ngữ khác, ngay cả khi nó có cảm giác hơi ngại ngùng khi bạn lần đầu tiên học nó. Tôi nghĩ rằng hiểu biết về khoa học và dữ liệu đằng sau ảnh hưởng của việc sử dụng ngôn ngữ nhất định, tôi nghĩ là thực sự hữu ích. Đúng vậy. Bởi vì điều đó đã giúp tôi hiểu rằng, chỉ vì bây giờ tôi hiểu các nguyên tắc cơ bản của nó, tôi cần đảm bảo tôi mô tả mọi người như là con người trước tiên. Đúng vậy. Vì vậy, một người có nghiện tốt hơn nhiều so với việc gọi ai đó là một người nghiện. Đúng, chính xác. Và một điều mà mọi người thường hỏi tôi, sẽ nói, thì nếu ai đó tự gọi mình như vậy thì sao? Bởi vì mọi người có thể làm điều đó. Và điều đó không sao cả. Mọi người có thể sử dụng bất kỳ ngôn ngữ nào họ muốn cho bản thân. Nhưng tôi nghĩ với tư cách là một chuyên gia chăm sóc sức khỏe, chắc chắn, hoặc một người đang cố gắng giúp chống lại sự kỳ thị, như, chúng tôi có thể lựa chọn sử dụng ngôn ngữ khác. Và thực sự tôi đã có bệnh nhân hỏi tôi, như kiểu, ồ, tại sao bạn lại sử dụng thuật ngữ đó khi họ sử dụng ngôn ngữ khác? Và thực sự có thể mang lại cảm giác quyền lực khi như kiểu, ồ, đúng rồi, tôi thực sự là một người trong quá trình phục hồi. Tôi là một người có nghiện. Điều mà tôi thực sự tò mò trong cuộc sống của mình nói chung, bởi vì trong cuộc trò chuyện, tôi thường, tôi đã nói điều gì đó hôm qua khi chúng tôi đang ăn tối với đội ngũ ở đây. Tôi đã nói, tôi không nhớ chính xác cụm từ, nhưng nó có ý nghĩa là, tôi không giỏi trong việc đó, hoặc tôi không phải là kiểu người đó, hoặc tôi không có tổ chức. Và tôi đã dừng lại, và đội sẽ nhớ, và tôi nói, thực sự, tôi không nên nói như thế. Tôi nên nói, ngay bây giờ, tôi đang làm gì… Bạn đang định nghĩa bản thân là không khả năng làm việc gì đó thay vì là tôi đang làm việc về tổ chức ngay bây giờ. Đúng, tôi nghĩ điều đó cực kỳ quan trọng, và chúng ta không nghĩ về nó, cách chúng ta tạo ra một danh tính cho bản thân một cách quá thoải mái mà thực sự, như, hạn chế một cách căn bản, hoặc đặt chúng ta vào một cái hộp, hoặc định khung chúng ta như là có khuyết điểm, hoặc nắm bắt toàn bộ danh tính của chúng ta trong một số loại thiếu sót mà chúng tôi thường đề cập đến trong trường hợp của những thói quen mà tôi đang nói đến. Có cái gì đó tương tự xảy ra khi chúng ta nói về việc gọi ai đó là một người nghiện? Đúng, bạn đang gán nhãn chúng như chỉ là điều duy nhất mà họ là, và rằng họ sẽ mãi mãi như vậy.
    Và, bạn biết đấy, một người bạn của tôi là nhà báo, đang trong quá trình phục hồi và viết rất nhiều về chứng nghiện. Maya Solovitz đã viết một bài tuyệt vời trên New York Times rằng chứng nghiện không phải lúc nào cũng kéo dài suốt cuộc đời, bởi vì tôi nghĩ là có một ý tưởng trong đầu chúng ta rằng, ồ, những người có vấn đề nghiện sẽ luôn có vấn đề đó, và đó là một thứ không thể chữa trị, trong khi thực tế là mỗi người có một hành trình rất khác nhau. Đối với một số người, bạn biết đấy, điều đó trở thành một điều mà họ phải đối mặt, và rồi họ tiến lên trong cuộc sống của mình. Đối với những người khác, đó là điều mà họ quản lý một cách tích cực, nhưng ý tưởng rằng bạn chỉ đơn giản hóa mọi thứ xuống thành, như, điều duy nhất mà tôi là ở thế giới này là một người bị nghiện, thực sự hạn chế mọi điều khác về bản thân bạn.
    Chúng tôi có một truyền thống kết thúc trong podcast này, nơi khách mời cuối cùng để lại một câu hỏi cho người tiếp theo, mà không biết họ sẽ để lại cho ai. Vậy nên, câu hỏi mà bạn nhận được là, nếu bạn có thể làm lại hoặc chỉnh sửa một điều gì đó mà bạn đã đạt được thành công, điều đó sẽ là gì và tại sao?
    Tôi đoán tôi sẽ nói, và tôi có thể nghĩ ra nhiều thành công mà tôi sẽ áp dụng điều này vào, nhưng tôi sẽ lấy ví dụ về đào tạo y tế, đó là một thành công. Tôi nghĩ tôi sẽ có mặt hơn một chút rằng chúng ta luôn, như là, đang vội vàng đến thành tựu, đến vạch đích, để đạt được mục tiêu tiếp theo. Và tôi nghĩ lại và ước gì tôi đã nhận ra hành trình tuyệt vời như thế nào ở thời điểm đó. Và, ý tôi là, ngay cả những thứ liên quan đến đào tạo y tế mà tôi sẽ không bao giờ trở thành phẫu thuật viên tim, nhưng đứng trong phòng mổ và nhìn vào lồng ngực của ai đó và xem trái tim đang đập là một trải nghiệm mà tôi sẽ không bao giờ có lại. Và tôi nghĩ trong hành trình này để luôn đạt được và tiến lên và đến kỳ thi tiếp theo và điều tiếp theo, đôi khi chúng ta bỏ lỡ, như là, phép màu ngay trước mặt chúng ta. Và vì vậy tôi nghĩ tôi sẽ có mặt hơn nữa. Điều đó áp dụng cho tất cả chúng ta. Tôi cảm thấy như mình đang bị lên án. Đúng cho việc nuôi dạy con cái, đúng cho mọi thứ. Cảm ơn bạn rất nhiều. Tôi rất biết ơn công việc mà bạn đang làm vì có quá nhiều thông tin mâu thuẫn, đặc biệt là về rượu. Đã có rất nhiều thông tin trong năm năm, mười năm qua về tác động của rượu đến chúng ta. Và tôi đã ngồi đây và có những cuộc trò chuyện với những người khá tin tưởng rằng ngay cả những mức độ uống rượu vừa phải cũng tốt cho chúng ta. Và sau khi đọc công trình của bạn, giờ tôi đã rõ về sự thật ở đó. Cảm ơn bạn đã làm những gì bạn làm. Nó cực kỳ quan trọng. Và tôi thực sự nghĩ rằng nó sẽ trở nên ngày càng quan trọng, thật không may, vì cách mà thế giới đang hướng tới, dịch bệnh cô đơn mà chúng ta đang trải qua và khả năng tiếp cận của chúng ta hiện nay với các thiết bị kỹ thuật số và tiêu thụ các chất gây nghiện với chi phí thấp khiến tôi cảm thấy đáng sợ. Tôi biết bạn có một cuốn sách sắp ra mắt, mà tôi cực kỳ háo hức, sẽ ra mắt vào mùa thu. Mùa thu tới? Mùa xuân năm 27. Vậy là chúng ta có chút thời gian. Được rồi. Cuốn sách đó nói về điều gì? Bạn có thể cho tôi một gợi ý được không? Tôi sẽ đoán. Nó sẽ nói về việc thay đổi câu chuyện xung quanh chứng nghiện và thực sự định hình lại cách mọi người nghĩ về nó, để thấy nó như một căn bệnh có thể điều trị được, với tiên lượng tốt, và sử dụng một số câu chuyện của những người mà tôi đã có đặc quyền biết đến để hy vọng giúp mọi người nhìn nhận mọi thứ theo cách khác.
    Mọi người có thể tìm bạn ở đâu nếu họ muốn liên hệ hoặc tìm hiểu thêm? Vâng. Họ có thể tìm tôi trên LinkedIn, trên Instagram. Họ có thể gửi email cho tôi. Vâng. Rất vui được kết nối và cũng rất muốn quay lại sau khi cuốn sách được phát hành. Tôi rất mong chờ điều đó. Tôi cũng rất muốn. Vậy Instagram, LinkedIn của bạn, tôi sẽ để thông tin đó bên dưới. Chắc chắn bạn sẽ nhận được rất nhiều tin nhắn vì những vấn đề này đặc biệt là những vấn đề rất quan trọng trong cuộc sống của mọi người và cũng rất cảm xúc. Vì vậy, cảm ơn bạn, thay mặt cho tất cả khán giả của tôi, cảm ơn bạn về sự hào phóng của bạn hôm nay, nhưng cũng cảm ơn bạn về sự khôn ngoan của bạn. Thực sự, tôi rất trân trọng. Và tôi rất muốn nói chuyện với bạn lần nữa sớm khi cuốn sách được phát hành. Cảm ơn bạn. Cảm ơn bạn đã mời tôi. Tôi thấy thật thú vị khi khi nhìn vào phía sau của Spotify và Apple và các kênh âm thanh của chúng tôi, phần lớn người xem podcast này vẫn chưa nhấn nút theo dõi hoặc nút đăng ký ở bất kỳ nơi nào bạn đang nghe. Tôi muốn đưa ra một thỏa thuận với bạn. Nếu bạn có thể làm cho tôi một ân huệ lớn và nhấn nút đăng ký, tôi sẽ làm việc tirelessly từ bây giờ đến mãi mãi để làm cho chương trình ngày càng tốt hơn. Tôi không thể nói với bạn nó giúp như thế nào khi bạn nhấn nút đăng ký. Chương trình trở nên lớn hơn, điều đó có nghĩa là chúng tôi có thể mở rộng sản xuất, đưa về tất cả các khách mời bạn muốn xem và tiếp tục làm điều mà chúng tôi yêu thích. Nếu bạn có thể giúp tôi bằng cách nhấn nút theo dõi, ở bất kỳ nơi nào bạn đang nghe điều này, điều đó sẽ có ý nghĩa rất lớn với tôi. Đó là ân huệ duy nhất tôi sẽ từng yêu cầu bạn. Cảm ơn bạn rất nhiều vì thời gian của bạn. Hẹn gặp lại bạn lần sau.
    造成健康問題的酒精劑量比你想的要低得多。
    好吧,如果我每天喝這杯酒……
    你會處於我們所稱的中等風險,這幾乎與每種癌症都有關聯。
    所以假設我正在喝……
    如果你喝兩杯,我們談的是約40%的增加。
    但即使喝這麼多,你患乳腺癌的風險仍會增加約5%。
    這個量?
    嗯哼。
    對於許多人來說,這是非常正常的。
    所以外面有很多錯誤資訊關於應該喝多少,我認為人們並不知道。
    但我可以帶你了解所有事情,所以……
    莎拉·瓦克曼博士是一位哈佛大學教授和成癮專家。
    她正領導著對抗我們這個時代最大公共健康危機之一的運動。
    成癮。
    帶來事實、同理心和辛苦得來的真相。
    每三個人中可能就有一個在其生命中的某個時期面臨酒精問題。
    而且全球每年有260萬人死於與酒精相關的原因,因為身體幾乎每一個器官都受到影響。
    你可以看到這是一個43歲的人,其大腦看起來就像一個90歲的癡呆者,因為長期酒精使用造成的大腦損傷。
    但究竟是什麼驅使人們使用物質呢?
    可能是最重要的問題。
    如果我們查看研究,約有40%到60%是遺傳因素。
    而公式的另一半是創傷。
    所以當你聽到某人談論酒精給他們帶來痛苦緩解,無論是情緒上的還是身體上的,這是非常真實的事。
    這是因為你的天然止痛系統在飲酒時會被啟動。
    它是一種抗焦慮和止痛藥的綜合體。
    所以當你思考我們如何治療成癮時,我們在哪裡出錯?
    最大的问题是人们并未获得理解成瘾所需的证据和工具。
    但许多戒毒所也没有提供我们知道实际上有效的东西。
    那么,人们需要什么呢?
    好问题。
    我们教人们的最有效工具之一是某种……
    他们发现人们在此后饮酒量大大减少。
    哇。
    我发现非常有趣的是,当我们查看 Spotify 和 Apple 及我们的音频频道的后台时,观看这个播客的大多数人还没有点击关注按钮或订阅按钮,无论你是在哪里收听这个。
    我想和你达成一个交易。
    如果你能给我一个很大的帮助,点击那个订阅按钮,我将不知疲倦地工作,从现在到永远让节目变得越来越好。
    我不能告诉你点击那个订阅按钮会有多大的帮助。
    节目的规模变大,这意味着我们可以扩大制作,邀请你想看到的所有嘉宾,并继续做我们所热爱的事情。
    如果你能给我这个小忙,点击关注按钮,无论你在哪里收听这个,那对我来说将是无比重要。
    那是我唯一会要求你的好意。
    非常感谢你的时间。
    莎拉·瓦克曼博士,你所做的所有工作,你的使命是什么?
    我的使命实际上是改变人们看待和理解酒精和药物问题的方式,以及提供证据和事实,让人们理解成瘾,即与酒精和药物使用相关的问题,但也理解围绕例如,应该喝多少酒的科学。
    喝酒健康吗?不健康吗?
    外面有很多错误信息,我想给人们工具,帮助他们在生活中做出正确的决策。
    你是誰?你的經歷和教育背景是什麼?
    所以我是一名受过训练的医生,所以我仍然做一些普通医学,如在医院照顾肺炎和心力衰竭,在门诊部照顾患者的糖尿病和抑郁症。
    但我特别是在成瘾医学方面受过训练,所以我获得了成瘾医学的董事会认证,这一直是我一生的工作。
    我在麻萨诸塞州波士顿一家大型学术医疗中心工作,我会说我在专业上的关注是思考如何将成瘾护理带回医疗系统,这样它就不是这个独立和不平等的常常非常糟糕的孤立系统,而实际上是人们所获得的医疗保健的一部分。
    然后我培训人员,所以我是我们的奖学金项目的项目主任,我培训想要成为成瘾医学专科医生的医生。
    当你思考我们在现代世界如何治疗成瘾时,你有哪些不满?
    我们哪里出错了?
    哦,我们还有多少时间?
    我觉得去年。
    我们从哪里开始?
    我的意思是,我认为从根本上讲,最大的问题是我们都被教导并注入了这个观念,成瘾是一种行为不当的问题,是道德问题,人们真的需要停止这种行为,鼓起勇气,拉自己一把,这是一个刑事法律问题,是意志力的问题。
    所以如果你相信这些,那么你为什么会认为某个人应该获得医疗照顾呢?
    或者如果你认为他们做错了事情,你为何会用同情和善意对待他们呢?
    因此,真正基于我们所有的科学和有效治疗是什么样的重塑我们对成瘾的看法,这常常与人们如果曾试图为自己或亲人寻求护理时的经历大相径庭。
    什么是成瘾?
    什么属于成瘾的范畴?
    你知道,因为我经常使用我的iPad。
    我频繁使用我的手机。
    那算不算成瘾?
    是的,这是一个很好的问题,因为我们经常用这个词进行口语表达。
    你知道,我沉迷于Netflix或其他什么。
    成瘾的真正定义是尽管有后果仍然继续使用。
    繼續在生活中做某件事情,儘管因為這件事情而發生了壞事。我們談論到成癮,並提到四個 C 作為一種記憶的方式。其中一個 C 是失去控制,意味著你已經嘗試改變卻無法做到。你嘗試減少使用或嘗試停止,但都做不到。另一個是強迫性使用。你的使用像是失控般的旋轉,以一種與理性思考並不相連的方式使用。接下來是後果。即使有負面後果出現,例如在生活、工作、人際關係和健康中,仍然持續使用。最後一個 C 是渴望,即想要使用的強烈心理衝動。就像你無法將飲酒的想法從腦海中揮去。因此,我們思考的正是這四個 C。然後我們根據人們滿足多少這 11 條不同標準來定義成癮。根據這個標準,人們可能會有輕度、中度或重度的使用障礙。其中中度和重度就是我們所認為的成癮。然而,這是基於使用的情況,儘管發生了壞事。那麼,哪些事情是可能成癮的?是的,很多事情。我的主要關注是酒精和毒品。酒精顯然可能是最常見的。我想我們今天會多談這個,讓我很興奮。毫無疑問,當我們從全球角度來看,有四億人有酒精使用障礙,也就是成癮於酒精。這是很多人。另一個是毒品。這可以是類鴉片藥物,如海洛因、止痛藥或芬太尼。可以是可卡因或興奮劑,如甲基安非他命或處方刺激劑,也可以是人們可能因焦慮而服用的鎮靜劑,如苯二氮平類藥物、大麻。因此,有很多種物質可能導致成癮。而一種物質的成癮性實際上與大腦中釋放的多巴胺量有關。我知道你和萊姆基博士有過一集精彩的節目,談到了多巴胺,因此你已經談過一些。不同物質有不同的成癮指數。例如,大麻的成癮性低於甲基安非他命。但所有這些物質都可能導致人們成癮。即使更進一步,有時我在生活中也在想自己是否對其他事情上癮,比如,我每天喝咖啡。當然,現在我真的有想喝的渴望。是的。那麼,這裡有幾個重要的問題。你的咖啡飲用是否對你的生活造成了任何傷害?沒有。我想它有幫助。也許它在幫助你,對嗎?好的,那就不是上癮。因此,生理依賴和成癮之間是有區別的。生理依賴意味著如果你不喝一杯咖啡,你就會頭痛。而成癮則意味著你整天花精力和金錢不斷購買更多咖啡。我們不太會看到這種情況。但如果在你的女友不停責備你,並且你因為買咖啡而遲到的情況下,仍然持續買更多的咖啡。這樣的情況我們不太會在咖啡上看到,但那會是某種上癮。那麼,這個問題有多大呢?如果你能框架一下,為什麼我們應該關心這個問題?為什麼在座的聽眾應該關心這個問題?因為我想象,這裡的許多人並沒有成癮到對他們的生活造成重大後果。我也想象有些人認為成癮是發生在其他人身上的事情。是的。所以你能幫我梳理一下這個情況,並解釋為什麼我們都應該關心這個問題,以及它對社會影響的規模嗎?我敢保證,許多正在收聽的人都或多或少受到了成癮的影響,無論是親身經歷還是周圍人的生活。因為受到污名化,我們傾向於不談論這一點。但是問題的規模是巨大的。全球每年有 260 萬人死於與酒精相關的原因。因此,今天有 7000 人將因酒精相關的死亡而去世。每年還有 60 萬人死於毒品相關的死亡。因此,今天有 1600 人將因毒品相關原因去世。然後當我們查看滿足物質使用障礙或成癮的標準時,全球約有 4 億人因酒精而受到影響,8000 萬人因吸毒而受到影響。因此,這是非常普遍的。如果你考慮到酒精,一些研究估計,在你的一生中,發展酒精成癮的終身流行程度在某些研究中高達 15% 到 30%。因此,三分之一的人在某個時刻可能會有酒精方面的問題。因此,這會影響到我們所有人。我們只是因為污名及將其他化的心理形象而不談論這個問題,例如,僅僅是那些注射海洛因的人才有成癮問題,或者那些每天早上顫抖並在醒來後就喝酒的人才有酒精問題。作為一個社會,我們的方向在哪裡?我們變得更好還是變得更加成癮?是的,這是一個很好的問題。大流行對成癮並不友好。因此,我們看到酒精和毒品的使用率以及相關死亡率在 COVID 大流行期間顯著上升。這些數據已經開始平穩下來。現在,與毒品使用相關的死亡率已回升至大流行前的水平,但在大流行期間確實出現了非常顯著的上升。當我們思考那些推動人們以問題方式使用酒精或毒品的因素時,這並不令人驚訝。我在查看一些預期壽命的圖表時,這張特別的圖令我感到非常震驚。我將把它放到屏幕上。但它顯示,顯然,您知道,我們本期望在大流行期間會有壽命下降。
    但即使與其他國家相比,這樣的差異也不算特別顯著。因此,我在想,在您看來,為什麼在疫情期間預期壽命會有如此顯著的下降? 是的,顯然,COVID是其中一個原因。 另一個主要原因是與物質相關的死亡。 實際上,在疫情開始後的幾個月,即2020年3月和4月,我們看到與酒精相關的死亡率增加了23%。 我們也見證了疫苗與毒品過量死亡的最高記錄。 這實際上影響了美國的預期壽命,直到今年。 這是我們見到變化的第一年。 言之所至,這裡究竟發生了什麼,因為您知道,成癮是基於其他因素的。 實際上發生了什麼? 是的,這是一個非常好的問題。 促使人們使用物質的原因是什麼? 這其實可能是我的工作中最重要的問題之一。 您知道,如果您不懂某人的物質使用是基於什麼或與什麼有關,您又怎麼能去解決它或幫助他們解決它呢? 所以,創傷可能是最主要的驅動因素。 您經常會聽到一些說法,例如大麻是入口毒品。 我會說,創傷才是入口毒品。如果我們查看許多研究,有兩種不同的因素推動一個人對成癮的風險。一個是基因。這大約有40%-60%是遺傳的,這與糖尿病的風險相似。顯然,這不是一個注定的事實。 有些人有強大的遺傳風險卻從未發展出成癮;而有人則沒有這種風險卻會發生成癮。 另一部分的因素基於您的遭遇和經歷。其中一個主要驅動因素是我們所謂的逆境童年經歷。 有一個著名的研究被稱為ACE(Adverse Childhood Experience,逆境童年經歷)研究,它已經被複製。 最近在歐洲也做了一個類似的研究,探討您擁有的逆境童年經歷的數量,這與您的物質使用障礙風險呈線性關係。 所以如果您思考物質對大腦的影響,您知道,當我們使用酒精或毒品時,各種感覺良好的荷爾蒙會被釋放,對吧? 多巴胺、內源性鴉片系統,這實際上是您天然的止痛劑。 如果您遇到過創傷的人,在物質使用中,人們可以找到巨大的慰藉。 在疫情期間,我們就是這樣看到的。疫情期間發生了什麼? 人們感到害怕,感到無聊,感到孤獨,被困在家裡。 他們失去了以往的日常生活。有些人失去了他們所愛的人。 所以我們看到所有這些增加的物質使用,且這種情況對於前線工人表現得尤為明顯。 這可能是一名醫療工作者,也可能是超市或便利店的工作人員,這些人不得不在疫情最可怕的時期工作,還有那些照顧者。因此,這兩組人在疫情期間的物質使用增加最為顯著。 那麼大腦裡究竟發生了什麼呢? 您那邊稍微提到了一下。 您提到多巴胺讓您感覺良好。 所以,您知道,天真地說,如果您感到不舒服,多巴胺會讓您感覺良好,您會想要更多的多巴胺。 但這是否更為複雜和微妙? 是的,酒精是一種非常複雜的物質,因為酒精對大腦有很多不同的影響。 任何可導致成癮的藥物或物質都會釋放多巴胺。 這是我們發現的許多被認為有價值的事情的主要驅動因素,無論是性、食物、酒精還是毒品。 但酒精還會,它會與我們大腦中稱為GABA的部分結合,這是我們的抗焦慮系統。 這是與某些抗焦慮藥物相同的系統,如人們可能聽說的阿普唑仑(Ativan)、羅拉西泮(lorazepam)或安眠藥(Xanax),這些藥物類似於鎮靜劑和抗焦慮藥。 酒精作用於大腦的這一部分。 它實際上會導致您的內源性鴉片在大腦中釋放,所以就像大腦的天然止痛劑。 所以這實際上就是為什麼其中一種幫助人們戒酒的藥物有效,是因為它只是阻止了大腦中的鴉片反應,這聽起來一開始不太合理。 直到您理解這些神經機制,實際上您的某種天然止痛劑系統是因為喝酒而被激活的。 所以當您聽到有人談論酒精給他們帶來疼痛緩解時,無論是情感上的還是身體上的,這都是一個非常真實的事情。 這是我們大腦中一個強大的系統,在您喝酒時會被激活。 啊,好的。 所以如果我在工作中感到壓力,工作讓我焦慮並影響我,那麼我更可能會想在周末狂飲,因為這實際上是一種止痛藥。 完全正確。 這是一種抗焦慮也可以算是止痛藥的一種。我認為這就是為什麼對酒精的認識和教育如此重要,因為我們看到這是一種自我治療的方式,對吧? 而且很容易讓這種情況失控。 我認為尤其是如果您心裡認為,只要我不是早上喝酒,或因為喝酒而缺勤,或因為喝酒而與人際關係出現問題,我就沒問題。 但事實上,與酒精相關的健康問題甚至生活問題有很多,如果人們能夠更早意識到這些問題,他們可能會為自己做出不同的決定。 您知道,我在想一位相當知名的朋友,他因為成癮相關的問題去世。 當他相對年輕的時候,他承受了很大的壓力。 他在受到很大壓力的時候並不一定是孩子,但他當時年輕。
    我在想,正如你所說,童年經歷,究竟是指什麼年齡段呢?是否有一個特定的年齡,在那個年齡經歷某種程度的創傷後,更難以從中恢復,並且更有可能產生成癮? 是的,這是一個很好的問題。任何時候的創傷都可能使你面臨成癮的風險。這樣的情況發生得越早,影響可能越持久。因此,當我們談論大腦的時候,你知道,大腦直到二十歲出頭才真正成熟。因此,無論是創傷還是早期的物質接觸,年輕時的風險都會更大。但這並不意味著更晚的生活中經歷創傷不會讓你面臨發展物質使用問題的風險。我見過人們,他們的第一次創傷是在二十、三十或四十歲時,他們仍然可能會發展出物質使用障礙。只是當你在孩童時期經歷這些逆境時,風險會更大。有趣的是,創傷並不是那麼多關於經歷本身,而是常常會讓人孤獨地面對那段經歷。因此,對某個人來說是創傷的事,對其他人來說可能不是。比如說,疫情,我跟一些人談過,他們覺得被困在家裡、孤獨且無聊,這對他們來說是非常創傷的。其他人卻沒有問題,他們在客廳裡,隨便做些事情,還找到方式去聯繫、過生活,過得不錯。同樣的經歷,卻被不同的人以截然不同的方式感受。所以,這不僅在於實際的經歷,而更多在於對那個人的影響,他們感到的情緒。而這通常是關於感到脫節。我們經常會說成癮的對立面不是清醒,而是連結。問題在於你如何再次與他人建立這種連結。我提到的那位朋友是利亞姆·佩恩,他來自一個著名的男孩樂隊“一方向”,他在幾年前去世了。他之前曾上過我的播客。在節目中,他說,讓他青少年時期如此艱難的原因,顯然是因為他被推上了這個大舞台。運作的方式是,你會置身於這個巨大的聚光燈下面。然後他們會把他放在舞台上,面對十萬個在杜拜的觀眾。之後,他經歷過這一切後,就被送回酒店房間,然後鎖在酒店房間裡。因為顯然他不能出去,因為他真的太有名了,如果你走上街頭,人群就會蜂擁而至。因此,他就被鎖在那個酒店房間裡。在節目中,他說,我被鎖在那裡,只有小酒吧,裡面是滿的酒,所以我會喝酒。這個循環就這樣重複。他會說,舞台、車子、酒店、被鎖、喝酒、舞台、車子,這一切反复發生。因此,當你談到孤立與孤獨的時候,我從未考慮過連結和社交關係可能會在某人上癮的過程中發揮作用。但這都是正確的。這讓我想到一位本週所見的患者,他真的想戒酒,能夠持續幾週不喝。但他的生活相當空虛。他現在沒有工作,也沒有很多的關係。所以當他不喝酒的時候,他就待在家裡,自己看電視。這樣不久之後,他就會想,唯一能給我帶來解脫的就是喝酒。因此,問題就不再在於酒精的分子,而是我們如何填補人們的生活?我們如何再次建立連結,建立社區,培養身份感、目的感和參與感,這些都不依賴於物質使用的解脫?你顯然非常聰明。當我遇到像你這樣的人時,我總是自問,你本可以將生活奉獻給任何事情。你可以在幾乎任何領域工作,並且會獲得成功,因為你具備成功所需的條件。那麼你為什麼如此在乎這件事?是的。我想和很多人一樣,我有一個個人威脅。我的一位家庭成員受到成癮的影響,實際上在我上醫學院時去世了。因此,這大概是一個關鍵時刻,彼時我正學習所有的科學,意識到,哇,我真希望我在年輕時就知道這些。以及去處理那些受到這件事影響的家庭成員和朋友,並且我們對此理解得如此錯誤。大多數人沒有能力和知識以不同的方式去應對。因此,你知道,有一句話,當你知道得更多時,你會做得更好。我想,我也想將我希望別人能擁有的東西分享出來。你提到的那位家庭成員。嗯嗯。你幾歲時失去了那個人?大概24歲。是因為成癮嗎?對。當你面對有成癮問題的家庭成員或者親近的人時,很多聽眾能夠感同身受那種感覺。是的。你能描述他們的感受嗎?我想這是希望讓他們感到被理解。因為有時候,尤其是回首往事,如果最終失去了那個人,你可能會充滿很多內疚或誤解,特別是在思考社會如何繼續前進時。因此,你怎麼用詞語表達成為一個有成癮問題的家庭成員的感受呢?是的,我想你會感到無力。你會感到想要做點什麼,但你要麼不知道該怎麼做,要麼覺得自己所嘗試過的一切都沒有奏效。我想,因為人們接觸到這種想法,這是一個意志力或選擇的問題,這真的暗示著如果人們夠想要這樣,那他們就能夠停止。
    所以如果你是家庭成員,就會很容易感到他們對我不夠愛,認為他們沒有選擇我,而是選擇了這個物質。因此,我認為人們經常感到非常受傷,而他們也曾經經歷過創傷。面對這樣狀況的家庭中有很多創傷。有時候,他們會得到一些很糟糕的建議,比如要把某人趕出去,或者一種所謂的嚴厲愛心的觀念,認為人們需要觸及底線。因此,有時候人們會這樣做,然後陷入對這是否正確的罪惡感中,或者他們甚至會覺得對家庭成員好或愛心都感到內疚。所以我認為有一整套混合的感受。而且,當你失去某人時,你總是會想,如果我能有所不同的做法,會不會他們今天還在?會不會有其他事情能改變?我想人們可能會感到憤怒、悲傷和內疚,並且會帶著這些情感。你失去的那些人需要什麼,卻沒有得到呢?我認為他們需要基於科學的治療、同情和共鳴。我認為他們需要一個不被看成羞恥或批判的世界,而是一個被視為問題的世界。你知道,從“你是問題”轉變為“你有問題,並且我們可以幫助你解決”。我認為我們過於頻繁地把它視為“你這個人是問題”。你有時會回想並想,如果我做了不同的事情,不論是你還是你身邊的其他人,或者那個人的周遭環境,他們是否會仍然在這裡?因為我認為這是第一個浮現的念頭。我回想起我做過的所有決定。我想,也許那是我所得到的糟糕建議。也許我應該打更多的電話。也許我可以在這裡介入。也許,哦,也許還有其他我可以做的事情。絕對是的。我時常在這樣思考。我想到了一位因過量而失去的朋友。我想到一位因酒精而失去的家庭成員。不僅是我可以做不同的事情,還有,這些人,他們去看了醫生。他們在醫院裡。他們有這些接觸點,所有那些可以讓別人參與並提供善良和實際有效的、科學支撐的護理的時刻。他們沒有得到這些。所以有很多錯過的時刻和機會。但我還想到的另一個問題是,我和他們之間失去了多少時間,因為我認為在這種所謂的嚴厲的愛和把人趕走的模式中,或者認為“我是不會再見你,直到你停止使用或停止喝酒,因為我認為這樣會幫助他們改變”,你會失去和你所愛的人在一起的瞬間,而這些瞬間是無法再回來的。因此,我認為在這種非黑即白的模型中存在著問題,像是你要麼是在戒酒康復中,要麼是在積極使用,這是好的而那是壞的,我們失去了這樣一個事實,即與成癮鬥爭的人是了不起、有趣、充滿愛的人,他們面臨著某種問題。但如果某人正在與癌症抗爭,你不會想要遠離他們。你會錯過所有的時間。在我想到的這兩個案例中,我永遠無法再回到那段時間,你知道嗎?幾年前我有一句話,而我現在在重新考慮,那就是“當繼續保持不變的痛苦大於改變的痛苦時,改變就會發生”。這與某人需要觸及自己的最低點以便改變的這個想法相吻合。我認為這個觀念之所以存在,是因為我們聽到了太多的故事,我在這個播客中聽到過,某人的家庭拒絕了他們,將他們趕出街道,而他們獲得了那種“啊,天哪,我需要改變我的生活”的領悟。而人們總是提到那種“最低點”的時刻,他們因為沒有到達水井的最底部而採取了行動。那句話你怎麼看?當改變的痛苦大於保持不變的痛苦時,改變就會發生。我認為確實存在這樣的時刻,這並不是要貶低它。我也聽到過這些故事。但我認為根據我們的證據,可能有更多的時候,人們只是一次又一次地忍受痛苦,直到他們從不改變。我認為我們所看不到的部分是,那些改變發生在他們開始獲得足夠的希望,認為事情可能會變得更好,有人愛著他們,有人夠在乎他們,伸出援手在黑暗中,實際上有前進的道路。我認為當人們感到絕望、認為一切都無法改變、他們永遠不會有希望、生命永遠無法變得更好時,他們就會停滯不前。因此,你知道,舉個例子。我經常聽到當他們摯愛的人進入監獄時,家庭成員會說“謝天謝地,他們至少在一個安全的地方”。這實際上有一種解脫感。甚至有一個術語叫“被救”,人們會感受到。我認為這只是顯示出家庭所面臨的絕望,但這種觀念是,這是一次安全的介入。而且你會聽到這些故事,對吧,有人被鎖起來了,這就是他們的啟示時刻。
    然而,如果監禁對於成癮是一種有效的干預措施,比如說,我們就不會看到其實在出獄後,與毒品有關的死亡風險增加了130倍。 曾經被囚禁過的人,從成癮中死亡的風險要高得多。 有這樣的故事,但我們往往更加重視那些令人驚豔的敘事。 我們忽略了許多人將會在痛苦、孤獨和隔絕中死去,因為他們失去了希望。 這並不是要貶低那些時刻。 有些人非常堅韌不拔,儘管面臨重重困難,即使經歷了最嚴重的創傷,他們仍然能夠挺過來。 這是不可思議的。 但這並不意味著我們應該建立一個讓人們面臨盡可能多困難的體系。 那麼,您會否認為,如果我們想要幫助某人改變,實際上是關於希望、他們的動力有多強、以及愛、同情和聯結? 絕對是。 還缺少什麼嗎? 還有有效的治療。 治療,好的。 這是主觀的,對嗎? 這可能取決於他們所處的情況。 這取決於成癮的類型和他們的情況,但在大多數情況下,這是一些心理治療和藥物治療的組合。 那麼酒精呢? 是的,我的意思是,酒精的歷程很有趣。 是的,這在社會對其看法方面經歷了一段旅程。 你能帶我了解這段旅程,告訴我我們現在的位置嗎? 當我這麼說時,我是指社會對其健康益處的看法以及其本質。 然後還有我們現在對酒精的錯誤看法。 是的。 是的,所以,我的意思是,酒精的歷程是迷人的。 首先,我想我們認為這是一個相對現代的事情,但,考古學家已經在13000年前的狩獵採集者的洞穴居所中發現了製造啤酒的設備。 那真是令人驚訝。 哇。 大約有13000年的歷史,人們在摸索著如何製作啤酒。 你知道,看看九千年前的中國。 這更像是一種精神上的旅程或社交活動。 它從來不是關於健康的。 在某個時候,我們開始講這是對健康有益的事情。 比如說,喝紅酒。 這會改善你的健康。 我認為這就是我們出錯的地方。 原因其實是我們看數據的方式。所以首先,如果你僅僅看一種健康狀況,有些健康狀況在適量飲酒的情況下確實對你的健康是有益的。 但這也與人們進行研究的方式有關。因此在大多數這些研究中,人們所做的就是選擇一個大規模的人群,幾萬人,我們擁有一些他們報告的飲酒量的數據。 然後我們查看健康風險隨著時間的變化。 科學家會將人們歸類為不喝酒、喝少量酒、喝適量酒或喝酒過量者。 他們發現,即使是喝酒到適度水平的人,其實比完全不喝酒的人更加健康。 於是,這就是喝酒有益健康的概念出現的原因。因此,人們會討論像是 J 形曲線,這意味著適度飲酒的人實際上面臨的健康問題風險較低。 然後只有當你開始喝非常大量的酒時,才會比完全不喝酒的人面臨更大的健康問題風險。 他們意識到這一點的錯誤在於,那些完全不喝酒的人中,許多人之所以不喝酒,實際上是因為他們的健康狀況真的不佳。 出於其他原因,例如,他們可能有心衰,而不想喝酒是因為不想和藥物發生交互作用,或者他們可能有酗酒障礙的歷史,實際上正在康復中。 所以他們已經因酒精受到了某種損害,而不喝酒正是因為這個原因。 當你改變參考組的時候,實際上就是將你比較對象改為那些非常少喝酒的人。 所以並不是說他們根本不喝酒,而是他們喝得非常非常少。 然後你開始看到那酒精的健康益處在失效,尤其是如果你看看所有的健康狀況。 你是在告訴我,沒有健康的酒精消費水平嗎? 是的。 我從不會說喝酒對健康有益。 這並不意味著在我們所謂的低風險水平飲酒不能成為健康生活的一部分。 所以這是一個微小的轉變,不要自欺欺人地認為喝一杯紅酒就像運動30分鐘。 這並不是促進健康的事情。 我更像是把這看作是享用甜點、吃培根、在陽光下曬太陽。 這些活動都與風險相關。 這並不意味著我會說你永遠不能做這些事情,但你需要了解其風險,然後為自己做出選擇。 所以我看著這杯紅酒和這品脫的啤酒。 是的。 如果我每天喝其中一種,並不算多,我認為人們通常會認為,哦,只有一杯。 所以我的身體會排出它,而不會有任何不利的健康後果。 是的。 這是真的嗎? 那麼,挑戰的一部分是我們對什麼是一杯酒的理解。 所以我認為就像如果你學會讀食物的份量,你會意識到一份冰淇淋大約是半勺。 它不會是一個巨大的冰淇淋聖代。 對酒精來說也是如此。所以在英國,所謂的低風險飲酒限度是以酒精的單位來計算的,這相當於8克的酒精。
    所以,多少酒精飲品含有八克酒精呢?
    要屬於低風險類別,你的攝取必須低於14單位。
    問題是,隨便一杯葡萄酒,就大概含有幾單位的酒精。
    所以這一杯,即使我們認為它是一杯酒,它可能實際上,我得猜測,但大概是三單位酒精。
    那麼,如果我每天喝一杯葡萄酒,我就會超過那個限制了?
    你會正好在那個限制上。
    問題是,大多數人不只喝一杯。
    如果你某天喝了兩杯,然後某天喝了一杯,然後在社交場合喝了三杯,突然之間你就大大超過了那個限制。
    所以,如果你說這大概是三單位,大概。
    而你每週能攝取14單位。
    你每週能攝取14單位。
    嗯哼。
    所以三乘以七。
    嗯哼。
    21。
    是的。
    所以如果你喝那麼多,就會超過了。
    對。
    好吧,如果我每天喝這杯葡萄酒,那我就會超過英國的限制嗎?
    較低風險的飲酒。
    較低風險的飲酒。
    所以我就會是中等風險的飲酒。
    你會進入我們所謂的中度風險,這與幾乎所有形式的癌症都有關聯,而我想人們並不知道這一點。
    好的。
    因為我在想為什麼癌症會不斷增加。
    是的。
    各種不同形式的癌症都有所增加。
    你知道,乳腺癌就是我們常聽說的正在增加的一種。
    所以你在說低風險或中度風險飲酒與癌症之間的數據呢?
    是的。
    所以數據正在增加,而且非常令人擔憂。
    對於乳腺癌來說,實際上,即使是在低風險限度下,也有一些癌症其風險會開始增加。
    所以我們會說,基本上沒有健康的,甚至沒有像低風險的量。
    例如乳腺癌和食道癌。
    所以乳腺癌,如果你在那些低風險限度以下飲酒。
    在美國,這會是少於七杯,但在美國,一杯酒是五盎司的葡萄酒,這比那小。或者在英國,則在14單位以下,所以根據那種大小的葡萄酒杯,會是少於七杯。
    我們仍然會看到乳腺癌風險稍微增加。
    大約是5%的增加。
    這意味著你患乳腺癌的風險會增加約5%。
    這並不算很高。
    所以我想,百分比的增加有點難以計算。
    但如果你想想,在美國,平均每位女性在一生中有13%的機會罹患乳腺癌。
    13%的機會?
    真的嗎?
    是的。
    哇。
    真的很高。
    所以5%的增加會把那提高到大約13.6%左右。
    這意味著如果這間房間裡有九位女性,其中一位在她的一生中會某種程度上患乳腺癌?
    在她的一生中。
    對。
    天哪。
    是的。
    為什麼會這樣?
    而且還在增加。
    是的。
    所以這背後的原因很可能是環境因素,因為你的基因在那段時間內並不會改變。
    所以風險因素,如果你想想乳腺癌,就是酒精。
    就是肥胖。
    就是生孩子的年齡,或者沒有生孩子的年齡,因為這是一種真正由荷爾蒙驅動的癌症。
    如果你再想想結腸癌,那也是一個非常可怕的癌症,我們看到越來越多的病例發生在年輕人身上。
    一些驅動因素,吃肉。
    所以加工肉類會增加結腸癌的風險。
    所以,這些非常正常的行為。
    老實說,可能還有其他環境因素,我們尚未測量或能夠測量的。
    考慮到加速度的速度,當我與我的腫瘤科醫生同事交談時,你知道,像塑料或其他我們還不知道的東西。
    顯然,環境中有某些因素正在驅動這些癌症風險的增加。
    所以即使在這種程度上,如果我飲酒,那可能是一單位,對嗎?
    是的。
    所以那就是一單位。
    所以那會少於14單位。
    所以你可以想像,如果你喝兩倍那樣的量,那就是相當多的葡萄酒。
    每週不能超過七杯,才能被視為低風險。
    但即使是喝這個量,你的乳腺癌風險也會稍微上升。
    即使這個量?
    嗯哼。
    在乳腺癌方面,其實沒有安全的酒精量。
    僅僅是乳腺癌嗎?
    所以那個低風險類別。
    所以當我們進行這些大型癌症研究時,將人們劃分為低風險或輕度飲酒者,中度或重度。
    對於幾乎所有的癌症來說,一旦你達到中度類別,我們就會開始看到增加。
    而且我們所謂的劑量反應關係也存在。
    喝得越多,癌症的風險越高。
    只有少數幾種癌症,即使在那麼低的水準下,風險也似乎會增加。
    而乳腺癌就是其中之一。
    食道癌也是其中之一。
    所以在某些癌症中,即使是少量的酒精也會增加你的風險。
    這會影響到在男性中比較常見的癌症嗎?
    是的。
    比如結腸癌,我們在許多年輕男性中看到了這種情況。
    肝癌。
    對。
    前列腺癌,顯然是一種男性癌症,我們不會想得太多,認為它是那種對酒精敏感的癌症。
    但大多數癌症,由於酒精影響我們的癌症風險的方式並不是真正針對肝臟以外的特定器官。
    而是關於它如何改變我們的DNA。
    所以這與炎症有關,以及所謂的反應性氧物種(reactive oxygen species),這些會改變我們的細胞並隨著時間推移增加導致癌症的突變風險。
    所以,是的,你能詳細說明這一點嗎?
    所以如果我是一名重度飲酒者,假設我每天持續喝兩杯葡萄酒,那如果我每天喝兩杯。
    如果你喝這兩杯,是的,你就會進入重度飲酒者的類別。
    所以每週喝兩杯的情況下,我就屬於重度飲酒者分類。
    是的,這會讓大多數人感到驚訝,對吧?對許多人來說,這是非常正常的。確實非常正常。我覺得年輕人更難理解這一點,因為年輕人喝酒比較少。但如果我思考一下比我年長的一代,喝每天兩杯酒算是相當正常的。下班後、週末或每餐時都會這樣。所以這樣的話,我就成了重度飲酒者。那麼,在我的癌症風險資料方面,統計數據是怎麼說的呢?是的,這會因癌症種類而異,但大致上,我們談論的是約40%的癌症風險增加,具體取決於癌症類型。而且你喝的越多,風險會越高。所以,這些是一些科學研究,它們對個體的精確度並不高,這些數據是基於大型人群。但肯定的,喝得越多,風險就越大。如果我還有其他一些,被稱為共病的疾病呢?對,正是如此。如果我肥胖,或者超重,我的概率會進一步上升。沒錯,如果你吸煙。酒精和癌症的主要驅動因素之一也是它實際上會使你更容易受到煙草中致癌物質的影響。所以如果你喝酒又吸煙,你的癌症風險會更高。這是怎麼運作的呢?觀點是,如果我們拿食道癌,從細胞層面來看,它會使你更容易受到致癌物的影響,這些都是煙草中的致癌化合物。因此,這不僅僅是看到附加的風險,實際上在癌症風險方面,你幾乎會得到一個乘數效應。所以吸煙,加上肥胖,是另一個大問題。如果你的體重指數上升,許多癌症的風險也是在增加。那麼,身體發生了什麼事呢?如果我喝酒,這是怎麼導致癌症的?你剛才稍微提到了一點,但我想確保我在這方面非常清楚,比如說,這些影響是什麼,以及怎麼樣會導致癌症。是的,我的意思是,有很多不同的機制。所以,我的意思是,也許我們可以先談談酒精在你體內的作用。你會攝取酒精。它的化學名稱是乙醇。這是一種分子,基本上它會比較快地被你的胃吸收。所以,它通常會在你喝酒後的10分鐘內進入你的血液。它進入你血液的程度取決於你體內的水分量。酒精不會滲透到你的脂肪中。它只是擴散到你身體的水分部分。因此,這也是為什麼對許多女性來說,她們在較低的酒精濃度下會感到更加醉,因為女性的體脂肪通常高於男性。但這會根據你個人而異。如果你有更多的體脂肪,你會有不同的影響。所以酒精進入你的血液中。酒精可以瞬間越過我們所謂的血腦屏障。因此,它會立即影響你的大腦。這就是許多人最初感到愉悅效果的地方,會感到有點放鬆、更社交、或稍微減少焦慮。如果你繼續喝酒,酒精的濃度繼續上升,那麼你的判斷力會開始受到影響。你可能會運動失調。我們都看到過這種情況,很多人可能都經歷過。你可能會踉蹌,無法安全地駕駛。你不會做出如果不喝酒時會做出的同樣決定。如果你繼續喝酒,你實際上可以失去意識。所以會昏倒,很多人也經歷過這種情況。你的身體會盡快分解酒精。像任何東西一樣,我們想排除任何異常,恢復正常的功能。因此,這個過程主要發生在你的肝臟中,這也是肝臟對酒精特別敏感的原因。因為你的身體把乙醇視為毒藥。是的。我知道你提到過這一點,Lemke醫生,但你的身體總是想要恢復所謂的穩態。你的身體永遠會努力恢復到它認為的正常狀態。因此,乙醇不是屬於你血液中的東西。你的身體會試著盡快排出它。然後它將其轉化為一種叫做醋酸的物質。然後你可以通過尿液或呼吸將其排出消除。因此,為了消除你體內的酒精,你必須經歷這個過程。而這個過程的一部分包括這種會在體內浮動並造成細胞損傷的毒素分子。這就是酒精可能導致癌症的一種方式。另一種是一般的炎症。人們可能聽說過炎症對身體是有害的,並且會增加癌症風險。而酒精在消除過程中會產生大量的炎症。因此,它實際上可以改變你的細胞,隨著時間的推移可能導致癌症。因此,我還找到一張圖表,這對於任何看不到我們目前所描述的內容的人來說,它顯示了肝病、死亡率和一般肝病的加速情況,與身體其他部位相比。是的。它顯示了身體其他器官的情況,我相信是這樣的。酒精對肝臟有什麼影響?我們這裡有一個小模型來展示人體。肝臟在哪裡?是的。好問題。這是我們的小模型。為了讓大家了解身體的結構,我們現在看到的是內部,不再有肋骨和皮膚外部。這兩個粉紅色的部分是肺部,它們包圍著心臟。你可以看到心臟在肺部後面,正在泵送你的血液。肝臟是一個棕色的器官,位於你身體的右側,正好在你的肋骨下方。它非常大。它很大。
    這是一個驚人的器官。
    它相當大。
    它處理我們攝入的各種毒素、食物、葡萄糖和酒精。
    有90%的毒素是由肝臟代謝的。
    所以肝臟可以說是體內的清道夫,清除身體中的廢物。
    還有腎臟,但肝臟的作用尤其巨大,特別是在酒精處理方面。
    它就坐落在這裡。
    它看起來幾乎和一個肺一樣大。
    是的。
    真的?
    是的。
    它是一個巨大的器官。
    而且它是一個驚人的器官。
    所以你甚至可以切掉80%的肝臟,它仍然會自行再生。
    有點像你知道那些蜥蜴,你切掉它們的尾巴,它們就能再生一條尾巴。
    肝臟真是讓人著迷。
    這就是為什麼我們可以進行活體肝臟移植。
    所以我可以取走你的一半肝臟,然後把它給一個需要肝臟的人。
    你仍然可以活著,他們也能因為你那部分的肝臟而獲得第二次生命的機會。
    所以這是一個非常酷的器官,可以再生。
    但它的再生也有一個限度。
    所以一旦你的肝臟裡有了很多疤痕組織,我們稱之為肝硬化,你就會達到一個無法回頭的點,在那時肝臟無法自我修復。
    所以我會把它想成,就像用烘焙的比喻,如果你正在做鬆餅或蛋糕,你一直在攪拌所有成分,然後你意識到在把它放進烤箱之前,哦,我忘了加蛋。
    你仍然可以把蛋加進去,把它們一起攪拌,那樣就會好。
    但如果鬆餅已經在烤箱裡烤,然後你忘了加蛋,你就不能倒蛋在上面再讓麵糊變一樣。
    肝臟就有點像這樣,達到一定程度後,你可以完全修復像酒精或肥胖等造成的影響。
    但一旦你超過那個點,變成疤痕組織,肝臟就無法再生了。
    所以當你想到那個圖表或肝臟疾病上升的趨勢時,肝病的主要驅動因素是肥胖,還有酒精。
    所以這是肝臟移植的主要原因。
    而且,最令人難過的是,嗯,我在醫院工作時經常看到這種情況,首先,我們看到越來越年輕的人出現肝衰竭。
    年輕的二十多歲的人因酒精進入急性肝衰竭,然後在醫院去世。
    而可怕的是,他們通常甚至不知道這會對他們的健康造成問題。
    等他們到了醫院時,情況已經非常糟糕,太遲了。
    然而,所有這一切本來都可以提前預防或修復,如果能早些發現的話。
    所以我覺得這就是這種教育的重要性,了解酒精對健康的真正危害是什麼?
    而且我們已經在許多場合下,尤其是在年輕人中,把狂飲視為完全正常的行為。
    然而,這樣有非常嚴重的健康後果。
    所以我對肝臟有一堆問題。
    這是否意味著我的肝臟能夠承受一些傷害,才會出現真正的問題?
    我想知道,像我這樣的人,我不喝酒。
    我沒有從事任何太不好的行為。
    但有時我確實在想,如果我能有一個狂歡的周末,然後我的肝臟會恢復到正常,我也會沒事。
    是的。
    我的意思是,首先,每個人都是不同的。
    一次大的狂歡周末,你可能會沒事。
    任何人可能都會沒事。
    挑戰在於,一個狂歡的周末會導致多個狂歡周末。
    隨著時間推移,這實際上會加速你肝臟的損傷。
    但你說我的肝臟會再生,所以我在想這個東西可以很快恢復到正常。
    只要你還沒進入那個疤痕階段。
    所以一旦你走得太遠,即使你停止飲酒,你的肝臟也無法恢復。
    困難的是,我們還不完全了解為什麼一些人如此年輕就會發生這種情況。
    這是一個活躍的研究領域,因為有些人已經喝了60年,他們的肝臟沒有顯示出任何疤痕的跡象。
    然後我們看到一些25歲的年輕人進來,然後在醫院去世。
    所以有一些個體因素,你無法知道它們會影響你發展肝腺炎和疤痕組織的風險。
    因此,預防的最安全方法就是不以那些我們知道會導致傷害的高方式飲酒。
    另一種方法是尋求醫療幫助,因為我們通常會通過血液檢查檢測到這些情況,我們還可以進行超聲檢查。
    當我們看到這些早期階段時,首先發生的事情是你真的會在肝臟內堆積脂肪。
    這是第一步。
    然後我們看到脂肪肝的炎症。
    如果你不停止驅動這些變化的因素,隨著時間推移,我們會看到所謂的纖維化的發展,也就是疤痕組織。
    然後這些疤痕組織會越來越嚴重,以至於你的肝臟停止工作,你要麼去世,要麼需要肝臟移植。
    除了酒精之外,哪些活動會對我們的肝臟造成巨大壓力,而我們可能並不會察覺到?
    是的。
    所以肥胖。
    食物也是。
    是的,食物。
    所以你的肝臟與葡萄糖代謝密切相關。
    所以我們的飲食和體重會影響肝臟健康。
    還有其他藥物,比如 acetaminophen 或 泰諾,這是非常常見的非處方止痛藥,超過一定劑量會造成嚴重的肝損傷。
    所以有時會看到一些案例,有人沒有意識到他們的感冒藥加上他們服用的泰諾都含有那種成分。
    然後他們出去喝酒。
    這樣的組合效應會導致肝損傷。
    你覺得有多少 – 這也許是一個不太明確的問題 – 但是多少酒精會導致肝損傷?
    所以,這再次因人而異。
    對於肝臟損傷來說,通常是中等到較高的飲酒量會造成傷害。其中一點是,您知道,這種大幅的飲酒,比如這些大規模的酗酒事件,可能比長期以適度的飲酒更具危害性。這些像是大幅的飲酒會造成毒性副產品的大量累積,您的身體必須清除這些。因而,如果您有數年的重度酗酒歷史,這實際上可能會造成比長期少量飲酒超過風險限制更大的損害。所以,真正努力減少並避免那些非常重的飲酒事件是非常重要的。而且,遵循我們剛學到的低風險准則,也就是說,低風險程度是非常令人瞩目的,將減少肝臟損傷的風險。
    那麼,酒精只影響肝臟嗎?不。我的意思是,酒精對我們的身體有影響。身體的許多部位都可能受到酒精的影響。因此,從上面開始,我們可以看大腦。我們可以用圖片來看,比如MRI。哦,我其實有一個。是的,我想要。這對我來說非常震驚。所以,當我們對某人的大腦進行MRI時,我們基本上,這就像一個橫截面。所以,這幾乎就像您面對我,我切掉您的臉,然後看著您的大腦。健康的大腦組織是灰白質。您希望它能夠豐滿,佔據儘可能多的空間,因為那裡就是您所有大腦活動的所在。當人們變得非常老或患有癡呆症時,我們看到的一件事是更多的黑色空間本質上是水。因此,我們看到大腦開始收縮,水分增多,而活躍的健康大腦組織則減少。這個過程在重度飲酒的情況下會加速。因此,您可以在這裡看到,這是一位43歲的重度酒精使用障礙患者,他的大腦看起來就像是90歲的癡呆症患者,因為隨著時間推移,酒精使用造成的大腦損傷。因此,我們實際上可以看出,一種癡呆症是與酒精使用相關的。所以,您的大腦可能會受到酒精的巨大影響。發生了什麼事?為什麼大腦會因為酒精而以這種方式衰退?是的,嗯,記住我說的乙醇,也就是那個分子,穿越血腦屏障。因此,尤其是在您體內的血酒精濃度很高時,乙醇會浸潤您的大腦。如果您考慮到我們討論過的炎症以及在大腦層面上對細胞、DNA和蛋白質的變化。另一件加速我們所見的酒精導致的大腦損傷的事情實際上是營養缺乏症。因此,人們可能喝得很多,但他們的飲食中實際上沒有攝取到真正關鍵的營養素。這可以加速大腦損傷的過程。我們甚至可以看到在營養不足的情況下,重度飲酒會導致非常突然的健忘症。
    好吧,這就是大腦。確定是大腦。接下來是口腔和食道。因此,顯然,您在喝酒,酒精浸潤著您的口腔,浸潤著您的食道和胃。我們看到癌症的發生率有所增加,正如我們所討論的,而這一過程又被吸菸加速。但我們也看到了一些良性但令人困擾和問題的健康狀況,最明顯的是胃食管逆流,也就是胃灼熱。因此,如果您注意到,我經常有胃灼熱,我不得不吃很多抗酸劑並服用藥物。您可能要考慮一下,我喝了多少?這是否在促進我的胃灼熱?這是一個非常普遍的情況。心臟也會受到酒精的影響。因此,您知道,心臟是這樣一個器官,在低風險水平下似乎不會受到酒精的傷害。但一旦您進入中等和高風險範圍,我們看到傷害。這些傷害可以有幾種形式。一個叫做心房顫動的情況,這基本上就是您的心臟開始不規則地跳動。在您的心臟中,有四個腔室,上面的兩個腔室。因此,這真的展示了心室和心房。血液流經的有兩個腔室。在正常的心臟中,您的電活動從心臟的上部開始,向下到心臟的底部,並告訴心臟進行泵送。因此,您會得到一個單一的脈衝到心臟的底部,說泵送,然後這樣泵送血液到您的大腦、身體、器官和肝臟。在心房顫動中,心臟的上部只是因為這種異常的電活動而顫動。因此,心臟無法以正常的方式進行泵送。我們實際上在醫學上有一個術語叫假日心臟,因為我們有時會看到人們在假期中喝很多酒,因而進入這種異常的節律,僅僅是因為那種酗酒模式。隨著時間的推進,如果您持續高水平地飲酒,您的心臟實際上會擴大,您可能會因為心肌病而患上充血性心力衰竭,這意味著心臟肌肉變得虛弱、纖細、鬆弛,無法進行所需的泵送。
    哦,天哪。有時我們會認為,如果我們能很好地應對啤酒或酒精,那就對我們的傷害更小。因此,無論出於什麼原因,我總是能夠很好地飲酒。當我曾經喝酒時,我不再喝酒,但在我曾經喝酒的時候,我的影響比我那位稍微大一點的朋友要小,他擁有稍微多一些的體脂肪,這真的很有趣,因為您指出了一個我從未意識到的關聯。稍微停一下。您在說如果某人有更多的體脂肪,他們更有可能喝醉嗎?是的,因為他們的體內水分較少,而酒精不會進入您的體脂肪。
    所以,基本上,就像你拿著一杯水,然後把紅色染料放進去,它會擴散到水中。 所以,水越多,擴散效果就越強,血液中的酒精濃度就會越低。 如果你的體脂肪很低,你的體內水分可能會比較多。 因此,對你來說,兩杯酒會擴散到更大量的水中。 這說明了很多。 因為我一直在想,他比我大得多。 當時,他體脂肪更多,而他會非常、非常快地喝醉。 你總是會以為,哦,大個子,他們能夠應付啤酒或其他東西,但他會很快喝醉。 所以,我曾經想過,我曾經認為,酒精對我影響不大,因為我沒有像他那樣醉。 但這並不是真的。 不,我的意思是,首先,我覺得這裡有一個有趣的故事,一方面,不僅僅是體脂肪,還有每個人酒精代謝的速度也不同。 你可能,嗯,我不知道你是否有這個特徵,你可能比你的朋友更少宿醉。 因為宿醉似乎與血液中酒精濃度的多少有關。 所以,那些代謝酒精不夠快的人往往有更嚴重的宿醉。 所以,那可能是你經歷過的事情。 但這並不能保護你免受酒精造成的其他健康損害,比如肝損傷、癌症,或者隨著時間的推移,心臟問題或食道問題。 宿醉是什麼? 對,宿醉是一件令人著迷的事情,人們對此有很多新興的證據和試圖理解發生了什麼。 它似乎與腦中乙醇濃度的高低最有關,因為他們實際上對小鼠和人類進行了大量的研究。 最初以為是因為酒精的副產品,比如我們提到的乙醛分子,但似乎與此無關。 它似乎與乙醇有關。 但本質上,這是一種症狀,當你喝酒後,一旦你的血液酒精濃度降至零,你會感到有些無精打采,疲倦,頭痛,通常會感到噁心。 因此,這是一種大腦在乙醇中浸泡後的後遺症。 然後當它離開時,你會感到非常糟糕。 因為人們有時認為這只是脫水。 是的,這不僅僅是脫水。 乙醇對你的大腦有實際的影響,這會導致宿醉。 我認為,如果你喝酒的量讓你有宿醉,這是一個好跡象,表明你喝的超過了對你的身體而言可以接受的限度。 因為我記得以前,如果我在睡覺前喝一大杯水,如果我喝過酒,早上會感覺好一些。 的確有某種脫水的因素,別誤會我。 這部分是因為,對,你想想,酒精是溶解在水中的。 所以,如果你的全身水分因為脫水而收縮,這樣你的乙醇濃度就會更高。 所以,喝水會幫助你沖走這些東西,感覺好些的。 我在喝水。 但這不僅僅是因為脫水。 現在會有一些人收聽這個。 我懷疑他們會到達這一步。 因為如果他們真的到了那裡,他們可能不會這麼想。 但會有些人在這段對話中走到這一步並在想,是的,但酒精幫我社交。 而社交真的很重要。 而且由於現代世界的設計,我不喝酒很難進行社交。 或者我喝酒時會玩的很好。 所以,我不想戒掉我的酒精使用。 而且,在某些情況下,會有高量和中量的酒精飲者。 你會對那些人說什麼? 嗯,首先,這裡沒有評判。 所以,乙醇分子並不比葡萄糖分子更道德或不道德。 你可以對飲食說同樣的話。 我們現在對加工食品、白面粉和白糖有很多意識。 這並不意味著每個人都會過著這種不苟且的生活方式,絕不吃甜點。 所以,我認為這真的很重要,你需要帶著睜大的眼睛去了解有哪些風險,什麼對你來說重要,以及如何進行計算。 因此,如果你決定這是你想要做的選擇,你想要為自己創造成功的機會。 所以,如果你決定,例如,我想減少我喝酒的量,但我每天晚上都要和朋友去快樂時光,然後在那裡試著不喝酒,你可能不會取得太大的成功,因為你會處於一種時常提醒你酒精使用的情況,並且周圍的人都在使用酒精。 所以,試著在生活、周和日程的安排上做一些不同的結構性改變。 你可能會發現,實際上,你並不那麼想念它,你可以去掉三、四天的飲酒,仍然在一周的兩天內獲得社交的快樂,而你的整體健康風險會顯著下降。 關於治療酒精濫用障礙,康復通常是最廣為人知的治療形式。 我的一位朋友對酒精成癮和毒品成癮都非常嚴重,曾多次對我說過,他告訴我,我已經去過三、四次康復,但這就是沒有用。 是的。 我認為,當最受歡迎或最知名的治療對你無效時,你會感受到更大的絕望感。 你是康復的支持者嗎? 總的來說,並不是。
    所以,你知道,戒治的概念就是你去某個地方待一週或幾週,然後你就算治癒了,對吧?這幾乎就像人們將上癮視為一種感染,認為你只需要兩週的抗生素,然後就結束了。實際上,我們理解的是,對於很多人來說,上癮更像是一種慢性疾病,甚至像癌症一樣,在最初的幾年中你需要很多治療。然後隨著時間的推移,你會達到穩定和緩解,幾乎就像是癌症倖存者一樣。你在長期康復中。因此,這種想法就是你去某個地方待幾週,然後出來就完全好轉的觀念,真的與我們對上癮的了解不相符。另一個問題是,在戒治中發生的很多事情,通常並不是那麼具有療效。對於上癮,我們知道的最有效的事情,一是藥物,這方面有很多污名和誤解。第二是,像是基於證據的心理治療。所以像認知行為療法、動機增強療法,你知道,針對你潛在的創傷進行工作。通常在戒治中心,模式確實是圍繞這種想法,即將自己從這個環境中移除。你在那裡參加一些群組。有時候,這些群組更多是基於同儕支持的模式。有時候,提供的療法坦率地說並不太基於證據。我們實際上做過一項研究。這是一項秘密顧客研究,我們致電全國的戒治計劃,詢問他們所提供的內容。許多地方提供像是馬療或海豚輔助療法這樣的東西,我相信與海豚游泳和與馬工作是非常美好的經歷。但這並不是經過研究證實有效的。而許多地方並不提供我們知道實際上有效的東西,比如在基於證據的療法或藥物治療中工作的受過訓練的臨床醫生。所以這是一種針對長期問題的短期解決方案,卻沒有實際獲得你所需要的治療。那麼對於酗酒問題,什麼是有效的,大多數人並不知道。我們有非常有效的藥物可以幫助你,即使你只是想少喝一點。所以,我最一開始提到的這種藥物實際上是阻止你的阿片受體。對。這聽起來有點搞笑,因為它對酒精有用。但之所以如此,是因為對於那些驅使他們喝酒的部分,飲酒時他們會從大腦中釋放的阿片類物質中感受到這種疼痛緩解的快感。這讓他們想要喝得更多。如果你阻止這一點,人們喝酒後不會感到不適,但他們會覺得不那麼有回報。因此,一位名叫辛克萊的研究人員在歐洲進行了一些引人入勝的實驗,甚至只是根據需要使用它。因此,與其把它當作每日藥物,如果你知道在某個節日活動中你會喝得比你想喝的多,你可以在出門前30分鐘服用。然後人們發現他們只喝了一杯,然後就覺得「啊,我很好。我沒有那種想要越喝越多的慾望,因為我沒有感受到同樣的好轉和解脫的愉悅。」你怎麼看待迷幻藥作為對抗像我們所描述的上癮行為的手段?是的。在過去幾年中,針對酗酒問題最具突破性的一項試驗就是氯蛙噪。關於氯蛙噪輔助的心理治療針對酗酒問題有一項大型研究,顯示出非常顯著的效果。參與者服用氯蛙噪,實際上與一些人進行比較,他們要麼服用大劑量的苯海拉明,要麼服用氯蛙噪,然後他們和治療師坐在一起,進行為期八小時的輔導性氯蛙噪之旅。他們發現,服藥後人們的飲酒量大大減少,所以它似乎確實有一些效果。理論上,迷幻藥的部份工作方式是提高神經可塑性,也就是大腦形成新通路和重新訓練自己的能力。因此,它似乎可能是一種治療酗酒問題的潛在辦法。氯蛙噪是魔法蘑菇中的活性成分。是的,正是如此。你聽說過伊博卡因嗎?我聽說過,是的。這是一種常與上癮相關的迷幻藥。是的。人們已經研究過伊博卡因對阿片使用障礙的影響。這些研究的前景不如氯蛙噪那麼樂觀,儘管最近並沒有以同樣嚴謹的方式進行測試。部分原因是針對阿片使用障礙,我們已經有非常有效的藥物,已證明可以改善康復並減少死亡,因此很難有比這更好的選擇。對於酒精來說,有一種非常有趣的新藥物類別,即用於減肥的藥物,人們可能聽說過。因此,像Wagovi、Ozempic,整個GLP-1類藥物似乎也能減少酒精使用,這非常有意思。真的嗎?是的。他們有研究過這個嗎?是的。他們有,首先,網上有整個Reddit討論串和社區,其中一些人因為糖尿病或減肥而被開了這些藥物,然後突然發現「我對抽煙或喝酒真的不感興趣了。」那種慾望完全消失了。對於某些人來說,他們形容這簡直是奇蹟。他們試圖戒酒多年,第一次沒有那種渴望和衝動。最近,還進行了一些實際的臨床試驗,做了安慰劑對照雙盲研究,顯示它確實減少了飲酒量。
    因此,這是一個非常有趣的領域,這些藥物似乎使渴望和食慾在更廣泛的層面上得以重置,而不僅僅是針對食物。
    這到底是什麼?
    我來告訴你。
    你們所有人可能都知道,我每年大約有50週的時間都在周遊世界。
    我一直提供的一個旅行小貼士就是:盡可能輕裝上陣。
    因為如果這樣做,我發現不需辦理行李托運,就可以節省幾小時,並且在另一邊不必等待行李。
    所以我總是攜帶一個小小的袋子,可以放在飛機上方的行李架上。
    無論我去哪裡,即使是為期數週的旅行,這都是一個巨大的旅行技巧。
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    就是exeter.com,使用代碼DOAC。
    我們許多人理解成癮的一種方式是,如果我們自己沒有親身經歷過,我們會在電視和名人流行文化中尋找榜樣。
    我們會看到這些榜樣,在舞台上出現,然後在公眾眼中開始惡化。
    最終,似乎那種情況總是不可避免地會讓TMZ的頭條新聞報導這個人已經去世。
    這種情況發生得實在太頻繁了。
    我們想到的名人,如惠特尼·休斯頓,或者我想邁克爾·傑克森也被認為是死於成癮。
    我想這是因為止痛藥或其他東西。
    還有普林斯、艾維斯·普雷斯利、馬克·米勒,很多人也會知道他。
    還有妮可·史密斯。
    即使在當今的公眾視野中,某些個體的行為開始出現不穩定的情況。
    他們在Instagram上發佈內容。
    他們在社會中以稍微不同的方式出現。
    當你在自己所在的工作領域看到這種情況時,你的自然反應是什麼?
    你會怎樣感受,因為目前我想到的幾個人,世界正談論著他們,我們認為他們有成癮問題。
    我們認為他們需要幫助。
    你對此的自然反應是什麼?
    他們需要什麼?
    嗯。
    當我讀到某人去世的標題時,對我來說,這是非常令人心碎的。
    首先,因為這明顯是一條人命,與某人的母親、姐妹或兄弟有關,還有很多人關心的公共人物。
    但最重要的是,這是完全可以防止的死亡。
    真的沒有任何人應該因為物質而死。
    我們擁有治療成癮的工具。
    我們知道如何預防,比如毒品過量的危害。
    因此,某人竟然會死去,尤其是那個大家都看著這麼久的人,我認為這只是悲劇的例子,顯示了我們在成癮的處理上與科學所說的有效方法之間的錯配。
    我認為,當我看到某人明顯展現出徵兆時,看到這種情況在公共場合發生總是令人感到悲傷,因為人們無法支持這個人。
    這不是魔法般的解決方案。
    不會有像你知道的那樣,進行一次干預,這個人就去接受治療,永遠恢復健康。
    我認為這常常是人們心中的想法。
    這是一個過程、一段旅程,就像任何改變一樣。
    因此,確實是在我們一開始提到的那個想法,如何開始理解這個人,他們的物質使用如何妨礙他們自己想要的東西?
    如果他們對改變自己的物質使用有信念,那麼基於他們所認為的更好的生活,生活會變得如何?
    我記得我有一位特定的朋友,他有成癮問題,我記得他一直是派對的核心。
    有一天,他在一個活動中走到我面前,坐在我面前,對我低聲說,他說,他像是對我耳語一樣,“我很痛苦”。
    他告訴我關於康復的事情,以及它怎麼樣讓他失望等等。
    但聽起來幾乎令人難以置信,這麼一個面帶大笑容的人會對我耳語,尤其是一個男人,因為男人通常不太談論自己的情感。
    “我很痛苦。”
    然後有趣的是,我看到世界怎麼對待那個人,而他對我耳語的一天。
    世界如何回應他的行為,攻擊他和批評他。
    但我知道那個耳語的內容。
    是的。
    而那一次耳語幫助我重新考量如何對待那個人,以及真正發生了什麼事情。
    這可能讓你給予他非常多的同情,對吧。
    是一種巨大的同情。
    因為我會像世界上其他人一樣。
    我會想,哦,這個人真傻。
    真是個混帳。為什麼他要那樣做?那是奇怪的行為。
    是的。
    而你說了一些非常重要的話,這是一個略微的措辭轉變。
    你沒有說他治療失敗了。
    你說是治療辜負了他。
    這一點非常重要,因為我認為,太常我們似乎讓人覺得是人们失敗了。
    就像如果他們去康復中心卻未能康復,那就是他們的錯,你知道。
    實際上,治療並不適合他們。
    如果某個人得了癌症,而他們的癌症復發,或沒有被化療治療,我們不會說,哦,他失敗了。
    你知道,我們會說,那麼下一步治療是什麼?
    我們該如何讓他們去正確的醫生那裡?
    所以有這種個人責備,這恰恰觸及了污名,這是人們不願意分享他們在物質上掙扎的主要原因之一,加上他們不尋求治療。
    因此,我們對於毒品和酒精成癮有著巨大的污名。
    這是全球最受污名化的社會狀況之一。
    因此,當你開始想,「哦,也許我真的有問題」時,像是「也許我的飲酒影響了我的生活」,說任何話都非常困難,因為你擔心會被評判、被標籤或者被誤解。
    在某些情況下,糟糕的事情可能會發生在你身上。
    你可能會被兒童福利機構帶走孩子。
    你可能會失去住房或失去工作。
    因此,這種污名造成了一個可怕的循環,人們不得不悄悄地告訴別人。
    這顯示了他對你有多麼信任,能夠誠實地說出他所經歷的事情,因為對於這種狀況有著如此多的污名。
    你一定有很多案件讓你心碎吧。
    是的。
    你可以告訴我一個改變了你的案例嗎?
    哦,天哪,太多了。
    你知道,有一位先生,他長期與海洛因成癮作鬥争,正如我們所討論的,這對他來說算是一種慢性疾病。
    他有過表現得非常好的時期,也有過困難的時期,並在所有這些期間都保持安全。
    而他生命中唯一一段真正有意義的關係是與他的母親之間的關係,他和她同住。
    他們住在公共住宅裡。
    他們像很多人一樣面臨著經濟不安全的問題。
    然後有人發現他和母親住在一起,這使得她面臨住房風險。
    所以他不想讓她失去住房,因此他離開了,但他剛成為無家可歸者。
    突然之間,因為社會障礙,他面臨著無家可歸和孤獨帶來的壓力。
    即使他和母親以及治療之間有很多的聯繫,他最終還是在兩輛停放的車之間被發現死去。
    他在街上獨自過量藥物。
    我總是想,如果——
    而你認識他。
    哦,是的。
    這些連鎖反應,你知道,其實本不必如此。
    我認為有如此多的死亡案例,我只是想,事情本不必這樣發生。
    而且確實沒有人應該以這種方式死去。
    有這麼多事情,在當下感覺是我們無法控制的。
    我想這也是我對這項工作的熱情所在,因為我不一定能拯救眼前的人或改變無家可歸或住房政策的問題。
    但我可以嘗試規模性地努力,讓下一個人有不同的體驗。
    我覺得這樣做在某種程度上抵消了我失去我所關心的人的痛苦。
    如果你是美國總統,例如,就以這個國家為例,你必須對社會設計進行上游的改變,以減輕毒癮和上癮行為等下游症狀。
    你會改變社會設計的哪些方面?
    你可以改變任何事情。
    是的。
    從上游入手,最大的改變將是早期建立韌性和連結。
    所以我認為這些看似與毒癮無關的事實上是深刻相關的,當我們思考逆境童年經歷時。
    所以當我們思考預防兒童問題時,常常有人會關注教育,比如告訴孩子們毒品是壞的。
    這是行不通的。
    真正有效的是實際上在年輕人中建立韌性。
    所以建立韌性、建立連結。
    那這樣的情境是什麼樣的?
    這就像是可以負擔得起的住房。
    這就像是人們能夠出去運動、玩耍和建立關係的公園。
    這就像是支持家庭,以便家庭能夠保持團結,這樣早期的關係和依附可以健康發展。
    這才是真正的預防工作,試圖打破代際創傷、貧困和物質使用的循環,實際上是在最開始時支持家庭和社區。
    這讓我想起了「老鼠公園」。
    是的。
    「老鼠公園」就是一個很好的例子。
    對於那些不了解的人來說,「老鼠公園」是什麼?
    是的。
    「老鼠公園」是一系列實驗,旨在用老鼠模型來理解成癮的驅動因素。
    他們把老鼠放在一個模型中,老鼠被孤立在自己的籠子裡,沒有任何事可做,也沒有和人類的聯繫。
    他們可以接觸到像嗎啡或可卡因這樣的物質,透過按下槓桿來獲取更多的藥物。
    在被剝奪了聯結和孤立的情況下,這些動物使用了更多的毒品。
    這讓他們感到舒緩,享受快樂。
    同樣的動物又被放進一個美妙的籠子裡,裡面有可以玩耍的地方,有可以爬的輪子,還有很多朋友和其他老鼠。
    突然間,他們發現這些老鼠不再按下槓桿,試圖獲取更多的藥物了。
    所以,這是一個略為簡化的模型,實際上它可能過於簡化。
    但它顯示了成癮背後的許多因素,真的圍繞著連結的觀念,重建我們周圍的世界、社區,以及我們之間的相互關聯性、機會、目的、意義和希望。
    所以我認為那才是真正的預防。
    然後還有我們如何實際上處理那些遇到問題的人。
    我認為我會首先使成癮治療在需要時立即廣泛可得。
    當你走進你的家庭醫生診所或急診室的那一刻,你會感受到同情、科學的對待,工作人員會詢問他們能怎麼幫助你,並提供有效的護理,就像如果你被診斷出新的癌症或心臟問題一樣。我們真的要重新塑造治療的方式,讓它看起來像其他健康狀況的處理方式。我們要停止懲罰那些使用物質的人,因為很多時候,人們仍然因為物質使用而被送進監獄,這真的是一個混淆的信息。如果我們一方面說這是一個健康問題,但同時又要把你關進監獄,這兩者並不一致。很多人活在第一種「鼠鼠公園」(Rat Park)的模型中。我們獨自生活,生活在這些大城市中。我們比以往任何時候都更靜態。也許,我們搬到大城市是因為沒有家庭的陪伴。我們可能在做一份讓人感到極度挑戰的工作。因此,當我們思考成癮、酒精和一些其他行為時,尤其是超越酒精這一物質的其他成癮行為,無論是社交媒體、飲食或色情,或是在某種反常的情況下,良好的習慣、健康的食品、運動,以及生產性的行為時,為什麼我們會如此掙扎。我常常在想,我們是否應該都去某個公社一起生活,你知道我的意思嗎?我想人類不應該這樣生活。這是一個相對新穎的事情,對嗎?我們往往生活在村莊或社區中,住在多代同堂的家庭裡。我有小孩,我認為擁有孩子的經歷讓我看到了為什麼人們會和父母、祖父母住在一起,擁有這麼大的家庭,以創造社區和一種擴展的家庭。我們在很多方面失去了這一點。我認為我們以前獲得這些的方式,比如宗教,對某些人來說可能仍然有共鳴,但對其他人則不一定。因此,找到其他參與、意義和目的的方式,這可以通過許多不同的方式實現。你知道,我認為人們正在找到創造性的方法來做到這一點。這可以包括,比如,尋找志願者活動、其他類型的社交團體。有些人通過運動來做到這一點。你知道,他們在一項活動或一支球隊的共同熱愛中找到了與陌生人的聯繫和參與感。但實際上,要將這視為優先事項,就像你在生活和健康中優先考慮其他事情一樣。你是否支持使用療法來應對早期童年創傷?當然,我認為其中一個問題是,療法太經常被迫施加於人們。我更傾向於這樣一種方式:我們需要提供可用、熱情和高質量的治療,以便人們能從中獲得價值。療法就是其中的一個重要部分。這涉及很多事情。它關乎連結,了解人們一開始使用物質的原因,解決和治癒那些創傷。擁有良好、受過良好訓練且有同理心的治療師也很重要。因此,有很多有趣的研究顯示,治療師的同理心實際上是最強的預測因子之一,影響你是否停止或改變酒精或藥物的使用。真的嗎?這非常有趣,因為我們經常認為,比如,你可能聽過有人說,我不太喜歡我的治療師。我認為這樣的反應會是,哦,你對療法不太感興趣。但實際上,研究顯示,同理心較低的治療師,他們的客戶在治療結束後更有可能使用更多的物質。因此,擁有一個受過良好訓練、充滿同情心且以證據為基礎的工作團隊也是非常重要的。我想這同樣適用於家庭和朋友。是的,我認為同理心真的很強大。那些我們認為是軟技能的東西實際上影響重大。扶持他人是有可能的嗎?我在跟安娜·蘭克博士討論這個問題,那就是你可以在某人的成癮中扮演一個角色。我想幫助我有成癮問題的朋友。所以我在他身邊,安慰他們。但在某種程度上,我實際上是在加強那種成癮行為,因為我在正向強化它,因為我如此支持他們,這麼愛他們,這麼關注他們的感受,實際上我是在幫助他們繼續那種成癮。這有可能嗎?是的。我認為這是一個「使能」(enabling)的概念,我認為這是很有層次的。我會說,核心上來看,愛和支持大多數時候不會造成傷害。當我與患者交談時,他們往往最終參加治療的原因並不是一些可怕的後果,而是在他們不喜歡自己的時候,有人關心他們並願意在他們絕望的時刻拉他們一把,讓他們重新找到信心。就是這些小小的善意時刻。我可以告訴你一個故事,是關於一位我們在醫院照顧的患者,他因為與毒品使用相關的危險感染住院。在他住院的周年紀念日,他給我們的團隊寫了一封信,他說,你們來看我,坐下來和我聊著,不會被我忘記。
    他現在每年都會在出院的周年紀念日發送一封電子郵件。
    正是這些人性的時刻、聯結的時刻——再次強調這種聯結的理念,往往成為變革的催化劑,帶來希望和信念,讓人認識到自己的生活在某種程度上可以變得更好,而不是增加他人的痛苦與折磨。
    這種情況有不同的表現方式。
    在家庭中,我們教給人們的一個最有效的工具叫做 CRAFT,這是社區增強和家庭訓練的縮寫。
    這和人們可能見過的情況非常不同,例如你應該如何策劃一次介入,並告訴某人是全有或全無的。
    但 CRAFT 是非常不同的。
    它首先教導家庭成員如何理解成癮的科學;其次,如何為自己獲得支持?
    因為在家庭中處理成癮問題非常困難。
    然後,如何以不同的方式開始了解後果?
    例如,如果你是一位父母,而你的孩子因為吸毒而缺課,你不希望掩護他們,進而鞏固他們的行為模式。
    但你也不需要把他們趕出家門,事實上有一系列的後果可以幫助人們改變。
    而改變的最大動力之一,其實是對你想要看到的行為的正向增強。
    在治療界被稱為應急管理(contingency management)。
    而且,健康保險公司,許多公司已經意識到了這一點,對嗎?
    如果你因為加入健身房而獲得退款,或者因為做一些人們希望看到的事情而獲得報銷,人們通常會更頻繁地去做這些事情。
    這在人類行為中是普遍存在的,尤其在成癮方面。
    但我們往往做的卻是相反的。
    我們試圖用懲罰的方式讓人們康復,而不是增強我們希望看到的健康行為,如果這樣說的話。
    是的,我想我正在代表聽這段話的觀眾,這位觀眾知道他/她的生活中有一位有成癮問題的人。
    他們試著表現出同理心,試著提供支持,試著幫那個人,但仍然沒有任何改變。
    在這種情況下,也許那個有成癮問題的人沒有接受支持,沒有參加會議,沒有與心理治療師交談。
    在你主動提供幫助的人又不接受的情況下,他們也不願意考慮其他的醫療治療,住在你家裡,干涉你的生活,等等。
    是否有某個時刻你會說“夠了”?
    是的。
    首先,作為家庭成員或朋友,這真的很難。所以對於正在聽的任何人,我經歷過,這是非常困難的。所以要對自己有耐心。
    我認為這是你所說的另一個決定——到某個時候,你必須做出一個保護自己的決定。
    假設你家中有一位面對成癮的人,他/她變得具攻擊性、偷竊金錢,或對住在房子裡的人造成創傷。
    在某個時候,你可能需要決定:為了我的福祉,也為了全家人的福祉,我目前無法讓這種情況繼續存在。
    這和說把他們趕出去就會讓他們好轉是截然不同的。
    因此,區別在於保護自己是可以的。有時候我們必須這樣做。
    但不要自欺欺人地認為這個行動就是在幫助另一個人,這也是可以的。
    我認為另一個重要的點是,在這一切結束之後,首先做一個治療者往往是更簡單的。
    我曾是一位家庭成員,也是一名臨床醫生。作為臨床醫生,我可以真正做到無條件。因此,無論某人是否繼續吸食海洛因或繼續飲酒,我都會成為他們的醫生。
    而這其中有一種非常美好的事情。我的介入與某人是否改變無關。
    作為家庭成員,這更難,特別是如果你依賴某人,或在婚姻中或關係中。
    所以你可能必須做出不同的選擇。
    但我認為,在這一切結束之後,人們不會因為我們認為他們應該改變的原因而改變。
    他們改變是因為他們認為自己的生活在某種程度上會變得更好。
    所以關鍵就在於找出,如果這個人對自己的酒精或藥物使用做出改變,他們的生活為何會變得更好?
    這是一次轉變,你會變成他們的夥伴,而不是試圖拖著他們往水邊走,就像把馬拉到水邊一樣。
    而且有一種迷人的人類本能告訴我們,沒有人喜歡被告知該怎麼做。
    所以有一種叫做寫作反射的東西,這對照顧者來說是非常難的。這對父母來說特別困難,因為我們愛告訴人們我們的好建議,並解釋他們的做法是錯誤的,他們應該接受我們的、如同醫生一般的建議。
    這可以表現為告訴某人,像是:“你難道不明白你正在做的事情會造成傷害嗎?你應該做出改變。”
    這也可以更微妙一些,可以是對某人進行講課或試圖教育他們。
    但當某人強迫把東西塞進你的喉嚨時,你的本能是反抗。這就是一種自然的人類行為,即使這個主意非常好。
    如果某人把冰淇淋放在你面前並強迫你吃,即使你喜歡冰淇淋,你可能會說,“等等,我不確定我想要這個冰淇淋。”
    所以關鍵是不要告訴某人該怎麼做,而是理解他們為何會想要做出改變。
    一旦你這樣做,你會突然意識到,這樣會感覺更好。
    你不是在試著拉人朝某個方向走。這並不意味著——你對他們做出的選擇沒有個人的利害關係。 但你實際上是與他們合作,試著弄清楚這些事情是如何影響到你,以及如果你改變你的酒精使用或飲酒或物質使用,你的生活可能會變得更好的原因。 在傳遞這個訊息時,表達上有什麼不同? 因為兩者的最終結果都是一樣的。 但聽起來語言可能略有不同。 是的,非常不同。 在所謂的醫學語言和治療語言中,我們談論一種叫做動機面談的東西,這幾乎成了一種心理技巧。 但這基本上是一種試圖從個人那裡識別他們改變原因的方法,並反過來反映給他們。 所以,不是你告訴他們你認為他們應該改變,而是你試圖引導他們的動機並放大它。 然後,最終你把權力交回給他們。 這可能看起來像某人說的話,比如—— 我會是你的病人。 所以,是的,我喝得很多。 我一天喝幾次,特別是在早上。 但沒關係。 你知道,我每天還是能上班。 顯然,我在工作上有幾個不當行為問題。 但除此之外,你知道,我的伴侶已經離開我。 但除此之外,一切都很好。 我能應對這一切。 聽起來你的酒精使用正在引發一些工作和人際關係問題。 確實如此,是的。 是的,我失去了——我的伴侶離開了我。 我在工作上一直收到不當行為的通知和紀律處分,因為我有時會遲到。 而且當我在那裡時,有時會睡著等等。 而且我——顯然,我在操作大型機械。 所以那裡有些風險。 但除此之外,還好。 聽起來你擔心在工作上的安全,還有你的飲酒開始如何影響到你的工作和人際關係。 確實如此,是的。 我是的,你知道。 我特別是在吊車上。 在吊車上醉酒特別造成了一些事故。 而且,你知道,我有時候確實擔心哪一天會走得太遠,是的。 是的,聽起來這真的很可怕,你真的擔心你的酒精使用可能會造成工作上嚴重或生命危險的事故。 是的,那我該怎麼辦呢,因為如果這樣的事情記在你的檔案上,那我將再也無法成為一名機械操作員了。 是的,而且你的工作對你來說真的很重要。 這是非常重要的。 酒精開始在這方面妨礙我。 是的,100%。 是的。 那麼,關於你的工作或關係,你的目標未來會是什麼? 我知道我真的應該,我真的應該解決我這個酒精問題。 我希望能找到一個伴侶。 這對我來說真的很重要,因為我想組建家庭。 所以,你知道,顯然成立家庭的先決條件真的就是找一位伴侶。 所以,是的。 聽起來你真的很想考慮改變你的飲酒,而你期待找到伴侶和家庭,並且擔心酒精可能會妨礙這一切。 所以你在這裡所做的事並不是引導我,而是有點推動我,如果這樣有道理的話。 有一種小小的「絕地心靈技巧」,基本上,這在你學習怎麼做的時候有點棘手,因為我所要做的就是在聆聽所謂的變化談話。 所以,任何你給我的關於改變的小線索。 所以你說,比如,我開始收到這些不當行為的通知。 我擔心工作上的安全問題。 我想要一位伴侶。 這些都是——這是改變的金礦小豆子。 而我則忽略了你所有的維持談話。 因此,任何你為現狀辯護的地方,這不算什麼。 喝酒根本沒那麼嚴重。 我無法改變。 我甚至不去承認或解決它。 這其實很困難,因為我認為大多數人都會注意到消極的東西。 所以如果你想像一下在工作上的績效評估,或者某人在告訴你任何形式的反饋,我們傾向於放大並記住某人對我們說的壞話,卻忘記了無數的好事。 所以你需要改變——你必須像訓練自己去做相反的事,去聽那些改變的細小線索。 然後我基本上就像一個鏡子,但我在放大它。 所以我在提取這些小改變的線索。 我在反映你的話語。 所以我不是告訴你你應該戒酒,因為在工作上這不安全。 我在反映給你,比如你開始擔心在工作上可能發生事故,而這是非常嚴重的。 而這有助於引導對話向前。 另一個關鍵是,如果你遇到抵抗的時候,你要轉變方向,因為一旦你開始爭論,不管是關於政治還是其他任何事情,人們就會固執己見。 所以如果你開始和某人爭論,你必須找到另一種方法。 你只需轉變方向並採用不同的策略,因為你越爭論,人們就越會堅守自己的觀點。 這更像是贏得辯論,而不是向前推進。 如果你想改變自己呢? 是否有一個過程、一個系統、一種方法論來幫助你發現你理想的行為是什麼,為什麼要這麼做,並實施改變? 這就是我經常說的,你的「為什麼」是什麼? 我認為這非常令人興奮。 我們都想要過上我們最好的人生,不管這對我們來說意味著什麼。 所以擁有一個目的,擁有一個目標可能是最重要的事情。 動機是重要的。 我們談論了很多關於動機的事情。
    但動機是短暫的。
    它可能會在一天中的不同時刻滑動。
    所以你可能會舉一個平凡的例子。
    你想要變得更健康,某一天你覺得非常有動力。
    但隔天早上,你的鬧鐘在早上五點響起,你感到疲憊,而床上非常舒適。
    也許你昨晚熬夜了。
    你的動力會減弱,對吧?
    如果你沒有一個目標或理由、一個「為什麼」或目的,那麼實際上要鼓起能量起床會非常困難。
    因此,找出那個目的,然後努力尋找享受這個過程的方法。
    因為如果你總是朝著未來的目標前進,有些人非常以目標為導向,這對他們有效。
    但在過程中找到快樂會幫助你。
    舉個例子,酒精。
    不是一個成癮問題。
    只是對你生活中的飲酒進行一些改變。
    如果你只是像說,「我應該停止飲酒,因為飲酒對我不好。」
    這是一個相對模糊的目標,對吧?
    這並不是真正關乎對你有特殊意義的事情。
    這樣堅持下去會很困難。
    如果你反而想,「好吧,我開始意識到每晚飲酒會讓我無法完成我想做的工作,因為我太累了,然後就睡著了。
    早上起來時我並不感到精神煥發,因為我睡得不好。
    我也沒有早起鍛煉,這是我非常重視的事情。
    我和家人在一起的時候也沒有像我希望的那樣投入。」
    那麼所有這些小目標就會讓改變變得更容易。
    所以你可能會決定,你知道的,我不會喝酒。
    我每週只喝兩天。
    而當我喝酒時,我會把量控制在這個範圍。
    但原因並不是來自某個醫生的模糊建議。
    而是因為你在工作上努力工作,晚餐後能夠感到有生產力的感覺很好。
    而且你正在為比賽訓練,想要早上起床去跑步。
    所以你實際上會注意到那些小步驟,比如,哇,今天早上我醒來感覺如此神清氣爽。
    像是你就在那裡強化你的目標。
    你不是在追求某個不再對你有意義的抽象事物。
    所以你想要設立這些非常專注、個性化的目標,並真正固定在你的「為什麼」上。
    你的「為什麼」可能和我的「為什麼」或其他人的「為什麼」非常不同。
    所以這可能是,睡眠對你來說真的很重要。
    或者,你對酒精的關係可能不同。
    那我會舉的另一個例子是,人們是不同的,對吧?
    我們對事物的反應不同。
    所以一些人可以打開一包薯片只吃兩片然後走開。
    而有些人則是,一打開袋子就會吃光所有的薯片。
    所以其實不打開袋子會更容易。
    酒精也是如此。
    一些人可能發現如果他們打開一瓶酒或家裡有酒的話,他們會喝光它。
    而想要限制飲用少量酒精的想法實際上真的很難。
    而且完全避免它,或只在餐廳喝酒會更簡單。
    所以你確實需要理解自己的目標、你的「為什麼」、你的目的與你對自己正在進行的事情的反應之間的相互作用。
    這對每個人都是不同的。
    還有其他什麼事情,任何其他習慣,在我們試圖克服成癮時應該考慮嗎?
    所以如果我們把酒精視為在溪流底部的東西,還有沒有其他上游的事情我應該考慮?
    我們談到社交聯繫和關係。
    所以我需要確保我被人圍繞著。
    我需要社交,因為這有助於減輕壓力和孤獨,這些會使我感到不適,進而導致我對酒精的需求。
    是的。
    但還有其他事情嗎,我在開始生活的改變時應該考慮的?
    是的。
    是的。
    有很多。
    我認為首先,任何行為改變,不論是酒精或其他的,如果你感到疲憊和耗竭,並且無法展現出最佳狀態,那麼將更難進行改變。
    所以如果你考慮過去做出哪些重大決定——改變工作、開始健身計劃、離開伴侶——你可能並不會在感到疲憊、焦慮、壓力重重、無法展示最佳狀態的那一天做出這個改變。
    變化是困難的。
    所以你想要努力增強生活中的其他方面,保持良好的飲食,獲得足夠的休息,嘗試鍛煉,這些都會幫助你在試圖做出改變時感覺健康,表現出最佳狀態。
    這和多巴胺有關嗎?
    是的,因為我們的自然獎勵系統,其觸發源包括運動、食物、性、聯繫等。
    所以,努力尋找健康的其他方式來釋放正面的多巴胺。
    很多人可能會感到酒精或某些物質是一種對自己好的方式。
    比如,“我要這樣做,這可以幫助我在工作後減壓。”
    所以,目標並不是你整夜都要努力忍耐,並在下班後感到非常壓力重重。
    而是你要找出一些其他的事情來幫助你在下班後減輕壓力。
    也許去參加朋友的瑜伽課。
    也許是和家人共度時光。
    也許是按摩或冥想,或觀看我喜歡的節目。
    所以你想要的不是僅僅去除你想要改變的事物。
    而是要把空缺的空間填滿其他的事物。
    那如果我用哈根達斯冰淇淋和漢堡來填滿呢?
    因為這也會讓人釋放多巴胺。
    所以假設我只是吃很多糖果和甜食,那這樣就能阻止我從事上癮行為。
    但我們經常會看到這種情況。
    這就像是用其他東西來替代。
    你知道,我之前在讀一篇文章,或許大家都聽過「乾燥一月」(Dry January),這個概念是指在一月這個月不喝酒,以重新思考與酒精的關係。
    我讀的文章指出,「乾燥一月」已經變成「高消耗一月」(High January),因為人們代替喝酒而吸食大量的大麻。
    因此,我認為你需要謹慎,不要只是用你試圖改變的東西替代另一種同樣會造成健康問題的事物。
    偶爾吃一次甜點是可以的,因為這樣你並不是從酒精中攝取熱量。
    每週享受一次美味的冰淇淋是對自己的一種更健康的犒賞,這或許與你的目標更加一致。
    這是可以的。
    我覺得,考慮這些事情的時候,實際上應該像看待甜點、日光浴和吃加工肉一樣看待酒精,這些東西在我們的生活中都有風險和益處。
    我覺得我們在酒精方面走錯的地方在於,這種想法認為飲酒是一種促進健康的行為,你不應該為了健康而喝酒。
    這並不會讓你更健康。
    而且,就像許多我們所做的非促進健康的活動一樣,總是有方法可以減少這些活動帶來的健康危害,讓它在你的生活中以小量存在是可以的。
    我覺得B2B行銷人員不斷重蹈覆轍。
    他們追求量而非質。
    當你想讓更多人看到而不是讓合適的人看到時,你所做的只是製造噪音。
    但這種噪音很少會改變結果。
    而且通常會非常昂貴。
    我知道,在我的職業生涯中曾經也犯過這個錯誤,許多人也會犯這個錯誤。
    最終,我開始在我們的節目贊助商的平台LinkedIn上發布廣告。
    那時事情開始有所改變。
    我認為這種改變源於幾個關鍵因素。
    其中之一是LinkedIn當時—以及現在—都是決策者前來的平臺,不僅用於思考和學習,也用於購買。
    當你在那裡推廣你的業務時,你正好把它放在那些實際有權力說「是」的人面前。
    而且你可以按職稱、行業和公司規模進行定位。
    這簡直是更明智的行銷預算支出方式。
    如果你還沒有試過,怎麼樣?
    試試LinkedIn廣告,我會給你100美元的廣告信用額度讓你開始。
    如果你訪問linkedin.com/diary,你現在就可以索取。
    就是linkedin.com/diary。
    回想我們之前說過的內容,早期的兒童創傷是如何導致大腦改變,進而導致上癮行為的。
    如果我經歷了一次早期的兒童創傷,我的腦袋因此改變,然後我在年輕時成為酒精成癮者,然後我設法戒掉酒精,但我的大腦仍然在上癮,是不是也就意味著我最終會對其他能讓我產生多巴胺的東西上癮?
    事實上,大腦是非常具可塑性的,也就是說它是可以改變的。
    隨著時間推移,我們可以看到這一點。
    所以第一點是,即使是逆境童年經歷(ACEs)也不是一種定局。
    我們經常討論ACE,但不太談論正向童年經歷(PCEs),但實際上通過增加正向童年經歷的數量,可以降低一個人發展成癮的風險。
    假設一個人經歷了一些可怕的逆境。
    他們的父母去世了,或者有一位父母在監獄裡,或者他們的家庭中有成癮問題。
    如果這個孩子有一位單獨的成年人會關心他們,那麼這可以減少他們上癮的風險。
    因此,即使在可怕的創傷中,我們也有許多正面的方式可以改變他們的發展軌跡。
    當你想起一個有物質使用障礙的人時,我們實際上有良好的數據顯示,在五年的康復後,通常這段時間是起伏不定的。
    大多數人認為這是一個斷然決定的過程,你決定停止飲酒,然後成功就是你不再飲酒。
    但對大多數人來說,我們發現這其實是一系列的步驟。
    所以我總是喜歡認為進步比完美更重要,並且不抱有這種非此即彼的心態,因為對於許多人來說,他們一開始可能會有一個月不喝酒。
    接下來可能是三個月,然後可能是一年。
    這些復發是會發生的,但最終他們會達到長期康復的狀態。
    在五年的康復後,一個人隨後發展成癮的風險與一般人群沒有更高。
    所以你的大腦確實會改變。
    在功能成像中我們可以看到這一點。
    在跟踪人群的縱向研究中我們也能夠發現這一點。
    所以你實際上可以克服這些問題,達到一個不比其他人高的風險。
    因為有些人會說,我有成癮的性格。
    是的。
    他們有時會自我標籤,自認為擁有成癮性格。
    有時他們甚至會提到自己的大腦容易上癮。
    這是真的嗎?
    是否有可能擁有成癮性格?
    這與性格關係不大,但我們對物質的反應確實不同。
    比如,對於酒精或鴉片類藥物等任何物質,第一次使用時的人們感受是不同的。
    所以,當你跟一個最終發展成癮的人交談時,他們通常會告訴你,他們第一次使用這種物質的時候,感覺是如此美妙。
    有些人形容過這種感覺像是墜入愛河,或像是一個溫暖的擁抱,或像是放鬆的浴缸。
    這些實在令人難以置信的安慰經歷。其他人則因為拔牙而被開給類似鴉片的藥物。他們感到噁心,並且有點不像自己,並且不喜歡這種感覺。因此,我們對物質的反應肯定是基於我們的神經生物學,並且因人而異。有些人因為基因的原因以及他們自己的大腦,更加容易有成癮的風險。了解自己的這一點是很重要的,因為這樣你可以做出不同的選擇。你可能決定從不在家中存放酒精,或選擇不喝酒,因為這樣的風險太大。你有多常思考其他社會上正在蔓延的事物?一些與物質無關的其他問題,例如社交媒體成癮、色情成癮,還有哪些是比較大的?飲食成癮。食物、性、賭博。我認為這些之間有很多相似之處。這不是我特別專注的領域,但我認為有很多交疊之處。我想,很多你剛才列出的事物,你可以提到,第一,明顯是多巴胺。但第二,這種需要用其他東西填滿自己的想法,不論是思考創傷、思考未獲得治療的心理疾病、還是僅僅是與他人失去聯結、意義或獎勵的缺失,這種情況促使人們去尋求外部解決方案。你能告訴我一個你曾經與患者合作的例子,通過與他們的合作和理解他們的創傷,發現了他們成癮行為根本原因的意想不到之處嗎?是的,我可以想到很多患者,但有一位特別的患者,我知道他曾經在生活中經歷過艱難的事。他曾經入獄,例如,這是一個創傷性的經歷。他失去了父母,這也是另一件事。我從未真正理解他創傷的深度,他一生都在與物質使用障礙作鬥爭,使用了很多東西,大多數是鴉片,還有酒精和可卡因,過得非常艱難。在認識他多年後,有一天,他在我辦公室崩潰了,分享說他小時候其實被人性侵。因此,有時候,人們心中有些事情從未覺得可以與任何人分享,這實際上是他們所面對的許多問題的根源。而那種像是向你耳語的人,保持內心的痛苦,不僅是作為孩子時期經歷的創傷,還有保存那個秘密並感覺到自己某種程度上是受損的,或是這種事情在你內心存在,卻無法治癒、無法談論、無法與人分享,我認為這是一口存在於人心中的痛苦之井。他康復了嗎?他其實去世了。是因為物質濫用嗎?是的,因為物質使用。你一定承擔了很多這些事情,因為你的工作聽起來你經常面對壞消息,比一般人更多。而你面對的消息是不同類型的消息。你正在處理某些人因為你多次說過在很多情況下可以預防而面臨生命盡頭的事。你是怎麼應對的?是的,我認為有幾件事。首先,有許多希望的故事,我認為抵消了這一點。因此,我想,心中還有其他的故事,我依然與那些生活得充實且在康復中的人保持聯繫並關心他們。在美國,僅僅有2400萬人處於康復中。所以這些人克服了創傷、悲劇和困難,並且生活得很棒。他們在養育孩子,工作。你可能根本不知道他們就在你周圍,因為他們未必會告訴別人他們正在康復。能夠成為這個過程的一部分,看到某人從面對所有健康問題和人際挑戰的時刻變得更好,這是一個非常美好的經歷。因此,我認為這帶來的希望和積極性是每天推動我前進的動力。顯然,找到照顧自己的方式,通過家庭和連結、運動來獲得支持。我跑步,我寫作。你知道,你必須在這一切中保持完整。但我認為,我從與人合作中獲得了巨大的目的感和希望,看到他們康復。還有什麼是我們沒有談到但應該談的最重要的事?我認為一件事就是語言。這是一個微妙的問題。我提到了一個例子,你做得很好的地方,即不說某人治療失敗,而是說治療未能幫助他們。但我們用於成癮的許多語言實際上隱含且不隱含地加劇了污名。有時聽起來我是在政治正確或是語意問題,但其實有非常好的數據支持這一點。所以,如果你考慮我們用來形容成癮的詞語,一個是物質濫用,對吧?所以濫用這個詞,究竟是指什麼?這實際上源自於一個舊的英語單詞,意思是故意的不當行為。這是一個我們用於兒童虐待、性虐待、家庭暴力的詞語。這是僅僅針對這些非常暴力且受到強烈污名化的行為,而我們知道這是可怕的事情。然而,我們卻將其用於這種我們所謂的健康狀況,即你是一個物質濫用者,或者你有物質濫用。
    因此,其實已經有一些優雅的研究,讓博士級的心理學家,及經訓練的臨床醫師來描述一個人,或者將其描述為物質濫用者,或者是有物質使用障礙的人。臨床醫師實際上更可能對被描述為物質濫用者的人推薦懲罰性的介入措施。
    這意味著什麼呢?在這個情況下,他們會給出一個選項。你閱讀這段關於一位虛構病人的段落,而他們並不知道研究者在測試什麼。他們會被給予一系列不同的介入選項,其中一個是像將他們送到藥物法庭或送進監獄。另一個則是提供他們,知道,你知道,門診有效治療。還有很多不同的選擇。當他們聽到某人被描述為物質濫用者時,他們實際上更可能推薦這種監禁形式的介入。因此,語言實際上會很大程度地影響我們的思維,甚至影響我們的臨床決策。
    他們也對公眾進行過這樣的研究。如果你將某人描述為藥癮者,公眾對他們的看法會比把他們描述為有成癮問題的人更消極。因此,在成癮的討論中,已經有這種微妙的轉變,我們開始真的使用一種所謂的以人為本的語言,這在醫學上已經成為常態。例如,我們以前會使用糟糕的詞語。我們會將某人稱為精神分裂症患者,或真的標籤他們的健康狀況。幸運的是,這種觀念有了改變,開始認識到人們首先是人,他們有病,卻不以此定義自己。
    因此,我絕對不會說我要去看房間204的肺癌。我會說我要去看患有肺癌的史密斯先生。同樣,在成癮的情況中,人們也是多於這些。所以說,形容某人是有成癮問題的人,或者有酒精使用障礙的人,而不是稱他們為癮君子或酒鬼。此外,即使像「乾淨」和「髒」這些術語在談論成癮時常被使用。
    所以,像「乾淨」這個詞聽起來真的很正面。你是在說,哦,你是乾淨的。但是,你實際上在說什麼?如果你現在是乾淨的,那麼當你正在積極掙扎的時候,你是什麼?你是髒的。因此,我始終記得一個例子,我的一位正在康復中的朋友在尋找康復領域的工作。面試時,人們會問他,他清醒多久了?他會說,好吧,我從出生以來就一直在洗澡。因此,我一生都很乾淨,而我已經康復五年或其他的。所以,我認為這些小事其實很重要,我們應該使用與其他健康狀況相同的術語。如果我們將有積極成癮的人標籤為髒或用那種語言將有成癮問題的人與兒童施虐者混為一談,我們實際上是在微妙地增強污名。因此,我們每個人都可以做的就是嘗試使用更人性化的語言。
    這真的很有趣,因為我意識到這一點,但我仍然發現自己不小心使用濫用這個詞。是的,我會不經意間說到它。我會說,該死的,我會像你提到的一樣。我試著避免使用癮君子這個詞。是的,這很難改變,但就像所有事情一樣,你只想謙虛、好奇,並持續嘗試。我是說,很多我們已經改變了的語言。想想那些與生有不同能力的人的術語,或是不同種族或其他身份的人,我們正確地修正了那種污名。我們學會了使用不同的語言,即使在學習的初期感覺有點尷尬。我認為理解這些語言使用所帶來的影響的科學和數據是非常有用的。是的,這幫助我理解,因為現在我明白了它的基本原則,我需要確保我首先把人描述為人。所以,說有成癮問題的人比稱呼某人為癮君子要好得多。是的,確實如此。
    人們常問我,如果某人自己這樣稱呼怎麼辦?因為人們可能會這麼做。這是可以的。人們可以為自己使用任何他們想要的語言。但是,我認為作為一名醫療保健專業人士,或是試圖幫助對抗污名的人,我們可以選擇使用不同的語言。我實際上經歷過病人問我,為什麼你使用那個術語,而他們用不同的語言。其實這也可以是一種賦能的方式,讓他們明白,哦,是的,我其實是一個正在康復的人。我是有成癮問題的人。
    我一直對這一點很感興趣,因為在生活中,我常常發現,在對話中,我會說,我不擅長這個,或者我不是那種人,或者我不擅長組織。我會停止自己,團隊會記得,我會說,其實我不應該這麼說。我應該這麼說,現在我在做什麼……你實際上是在給自己下定義,認為自己無法做某件事,而不是說我現在在努力改善我的組織能力。是的,我認為這一點是非常重要的,我們並不會意識到我們是多麼隨意地為自己創造一種身份,這本質上是限制性的,或者把我們放進一個框框裡,或者將我們框架為有缺陷,或將我們整個的身份捕捉在某種缺陷中,通常是在我提到的習慣的情況下。
    在談論稱某人為癮君子時,類似的影響會發生嗎?是的,你實際上是在標籤他們,讓他們覺得這是他們唯一的身份,並且他們將永遠如此。
    當然,這是翻譯成繁體中文的文本:
    你知道,我有一位朋友是一名記者,目前正在康復中,並且經常寫關於成癮的文章。
    瑪雅·索洛維茨(Maya Solovitz)寫過一篇很棒的《紐約時報》文章,探討成癮並不一定會持續一生,因為我認為我們心中有這樣一種觀念,像是說,成癮者會永遠成癮,這是種無法治癒的病。然而,其實每個人的旅程都是不同的。
    對於某些人來說,成癮成為他們需要面對的挑戰,然後他們在人生中繼續前行。
    而對其他人來說,這是他們積極管理的一部分,但這種將自己簡化為「我在這個世界上唯一的身份就是成癮者」的想法,卻真的限制了你自己其他的一切。
    我們在這個播客上有一個閉幕傳統,最後一位嘉賓會為下一位嘉賓留下問題,而他們不會知道自己留下的問題會問到誰。
    所以,為你留下的問題是,如果你可以重做或修正一件你已經成功完成的事情,那會是什麼,為什麼?
    我想我會說,我可以想到很多成功的成就可以應用這個想法,但我拿醫療訓練作為例子,這是一項成功的成就。
    我覺得我應該更加專注於當下,我們總是匆匆忙忙地追求成就、衝向終點,努力達成下一個目標。
    我回想起來,希望我能意識到當時那段旅程是多麼美妙。
    而且,我的醫療訓練中,有些事情我從來就不會成為心臟外科醫生,但站在手術室裡,看到某人的胸腔和一顆有力跳動的心,我的確經歷過那種無法再重複的體驗。
    在追求成就、向前推進、獲得下一次考試和下一件事情的過程中,有時我們會錯過眼前這個奇蹟。
    所以我認為我會更加專注於當下。
    這適用於我們所有人。
    我感覺自己被點名了。
    對於養育孩子來說也是如此,對於所有事情都是這樣。
    非常感謝你。
    我對你所做的工作感激不已,因為有太多相互矛盾的信息,特別是關於酒精的問題。
    在過去五、十年中,有關酒精對我們影響的信息可謂汗牛充棟。
    我曾和一些人交談,他們非常堅信,即使是適度的酒精攝取對我們是有益的。
    而在閱讀了你的作品後,我現在對這方面的真相有了清楚的認識。
    謝謝你做的事。
    這真的非常重要。
    我認為這將變得越來越重要,不幸的是,因為世界的發展方向、我們正在經歷的孤獨流行病,以及我們現在對數字設備的接觸和低成本的成癮物質消費的能力,讓我感到非常恐懼。
    我知道你有一本書即將出版,我對此感到非常興奮,預計在秋季出版。
    明年秋天嗎?
    2027年的春天。
    所以我們還有時間。
    好的。
    那本書的內容是什麼?
    你能給我一點提示嗎?
    我猜測。
    這本書會討論如何改變對成癮的敘述,真正重新框架人們對其的思考,將其視為一種可治療的、預後良好的疾病,並利用一些我有幸認識的人的故事,希望幫助人們以不同的方式看待問題。
    如果人們想要主動聯繫或了解更多,他們可以在哪裡找到你?
    是的。
    他們可以在LinkedIn和Instagram上找到我。
    他們也可以發送電子郵件給我。
    是的。
    很高興能聯繫,並且希望書出版後能再次回來。
    我期待那時。
    我非常樂意。
    所以你的Instagram和LinkedIn,我會把這些資訊放在下面。
    我相信你可能會收到很多消息,因為這些問題在每個人的生活中都是非常強烈而且情感豐富的議題。
    所以,代表我所有的觀眾,感謝你今天的慷慨,也謝謝你的智慧。
    我真的非常感激。
    我希望不久的將來,書出版時能再次和你交談。
    謝謝。
    謝謝你邀請我。
    我覺得非常有趣的是,當我們查看Spotify和Apple的後台以及我們的音頻渠道時,大多數收看這個播客的人尚未按下關注或訂閱的按鈕。
    我想和你達成一個協議。
    如果你能幫我一個大忙,按下訂閱按鈕,我將不懈努力,從現在起一直到永遠,讓節目越來越好。
    我無法告訴你,當你按下訂閱按鈕時,對我們的幫助有多大。
    節目變得更大,這意味著我們可以擴大製作,邀請所有你想見的嘉賓,繼續做我們熱愛的事情。
    如果你能幫我這個小忙,按下跟隨按鈕,無論你在哪裡收聽這個,都對我來說意義重大。
    那是我唯一會請求你的幫忙。
    非常感謝你的時間。
    下次見。

    Are you unknowingly damaging your brain and raising your cancer risk with just one drink? Discover the alarming truth about alcohol from Dr. Sarah Wakeman, what every adult needs to know now.

    Dr. Sarah Wakeman is a senior medical director for substance use disorder at Massachusetts General Brigham Hospital, the number one research hospital in the world. She is also the Medical Director of the Mass General Hospital Addiction Consult Team and Assistant Professor of Medicine at Harvard Medical School. 

    She explains: 

    • How alcohol is hijacking your dopamine system.

    • Why no amount of alcohol is good for your brain.

    • The shocking truth about moderate drinking.

    • How doctors are failing addiction patients on a daily basis.

    • Why 1 in 3 people will struggle with alcohol.

    00:00 Intro

    02:23 Sarah’s Mission

    02:52 Sarah’s Education and Experience

    03:40 Issues With Addiction Treatment in the Modern World

    04:31 What Is Addiction?

    05:48 What Things Are Capable of Being Addictive?

    06:47 Physiological Dependence vs. Addiction

    07:25 Scale of the Problem: Why Should People Care?

    08:59 Is Society Getting Better or More Addicted?

    09:32 Substance-Related Deaths During the Pandemic

    10:22 What Drives People to Use Substances?

    12:24 Substances’ Effects on the Brain

    14:29 Does Trauma at a Young Age Increase Addiction Risk?

    16:36 The Opposite of Addiction Is Connection

    18:11 Why Addiction Matters to Sarah

    19:02 Living With a Family Member Struggling With Addiction

    20:43 Who Is Sarah Trying to Save?

    22:57 Change Happens When the Pain of Staying the Same Is Greater Than the Pain of Change

    25:53 Misconceptions About Alcohol

    28:15 Is There a Healthy Level of Alcohol Consumption?

    28:50 Is One Drink a Day Safe for Health?

    30:38 Link Between Moderate Drinking and Cancer

    33:23 Types of Cancer Linked to Alcohol Consumption

    34:51 Cancer Risk Among Heavy Drinkers

    35:31 Heavy Drinking and Comorbidities as Cancer Risk Factors

    36:20 How Alcohol Drives Cancer Mechanisms

    38:00 Alcohol and Weight Gain

    38:54 The Role of the Liver

    42:07 Liver’s Ability to Regenerate

    46:37 How Alcohol Causes Brain Deterioration

    47:23 Other Organs Affected by Alcohol

    48:00 Alcohol’s Impact on the Heart

    49:08 Body Fat Percentage and Alcohol Tolerance

    50:05 Does High Alcohol Tolerance Prevent Organ Damage?

    50:46 What Is a Hangover?

    52:14 Balancing the Risks and Benefits of Alcohol

    53:47 Is Rehab Effective for Addiction?

    56:50 Psychedelic Therapy for Addiction

    57:36 GLP-1 Medications for Addiction Treatment

    59:03 Ads

    59:59 Celebrity Addictions

    1:02:24 Stigma Around Addiction

    1:04:41 Addiction Cases That Broke Sarah’s Heart

    1:12:43 Is Empathy Positive Reinforcement for Addicted Individuals?

    1:15:34 Setting Boundaries With an Addicted Person

    1:18:57 Motivational Interviewing to Support Recovery

    1:22:19 Finding Motivation for Positive Change

    1:26:03 Habits to Support Addiction Recovery

    1:29:12 Ads

    1:30:18 Can the Brain Recover From Addiction?

    1:34:55 Unexpected Sources of Addictive Behavior

    1:35:35 How Sarah Copes With Difficult Addiction Cases

    1:37:10 Importance of Language Around Addiction

    1:41:40 How Labels Limit People’s Potential

    1:46:05 Sarah’s Upcoming Book

    You can find out more about Dr. Sarah’s profile, here: https://bit.ly/4mxu191 

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  • Teaching Computers to Smell

    Alex Wiltschko got obsessed with perfume when he was 12 years old. He grew up to be an AI researcher at Google. Then he started Osmo, a company that fused his job at Google with his childhood obsession: Osmo is using AI to teach computers to smell.

    The company is getting into the perfume business, and it plans eventually to use scent to diagnose disease and detect security risks.


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