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SPEAKER_3: Coming up on Star Talk Special Edition, this one is on addiction.
SPEAKER_3: And we have as our special guest, Anna Lembke.
SPEAKER_3: She's a professor of psychiatry at Stanford University.
SPEAKER_3: And we discuss social media, is that addicting?
SPEAKER_3: If it is, how does it addict us?
SPEAKER_3: We also talk about other emergent modern addictions, like gambling, we always know it was out there, but now it seems to be more prevalent than ever.
SPEAKER_3: We talk about the science of dopamine, how it works in what parts of your brain, and can we control it, should we control it?
SPEAKER_3: Why is it there at all?
SPEAKER_3: Where did it come from evolutionarily?
SPEAKER_3: All that and more on Star Talk coming up.
SPEAKER_3: Welcome to Star Talk.
SPEAKER_3: Your place in the universe where science and pop culture collide.
SPEAKER_3: Star Talk begins right now.
SPEAKER_3: Hey, everybody, Neil deGrasse Tyson here.
SPEAKER_4: And I'm Lindsay Nix Walker.
SPEAKER_4: And Neil and I, we just co-authored a brand new StarTalk book, and it's coming out very soon.
SPEAKER_3: Yeah, this is the third in a series of collaborations with National Geographic Books.
SPEAKER_3: And this one is titled, To Infinity and Beyond.
SPEAKER_3: And it's available for pre-order from the StarTalk website, startalkmedia.com/books.
SPEAKER_3: If you pre-order it, you gain access to a live stream that Lindsay Walker and I will do from this office.
SPEAKER_3: And you have the occasion to submit questions that we will answer.
SPEAKER_4: Yep, that's right.
SPEAKER_4: So if they go to startalkmedia.com/books, they can pre-order and ask us their query, whatever they want.
SPEAKER_4: I mean, I know that StarTalk fans can ask some really fun off the wall questions.
SPEAKER_4: So I'm looking forward to seeing what they come up with here.
SPEAKER_3: All right, right now get ready for the next episode of StarTalk.
SPEAKER_3: This is StarTalk, Neil deGrasse Tyson here, your personal astrophysicist.
SPEAKER_3: And today it's a StarTalk special edition, completely, completely devoted to addiction.
SPEAKER_3: What does it mean?
SPEAKER_3: What role does it play in our lives?
SPEAKER_3: And is it good?
SPEAKER_3: Is it bad?
SPEAKER_3: Where did it come from?
SPEAKER_3: Where's it going?
SPEAKER_3: And before we introduce our special guest for this, let me get my co-host here, Chuck Nice, Chuck.
SPEAKER_2: Speaking of addiction, Chuck Nice.
SPEAKER_3: Okay, fine.
SPEAKER_3: And we got Gary O'Reilly.
SPEAKER_3: Gary.
SPEAKER_5: Hi, Neil.
SPEAKER_3: Hey, good.
SPEAKER_3: Gary, former soccer pro and soccer sports announcer, and we got him for our show.
SPEAKER_3: We're borrowing him from all the others, from all the others.
SPEAKER_3: So, Gary, you and your fellow producers put this show together.
SPEAKER_3: What do you have in mind for us?
SPEAKER_2: And are you reaching out for help, Gary?
SPEAKER_2: Is this a clandestine cry for help?
SPEAKER_5: Yeah, this is all about me, darling.
SPEAKER_5: So there are many things that we can get addicted to.
SPEAKER_5: It's just alcohol, it's drugs, it's gambling, the list is endless.
SPEAKER_5: Food.
SPEAKER_2: Anything.
SPEAKER_5: And food.
SPEAKER_5: Food.
SPEAKER_5: So there are modern addictions which we will get into later into the show.
SPEAKER_5: I mean, there's that point where you ask the question, does the relentless pursuit of pleasure always lead to pain?
SPEAKER_5: What role does dopamine and serotonin play in addiction?
SPEAKER_5: Have our minds been manipulated and tricked into addictive behavioral patterns?
SPEAKER_5: And what can be done to avoid?
SPEAKER_5: What can we do with our brains and stop them being rewired in sort of a case of social media?
SPEAKER_5: So for that, we're going to need someone really rather special.
SPEAKER_5: Chief of Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University, author of Drug Dealer MD, and also dopamine nation.
SPEAKER_5: May I introduce Anna Lembke?
SPEAKER_3: Anna Lembke, welcome to Star Talk.
SPEAKER_6: Thank you for inviting me.
SPEAKER_6: I'm happy to be here.
SPEAKER_3: Yeah, and we learned that your background is as a psychiatrist.
SPEAKER_3: So you can authentically prescribe medicines in ways that many therapists cannot.
SPEAKER_2: The best kind of doctor.
SPEAKER_2: Only the best ones that can give you the good drugs.
SPEAKER_3: I'm delighted that you exist in this capacity because it's taken such a toll on society, not only in the past, but especially most recently.
SPEAKER_3: And let's take our first segment and focus on dopamine.
SPEAKER_3: Yeah, yeah.
SPEAKER_3: So, first, is there such a thing as an addictive personality?
SPEAKER_3: Do some people release more dopamine than others when subject to the same stimulus?
SPEAKER_6: The short answer is yes, but we don't use that terminology anymore, the terminology of the addicted personality.
SPEAKER_6: Now, we talk more about people being vulnerable to addiction or having a genetic load for addiction.
SPEAKER_6: So, we think of it more in the sort of disease model or the disease diathesis, rather than, you know, this person's personality.
SPEAKER_2: That makes sense when you think about it because if you make it about a person's personality, then what you're doing is you're handing over control of the addiction to the person.
SPEAKER_2: When addiction is just the opposite of that, you will never meet an addict who says, hey, man, I lost all my teeth.
SPEAKER_2: I can't see my kids.
SPEAKER_2: But this is great.
SPEAKER_2: I want to keep doing this.
SPEAKER_3: Yeah.
SPEAKER_3: So, tell us, what is dopamine specifically?
SPEAKER_6: So, dopamine is a chemical that we make in our brains.
SPEAKER_6: It has many different functions, but one of the most important functions is that it's central to the experience of pleasure, reward, and motivation.
SPEAKER_6: And it may be even more important for motivation than for actual pleasure itself.
SPEAKER_3: But what do I hear about serotonin?
SPEAKER_3: When I hear about serotonin, it's just synonymous with dopamine?
SPEAKER_6: It's not synonymous, but serotonin and dopamine are both neurotransmitters.
SPEAKER_6: Neurotransmitters are the molecules that bridge the gap between synapses to allow for finer tuning of our electrical circuits that make us who we are.
SPEAKER_6: And so dopamine and serotonin are related.
SPEAKER_6: They have distinct functions, however.
SPEAKER_6: And although serotonin is involved in mediating addiction to certain types of substances and behaviors, dopamine is considered the final common pathway for all reinforcing substances and behaviors, which is why neuroscientists tend to use it as a kind of universal currency for measuring addiction.
SPEAKER_5: So what triggers the release?
SPEAKER_5: What triggers the release, Professor, of dopamine?
SPEAKER_5: Because it can't just be, you know, what brain says, you have that now.
SPEAKER_5: Something must be triggering.
SPEAKER_5: Where is it triggering?
SPEAKER_5: And what's it?
SPEAKER_5: Well, there you are.
SPEAKER_6: Why can't it?
SPEAKER_6: Yeah.
SPEAKER_6: So dopamine is released in response to reinforcing substances and behaviors.
SPEAKER_6: And by reinforcing, I mean things that are something that we deem necessary for survival, that typically feel good, or that our brains tell us this is important.
SPEAKER_6: You need to pay attention to it.
SPEAKER_6: So even like novelty, a dopamine is very sensitive to novelty and newness.
SPEAKER_6: But for example, intoxicants, the sort of difference between something that is thought of as a drug or as very addictive and something that's thought of as not particularly addictive is how much dopamine is released in the reward pathway and how quickly it's released.
SPEAKER_6: And substances and behaviors that are highly addictive release a lot of dopamine all at once in this dedicated part of the brain called the reward pathway.
SPEAKER_5: Alright, okay, reward pathway, new phrase.
SPEAKER_5: Phrase of the day so far.
SPEAKER_5: What are we calling, what is a reward pathway?
SPEAKER_6: Well, one of the exciting findings in neuroscience in the past hundred years or so is the discovery of a dedicated circuit in the brain that is central to this reward function, this motivation function.
SPEAKER_6: It consists broadly of the nucleus accumbens and the ventral tegmental area.
SPEAKER_6: These are sort of basal forebrain nuclear structures and then the prefrontal cortex, that large gray matter area right behind our foreheads.
SPEAKER_6: So that's a gross oversimplification.
SPEAKER_6: It's a very complex pathway.
SPEAKER_6: But that's in sort of reductionistic way what the reward pathway consists of.
SPEAKER_6: And that area is very rich in dopamine releasing neurons.
SPEAKER_3: So you gave us the location in the brain where that occurs is what you're saying there, right?
SPEAKER_6: That's right.
SPEAKER_2: But it's also that prefrontal cortex is also attached to our executive function, right?
SPEAKER_6: Exactly right.
SPEAKER_2: So that when that gets hijacked, then that puts us at risk of not being able to make the right decisions or to say no when we should say no or to be extremely capricious without even realizing why we're doing it.
SPEAKER_6: Yeah, very well said.
SPEAKER_6: So the prefrontal cortex is central to the ability to delay gratification, to appreciate future consequences, to tell autobiographical narratives or stories.
SPEAKER_6: And you might think of the prefrontal cortex as the brakes on the car and then the nucleus accumbens in ventral tegmental area, which is really rich in dopamine-releasing neurons as the accelerator.
SPEAKER_6: So addiction is some kind of problem either with the brakes or the accelerator or both.
SPEAKER_5: So, Doctor, come across the phrase of dopamine rush.
SPEAKER_2: That's called cocaine, Gary.
SPEAKER_2: I'll handle this one for you, Doc.
SPEAKER_2: Yeah, Gary, that's called cocaine.
SPEAKER_2: Chuck will take it from here.
SPEAKER_2: Yeah, here we go.
SPEAKER_5: Alright, I'm with you.
SPEAKER_5: So, they say when you get love struck, it's about a dopamine rush.
SPEAKER_5: So, if we're falling in love, are we now...
SPEAKER_5: Is it kind of that in a form of addiction?
SPEAKER_6: So, maybe I can go back to some basic science experiments looking at the response in terms of the release of dopamine to various stimuli.
SPEAKER_6: So, we're always releasing dopamine at a kind of baseline tonic level.
SPEAKER_6: It's sort of like the heartbeat of the brain in some sense.
SPEAKER_6: But experiments in which a probe was stuck deep into this reward circuitry in rodents to measure a dopamine release in response to different stimuli showed that dopamine firing increased above baseline 50% in response to chocolate, 100% in response to sex, 150% in response to nicotine, something like 225% in response to cocaine, and approximately 1000% in response to methamphetamine.
SPEAKER_6: And indeed, if you match that behaviorally to whether or not a rodent will press a lever to get that substance or to engage in that behavior, you find that the more dopamine that's released, the more likely that rat is to press that lever until it dies.
SPEAKER_2: And when it comes to meth, they just rip the lever out of it.
SPEAKER_6: Right, essentially.
SPEAKER_6: Now, there is something a little artifactual about that in the sense that the way that meth works is to directly increase dopamine within the synapse, whereas something like food or sex works through other chemical cascades, like serotonin, for example, as we talked about.
SPEAKER_6: But the final common pathway, again, for all of these is to release dopamine, which is why neuroscientists like to use it as this kind of common currency.
SPEAKER_2: And that goes back to what you were saying earlier about motivation.
SPEAKER_2: So when we eat, we get a little hit of dopamine because that satisfaction allows us to say, hey, I should do this again.
SPEAKER_2: Otherwise, we would just not eat.
SPEAKER_2: We'd be like, yeah, whatever, who cares?
SPEAKER_2: Which is why sometimes when people are really depressed, one of the things they do not do is eat.
SPEAKER_6: Right, yeah, very well said.
SPEAKER_6: And furthermore, if I eat a piece of broccoli, I personally will get very little dopamine release, most likely.
SPEAKER_6: But if I eat...
SPEAKER_3: Neither does anyone.
SPEAKER_6: Yes.
SPEAKER_6: Neither will anyone.
SPEAKER_6: Right, exactly.
SPEAKER_6: But if I eat a chocolate cupcake, I'll get a lot more dopamine.
SPEAKER_6: But now, qualifying the broccoli idea, if I haven't eaten for two days and you give me a piece of broccoli, that's going to be really yummy to me, right?
SPEAKER_6: That's going to release more dopamine, at least from my baseline than not.
SPEAKER_6: And yes, I thought it was really important that Chuck talked about sort of other contextual factors like depression, right, which then sort of hypothetically decrease baseline dopamine firing levels, such that almost everything loses its salience or its attractiveness.
SPEAKER_6: Likewise, other co-occurring mental health disorders can have other impacts on our experience of reward.
SPEAKER_6: It's thought, for example, that people with attention deficit disorder might be relatively insensitive to dopamine firing, which is why they maybe tend to be sensation seekers and need more rewards to get any kind of response at all, or furthermore.
SPEAKER_3: So everybody's got a different baseline.
SPEAKER_3: It's a baseline thing, right?
SPEAKER_6: Everybody's got a different baseline.
SPEAKER_5: What I wanted to ask you, Professor, was with the meth being as addictive as it is, is it working purely to detonate the dopamine or does it have other little techniques that are engaging and triggering?
SPEAKER_6: Well, yeah, the talk about dopamine is an oversimplification of a very complex process.
SPEAKER_6: Meth works through other chemical cascades, other neurotransmitters.
SPEAKER_6: Also, when we look at these experiments in rodents, rodents at the end of the day are not people and our brains are much more complex.
SPEAKER_6: And we cannot ignore the very important concept of drug of choice, which is to say my particular wiring might lead me to be more attracted to certain types of reinforcers that are different from what your particular brain is wired for, such that I might work very, very hard to repeat an experience I have on social media, but not necessarily for meth or alcohol or something else because my wiring is just my wiring.
SPEAKER_2: That's so wild because you hear people say it all the time.
SPEAKER_2: Well, I shouldn't say you hear people say it all the time.
SPEAKER_2: I've heard people say it often where, oh, I tried this and it just did nothing for me.
SPEAKER_2: It just didn't.
SPEAKER_2: Yeah.
SPEAKER_2: I tried to have alcohol, but it did nothing for me.
SPEAKER_2: Or I smoked marijuana once.
SPEAKER_2: I mean, it just didn't do a damn thing to me.
SPEAKER_2: I got sleepy and that was it.
SPEAKER_2: So that's what you're talking about.
SPEAKER_6: Exactly.
SPEAKER_2: Kind of fascinating.
SPEAKER_3: But Anna, what of the stereotype depressed person who just broke up with, okay, a woman just breaks up with her boyfriend and you see her, this is in movies all the time, in rom-coms, where she's sitting on the bed eating a box of chocolates looking at some sad movie.
SPEAKER_3: So they're eating in that case rather than not eating.
SPEAKER_3: Is that a different kind of depression that responds?
SPEAKER_3: So they're basically compensating for that loss of pleasure because now all they have access to is a box of chocolates.
SPEAKER_6: Yeah.
SPEAKER_6: So there are many different risk factors for addiction, but one very well-known risk factor is severe stress.
SPEAKER_6: So if we have some kind of giant stressor in our life, it's very natural for us to reflexively turn to substances or behaviors that will release those feel-good neurotransmitters as a way to cope or compensate.
SPEAKER_6: One of my favorite experiments in the neuroscience literature in rodents is a group of rodents was trained to press a lever for intravenous cocaine, and rats and mice will press that lever until exhaustion or death.
SPEAKER_6: If you then take the cocaine away, eventually that behavior of pressing that lever will extinguish, which is to say they'll stop pressing the lever.
SPEAKER_6: But if you then expose that rat or that mouse to a severe painful foot shock, the rodent will immediately run over to the lever and start pressing it again.
SPEAKER_5: Whoa!
SPEAKER_6: So that's a very nice paradigm for what we as humans do, that stressor is something that can kick off, exacerbate, contribute to, maladaptive consumptive behaviors.
SPEAKER_6: And for people who are in recovery or abstaining from their drug of choice, if they then experience acute stressor, they will almost reflexively turn to or want to turn to their addictive behaviors as a way to shore themselves up again.
SPEAKER_2: That is fascinating.
SPEAKER_6: I'm glad you like it, Chuck.
SPEAKER_2: That is amazing.
SPEAKER_3: Did you use the phrase maladaptive consumptive behavior?
SPEAKER_3: Isn't that the same thing as overheating?
SPEAKER_6: Yeah, so maladaptive consumptive behavior can apply to almost anything.
SPEAKER_3: Yes.
SPEAKER_3: Okay, or something that might not otherwise be good for you, whether or not it's food.
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SPEAKER_5: So, Professor, is there a way naturally or through intervention chemically to regulate, to manage this dopamine release rather than just have it gushing and be out of control?
SPEAKER_6: Sure.
SPEAKER_6: I mean, that's what treatment and recovery is all about.
SPEAKER_6: We think of addiction as a biopsychosocial disease.
SPEAKER_6: That means there are biological, psychological and social risk factors, and we have to intervene at the biological, psychological and social level.
SPEAKER_6: So in terms of the biological level, we have medicines that can treat addiction.
SPEAKER_6: For example, we use a medicine that blocks opioid receptors and it's FDA approved not just to treat opioid addiction, but also alcohol addiction, because we know that alcohol works not just on the GABA systems, but also on our endogenous opioid systems.
SPEAKER_6: And by blocking the opioid receptor, what we're probably doing is blocking the reinforcing effects of alcohol, such that people will describe that when they drink, alcohol, while they're taking naltrexone, it just doesn't taste as good.
SPEAKER_6: They're not as interested in having another drink, which is great because we can use it then to help people, not just abstain, but to moderate their use.
SPEAKER_6: So that's one example of a biological intervention.
SPEAKER_6: Psychological interventions, there are many.
SPEAKER_6: One of the things we teach people is to surf their urges or think through the drink.
SPEAKER_6: So these are like mindfulness practices where they can learn to identify their triggers, not react to those triggers, to distance themselves, to wait those triggers out.
SPEAKER_6: And then in terms of social interventions, we, you know, 12 steps, alcoholics anonymous, narcotics anonymous, other 12 step groups is basically a way to contextualize and socialize recovery so that you're in a sober social networks that you can reach out to another person when you're having urges or cravings and then that person can help you co-regulate.
SPEAKER_6: That's just one example of how 12 step works.
SPEAKER_3: Yeah, but if you know that there's chemistry going on in the brain, why would 12 steps work at all?
SPEAKER_6: Well, because 12 step changes bring chemistry and we don't just...
SPEAKER_6: Okay.
SPEAKER_6: Yeah.
SPEAKER_2: Is it more the social interaction or is it the disciplines that they introduce to your life?
SPEAKER_2: Or is it merely having a community around you that you're familiar with, that understands you, that brings you compassion, all these things that we tend to take for granted when we're living in normal social sets?
SPEAKER_6: I really think it's all of the above.
SPEAKER_6: So I think it's the foundational philosophy, the shifting the locus of control from inside of us to a power outside of ourselves, something greater than ourselves, doesn't have to be a deified entity.
SPEAKER_6: It could just be the 12 step community.
SPEAKER_6: It's the working of the steps, all 12 of them, including especially step four, where we acknowledge what we have contributed to the problem, what our character defects are, which allow us to create a more valid narrative about our lives, which then also gives us access to more information to make better choices going forward.
SPEAKER_6: Then of course, it is the social network, both the de-shaming that happens when you interact with other people struggling with addiction, but also, as I talk about in my book, The Dopamine Nation, a kind of leveraging the shame within the group, such that people would not want to relapse because they would want to have to come back and declare themselves as a newcomer, something that I label pro-social shame.
SPEAKER_5: Professor, when you've got these pathways and the dopamine is running, and you talk about drug of choice, what else is out there that's triggering apart from some very obvious, well-known ones?
SPEAKER_6: Well, it's important to recognize that you can get addicted not just to substances that we ingest, but also behaviors that we do.
SPEAKER_6: And because this motivational reward pathway is conserved over millions of years of evolution across species, it's really fundamental to survival and to get us to be motivated to do anything.
SPEAKER_6: So theoretically, you could get addicted to just about anything.
SPEAKER_6: And what we are seeing in the modern age, especially as more and more substances and behaviors have been made more potent, more reinforcing, more novel, more accessible and come in greater and greater quantities, is that we're seeing people get addicted to all kinds of things today that we would not have imagined possible in prior generations.
SPEAKER_2: So now, is it still considered an addiction if the behavior itself is not only acceptable, but maybe beneficial?
SPEAKER_2: I get up every day.
SPEAKER_2: By the way, this is an example, people.
SPEAKER_2: This is not my life.
SPEAKER_2: I get up every day at 6 a.m.
SPEAKER_2: and I head straight to the gym.
SPEAKER_2: Because my day isn't right unless I get up and head straight to the gym.
SPEAKER_2: And I do that if I could do it seven days a week.
SPEAKER_2: I do it seven days a week.
SPEAKER_2: If I could go twice a day, I'd go twice a day.
SPEAKER_2: You know, if you meet a person like that, I mean, the behavior is seen as good.
SPEAKER_2: So we don't say, hey man, you might have a problem.
SPEAKER_6: Yeah, an excellent point and a good opportunity to define addiction.
SPEAKER_6: Addiction is the continued compulsive use of a substance or behavior despite harm to self and or others.
SPEAKER_6: So just very broadly speaking, if we're diagnosing addiction, we have to identify that it's doing some kind of harm.
SPEAKER_6: It might be a harm that that person sees for themselves.
SPEAKER_6: It may be a harm that they don't recognize but that others recognize.
SPEAKER_6: Having said that, you are absolutely right that this is contextualized within a given time and place and that if society has deemed certain behaviors healthy, even when people do them to the detriment of their own health potentially or other people's harm, then we might not call it an addiction.
SPEAKER_6: And you use exercise and people can actually get addicted to exercise where they're continuing to engage in that activity despite being injured despite not spending time doing other things that they value.
SPEAKER_6: Workaholism is another great example.
SPEAKER_6: People who are compulsively focused on work, money, achievement and one that we celebrate in our culture and that we usually don't call out.
SPEAKER_6: So addiction is an interesting field because there is this what I think is a fascinating intersection between culture and biology.
SPEAKER_5: So, Professor, if it's something that's core and necessary for life, say water, how about then?
SPEAKER_2: Man, if you're addicted to water, you are the most boring person in the world.
SPEAKER_2: You need help.
SPEAKER_2: It is tasteless.
SPEAKER_2: It has zero calories.
SPEAKER_5: I know, but you'll pee a lot.
SPEAKER_2: Right.
SPEAKER_5: So, Professor, has that been a notified addiction?
SPEAKER_6: Yeah.
SPEAKER_6: So, I've seen one case of that in my career.
SPEAKER_6: It was actually very sad.
SPEAKER_6: It was a woman with a very severe alcohol addiction who got into recovery from her alcohol addiction.
SPEAKER_6: That is to say she was no longer consuming alcohol.
SPEAKER_6: She was actively working on her health.
SPEAKER_6: But somehow or another, she discovered that if she drank water in copious amounts, she could feel altered.
SPEAKER_6: And she got addicted to that process and ultimately died of hypo...
SPEAKER_6: Well, she had several very severe episodes of hyponatremia and almost died from those episodes.
SPEAKER_2: While washing out the electrolytes, you can't drink that kind of water.
SPEAKER_6: No.
SPEAKER_2: Yeah, it's very dangerous.
SPEAKER_2: Holy crap, I was only joking.
SPEAKER_2: Now I feel like a jackass.
SPEAKER_6: No, no, it's okay.
SPEAKER_3: That's right.
SPEAKER_5: We're all learning, Chuck.
SPEAKER_5: We are all learning.
SPEAKER_3: Chuck, especially.
SPEAKER_2: You guys are the worst.
SPEAKER_5: So, Professor Dent, there's this term sort of dopamine cleansing, dopamine fasting.
SPEAKER_5: Didn't they used to call that cold turkey or something similar back in the day?
SPEAKER_3: I haven't heard that term.
SPEAKER_3: I haven't turned that term lately, cold turkey.
SPEAKER_2: Dopamine fasting and cold turkey.
SPEAKER_2: I haven't heard cold turkey.
SPEAKER_2: Nobody does anything cold turkey anymore.
SPEAKER_2: That used to mean that you had the right stuff.
SPEAKER_6: Well, cold turkey is a term that comes from what happens to our skin when we abruptly stop something like an opioid.
SPEAKER_6: We get this kind of goose flesh as part of the opioid withdrawal syndrome.
SPEAKER_6: So, that is a term that's sort of used more broadly to describe just quitting something just completely all at once rather than…
SPEAKER_3: So, it's not cold turkey, it's cold goose.
SPEAKER_6: Right, it's cold goose or something like that.
SPEAKER_6: Yeah, exactly.
SPEAKER_6: Or for that matter, the term kicking the habit is related to the same kind of opioid withdrawal phenomenon.
SPEAKER_6: People tend to get muscle fasciculations and will have involuntary muscle movements.
SPEAKER_6: So, kicking the habit, going cold turkey, those are all terms that come from the withdrawal syndrome associated with opioids.
SPEAKER_6: And quitting opioids all at once is really, really hard to do.
SPEAKER_6: So, we still do ask people to quit cold turkey as long as they're not at risk for life-threatening withdrawal.
SPEAKER_6: It's important to remember that people with severe physiologic dependence to alcohol, benzodiazepines like Xanax, or in some cases opioids, can have such a severe withdrawal syndrome that they could actually die from that withdrawal syndrome.
SPEAKER_6: So, we would not ask that of people who were at risk of a life-threatening withdrawal.
SPEAKER_6: We also wouldn't ask people to stop abruptly if they had tried repeatedly to do that on their own and weren't able to.
SPEAKER_6: But it is an intervention that we do use as kind of an early intervention for people who are a little bit addicted all the way up to moderately addicted but not yet severely physiologically dependent.
SPEAKER_6: And we ask them typically in clinic to sort of try to wrap their heads around stopping for 30 days.
SPEAKER_6: Because 30 days is on average the amount of time it takes to sort of reset these dopamine reward pathways and to sort of get that prefrontal cortex back online and be able to make informed decisions about what they want to do going forward.
SPEAKER_5: So, okay, we've talked about dopamine.
SPEAKER_5: What if naturally occurring within people's bodies there's not enough, as you said, that baseline?
SPEAKER_5: What happens then?
SPEAKER_5: Because there's got to be an detrimental effect if it's below base.
SPEAKER_5: So what conditions come forward if there is, like I say, a lack of dopamine in the body?
SPEAKER_6: Well, you know, this is...
SPEAKER_6: There's not a whole lot of deep understanding of this yet, but some preliminary data suggests that depression is characterized by low levels of dopamine transmission.
SPEAKER_6: As I said before, there's some thinking that people with attention deficit disorder might at baseline have lower levels of dopamine transmission, making them less sensible or sensitive to rewards.
SPEAKER_6: And we also know, very importantly, that with repeated exposure to highly reinforcing substances and behaviors that release a lot of dopamine all at once, the brain tries to adapt to that increased dopamine firing by down regulating dopamine transmission, not just the baseline levels, but actually below baseline levels.
SPEAKER_2: So if you're a person who abuses a drug that floods your brain with dopamine, then your brain says, oh man, we're making too much dopamine.
SPEAKER_2: We got to chill out on this dopamine production.
SPEAKER_2: So then you stop doing the drug and all of a sudden you have no dopamine where you should have dopamine.
SPEAKER_2: And does that mean at that point you're like, man, I need some drugs because I need some dopamine.
SPEAKER_6: That's exactly right, Chuck.
SPEAKER_6: You said it really, really well and more clearly than I could have.
SPEAKER_3: So Anna, why do we have you when we have Chuck?
SPEAKER_3: He could have just...
SPEAKER_6: Honestly, I've been thinking that myself this whole time.
SPEAKER_6: I was like, the comedian could basically give the talk.
SPEAKER_6: Yeah, that's exactly what happens, is that with repeated use of the same or similar reinforcing substance and behaviors, we eventually end up in this kind of dopamine deficit state.
SPEAKER_6: Now we need more of our drug and more important forms over time, not to get high, but just to feel normal and stop the craving, which is exactly why people with severe addiction will relapse even weeks after they've stopped using, even though they can objectively tell you, yes, my life is much better because I'm not using and my spouse is back and my job is back, and from a physical health point of view, I'm doing better.
SPEAKER_6: But mentally, many of them are still struggling with those universal symptoms of that dopamine deficit state, which are anxiety, irritability, insomnia, depression and craving.
SPEAKER_6: And craving manifests in many different ways.
SPEAKER_6: It can be ruminations to want to use.
SPEAKER_6: It can be long-winded narratives that are essentially rationalizations for why I should use.
SPEAKER_6: So craving is really a wily kind of thing that swims through our brain and catches us unaware.
SPEAKER_3: So Anna, if for some reason dopamine stopped getting made entirely, does that itself have consequences?
SPEAKER_3: Is that the life of a depressed person or is there some other symptoms of that?
SPEAKER_6: It depends what part of the brain dopamine production decreased in.
SPEAKER_6: So for example, if we had a decrease in dopamine production in the part of the brain called the substantia nigra, which is a discrete and separate part from the reward pathway, then we would end up with Parkinson's disease, which is a movement disorder.
SPEAKER_6: So dopamine, as I said, has different functions and it's also very essential for movement, and it's probably no coincidence that the same neurotransmitter that's important for movement is also important for pleasure, reward and motivation because we typically need to move our bodies in order to get the reward that we want.
SPEAKER_6: Unfortunately today, that's no longer necessarily true.
SPEAKER_6: We're now living in a time and place when we can just sit on the couch and swipe right and swipe left and have it delivered to the doorstep.
SPEAKER_3: So why can't you reverse engineer that and cure Parkinson's?
SPEAKER_6: When you say reverse engineer, you mean...
SPEAKER_3: You said there's a section of the brain, if it stops making dopamine, you have Parkinson's.
SPEAKER_6: Yeah.
SPEAKER_3: So why not introduce dopamine back into the brain and then cure Parkinson's that way?
SPEAKER_6: So that's in effect how we do treat Parkinson's.
SPEAKER_6: So if you had Parkinson's and I gave you dopamine, a spoonful of dopamine, it would do absolutely nothing because it doesn't cross the blood-brain barrier.
SPEAKER_6: So instead I have to give you something called L-Dopa, which is a dopamine precursor that does cross the blood-brain barrier, and then that gets converted into dopamine, which then gives you more dopamine in the substantia nigra, which then allows you to have more fluid movements to counteract the disease of Parkinson's.
SPEAKER_6: Unfortunately, it binds non-specifically throughout the brain, so that means that that dopamine I gave you is now binding to dopamine receptors in the reward pathway, and what we see is about a quarter of people treated with L-DOPA for Parkinson's end up with some kind of compulsive, consumptive behavior like pathological gambling, pathological shopping, etc.
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SPEAKER_3: Let's pick up some of the modern addictions that we see, with gambling as legal lately as it's ever been.
SPEAKER_3: You know, I see ads, I see, and then of course the ads are accompanied with a little phone number at the bottom, have a gambling problem, call this.
SPEAKER_3: And I just think to myself, we have people exploiting the susceptibility of innocent members of the general public to gambling urges.
SPEAKER_3: And I'm saddened by this, because they're hijacking our neurochemistry to make this happen.
SPEAKER_3: And of course, that also brings up social media, the addiction to how many likes you're gonna get.
SPEAKER_3: Could you just reflect on this modern emergence of addiction relative to the classical addictions we all grew up with?
SPEAKER_6: Yeah, so I'm equally sad.
SPEAKER_6: And I agree with you that these corporations are really preying on people who are vulnerable to addiction and also making us all, broadly speaking, more vulnerable to addiction.
SPEAKER_6: One of the biggest risk factors for addiction that people often discount is simple access.
SPEAKER_6: If you live in a neighborhood where drugs are sold on the street corner, you're more likely to try them and you're more likely to get addicted to them.
SPEAKER_6: And what we're seeing with gambling, especially for example, online sports betting, which has now become legal in multiple states in the union, is that in those states, we're seeing a 300 to 500% increase in calls to pathological gambling hotlines.
SPEAKER_6: So it's very clear that as gambling becomes more accessible, especially through a mobile app, we are going to have more people who are struggling with gambling addiction.
SPEAKER_6: And very sadly, I would add to that, that these corporations actually often specifically prey on people who get addicted to gambling.
SPEAKER_6: So they track those people and they pursue them and they proffer, they will actually-
SPEAKER_6: Yeah, they give them money.
SPEAKER_6: They give them money to allow them to gamble.
SPEAKER_6: And they also change the algorithm to make sure that they win early on.
SPEAKER_6: And then by getting them hooked, then it's really, it's very-
SPEAKER_2: It's a classic drug dealer move.
SPEAKER_2: That's right.
SPEAKER_2: That's the oldest line in the book.
SPEAKER_2: The first one is always free.
SPEAKER_6: Right, exactly right.
SPEAKER_6: Exactly right, so it's really very distressing.
SPEAKER_5: So professor, you talked about movement being a trigger.
SPEAKER_5: Historically, in our primal brain.
SPEAKER_5: We are now, the primal brain that we have is now fighting some serious modern technology.
SPEAKER_5: So I'm going to upgrade to cartoon garish colors.
SPEAKER_5: I'm going to give you movement.
SPEAKER_5: How many other strategies are out there that are keeping my attention?
SPEAKER_5: Because that's the, for me, the product that's generated in social media is my attention time.
SPEAKER_5: Right.
SPEAKER_3: It's the new currency, yeah.
SPEAKER_5: That is it.
SPEAKER_5: So how are they making sure I am utterly fixated?
SPEAKER_2: Yes, and please take your time explaining this so that I can take notes for my own social media accounts.
SPEAKER_6: Yeah, so you're getting at what is one of the huge issues in considering these digital devices and these digital media as having genuine product liability.
SPEAKER_6: Just the way that we think of cigarettes as having inherent harm, there's now a shift toward thinking about the inherent harm of digital media of all sorts because of the built-in design functions and I think the first and foremost, the design function of 24-7 portable accessibility that increases access wherever we are, whenever we are, has made an enormous impact on the addictive potential and the number of people struggling with digital addiction, addiction to technology and to the internet.
SPEAKER_6: Yeah, so in the early 2000s with the advent of smartphones, smartphones, we saw a huge increase in the number of people struggling with addictive pathological gambling, pornography viewing.
SPEAKER_6: And then as time went on, we started to see addictive video game use, addictive shopping, addictive social media use.
SPEAKER_3: It's because they can take it with them.
SPEAKER_3: It's because it's with them at all times.
SPEAKER_6: That's right.
SPEAKER_6: That's a huge part of it that people, I think, really don't fully appreciate.
SPEAKER_6: And it's important to realize that because that means that the intervention is going to be separating ourselves for some period of time every day from our digital devices.
SPEAKER_6: And that's what we're not doing.
SPEAKER_6: We're basically almost cybernetically enhanced with our devices with us at all times.
SPEAKER_2: That's so true.
SPEAKER_2: Because in the 80s, when I was growing up, if you wanted to take porn with you, that was really quite an undertaking.
SPEAKER_6: Good luck.
SPEAKER_6: Good luck, friends.
SPEAKER_5: Professor, how do you ensure security of the mind, particularly in the younger age groups?
SPEAKER_3: I like that phrase.
SPEAKER_5: How do you get that holistic protection?
SPEAKER_5: What levels of engagement and where does it come from for this to be something we can carry forward?
SPEAKER_3: You've got to lock your kids in a box.
SPEAKER_6: Yeah.
SPEAKER_6: Exactly.
SPEAKER_2: Wait a minute.
SPEAKER_2: Am I the only one that does that?
SPEAKER_3: Wait.
SPEAKER_6: This is both an individual problem and a collective problem.
SPEAKER_6: That means we need both bottom up solutions where we individually change our habits as individuals and as families, but we also need top down interventions, schools, corporations that make and profit from the media and the devices, the federal government who can impose regulations.
SPEAKER_6: It needs to be coming from both ends in order for us to get a handle on this huge worldwide collective problem.
SPEAKER_6: And specifically in terms of what can be done beyond the kinds of individual and family interventions that I talk about in my book, when you think about it from a policy perspective, I think about it as in three categories.
SPEAKER_6: We can try to change the design, which is what you were talking about earlier, Gary, this idea of the bottomless bowls, the flashing lights, the AI algorithms that learn what we've liked before and then push content similar, but slightly different than what we've watched before, which then keeps people's engagement, their attention, makes it more compulsive, pushes them to extreme versions, more potent versions.
SPEAKER_6: So we need to change the design in order to decrease the liability of the products.
SPEAKER_6: We also need to think about access.
SPEAKER_6: So limiting access, as we've talked about, it's not just what we're doing online, it's the sheer quantity and frequency of viewing that screen, which is changing our brains and leading to morbidity and mortality.
SPEAKER_6: And when I think of access, really low-hanging fruit, in my opinion, is the school system.
SPEAKER_6: It seems to me very obvious that children should not be having their smartphones with them during school hours, especially not during class, but also potentially not at all.
SPEAKER_6: And what we're seeing is some schools, typically private schools that have more resources, have taken phones away and given their students flip phones.
SPEAKER_6: And what you're hearing is, you're hearing about huge improvements in student wellbeing and student mental health.
SPEAKER_6: You're hearing teachers and administrators say, the schools are noisy again.
SPEAKER_6: Why?
SPEAKER_6: Because kids are engaging with each other.
SPEAKER_3: You know, a flip phone is just a phone.
SPEAKER_3: It's not all the rest of the day.
SPEAKER_6: It's boring.
SPEAKER_6: The kid's not going to spend their time on a flip phone.
SPEAKER_3: But they can't complain that they don't have phone access to an emergency call to home or something.
SPEAKER_6: That's exactly right.
SPEAKER_3: So how much of this is covered in your dopamine nation book, which came out just a couple of years ago?
SPEAKER_6: Dopamine nation focuses very much on what we as individuals and we as families can do.
SPEAKER_6: And it describes in simple terms, the neuroscience of what's happening and why we get addicted to potentially almost anything.
SPEAKER_6: And then specifically steps that we can take.
SPEAKER_6: So it's not much focused on policy, but since it came out, I've been more and more involved in policy discussions and trying to consider what can be done beyond the level of the individual and the individual family.
SPEAKER_2: And what about family policy?
SPEAKER_2: Because I'm sure right now, anybody who's a parent who is listening to this is thinking it's impossible for me to stop my kids or get them off of the video game, to get them off of the tablet, to stop them from...
SPEAKER_2: And by the way, there's social media companies now push out all the content everywhere.
SPEAKER_2: So if you keep your kids off of X, Twitter, whatever that is, or Facebook or whatever, they're just gonna get it on YouTube or YouTube Shorts or whatever, or on Discord.
SPEAKER_2: So what do you do to curtail, aside from the draconian measure of ripping the phone away from them, what do you do to curtail their behavior?
SPEAKER_3: You put them in a box.
SPEAKER_3: We resolved that already.
SPEAKER_2: We already told you that.
SPEAKER_3: I thought we moved on from that.
SPEAKER_3: We already decided.
SPEAKER_6: You know, you don't put the kid in the box, but you probably should put the devices in a box.
SPEAKER_2: Oh, so you are an advocate of literally snatching it away from them.
SPEAKER_6: So let me qualify that.
SPEAKER_6: For kids up until a certain age, and I would say this is usually around 11 or 12, I believe that we as parents still have enough control, generally speaking, in the household, especially if we're co-parenting with somebody that agrees with us and we can organize it together.
SPEAKER_6: And I think it's very possible and also good to sit down as a family and say, hey, we've been using devices in this way, but it's not healthy.
SPEAKER_6: And here are the reasons why.
SPEAKER_6: And so as a family, we need to make some changes.
SPEAKER_6: And I've seen families do this.
SPEAKER_6: And it can be very distressing for all comers, because very often parents are as addicted as kids.
SPEAKER_6: But to do it together as a family with younger children can be so healthy for families to just really reorient.
SPEAKER_6: It doesn't mean your kid's never on the device, but they're on the device for a limited quantity of time after they've done their children or schoolwork as a kind of thing that they've earned for good behavior for a limited amount of time and not every day.
SPEAKER_6: And then not every day is really key.
SPEAKER_6: If you want a number of hours, there's some general consensus less than two hours a day.
SPEAKER_6: Now, once you're...
SPEAKER_6: I know.
SPEAKER_6: And I'm talking about your...
SPEAKER_2: Who's going to raise my kids if they're only allowed to?
SPEAKER_6: Yeah, exactly.
SPEAKER_6: But it's important to get in there while they're little because it lays the foundation for their wiring and their neurological scaffolding that they're going to be left with the rest of their adult lives.
SPEAKER_6: Now, once kids get to be about 13, they're no longer in your control.
SPEAKER_6: They're going to do what they're going to do.
SPEAKER_6: But at that point, what we can do as parents is model the behavior that we want to see, give them feedback on what we're observing, use contingency management, which is punishments and rewards to incentivize the kinds of behavior that we want to see and just talk about it openly as a family and try to have a certain tech etiquette around when it's appropriate to use devices and when it's not.
SPEAKER_6: When we're having friends over for a meal, you shouldn't be on your device.
SPEAKER_6: You should be looking in them in the eye, greeting them, spending some time talking, not just being.
SPEAKER_6: So these, I think these are the conversations we really have to have.
SPEAKER_3: Yeah, but does that mean it's not, there's no hope through legislation or Congress or lobbying the companies themselves?
SPEAKER_6: Oh, absolutely.
SPEAKER_6: That's the third piece of it is, you know, hope the corporation's accountable.
SPEAKER_6: And the way to do that is really through various types of nudges through policy reform and regulations.
SPEAKER_6: And just to give an example, I talked about thinking that kids should have as a top-down policy, no smartphones during school hours.
SPEAKER_6: And, you know, the federal government could do that by, they give lots of funds to public schools.
SPEAKER_6: You know, they could say either, we're not going to give you as much of those funds unless you manage technology in your school in a different kind of way.
SPEAKER_6: Or they could sweeten the pot and say, we will give you more funds if you do something like, you know, implement some kind of new smartphone use policy in your school.
SPEAKER_6: So there are ways to get in there.
SPEAKER_6: And this is, there are precedents as well.
SPEAKER_6: So for example, the age 21 drinking laws, which are now universal in every state, it really came to be because the federal government said, well, we're not going to give you highway funds if you keep your drinking age lower.
SPEAKER_6: So there are ways to, you know, kind of create these nudges.
SPEAKER_5: So professor, they're called smartphones, right?
SPEAKER_5: There must be a way, I mean, I'm not technically gifted in any way, but you build in a phone and you've got to have a trust program here where if it's going to a young person under the age of 11 or 10, say like that, then it gets timed to shut down on usage per day, as you said, no more than two hours or whatever the limit might be.
SPEAKER_3: Yeah, there are apps for that.
SPEAKER_5: Surely there is a way.
SPEAKER_3: There are apps for that.
SPEAKER_6: Yeah, they do.
SPEAKER_5: They must then be mandatory.
SPEAKER_6: Well, there are lots of software apps that do that, but these kids very early on figure out all kinds of workarounds.
SPEAKER_2: All kinds of ways of workarounds.
SPEAKER_6: But what you're implying is actually something that I don't think has been done to any great degree, which is that there should be hardware implementation.
SPEAKER_6: So for example, I'm not an engineer or a computer, or a computer science person, but I can imagine a school laptop that might help, especially for younger children, avoid some of the content that we want them to avoid.
SPEAKER_6: So not just expecting software companies, but also hardware companies.
SPEAKER_6: But this gets to the whole content issue, which is very hard to regulate because it's in direct conflict with privacy laws.
SPEAKER_6: So for example, in some states, I think Louisiana is one of them, they've implemented a law that says in order to sign up for a website like Pornhub, you have to prove that you are 21 and you have to do that by uploading your driver's license.
SPEAKER_6: But of course, nobody is going to go on Pornhub wants to upload their driver's license and be associated with having done that.
SPEAKER_6: So now they've worked out having these third party sites, which kind of anonymously process.
SPEAKER_2: You can register with the third party site and your registration with that third party site allows you access to the porn site.
SPEAKER_3: Why do you know that, Chuck?
SPEAKER_3: Why do you know that?
SPEAKER_2: Because I have a very good friend in Louisiana.
SPEAKER_3: You got a friend.
SPEAKER_5: So Professor, let's get to the content aspect.
SPEAKER_5: I mean, it's not just the porn or online gambling.
SPEAKER_5: There is extreme content that comes through and it is getting extreme reactions from individuals.
SPEAKER_5: You're a psychiatrist.
SPEAKER_5: Are we hardwired to react extremely to extreme content?
SPEAKER_3: And let me sharpen that question.
SPEAKER_3: I'm all with it, but I want to tune it specifically because we got to wrap this up very shortly.
SPEAKER_3: Is we are seeing content, forget the kids now, the adults are being fed content by the algorithm that enrages us and motivates us to act in some way.
SPEAKER_3: And in the limiting case, it motivates us to commit violence.
SPEAKER_3: Again, some group-
SPEAKER_2: Going to the Capitol.
SPEAKER_3: Right.
SPEAKER_2: It's not.
SPEAKER_3: So, this is not so much addiction, but there's definitely a brain thing going on there that's being fed and that we're reacting in a way that we think is completely sensible, but it's not when you take one step back from it.
SPEAKER_6: Yeah, and I think we can hypothesize that dopamine is involved in this process too, that essentially when we see, when our opinion is validated with a large group and then we're experiencing an emotion at the same time, that many other people are experiencing that emotion, that's one of the ways that we feel connected to other people, right?
SPEAKER_6: Sharing an emotional experience.
SPEAKER_6: And we know that feeling connected to other people, releases oxytocin, which is our love homer, which binds to dopamine receptors in the reward pathway, which then release dopamine.
SPEAKER_6: So I think there is this sense in which we are kind of getting high off of this group experience, whatever it may be, whether it's people watching people, watching other people make music.
SPEAKER_6: Like now, it's not just videos of people making music, we watch other people having a reaction to the music and that makes it more potent because we're having a shared emotional experience.
SPEAKER_3: They're called reaction videos.
SPEAKER_3: Yeah, and they're for everything.
SPEAKER_3: They got it from...
SPEAKER_3: I've even been encouraged to...
SPEAKER_3: I've posted a reaction video to a TikTok just for that context because I was duly notified by...
SPEAKER_2: You were watching your own TikTok?
SPEAKER_3: I was duly notified by someone one third my age on our staff that that was a thing to do for a particular posting by another person who made music about the planets.
SPEAKER_3: And then I comment, I was reacting to the...
SPEAKER_3: We weren't promoting insurrection, okay?
SPEAKER_6: Good to know.
SPEAKER_5: Professor, this sort of safety in numbers didn't back in my day, you used to call that herd mentality.
SPEAKER_6: Right, herd mentality, feeding frenzy, these types of things.
SPEAKER_5: But I mean, what's the term?
SPEAKER_5: Is it rageaholic?
SPEAKER_6: Yeah, rageaholic.
SPEAKER_6: It is important to realize that you can get addicted not just to sort of positive stimuli, but actually aversive or negative.
SPEAKER_6: You know, people are doom scroll, they get addicted to the news, they get addicted to becoming enraged.
SPEAKER_6: I think that the addiction phenomenon could even apply to like a domestic violence situation where people kind of get addicted to the uncertainty of that kind of, you know, violent relationship, which is maybe why, you know, sometimes people keep going back.
SPEAKER_3: And what about people who jump out of airplanes for fun?
SPEAKER_6: Yeah, so that's been a research to some degree.
SPEAKER_6: And what they find is that after the first jump, there's this kind of like paralyzed terror in the aftermath.
SPEAKER_6: But with subsequent jumps, people get just frankly euphoric.
SPEAKER_6: There's an enormous high.
SPEAKER_6: But also with people who jump all the time, they develop anhedonia, which is to say they develop a kind of depressed state.
SPEAKER_6: There's probably like a flooding of their brain of neurotransmitters.
SPEAKER_6: And then it's too much and then you have this kind of compensation so that it's possible and it's hypothesized even in the literature based on a couple studies.
SPEAKER_2: Well, there's an answer.
SPEAKER_6: Yeah.
SPEAKER_2: There's an answer to that.
SPEAKER_2: The next jump you make, just do it without the shoot.
SPEAKER_6: That's it.
SPEAKER_6: Right, or go higher and higher or whatever it is.
SPEAKER_3: Okay, thank you, Chuck, for solving that problem for us here.
SPEAKER_3: Gary, Gary, we got to close this down.
SPEAKER_5: I know, but before we do, what's the next big addiction?
SPEAKER_5: Is it going to be AI?
SPEAKER_2: Oh my God, that sounds like the worst reality show ever.
SPEAKER_2: The next big addiction.
SPEAKER_6: Gosh, I know.
SPEAKER_6: I'm trying hard to prevent people from getting addicted to more stuff.
SPEAKER_3: Well, we've already seen that movie.
SPEAKER_3: It was called Her.
SPEAKER_3: That movie's been made.
SPEAKER_6: Yes, yes.
SPEAKER_3: Oh, yeah.
SPEAKER_3: Yeah, the main character's addicted to this AI woman on his phone.
SPEAKER_3: And then you see everybody around him addicted to their own AI lover.
SPEAKER_3: Right.
SPEAKER_3: It's because people were left to their own devices.
SPEAKER_6: Very well put.
SPEAKER_2: I saw what you did there.
SPEAKER_2: I saw what I did there.
SPEAKER_3: Listen, Anna, this has been a delight.
SPEAKER_3: On a sad topic, you shed some important light on it for us all.
SPEAKER_3: Really?
SPEAKER_3: And it clearly hasn't or shouldn't end here.
SPEAKER_3: We will totally find another reason to bring you back on, because this is a never-ending challenge that we all face, if not for ourselves, but for loved ones, or certainly for society at large.
SPEAKER_3: So, thank you for your expertise there.
SPEAKER_3: And your two books.
SPEAKER_6: You're very welcome.
SPEAKER_3: And your two books.
SPEAKER_3: Give me the names of those again.
SPEAKER_3: I love the first one.
SPEAKER_3: Drug Doctor MD.
SPEAKER_3: What was that?
SPEAKER_6: Drug Dealer MD.
SPEAKER_3: Drug Dealer MD.
SPEAKER_3: Great title there.
SPEAKER_3: Who publishes these, by the way?
SPEAKER_6: The first is Johns Hopkins University Press.
SPEAKER_6: And the Dopamine Nation is published by Dutton Penguin Random House.
SPEAKER_3: So that means it's got good distribution there.
SPEAKER_3: Well, we'll look for that.
SPEAKER_3: All right.
SPEAKER_3: So Anna, thank you for being on Star Talk.
SPEAKER_6: You're welcome.
SPEAKER_6: Thank you for inviting me.
SPEAKER_3: All right.
SPEAKER_3: Chuck, Gary, we out.
SPEAKER_3: It's a pleasure.
SPEAKER_3: It was a pleasure.
SPEAKER_3: This has been Neil deGrasse Tyson, your personal astrophysicist, for Star Talk Special Edition on addiction.
SPEAKER_3: Until next time, as always, keep looking up.
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