March 21, 2023

Overcoming Addiction and Childhood Trauma: Insights from Dr. Anna Lembke

Welcome to the Think Unbroken Podcast, where we are thrilled to have Dr. Anna Lembke, a renowned addiction researcher and scientist, as our guest. Dr. Lembke... See show notes at:

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Welcome to the Think Unbroken Podcast, where we are thrilled to have Dr. Anna Lembke, a renowned addiction researcher and scientist, as our guest. Dr. Lembke is a professor of psychiatry at Stanford University School of Medicine and the Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She has dedicated her life to helping and treating people with addiction and is considered one of the leading experts on addiction on the planet.

In this episode, we dive deep into the subject of addiction and its correlation with childhood trauma. As the host of this show, I share my personal battle with addiction, and we discuss how it impacts our lives and those around us. Dr. Lembke's insights and expertise offer practical advice and strategies for navigating addiction and ultimately taking back control of our lives.

We also talk about her book, Dopamine Nation, and how it can help people who are addicted to different behaviors such as their phones, sex, or even listening to podcasts. If you or someone you know is struggling with addiction, then this episode is a must-listen. Tune in to learn from one of the leading addiction experts on the planet and discover how to break free from the cycle of addiction.

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Michael: Hey! What's up, Unbroken Nation! Hope that you're doing well, wherever you are in the world today. I'm very excited to be back with you with another episode with my guest, Anna Lembke, who is a professor of Psychiatry at Stanford University School of Medicine, and Chief of the Stanford Addiction Medicine, Dual Diagnosis Clinic and I'm very, very excited to have you on this episode, my friend, how are you today?

Dr. Anna: I'm good. Thank you, thanks for having me. I'm excited to be here.

Michael: Yeah, it is my pleasure. So I want to start off and first and foremost, just kind of create a little bit of context about my story, and that way, you can have a little bit better understanding about who I am. And I know The Unbroken Nation of heard this a million times, but you haven't, and you will see why with the first question I think this is very necessary.

So uncommon very traumatic background, mother was a drug addict and alcoholic, she actually cut off my right index finger when I was 4 years old. My stepfather super addictive personality, incredibly abusive borderline alcoholic, probably many other things, spent the majority of my childhood homeless and in poverty. And by the time that I was 12 years old, I got high for the first time drunk at 13 and expelled from school for drugs insert everything else that you imagine that comes along with that in the place where I want to start here with you today, obviously is your area of expertise but most importantly, something very specific is why do you believe that trauma can often be get addiction?

Dr. Anna: Great question. Addiction is many things but one of the things that is a maladaptive way of coping. So the more we have to cope with in our lives the more trauma we have the more likely we might be to turn to substances or addictive behaviors as a way to manage the pain of that experience. Addiction is also potentially and a maladaptive way of creating or replacing the need for human attachment, that is to say that when we are not healthily and appropriately attached to the people around us we might then look to substances or behaviors to fill that vacuum. And in many ways, you know, intoxicants can do that, they can create that; loved for, cared for, warm feeling that we are not getting from the people around us at least for a while. The problem with intoxicants is that they eventually stop working and then they turn on us and then they create more problems than they solved but certainly in the short term I've had many patients describe, their relationship with addictive substances and behaviors as a love affair in essence. So those are two reasons that come to mind.

The other thought that sort of comes to mind is the Animal experiments which are really fascinating and, of course, we're not animals in the sense that we're not rats and mice the organisms on whom, much of these experiments have been performed but we have a lot of the same neural circuits and in fact, our reward pathway is conserved for millions of years and across species it hasn't. You know, my reward pathway is no different from a rat's, reward pathway and what we see interestingly in animals who have become addicted to, for example, cocaine let's say they've learned that if they press this lever, they're going to get a shot of cocaine intravenously essentially animals will continue to press that lever to the point of exhaustion or until they literally die. But if then the cocaine is taken away, the animal will eventually stop pressing the lever for cocaine neuroscientists call that extinguishing the behavior they'll eventually stop pressing because they know no cocaine is forthcoming but if you then administer a violent foot shock, to that animal the first thing, the animal will do is rush to the lever and start pressing it again. So that powerfully communicates that we reflexively will turn to chemicals and behaviors that release, dopamine, serotonin norepinephrine and other feel-good hormones, that our body actually makes as a way to compensate for injury.

Michael: What came to my mind immediately when you said that is thinking about the autonomic responses that we have to stimulus that may be for, you know, survival or for love or for filling of companionship. So when the mouse has his foot shocked again, is that then an autonomic response based on survival mechanisms?

Dr. Anna: So when you say autonomic response, I know I don't know exactly what you mean by that. If you mean the autonomic nervous system like you guys are parasympathetic and sympathetic. I think another way of talking about that is to say it's a reflexive response it's not something that we choose or will, it's outside even of conscious awareness and it's reflexive in our body just automatically does it. And in that sense, yes, I think that's right.

Michael: And with that, one of the things I'm very curious if so, when I was very young, and I wouldn't miss this, not only in myself, my community family, friends even up to today, it always felt like a lot of the things we move towards in terms of addiction, whether it was drugs, alcohol, sex, porn, whatever that thing was felt like it was self-soothing. You know, for me being 12 years old, getting high for the first time and that being at the Crux of Developmental years looking at this thing where it was like there is safety in this. So every time there was pain or a stimulus that would kind of force me into this position of suffering, for lack of a better term growing up, especially in a very volatile environment. I turned to drugs and marijuana and popping pills and these really aggressively addictive behaviors and it wasn't until more or less those behaviors to your point earlier, what would happen is, I would get high and then I would have the most insane like panic attack that you can imagine, right? It would feel like everything was closing down around me like – my body was forcing and rejecting that out of me so I could be present in the pain. Do you see that holds true in your research that eventually it comes to pass that maybe for some of us that thing that once brought us pleasure then in turn brings us pain?

Dr. Anna: Oh, absolutely. I mean, that's the great Paradox of addiction that we start out using for fun, or to solve a problem in your case it was to solve the problem of the pain of your traumatic environment, but eventually the substance itself becomes the problem and it becomes a problem in a number of different ways first of all, it stops working over time, our brain adapts and it just doesn't do the job anymore. The other thing is that it can actively turn on us and start to do the opposite of what we intended. So people who use cannabis at night to help them sleep after a while, cannabis can actually cause the insomnia and there are many many different examples of that. In some people, very short period of use will lead to these kinds of paradoxical or counter effects. For other people it may take decades before they get there but I have yet to meet a person who was a regular heavy user of an addictive substance or behavior who didn't eventually get to the place where it stopped working or it turned on them and cause the opposite phenomenon. I want to add one thing and key on a word you said about how drugs became kind of your safe place and one of the things that so appealing about drug, which I think it's important to openly recognize and acknowledge, is that, at least at the beginning, they provide a way that we can control how we feel. So, instead of having to be at the mercy of other people, or things that happen in our lives, here's a thing we can do, or we can take, which immediately improves our own subjective experience in the world and that is a very powerful draw.

Michael: That's a very much how I felt about it, too. I mean, I think you're spot on the sneaking out and I think also the creativity and finding ways to getting high was also a part of the rush in the filling of it and I know that you talked about this in your book, this idea of the man with the electro-stimulation and looking at that and going at what point is there kind of like this crossover where maybe I'm not using this, right but this is the way I interpreted it as my experience. There was almost more of an addiction in the process of getting to getting high then actually getting high and do you think that holds true?

Dr. Anna: Oh for sure. I mean my colleague, Rob Milenka, who's a world renowned neuroscientist says that the way that they measure addiction in laboratory animals is very simply how hard is that organism willing to work to get their drug. So it's not how much of the drug do they take or how high they seem afterwards but just simply how hard is the organism willing to work? And that really does ultimately distinguish people who are addicted in those who are not. If you take two people, you expose them to the same drug, they both have a similar intoxicating, positive feeling, they both want to do it again, but the person without that, you know, vulnerability to addiction will eventually it's not worth it, it's too exhausting. A person with a twill addiction with the addiction you know what? This is so worth it like – I'm willing to put it all in order to get to that place. I mean those are sort of innate vulnerabilities and yes, the problem-solving piece of how to get the drug itself actually becomes part of the reward, it's like the creativity that goes into, how am I going to get this thing? How am I going to get the money to get this thing? How I going to hide that I used this thing that gets to be all part of the appeal in the Mystique.

Michael: I think about this a lot when I look at my 20s, my early 20s, especially I put myself and many people that I knew and very high risk situations, very dangerous situations too kind of satiate that need of desire. Part of it was and now, I look back in hindsight and I recognize and understand through making meaning and ultimately doing a lot of work around this, that it was this thrill that I was chasing to basically reinvent the chaos of my childhood experiences because that's where I felt comfort. But I noticed that for lack of a better term, hitting what I would call rock bottom moment, I can almost certainly guarantee you I would not be here having this conversation with you. One of the things that I'm really curious about is how can we mitigate the risk of chasing that dragon for lack of a better expression in this moment and putting ourselves in these dire circumstances but instead prior to hitting rock bottom, mitigate that risk by having a better understanding of ourselves or the environment or why we do that. You know, big part of why I created this show was to give people tools that I've discovered through the fucking hard way, just to be frank with you and so what I'm curious about Anna's, is there a way in real time to make notice and pay attention to your behaviors that are setting you up for failure?

Dr. Anna: Yeah. Great question. It is very difficult when we are chasing dopamine, which is another way of saying in our addiction vortex to see true cause and effect. And what I mean by that is that we will 99 times out of 100 minimize the adverse effects of our drug and glorify the deposit of effects. So that in order to really be able to see the ways in which we're being harmed by our drug use, before were seriously harmed by the drug use, which it sounds, like is what you're asking, is, I believe to take a period of 30 days away from that drug and, of course, that's easier said, than done and some cases you would want to do that under medical supervision. But by putting the pause button on drug consumption long enough for the brain to readapt to the absence of the drug and to make neural connections, with our prefrontal cortex, which is our gray matter right behind our foreheads that allows us to see true cause, and effect, and consider future consequences, we really need a time away from the drug itself. So I know you're probably thinking to yourself well, this isn't exactly like the million-dollar inside I was hoping for because it's really a very on, its face, obvious behavioral intervention without being an intellectual or emotional insight, but I'm going to still argue that it's an essential first step because if we think that there's some kind of, you know, aha moment or great insight about why we use that we're going to come to while we're still using, it's probably not going to happen. The truth of the matter is that again, when were in our addiction, we cannot see clearly we are not engaging our frontal lobes and its really awesome often only with serious consequences that people are then forced to stop and then when they're forced to stop, they can get the perspective to have that aha moment. So, instead of waiting till the serious and potentially life-threatening consequence, the thing to do is to do an experiment and challenge yourself to not use your drug of choice for one month, why? Because my clinical experience in the data support it takes a minimum of 1 month, 2 rest the word pathways and when my patients do that, I no longer have to convince them that stopping or decreasing their drug use is a good idea, they become convinced themselves because then they can see with more clarity the true impact of their drug use on their lives.

Michael: Would that hold true to other addictions to cell phones, video games, porn, work, like listening to podcast, I don't know, but doesn't apply listening to this.

Dr. Anna: Listening to the podcast is okay. Absolutely. It applies to all of those ways large and small that we reward ourselves, which is a lot, you know, the way that we kind of bookend or organize a day in modern life is essentially a series of rewards. So it's very disorienting not to have our little bookended rewards but that's exactly what I'm talking about. Choose that one thing that, you know, we feel we really have an out-of-control relationship with and cut it out for 30 days and it has to be at least 30 days for most things because again, that's the minimum amount of time it takes to reset reward pathways look back and see with clarity on the true impact, on our lives of our substance use.

Michael: One of the things I'm curious about in that, you know, you look at these time built parameters around things like this and I think you can measure this against building habits as well. People get caught up in that in time and kind of lose sight on, like, right now this moment today. And what I'm wondering is, why is it that the data supports the minimum viable efficacy of that timeframe being 30 days?

Dr. Anna: Well, let me just say that there isn't a whole lot of data and it's certainly not for all substances and behaviors, and people's brains are and for different types of drugs or behaviors in different brains it might be less than that. In other people it certainly more than that, but I can tell you in my clinical experience, 30 days is sort of like the point at which people get to where they are relieved of the constant intense cravings and intrusive thoughts of using, and that's really the torture. So the universal symptoms of withdrawal from any addictive substance or anxiety, irritability, insomnia, depression and intrusive thoughts of wanting to use and as long as we have all of that, which is really, really bad in there first two weeks after stopping, we're essentially using up all our reserve energy and creativity just to withstand not using again and it's really only in weeks three and four where people begin to feel relief, where they begin to be able to enjoy other things in their lives. Addiction is characterized by this narrowing of focus, just on that one, rewarding activity and other things become less rewarding. So as we restore homeostasis or baseline reward firing we move away from that narrowed focus on our drug of choice, our lens opens, we're able to enjoy other things, we're not plagued by the constant thoughts of wanting to use. Again, we are freer right? We are no longer in this reflexive addictive vortex, we've now re-engaged our frontal lobe, and we can choose. And the ability to choose is, I mean, I think fundamental to the ability and to be being human.

Michael: And in that what exactly is happening in that week, three to four in the brains, neurochemistry, that's allowing you to have. I want to call it clarity because I felt like that's what I had when I went through, going through sobriety for the first time in my life. I'm like – wow, holy crap! I can like make cognitive thoughts. So what is happening in that week three or window, that's creating this efficacy?

Dr. Anna: Okay, so to understand that, it's important to understand how our brain processes pleasure and pain and also what happens in the brain as we become addicted. So one of the most important findings in Neuroscience in the last hundred years or so, is that pleasure and pain are co-located; the same parts of the brain that process pleasure also process pain and they work like opposite sides of a balance. So imagine that in your brain called the reward pathway, there's a board on a fulcrum like – a teeter-totter and a kid’s playground. When we do something pleasurable at tips one way, when we do something painful, it tips the other and the overarching rule governing this balance is that it wants to be level, it doesn't want to be deviated very long to the side of pleasure or pain. In fact, that deviation from neutrality is the definition of stress, any deviation from our level physiology is biological stress. So when we have a deviation brands are going to work very hard to restore a level balance or what neuroscientists call homeostasis. So let's take example, in my life, if I read a romance novel, I got addicted to romance novels that will release dopamine in my brains reward pathway and I will experience pleasure and that balance will tip to the side of pleasure but no sooner has that happened than my brain will want to restore a level balance. Now, here's the key, the way that my brain restores a level balance is by tipping first and equal and opposite amount to the side of pain before going level again. My brain releases dopamine that pleasure neurotransmitter and what happens is these neural adaptations Gremlins hop on the pain side of my balance to bring it level again, but they like it on the balance so they stay on an equal and opposite arm out to the side of pain, that's my brain down regulating to acclimate transmission not just a baseline levels below baseline levels; that's the moment of me wanting to read another romance novels soon as I finish the first one. If I wait long enough, those Gremlins hop off and homeostasis is restored, but if I don't wait, if I continue to consume romance novels over time weeks to months to years basically, I start to accumulate more and more Gremlins on the pain side of the balance because my brain remembers, that means that initial deviation to pleasure gets shorter and weaker, but that after response, get stronger and longer and that's what's happening in the addicted brain that eventually we get developed tolerance, that drug stops working, we need more and more to get the same effect. Now, we've got enough, gremlins, camped out on the pain side of the balance to fill this whole room which means that we reset our pleasure pain, set point. Now, we need our drug not to get high and feel good but just to love them balance and feel normal and when we're not using we're walking around with a balanced tilted to the side of pain experience in the Universal symptoms of withdrawal, anxiety, irritability, insomnia, dysphoria that means that like simple pleasures no longer do it, right? Because I've got a balanced it to the side of pain and now I'm narrowly focused and craving on my drug of choice, just to feel normal. And that's also why people with addiction will relapse even months after they've stopped because, for many people, it can take not just 30 days but many months for those Gremlins to hop off and for homeostasis to be restored. So why the 30-day absence period because for most people 30 days is enough time for those Gremlins to hop off and for homeostasis or a level balance to be restored. And that's what the key because we need to have a level balance in order to be able to enjoy other more modest rewards and in order to have the resilience to respond to our environment, both with pleasure and pain and then restore things again to that level position.

Michael: I think with the access to literally anything that we want at all times now unlike any time in human history, and please if I'm wrong tell me but would it be fair to say that people are more addicted now just across the spectrum than ever before?

Dr. Anna: Oh, absolutely. I mean, that's very clear. We now have not just more potent forms of traditional drugs, but more access to those highly potent drugs. We have drugs that didn't exist before like video games and social media. I mean essentially if you think about the the four characteristics of what makes for things to be more addictive, it's quantity, access, potency, and novelty. We have almost infinite access, our smartphones are like the hypodermic syringe, delivering digital dopamine 24/7. We have analyst quantities, TikTok never runs out, we have more potency, that Nell is the perfect opioid example, this incredibly potent, credibly lethal opioid, but we also have more potent, digital products, right?

We combine games with music, with lights, with beautiful faces, everybody knows that when you take two independent drugs and you combine them together, you get a more potent form of that original drug, and we have greater variety. So we have all kinds of things that have become drug even if I'd even healthy things previously, healthy things have now become drug if I'd food human attachment such that now we're all more likely to encounter our drug of choice and the data will show that addiction diagnosable addiction is going up in all age categories, including in demographics that were previously thought to be relatively immune, like alcohol use disorder is increased 80% in women and 50 percent of people over age 65. We've got more and more people struggling with alcohol misuse and sort of minor compulsions and addictions people who smoke, cannabis, 30 years ago used to be primarily weekend users of week pot, now people who use cannabis many of them are using every day all day dabbing and using other highly potent forms. And whatever drug you look at, it's the similar process we have more access or quantity, more potency, more novelty, and more addiction.

Michael: And in that, what I'm curious about, is there a correlation? And you may not know and honestly, I haven't really dived into it enough to be able to make a foundational statement but I have a hypothesis based on my own experience and I want to see if you believe this to be possibly accurate and that is in growing up in homes, without love, companionship, empathy, compassion, all the things that I think you need to regulate into unregulated needed world and society, we find that regulation and the need for those hits of dopamine and again, I don't know the something to be cautious how I use these words here. I find it more of a demand for people who come from traumatic backgrounds using myself, as you know, part of this hypothesis that I need to go deeper harder, faster, stronger more deeply into the hole to regulate than maybe someone who might have grown up in, what you would call a normative household. Does that hold true?

Dr. Anna: Oh, absolutely. I mean the data are very robust that if you have experienced significant childhood trauma, you are at higher risk for addiction. And I really like the way you phrase that because, you know, we all need to engage in emotion regulation, it's part of fundamental survival and certainly part of a sense of well-being. One of the very first ways that we learn how to do emotion, self-regulation is to rely on the people around us, our caregivers in those early years to we observe how they manage their own emotions self-regulation, we mimic them, our interactions with them, those can also be tools to help us learn to regulate ourselves in moments of distress and if that's an unhealthy attachment or worse yet and abusive kind of attachment, then we're deprived of all of those extenders for emotion regulation and really left, you know, sort of desperation. I mean, fortunately, it sounds like you are living proof that we can make up for this later in life that we can even do after we've entered, adulthood relearn new ways to regulate ourselves that are healthy and adaptive and not kind of a repetition of the early childhood environment, which is great.

Michael: So I will say this for context and I want to be very clear about it. That did not come without (a) tremendous amount of suffering like an unbelievable amount of suffering, like – hitting rock bottom, because when I was in my early mid 20s, I'll paint you a picture here because I would love to go a little bit deeper in here to help me context for listeners. I was 350 pounds, smoking two packs a day, drinking myself to sleep, getting high from the moment I woke up till the moment I went to bed, cheating on my partners and chasing money like, it was my fucking job. So, what I think about is I have this catastrophic like cataclysm of all these experiences happening simultaneously that put me in this position were suddenly at 26, my life imploded on itself when I had a suicide attempt. And the next day I was laying in bed, it was 11:00 in the morning, keep in mind, at this point I'm 350 pounds, I'm smoking a joint, eating chocolate cake and watching the CrossFit, right? What if that's not rock bottom, I don't know what it is and this really fascinating thing happen where I walked into the bathroom, I looked at myself in the mirror and I had this distinct memory of being 8 years old, and the water company had come and turned our water off, this was super common, they turn off our water, our electricity, we were getting an evicted all the time. I lived with like 30 different families in the course of three and a half years and I take this little blue bucket from my backyard, I walk across the street to the neighbor's house, I turn on their spicket and for the first time in my life, I stole water. And I remember in that moment I was like, all right, when I'm a grown-up this won't be my life. Now, wasn't from a financial aspect because I did very well in my career, but in every other way, I was still like that hurt, lost little boy. And so, in this moment, looking in the mirror having this realization, I ask myself an incredibly important question that became the catalyst in the proxy for everything that I am now almost 12 years later. I said, what are you willing to do to have the life that you want to have? And in that moment the response was no excuses, just results. And basically, what that meant in that moment was, I'm tired of my own bullshit where I'm at today as my fault, I'm not taking culpability for the past because that is not on me but every time I eat a cheeseburger, every time I go to a fucking McDonald's, they're gonna sue me one day, every time I go to a burger place like I don't work out, I get that joint, I have sex with that stranger from the internet, I am doing this. And the reason I'm professing this is because I want to lead to this question because even I don't understand it, I've talked with amazing mindset people around the world from Tom Bilyeu, a day of Hollis to you name them and the thing that I've come to is I have no idea why in that moment, everything changed. And so, I’m really curious if you have any insight to that because there are people who listen to where they go, I had my rock bottom moment and then change occurred.

Dr. Anna: Yeah, so fascinating. Wow, I love it. And I love those pivotal moment stories, I think those are such powerful moments in our lives and they stay with us, right? They provide a frame of reference that transforms our whole lives and it's just that single moment of course, we're building up to that moment. But when the moment comes, you can feel sort of the stars, you know, in the orbit realign and it's absolutely a fundamental life-changing moment. So, a couple things that I believe that might help understand what happened to you in that moment. First of all, I do believe that it is our ability to choose when we are given the option of the right path and the wrong path, that makes us; I'm going to go out on a limb here and I'm going to say that makes us in the image of God and I really mean God very, very loosely to be like the mystery of the universe, but there is something in that moment when we choose what, we know to be the right and good thing that really elevates us and we transcend, all of our frailty and brokenness and everything that really is such like the human condition. I think those are the most important moments of our lives and they can come in and Big Bangs like yours, but they also manifest every day and every moment of choice or we can choose to do the right thing, or we can choose to do the wrong thing. And when we just slow down enough to know what the right thing is and choose, the right thing, we are transcended, biochemically or neurologically what's happening there I mean, I have my theories, some science and I'm actually researching this now, but I think that what happens also, there is that we transcend those reflexive lower brain functions, like choosing between pleasure and pain, and all of that. And we essentially are rewriting, our story and the prefrontal cortex is the storytelling part of our brain. And the narratives that we tell about our lives are really, really important, they're not just important to organizing past experience, their fundamental to determining our future because they become essentially road maps made with the tools of language.

And when we're telling the right kind of story about our lives, we are going to have a much better life and if there's one thing that I've learned from working with my patients in recovery from very severe addictions, is that if they're telling a story in which they are always the victim of circumstance, they will always be the victim of circumstance but if they tell a story in which they do the really hard thing in life, which is to own their piece of it, what they contributed that's so fundamental to telling truer stories and also stories that allow them to make real important positive changes. So I don't know if that if that helps at all, but that's how I think about it.

Michael: Yeah, I mean, that feels copacetic to me because I have this thought that if it's true which I believe it all is that we are the stories that we tell ourselves and I recognized I was very rational about this that I was being so mean to myself that if I said the things I was saying to myself to someone else, they would punch me in the face and I started to adapt standing of wait a second and this is one of the same thing I teach my clients. If I know that what I think becomes what I speak, what I speak become my actions, my actions become my reality then if I could convince myself that I was, the kind of person who was kind to myself, then I would, perhaps act as a kind person would thus challenging the narrative that they had of who they were in the world and the validity that they had in, creating their life and in turn on a long enough time line, that would make me be who I am today and I have found that has held incredibly true, but it started with me lying to myself. And so what I want to ask you here is you have this fascinating and beautiful under like idea about radical honesty, but for me in order to get to this place of radical honesty with myself, I had to actually begin by lying to myself and telling myself that I did love myself that I did give a damn about myself and that I was kind of to myself and on a long enough time line I convinced myself that that was true and that has led me to where I am. Is there a parley in what you consider radical honesty and what I consider like lying to yourself to me?

Dr. Anna: Yes, first of all, there's that brings to mind a very common phrase in the recovery world; fake it till you make it, which is really true about early recovery and in early recovery, you know, when you decided to give up all of the kind of addictive substances and behaviors that you were using to self-soothe and change your life, you had to fake it till you made it. But I don't think I would call that lying because I think that really what you were doing was you were accessing your truer narrative or your truest self, you didn't feel it yet but it is true and you just had to get there. So, you know, you had to fake it until you felt it, but you can think something that's true, even when you're not feeling it and in fact, this is really what I tell my patients all the time when they first give up substances and behaviors, try to get into recovery I said, you know, you have to do things now that are opposite to what your brain is telling you to do, absolutely opposite because we cannot rely on your brain right now because your brain isn't trustworthy right now because your brain is, you know, it caught in this addictive loop.

So when your brain tells you all these rationalizations for why, it's okay to go use even though you don't want to and you committed to not using your brains a liar and you just need to know that your brain is lying to you but you know what, the truth is and the truth is that you need to stay the course, so that's how I look at it. I think you don't think you were lying to yourself, I think you were talking back to your addicted brain.

Michael: Interesting concept to me. I haven't thought about it from that aspect and it really very much in real time it felt like – even at 12 years old like I would sell drugs out, break into people's houses, steal their cars, like whatever it was survival, no, this isn't right but I feel I have to write and then it'd be nice I literally flip that narrative, this is right and I have to write in that became this thing of how I started to operate in the world. And I know that there are people listening right now and they will tell me as an anomaly I promise you, I am not and one of the things I'm really curious about, have you found anything that feels to be consistent over people have made radical changes in their life?

Dr. Anna: Yeah, I mean, yes, I do think so. I think it begins with that moment of crisis, you know, which can be sort of a sudden crisis or it can be the slow accumulation over many years of crisis, followed by kind of a period of defense or denial where they don't want to look at all of the signs pointing to you need to change your life like you think is something really significant has to change followed by intense despair, what they know they should be doing is at odds with what they are doing. And then finally, that moment of surrender, which can take many different forms, but it's the moment where people say, I have to walk a new path.

Michael: Is there is there a biological response that is happening in the brain in those moments; here's what I was saying about like there's this chasm, right? There's where you are today and on the other side of that, chasm, that's that belief that you have that you could be the person that you're capable of being. But there is all of this conscientious unconscious and subconscious reinforcement from your parents, your teachers, your family, your neighborhood, the television, you're not good enough, you're not strong enough, you're not capable enough, whatever that thing is that often makes us feel tied to this identity that we have that we're not and so we stand her at this precipice looking out what could be and yet we don't either jump over it or leap or take the risk or do the thing. Is there actually a biological response that is keeping us stuck?

Dr. Anna: I describe what happens in the addicted brain and when we get in that Loop and then we reset our pain thresholds, pleasure pain threshold so that were actually more vulnerable to pain and less able to experience pleasure. So I do think that's one important piece of it, which is why it's really impossible to move forward while we're still in the addictive Loop. And I didn't use to target and treat Addiction in my practice, I was targeting mood and I was targeting anxiety, sleep and totally ignoring addiction and my patients did not get better. It was really only when you know, I recognize the power of addiction and how it was impacting, mood, anxiety, creativity self-love all those things. So that really needs to get taken care of and then we can begin to work on, all right, how can I cross this chasm? How can I get to that place, so that so that I can live my best life and fulfill my goals?

And I think people achieve that in different ways but again, I will say that those autobiographical narratives that we tell are really important, again language is a tool, story is the map and so the stories that we tell they are the guide for getting us there. So it's really, really important what stories were telling us that there are stories that are adaptive and get us there are stories that hold us back. And then I guess I also think that spiritual pathways are really important, I think that is also a way for people to maintain a sense of feeling held and a trust in the universe and where they're going even when people may disappoint.

Michael: When I think about the idea of spirituality, I often tie that to something bigger than me. God, Spirit, Universe, even an idea, one of my missions and my primary objective in life is to end generational trauma in my lifetime, through education, information and media through giving children, and adults a growth mindset and empowering with the ability to be the hero of their own story. I recognize and understand that doing that in my lifetime is not only impractical probable, but likely impossible, but that doesn't mean I'm going to stop and it wasn't until I held onto that as a spiritual belief of what I could grasp onto through the universe, God, whatever that massive change happened in my life. 

Dr. Anna: Oh, I just said that's wonderful.

Michael: When you're talking about this idea of spirituality, can it be as simple as a grandiose and far-fetched idea?

Dr. Anna: Absolutely, right? It's a kind of a hope and a faith. In an idea essentially, this idea that that number one, we matter and number two, the things that we do can matter not just to ourselves but to other people that we can participate in the good of the world through our actions and that we can do that every day of our lives that there are everyday provides us opportunities to choose and to participate in the good flows through the universe and that's at the heart of that spiritual process; however, you define that.

Michael: What would you say for those who will hear this, they'll make it to right now, Anna, they're in this conversation like, yeah, I'm thinking about this, I'm contemplating them, I take action and then I relapse and then I go, well, maybe I actually don't matter because I did this thing again. What did you say to them?

Dr. Anna: Well, what I would say is that any period of sobriety that you get it's always in your back pocket, that's never taken away from you and you can always go back to that as a touchstone that you did it before and you can do it again, it's a never give up hope. It's just a matter of that we keep going that's the essence, right? Just foot in front of the other keep trying, we're all broken. I mean, I think it's so easy to look around and think that, you know, we're the only ones or we have a target on our back or we'll never make it or were so much worse in however many different ways, but everybody struggles and everybody suffers. And if you see your suffering sort of join together with other people's suffering I think it's easier to bear and we just have to keep the faith and even people who have terrible addiction, can in a single moment, even when they're actively using, you know, do something good, it gives something good to the world when we none of us know, what's next, right? Or engaging in this constant flow and change and yet we preserve at any given moment the ability to choose to do the right thing.

Michael: I love that you said that, and I often go to an understanding that as profoundly impacted my life forever. And that is that, we are all having a human experience and none of us know what the hell were doing.

Dr. Anna: Yeah, and the other thing that helps me a lot is, it's again a mantra from the recovery world, which is one day at a time, but I take a lot of solace in that because when I do too much forward projecting and I can't testifies, and then I feel also the burden of the weight of responsibility, I can feel overwhelmed but if I just say, you know what, I don't know what's going to happen today, but I'm going to do my best to be present for today and do good and make good choices, be honest and show up, just today that's really all I have to do is today, and if I get enough of those good days, strung together, that'll be a good week and enough good week so I guess that's going to be a good month and before you know it you're looking at a pretty good decade.

Michael: Yeah, and that's literally word for word, one of the things that I've thought about that as helped catapult my life to where it is today and hope you will wear it will be tomorrow. My friend, this been amazing conversation before I ask you my last question, can you tell everyone where they can find you?

Dr. Anna: Well, I'm not that findable to be honest. You know, my book is a place you can learn about my work and hopefully get some some good ideas for living in this crazy mixed-up world that we live in now and that's dopamine nation and there's a website for the book and that's sort of it.

Michael: Awesome. And of course, we will put the links in the notes for the listeners. Anna, my friend my last question for you is, what does it mean to you to be unbroken?

Dr. Anna: Okay, so echoing, some themes that we've already talked about. To me to be unbroken, it is really just to know that I have the ability to choose between right and wrong and that wherever I find myself, I will have opportunities to, in a single moment in time, choose; and I can choose the right thing.

Michael: Beautifully said, my friend, thank you so much for being here.

Unbroken Nation, thank you so much for listening.

Please like, subscribe, comment, share.

Tell a friend.

And Until Next Time.

My friends, Be Unbroken.

-I'll see you.

Anna LembkeProfile Photo

Anna Lembke


Anna Lembke is professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. A clinician scholar, she has published more than a hundred peer-reviewed papers, book chapters, and commentaries. She sits on the board of several state and national addiction-focused organizations, has testified before various committees in the United States House of Representatives and Senate, keeps an active speaking calendar, and maintains a thriving clinical practice.

In 2016, she published Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press, 2016), which was highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic (Zuger, 2018). Dr. Lembke recently appeared on the Netflix documentary The Social Dilemma, an unvarnished look at the impact of social media on our lives.

Dopamine Nation: Finding Balance in the Age of Indulgence (Dutton/Penguin Random House, August 2021), an instant New York Times Bestseller, explores how to moderate compulsive overconsumption in a dopamine-overloaded world.

Michael UnbrokenProfile Photo

Michael Unbroken


Michael is an entrepreneur, best-selling author, speaker, coach, and advocate for adult survivors of childhood trauma.