Finding Balance In The Age of Indulgence w/ Dr. Anna Lembke

opioid system and ultimately releases dope mean. So we're all wired a little bit differently, and what may release a lot of dope mean in your brain may not release as much dop mean in my brain. And advice VERSA.

Doctor Lempke's latest book, which is the main topic of discussion for today, is called Dopamine Nation, Finding Balance in the Age of Indulgence. This book is very timely. Dopamine is a transmitter that affects our motivation, exploration, and our pleasure. While dopamine is not the pleasure molecule necessarily, it is involved in setting our expectations of reward in the future

based on past experiences. This can cause all sorts of problems, especially when we are no longer receiving pleasure from engaging in something that once gave us pleasure. In this episode, we discuss the implications of doctor Lemke's research for helping you do a dopamine reset and take control over your life and what you actually want to be rewarding. So, without further ado, I bring you doctor Anna lem Hey, doctor Lemke, welcome to the Psychology Podcast.

berries were safe to eat and which weren't. You had to know where the lions den was, and a lot of the purpose of our existence is essentially taking in novelty, metabolizing it, so to speak, making sense of it, and then using that information to inform our next steps. And dopemine is crucial for that. It's the chemical that says, hey, this is something you need to pay attention to, potentially approach, get more of, investigate because it's important for survival.

So for some reason, for well, for that, for that reason, things like sex, uh, well we didn't have money, you know, back then, but just what the whole concept of money, you know, and and power are things that were The things we call competitive rewards seem to be more inherently dopamine inducing than intellectual stimulation. But we can get to that later because it is interesting. I think some people do have what I've called a nerdy dopamine pathway in

the prefontal cortex. So we could talk about that later. But it seems like from evolutionary point of view, is that is that right? Is that? Is that? Is that a fair statement that there are certain things that are just more captivating to our dopamine system because of our evolutionary systems.

like cocaine or methamphetamines. Some of those things work through a complex chemical cascade, like alcohol which works on our endogenous opioid system or indogenous GABBA system and then ultimately releases dope mean in the reward pathway, or sex which which works on our serotonergic system also our indogenous opioid system and ultimately releases dope mean. So you've got both proximal and distant levers contributing to the release and how

much of dope mean in our dedicated reward pathway. And then on top of that, you have enormous interindividual variability, so we're all wired a little bit differently, and what may release a lot of dope mean in your brain may not release as much dop mean in my brain, and vice versa. And from an evolutionary perspective, that makes sense. If you have a tribe that needs to shepherd scarce resources in order to survive, you don't want everybody going

for bison or everybody going for blueberries, right. You want folks to be attracted to different things so that collectively we have all the things that we need. So that's how I would think about that In terms of you're mentioning sort of nerdy dopamine, hits or intellectual rewards. We know that learning releases dope me in the reward pathway, and I could you know, it makes sense that you have some people who are wired more for learning than others.

Sometimes some of us are more cerebral, some of us are more physical, So our appetites will differ based on our uniqueness. The key thing about substances and behaviors that ultimately end up addicting a lot of people are that they tend to release a whole lot of dope mean very quickly, whereas things that release dope mean that tend to be less addictive are things that release less dope mean more slowly and often require more upfront effort to get them.

When we're exposed to a substance or behavior initially, if it has what's called salience for us, what we mean by that is that it releases dopamine, so it is triggering our approach response, So it is related to pleasure or like the initial exposure, but with repeated exposure, our brain adapts and ultimately resets dopamine not at baseline levels of dopamine firing, but below baseline in a chronic dopamine

deficit state, which is the addicted brain. And then then our seeking mechanism is propelled primarily by wanting and primarily dopaine is then primarily mediating motivation rather than pleasure or liking. But it must us to begin with salience, some degree of pleasure, some Oh, yes, this is something that felt good and I want to do it. I'd like to do it again. If that makes any sense.

that gets us out of bed in the morning. Yes, if we didn't have any dopamine production, you know, as as some disorders, right, we see what happens. You know, there's a rate with lethargy, you know, lack of motivation. So we want it. But at the same time, it can cause us to run for things that are no longer serving our growth or maybe maybe never even served our growth, because there's a differencing pleasure and meaning, right.

directionality perspective, the same as getting pleasure in terms of you know, how our brain is reading that largely we have a very vivid memory for those initial exposures, but with repeated use, after it stops working and then can even turn on us and do the opposite of what we're seeking, we tend to not encode that with the same kind of fidelity, and we have what's often referred to in the field as youphic recall, where we're now

just remembering those initial exposures, the early highs, and the rest of our sort of behavior is in the service of trying to recreate those initial highs, which can get us into a lot of trouble because then we can't

see clearly when it's no longer serving that purpose. I would also just add that you're absolutely right that you know we're all releasing dopamine at a kind of tonic baseline level, but that can differ between persons and people who have depression, for example, are thought to probably have lower baseline tonic levels of dopamine firing. The state of being addicted is essentially the state of progressing toward a lower level of dopamine firing, so really looks very much

like a clinical depression. So whether you know. In other words, some of us come into the world with a lower baseline dopamine level, some of us acquire a lower baseline dopening levels because of exposing our brains to these high rewards over time. And then there are other forms of psychopathology characterized by abnormalities in dopamine levels.

itself cannot cross the blood brain barrier. So we give these dopamine precursors that get converted to dopamine in the brain and then bind to dopamine receptors in the substantial nigro which allow for a more fluid movement alleviating the symptoms of Parkinson's, but problematically also bind to dopamine receptors in the reward pathway, the reward circuitry, just like other dopeminergic substances and behaviors, i e. Intoxicants do leading to

addictive behaviors in people who take dopamine precursors for the treatment of dopamine. So about a quarter of folks who get dopamine precursors to treat their Parkinsons will actually end up with a compulsive shopping disorder or a compulsive sex to pornography and masturbation disorder. And these disorders tend to be dose dependent, So when the dopamine precursor has stopped, the symptoms not in all cases, but most often tend to get better or resolve.

So so in that sense, you know, as a cognitive scientist by the way, who studied intelligence and working memory, I don't think we realize the extent to which dope mean also plays a role in our working memory and how some people have genes. I mean, we can really nerd out here d r D for there are certain genes that that uh, for certain individuals from an individual difference perspective, too much dope mean influx in the prefilt the cortex can cause them to have reduced working memory capacity.

And I find that super super interesting. There seems to be like an optimal balance there.

or pre prefunt the cortex. There is an interesting relationship between dopamine production and the ability to you know, for instance, ADHD is relevant here, right, you know, being able to concentrate, being able to focus, being able to hold multiple pieces of information in your in your cognition at once. And I only bring this up as just just to explain and to and for just purpose of discussion that we're

not when we talked about dopamine. It has far reaching consequences across the brain, and we're not just talking about sex and druss.

ADHD and dopamine. I think people are very wanting knowledge about that, and I mean, I wouldn't say it's my area of real expertise, but what I do know is that there are studies showing that people with ADHD may indeed come into this world with a lower baseline level of dopamine firing, which means that they're relatively insensate to rewards, which means that they need more potent rewards a priori to get any kind of reward response at all, which

may go some way into explaining the kind of impulsivity that's often associated with ADHD, impulsivity being difficulty putting the breaks between a thought or desire to do something and actually doing it because they're in an embodied way experiencing the stimulus differently than people who don't have ADHD. So I think those types of findings are really interesting.

schizophrenia have. You know, we think of that as a form of psychopathology, but we could equally well conceptualize that as just a different way of processing information, a different way of experiencing certain types of emotions, mediated in part probably by dopamine because we know that when we give dopamine blockers to people those symptoms, those symptoms tend to reduce.

So we infer from that that don't meine is involved in this experience of hearing voices other people don't hear, seeing things that other people don't don't see, you know, which we have organized into this this bucket we call schizophrenicform disorders. But it's all very interesting.

little a little of both. There's one finding in your book that really I fell off my chair and I just had to I just I can't stop thinking about it.

interesting to me. Could you explain that finding a little bit more.

the definition of addiction. And what the researchers did was they measured dopamine firing when pathological gamblers won at gambling and compared that to when non pathological gamblers, what we'll call moderate, non risky or healthy gamblers, just recreational gamblers.

And what they found was that with winning in a game that required that it included uncertainty and risk and monetary reward, the potential for a monetary award was that with winning, both pathological gamblers and recreational gamblers had increased

dopemin firing, but with losing. Recreational gamblers did not have an increase in dope mean, but pathological gamblers had an increase in dopamine firing even when losing, which maps very nicely onto the phenomenology or the subjective experience of pathological gamblers, who will often report what's called loss chain, where they actually want to lose because losing justifies in their minds staying longer gambling, or staying in the game longer, which

is essentially what they want. The game itself is the drug,

it's not necessarily the monetary reward. And for pathological gamblers, the highest dopamine release, or the peak and dopamine release was when there was an equal chance of winning and losing, So that point of maximal uncertainty was the biggest high for pathological gamblers, which is really fascinating because what it suggests is that on some level we like uncertainty, and we crave and need it even as we're making enormous efforts in our lives to kind of try to control

the outcome and control our experience.

And initially they paired lever pressing with sugar release, which is rewarding for rats, so they will press. Rats will press a lever just for sugar water, but they also saw the selfie and with repeated use, even when the even when the sugar water was stopped, the rats compulsively pressed the lever to get selfies of themselves. So in fact, even rats like to look at their own image. Who knows, maybe there's a rat heaven. They'd be willing to press a lever for.

think about dopamine. And I've been thinking about that. You know, I've seen there's a certain kind of guy that you know, has women falling all over him, but he keeps all of them at this sort of fifty percent uncertainty and he drives them crazy. Now there's this archetype of this guy. And I've had friends, I've had guy friends. So I think humans can co opt this right to kind of like have people dependent on them, And you can see

it with codependency relationships. Perhaps, so am I making any sense? Does this? Can we link this?

Most often these just happen to be women more often than men, who are often connected or pursuing or in relationship with a man with more of a narcissistic type of character structure. And what we essentially mean by love addiction or codependency is that the individual becomes addicted to the other individual and then essentially uses that person as a way to manage their own emotionality, manage their own

emotional needs. Often when a codependent person and the term codependency originates from the addiction world right where you have the person who's the addict, and then you have their codependent loved one who is trying, often nominally trying to help them, but also simultaneously can in their behaviors, perpetuate

or what we call enable the addiction. So you have a very strange kind of push me, pull me situation where it looks on the surface as if the loved one is trying to help this person get out of addiction, but really they're not because the dynamics of the relationship itself become a drug to them, and then they engage with that person as a way to try to predict and control their emotions. So the evil we know is better than the good that seems out of reach. That

kind of thing. There's also speculation that domestic violence is related to dope mean release right right, The kind of uncertainty of knowing if your partner will lash out, and then the pain when they do, followed by the making it up afterwards. This whole cycle can become for some individuals reinforcing and quite addictive, and is probably mediated by dopamins.

So yeah, and I think in this day and age of social media, we're all more vulnerable to getting addicted to other people because the me itself has distilled human relationships down into their most addictive components. So we know that, for example, oxytocin, the love hormone, is released when we

have an intimate connection to another human being. It's involved in mother pair bonding and love bonding, and the work of my colleague Rob Malenka here at Stanford has shown that oxytocin binds to dopamine, releasing neurons in the reward pathway and leads to the release of dopamine, which is why falling in love feels good. No surprise is there.

But social media has essentially again distilled human connection down to its most addictive components, where for very little upfront work, we can have a lot of reward, beautiful face and intimate connection, and the moment it becomes distressing or frustrating, we can just delete it or swipe right or swipe left and find somebody else. So that now more and more of us, I think, are engaging with other people in a way that is really addictive. And this explicitly

plays out with dating apps. We see lots of patients who are addicted and harmed by dating apps. Dating apps, on some level, you could argue, are engineered to be addictive because they really don't want people to successfully match with a partner and leave the dating app. What they want people is to stay in the dating app and

keep looking for other people. So there's you know, there are ways in which the medium itself really does contribute to compulsive, addictive orientation on human relationships.

and I thought it was really clever. Part of your advice was you would go through you go through each other acronym. It's dopamine. You turn out, you turned dopamine into an acronym, right, right, So could do you mind if we go through that a little bit?

on their own and wasn't able to. This is really an early intervention for people with you know, the sort of mild to moderate forms of But D essentially stands for data. That's where we try to get information what people are consuming, how much and how often, not just for drugs and alcohol, but also for all of the

digital media that essentially represent digital drugs. So how much time on social media, on YouTube, on pornography, on online shopping, on LinkedIn, on the internet more globally, and when we discover heavy daily use and you could you know, we don't have a lot of data on what constitutes heavy necessarily for a given individual, but you know, you have a sort of a good shelt of like, oh gosh, this person's repeatedly staying up till one, two three in

the morning, waking and not getting enough sleep, waking up tired, using even when they shouldn't. Those are the types of things that we're looking for. So data is a way to just get the information what are people doing, how much and how often? O of the dopamine acronym stands for objectives. Why are they using? Raadly speaking, people use for one of two reasons to have fun or to solve a problem. Importantly, what starts out is fun and adaptive.

Often with repeated use becomes not fun and not problem solving. But we'll get to the next letter, which is the P, which refers to problems related to use. And this is where we just asked them talk about what are the physical, mental, relationship, work, school, psychological, spiritual problems as a result of this behavior. And sometimes the problem is just an opportunity cost, right, the things I'm not doing because I'm spending so much time watching YouTube.

So we try to lay out those things. And then the A of the dopamine acronym stands for abstinence and asceticism. Abstinence is where we ask them to do a thirty day dopamine fast from their drug of choice. So with a sex addiction, that means no orgasms with yourself or others for thirty days. Somebody, Yeah, yes, it's you know. Admittedly, especially if you've been using let's say masturbation as a coping strategy for emotion regulation, it's hard to imagine how

you could go without. But that is the ask. We always want people that they're going to feel worse before they feel better, because they're going to be in withdrawal, but that the bad feelings, the universal symptoms of withdrawal, anxiety, irritability, insomnia, depression, and craving are they peak within about ten to fourteen days, and then they tend to get better, and people can make it the full thirty days, they find that they feel so much better, not just better than they did

when they were going to keete withdrawal, but actually better than they have in a really long time. And what I want to emphasize here is that actions have to come before feelings. We can't wait until people feel like giving up their drug of choice, and I use the term drug very broadly to encompass behaviors. If we wait

for that, the day will never come. We have to have them experience, in an bodied way a difference in their lives to be able to then form cognitions and emotions based on this lived experience that will allow them to make better choices in the future. So really really important to emphasize that, and I think especially in mentalhealth, where you know, in many instances we appropriately spend a lot of time asking people about their feelings, their motivation,

their thoughts, but don't necessarily move them to action. We're waiting for them to be motivated for action. Sometimes you just have to say, you know what, that's not going to come. You just have to you have to try to change change this behavior, and then the feelings will follow. And the A also stands for asceticism, which is this idea of doing something more painful than the pain of withdrawal as a way to speed up the process of

resetting reward pathways. Because we know, for example, that exercise is immediately taught sick to cells, but we also know this exercise is good for us and makes us feel good. Why is that Because the body senses injury and then in response to that micro injury up regulates feel good neurotransmitters like dopamine, and then those dopamine levels will stay elevated even hours after we stop exercise, before coming back down to baseline levels without going into that dopamine deficit state.

That set that sets up the craving, which is why most of us don't crave exercise the next day. We have to remind ourselves, oh wait, I feel better after exercise. So the asset of SIMS is leaning into right sized pain in order to upregulate dopamine levels. And let me

just emphasize in our patient population. For many of our patients today living in the world today, just getting up off the couch, turning off the phone, going outside without a device and walking around the block is extraordinarily difficult and painful. That is leaning into pain.

thing with exercise. Exercise is good for us, but now it's tied to social media. We're now making these comparisons on leader boards and other social media sites. People are counting themselves and counting their heart rates and their steps, and you know, down to the micro how hard they're working. And that enumeration also increases the addictive nature of these activities because then we get very fixated on the numbers,

wanting to improve the numbers, improve our rankings. So we've also you know, drugified exercise, which is unfortunately unfortunate.

We have to learn to sit with those uncomfortable emotions and watch them kind of pass over us like a wave. The eye stands for insight. It's amazing again how much we learn about ourselves when we do a dopamine fast and give up our drug of choice. That's really impossible knowledge that's impossible to acquire any other way. It is experiential knowledge. The end stands for next steps. People come back after four weeks of abstaining from their drug. Oftentimes

they're very surprised at how much better they feel. Some don't feel better, and that's information too, But in general, even those folks who do feel better, typically they want to go back to using their drug of choice, but they want to use less. They want to use in moderation. So then we talk about exactly what they will look that will look like, and the devil's in the details.

I spend a lot of time with patients going through Okay, what days are you going to use, how much, with whom in what circumstances, what are your red flags for knowing that you're slipping again, or for people who want to continue to abstain from their drug of choice, how is that going to look? What self binding strategies are you going to put in place so that the drug is not immediately available? And then E stands for experiment.

That's where folks then take this new plan and these reset reward pathways and they go out into the world and they try again. So it's a cyclical thing, you know. Sometimes people are able to maintain their gains. Other times they slip up immediately and they're back to using possibly even more than they were before. Then we have to try another discussion, another intervention. So it's an iterative process.

coursing through your system. And there's so much heated debates. I go to psychological conferences where some people are adamant there's no such thing as sex addiction. There's a whole group of sex therapists who are well respected, who really believe No, it's just a compulsion. But then I'm getting all confused. I'm like, then, what's a compul what's the difference soon a compulsion and an addiction? I mean, I'm a psychologist twenty years of experience, I still don't fully

wrap my head around around all these distinctions. Can you help us shed some light on some of these distinctions for me? Sure?

three c's, as well as tolerance and withdrawal. So the first C is control or out of control use, repeatedly planning to use a certain amount and repeatedly going over. That second C is compulsive use. What do we mean by that? We mean a lot of mental real estate occupied with thinking about the drug and a certain level of automaticity around initiating drug use even when we planned not to. So again, some'm a loss of agency is really at the heart of the compulsive aspect of the disease.

And then the third C is consequences, especially continued use despite consequences. So there's sort of this notion that every single person with addiction is in denial and doesn't see the consequences. Denial is a big problem with this disease, where we don't really see true cause and effect of our behaviors on our lives, especially the negative behaviors. But there are many, many people with addiction who can clearly

see the harm and still can't stop. So those are the behavioral definitions of the behavioral broadly summarize the behavioral manifestations of addiction. And then there's tolerance, which speaks to the physiologic changes. Tolerance is needing more of the drug over time to get the same effect or finding at

the current dose it stops working. So if we are going to think about sex addiction, very often, what we'll see clinically as people who start out with kind of vanilla toast pornography and over time it stops working, so they need more and more deviant forms and might end up ultimately using child pornography, getting into trouble with the

law having serious legal consequences being suicidal. So the continued use despite consequences, including life threatening consequences, and we see that, which is why I think the argument about whether or not you know sex addiction is real. You know, I would invite folks if it were possible, to be a fly on the wall in my office, because clearly there are individuals for whom this phenomenology plays out in an identical way with pornography or other forms of sexual gratification,

as with drugs and alcohol. And then the final one is withdrawal. That is to say, when we try to stop or reduce our use of the drug, we experience it withdrawal phenomenon. For various drugs, the withdrawal phenomenon is usually the opposite of whatever the drug does. So people who are addicted to alcohol, which is a sedative, when they're withdrawing, they have hyper arousal. They can even have seizures,

a kind of physiologic storm. People who are addicted to stimulants like cocaine, their withdrawal will be characterized by extreme sedation and depression of the opposite. Again, the universal finems of withdrawal from any addictive substance or anxiety or ability, and so depression and craving. And for behavioral addictions, we see those psychiatric symptoms, but we also often see physical

signs of withdrawal. So getting back to sex addiction, I have lots of patients who when they give up pornography and masturbation for a month or try to, they will have extreme, debilitating fatigue, extreme insomnia, They will have headaches, and as they will have nausea, they will have hyperventilation. So it's it can be you know, the mind and body are so connective, of course it's going to be physical.

So yeah, so that that's how you diagnose it. You know, at the end of the day, sitting around sort of splitting hairs. Is this a you know, is this OCD? Is this an eating disorder? Is this an addictive disorder?

lot of recovery and really get their lives back. And so it works, right, it works. It doesn't work for everybody, but it works for enough people that it seems to me quite valid to use that addiction lens.

of us can resonate with that. Something that I found so interesting in reading your book is is some of the people who were addicted described that they lost track of time. Some of the things that they said seemed to seem to reflect that flow state of consciousness that we can apply towards maybe more healthier pursuits. But it just made me think philosophically a lot about I wanted to. I want to just like step up a second, you know,

a level in a very non judgmental way. So I guess I think you can have a compulsion without an addiction, right, Like you said that addiction involves the compulsion component, but also involves uh destroy, you know, like negativity towards harm, harm towards yourself and others. You can have a compulsion and not have harm. Right, So for me personally, I'll

give you a personal example. I took up magic as a hobby in January of this for actually, for the past year, I've become i'll use the word obsessed with mentalism. And I've been spending way too much money and magic tricks and I can't stop thinking about it now. And every day I wake up and I look forward to the day I look forward to like mastering a new trick,

you know. So I'm like, Okay, well, I think maybe I'm addicted to check at this point, but it's not really I mean, it's causing some harm with money the issues, but that aside, it's not like ruining my life, and it's bringing people joy. So I guess I'm really having a hard time articulating what exactly my point is, but it's something I just wanted to like talk through with you because I'm so I'm such a non judgmental person, and I feel like what brings one person flow and passion? Well,

you know what's the difference between passion and addiction? You know, Like, don't we want people to be passionate about what they do? Am I making any sense at all?

You know, if if somebody has certain sexual preferences that you know may not fall into whatever you know, we consider to be sort of standard categories, I wouldn't diagnose that person with anything at all unless they came to me and said, these behaviors are causing problems in my life because that of control use, compulsive use, continued use despite consequences, tolerance, why I need to use more over time to get the same effect, and withdraw when I stop.

So I think that's really important to make that distinction. You know, I'm not saying that anybody uses pornography as addictive, or anybody who makes pornography as a bad person, or any that, oh, there's only one type of sex that people should be have. No, I'm saying that the people who come to me who identify this as a problematic behavior and want help. Okay, let's talk about what's going on there now. Your other question, or the related question, was, well,

how do we distinguish between an addiction and a passion? Right, something that's a passionate hobbyer that I'm thinking a lot about. You know, we all have very busy minds, and it is generally healthy for us to have something for our busy minds to land on that's adaptive, contributing to the world in a positive way, creative, engaging. We need, we

need to stay busy. If we don't keep our minds engaged in a healthy way, we will ruminate on other things that we don't want to be ruminating on, right, that are not healthy or adaptive. So again, the same thing kind of holds if you're mad. Passion for mad is healthy. Gives you a reason to get out of bed in the morning, isn't hurting you isn't hurting anybody else. You're not going into financial debt because you know you're you know, because you're spending all your money you don't

have on magic tricks. If you don't have a partner who says they want to leave you because you never pay attention to them because you're always doing magic. I mean, these are the things that you know that we would

look for. And I want to contextualize all of that by saying we live in a drugified world where it has now become so easy to make all of these passionate hobbies more accessible, more potent, more bountiful, more novel, such that even something seemingly innocent as learning magic tricks actually could become an addiction. Where you know, fifty one hundred, one hundred and fifty years ago, it couldn't because there weren't a million YouTube videos that you could get sucked into.

There weren't a million things you could buy on Amazon, there wasn't the same amount of leisure time, there wasn't

the same amount of disposable income. So I think we need to qualify and circumscribe what we mean by addiction, how it's different from a passion you know how it's different from just somebody's preferences, But we also need to contextualize it in a world that has pretty much made everything addictive, such that even putatively healthy and adaptive behaviors now have the potential to be to become compulsive, you know.

It started with the Twilight Saga, and I was just sort of off and running, facilitated by a Kindle that I got, which then allowed me to sort of as soon as I finished one, I got another. Then I got all these free samples, and then I was essentially reading twenty four to seven. I couldn't wait to get home at night so I could just read. I wanted to be done with my kids so I could read. I was up till two three in the morning reading, took romance novels to work, reading in between patients. I

just didn't want to be in my own body. I just wanted to be in this kind of escape, fantasy place, and ultimately started to get more depressed, more anxious, and didn't see what was happening to me until it was pointed out by somebody else exactly what my patients described when they get addicted to drugs. Now, I decided to fast from romance novels for four weeks, as I recommend my patients. I was shocked by how difficult it was. I had a terrible time sleeping at night.

now there's no appeal for me in the genre. It's like I've sort of burned out those neurons, which is that wanting more than liking thing that we started with, right, where you get to a point where you've kind of, in a way, you've exposed your brain to your drug of choice for so long that there's no possibility of pleasure there anymore, even though I'm still drawn to them, like I see them and I want to read them, but then I begin to read them, I don't experienced

pleasure for them. It's like I've changed my reward threshold for romance novels and they probably will never be pleasurable pleasurable again, which is sad. Right, It's a grief reaction, and that's a lot of what people addicted to drugs and alcohol feel knowing they have to give up their drug on some level wanting to, but on the other level of feeling a real kind of grief reaction.

and pleasure. I think a lot of people responsively practice BDSM, you know, have enjoyed pain, but do it in irresponsible, healthy way. As you can tell, I'm very open minded and non judgmental about people if they do things in consensual, healthy ways, you know. And so people need to I think this point of your book is people need to find in their own way the best healthiest balance. Yes, iain and pleasure. I do agree, and I think.

In this way, the world may reveal itself to you as something magical and all inspiring that does not require escape. Instead, the world may become something worth paying attention to. Doctor Lemke. Is such an honor to talk to you today and thank you for all the work you've done to really heal and help people rediscover or discovered, maybe for the first time, the meaning and all that exists in the world.