Today, we're re-releasing my conversation with psychiatrist Anna Lembke on the future of addiction. Whether its substances, screens, or work itself, addiction in some form touches nearly all of our lives either directly or through someone we care about. Anna breaks down the dopamine mechanisms behind addiction of all kinds, from opioids to social media to, in her own case, romance novels, and shares what actually works in recovery, including exercise and structured abstinence. Whether you're thinking about screen habits, substance use, or just how to build healthier routines, this one's well worth another listen.
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Chapters:
(00:00:00) Introduction
Russ Altman introduces Anna Lembke, a professor of psychiatry and behavioral sciences at Stanford University.
(00:01:52) Defining Addiction
Why addiction involves compulsive use despite harm, even when the behavior seems ordinary.
(00:03:31) Romance Novels and Harm
How Lembke’s own reading habit became a case study in subtle addiction.
(00:05:49) Dopamine and the Addicted Brain
What repeated dopamine spikes do to reward pathways and withdrawal symptoms.
(00:08:34) Seeing the Problem
How naming a compulsive habit can make it visible and open the door to change.
(00:10:34) Addiction Medicine Today
How the opioid epidemic changed medical training and addiction awareness.
(00:12:48) Russ Altman’s “Addictions”
Russ details his own dopamine habits for the audience.
(00:14:37) Exercise and Hormesis
Why movement, effort, and discomfort can help restore healthier dopamine patterns.
(00:17:22) Dopamine Fasting
The self-intervention Dr. Lembke used & her potential cross-addictions.
(00:21:22) Vulnerability to Addiction
Why genetic risk, family history, and drug of choice shape addiction vulnerability.
(00:22:53) The Opioid Epidemic
How prescription opioids, heroin, and fentanyl shaped three waves of crisis.
(00:24:51) Fentanyl and Overdose Risk
Why counterfeit pills and fentanyl exposure can be lethal even for new users.
(00:26:28) Treating Opioid Addiction
Why medications like methadone and buprenorphine help restore stability.
(00:28:17) The Future of Addiction
Why Lembke sees addiction as a long-term challenge across drugs, media, and food.
(00:29:22) Conclusion
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