AI transcript
0:00:04 There’s over 500,000 small businesses in B.C. and no two are alike.
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0:00:47 Every Tuesday, Wednesday and Friday, John Lovett, Tommy Veter, John Favreau, and Dan Pfeiffer
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0:02:17 Episode 339. 339 is the area code serving the Boston, Massachusetts area in 1939,
0:02:21 the Wizard of Oz, from a true story, whenever I climax with a woman,
0:02:33 I scream out, surrender Dorothy, or I’m melting. I’m melting, melting. Go, go, go.
0:02:43 Welcome to the 339th episode of the PROP G-POP. What’s happening?
0:02:49 The dog is howling. He’s busy. He’s like one of those Belgian Malinois dogs. It is not happy
0:02:54 unless it’s working all the time, like roaming property or defending someone. I accept, I’m not
0:02:59 like that, but I basically have the tasks of a Belgian, of a Belgian Malinois. And that is,
0:03:04 I have so much shit going on today. I flew in last night from Barcelona, got in late,
0:03:09 came here, took an edible crash for like five hours. Now I’m up. I’m at the Fayena Hotel,
0:03:14 which I love. Even though it’s not really my design aesthetic, it’s like a very
0:03:21 handsome, wealthy, metrosexual Buenos Aires exploded into a hotel, which I think is pretty
0:03:26 much the owner of this hotel. And then I got to do this and I’m going to this conference,
0:03:31 this 0100 conference to host a lunch. Then I got a bomb up to Palm Beach where I’m doing a speaking
0:03:38 gig. Then I’m on a plane in New York and wash rints and repeat. But anyways, I’m in Miami. It’s
0:03:43 absolutely beautiful. Isn’t good to know what I’m up to? Thank God I know where he is. Thank God I
0:03:48 know what’s going on here. Anyways, what are we going on? Today’s episode, we speak with Dr. Anna
0:03:52 Lemke, professor of psychiatry at Stanford University and author of the best-selling book,
0:03:59 Dopamine Nation, Finding Balance in the Age of Indulgence. We discussed with Dr. Lemke the rise
0:04:02 of addiction in the digital age from drugs to social media and why our brains are wired to
0:04:08 create more. Plus, Dr. Lemke shares practical solutions to help build a healthier relationship
0:04:15 with pleasure. I really enjoyed this conversation. You occasionally interview somebody, especially
0:04:20 it’s so rewarding when you interview someone in the sciences, in the public health field.
0:04:24 And you get the sense they genuinely care that they want to figure this stuff out,
0:04:29 they want to help people. And she highlighted something we did this interview, I think about a
0:04:37 week ago, about a lot of young men are just a lot of men have addictions to porn. And there’s a lack
0:04:42 of peer-reviewed research on it because very few academics want to be known as the porn professor.
0:04:50 And just literally after she highlighted what an issue it has become for many of her patients,
0:04:54 I have had no joke, three men come up to me and start talking to me and we start talking about
0:04:58 addiction. And they look around and in their very self-conscious, they say, “Well, I have an addiction
0:05:02 problem.” And we start talking and I’m pretty straightforward. I said, “What’s your addiction
0:05:09 problem?” And all three times it’s been porn. And I want to learn more about it because it’s
0:05:14 something that I don’t think we talk a lot about. And there’s very little peer-reviewed research.
0:05:19 And as we think about men, especially young men and the access to this type of porn,
0:05:27 I’ve often said that the nicest thing in my life is getting to raise children with a competent
0:05:34 partner. If you can figure that out, if you can find someone who you share values with,
0:05:38 that you’re aligned with around money and that, quite frankly, you want to have sex with,
0:05:43 and you are blessed with healthy children, that’s kind of the whole shooting match. Or at
0:05:48 least that’s what I’ve decided is a whole shooting match. Everything else for me was just like a
0:05:52 means to an end. And I was never sated. I was wanting more and more money, more experiences,
0:05:56 more relevance. And I’m still on this fucking hamster wheel. And it’s the reason why I’m here.
0:06:01 Speaking to you right now, is that fair? Is that fair? Anyways, let me stay up to fine, you know.
0:06:09 But if I had been a young man and had access to porn, I’m not sure any of that would have happened.
0:06:14 And why is that? No joke. Part of the reason I used to go on campus and probably the only reason
0:06:19 I got a 2.27 GPA from UCLA and not a 1.87, which one, I wouldn’t have graduated. I wouldn’t have
0:06:23 gotten a job at Morgan Stanley. I wouldn’t have gotten into a high school of business, wouldn’t
0:06:29 have met my co-founder or a profit, wouldn’t have started businesses, and 30 years later, 35,
0:06:36 be at the fineena. And that is because I would go on campus and go to class because I was hoping
0:06:41 deep down, or something in the back of my mind, was that I was going to meet a stranger. I’m going
0:06:45 to establish a rapport with her and at some point have sex with her. That was very motivating for me.
0:06:54 And that sounds crass, but I don’t think there’s anything wrong with wanting to mate. And what I
0:07:02 tell young men is the following. I tell them, like, I can consume porn, but I’ve tried to, for the last
0:07:07 10 or 15 years when porn came on the scene, and I think it’s really good advice, especially for
0:07:15 young men, try and modulate your use. Because some of that desire, some of that wanting to meet people
0:07:22 such that you can make your own bad porn is key. You don’t want to extinguish those flames of desire,
0:07:26 because those flames of desire can actually result in good things. They want you, they make you want
0:07:30 to be more successful. They make you want to be in better shape. They make you want to develop a
0:07:35 wrap. They make you want to figure out a way to make someone else laugh. They make you want to
0:07:41 have a plan such that you’re more attractive, such that you might in fact be able to get out there
0:07:46 and establish your own romantic relationships. Anyways, what’s the, what’s the bottom line?
0:07:52 And the advice I would give to anybody, but especially young men, look, most people consume
0:07:58 porn. Is that true? Most men, I think, consume porn. I get it. But try and modulate your use
0:08:04 and try and figure out a way to develop the mojo, the desire, and the skills that you can get out
0:08:10 there and start making your own bad porn. So with that, here’s our conversation with Dr. Anna Lemke.
0:08:20 Dr. Lemke, what is this podcast behind you? I am physically sitting in my office here at
0:08:25 Stanford University. This is where I treat patients and do my work.
0:08:30 Sounds good. So let’s bust right into it. In your bestselling book, “Dopamine Nation,”
0:08:37 published back in 2021, you argued that constant access to stimulation is rewiring our brains.
0:08:43 Four years later, has anything changed or any additional observations between then and now?
0:08:49 I would say that the four years that have elapsed have really, unfortunately,
0:08:55 just seen an acceleration in this problem. I guess the good news is that people are
0:09:00 talking about it more, more aware of it. I think the groundswell really started with parents
0:09:07 concerned about their kids, but I think in general, the average person is now
0:09:13 more aware of and concerned about their consumption of digital media.
0:09:18 Something that I’m especially concerned about is the father of a 14 and a 17-year-old,
0:09:23 especially with a 14-year-old. And my colleague, Jonathan, I talk a lot about this, is that
0:09:29 the rewiring is especially, or I guess the more appropriate term would be the wiring of the brain
0:09:32 as children are going through puberty, that that can be especially damaging. Are we
0:09:38 about to flush into the economy or society millions of essentially dopa addicts that,
0:09:41 if they don’t find it on their screen, they’re going to find it elsewhere?
0:09:47 Yeah, it’s a great question. I think it’s important to emphasize that we are constantly rewiring our
0:09:54 brains, wiring just really being a metaphor for neurons and the plasticity of neurons and the
0:10:00 way that we’re constantly making new connections between neurons. Every single experience that
0:10:09 we have rewires our brain in some way. So the fact that we’re spending enormous amounts of time
0:10:16 online by the latest report, I think it was Pew Surveys came out and said that about 50%
0:10:21 of teenagers now report being continuously online during the waking hours. Of course,
0:10:28 that is rewiring our brain. The question is, to what end? Because we have to adapt to any
0:10:32 environment. We’re always rewiring our brains, but are we now rewiring our brains in a way
0:10:38 that is ultimately not good for us as individuals, not good for societies, not good for humanity?
0:10:45 I would say, and I think I’m a little bit more measured than Jonathan Hyde about this,
0:10:50 although I totally respect him in his work, I would say, yes, there is a lot to be concerned
0:10:58 about here, but that I’m ultimately optimistic that we will both self and other regulate. What
0:11:02 do I mean by that? I’m already seeing people who are beginning to say, you know what,
0:11:08 this isn’t good for me or this isn’t good for my family, even teenagers themselves forming these
0:11:12 groups and saying, let’s get off social media together. Let’s try to do things that we can do
0:11:19 in real life with each other. Other regulate because it can’t just be left up to the individual.
0:11:28 This is far too powerful a transformation to just say, well, it’s up to you to figure out
0:11:32 how to moderate your consumption of digital media. We have to get smartphones out of schools,
0:11:38 bell to bell. We have to hold the companies accountable. We have to legislate, particularly
0:11:44 to protect kids. Talk about the different types of addiction. There’s obviously addiction to
0:11:49 the screen, then there’s drugs, there’s alcohol, there’s pornography, there’s gaming. Is there
0:11:55 any way to sort of stack rank these addictions? And I was always told, I’m pretty open to my
0:11:59 podcast. I love marijuana. I loved it in college. I took kind of a 20-year break because I was
0:12:04 working my ass off and I started using it again. And I enjoy it. And I actually think it’s
0:12:10 additive to my life. But I remember people was telling me that it was a gateway drug to more
0:12:16 serious addictions. If you were to sort of stack rank different types of addictions in terms of
0:12:23 what is the most dangerous or what perhaps is a gateway to other things, any thoughts about sort
0:12:29 of the hierarchy or the waterfall of different types of addiction? Great question. I have become
0:12:36 pretty much convinced over the course of my career that it depends on the person and their
0:12:43 unique wiring and their drug of choice. For one given individual traditional drugs like alcohol,
0:12:52 cannabis, opioids, nicotine may not hold much appeal, but social media may indeed be the drug
0:12:58 that overpowers them and leads to a very serious and devastating addiction. Furthermore,
0:13:06 people are variably vulnerable to addiction period. Some people are much more vulnerable
0:13:10 than others and can get addicted to a lot of different substances and behaviors.
0:13:15 Other people getting addicted is something that probably won’t happen to them to a
0:13:20 significant degree. And again, the uniqueness of the wiring, although I have argued that we’re
0:13:25 all more vulnerable to addiction now than before because of the drugification of our environment,
0:13:30 I think we also have to take into consideration that when we’re thinking broadly about danger,
0:13:36 it’s not just the addictiveness of the drug. Nicotine is very addictive for many people,
0:13:44 but also the lethality of the drug. Opioids is something that can kill even when the dose is
0:13:52 just a little bit beyond what the dose is for the desired effect. That’s not true in the short term
0:14:00 for nicotine or cannabis, which can do significant harm in people who are addicted and use heavily,
0:14:08 but it usually takes a long time, many, many years of exposure. In your case, somebody who
0:14:13 loves marijuana, who gave it up for a period of time is now using it and just basically finds it
0:14:21 enjoyable. Great. It’s nice if that can be an enjoyable part of a person’s life and toxicants
0:14:26 in various forms have been around since the beginning of time. The one thing that I would
0:14:32 caution about always is just that we’re not always the best self-observers around whether or not
0:14:43 our enjoyment is really leading to long-term enjoyment or is interfering in ways that we
0:14:53 can’t see just because these drugs tend to interfere with our insight in terms of what they’re doing
0:14:59 to us. Often, they can be causing harm or we can be getting addicted and really not see it.
0:15:05 I’ve observed something and I’d love you to get your thoughts on it. I go to a lot of conferences
0:15:09 where there’s a lot of young, successful people, whether it’s South by Southwest or I go to this
0:15:16 event called Summit. I’ve noticed over the last 20 years that young people are not drinking,
0:15:23 but it’s not as if they’ve gone healthy or healthy era. The aspirational set likes to
0:15:29 think they’ve discovered a new technology and that they’re innovators and now they’re all doing
0:15:38 ketamine, not all, a lot of them have substituted or traded out alcohol for ketamine, ecstasy/moli,
0:15:46 2C, which I guess is a mix of ketamine and molly, even to the point where they would roam around
0:15:51 these conferences with their own concoction, using eyedroppers and different means of,
0:15:57 I mean, it’s just staggering to me. I went to this thing called Summit at Sea and it was on a
0:16:01 cruise ship and I went up in order to drink and the bartender said, Jesus, someone’s actually
0:16:09 ordering a drink. This is amongst a crew doctor of wealthy young people who would generally be
0:16:15 aligning at the bar and the one I mixed was mushroom chocolates and I imagine there’s
0:16:21 a lot of edibles in there too. I’ve just seen an enormous and if you look at, it’s having such
0:16:27 weird knock-on effects and London 40% of nightclubs have closed since pre-pandemic because kids aren’t
0:16:32 drinking and some of that is they don’t have the money anymore, but they’ve swapped out,
0:16:38 they’re under the impression that it’s healthier or less bad for you and they’d rather do
0:16:44 mushroom chocolates and have one drink or molly and they see alcohol as old technology.
0:16:51 I’m curious if you see, this is just anecdotal evidence or if you see real evidence of this
0:16:56 and what your thoughts are around addiction and what it means for society when we’re no longer
0:17:02 two martini lunches, we’re maybe doing a little bit of ketamine and trying to get on with our day.
0:17:09 What do you see going on here? Yeah, well, I mean, I’m really torn because on one level,
0:17:15 as an addiction psychiatrist, I’m thrilled that people are taking more seriously the harms of
0:17:23 alcohol, which we’ve known for many thousands of years. Of course, again, alcohol in moderation,
0:17:28 the healthiest people being those who drink no more than one to two standard drinks per week
0:17:34 and the threshold being per week. Right, per week. If we’re taking the healthiest people on the
0:17:42 planet… Oh, doctor. I was almost entirely sure you were going to say per day, but okay, maybe.
0:17:48 I know, I know. But let me qualify that. Let me qualify that. Okay. So that’s a J-shaped curve
0:17:53 that shows that people who drink one to two standard drinks per week are the healthiest,
0:17:57 but it’s probably because there are confounds there. Those are people who do a lot of things
0:18:02 in moderation. They eat in moderation. They exercise in moderation. They’re even healthier
0:18:08 than people who don’t drink at all, but that’s not because alcohol itself is good for us. It’s
0:18:12 because in that non-drinking cohort, you get people who are what we call sick quitters who used to
0:18:18 drink heavily and now are on the liver transplant list. But what we do know is that beyond two drinks
0:18:24 per week, and again, these are large epidemiologic catchment studies, one given individual is going
0:18:31 to have their own trajectory, but beyond two drinks a week, you get to a threshold in women
0:18:36 where more than seven drinks per week and men, men more than 14 drinks per week, where you start to
0:18:43 see a significant increase in all cause morbidity and mortality, whether it’s risk of cancer, risk
0:18:51 of accidental death or trauma, risk of pancreatitis, liver disease, dementia, what have you. So that’s
0:18:56 why we generally recommend that men have no more than 14 standard drinks per week and no more than
0:19:01 four on a given occasion when women no more than seven per week and no more than three on a given
0:19:07 occasion. But in general, through most of my career, it’s been an uphill battle trying to convince
0:19:14 people that alcohol is not good for them when consumed in excess, excess being as I just defined
0:19:19 it with the 14 or four. There’s been a huge sea change in the last five years where all of a sudden
0:19:26 people seem much more aware of the dangers of alcohol, much less inclined to consume it recreationally
0:19:32 because they’re concerned with the dangers. This maps perfectly with what we know about perceived
0:19:38 dangers in use. When people perceive that a substance is dangerous, they’re less likely to use it,
0:19:43 less likely to use it in excess, less likely to get addicted. The huge shift along with that,
0:19:50 I think, is twofold. One, what you’ve already identified, the incredible surgeons of designer
0:19:54 drugs in all their various forms, including plant medicines, hallucinogens, psychedelics,
0:20:02 where people really misperceive the dangers, think they’re much safer than they actually are,
0:20:07 and also have become acquainted with having some kind of actualization experience or spiritual
0:20:12 growth experience. So you’ve got the combination of people thinking they’re not dangerous. Why?
0:20:16 Because they’ve been heavily promoted is not dangerous, including the studies that promote
0:20:21 their use, for example, the use of psilocybin as a treatment for depression. Those studies
0:20:27 systematically ignore harms, don’t document harms, and the lay press has picked that up,
0:20:33 that has legs, and now people think, oh, you know, hallucinogens, psychedelics, they’re not addictive,
0:20:38 they’re not harmful, and I might have a spiritual awakening. So that’s what’s happening there.
0:20:43 I think the other piece of it too that can’t be ignored is that we are narcotizing ourselves
0:20:48 with digital media. So where we might go drink and get together with others, which in some sense,
0:20:53 at least it was more social, you know, now, you know, I can speak for myself, I’m like in my
0:20:59 bedroom watching one YouTube video after another, and it feels very pleasant. And yet I know it’s
0:21:11 not good for me. We’ll be right back. Suppose in the future there’s an artificial intelligence.
0:21:16 I’ve been asking some very smart people a question that’s been on a lot of our minds.
0:21:23 Should we be worried about artificial intelligence? But the answers I got from the greatest minds in
0:21:30 AI surprised me. One guy told a parable of an AI that could cause an apocalypse.
0:21:35 Let’s give this super intelligent AI a simple goal. Produce paper clips.
0:21:44 Be a paper clip? Another woman cast AI as an octopus. We posit this octopus to be mischievous
0:21:48 as well. And yet another story sounded like it was out of the Bible.
0:21:54 She seems likely to drown. What should you do? Imagining AI as a savior. Like a god.
0:22:02 And all of these fantastical tales from the greatest minds in AI made me wonder maybe even
0:22:09 these people don’t know what to think. I’m Julia Longoria, Good Robot, a series about AI
0:22:14 coming March 12th on Unexplainable, wherever you get podcasts.
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0:23:56 can try it yourself. Just go to LinkedIn.com/Scott. That’s LinkedIn.com/Scott. Terms and conditions
0:24:09 apply only on LinkedIn ads. So, and I don’t know if the producer warned you, but basically I use
0:24:14 these podcasts and I guess as a vehicle to talk about me. You know what? Go for it. I love it.
0:24:19 It’s so much more interesting for me because I get to like, you know, see a real human being.
0:24:23 And I have one of the top domain experts in the world, so. On yourself or on something?
0:24:29 I’m teasing you. On addictions. And I’m fascinated with addictions. And I want to talk about a
0:24:33 couple of addictions I think I have and you talk about whether they’re actually clinically
0:24:37 diagnosed addictions and what to do about them. And then I want to talk about the advice I give
0:24:41 to young men and what I’m getting right and wrong because what I realize is I have a series of
0:24:45 principles that I lecture young men about and I don’t know. I think I’m right, but I want to know
0:24:51 what I don’t know. So the first is I believe that everyone has a certain amount of addictions.
0:24:57 That’s not true. Some more than others. But I think almost everybody has some level of something
0:25:02 they do that is probably, if they did less, it would probably be better for them across their
0:25:07 life, whether it’s addictions to shopping, the affirmation, whatever it might be. And I’m addicted
0:25:12 to the affirmation of strangers. I care too much about what other people who I don’t know will
0:25:18 never know think. And sometimes it gets in the way of my relationships with people who I do,
0:25:23 I should care about. Someone will say something mean about me or insult my work on a social media
0:25:29 platform and it inhibits my ability to be close to my loved ones that weekend. I see that as an
0:25:33 addiction, an addiction to the affirmation of others and strangers. And I think that might be
0:25:37 something that plagues quite frankly a lot of successful people or insecure people.
0:25:44 And then I would also argue I have an addiction to money that I’m very blessed and I got kind of
0:25:51 enough money to live well or be economically secure. And I still almost every waking hour
0:25:56 spent a decent amount of that time thinking about how to get more money, even when I should probably
0:26:00 and I talk myself into believing it’s for me and my family, but it’s really just an addiction.
0:26:05 I’ve spent so long trying to dig out of economic insecurity that I’ve become addicted to more
0:26:10 specifically more money. So addiction to the affirmation of others, addiction to money. Are
0:26:14 those clinically diagnosed addictions? And how should I be thinking about them?
0:26:21 Wow, those are really good ones that I don’t get asked about very often. So thank you for your
0:26:27 honest self-disclosure. Let me go back a little bit to your first comment, this idea that everybody
0:26:33 has something that they do more of than they wish they did. I mean, and that’s been true since the
0:26:39 beginning of time. We know going all the way back to what Aristotle called wide-eyed incontinence.
0:26:45 Incontinence is actually something that we, a term we use in medicine to talk about when people
0:26:50 can’t hold their bladder. But this kind of where Aristotle talked about wide-eyed incontinence,
0:26:56 I see the thing that I am doing. I have wide eyes when I’m seeing it. I want to stop doing
0:27:02 as much of it as I’m doing, and yet I am unable to. And so I agree with you that that is true for
0:27:11 all of us in varying degrees. And it’s because of the way we are wired over many, many, many
0:27:17 thousands of years of evolution to reflexively approach pleasure and avoid pain, because that
0:27:22 is what ensured our survival in a world of scarcity and ever-present danger, which is the
0:27:28 world that we lived in for most of human existence. As civilization has progressed, we have managed
0:27:34 to use our big brains to apply technology. It’s not right. Now we’ve drugified everything. We’ve
0:27:41 made it more potently rewarding, more easily accessible, more abundant, more novel. And so now
0:27:46 we’re all struggling with this problem of compulsive overconsumption, which is really
0:27:54 making us unhappy. This idea of the affirmation of strangers, so it’s very clear that we are also
0:28:02 wired over evolution to want to connect with people. Being in a tribe is what ensures that we
0:28:08 will find mates, stewards, scarce resources, protect ourselves against predators. And that
0:28:13 wiring works through our dopamine reward pathway. We know that oxytocin, the love hormone, binds
0:28:18 to dopamine-releasing neurons in the reward circuitry to release dopamine, which is our
0:28:22 pleasure reward neurotransmitter. The more that dopamine is released and the faster that it’s
0:28:31 released, the better it feels. And this is healthy and normal and wonderful until you have drugified
0:28:36 human connection, which is exactly what the internet and social media and digital media has done.
0:28:42 So you’re somebody who is relational. You care about what other people think of you. We all do,
0:28:49 by the way, to varying degrees. But most of us, if not all of us, care what other people think
0:28:56 that’s so deeply ingrained. But now you live in a world where you can have instant affirmation
0:29:04 or its opposite at scale, hundreds to thousands to millions of people, right,
0:29:11 quantified with likes and shares and on and on. And now you really have a very potent drug,
0:29:16 which, when it’s going well, is incredibly reinforcing, much more so than some nice compliment
0:29:22 my husband might give me. Like, that’s not as exciting as my book is number one on Amazon,
0:29:27 right, with a whole bunch of reviews and people telling me that I’m great. And it’s very easy
0:29:34 to get caught up in that. So, yes, I think we can get addicted to the affirmation of strangers. I
0:29:40 think that the internet and social media has become the drugification of social affirmation,
0:29:46 making us all more vulnerable to that problem. And my intervention for that problem would be
0:29:52 the same as for people addicted to drugs and alcohol, which would be to abstain from social
0:29:58 affirmation venues, especially when you’re dealing with them at scale. So, try to avoid
0:30:04 those types of situations where you would be exposed to, like, all of the love. Because,
0:30:10 ultimately, what happens with that huge surge of dopamine is that our brain compensates by
0:30:16 downregulating dopamine transmission, not just to tonic baseline levels, but actually below baseline.
0:30:21 We go into a dopamine deficit state. That is the addicted brain. Now we need more of our drug and
0:30:27 more potent forms, not to get high and feel good, but just to sort of level our balance, go back
0:30:32 to baseline and feel normal. And we’re in a constant state of craving. Plus, we’re experiencing
0:30:36 the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability,
0:30:42 insomnia, dysphoria, and craving. Getting more of our drug temporarily relieves that, but it doesn’t
0:30:48 last very long and actually makes the problem worse. And in terms of money, there’s so much
0:30:54 evidence that monetary gain lights up the same reward pathway as drugs and alcohol. It’s why
0:31:02 we’re seeing a huge, huge increase in online pathological gambling, sports betting has been
0:31:09 made legal in many states and the nation. And with it, like, a 300 to 500% increase in calls to
0:31:15 hotline pathological gambling centers, because people are losing everything in the face of,
0:31:22 you know, their parlays having to do with whether or not the referee is going to touch his hat five
0:31:27 times, you know, during the game. So, yeah, I mean, this is sort of human nature,
0:31:35 like writ large, because we live in an ecosystem that has taken all of these things that are in
0:31:40 some fundamental way, healthy and good for us, and something that our brains need to be doing,
0:31:45 and turned it into a drug. Yes, prior to that, I believe that one of,
0:31:50 I’m constantly saying something as a crisis, I would use the word crisis, but I do think we
0:31:57 have a crisis of loneliness. Do you think you can be addicted to loneliness, or that we just
0:32:02 fill in the dope that we used to get from being social, as you reference, getting that hit with
0:32:10 a low cost, low entry, low risk activity, like YouTube, or what have you, can you get it?
0:32:19 I have to force myself. It takes me almost as much discipline to get out and be around other people.
0:32:27 As it is to drink less. I have become, as I’ve gotten older, addicted to being alone,
0:32:34 and I just find it easier comforting whatever happens, and I know it’s bad for me.
0:32:40 Could you say a certain level of deciding to be alone, maybe more than it’s healthy,
0:32:46 could that be classified as an addiction? Drugs in all their forms are the great human
0:32:55 replacement. Addiction is a disease of loneliness. Even if we have a lot of great people in our
0:33:03 lives, if we get addicted, we will isolate, and we will use our drug to replace that human connection.
0:33:09 I say that because we sometimes talk about loneliness as the cause of addiction,
0:33:16 but more often than not, what I see is that the addiction causes the loneliness. That because we
0:33:24 are able to use this drug, or this device, or this behavior to meet our physical, emotional,
0:33:31 sexual needs, we are no longer seeking out other people. It’s an enormous problem,
0:33:37 because not only are more people in the United States actually physically living alone than ever
0:33:44 before, but more people than ever before are endorsing loneliness. This is a huge problem,
0:33:50 and again, the antidote is to do the thing that’s painful and difficult in the short term,
0:33:56 because in the long term, it will make us feel better, and it will make our lives better.
0:34:04 How have you seen the patients and the research you see come through your office and across your
0:34:10 desk? Which addictions or types of addictions have you seen increase and decrease?
0:34:19 In terms of our patient population, the most common addictions for years have been the usual
0:34:26 suspects, alcohol, nicotine, cannabis, and then starting the early 2000s opioids, prescription
0:34:34 opioids, segueing to heroin and illicit fentanyl. Starting in the early 2000s, we saw the very first
0:34:40 signal of typically middle-aged men coming in with sex pornography and compulsive masturbation
0:34:46 addiction and almost universally endorsing that it was the advent of the internet and then explicitly
0:34:53 the mobile devices, the smartphones that led them from moderate, manageable pornography use to
0:34:59 immoderate, unmanageable addictive use and destroying lives, like losing their families,
0:35:07 their jobs, engaging in illegal activity. Since that time, we’ve just seen an increase in escalation
0:35:13 in people coming, presenting with digital media addictions, video games, social media, online
0:35:19 gambling, online shopping, the internet more broadly a kind of diffuse addiction to the internet.
0:35:26 That’s what we’re really seeing increasing. We’re here in Northern California, so cannabis is huge.
0:35:31 We’re also seeing a lot of, as we talked about, designer drugs, psychedelics, hallucinogens.
0:35:38 Nobody uses, they used to call, let’s say 25, 30 years ago, they had this term white
0:35:44 glove, alcoholics. These were folks who were just addicted to alcohol and not anything else.
0:35:53 We never see that anymore. Everybody’s using a whole bunch of stuff. It’s a real polypharmacy
0:35:59 festival. I coach and work with a lot of young people, specifically I think a lot about young men,
0:36:06 and the addiction I see emerging that I don’t think is getting enough attention, that just
0:36:12 feels like a ticking time bomb to me, is online gambling. The reason I think of it as being so
0:36:20 dangerous is my mother was a docent at the Bellagio in Vegas. She used to come home with
0:36:25 all these facts about gambling addiction, and she told me, and you can confirm or deny this,
0:36:32 that it has the highest suicide rate because you can get in so deep. If I develop an addiction to
0:36:37 meth or alcohol, it generally becomes pretty visible to the people around me, and they intervene
0:36:45 and try to do something. I can get so deep with gambling, and nobody knows. Then I get in so
0:36:51 deep. I’ve spent my kids college fun, mortgage the house. My spouse doesn’t know what I’ve done.
0:36:59 I see no way out, and I decide to end it. I’ve just seen these stats that 50% of college males
0:37:05 bet on the Super Bowl. Occasionally, I’m in a scenario where I’m with a bunch of young men,
0:37:09 and they’re all on their phones, and I think, “Oh, that’s natural people. I know kids are on the
0:37:14 phones.” They’re all gambling on the game they’re watching, and they’re not gambling. They’re not
0:37:22 doing 100 bucks. Liverpool will beat Arsenal. They’re gambling every seven minutes. The ball’s
0:37:29 going to turn over. What you were saying about the ref, and I know these companies and the people
0:37:33 architecting these algorithms, they will figure out who’s going to lose their money and encourage
0:37:38 them to bet more, and the ones who actually know what they’re doing, they will block out of the
0:37:45 platform. It’s a guaranteed loss of income. I like to gamble. I think it’s fun. I go to Vegas.
0:37:51 I gamble, but I assume it’s consumption. I assume I’m going to lose it all. It strikes me that we
0:38:00 might, and tell me if I’m being just hyperbolic or inflammatory, or exaggerating, or just
0:38:07 warring too much here, that we’re going to have hundreds of thousands of young men, and my sense
0:38:11 as young men, and I like to validate and allify this, are much more prone to gambling addiction
0:38:19 than women, who enter the world with massive financial hangovers and shame because of the
0:38:28 constant presence of gambling apps, your thoughts? Yeah. It’s funny that you, I thought for sure you
0:38:36 were going to say online pornography, because I would probably put, in terms of risks to men
0:38:42 living in the world today, I would probably put that above online gambling, but I would make online
0:38:49 gambling a close second. It’s very hard to get actual data on this, but this is sort of based on
0:38:55 my clinical impression of what I’m seeing. Of course, I’m seeing treatment seekers, but
0:39:03 yeah, this is an enormous problem. I always like to start by emphasizing the vast majority of people
0:39:09 who gamble will not get addicted to gambling, and that’s true for any drug, right? Most people
0:39:16 will be able to moderate their use, but as with drugs and alcohol, about 10 to 20% of folks who
0:39:22 consume will develop an addiction. An addiction is a brain disease, a very serious and potentially
0:39:28 life-threatening one, and until you’ve either experienced it yourself or seen it in somebody
0:39:33 you care about deeply, it’s really hard to imagine how people could get to a place where
0:39:40 they would sacrifice everything in pursuit of their drug, but that’s exactly what happens.
0:39:47 What is the vulnerability there? What is the difference? The risks I usually classify into
0:39:52 nature, nurture, and neighborhood. Some people are inherently more vulnerable than others,
0:39:57 but as we’ve talked about, drug of choice matters. If you meet your drug of choice and it’s gambling,
0:40:03 you may never get addicted to alcohol, but gambling may just be the end of you. Co-occurring
0:40:10 psychiatric disorders pays people at risk because of a kind of a self-medication myth and cycle.
0:40:15 We know that trauma contributes to the risk of addiction. That’s the nurture part of it,
0:40:20 but also neighborhood is really key, and this is, again, the ecosystem that we live in. The easier
0:40:26 it is to get your drug of choice, the more of it you’ll use, the more you’ll change your brain,
0:40:29 and the more likely you will be to develop a very serious addiction.
0:40:42 Gambling is everywhere. There’s enough data to verify your impression that it’s more men than
0:40:47 women, although women also struggle with it. The same is true for online pornography. More men
0:40:53 than women develop an addiction to that, although women do develop pornography and sex addictions.
0:41:00 There are some addictions where women are more vulnerable than men like online shopping
0:41:06 and social media, but in terms of the gambling and pornography, definitely men are more vulnerable,
0:41:10 and I absolutely agree with you that this is a huge and largely unseen problem,
0:41:19 complicated, as you say, by the shame issue, where for gambling addiction, there’s still so much about
0:41:28 in our culture about being a man who becomes wealthy and successful as our modern-day hero,
0:41:34 that if you’re somebody who’s not done that or, God forbid, gotten into financial trouble,
0:41:40 very, very hard to come forward and ask for help. Frankly, the same is true with sex and
0:41:48 pornography addiction. We have this prevailing cultural, I believe, false notion that all men
0:41:55 are sexual predators. To come forward, you can only imagine the shame of somebody having to
0:41:59 come forward and say, “I’m addicted to sex or I’m addicted to pornography,” or, “I watch these types
0:42:06 of pornographic images and they’re stimulating for me.” Very shameful, very hard. I’ve had patients
0:42:13 come in and say they had a problem with some drug, which wasn’t even their problem. It was
0:42:19 pornography and it took them four visits to be able to admit it. Huge, huge problem here. Again,
0:42:27 access, ease of access, quantity, all the touch of our fingertips, which just makes it very,
0:42:34 very difficult for us as humans who are reflexively wired to approach pleasure and avoid pain,
0:42:38 to withstand the lure of these incredibly potent drugs.
0:42:43 There are professors and academics such as yourself looking at gaming.
0:42:48 I found it really difficult to find anybody with deep domain expertise or peer-reviewed
0:42:53 research around porn. My assumption is that professors don’t want to be known as Professor
0:42:57 porn, that there’s actually shame in the academic community. You don’t want to be that guy or gal.
0:43:03 It’s like, “Well, why did you decide to do that, Professor?” It’s the second largest category,
0:43:10 I think, on the internet and relative to the size of it, there’s a ridiculous scant amount or dirt
0:43:15 or research around it. I had thought that, or some of the stuff I’ve read is that it’s a small
0:43:21 population consuming a disproportionate amount of porn, that most men, young men, and young women
0:43:29 are able to modulate it. My fear around it has always been that it’s just being very transparent.
0:43:34 One of the reasons I went on campus every day at UCLA was one, because I knew I was supposed to go
0:43:40 to class, but two, the prospect that I might meet someone who, over the medium or long term,
0:43:44 would decide to have sex with me. You sound like my son.
0:43:50 I sound like most sons in their head, and I think I just articulate it.
0:43:57 If I’d had porn available at home, I’m pretty certain I wouldn’t have been on campus
0:44:00 five days a week. I might have gone to four or three or two, because it just might have been…
0:44:07 I mean, the reality is, I wanted sex so badly, and my hormones were raging so much that I was
0:44:12 willing to take social risk and go out and try and meet people. By the way, I think that’s really
0:44:19 healthy to think, “I want to take these risks. I want to meet people in hopes that I can have a
0:44:24 coffee, invite to a party, establish a relationship, and at some point along the way, maybe have
0:44:28 those types of physical encounters.” I think that is really, really healthy,
0:44:34 and I worry that, and curious to get your take, that it’s not the hardcore addicts that are
0:44:41 screwing up America around this stuff. It’s that it just decreases across an enormous population
0:44:49 of young men, their willingness to establish connections with others, that we’re evolving
0:44:57 it. We’re maturing a new species of asexual, asocial males that never get categorized or
0:45:03 clinically diagnosed as addicts, but are just alone their whole lives and never develop these
0:45:09 skills. Is there a low-level form of, I don’t even call it addiction, but avoidance or replacement
0:45:15 theory that could be even more damaging than what we think of as traditionally diagnosed addiction?
0:45:23 Absolutely, and there are data to support this. For all our liberated sexual moors,
0:45:31 young people are having less sex today than ever before. Many young men will report that they
0:45:38 feel like the social landscape out there when it comes to dating and having sex is so uncertain
0:45:45 and such a landmine that they just end up staying home, watching pornography and masturbating,
0:45:50 and for folks who are vulnerable to that as their drug of choice, it can evolve to the point where
0:45:57 they literally cannot stop. Like with any drug, they need more potent forms over time. Pornography
0:46:05 becomes chat rooms, chat rooms become meeting in person, prostitutes, child pornography. I mean,
0:46:15 this is a huge issue right now. By the way, I think your point here about it being so widespread
0:46:22 that we can hardly even call it, it’s like an endemic disease. It’s not even a rare disease.
0:46:31 I have had in the last little bit of, like the last month, two mothers call me who are
0:46:39 in desperation because their sons have been identified as viewers of child pornography.
0:46:47 Now, these are teenage boys who are watching teenage girls and who now are facing potential
0:46:58 felony. I just think that the whole system is not set up for the degree to which this behavior has
0:47:04 become so widespread, so normative. I mean, we can’t be convicting all of these young men of
0:47:13 felonies and I’m not by any means endorsing child pornography or teen pornography. My personal
0:47:22 opinion is that none of it’s good for so many reasons. But the issue is we have a court system
0:47:29 who is now looking to convict an 18-year-old boy for viewing pornography of a 17-year-old girl
0:47:35 and facing like being a lifetime sex man. Our legal system has clearly not caught up
0:47:41 with what is happening. The corporations that make and profit from these media are not remotely
0:47:47 being held responsible for what’s going on. I mean, this is really endemic proportion problems.
0:47:57 I talk about the smartphone as our masturbation machines and I mean that in every sense of the
0:48:04 word, that’s what they are. We’re using the internet and these devices to meet all of these needs
0:48:11 that used to require other people and part of what connects people together is our interdependency,
0:48:17 our mutual need. If we didn’t need other people, we wouldn’t bother to do the work to go interact
0:48:22 with them because it’s a heck of a lot of work and it’s complicated and it’s ambiguous and it’s
0:48:29 painful because of all the ways in which we’re all so complicated. So yeah, this is a huge
0:48:37 problem. We’re creating a generation of mole people as in mole the animals who never go out
0:48:42 and never leave their little hidey holes. Super scary. We’ll be right back.
0:48:53 We’re taking Vox Media podcasts on the road and heading back to Austin for the South by Southwest
0:49:00 Festival March 8th to the 10th. What a thrill. We’ll be doing special live episodes of hit shows
0:49:05 including Pivot. That’s right. That dog’s going to the great state of Texas. Where should we begin?
0:49:12 With Esther Perrell, a Touch More with Sue Bird and Megan Rapinoe, not just football with Cam Hayward
0:49:18 and more presented by Smartsheet. The Vox Media podcast stage at South by Southwest is open to
0:49:23 all South by Southwest badge holders. We hope to see you at the Austin Convention Center soon.
0:49:31 Visit voxmedia.com/sxsw to learn more. That’s voxmedia.com/sxsw.
0:49:42 Support for Prop G comes from 1-800-FLOWERS. Roses are a classic way to say “I love you” and
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0:50:22 think? What did you think of those flowers?” They’re the best roses I’ve ever received. They’re beautiful
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0:50:47 offer. Go to 1-800-FLOWERS.com/PropG. That’s 1-800-FLOWERS.com/PropG. We’re taking Vox Media
0:50:51 podcasts on the road and heading back to Austin for the South by Southwest Festival March 8th
0:50:58 through the 10th. What a thrill, chicken fajitas, queso, strawberry margarita, extra shot of tequila.
0:51:03 There you’ll be able to see special live episodes of hit shows including our show Pivot. Where should
0:51:09 we begin with Esther Perrell? A Touch More with Sue Bird and Megan Rapinoe. Not just football with
0:51:16 Cam Hayward. And more presented by Smartsheet. The Vox Media podcast stage at South by Southwest
0:51:21 is open to all South by Southwest badge holders. We hope to see you at the Austin Convention Center
0:51:27 soon. I’m not joking. I love South by Southwest. The people are a ton of fun. It’s a great time.
0:51:37 If you do come come up and say hi, visit voxmedia.com/sxsw to learn more. That’s voxmedia.com/sxsw.
0:51:54 We’re back with more from Dr. Anna Lemke. I want to move to solutions and I’m sure you get calls
0:52:00 from government officials in DC and Sacramento or ask for your advice on the stuff. I think most of
0:52:07 this, if I could think of one thing to try and set a context that would reduce addiction, it would
0:52:12 be third spaces. And that is trying it as many young people as often as possible in the company of
0:52:18 other young people and in the company of potential mentors, friends, and mates. I was in Israel after
0:52:26 October 7th at the Nova Music Festival site or memorial and I met with a battalion of IDF
0:52:34 soldiers and they were these young extraordinary fit 120 kids, 19 to 21 outdoors in the company of
0:52:40 each other. Many of them go on to start businesses together, lifelong friends. A lot of them meet
0:52:46 their spouses outdoors serving in the agency of something bigger than themselves. And I thought,
0:52:50 I just don’t think nearly as many of these young adults are going to end up addicts.
0:52:58 And I thought, how can we do this a million times in different ways, whether it’s
0:53:04 continuing education, softball league, church, nonprofit, like third spaces. If I could do one
0:53:09 thing, it would be third spaces. What is the one thing, your thoughts on that and what is the one
0:53:15 or two things you would want to do to set up a context of success and addiction avoidance?
0:53:22 Because we are creatures innately designed to approach pleasure and avoid pain,
0:53:31 we need to create spaces where we have access to healthy sources of pleasure and a sufficient
0:53:37 challenge to make that interesting enough for us that we creatures who need a certain degree of
0:53:45 friction find it interesting, and also spaces that limit our access to unhealthy sources of
0:53:51 pleasure, unhealthy dopamine, as in the instant pleasures of the various intoxicants we’ve been
0:53:58 talking about. So I love the idea of third spaces, but it sounds a little rarefied,
0:54:04 like it would be for the elite and the wealthy. We have the potential to create those third spaces
0:54:09 in the public school system where kids spend the vast majority of their lived hours.
0:54:10 So after school programs?
0:54:15 Not even after school, during school. How can we do that? Get smartphones out of schools, bell
0:54:25 to bell, create, give hands on, bring back. What happened to, I mean, I didn’t like auto shop,
0:54:34 but at least we had it. Let’s have more art, more hands-on stuff. Let’s have writing classes
0:54:39 where they’re not allowed to use chat DTP and they get real, not to say that we should never
0:54:45 use those tools, but everything’s gone online in the schools. It’s all digitized. We’re learning
0:54:52 everything by watching somebody else do something. Kids need to do, and schools are the place,
0:54:59 the default place to make that happen, which means getting the digital drugs out of their hands during
0:55:06 school time hours. I’m also a huge believer in age verification. We have to recognize that
0:55:13 digital media is a drug for the vulnerable. The vulnerable include a kid with a developing
0:55:17 brain. We cannot have five-year-olds on iPads for eight hours a day.
0:55:20 What do you think that number is? Is it 16? Is it 12? What is it?
0:55:29 I think it’s at minimum, at minimum 13, and even then, I think there has to be a lot more
0:55:35 in terms of guardrails. We really need real age verification, like the real deal,
0:55:39 where you have a third-party site, your register. I know there’s a lot of problems with that in
0:55:47 terms of people’s privacy, but I’m sorry, we make a lot of sacrifices to protect the vulnerable few
0:55:53 as we should do in our society. We already don’t let kids drive cars by firearms, go into
0:55:59 casinos in gamble, buy cigarettes, buy alcohol, buy drugs. Join the military. We age get a lot of
0:56:04 things. We recognize that kids have vulnerable grains, and that their frontal lobe isn’t fully
0:56:09 connected. If we just let them run amok, we would have many fewer kids on the planet,
0:56:14 and we’ve got to protect our kids. That’s what I think.
0:56:16 Do you have kids, doctor? I do.
0:56:22 What advice would you have? I find it difficult sometimes to discern between
0:56:30 normal adolescent behavior, which is abnormal, as far as I can tell, and when I should be worried,
0:56:37 when I should think, okay, he takes his phone into the bathroom to watch TikTok and pretends
0:56:44 he’s in the bathroom for 10, 20 minutes. Okay, is this 14-year-old behavior, or should I be
0:56:54 worried? As someone who’s been a parent, and what pieces of advice, I don’t know how old
0:57:01 your children are, but as it relates to addiction, are there any sort of unlocks or critical success
0:57:08 factors or red flags in your child’s behavior where you can help discern the difference between
0:57:14 what you call not necessarily behavior we shouldn’t correct, get out of the bathroom enough already,
0:57:19 but where you probably think, okay, this is getting serious and might require professional
0:57:26 intervention? Yeah, so there’s no blood test or brain scan and diagnosis addiction. We base
0:57:31 it on phenomenology on what’s called the DSM, the Diagnostic and Statistical Manual of Mental
0:57:36 Disorders, which briefly summarized as the foresees, control, compulsions, cravings, and
0:57:43 consequences, especially continued use despite consequences. The problem is that a lot of kids
0:57:50 use substances, engage in addictive behaviors, and don’t have obvious consequences, so it’s very
0:57:55 hard to tell at that age because they’re young, they’re resilient, and they’re good at hiding it.
0:58:01 So although you won’t find these criteria in the DSM, I think a warning sign to look for,
0:58:06 unless there are obvious signs of unraveling, but if you’ve got a kid who, you know, isn’t
0:58:13 obviously unraveling, but you’re kind of wondering, is look for lying and other anti-social behavior.
0:58:18 Again, you won’t find that in any psychiatric diagnostic manual, but I think those are very
0:58:25 important soft signs of something going wrong with the kid or in the family. Now, all people lie,
0:58:30 the average adult tells one to two lies per day. These tend to be small little lies about, you know,
0:58:36 hiding our own selfishness and foibles, and teenagers definitely lie. But if you get a kind
0:58:42 of a more significant systematic lying about where I’ve been, who I was with, what I was doing,
0:58:51 or even just kind of anti-social behavior, rudeness, hostility, rage, these are the things
0:58:56 that I think, you know, we should look for as potential warning signs for something going wrong
0:59:02 with our kid. Last question, Dr. You’ve been very generous with your time. Very curious to get your
0:59:09 thoughts and take on GLP-1 drugs. GLP-1 drugs are super exciting. I’m really glad they’re here.
0:59:15 They don’t work for everyone all the time because we’re all unique and we have these unique brains.
0:59:21 But the more tools we have to stop the kind of addiction chatter that happens for some people,
0:59:27 the better. As you know, GLP-1 agonists are FDA-approved to treat diabetes and obesity.
0:59:33 They modulate stomach emptying, slow down, you know, the gastric flow and make people feel more
0:59:38 full. But they also work on the brain’s reward pathway. They modulate dopamine release, our
0:59:43 reward neurotransmitter. And there is very active research now looking at their use broadly in
0:59:50 addictions for most alcohol addiction, but also there’s some preliminary evidence for benefit
0:59:55 with nicotine addiction with opioid use disorder, which is really interesting, as well as behavioral
1:00:01 addictions like gambling and sex. We are using them off-label occasionally in our clinic for
1:00:06 treatment refractory alcohol use disorder. This is folks who have tried everything for their
1:00:12 alcohol addiction and we’re getting some good traction in a few of our folks. Other folks
1:00:16 are trying it and don’t find it that helpful. So, you know, nothing is going to be like the
1:00:23 miracle drug. I don’t think GLP-1s will either, but they’re exciting new development and they
1:00:28 can be very effective for food addiction and potentially other addictions as well.
1:00:34 Dr. Anna Lemke is a professor of psychiatry at Stanford University School of Medicine.
1:00:39 She’s also the author of the bestselling book, Dopamine Nation, Finding Balance and the Age
1:00:44 of Indulgence. I really enjoy this conversation and you’re doing such important work and you
1:00:49 have such a nice vibe about you. You just reek of credibility and I can see why you’re
1:00:53 having such an impact because I find myself just hanging on every word because I get the sense
1:00:59 that you are really, I don’t know, a good actor trying to just call balls and strikes. Really
1:01:10 appreciate your good work and enjoy the conversation, Dr.
1:01:25 Osborne of Happiness. I am starting, I had a bit of a gap, but I’m starting to coach young men
1:01:31 again and actually had a kid come up to me last night. This guy is really super impressive in
1:01:38 the ad tech market, making real good money and kind of stalking me and asking me to be his mentor.
1:01:42 And finally I just said, “Dude, you don’t need my help.” And who I’m trying to focus on are quite
1:01:46 frankly young men who are struggling. And I’ve actually taken on a couple men my age who are
1:01:53 trying to reinvent themselves who are struggling, but I’m doing this exercise and it’s yielding
1:02:00 real benefits, especially with young men. And that is, I was just struck by the stat I read that
1:02:09 over half of men ages 18 to 24 have never asked a woman out in person. They’ll swipe right, right?
1:02:14 They’ll email somebody or whatever it might be or though who knows, like go on Craigslist and
1:02:22 get whatever, but there’s very, the majority of men 18 to 24 have not asked a woman out in person.
1:02:32 And that just rattled me and made me so upset and sad. When I think about 18 to 24 for me was
1:02:36 putting myself in an environment where I’d have a greater likelihood of being able to ask a woman
1:02:42 out. And I show me someone who can ask a woman out or handle the rejection or be successful.
1:02:46 I’m going to show you someone who’s good in a bar is good in a, is good in a boardroom. I think
1:02:52 it’s a key skill for young men. And so the exercise I’ve been doing and I talk a lot about this is
1:02:56 one, we’re going to get fit to start making a little bit of money, no matter what it is,
1:03:04 lift driver, task rabid. Three, we’re going to put ourselves in a context in an environment with
1:03:10 strangers regularly in the context of something bigger than you, whether it’s a church group,
1:03:15 softball league, nonprofit, whatever it might be. And, and this is what we’re going to do.
1:03:20 And this is what I’m going to recommend if you’re a young man right now. I need you to approach
1:03:26 a stranger and express interest in friendship or exploring a romantic relationship. And those are
1:03:29 weird words. You would never say that. Hey, are you, you know, what are you doing this weekend?
1:03:34 You want to get together or go to a bar, watch the game? Hi, would you, you know, lay on your
1:03:39 wrap or develop your wrap or lack thereof, would you mention grabbing coffee or grabbing a drink?
1:03:47 What have you? And that’s not the win. That’s not the exercise. The win is I need you to get to know.
1:03:51 And unfortunately, that happens a lot, right? And that is, I want you to go up to someone,
1:03:55 do your best, try, say hi, and shoot, would you like to have coffee? And then call me the next day,
1:03:59 and this is what’s going to happen. Most of the time, the answer will have been a no.
1:04:04 It’s usually applied, no, but it’s usually a no. And that, and then I’m going to say,
1:04:08 how are you? And this is what you’re going to tell me. You’re going to say, well, I’m upset,
1:04:14 I’m bum, but yeah, on the whole, I’m fine. That’s the victory. That’s the payoff. Because here’s
1:04:22 the thing. No is the way to success. Specifically, your willingness to put yourself in a room where
1:04:29 you get no’s. If you’re not getting no’s, it means you’re in the wrong room. And you miss all the
1:04:37 shots you don’t take. The number of no’s, no’s are your path to yes and success. So here’s the
1:04:41 victory. You express an interest in friendship, you express an interest in romantic relationship,
1:04:47 and you get to the no. And that’s the victory. Because you find out, you find out, you’re fine,
1:04:52 they’re fine, and it hurts a little less the next time you get to a no. Whether it’s inquiring about
1:04:57 a job you’re not qualified for, whether it’s expressing interest in lunch with someone who
1:05:02 might be able to mentor you or help you, whether it’s expressing interest in someone that you are
1:05:08 physically and romantically attracted to. The reason I’m staying, I get to live the life I lead,
1:05:12 and I get to partner with someone who is much higher character and much hotter than me,
1:05:19 was no. Specifically, my willingness to get to a shit ton of no’s, and then mourn and move on
1:05:28 and get through them. What is the key to success? No. This episode was produced by Jennifer Sanchez.
1:05:33 Our intern is Dan Chalon. Drew Burroughs is our technical director. Thank you for listening to
1:05:37 the Property Pod from the Vox Media Podcast Network. We will catch you on Saturday for No
1:05:43 Mercuno Mouse, as read by George Hahn. And please follow our Prodigy Markets Pod wherever you get
1:05:56 your pods for new episodes every Monday and Thursday. All right, Sean, you can do this promo
1:06:01 talking about all the great Vox Media podcasts that are going to be on stage live at South
1:06:07 by Southwest this March. You just need a big idea to get people’s attention, to help them,
1:06:12 you know, keep them from hitting the skip button. I don’t know. I’m going to throw it out to the
1:06:18 group chat. Kara, do you have any ideas? In these challenging times, we’re a group of mighty hosts
1:06:23 who have banded together to fight disinformation by speaking truth to power, like the Avengers,
1:06:29 but with more spandex. What do you think, Scott? I’m more of an X-man fan myself. I call me professor.
1:06:35 Could I read minds? I can’t really read minds, but I can empathize with anyone having a mid-life
1:06:41 crisis, which is essentially any tech leader so. Minds are important, Scott, but we’re more than
1:06:48 that. I think that you can’t really separate minds from feelings, and we need to talk about
1:06:54 our emotions and explore the layers of our relationships with our partners, co-workers,
1:06:59 our families, neighbors, and our adjacent communities. I just want to add a touch more.
1:07:04 From sports and culture to tech and politics, Vox Media has an all-star lineup of podcasts
1:07:11 that’s great in your feeds, but even better live. That’s it. All stars. Get your game on, go, play,
1:07:18 come see a bunch of Vox Media all stars, and also me at South by Southwest on the Vox Media podcast
1:07:25 stage presented by Smartsheet and Intuit. March 8th through 10th in Austin, Texas. Go to
1:07:33 voxmedia.com/sxsw. You’ll never know if you don’t go. You’ll never shine if you don’t glow.
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0:00:55 Yes, Tommy’s shoes get ruined.
0:01:01 Yes, he’ll do it again tomorrow because the endeavor is worth it, and so is your sanity.
0:01:05 Tune in to HOD Save America wherever you get your podcasts and on YouTube.
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0:02:17 Episode 339. 339 is the area code serving the Boston, Massachusetts area in 1939,
0:02:21 the Wizard of Oz, from a true story, whenever I climax with a woman,
0:02:33 I scream out, surrender Dorothy, or I’m melting. I’m melting, melting. Go, go, go.
0:02:43 Welcome to the 339th episode of the PROP G-POP. What’s happening?
0:02:49 The dog is howling. He’s busy. He’s like one of those Belgian Malinois dogs. It is not happy
0:02:54 unless it’s working all the time, like roaming property or defending someone. I accept, I’m not
0:02:59 like that, but I basically have the tasks of a Belgian, of a Belgian Malinois. And that is,
0:03:04 I have so much shit going on today. I flew in last night from Barcelona, got in late,
0:03:09 came here, took an edible crash for like five hours. Now I’m up. I’m at the Fayena Hotel,
0:03:14 which I love. Even though it’s not really my design aesthetic, it’s like a very
0:03:21 handsome, wealthy, metrosexual Buenos Aires exploded into a hotel, which I think is pretty
0:03:26 much the owner of this hotel. And then I got to do this and I’m going to this conference,
0:03:31 this 0100 conference to host a lunch. Then I got a bomb up to Palm Beach where I’m doing a speaking
0:03:38 gig. Then I’m on a plane in New York and wash rints and repeat. But anyways, I’m in Miami. It’s
0:03:43 absolutely beautiful. Isn’t good to know what I’m up to? Thank God I know where he is. Thank God I
0:03:48 know what’s going on here. Anyways, what are we going on? Today’s episode, we speak with Dr. Anna
0:03:52 Lemke, professor of psychiatry at Stanford University and author of the best-selling book,
0:03:59 Dopamine Nation, Finding Balance in the Age of Indulgence. We discussed with Dr. Lemke the rise
0:04:02 of addiction in the digital age from drugs to social media and why our brains are wired to
0:04:08 create more. Plus, Dr. Lemke shares practical solutions to help build a healthier relationship
0:04:15 with pleasure. I really enjoyed this conversation. You occasionally interview somebody, especially
0:04:20 it’s so rewarding when you interview someone in the sciences, in the public health field.
0:04:24 And you get the sense they genuinely care that they want to figure this stuff out,
0:04:29 they want to help people. And she highlighted something we did this interview, I think about a
0:04:37 week ago, about a lot of young men are just a lot of men have addictions to porn. And there’s a lack
0:04:42 of peer-reviewed research on it because very few academics want to be known as the porn professor.
0:04:50 And just literally after she highlighted what an issue it has become for many of her patients,
0:04:54 I have had no joke, three men come up to me and start talking to me and we start talking about
0:04:58 addiction. And they look around and in their very self-conscious, they say, “Well, I have an addiction
0:05:02 problem.” And we start talking and I’m pretty straightforward. I said, “What’s your addiction
0:05:09 problem?” And all three times it’s been porn. And I want to learn more about it because it’s
0:05:14 something that I don’t think we talk a lot about. And there’s very little peer-reviewed research.
0:05:19 And as we think about men, especially young men and the access to this type of porn,
0:05:27 I’ve often said that the nicest thing in my life is getting to raise children with a competent
0:05:34 partner. If you can figure that out, if you can find someone who you share values with,
0:05:38 that you’re aligned with around money and that, quite frankly, you want to have sex with,
0:05:43 and you are blessed with healthy children, that’s kind of the whole shooting match. Or at
0:05:48 least that’s what I’ve decided is a whole shooting match. Everything else for me was just like a
0:05:52 means to an end. And I was never sated. I was wanting more and more money, more experiences,
0:05:56 more relevance. And I’m still on this fucking hamster wheel. And it’s the reason why I’m here.
0:06:01 Speaking to you right now, is that fair? Is that fair? Anyways, let me stay up to fine, you know.
0:06:09 But if I had been a young man and had access to porn, I’m not sure any of that would have happened.
0:06:14 And why is that? No joke. Part of the reason I used to go on campus and probably the only reason
0:06:19 I got a 2.27 GPA from UCLA and not a 1.87, which one, I wouldn’t have graduated. I wouldn’t have
0:06:23 gotten a job at Morgan Stanley. I wouldn’t have gotten into a high school of business, wouldn’t
0:06:29 have met my co-founder or a profit, wouldn’t have started businesses, and 30 years later, 35,
0:06:36 be at the fineena. And that is because I would go on campus and go to class because I was hoping
0:06:41 deep down, or something in the back of my mind, was that I was going to meet a stranger. I’m going
0:06:45 to establish a rapport with her and at some point have sex with her. That was very motivating for me.
0:06:54 And that sounds crass, but I don’t think there’s anything wrong with wanting to mate. And what I
0:07:02 tell young men is the following. I tell them, like, I can consume porn, but I’ve tried to, for the last
0:07:07 10 or 15 years when porn came on the scene, and I think it’s really good advice, especially for
0:07:15 young men, try and modulate your use. Because some of that desire, some of that wanting to meet people
0:07:22 such that you can make your own bad porn is key. You don’t want to extinguish those flames of desire,
0:07:26 because those flames of desire can actually result in good things. They want you, they make you want
0:07:30 to be more successful. They make you want to be in better shape. They make you want to develop a
0:07:35 wrap. They make you want to figure out a way to make someone else laugh. They make you want to
0:07:41 have a plan such that you’re more attractive, such that you might in fact be able to get out there
0:07:46 and establish your own romantic relationships. Anyways, what’s the, what’s the bottom line?
0:07:52 And the advice I would give to anybody, but especially young men, look, most people consume
0:07:58 porn. Is that true? Most men, I think, consume porn. I get it. But try and modulate your use
0:08:04 and try and figure out a way to develop the mojo, the desire, and the skills that you can get out
0:08:10 there and start making your own bad porn. So with that, here’s our conversation with Dr. Anna Lemke.
0:08:20 Dr. Lemke, what is this podcast behind you? I am physically sitting in my office here at
0:08:25 Stanford University. This is where I treat patients and do my work.
0:08:30 Sounds good. So let’s bust right into it. In your bestselling book, “Dopamine Nation,”
0:08:37 published back in 2021, you argued that constant access to stimulation is rewiring our brains.
0:08:43 Four years later, has anything changed or any additional observations between then and now?
0:08:49 I would say that the four years that have elapsed have really, unfortunately,
0:08:55 just seen an acceleration in this problem. I guess the good news is that people are
0:09:00 talking about it more, more aware of it. I think the groundswell really started with parents
0:09:07 concerned about their kids, but I think in general, the average person is now
0:09:13 more aware of and concerned about their consumption of digital media.
0:09:18 Something that I’m especially concerned about is the father of a 14 and a 17-year-old,
0:09:23 especially with a 14-year-old. And my colleague, Jonathan, I talk a lot about this, is that
0:09:29 the rewiring is especially, or I guess the more appropriate term would be the wiring of the brain
0:09:32 as children are going through puberty, that that can be especially damaging. Are we
0:09:38 about to flush into the economy or society millions of essentially dopa addicts that,
0:09:41 if they don’t find it on their screen, they’re going to find it elsewhere?
0:09:47 Yeah, it’s a great question. I think it’s important to emphasize that we are constantly rewiring our
0:09:54 brains, wiring just really being a metaphor for neurons and the plasticity of neurons and the
0:10:00 way that we’re constantly making new connections between neurons. Every single experience that
0:10:09 we have rewires our brain in some way. So the fact that we’re spending enormous amounts of time
0:10:16 online by the latest report, I think it was Pew Surveys came out and said that about 50%
0:10:21 of teenagers now report being continuously online during the waking hours. Of course,
0:10:28 that is rewiring our brain. The question is, to what end? Because we have to adapt to any
0:10:32 environment. We’re always rewiring our brains, but are we now rewiring our brains in a way
0:10:38 that is ultimately not good for us as individuals, not good for societies, not good for humanity?
0:10:45 I would say, and I think I’m a little bit more measured than Jonathan Hyde about this,
0:10:50 although I totally respect him in his work, I would say, yes, there is a lot to be concerned
0:10:58 about here, but that I’m ultimately optimistic that we will both self and other regulate. What
0:11:02 do I mean by that? I’m already seeing people who are beginning to say, you know what,
0:11:08 this isn’t good for me or this isn’t good for my family, even teenagers themselves forming these
0:11:12 groups and saying, let’s get off social media together. Let’s try to do things that we can do
0:11:19 in real life with each other. Other regulate because it can’t just be left up to the individual.
0:11:28 This is far too powerful a transformation to just say, well, it’s up to you to figure out
0:11:32 how to moderate your consumption of digital media. We have to get smartphones out of schools,
0:11:38 bell to bell. We have to hold the companies accountable. We have to legislate, particularly
0:11:44 to protect kids. Talk about the different types of addiction. There’s obviously addiction to
0:11:49 the screen, then there’s drugs, there’s alcohol, there’s pornography, there’s gaming. Is there
0:11:55 any way to sort of stack rank these addictions? And I was always told, I’m pretty open to my
0:11:59 podcast. I love marijuana. I loved it in college. I took kind of a 20-year break because I was
0:12:04 working my ass off and I started using it again. And I enjoy it. And I actually think it’s
0:12:10 additive to my life. But I remember people was telling me that it was a gateway drug to more
0:12:16 serious addictions. If you were to sort of stack rank different types of addictions in terms of
0:12:23 what is the most dangerous or what perhaps is a gateway to other things, any thoughts about sort
0:12:29 of the hierarchy or the waterfall of different types of addiction? Great question. I have become
0:12:36 pretty much convinced over the course of my career that it depends on the person and their
0:12:43 unique wiring and their drug of choice. For one given individual traditional drugs like alcohol,
0:12:52 cannabis, opioids, nicotine may not hold much appeal, but social media may indeed be the drug
0:12:58 that overpowers them and leads to a very serious and devastating addiction. Furthermore,
0:13:06 people are variably vulnerable to addiction period. Some people are much more vulnerable
0:13:10 than others and can get addicted to a lot of different substances and behaviors.
0:13:15 Other people getting addicted is something that probably won’t happen to them to a
0:13:20 significant degree. And again, the uniqueness of the wiring, although I have argued that we’re
0:13:25 all more vulnerable to addiction now than before because of the drugification of our environment,
0:13:30 I think we also have to take into consideration that when we’re thinking broadly about danger,
0:13:36 it’s not just the addictiveness of the drug. Nicotine is very addictive for many people,
0:13:44 but also the lethality of the drug. Opioids is something that can kill even when the dose is
0:13:52 just a little bit beyond what the dose is for the desired effect. That’s not true in the short term
0:14:00 for nicotine or cannabis, which can do significant harm in people who are addicted and use heavily,
0:14:08 but it usually takes a long time, many, many years of exposure. In your case, somebody who
0:14:13 loves marijuana, who gave it up for a period of time is now using it and just basically finds it
0:14:21 enjoyable. Great. It’s nice if that can be an enjoyable part of a person’s life and toxicants
0:14:26 in various forms have been around since the beginning of time. The one thing that I would
0:14:32 caution about always is just that we’re not always the best self-observers around whether or not
0:14:43 our enjoyment is really leading to long-term enjoyment or is interfering in ways that we
0:14:53 can’t see just because these drugs tend to interfere with our insight in terms of what they’re doing
0:14:59 to us. Often, they can be causing harm or we can be getting addicted and really not see it.
0:15:05 I’ve observed something and I’d love you to get your thoughts on it. I go to a lot of conferences
0:15:09 where there’s a lot of young, successful people, whether it’s South by Southwest or I go to this
0:15:16 event called Summit. I’ve noticed over the last 20 years that young people are not drinking,
0:15:23 but it’s not as if they’ve gone healthy or healthy era. The aspirational set likes to
0:15:29 think they’ve discovered a new technology and that they’re innovators and now they’re all doing
0:15:38 ketamine, not all, a lot of them have substituted or traded out alcohol for ketamine, ecstasy/moli,
0:15:46 2C, which I guess is a mix of ketamine and molly, even to the point where they would roam around
0:15:51 these conferences with their own concoction, using eyedroppers and different means of,
0:15:57 I mean, it’s just staggering to me. I went to this thing called Summit at Sea and it was on a
0:16:01 cruise ship and I went up in order to drink and the bartender said, Jesus, someone’s actually
0:16:09 ordering a drink. This is amongst a crew doctor of wealthy young people who would generally be
0:16:15 aligning at the bar and the one I mixed was mushroom chocolates and I imagine there’s
0:16:21 a lot of edibles in there too. I’ve just seen an enormous and if you look at, it’s having such
0:16:27 weird knock-on effects and London 40% of nightclubs have closed since pre-pandemic because kids aren’t
0:16:32 drinking and some of that is they don’t have the money anymore, but they’ve swapped out,
0:16:38 they’re under the impression that it’s healthier or less bad for you and they’d rather do
0:16:44 mushroom chocolates and have one drink or molly and they see alcohol as old technology.
0:16:51 I’m curious if you see, this is just anecdotal evidence or if you see real evidence of this
0:16:56 and what your thoughts are around addiction and what it means for society when we’re no longer
0:17:02 two martini lunches, we’re maybe doing a little bit of ketamine and trying to get on with our day.
0:17:09 What do you see going on here? Yeah, well, I mean, I’m really torn because on one level,
0:17:15 as an addiction psychiatrist, I’m thrilled that people are taking more seriously the harms of
0:17:23 alcohol, which we’ve known for many thousands of years. Of course, again, alcohol in moderation,
0:17:28 the healthiest people being those who drink no more than one to two standard drinks per week
0:17:34 and the threshold being per week. Right, per week. If we’re taking the healthiest people on the
0:17:42 planet… Oh, doctor. I was almost entirely sure you were going to say per day, but okay, maybe.
0:17:48 I know, I know. But let me qualify that. Let me qualify that. Okay. So that’s a J-shaped curve
0:17:53 that shows that people who drink one to two standard drinks per week are the healthiest,
0:17:57 but it’s probably because there are confounds there. Those are people who do a lot of things
0:18:02 in moderation. They eat in moderation. They exercise in moderation. They’re even healthier
0:18:08 than people who don’t drink at all, but that’s not because alcohol itself is good for us. It’s
0:18:12 because in that non-drinking cohort, you get people who are what we call sick quitters who used to
0:18:18 drink heavily and now are on the liver transplant list. But what we do know is that beyond two drinks
0:18:24 per week, and again, these are large epidemiologic catchment studies, one given individual is going
0:18:31 to have their own trajectory, but beyond two drinks a week, you get to a threshold in women
0:18:36 where more than seven drinks per week and men, men more than 14 drinks per week, where you start to
0:18:43 see a significant increase in all cause morbidity and mortality, whether it’s risk of cancer, risk
0:18:51 of accidental death or trauma, risk of pancreatitis, liver disease, dementia, what have you. So that’s
0:18:56 why we generally recommend that men have no more than 14 standard drinks per week and no more than
0:19:01 four on a given occasion when women no more than seven per week and no more than three on a given
0:19:07 occasion. But in general, through most of my career, it’s been an uphill battle trying to convince
0:19:14 people that alcohol is not good for them when consumed in excess, excess being as I just defined
0:19:19 it with the 14 or four. There’s been a huge sea change in the last five years where all of a sudden
0:19:26 people seem much more aware of the dangers of alcohol, much less inclined to consume it recreationally
0:19:32 because they’re concerned with the dangers. This maps perfectly with what we know about perceived
0:19:38 dangers in use. When people perceive that a substance is dangerous, they’re less likely to use it,
0:19:43 less likely to use it in excess, less likely to get addicted. The huge shift along with that,
0:19:50 I think, is twofold. One, what you’ve already identified, the incredible surgeons of designer
0:19:54 drugs in all their various forms, including plant medicines, hallucinogens, psychedelics,
0:20:02 where people really misperceive the dangers, think they’re much safer than they actually are,
0:20:07 and also have become acquainted with having some kind of actualization experience or spiritual
0:20:12 growth experience. So you’ve got the combination of people thinking they’re not dangerous. Why?
0:20:16 Because they’ve been heavily promoted is not dangerous, including the studies that promote
0:20:21 their use, for example, the use of psilocybin as a treatment for depression. Those studies
0:20:27 systematically ignore harms, don’t document harms, and the lay press has picked that up,
0:20:33 that has legs, and now people think, oh, you know, hallucinogens, psychedelics, they’re not addictive,
0:20:38 they’re not harmful, and I might have a spiritual awakening. So that’s what’s happening there.
0:20:43 I think the other piece of it too that can’t be ignored is that we are narcotizing ourselves
0:20:48 with digital media. So where we might go drink and get together with others, which in some sense,
0:20:53 at least it was more social, you know, now, you know, I can speak for myself, I’m like in my
0:20:59 bedroom watching one YouTube video after another, and it feels very pleasant. And yet I know it’s
0:21:11 not good for me. We’ll be right back. Suppose in the future there’s an artificial intelligence.
0:21:16 I’ve been asking some very smart people a question that’s been on a lot of our minds.
0:21:23 Should we be worried about artificial intelligence? But the answers I got from the greatest minds in
0:21:30 AI surprised me. One guy told a parable of an AI that could cause an apocalypse.
0:21:35 Let’s give this super intelligent AI a simple goal. Produce paper clips.
0:21:44 Be a paper clip? Another woman cast AI as an octopus. We posit this octopus to be mischievous
0:21:48 as well. And yet another story sounded like it was out of the Bible.
0:21:54 She seems likely to drown. What should you do? Imagining AI as a savior. Like a god.
0:22:02 And all of these fantastical tales from the greatest minds in AI made me wonder maybe even
0:22:09 these people don’t know what to think. I’m Julia Longoria, Good Robot, a series about AI
0:22:14 coming March 12th on Unexplainable, wherever you get podcasts.
0:22:21 Support for the show comes from Betterment. When investing your money starts to feel like a
0:22:26 second job, Betterment steps in with a little work-life balance. They’re an automated investing
0:22:30 and savings app, which means they do the work. While they build and manage your portfolio,
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0:22:40 you just get to enjoy what matters. They’re automated tools simplify the complex and put
0:22:45 your money to work optimizing day after day and again and again. So go ahead, take your time to
0:22:50 rest and recharge because while your money doesn’t need a work-life balance, you do.
0:22:58 Make your money hustle with Betterment. Get started at Betterment.com. That’s B-E-T-T-E-R-M-E-N-T
0:23:02 .com. Investing involves risk, performance not guaranteed.
0:23:08 Support for PropG comes from LinkedIn. One of the hardest parts about B2B marketing is reaching
0:23:12 the right audience. And sometimes it feels like the only solution is posting everywhere,
0:23:16 paying exorbitant amounts of money just to get one company to notice you.
0:23:20 It’s time for a new strategy, so your ads don’t get lost in the noise.
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0:23:49 only on LinkedIn ads. LinkedIn will even give you a $100 credit on your next campaign so you
0:23:56 can try it yourself. Just go to LinkedIn.com/Scott. That’s LinkedIn.com/Scott. Terms and conditions
0:24:09 apply only on LinkedIn ads. So, and I don’t know if the producer warned you, but basically I use
0:24:14 these podcasts and I guess as a vehicle to talk about me. You know what? Go for it. I love it.
0:24:19 It’s so much more interesting for me because I get to like, you know, see a real human being.
0:24:23 And I have one of the top domain experts in the world, so. On yourself or on something?
0:24:29 I’m teasing you. On addictions. And I’m fascinated with addictions. And I want to talk about a
0:24:33 couple of addictions I think I have and you talk about whether they’re actually clinically
0:24:37 diagnosed addictions and what to do about them. And then I want to talk about the advice I give
0:24:41 to young men and what I’m getting right and wrong because what I realize is I have a series of
0:24:45 principles that I lecture young men about and I don’t know. I think I’m right, but I want to know
0:24:51 what I don’t know. So the first is I believe that everyone has a certain amount of addictions.
0:24:57 That’s not true. Some more than others. But I think almost everybody has some level of something
0:25:02 they do that is probably, if they did less, it would probably be better for them across their
0:25:07 life, whether it’s addictions to shopping, the affirmation, whatever it might be. And I’m addicted
0:25:12 to the affirmation of strangers. I care too much about what other people who I don’t know will
0:25:18 never know think. And sometimes it gets in the way of my relationships with people who I do,
0:25:23 I should care about. Someone will say something mean about me or insult my work on a social media
0:25:29 platform and it inhibits my ability to be close to my loved ones that weekend. I see that as an
0:25:33 addiction, an addiction to the affirmation of others and strangers. And I think that might be
0:25:37 something that plagues quite frankly a lot of successful people or insecure people.
0:25:44 And then I would also argue I have an addiction to money that I’m very blessed and I got kind of
0:25:51 enough money to live well or be economically secure. And I still almost every waking hour
0:25:56 spent a decent amount of that time thinking about how to get more money, even when I should probably
0:26:00 and I talk myself into believing it’s for me and my family, but it’s really just an addiction.
0:26:05 I’ve spent so long trying to dig out of economic insecurity that I’ve become addicted to more
0:26:10 specifically more money. So addiction to the affirmation of others, addiction to money. Are
0:26:14 those clinically diagnosed addictions? And how should I be thinking about them?
0:26:21 Wow, those are really good ones that I don’t get asked about very often. So thank you for your
0:26:27 honest self-disclosure. Let me go back a little bit to your first comment, this idea that everybody
0:26:33 has something that they do more of than they wish they did. I mean, and that’s been true since the
0:26:39 beginning of time. We know going all the way back to what Aristotle called wide-eyed incontinence.
0:26:45 Incontinence is actually something that we, a term we use in medicine to talk about when people
0:26:50 can’t hold their bladder. But this kind of where Aristotle talked about wide-eyed incontinence,
0:26:56 I see the thing that I am doing. I have wide eyes when I’m seeing it. I want to stop doing
0:27:02 as much of it as I’m doing, and yet I am unable to. And so I agree with you that that is true for
0:27:11 all of us in varying degrees. And it’s because of the way we are wired over many, many, many
0:27:17 thousands of years of evolution to reflexively approach pleasure and avoid pain, because that
0:27:22 is what ensured our survival in a world of scarcity and ever-present danger, which is the
0:27:28 world that we lived in for most of human existence. As civilization has progressed, we have managed
0:27:34 to use our big brains to apply technology. It’s not right. Now we’ve drugified everything. We’ve
0:27:41 made it more potently rewarding, more easily accessible, more abundant, more novel. And so now
0:27:46 we’re all struggling with this problem of compulsive overconsumption, which is really
0:27:54 making us unhappy. This idea of the affirmation of strangers, so it’s very clear that we are also
0:28:02 wired over evolution to want to connect with people. Being in a tribe is what ensures that we
0:28:08 will find mates, stewards, scarce resources, protect ourselves against predators. And that
0:28:13 wiring works through our dopamine reward pathway. We know that oxytocin, the love hormone, binds
0:28:18 to dopamine-releasing neurons in the reward circuitry to release dopamine, which is our
0:28:22 pleasure reward neurotransmitter. The more that dopamine is released and the faster that it’s
0:28:31 released, the better it feels. And this is healthy and normal and wonderful until you have drugified
0:28:36 human connection, which is exactly what the internet and social media and digital media has done.
0:28:42 So you’re somebody who is relational. You care about what other people think of you. We all do,
0:28:49 by the way, to varying degrees. But most of us, if not all of us, care what other people think
0:28:56 that’s so deeply ingrained. But now you live in a world where you can have instant affirmation
0:29:04 or its opposite at scale, hundreds to thousands to millions of people, right,
0:29:11 quantified with likes and shares and on and on. And now you really have a very potent drug,
0:29:16 which, when it’s going well, is incredibly reinforcing, much more so than some nice compliment
0:29:22 my husband might give me. Like, that’s not as exciting as my book is number one on Amazon,
0:29:27 right, with a whole bunch of reviews and people telling me that I’m great. And it’s very easy
0:29:34 to get caught up in that. So, yes, I think we can get addicted to the affirmation of strangers. I
0:29:40 think that the internet and social media has become the drugification of social affirmation,
0:29:46 making us all more vulnerable to that problem. And my intervention for that problem would be
0:29:52 the same as for people addicted to drugs and alcohol, which would be to abstain from social
0:29:58 affirmation venues, especially when you’re dealing with them at scale. So, try to avoid
0:30:04 those types of situations where you would be exposed to, like, all of the love. Because,
0:30:10 ultimately, what happens with that huge surge of dopamine is that our brain compensates by
0:30:16 downregulating dopamine transmission, not just to tonic baseline levels, but actually below baseline.
0:30:21 We go into a dopamine deficit state. That is the addicted brain. Now we need more of our drug and
0:30:27 more potent forms, not to get high and feel good, but just to sort of level our balance, go back
0:30:32 to baseline and feel normal. And we’re in a constant state of craving. Plus, we’re experiencing
0:30:36 the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability,
0:30:42 insomnia, dysphoria, and craving. Getting more of our drug temporarily relieves that, but it doesn’t
0:30:48 last very long and actually makes the problem worse. And in terms of money, there’s so much
0:30:54 evidence that monetary gain lights up the same reward pathway as drugs and alcohol. It’s why
0:31:02 we’re seeing a huge, huge increase in online pathological gambling, sports betting has been
0:31:09 made legal in many states and the nation. And with it, like, a 300 to 500% increase in calls to
0:31:15 hotline pathological gambling centers, because people are losing everything in the face of,
0:31:22 you know, their parlays having to do with whether or not the referee is going to touch his hat five
0:31:27 times, you know, during the game. So, yeah, I mean, this is sort of human nature,
0:31:35 like writ large, because we live in an ecosystem that has taken all of these things that are in
0:31:40 some fundamental way, healthy and good for us, and something that our brains need to be doing,
0:31:45 and turned it into a drug. Yes, prior to that, I believe that one of,
0:31:50 I’m constantly saying something as a crisis, I would use the word crisis, but I do think we
0:31:57 have a crisis of loneliness. Do you think you can be addicted to loneliness, or that we just
0:32:02 fill in the dope that we used to get from being social, as you reference, getting that hit with
0:32:10 a low cost, low entry, low risk activity, like YouTube, or what have you, can you get it?
0:32:19 I have to force myself. It takes me almost as much discipline to get out and be around other people.
0:32:27 As it is to drink less. I have become, as I’ve gotten older, addicted to being alone,
0:32:34 and I just find it easier comforting whatever happens, and I know it’s bad for me.
0:32:40 Could you say a certain level of deciding to be alone, maybe more than it’s healthy,
0:32:46 could that be classified as an addiction? Drugs in all their forms are the great human
0:32:55 replacement. Addiction is a disease of loneliness. Even if we have a lot of great people in our
0:33:03 lives, if we get addicted, we will isolate, and we will use our drug to replace that human connection.
0:33:09 I say that because we sometimes talk about loneliness as the cause of addiction,
0:33:16 but more often than not, what I see is that the addiction causes the loneliness. That because we
0:33:24 are able to use this drug, or this device, or this behavior to meet our physical, emotional,
0:33:31 sexual needs, we are no longer seeking out other people. It’s an enormous problem,
0:33:37 because not only are more people in the United States actually physically living alone than ever
0:33:44 before, but more people than ever before are endorsing loneliness. This is a huge problem,
0:33:50 and again, the antidote is to do the thing that’s painful and difficult in the short term,
0:33:56 because in the long term, it will make us feel better, and it will make our lives better.
0:34:04 How have you seen the patients and the research you see come through your office and across your
0:34:10 desk? Which addictions or types of addictions have you seen increase and decrease?
0:34:19 In terms of our patient population, the most common addictions for years have been the usual
0:34:26 suspects, alcohol, nicotine, cannabis, and then starting the early 2000s opioids, prescription
0:34:34 opioids, segueing to heroin and illicit fentanyl. Starting in the early 2000s, we saw the very first
0:34:40 signal of typically middle-aged men coming in with sex pornography and compulsive masturbation
0:34:46 addiction and almost universally endorsing that it was the advent of the internet and then explicitly
0:34:53 the mobile devices, the smartphones that led them from moderate, manageable pornography use to
0:34:59 immoderate, unmanageable addictive use and destroying lives, like losing their families,
0:35:07 their jobs, engaging in illegal activity. Since that time, we’ve just seen an increase in escalation
0:35:13 in people coming, presenting with digital media addictions, video games, social media, online
0:35:19 gambling, online shopping, the internet more broadly a kind of diffuse addiction to the internet.
0:35:26 That’s what we’re really seeing increasing. We’re here in Northern California, so cannabis is huge.
0:35:31 We’re also seeing a lot of, as we talked about, designer drugs, psychedelics, hallucinogens.
0:35:38 Nobody uses, they used to call, let’s say 25, 30 years ago, they had this term white
0:35:44 glove, alcoholics. These were folks who were just addicted to alcohol and not anything else.
0:35:53 We never see that anymore. Everybody’s using a whole bunch of stuff. It’s a real polypharmacy
0:35:59 festival. I coach and work with a lot of young people, specifically I think a lot about young men,
0:36:06 and the addiction I see emerging that I don’t think is getting enough attention, that just
0:36:12 feels like a ticking time bomb to me, is online gambling. The reason I think of it as being so
0:36:20 dangerous is my mother was a docent at the Bellagio in Vegas. She used to come home with
0:36:25 all these facts about gambling addiction, and she told me, and you can confirm or deny this,
0:36:32 that it has the highest suicide rate because you can get in so deep. If I develop an addiction to
0:36:37 meth or alcohol, it generally becomes pretty visible to the people around me, and they intervene
0:36:45 and try to do something. I can get so deep with gambling, and nobody knows. Then I get in so
0:36:51 deep. I’ve spent my kids college fun, mortgage the house. My spouse doesn’t know what I’ve done.
0:36:59 I see no way out, and I decide to end it. I’ve just seen these stats that 50% of college males
0:37:05 bet on the Super Bowl. Occasionally, I’m in a scenario where I’m with a bunch of young men,
0:37:09 and they’re all on their phones, and I think, “Oh, that’s natural people. I know kids are on the
0:37:14 phones.” They’re all gambling on the game they’re watching, and they’re not gambling. They’re not
0:37:22 doing 100 bucks. Liverpool will beat Arsenal. They’re gambling every seven minutes. The ball’s
0:37:29 going to turn over. What you were saying about the ref, and I know these companies and the people
0:37:33 architecting these algorithms, they will figure out who’s going to lose their money and encourage
0:37:38 them to bet more, and the ones who actually know what they’re doing, they will block out of the
0:37:45 platform. It’s a guaranteed loss of income. I like to gamble. I think it’s fun. I go to Vegas.
0:37:51 I gamble, but I assume it’s consumption. I assume I’m going to lose it all. It strikes me that we
0:38:00 might, and tell me if I’m being just hyperbolic or inflammatory, or exaggerating, or just
0:38:07 warring too much here, that we’re going to have hundreds of thousands of young men, and my sense
0:38:11 as young men, and I like to validate and allify this, are much more prone to gambling addiction
0:38:19 than women, who enter the world with massive financial hangovers and shame because of the
0:38:28 constant presence of gambling apps, your thoughts? Yeah. It’s funny that you, I thought for sure you
0:38:36 were going to say online pornography, because I would probably put, in terms of risks to men
0:38:42 living in the world today, I would probably put that above online gambling, but I would make online
0:38:49 gambling a close second. It’s very hard to get actual data on this, but this is sort of based on
0:38:55 my clinical impression of what I’m seeing. Of course, I’m seeing treatment seekers, but
0:39:03 yeah, this is an enormous problem. I always like to start by emphasizing the vast majority of people
0:39:09 who gamble will not get addicted to gambling, and that’s true for any drug, right? Most people
0:39:16 will be able to moderate their use, but as with drugs and alcohol, about 10 to 20% of folks who
0:39:22 consume will develop an addiction. An addiction is a brain disease, a very serious and potentially
0:39:28 life-threatening one, and until you’ve either experienced it yourself or seen it in somebody
0:39:33 you care about deeply, it’s really hard to imagine how people could get to a place where
0:39:40 they would sacrifice everything in pursuit of their drug, but that’s exactly what happens.
0:39:47 What is the vulnerability there? What is the difference? The risks I usually classify into
0:39:52 nature, nurture, and neighborhood. Some people are inherently more vulnerable than others,
0:39:57 but as we’ve talked about, drug of choice matters. If you meet your drug of choice and it’s gambling,
0:40:03 you may never get addicted to alcohol, but gambling may just be the end of you. Co-occurring
0:40:10 psychiatric disorders pays people at risk because of a kind of a self-medication myth and cycle.
0:40:15 We know that trauma contributes to the risk of addiction. That’s the nurture part of it,
0:40:20 but also neighborhood is really key, and this is, again, the ecosystem that we live in. The easier
0:40:26 it is to get your drug of choice, the more of it you’ll use, the more you’ll change your brain,
0:40:29 and the more likely you will be to develop a very serious addiction.
0:40:42 Gambling is everywhere. There’s enough data to verify your impression that it’s more men than
0:40:47 women, although women also struggle with it. The same is true for online pornography. More men
0:40:53 than women develop an addiction to that, although women do develop pornography and sex addictions.
0:41:00 There are some addictions where women are more vulnerable than men like online shopping
0:41:06 and social media, but in terms of the gambling and pornography, definitely men are more vulnerable,
0:41:10 and I absolutely agree with you that this is a huge and largely unseen problem,
0:41:19 complicated, as you say, by the shame issue, where for gambling addiction, there’s still so much about
0:41:28 in our culture about being a man who becomes wealthy and successful as our modern-day hero,
0:41:34 that if you’re somebody who’s not done that or, God forbid, gotten into financial trouble,
0:41:40 very, very hard to come forward and ask for help. Frankly, the same is true with sex and
0:41:48 pornography addiction. We have this prevailing cultural, I believe, false notion that all men
0:41:55 are sexual predators. To come forward, you can only imagine the shame of somebody having to
0:41:59 come forward and say, “I’m addicted to sex or I’m addicted to pornography,” or, “I watch these types
0:42:06 of pornographic images and they’re stimulating for me.” Very shameful, very hard. I’ve had patients
0:42:13 come in and say they had a problem with some drug, which wasn’t even their problem. It was
0:42:19 pornography and it took them four visits to be able to admit it. Huge, huge problem here. Again,
0:42:27 access, ease of access, quantity, all the touch of our fingertips, which just makes it very,
0:42:34 very difficult for us as humans who are reflexively wired to approach pleasure and avoid pain,
0:42:38 to withstand the lure of these incredibly potent drugs.
0:42:43 There are professors and academics such as yourself looking at gaming.
0:42:48 I found it really difficult to find anybody with deep domain expertise or peer-reviewed
0:42:53 research around porn. My assumption is that professors don’t want to be known as Professor
0:42:57 porn, that there’s actually shame in the academic community. You don’t want to be that guy or gal.
0:43:03 It’s like, “Well, why did you decide to do that, Professor?” It’s the second largest category,
0:43:10 I think, on the internet and relative to the size of it, there’s a ridiculous scant amount or dirt
0:43:15 or research around it. I had thought that, or some of the stuff I’ve read is that it’s a small
0:43:21 population consuming a disproportionate amount of porn, that most men, young men, and young women
0:43:29 are able to modulate it. My fear around it has always been that it’s just being very transparent.
0:43:34 One of the reasons I went on campus every day at UCLA was one, because I knew I was supposed to go
0:43:40 to class, but two, the prospect that I might meet someone who, over the medium or long term,
0:43:44 would decide to have sex with me. You sound like my son.
0:43:50 I sound like most sons in their head, and I think I just articulate it.
0:43:57 If I’d had porn available at home, I’m pretty certain I wouldn’t have been on campus
0:44:00 five days a week. I might have gone to four or three or two, because it just might have been…
0:44:07 I mean, the reality is, I wanted sex so badly, and my hormones were raging so much that I was
0:44:12 willing to take social risk and go out and try and meet people. By the way, I think that’s really
0:44:19 healthy to think, “I want to take these risks. I want to meet people in hopes that I can have a
0:44:24 coffee, invite to a party, establish a relationship, and at some point along the way, maybe have
0:44:28 those types of physical encounters.” I think that is really, really healthy,
0:44:34 and I worry that, and curious to get your take, that it’s not the hardcore addicts that are
0:44:41 screwing up America around this stuff. It’s that it just decreases across an enormous population
0:44:49 of young men, their willingness to establish connections with others, that we’re evolving
0:44:57 it. We’re maturing a new species of asexual, asocial males that never get categorized or
0:45:03 clinically diagnosed as addicts, but are just alone their whole lives and never develop these
0:45:09 skills. Is there a low-level form of, I don’t even call it addiction, but avoidance or replacement
0:45:15 theory that could be even more damaging than what we think of as traditionally diagnosed addiction?
0:45:23 Absolutely, and there are data to support this. For all our liberated sexual moors,
0:45:31 young people are having less sex today than ever before. Many young men will report that they
0:45:38 feel like the social landscape out there when it comes to dating and having sex is so uncertain
0:45:45 and such a landmine that they just end up staying home, watching pornography and masturbating,
0:45:50 and for folks who are vulnerable to that as their drug of choice, it can evolve to the point where
0:45:57 they literally cannot stop. Like with any drug, they need more potent forms over time. Pornography
0:46:05 becomes chat rooms, chat rooms become meeting in person, prostitutes, child pornography. I mean,
0:46:15 this is a huge issue right now. By the way, I think your point here about it being so widespread
0:46:22 that we can hardly even call it, it’s like an endemic disease. It’s not even a rare disease.
0:46:31 I have had in the last little bit of, like the last month, two mothers call me who are
0:46:39 in desperation because their sons have been identified as viewers of child pornography.
0:46:47 Now, these are teenage boys who are watching teenage girls and who now are facing potential
0:46:58 felony. I just think that the whole system is not set up for the degree to which this behavior has
0:47:04 become so widespread, so normative. I mean, we can’t be convicting all of these young men of
0:47:13 felonies and I’m not by any means endorsing child pornography or teen pornography. My personal
0:47:22 opinion is that none of it’s good for so many reasons. But the issue is we have a court system
0:47:29 who is now looking to convict an 18-year-old boy for viewing pornography of a 17-year-old girl
0:47:35 and facing like being a lifetime sex man. Our legal system has clearly not caught up
0:47:41 with what is happening. The corporations that make and profit from these media are not remotely
0:47:47 being held responsible for what’s going on. I mean, this is really endemic proportion problems.
0:47:57 I talk about the smartphone as our masturbation machines and I mean that in every sense of the
0:48:04 word, that’s what they are. We’re using the internet and these devices to meet all of these needs
0:48:11 that used to require other people and part of what connects people together is our interdependency,
0:48:17 our mutual need. If we didn’t need other people, we wouldn’t bother to do the work to go interact
0:48:22 with them because it’s a heck of a lot of work and it’s complicated and it’s ambiguous and it’s
0:48:29 painful because of all the ways in which we’re all so complicated. So yeah, this is a huge
0:48:37 problem. We’re creating a generation of mole people as in mole the animals who never go out
0:48:42 and never leave their little hidey holes. Super scary. We’ll be right back.
0:48:53 We’re taking Vox Media podcasts on the road and heading back to Austin for the South by Southwest
0:49:00 Festival March 8th to the 10th. What a thrill. We’ll be doing special live episodes of hit shows
0:49:05 including Pivot. That’s right. That dog’s going to the great state of Texas. Where should we begin?
0:49:12 With Esther Perrell, a Touch More with Sue Bird and Megan Rapinoe, not just football with Cam Hayward
0:49:18 and more presented by Smartsheet. The Vox Media podcast stage at South by Southwest is open to
0:49:23 all South by Southwest badge holders. We hope to see you at the Austin Convention Center soon.
0:49:31 Visit voxmedia.com/sxsw to learn more. That’s voxmedia.com/sxsw.
0:49:42 Support for Prop G comes from 1-800-FLOWERS. Roses are a classic way to say “I love you” and
0:49:45 since Valentine’s Day is coming up, you might want to start thinking about how you’re going to
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0:50:51 podcasts on the road and heading back to Austin for the South by Southwest Festival March 8th
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0:51:03 There you’ll be able to see special live episodes of hit shows including our show Pivot. Where should
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0:51:54 We’re back with more from Dr. Anna Lemke. I want to move to solutions and I’m sure you get calls
0:52:00 from government officials in DC and Sacramento or ask for your advice on the stuff. I think most of
0:52:07 this, if I could think of one thing to try and set a context that would reduce addiction, it would
0:52:12 be third spaces. And that is trying it as many young people as often as possible in the company of
0:52:18 other young people and in the company of potential mentors, friends, and mates. I was in Israel after
0:52:26 October 7th at the Nova Music Festival site or memorial and I met with a battalion of IDF
0:52:34 soldiers and they were these young extraordinary fit 120 kids, 19 to 21 outdoors in the company of
0:52:40 each other. Many of them go on to start businesses together, lifelong friends. A lot of them meet
0:52:46 their spouses outdoors serving in the agency of something bigger than themselves. And I thought,
0:52:50 I just don’t think nearly as many of these young adults are going to end up addicts.
0:52:58 And I thought, how can we do this a million times in different ways, whether it’s
0:53:04 continuing education, softball league, church, nonprofit, like third spaces. If I could do one
0:53:09 thing, it would be third spaces. What is the one thing, your thoughts on that and what is the one
0:53:15 or two things you would want to do to set up a context of success and addiction avoidance?
0:53:22 Because we are creatures innately designed to approach pleasure and avoid pain,
0:53:31 we need to create spaces where we have access to healthy sources of pleasure and a sufficient
0:53:37 challenge to make that interesting enough for us that we creatures who need a certain degree of
0:53:45 friction find it interesting, and also spaces that limit our access to unhealthy sources of
0:53:51 pleasure, unhealthy dopamine, as in the instant pleasures of the various intoxicants we’ve been
0:53:58 talking about. So I love the idea of third spaces, but it sounds a little rarefied,
0:54:04 like it would be for the elite and the wealthy. We have the potential to create those third spaces
0:54:09 in the public school system where kids spend the vast majority of their lived hours.
0:54:10 So after school programs?
0:54:15 Not even after school, during school. How can we do that? Get smartphones out of schools, bell
0:54:25 to bell, create, give hands on, bring back. What happened to, I mean, I didn’t like auto shop,
0:54:34 but at least we had it. Let’s have more art, more hands-on stuff. Let’s have writing classes
0:54:39 where they’re not allowed to use chat DTP and they get real, not to say that we should never
0:54:45 use those tools, but everything’s gone online in the schools. It’s all digitized. We’re learning
0:54:52 everything by watching somebody else do something. Kids need to do, and schools are the place,
0:54:59 the default place to make that happen, which means getting the digital drugs out of their hands during
0:55:06 school time hours. I’m also a huge believer in age verification. We have to recognize that
0:55:13 digital media is a drug for the vulnerable. The vulnerable include a kid with a developing
0:55:17 brain. We cannot have five-year-olds on iPads for eight hours a day.
0:55:20 What do you think that number is? Is it 16? Is it 12? What is it?
0:55:29 I think it’s at minimum, at minimum 13, and even then, I think there has to be a lot more
0:55:35 in terms of guardrails. We really need real age verification, like the real deal,
0:55:39 where you have a third-party site, your register. I know there’s a lot of problems with that in
0:55:47 terms of people’s privacy, but I’m sorry, we make a lot of sacrifices to protect the vulnerable few
0:55:53 as we should do in our society. We already don’t let kids drive cars by firearms, go into
0:55:59 casinos in gamble, buy cigarettes, buy alcohol, buy drugs. Join the military. We age get a lot of
0:56:04 things. We recognize that kids have vulnerable grains, and that their frontal lobe isn’t fully
0:56:09 connected. If we just let them run amok, we would have many fewer kids on the planet,
0:56:14 and we’ve got to protect our kids. That’s what I think.
0:56:16 Do you have kids, doctor? I do.
0:56:22 What advice would you have? I find it difficult sometimes to discern between
0:56:30 normal adolescent behavior, which is abnormal, as far as I can tell, and when I should be worried,
0:56:37 when I should think, okay, he takes his phone into the bathroom to watch TikTok and pretends
0:56:44 he’s in the bathroom for 10, 20 minutes. Okay, is this 14-year-old behavior, or should I be
0:56:54 worried? As someone who’s been a parent, and what pieces of advice, I don’t know how old
0:57:01 your children are, but as it relates to addiction, are there any sort of unlocks or critical success
0:57:08 factors or red flags in your child’s behavior where you can help discern the difference between
0:57:14 what you call not necessarily behavior we shouldn’t correct, get out of the bathroom enough already,
0:57:19 but where you probably think, okay, this is getting serious and might require professional
0:57:26 intervention? Yeah, so there’s no blood test or brain scan and diagnosis addiction. We base
0:57:31 it on phenomenology on what’s called the DSM, the Diagnostic and Statistical Manual of Mental
0:57:36 Disorders, which briefly summarized as the foresees, control, compulsions, cravings, and
0:57:43 consequences, especially continued use despite consequences. The problem is that a lot of kids
0:57:50 use substances, engage in addictive behaviors, and don’t have obvious consequences, so it’s very
0:57:55 hard to tell at that age because they’re young, they’re resilient, and they’re good at hiding it.
0:58:01 So although you won’t find these criteria in the DSM, I think a warning sign to look for,
0:58:06 unless there are obvious signs of unraveling, but if you’ve got a kid who, you know, isn’t
0:58:13 obviously unraveling, but you’re kind of wondering, is look for lying and other anti-social behavior.
0:58:18 Again, you won’t find that in any psychiatric diagnostic manual, but I think those are very
0:58:25 important soft signs of something going wrong with the kid or in the family. Now, all people lie,
0:58:30 the average adult tells one to two lies per day. These tend to be small little lies about, you know,
0:58:36 hiding our own selfishness and foibles, and teenagers definitely lie. But if you get a kind
0:58:42 of a more significant systematic lying about where I’ve been, who I was with, what I was doing,
0:58:51 or even just kind of anti-social behavior, rudeness, hostility, rage, these are the things
0:58:56 that I think, you know, we should look for as potential warning signs for something going wrong
0:59:02 with our kid. Last question, Dr. You’ve been very generous with your time. Very curious to get your
0:59:09 thoughts and take on GLP-1 drugs. GLP-1 drugs are super exciting. I’m really glad they’re here.
0:59:15 They don’t work for everyone all the time because we’re all unique and we have these unique brains.
0:59:21 But the more tools we have to stop the kind of addiction chatter that happens for some people,
0:59:27 the better. As you know, GLP-1 agonists are FDA-approved to treat diabetes and obesity.
0:59:33 They modulate stomach emptying, slow down, you know, the gastric flow and make people feel more
0:59:38 full. But they also work on the brain’s reward pathway. They modulate dopamine release, our
0:59:43 reward neurotransmitter. And there is very active research now looking at their use broadly in
0:59:50 addictions for most alcohol addiction, but also there’s some preliminary evidence for benefit
0:59:55 with nicotine addiction with opioid use disorder, which is really interesting, as well as behavioral
1:00:01 addictions like gambling and sex. We are using them off-label occasionally in our clinic for
1:00:06 treatment refractory alcohol use disorder. This is folks who have tried everything for their
1:00:12 alcohol addiction and we’re getting some good traction in a few of our folks. Other folks
1:00:16 are trying it and don’t find it that helpful. So, you know, nothing is going to be like the
1:00:23 miracle drug. I don’t think GLP-1s will either, but they’re exciting new development and they
1:00:28 can be very effective for food addiction and potentially other addictions as well.
1:00:34 Dr. Anna Lemke is a professor of psychiatry at Stanford University School of Medicine.
1:00:39 She’s also the author of the bestselling book, Dopamine Nation, Finding Balance and the Age
1:00:44 of Indulgence. I really enjoy this conversation and you’re doing such important work and you
1:00:49 have such a nice vibe about you. You just reek of credibility and I can see why you’re
1:00:53 having such an impact because I find myself just hanging on every word because I get the sense
1:00:59 that you are really, I don’t know, a good actor trying to just call balls and strikes. Really
1:01:10 appreciate your good work and enjoy the conversation, Dr.
1:01:25 Osborne of Happiness. I am starting, I had a bit of a gap, but I’m starting to coach young men
1:01:31 again and actually had a kid come up to me last night. This guy is really super impressive in
1:01:38 the ad tech market, making real good money and kind of stalking me and asking me to be his mentor.
1:01:42 And finally I just said, “Dude, you don’t need my help.” And who I’m trying to focus on are quite
1:01:46 frankly young men who are struggling. And I’ve actually taken on a couple men my age who are
1:01:53 trying to reinvent themselves who are struggling, but I’m doing this exercise and it’s yielding
1:02:00 real benefits, especially with young men. And that is, I was just struck by the stat I read that
1:02:09 over half of men ages 18 to 24 have never asked a woman out in person. They’ll swipe right, right?
1:02:14 They’ll email somebody or whatever it might be or though who knows, like go on Craigslist and
1:02:22 get whatever, but there’s very, the majority of men 18 to 24 have not asked a woman out in person.
1:02:32 And that just rattled me and made me so upset and sad. When I think about 18 to 24 for me was
1:02:36 putting myself in an environment where I’d have a greater likelihood of being able to ask a woman
1:02:42 out. And I show me someone who can ask a woman out or handle the rejection or be successful.
1:02:46 I’m going to show you someone who’s good in a bar is good in a, is good in a boardroom. I think
1:02:52 it’s a key skill for young men. And so the exercise I’ve been doing and I talk a lot about this is
1:02:56 one, we’re going to get fit to start making a little bit of money, no matter what it is,
1:03:04 lift driver, task rabid. Three, we’re going to put ourselves in a context in an environment with
1:03:10 strangers regularly in the context of something bigger than you, whether it’s a church group,
1:03:15 softball league, nonprofit, whatever it might be. And, and this is what we’re going to do.
1:03:20 And this is what I’m going to recommend if you’re a young man right now. I need you to approach
1:03:26 a stranger and express interest in friendship or exploring a romantic relationship. And those are
1:03:29 weird words. You would never say that. Hey, are you, you know, what are you doing this weekend?
1:03:34 You want to get together or go to a bar, watch the game? Hi, would you, you know, lay on your
1:03:39 wrap or develop your wrap or lack thereof, would you mention grabbing coffee or grabbing a drink?
1:03:47 What have you? And that’s not the win. That’s not the exercise. The win is I need you to get to know.
1:03:51 And unfortunately, that happens a lot, right? And that is, I want you to go up to someone,
1:03:55 do your best, try, say hi, and shoot, would you like to have coffee? And then call me the next day,
1:03:59 and this is what’s going to happen. Most of the time, the answer will have been a no.
1:04:04 It’s usually applied, no, but it’s usually a no. And that, and then I’m going to say,
1:04:08 how are you? And this is what you’re going to tell me. You’re going to say, well, I’m upset,
1:04:14 I’m bum, but yeah, on the whole, I’m fine. That’s the victory. That’s the payoff. Because here’s
1:04:22 the thing. No is the way to success. Specifically, your willingness to put yourself in a room where
1:04:29 you get no’s. If you’re not getting no’s, it means you’re in the wrong room. And you miss all the
1:04:37 shots you don’t take. The number of no’s, no’s are your path to yes and success. So here’s the
1:04:41 victory. You express an interest in friendship, you express an interest in romantic relationship,
1:04:47 and you get to the no. And that’s the victory. Because you find out, you find out, you’re fine,
1:04:52 they’re fine, and it hurts a little less the next time you get to a no. Whether it’s inquiring about
1:04:57 a job you’re not qualified for, whether it’s expressing interest in lunch with someone who
1:05:02 might be able to mentor you or help you, whether it’s expressing interest in someone that you are
1:05:08 physically and romantically attracted to. The reason I’m staying, I get to live the life I lead,
1:05:12 and I get to partner with someone who is much higher character and much hotter than me,
1:05:19 was no. Specifically, my willingness to get to a shit ton of no’s, and then mourn and move on
1:05:28 and get through them. What is the key to success? No. This episode was produced by Jennifer Sanchez.
1:05:33 Our intern is Dan Chalon. Drew Burroughs is our technical director. Thank you for listening to
1:05:37 the Property Pod from the Vox Media Podcast Network. We will catch you on Saturday for No
1:05:43 Mercuno Mouse, as read by George Hahn. And please follow our Prodigy Markets Pod wherever you get
1:05:56 your pods for new episodes every Monday and Thursday. All right, Sean, you can do this promo
1:06:01 talking about all the great Vox Media podcasts that are going to be on stage live at South
1:06:07 by Southwest this March. You just need a big idea to get people’s attention, to help them,
1:06:12 you know, keep them from hitting the skip button. I don’t know. I’m going to throw it out to the
1:06:18 group chat. Kara, do you have any ideas? In these challenging times, we’re a group of mighty hosts
1:06:23 who have banded together to fight disinformation by speaking truth to power, like the Avengers,
1:06:29 but with more spandex. What do you think, Scott? I’m more of an X-man fan myself. I call me professor.
1:06:35 Could I read minds? I can’t really read minds, but I can empathize with anyone having a mid-life
1:06:41 crisis, which is essentially any tech leader so. Minds are important, Scott, but we’re more than
1:06:48 that. I think that you can’t really separate minds from feelings, and we need to talk about
1:06:54 our emotions and explore the layers of our relationships with our partners, co-workers,
1:06:59 our families, neighbors, and our adjacent communities. I just want to add a touch more.
1:07:04 From sports and culture to tech and politics, Vox Media has an all-star lineup of podcasts
1:07:11 that’s great in your feeds, but even better live. That’s it. All stars. Get your game on, go, play,
1:07:18 come see a bunch of Vox Media all stars, and also me at South by Southwest on the Vox Media podcast
1:07:25 stage presented by Smartsheet and Intuit. March 8th through 10th in Austin, Texas. Go to
1:07:33 voxmedia.com/sxsw. You’ll never know if you don’t go. You’ll never shine if you don’t glow.
Dr. Anna Lembke, Professor of Psychiatry at Stanford University and author of the bestselling book, Dopamine Nation: Finding Balance in the Age of Indulgence, joins Scott to discuss the rise of addiction in the digital age – from drugs to social media – and why our brains are wired to crave more.
Plus, Dr. Lembke shares practical solutions to help build a healthier relationship with pleasure.
Algebra of Happiness: no is the key to success.
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