How to Quit Addiction
https://www.youtube.com/watch?v=XXYNvwrVKdE&loop=0
So let’s talk about dopamine. Most people have heard of dopamine, and we hear all the time now about “dopamine hits.” But actually, there’s no such thing as a dopamine hit. The way your body uses dopamine is to have a baseline level of dopamine—meaning an amount of dopamine that’s circulating in your brain and body all the time. That turns out to be important for how you feel generally, whether or not you’re in a good mood, motivated, etc. You also can experience peaks in dopamine above baseline.
But if you remember nothing else from this episode, please remember this: when you experience something or you crave something really desirable, really exciting, very pleasurable, what happens afterward is your baseline level of dopamine drops. These peaks in dopamine influence how much dopamine will generally be circulating afterward. You might think, “Oh, a big peak in dopamine—after that I’m going to feel even better because I just had this great event.” Not the case. What actually happens is that your baseline level of dopamine drops.
Fortunately, most people do not experience or pursue enormous increases in dopamine leading to these severe drops in baseline. Many people do, however, and that’s what we call addiction: when somebody pursues a drug or an activity that leads to huge increases in dopamine. Now you understand that afterward the baseline of dopamine drops because of depletion of dopamine. The readily releasable pool—the dopamine is literally not around to be released—so people feel pretty lousy. Many people make the mistake of then going and pursuing the dopamine‑evoking, dopamine‑releasing activity or substance again, thinking mistakenly that it’s going to bring up their baseline or give them that peak again. Not only does it not give them a peak, their baseline gets lower and lower because they’re depleting dopamine more and more.
We’ve seen this over and over again: when people get addicted to something, they’re not achieving much pleasure at all. Dopamine is a universal currency in all mammals (but especially in humans) for moving us toward goals. How much dopamine is in our system at any one time, compared to how much dopamine was in our system a few minutes ago, and how much we remember enjoying a particular experience in the past—that dictates your so‑called quality of life and your desire to pursue things. This is really important. Dopamine is a currency, and it’s the way you track pleasure, success, and whether you are doing well or poorly. That is subjective, but if your dopamine is too low, you will not feel motivated. If your dopamine is really high, you will feel motivated. And if your dopamine is somewhere in the middle, how you feel depends on whether you had higher dopamine a few minutes ago or lower dopamine. This is important: your experience of life and your level of motivation and drive depends on how much dopamine you have relative to your recent experience. This is again something that’s just not accounted for in the simple language of “dopamine hits.”
A simple way to envision dopamine hits: every time you do something you like—eat a piece of chocolate, dopamine hit; look at your Instagram, dopamine hit; see someone you like, dopamine hit—all these things described as dopamine hits neglect the fact that if you scroll social media and you see something you really like, sure, there’s an increase in dopamine, but then you get to something else and you go, “Not that interesting.” However, had you arrived at that second thing first, you might think it was really interesting. If you had arrived at that second Instagram post three days later or four days later, you might find it extremely interesting again. How much dopamine you experience from something depends on your baseline level of dopamine when you arrive there and your previous dopamine peaks. That’s super important to understand, and it’s completely neglected by the general language of “dopamine hits.” This is why, when you repeatedly engage in something that you enjoy, your threshold for enjoyment goes up and up. Dopamine is this universal currency; it establishes value based on not just what you’re experiencing in the moment but what you experienced in the days and minutes before.
Now that you understand how your previous level of dopamine relates to your current level, and how your current level will influence your future level, it should become obvious why things like pornography—not just the accessibility of pornography but the intensity of pornography—can negatively shape real‑world romantic and sexual interactions. This is a serious concern. The discussion is happening now. The underlying neurobiological mechanisms you now understand. This isn’t to pass judgment on whether people like or don’t like pornography—that’s an ethical discussion, a moral discussion that has to be decided for each individual by virtue of age, etc. But again, any activity that evokes a lot of dopamine release will make it harder to achieve the same level (and certainly a greater level) of dopamine through a subsequent interaction. So yes, many people are addicted to pornography, and yes, many people who regularly indulge in pornography experience challenges in real‑world romantic interactions. You now understand the mechanism behind what I’m telling you.
You can even see this with video games. People will play a video game; they love it, it’s super exciting to them, and then they’ll keep playing and playing. Either one of two things happens (typically both). First of all, I always say addiction is a progressive narrowing of the things that bring you pleasure. So often what will happen is the person only has excitement and can achieve dopamine release to the same extent doing that behavior, not other behaviors. They start losing interest in school, relationships, fitness, and well‑being, and it depletes their life. Eventually, what typically happens is they will stop getting dopamine release from that activity as well, and then they drop into a pretty serious depression. This can get very severe, and people have committed suicide from these sorts of patterns of activity.
Just very briefly, because it was also covered in the interview episode I did with Anna Lembke about addiction: some of you might be asking what should I do if I experience a drop in my baseline level of dopamine because of engagement with some activity or substance that led to big peaks? To put some color on this, an example: a few episodes ago I talked about a friend I’ve known a long time. This is actually the child of a friend who has basically become addicted to video games. He decided, after seeing that episode with Anna, to do a 30‑day complete fast from phone, video games, and social media of all kinds. He’s now at day 29; he’s really accomplished this. Not incidentally, his levels of concentration and overall mood are up; he’s doing far better. What he did is hard—in particular the first 14 days are really hard—but the way you replenish the releasable pool of dopamine is to not engage in these dopamine‑seeking behaviors. Remember, typically people arrive at a place where they want to stop engaging in these behaviors or ingesting substances when that dopamine is depleted, when they’re not getting the same lift. In his case, he was feeling depressed. He thought he had ADHD; they were starting to treat it as ADHD. Certainly there are people out there who have ADHD, but what he found was that his levels of concentration are back. He does not need to be treated for ADHD, and actually the psychiatrist wondered if he did prior to this video game/social media fast. He’s feeling good, exercising again. I’m not making this up—this is a very specific but very relevant example of how the dopamine system can replenish itself. Of course, if there’s a clinical need for ADHD treatment, by all means pursue that, but I think a lot of ADHD does go misdiagnosed because of this depletion of dopamine that occurs from overindulgence in other activities and the drop in baseline.
So for anyone who’s experienced a real drop in baseline, who has addictive tendencies (whether those involve behaviors or substances), the path forward is always going to be either cold turkey or some sort of tapering to limit interactions with what would otherwise be the dopamine‑evoking behavior or substance.
If I were to put a really simple message around dopamine, it would be: there’s a molecule in your brain and body that, when released, tends to make you look outside yourself, pursue things outside yourself, and crave things outside yourself. The pleasure that arrives from achieving things also involves dopamine but is mainly the consequence of other molecules.