Dopamine and addiction: navigating pleasure, pain, and the path to recovery | Anna Lembke, M.D.

**Peter Attia** (0:11)
Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is Dr. Anna Lembke. Anna is the Chief of the Stanford Addiction Medicine Dual Diagnostics Clinic, the Medical Director of Addiction Medicine and Professor of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine, where her clinical focus is addiction medicine. In 2021, she published her book, Dopamine Nation, Finding the Balance in an Age of Indulgence. On October 1st of this year, she's releasing the official Dopamine Nation workbook, A Practical Guide, which I actually can't wait to indulge in myself. In my conversation with Anna, we begin by laying the foundation for understanding addiction and understanding the biochemistry and neurobiology of dopamine, explaining the various functions of, for example, the prefrontal cortex in all of this. Anna explains the framework she uses to address patients with addiction. We talk through some examples of addiction and how this framework would be put into practice for, say, alcohol and gambling addictions. And we also speak about addictions to cannabis, sex, social media, and exercise. Anna outlines the risk factors for addiction, including inherited and nurture-based risks, and why different individuals are more susceptible to specific and different addictions. We then dive into the rise of addictions in the younger generation, particularly the addiction to pornography in young men, and how to have conversations with your children about these subjects. From there, we discuss healthy coping strategies, the famous Marshmallow Experiment, and how it has been revised. We talk about cross addiction, and also Anna's experience and knowledge around GLP-1 agonists and whether or not they may be a tool for treating addictions. Lastly, we speak about 12-step programs, and Anna's perspective on their benefits and impact, as well as how she personally copes with the intensity of her work. So without further delay, please enjoy my conversation with Anna Lembke.
Anna, thank you so much for making time to sit down with me today. I've been looking forward to this for quite a while, months actually. So thank you for humoring me and talking about subject that I know talk about a lot.

**Anna Lembke** (3:15)
Well, thank you for inviting me. I'm delighted to be here. I actually hadn't realized that you were a fellow Stanford grad, so that was fun to learn.

**Peter Attia** (3:23)
I know. I feel like we were passing each other briefly, right? Because I think you graduated two years before I started, but then you were in your residency while I was in med school. So the probability that we ran into each other in the cafeteria or going through the hall is probably pretty high.

**Anna Lembke** (3:42)
Yes. It's perfectly possible that I scutted you out as a medical student and made you go do things that I didn't want to do.

**Peter Attia** (3:51)
I always tell people, I have the fondest memories of medical school, but there are certain things that I still remember and I can't believe they were the case. One of them is that for a school as fancy and prestigious, do you recall we didn't have a bathroom in the library?

**Anna Lembke** (4:06)
Ah. Do you remember that fact? Yes. It could be I did not spend as much time in the library as I should have. I do remember that we had our anatomy classes in trailers.

**Peter Attia** (4:17)
In trailers. I remember that.

**Anna Lembke** (4:19)
Yes.

**Peter Attia** (4:20)
Well, we ended up studying mostly in the business school library, which was really fancy, had bathrooms and didn't have business students in it because of reasons that are probably obvious. So anyway, great to sit down with you. There's actually a lot I want to talk about with you. Some of it is the substance of what you've written about in Dopamine Nation and I'd love to probably start there, but there's so much other material I'd love to cover with you if our time permits. But obviously, one of the things that anyone who's familiar with you thinks about is this role of dopamine and understanding addiction. This clearly plays into a big part of your clinical practice as a psychiatrist. But I also realize that terms get thrown around quite loosely and sometimes it can just be helpful for people to understand a little bit of what we describe as the semantics. So I'd like to actually start with an understanding maybe of some of the biochemistry and the neurobiology of dopamine and then I want to actually talk about what an addiction really is. But this word dopamine is something everyone has heard of.