EP #97

Dopamine Nation with Dr. Anna Lembke

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In this episode of the “Alcohol Minimalist Podcast,” Molly introduces the concept of “More Sober October,” encouraging listeners to set their own alcohol-free goals for the month, whether it’s one or more days. She emphasizes the importance of collecting data and understanding the role alcohol plays in one’s life, suggesting that an evaluation of the relationship with alcohol should involve asking if there are problems related to its use. Molly discusses the significance of a 30-day abstinence period, referencing Dr. Lemke’s advocacy for this approach to reset brain pathways and evaluate habits accurately. She explores the mental approach to abstinence, emphasizing the need to address the underlying reasons for drinking. Guest Dr. Anna Lembke, a mental health professional, shares insights into addiction, neurochemistry, and the importance of a dry, weary period for self-reflection. The episode delves into the challenges of moderation and abstinence and concludes with a discussion on the dangers of misinformation about dopamine and the significance of understanding brain function in changing habits.

Hey, it’s Molly from alcohol minimalist. What do you do in this October? I would love to have you join me in my more sober October challenge. What do I mean by more sober October, it simply means that we’re going to add in more alcohol free days than you currently been doing, whether that’s one or two or 31 It’s up to you, you get to set your own goal and that’s why it’s more sober October you can check it out and learn more at get that sunnyside.co/molly It’s totally free. I’ve got grises I’m going to be going live every week to announce the prize winners and it’s just going to be an awesome event. So I would love to have you join me you can learn more at get.sunnyside.co/molly and you can get registered Today. Well hello, and welcome or welcome back to the alcohol minimalist podcast with me your host Molly Watts coming to you from Gosh, folks. It’s just been unrelentless the rain, just windy, blustery, cold, not cold enough to snow. That’s that’s never the case. Although this week when it clears up a little bit and we don’t have as much rain. That’s when it will get cold around here. So right now we’re just in this constant pattern of low 40s and lots of rain. Welcome to the Pacific Northwest during late fall early winter. Today on the show, I am so thrilled to bring this conversation to you and just want to say upfront how much I appreciate the time the consideration the candor of our conversation. Dr. Ana Lemke. Dr. Lemke is the author of dopamine nation. She is also a professor at Stanford University. She is currently the professor and medical director of Addiction Medicine at Stanford University School of Medicine. She is the program director of Stanford addiction medicine fellowship, and chief of the Stanford Addiction Medicine dual diagnosis clinic. She is a diplomat of the American Board of Psychiatry and Neurology and a diplomat of the American Board of Addiction Medicine. So to say that she has well versed is a complete understatement. And her book dopamine nation has really brought to the forefront in just for all of us, right? It’s not just for people who are clinically addicted. But for everyone, the idea that we are immersed in a world that has so much so many consumables and whether it’s an end behaviors and activities that are deriving our desire or dopamine, and the book, dopamine nation shares in it, a an acronym so that dopamine actually stands for D equals data. And when you are observing a habit that doesn’t serve you like you’re drinking, potentially, right, you want to be collecting data. And daily use of a substance is a pathway to addiction. So we want to make sure that we are understanding the data that we have in terms of what our use looks like. O stands for objectives for using What does drinking do for you. What is it giving you how is it helping you we need to understand that we are getting something out of our dopamine seeking behavior, key problems related to use. Are there any problems alcohol is causing for you, I dopamine drugs, lead to problems if you use them regularly, this is in the book. And this is just one of those things, the more that you overuse substance, the more problems you’re going to get. And so when you’re evaluating a habit like your relationship with alcohol, you want to ask yourself, Are there problems related to the use? A stands for abstinence. And Dr. Lemke as you will hear is a very firm advocate of taking a 30 day abstinence period, and how it resets the pathways in the brain pathways and creates the homeostasis for dopamine that we need to be able to truly evaluate a habit. And we get into that in quite some depth in this conversation. Because I of course, came at this from a different perspective and didn’t take a 30 day abstinence period until I had greatly reduced my alcohol use. So we talk about that. M in dopamine stands for mindfulness, when you first stop, you can get withdrawal feelings that may make you feel worse, and you just need to tolerate that pain, you need to be mindful of it and really understanding that, that the connection between your cognition and your feelings, and your actions is something that is so important. And really, only when our prefrontal cortex, our brain’s ability to observe its own thinking, when we’re able to step into that is a way that we are going to be able to create sustainable change for ourselves. Buy in dopamine stands for insights. And what insights do you have about how taking this abstinence period is, you know, what do you learn about the habit? What do you learn about yourself? What do you learn about why you might be choosing to what were you getting right? And stands for next step? So after this abstinence period, do you want to continue to abstain or moderate? Do you want to go back to using to drinking again, but using it less? This is something she talks about and how the fact that if you’re not looking for an abstinence based program, then there is the ability to moderate if you but you’re going to have to have some binding, and she talks about that in the book as well. And E is experiment, what I loved about our conversation is she talks about the fact that, you know, you’re going to figure it out, right. And I really believe that I believe all of us, we have the ability to use our beautiful, brilliant brains and figure out the relationship we want to have with alcohol. And the ability to moderate has become more important because of this overabundance of dopamine stimulation available in the world. And it’s truly a skill that we all need to learn whether it’s alcohol, or anything else. So I cannot wait for you to hear from Dr. Ana Lemke. And I encourage you if you haven’t already read it. Pick up dopamine nation. Here is my conversation with Dr. Otto Lemke. Hello, Ana, thank you so much for taking the time to join me on the alcohol minimalist podcast. It is just so exciting to have this conversation with you. I’m really honored that you are taking the time out of your schedule to do it. Oh, my goodness, I’m so happy to be here. Thank you for inviting me. Yeah. So in the introduction to our conversation, I shared information and the acronym for dopamine that you share in dopamine nation. And it’s so it’s such a great framework. And I really loved that because, as I mentioned to you earlier, it aligned very closely with my own experience in changing my relationship with alcohol. Now I know you are a psychologist, a psychiatrist, psychiatrist, yep. Tai Chi interest. Yes. And you work with people and have worked with people who are technically so I want to get your thoughts on this physically, and or psychologically addicted to a substance? And do you believe there’s a difference between physical and psychological dependence on on substances? Well, technically, the way that the DSM defines it now there is a difference. And that physical dependence alone on any substance, but especially one that’s prescribed by a doctor, in some form, cannot be counted as a form of addiction. I personally am quite skeptical of this idea. Okay. I think that once we develop physical dependence, we’ve crossed some kind of Rubicon where we’ve changed the brain. And we’ve changed the brain, you know, in the way that we know the brain is changed when when we become addicted. So I really do think that physical dependence is is a form of addiction, and almost always also accompanied by the psychological aspects the Learning behavior, the habitual pieces of it, I’m not sure we can really differentiate those two, I also think it kind of makes it a false dichotomy between psychology somehow not being biological, and then the physical piece being biological. And of course, we know that, you know, our thinking and our emotion, all that is, is rooted in biology and in our neurotransmitters in our neural circuits. So I appreciate why the DSM Diagnostic and Statistical Manual has made this distinction. I’m not sure, though, that it really speaks to anything that’s can really be shown to be a distinction biologically, and ultimately, I’m not sure how useful it is. Yeah, I think that so for me, what I what I find to be the reason that I or even consider it or, or look at it is because there’s a lot of misunderstanding or people have beliefs about their dependence on alcohol. And there’s actually quite a bit of, of research that shows that not as many people are actually physically dependent, even though they want to believe that that’s, that’s the cause of their issue. I really think that most people probably develop a psychological dependence on alcohol or, or any other dopamine rich substance before they develop a physical if they will ever develop a physical dependence, that psychological dependence is probably a precursor. Would you agree? The psychological dependence in my mind is physical? Right, that, that but but you’re making an important point. And let me try to articulate it in based on my experience, I have a lot of patients who come to me and say, Well, I can stop drinking, no problem. I don’t have significant withdrawal. I can go for long periods or days at a time and I don’t have withdrawal. So therefore I am not addicted. And I think that’s what you’re getting at. You can be very, very addicted to alcohol and not experience significant alcohol withdrawal, in the sense of waking up in the morning with you know, tremors, you know, having DTS or you’re having, you know, for vacation, or the feeling that bugs are crawling all over you hallucinating, having seizures, that’s what a lot of people equate with alcohol addiction, you know, and being addicted to alcohol. But in fact, you can have none of those things. And the vast majority of people who are addicted to alcohol don’t have those experiences, and yet they are deeply addicted to alcohol. I always like to emphasize to that. We think of withdrawal as being primarily physical signs and symptoms, which for some substances for many substances and behaviors. There are physical signs and symptoms, but the universal symptoms of withdrawal from any addictive substance, whether it’s alcohol or your smartphone, or anxiety, irritability, insomnia, depression and craving. This comes up repeatedly with cannabis, for example, people so I’m not addicted to cannabis because I don’t have any physical withdrawal. Okay, well, when you try to stop, do you get anxious? Do you get depressed? Are you unable to sleep? Are you preoccupied this using then that’s withdrawal. Right? Right. And that’s really important because I talk about that a lot. There’s a there’s a neurochemical basis for that it’s actually the brain’s attempt to get back to homeostasis when you have continually fed at some substance in then it’s basically shooting up all those excitatory neurotransmitters and the way that we think that we need to resolve that is by taking this up since again because that’s the that’s the thing that will but it says that that’s that many withdrawal that people are getting that is really what what they’re feeling when they feel those anxiety or stability and yeah, so I this is a this is a kind of a sidebar because I already have have shown my true colors of being a sort of an armchair psychologist, is there danger in this world of this kind of so much information on the internet and, you know, lots of things that we’re learning and hearing about dopamine so right i I’ve, I’ve educated myself quite a bit on neuro chemistry. And I really believe that it helped me to resolve my relationship with alcohol, which, you know, it helped me change a daily drinking habit. I know you share in the book, your you know, your divergence with with romance novels, which I can appreciate because I love a good I love reading so I you know, that was that was interesting to me. But do you think that there’s danger or misinformation or unhelpful messages that we hear about dopamine specifically coming out in the world today? I mean, some people might say that, you know, my, my message. I mean, you know, who knows? I mean, you know, yeah, I mean, there’s a lot of there are a lot of people out there, you know, talking about a lot of things and you know some of its obviously unreliable some of its unreliable in a more subtle way. You know, I like to think that what I’ve put forward is grounded in the science. But you know, the science is also changing 50 years from now, we may have a different conceptualization of the exact mechanism of dopamine and an addiction, because we’ll have more knowledge hopefully. Right. Right. And, and also, importantly, you know, sometimes we oversimplify, in order to communicate a fundamental truism, which I think is important to clarify, you know, as you know, in dopamine nation, I use this metaphor of the balance and the gremlins. Now, that’s clearly an oversimplification of how the brain works. And I don’t pretend otherwise. But in this age of information overload also, because I’m talking to a lot of non non scientists, you know, I want to communicate something that’s fundamentally true and real about how the brain works. And part of the way to do that is to leave out some of the nuances or details. So I don’t know if that answers your question, but that’s my Oh, it does. Yeah. And I think that that’s really important, too. I mean, the we have learned continued to learn about the brain, right. So like, neuroplasticity was not even a concept that people knew back in the early 90s, and even the mid 1900s, barely. And so, you know, all of everything that we continue to learn about the brain will just continue to evolve. And I think that’s really the, you know, what I love about it, right? The brain is, I call it my beautiful, brilliant human brain. I mean, we, as humans have evolved past the mammals. And you know, we have this beautiful prefrontal cortex that allows us to actually think and become mindful of our own thinking, which is not something that you know, everybody, you know, the other the other species can do. So it’s a pretty amazing thing. And you can allow us to achieve things in terms of changing some of these behaviors that may not serve us. So the 30 day abstinence period, I want to talk about this a little bit, because as I’ve shared with you, having a 30 day abstinence period was not something that I did until I had been working on my relationship with alcohol for a while. And if I had if someone told me initially, like, you have to do this, I would have I went, Well, I did. I reason I resisted that effort for a long time, because I was afraid of what it would mean, if I couldn’t take full 30 days. Now, I asked you kind of to bear out that it’s science based. And it’s also from your own experience, in terms of your clinical experience with all of the people that you’ve worked with. I also remember in the book you kind of talked about, it really depends on how much how much of a substance someone’s taking. So it’s going to be kind of Is it is it just, categorically 30 days, or talk to me a little bit about that? Right. So, you know, intuitively, you would think that somebody who had been using more of a drug in larger quantities for longer periods of time, would need longer, longer abstinent in order to heal their brain. And I think generally speaking, that is generally true. But what is pretty fascinating, based on my clinical experience, and also, you know, some some data out there some studies reflecting what I’ve and others, not just myself, many, many others have experienced clinically, is that there seems to be something about that one month mark, that is significant that if people can get to 30 days with not using there seems to be there’s it’s not like the brain is fully healed. But there’s some kind of tipping point that occurs, where they get out of you think of like addiction as this black hole kind of sucking us in. And when we’re right here, you know, we can’t even really see that the black hole sucking us in, but somehow we get here and also it’s like, oh, there’s a black hole, and it was sucking me in. And now I actually have a little bit of a choice, I can move toward that black hole and back to that place where I was being sucked in, or I might want to like go this way, you know, or maybe even orbit around it but not get sucked in. And that happens pretty consistently for the vast majority of people that we will see with 30 days of absence, whether or not there you know, heroin, alcohol, cannabis, whether they’ve been using for decades, they’ve been using for for months, two weeks. So that’s all I can tell you from clinical experience. There’s something important about those 30 days now, as you know, you know, I include in the book a study by Nora Volkoff and her colleagues, which looks at the brain at the two week mark, and looks at dopamine transmission to the two week mark and sees that people who have been using substances chronically are still In that dopamine deficit state, they’re still here by the black hole at two weeks, right? Somehow, I can tell you clinically a four weeks, it’s like dopamine transmission starts to upregulate. Right? The brain gets the message, oh, wait a minute, I’m not getting all this dopamine from these external agents, I need to start making my own again, right? The prefrontal cortex, which is that large gray matter area right behind our foreheads, so important for future planning, appreciating delayed consequences, autobiographical narrative that gets back online, and we’re able to say, oh, my gosh, who was that person who prioritized substance use or addictive behaviors to that extent, I don’t want to be that person again. So 30 days is it’s not like, Oh, good, you’re good now, you know, 30 days. But there is some kind of a ha moment that that happens for the majority of people no matter what their prior level of use was your level of addiction. Hey, all just a quick break in the show to talk with you for a minute about sunny side. It’s fall and it’s time for tailgaters and holiday parties on the horizon. There is never a better time than right now, to put a mindful plan into place. And Sunnyside is my recommendation for how you can really use a tool that provides a way to track your drinks, measure your progress, and really uses proven behavior change techniques to create lasting habit change. The thing is, you can reduce your drinking by 30% in the first 30 days with Sunnyside and you can save over $50 a month, cut out 2500 calories out of your diet. And these are just based on average results. I know that people that I talk to and people that I work with are using sunny side and getting great results. If you’d like to find out if it will work for you go to www.sunnyside.co/minimalist to get started on a free 15 day trial today. We’re heading into dry you weary which January is this, this timeframe for people who are drinking alcohol especially for people who are not trying to become abstinent. And that I think we’ll talk about that in a second. Because I know you’ve you’ve had a lot of experience with with AAA with people that have used a and you’ve got a lot of colleagues that you’ve you know that you’ve learned from but this dry, weary period, do you think that there is significance in how you mentally approach a period of abstinence? Now I’m asking this because what I’ve seen happen is people do this dry weary, but the whole time they’re doing it the all they’re thinking about is when the dry weary period is over, I get to write. So is there I mean that that that thinking right causes a feeling of desire, there’s and that’s kind of what I talk about a lot is that connection, making the connection between the thoughts and the feelings driving the desire to drink? So does it matter if you go into a period of abstinence, how you are approaching it in terms of and becoming more mindful? Because M is mindfulness. Right. Right. Well, I mean, I think, you know, it matters and it doesn’t. So we often think in, you know, in the field of mental health, that it’s all about cognitions and emotions. And if we can just identify cognitions and emotions and change them, we will change their behavior. But what I do a lot of talking about is No, first we have to change the behaviors. And then the cognitions and emotions will follow. I have many, many patients who do that 30 days of abstinence entirely focused on getting to day 31 And being able to use or drink again. And the only way they can get through those 30 days is to, you know, plan on that. Does that make the 30 days not useful? Not at all, the 30 days is still incredibly useful, because you know, as we’ve talked about, it leaves enough time for the brain to begin to restore homeostasis to reset reward pathways to upregulate dopamine to be able to look back and see true cause and effect, which we don’t do well when we’re chasing dopamine or in our addiction. So the vast majority of folks who can get to those 30 days, even if they plan to drink again, they almost universally want to drink differently. They want to drink less, and they want to have a different kind of relationship to alcohol. So then the discussion becomes Alright, how are we going to do that? And the level of specificity here is really really key. When are you going to drink Who are you going to drink with under what circumstances how much What are you going to drink? What are your going to be your red flags, how are you going to keep track right and I not yet had in all my years, a patient who was able to do the 30 days, and then who was uninterested in engaging in that piece of it, they’re all interested in engaging in that piece of it. Now, I think what you’re getting at is sort of the big picture where Oh, yeah, I’m going to drink differently. Now I’m going to drink less, I’m only going to drink on special occasions. And immediately, there’s a special occasion every day. Right, right. Right. And immediately, you know, one drink is too many. And two is too few, as they say in a, you know, they’re plunge right back into it. But again, that’s all data, right? That’s that then there’s this kind of like, well, does is moderation working for you? Right? It often isn’t working. And then people come around to Oh, okay, you know what, I think abstinence is what I need to do. Moderation doesn’t work for me. Or maybe I was able to moderate but it was exhausting. And it wasn’t worth it. So I’m going to abstain. Or maybe it was, you know, what moderation is working. It’s with all of these barriers in place. It’s working for me. So I do think that even if you go into the absence period, thinking, you know, as soon as I get done with this, I’m gonna drink. I still think it’s an important exercise and informative exercise for most people. Absolutely. Well, I think it’s, you know, like I said, I encourage people to take the the dry, weary period. And really, yeah, I mean, we want to examine why we’re using anything, right? Why any substance, whether it’s alcohol or anything else, that’s dopamine driven. the why behind it, is really what we’re looking for in the glass. Right? There’s because I don’t think that I mean, most I talked to a lot of people in that. I mean, surely you do to where they say, Oh, well, it’s just I just love the taste of it. I just love this, I really, you know, or whatever it is, right? But I truly believe that there’s always a why they’re somewhere, they may not want to, you know, there’s there’s there’s work to be done it sometimes running in the unconscious, but no one develops a habit that doesn’t serve them or an overuse of a substance into unless they’re trying to solve some sort of why, in my opinion. Okay, so let me interject there, because we might have looked a little bit of a difference of opinion. First, I think one thing that we would agree on is that you can’t get to the why, while you’re still drinking, which is why it because in those first, when you’re in your substance use no matter what level you can’t see true cause and effect. It’s just our brains are, we’re so innately wired to approach pleasure and avoid pain that we cannot see the consequences of our drinking, when we’re in our drinking. So I absolutely agree with you that you need to get to sort of the possible wise, but it’s impossible to do that while you’re still drinking. And that’s why you have to do the 30 days to get clarity. But I guess the piece, which I always like to emphasize, which is sometimes you can have really the perfect life, and there isn’t some kind of underlying trauma or psychological problem, and you’re just addicted to alcohol, because alcohol is addictive. Right? It mimics you know, our own endogenous opioid system, our own endogenous GABAergic wizard, a calming neurotransmitter, the more we use, the more we want. And all of a sudden, you’re an addicted brain, just because you’re addicted. And I think that’s an important message. Because what I see a lot of is people trying to first of all get to the why while they’re still drinking, which, which, frankly, can create this victim narrative that just perpetuates consumption. But also then kind of like looking for trauma where no trauma exists. And I think that’s dangerous. Yeah, agreed. And I don’t think that there’s I think that that’s the why can also be just as simple why it doesn’t have to be a big one. You know what I mean? It doesn’t have to be a trauma, why? It can just be that that’s what we’ve trained our brains to do, because we’ve trained it into a habit pattern where it’s like, I get home from work, and yeah, right. And I and I’ve, I’ve, I’ve decided that the way that I unwind is by having a glass of wine, right? And so once you do that often enough, right? Your brain is just like, Yep, this is how we do it. This is what we do. Yes, right. It’s just very much setup for that kind of automation and so but there’s still a why the why that the story that I’m telling myself is that I needed glass of wine to unwind which is actually clinically not even true we do when we drink it’s we just talked about this it actually is probably causing me to feel more stressed out and anxious because in the long term in the long term right away yeah petition Yeah, with repetition right with the way the neurotransmitters work. I don’t know I have to do some I like I said, because my own experience was so different. I just I but I also was educating myself on a A lot of neuroscience educating myself on how the brain works, educating myself on understanding the habit system, the reward system, so that I really understood how I was driving the habit. So for me that in combination with making a plan ahead of time, and then, I mean, like I said, I eventually got to a point where I wanted to take a 30 day abstinence period. But I did that in a totally different way than I would have had I started. But I also I mean, like I said, it’s it’s, you know, who knows? Because from from most clinical standpoint, nobody would have said, Oh, you have a an alcohol use problem, right? I mean, I wouldn’t have looked like somebody who was physically dependent. I certainly wasn’t physically dependent. Same thing. But psychologically, I had a habit that didn’t serve me. So, you know, which is again, kind of a fine line to draw. Right between was it, you know, psychologically dependent, addicted? Or did I just have a really bad habit? Yeah, I mean, I hear what you’re saying. You’re saying that, you know, through your own study of the neuroscience, you came to understand what was happening in your brain. And that then motivated you to try stopping for 30 days? And I guess you’re implying that had you known that earlier? You might have tried it earlier. But until you had that knowledge, you weren’t able to get to that place where it seemed like a worthy endeavor? Well, now what I mean is that I took I was in the process of I had greatly reduced the amount that I was drinking, by the time that I actually took a 30 day abstinence period, I was already incorporating, I’d gone from a daily drinking habit of, you know, two, three drinks per day, pretty much every day and more on the weekends for decades, to then, you know, basically more alcohol free days than I did alcohol days. But that again, mean it for me, that’s what worked for me, I met myself where I was at I made doable plans. I slowly Incorporated. You know, it, there wasn’t that so there’s this weird thing with alcohol, right? Because if somebody is truly physically dependent on alcohol, it would be dangerous to cut off all the way completely right, you would do a medical titration you would because that there are degrees of physical dependency you can be you can be physical, physically dependent, in a much more mild degree and stop abruptly and experience some degree of alcohol withdrawal and be fine. Right? But But you’re absolutely right. If you’re, if you’re at risk for life threatening alcohol withdrawal, you would not want to stop abruptly. You wouldn’t want it medically monitored detox. But like I said, I wasn’t that wasn’t me at all. It was just the process that I went through. What I think I hear you saying is you probably could have gotten these results a lot quicker. Molly, had you done that? 30 day abstinence period sooner? I just, I don’t know. I don’t know. You know, everybody has their own process. It sounds like you didn’t go see a you know, a mental health professional. It sounds like you sort of read your way to this and changed your behavior. And I mean, I’m curious. So you reduced way down and then you decided to do the three Dave apps now? Why did you decide to do that? And what difference did it make for you? Yeah, no, it was dry you weary. That’s why I did it. So I had been working on my relationship with alcohol I had worked on the whole, you know, like I said, basically cutting, really incorporating alcohol free days having a plan ahead of time really understanding that I stick to low risk limits. I really educate people on those one drinks per day for me, I understood the science behind alcohol. I understood the chemical neurotransmitter imbalance, that that that dopamine deficit, really understanding what was going on in my brain, educating it, and really challenging the stories that I had around alcohol. Like, why I believed for so long that I quote, unquote, you know, like, literally, the thought that came in was I need a drink, right? It wasn’t true. I knew. I knew intellectually. I didn’t need one. I wanted one. Right. But challenging that story. Understanding the true science behind it really wasn’t no I didn’t wasn’t even serving me for what I thought I was accomplishing. Right, right. Anyway, bottom line is eventually I had an experience where I then over drank after having a lot of alcohol free, you know, time or not, I mean, just just a very lowered tolerance, probably right. And after that experience, I was very aware of that rebound anxiety. And I really, for the first time, like made that mental connection of right oh, this is what this feels like. This is exactly what’s happening. This is not I do not want this again. So I took a mini break right then in there like right after that for 12 days, that was in the middle of November. And then it I was doing research, I started to realize, like more and more the benefits of the alcohol free parts of my life. And so it just came in timing wise dry. You were it was coming in January. So it it you know what I mean? It felt like it was a doable timeframe. And then I had already shown to myself, Oh, okay, you can have multiple alcohol free days. And it can be beneficial. And you probably want to do this and see how it feels. So now I incorporate one alcohol free. I always do dry weary, it’s always an alcohol free month per year, multiple alcohol free days per week. Now alcohol free weekend, every month, because I want to always challenge my thinking around alcohol. And so yeah, and I help other people do the same, hopefully. Yeah, yeah, that’s great. So I mean, this is what, you know, I’ve seen clinically repeatedly over the years, which has made me you know, which is what inspired me to write Yeah, dopamine nation, in part, you know, folks coming in depressed, anxious, unable to sleep, also happening to be drinking heavily, but not necessarily meeting criteria for an alcohol addiction. And then my learning over time, well, you know, if you if you take a break from alcohol, all of these other psychiatric problems might just go away entirely on their own. And people being very skeptical of that, because, of course, in the moment, that drink does make us feel better. It does relieve anxiety and depression, boredom and makes us sleepy. But in an iterative fashion over time, you know, it doesn’t serve us well. And so it is that taking the break, that then allows people to have that moment of insight where they see true cause and effect, right, where they realize, oh, this substance that I thought was helping me rewarding me, taking care of me is actually the source of my not feeling well in the world. And that is a really important discovery. Because then I’m not sitting here trying to persuade this person, that too much alcohol is not good for them. They’ve experienced it. But you did it sort of differently, where you kind of slowly decreased and then binged, and then felt terrible. And you’re like, Oh, I get it. Now I see the connection. Usually, what we do with the 30 day fast is people feel better and better and better. And then they see the connection between not drinking and feeling better, which you did, too. But kind of slightly, slightly, your own version of that. So let’s say you have somebody who says, okay, yeah, I’ll do this. I’ll do the 30 day abstinent period, and then it doesn’t, then they screw up. Yeah. Talk to me about what that looks like, from your perspective. I mean, what I don’t want to say screw up, but when they are able to, yeah, when they aren’t able to stick to that plan. Yeah, so we talked about that upfront, we say, you know, this is the plan, they agree on it, we talk about self finding strategies they can put in place to try to optimize their chances of success. Sometimes we prescribe non addictive medications to help them optimize their success. You know, we put all the pieces in place. And then I always say, you know, before they walk out the door, I say, hey, you know what, and if you’re not able to do this, no shame, no blame, come back, we’ll talk about it, we’ll find out what happened. And, you know, sometimes what it means is, while you don’t have the volitional control over your alcohol use that, that you thought you did, we set this goal, you were on board, you weren’t able to achieve it, sometimes it’s like, well, you know, it just didn’t work out this month, pay, let’s do a reset, let’s try again, let’s try this next month and see how you do. Maybe we need a few other things in place there, that we didn’t have to help support you through this process. So it’s very much not a blaming, and also not a like a, you know, this must mean X, Y or Z. It’s like, Hey, these are experiments that you know, you’re doing on yourself, so that you can figure out what is your best, you know, life right? How can you achieve a life of balance and thriving and feeling good about yourself and, you know, good about your body and good about your relationships and all the things that we need and want. So this is just experiments and we tinker with the variables, you know, as we repeatedly we have a patient who sort of sets the goal and is unable to to achieve them or say, hey, you know what, maybe really, this is a sign that you are more addicted to this substance than you thought and maybe also you need a higher level of care. It’s unfair, it could be that it’s unfair to you to expect that you can stop using on your own just by continuing to work and be in your usual environment. Maybe you really do need to go and get what we call a higher level of care. Maybe you do need to go to rehab. Maybe you do need to go to like an intensive, day per Maybe you do need to go to Alcoholics Anonymous, right? So kind of, you know, sort of wondering aloud with patients about sort of what what will work for them in a non judgmental way. I know in the book you say that the tenants from AAA have long since have long been abstinence is the only way. I take exception with that mostly because not because I don’t agree that the safest amount of alcohol in anyone’s life is zero, that is a constant here in the show. I always talk about that in terms of if you want to have the most safe relationship with alcohol, it’s zero, there is no known safe amount. What I find to be counterproductive with that with the culture that AAA has kind of set up is that, again, it seems as though if you can’t do it, you’re a failure. And if you you know what I mean, and it sets people up for this kind of black and white, right and wrong moral impression of someone that that is over drinking. And so last thoughts on that in terms of I mean, and like I said, taking nothing away from the many, many 1000s of people that AAA helps, because I know that that it works for some people. And if it helps, I always say that too, if it helps you wonderful. But do you think there’s danger in just not reaching people that could benefit from doing some work on some habits that don’t serve them? If they think that there’s only one, there’s only one way out? Right? If that’s abstinence, or, or nothing? I think really what’s required here is just clarity on goals. And what I say to patients is, AAA is an abstinence oriented organization. So if your goal is abstinence from alcohol, lifelong absence from alcohol, or just even near term absence, alcohol, and you think you might benefit from that support from that organization, although the thinking really in AAA is that it would be a lifelong endeavor, then that is a good organization for you to check out. But if your goal is moderation, do not go to AAA. Because that’s not the goal of AAA. And that’s not what that fellowship is working toward. I don’t I think it’s unfair to say that AAA is, you know, shaming and blaming people for drinking in moderation, because the bottom line is that it’s an abstinence oriented organization like the right. Yeah, the only requirement to be a member of AAA is it’s a very short sentence, the desire to stop drinking, that’s it, you can show up intoxicated, but you must have the desire to stop drinking, if that is not your desire. That’s not the organization for you. There are many other organizations. And they’re, you know, increasing by the second today, especially with you know, the kind of online fellowships they’re developing, the goal of which is moderation. Go seek out those organizations for that goal of becoming alcohol minimalist. If you’re around here, that’s my My motto is alcohol minimalist, we want to stick to low risk limits. We want it to be a minimal part of our lives, right. And I think that goes for anything that you might be over consuming, right? This dopag nation. Thank you so very much for being here today. Folks, you have got to read dopamine nation, if you haven’t, I know I’ve already shared it with my audience. It’s on my recommended reading list. It is superb. And you will get so much out of it. Whether it’s your relationship with alcohol, or romance novels, or anything else that you might be over consuming. Learn because I really believe that helping when we understand better how our brains are working. It really helps it really it helped me and it helps. I believe it helps anybody and everybody’s capable of learning about their brain. Thank you very much, Dr. Lemke. I appreciate you taking the time. Oh, Molly. It was it was my pleasure. I hope I wasn’t too aggressive on pushing back on some things. Absolutely not. I love that. I want I want to have conversations about this. I think that’s the most important part. Right. And you too. Thanks for having me. Thank you for listening to the alcohol minimalist podcast. This podcast is dedicated to helping you change your drinking habits and to create a peaceful relationship with alcohol. Use something you learned in today’s episode and apply it to your life this week. Transformation is possible. You have the power to change your relationship with alcohol now, for more information, please visit me at www dot Molly watts.com