Dr. Anna Lembke is a psychiatrist, author and specialist in the treatment of addiction. Her new book, “Dopamine Nation: Finding Balance in the Age of Indulgence,” is available now.
As a Prison Recovery Worker who labours in the field of addiction, I found Dr. Anna Lembke’s recent appearance on The Joe Rogan experience to be both inspiring and encouraging.
She calmly articulated several viewpoints that I myself have long-held when it comes to addiction treatment. Whilst much of the first part of the podcast is taken up by Rogan talking about his own addiction to video games and attempting to distinguish between a level of commitment that leads to greatness (Floyd Mayweather Jr., Michael Jordan etc) – and addiction itself, the part of the podcast that really spoke to me was when Dr Lembke was able to share her practical experience of recovery work with her clients.
I was also impressed by the fact, that when Rogan predictably advocated for psychedelics and other mind and mood-altering substances as a potential treatment for addiction – Dr Lembke humbly stated that whilst her mind remained open to the possibilities of such treatments, she was also aware of the pitfalls of prescribing to those whose modus operandi is to seek out a drug for every occasion.
I have transcribed several excerpts from the podcast episode – and have shared it below, with some of my own thoughts on the subject matter.
Dr Lembke: “One of things that I have concluded is that there is no point initially in trying to figure out, one, why the person got addicted, or two, whether or not they’ll be able to get better. It’s a waste of time trying to figure out why initially, because it doesn’t matter. Whatever your doorway into addiction was, once you develop addiction, the intervention is the same and recovery starts with abstinence and requires all of the necessary interventions. Later on, you can spend time trying to unpack ‘how did we get here?’, what are some of the early antecedents, including childhood antecedents or trauma – although again there’s a danger there in focussing too much on the why and not enough on the ‘OK, how do I get better?’.”
The above reminded me of an encounter I had several months ago with a newcomer at a 12 Step Beginners meeting. I spoke with the man (six weeks sober, still obviously very shaky) after the meeting who informed me that he was attending a 12 Step meeting once a week and meeting with his counsellor once a week. He said to me: ‘I know I need to identify the underlying causes and the reasons why I drink’. I remember thinking to myself: ‘No, at six weeks removed from your last drink, you really don’t need to spend time identifying the reasons why you drink’. I suspect if I were to ask ten alcoholics in long-term recovery to tell me the reasons why they drank I would get ten different answers. In most cases, it’s a philosophical abstraction that really doesn’t matter.
My friend Mike once said to me: “I was thinking about what you said about whether or not it’s necessary to uncover the reasons why we drink. Well, I reckon that the danger for me, is that once I think I’ve figured out the reasons why I drank – or the underlying cause – then I could well be in danger of thinking I can drink again – because I’ve figured out the reasons why I drank!” This is, of course, a perceptive example of the insanity of alcoholic thinking. Another friend of mine in recovery has recently undergone some trauma counselling – related to a turbulent childhood and a violent father. Three years sober, he has a solid foundation in recovery – and felt ready to dig deeper. He also had a clear vision of what he was hoping to achieve in therapy. Something, I feel, that is vital to avoid being caught in a rut of perpetual obsessive navel-gazing.
Dr Lembke: “The other thing that I’ve learned after many years of being a psychiatrist, is that I am terrible at predicting who’s going to get better and who isn’t. I used to think that I could tell when someone walked through the door: ‘Oh, this person’s going to do great, or this person – there’s no hope’. Not true. I have had many patients where I thought: ‘There is nothing I’m going to be able to do for this person’ – and then witnessed a miraculous recovery. Others that I was certain would get better in a jiffy – and no matter what I did I couldn’t help them. I don’t predict any more. I don’t try to predict. I just take each person as they come and just try to essentially be a witness to their journey. And one of the tricks, at least my Achille’s Heel that I’ve learned over time is that if I identify with the person, I’m more likely to think that they’re going to get better and more likely to miss some key things.”
This is something that I can really relate to. As I often say: ‘’I’m not God and whilst I do my best to help people – I don’t get to decide who lives or dies.” I know people in recovery who have seemingly written their own children off – stating that they will never recover from addiction. This may be a mechanism to protect themselves from the painful emotions surrounding their loved one’s illness – but I prefer to operate with a ‘It ain’t over ‘till it’s over’ mindset Yes, there are those who will not recover – but I don’t get decide who they are.
I once had a sponsee who I devoted literally hundreds of hours of my time to in the first eighteen months of his recovery. Big Book reading sessions at my house, nightly phone-calls that would often last for over an hour, hundreds of messages and emails exchanged, attendance at meetings etc. He experienced real change as a result of working the program – and then stopped doing all the things that had got him well. He relapsed badly. I can now see that I was so invested in him and his recovery, identified with him so strongly (almost seen him as ‘Jules Junior’) that my normally fairly reliable sensors failed to function. I have also had sponsees who, I am pleased to say, are doing far better than I initially predicted they would. Like a gambler who never actually places a bet, I still make the occasional prediction – and am greatly amused when I am inevitably proven wrong. #NotGod
Dr Lembke: “Insight is certainly useful. When people have insight into the fact that they are addicted that is helpful but that’s not’s necessarily a guaranteed winner. I have had patients who had incredible insight into their addiction and don’t get better. So, insight is not the key, although it’s helpful. One of the things I’ve noticed over the years is that if I have a patient who comes in and they tell their story in a way that blames everybody else for their problems. That person is…”
Joe Rogan: “They’re fucked.” (Both laugh)
Dr Lembke: (Still laughing) “Let’s just say it’s a slow road. I wouldn’t say that they’re not totally not going to get better because one of the very interesting things that happens in the process of recovery is people start telling their story differently. And that, of course, is part of the 12 Steps of Alcoholics Anonymous: acknowledging our part and our responsibility and where we contributed to the problem. And when people are in really good recovery, they get really good at that – because of course that’s a muscle too, they practice, they’re constantly taking their own inventory. “I’m feeling uncomfortable, where might I have messed up somewhere?”
If I were to have written my autobiography the month before I came into recovery, it would be very different to the one that I would write at five years clean. That’s not to say that the linear narrative and biographical details would be changed, it’s just that the story would be told from a completely different perspective, one that would elevate the significance of certain episodes, whilst minimising the importance of others. In my early days in recovery, I thought of myself as a bold and fearless truth seeker. Now I’m older, I’ve come to realise that maybe that search for the truth is less important than the quality of the simple stories that we tell ourselves about ourselves and our lives.
Regarding the person who blames all their problems on other lesson that I learned early on in recovery, is that those with a deeply ingrained victim mentality are unlikely to get sober.
Joe Rogan: “What are your thoughts on treatments such as Ibogaine?”
Dr Lembke: “I’m not an expert in that area. I haven’t taken the time to really research it. It may not be addictive for the vast majority of people but for my patients who are vulnerable to addiction, it definitely can be, because anything that leads to a mind-altering experience of that kind of potency and intensity will be a draw for them. I’m open to the possibility of such treatments. I do believe that getting a totally new perspective on our lives can be life-changing in a positive way. Here’s what I wonder though: I wonder if there are other, better ways to get there.”
(Note: Ibogaine use in the UK is relatively rare. The drug and plant is used by shaman in the African Buiti religion as a sacrament (to bring on a trance-like state). It is currently being tested for its use in treating opiate and stimulant dependency.The drug is both hallucinogenic, a stimulant and a depressant. It causes visual hallucinations in high doses as well as a feeling of lightness, dryness of the mouth, sweating, dilation of the eye’s pupils, increased pulse rate and fine tremors. The peak effect is reached at about 2 hours after swallowing the drug.) From: http://www.drugwise.org.uk
Dr Lembke: “I think that some of the healthiest people that I have ever met and will ever meet are people with addiction in robust recovery. I hear that all the time from people in recovery, that they’re actually gratefully for their addiction – because without their addiction they would have never found recovery.”
Joe Rogan: Wow. So, recovery and the structure that it provides has been so beneficial to them in giving them a clear scaffolding and framework for life, that it’s better to have gone through it.
Dr Lembke: “Yes. We were talking earlier about humility and how important humility is to a life well-lived and there’s nothing that will humble you more than getting seriously addicted – and having to crawl your way out of that. These are incredibly courageous, humble, wise people – and I’ve learned a lot from my patients.”
Listen to this episode from The Joe Rogan Experience on Spotify.