Essentials: Understanding & Treating Addiction | Dr. Anna Lembke
Andrew Huberman
安德鲁·休伯曼
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance.
欢迎来到 Huberman Lab Essentials，在这里我们回顾过去的剧集，寻找针对心理健康、身体健康和表现的最有效、最可操作的基于科学的工具。
Andrew Huberman
安德鲁·休伯曼
And now for my discussion with Dr. Anna Lembke.
现在我与 Anna Lembke 博士进行了讨论。
Andrew Huberman
安德鲁·休伯曼
I, and many listeners of this podcast are obsessed with dopamine.
我和这个播客的许多听众都沉迷于多巴胺。
What is dopamine, and what are maybe some things about dopamine that most people don't know, and probably that I don't know either?
什么是多巴胺？关于多巴胺，有哪些是大多数人不知道、或许我也不知道的事情？
Dr. Anna Lembke
安娜·伦布克博士
So dopamine is a neurotransmitter, and neurotransmitters are those molecules that bridge the gap between two neurons.
因此，多巴胺是一种神经递质，而神经递质是那些在两个神经元之间架起桥梁的分子。
So, they essentially allow one neuron, the presynaptic neuron, to communicate with the postsynaptic neuron.
因此，它们本质上允许一个神经元（突触前神经元）与突触后神经元进行通信。
Dopamine is intimately associated with the experience of reward, but also with movement, which I think is really interesting because movement and reward are linked, right?
多巴胺与奖励体验密切相关，但也与运动密切相关，我认为这非常有趣，因为运动和奖励是相关的，对吧？
If you think about early humans, you had to move in order to go seek out the water or the meat, or whatever it was.
如果你想想早期人类，你必须移动才能寻找水或肉，或任何东西。
So, dopamine is this really powerful, important molecule in the brain that helps us experience pleasure.
因此，多巴胺是大脑中真正强大、重要的分子，可以帮助我们体验快乐。
It's not the only neurotransmitter involved in pleasure, but it's a really important one.
它不是唯一与快乐有关的神经递质，但它是一个非常重要的神经递质。
Dr. Anna Lembke
安娜·伦布克博士
And if you want to think about something that most people don't know about dopamine, which I think is really interesting, is that we are always releasing dopamine at a kind of tonic baseline rate, and it's really the deviation from that baseline rather than hits of dopamine in a vacuum that make a difference.
如果你想思考一下大多数人不知道的关于多巴胺的事情，我认为这非常有趣，那就是我们总是以某种强直基线速率释放多巴胺，而真正产生影响的是与该基线的偏差，而不是真空中多巴胺的点击量。
So, when we experience pleasure, our dopamine release goes above baseline.
因此，当我们体验到快乐时，我们的多巴胺释放量就会高于基线。
And likewise, dopamine can go below that tonic baseline, and then we experience a kind of pain.
同样，多巴胺可以低于强直基线，然后我们会经历一种疼痛。
Andrew Huberman
安德鲁·休伯曼
Mm.
嗯。
Andrew Huberman
安德鲁·休伯曼
Interesting.
有趣。
So is it fair to say that one's baseline levels of dopamine, how frequently we are releasing dopamine in the absence of some drug, or food, or experience, just sitting, being, is that associated with how happy somebody is, their kind of baseline of happiness, or level of depression?
那么，公平地说，一个人的多巴胺基线水平，即在没有某种药物、食物或经验的情况下，只是坐着、存在时，我们释放多巴胺的频率，与一个人的幸福程度、他们的幸福基线类型或抑郁程度有关吗？
Dr. Anna Lembke
安娜·伦布克博士
There is evidence that shows that people who are depressed may indeed have lower tonic levels of dopamine.
有证据表明，抑郁症患者的多巴胺水平可能确实较低。
So, that's a really reasonable thought, and there's some evidence to suggest that that may be true.
所以，这是一个非常合理的想法，并且有一些证据表明这可能是真的。
The other thing that we know is that if we expose ourselves chronically to substances or behaviors that repeatedly release large amounts of dopamine in our brain's reward pathway, that we can change our tonic baseline, and actually lower it over time as our brain tries to compensate for all of that dopamine, which is more really than we were designed to experience.
我们知道的另一件事是，如果我们长期接触那些在我们大脑的奖赏通路中反复释放大量多巴胺的物质或行为，我们就可以改变我们的强直基线，并随着时间的推移，当我们的大脑试图补偿所有多巴胺时，实际上会降低它，这比我们设计时要经历的更真实。
Andrew Huberman
安德鲁·休伯曼
Interesting.
有趣。
And is it the case that our baseline levels of dopamine are set by our genetics, by our heredity?
我们的多巴胺基线水平是由我们的基因、遗传决定的吗？
Dr. Anna Lembke
安娜·伦布克博士
Well, if you think about sort of the early stages of development and infancy, certainly that is true.
好吧，如果你考虑一下发展的早期阶段和婴儿期，那当然是正确的。
You're kind of born with probably whatever is your baseline level.
你的基线水平可能是生来就有的。
But obviously, your experiences can have a huge impact on where your dopamine level ultimately settles out.
但显然，你的经历会对你的多巴胺水平最终稳定产生巨大影响。
Andrew Huberman
安德鲁·休伯曼
Do you think that's set in terms of our parents, and obviously nature and nurture interact, but is dopamine at the core of our temperament?
你认为这是由我们的父母决定的吗？显然，先天和后天是相互作用的，但多巴胺是我们气质的核心吗？
Dr. Anna Lembke
安娜·伦布克博士
I don't really think we know the answer to that, but I will say that people are definitely born with different temperaments.
我真的不认为我们知道这个问题的答案，但我会说，人们肯定生来就有不同的气质。
And those temperaments do affect their ability to experience joy.
这些气质确实会影响他们体验快乐的能力。
And, we've known that for a long time, and we describe that in many different ways.
而且，我们很早就知道这一点，并且我们以多种不同的方式描述这一点。
One of the ways that we describe that in the modern era is to use psychiatric nomenclature, like, "This person has a dysthymic temperament," or, "This person has chronic major depressive disorder."
我们在现代描述这一点的方式之一是使用精神病学术语，例如“这个人有心境恶劣的气质”，或者“这个人患有慢性重度抑郁症”。
Dr. Anna Lembke
安娜·伦布克博士
In terms of looking specifically at who's vulnerable to addiction, that's an interesting sort of mixed bag, because when you look at the research on risk factors for addictions, or what kind of temperament of a person makes them more vulnerable to addiction, you see some interesting findings.
就专门研究谁容易上瘾而言，这是一种有趣的混合体，因为当你查看有关成瘾风险因素的研究，或者一个人的什么样的气质使他们更容易上瘾时，你会看到一些有趣的发现。
First, you see that people who are more impulsive, who have a thought to do something and just do it impulsively, are people who are more vulnerable to addiction.
首先，你会发现那些比较冲动的人，那些想做某事却冲动地去做的人，是更容易上瘾的人。
Andrew Huberman
安德鲁·休伯曼
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
What we now conceptualize in our current ecosystem as mental illness, are actually traits that in another ecosystem might be very advantageous.
我们现在在当前的生态系统中将其概念化为精神疾病，实际上是在另一个生态系统中可能非常有利的特征。
They're just not advantageous right now because of the world that we live in.
由于我们生活的世界，他们现在并不具有优势。
And I think impulsivity is potentially one of those, right?
我认为冲动可能是其中之一，对吧？
Because we live in this world that's such a sensory-rich environment, that we are being bombarded with all of these opportunities, these sensory opportunities, and we have to constantly check ourselves.
因为我们生活在这个感官丰富的世界，我们受到所有这些机会、这些感官机会的轰炸，我们必须不断地检查自己。
And so impulsivity is something that right now can be a difficult trait, but isn't in and of itself a bad thing.
因此，冲动现在可能是一种困难的特质，但其本身并不是一件坏事。
Andrew Huberman
安德鲁·休伯曼
In a previous conversation we had, you said something that really rung in my mind, which is that many people who become addicted to things have this feeling that normal life isn't interesting enough.
在我们之前的一次谈话中，你说了一句话让我印象深刻，那就是很多沉迷于事物的人都会觉得正常的生活不够有趣。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Andrew Huberman
安德鲁·休伯曼
Maybe you could just tell us a little bit about your experience with this association, if it really exists, between people's sense of the normalcy, or maybe even how boring life can be, and their tendency to become addicts of some sort.
也许你可以告诉我们一些你对这种关联的经历，如果它真的存在的话，在人们对常态的感觉，甚至可能是生活有多无聊，与他们成为某种成瘾者的倾向之间。
Dr. Anna Lembke
安娜·伦布克博士
I think that life for humans has always been hard, but I think that now it's harder in unprecedented ways, and I think that the way that life is really hard now is that it actually is really boring.
我认为人类的生活一直很艰难，但我认为现在以前所未有的方式更加困难，而且我认为现在的生活真正艰难的是它实际上非常无聊。
All of our survival needs are met.
我们所有的生存需求都得到满足。
We don't even have to leave our homes to meet every single physical need, as long as you have a certain level of financial well-being.
只要您有一定程度的财务状况，我们甚至不必离开家来满足每一项物质需求。
Which frankly, we talk so much about the income gap, and certainly there is this enormous gap between rich and poor, but that gap is smaller than it's ever been in the history of humans.
坦率地说，我们谈论了很多关于收入差距的问题，当然贫富之间也存在着巨大的差距，但这种差距比人类历史上的任何时候都要小。
Dr. Anna Lembke
安娜·伦布克博士
We don't really have anything that we have to do, so we're all forced to make stuff up, whether it's being a scientist, or being a doctor, or being an Olympic athlete, or climbing Mount Everest.
我们真的没有什么必须做的事情，所以我们都被迫编造一些东西，无论是成为一名科学家，还是一名医生，或者是一名奥林匹克运动员，或者是攀登珠穆朗玛峰。
And people really vary in their need for friction, and some people need a lot more than others.
人们对摩擦的需求确实各不相同，有些人比其他人需要更多。
And if they don't have it, they're really unhappy.
如果他们没有，他们真的会不高兴。
And I do think that a lot of the people that I see with addiction and other forms of mental illness, are people who need more friction.
我确实认为，我看到的很多患有成瘾和其他形式精神疾病的人都是需要更多摩擦的人。
They're unhappy not necessarily because there's something wrong with their brain, but because their brain is not suited to this world.
他们不快乐不一定是因为他们的大脑出了问题，而是因为他们的大脑不适合这个世界。
Andrew Huberman
安德鲁·休伯曼
Let's talk about the pleasure-pain balance and addiction.
我们来谈谈快乐与痛苦的平衡和成瘾。
And I've heard you use this seesaw or balance scale analogy before, and I think it's a wonderful one.
我听说你以前用过跷跷板或天平秤的类比，我认为这是一个很棒的类比。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
So, to me, one of the most significant findings in neuroscience in the last 75 years is that pleasure and pain are co-located, which means the same parts of the brain that process pleasure, also process pain, and they work like a balance.
因此，对我来说，过去 75 年神经科学最重要的发现之一是快乐和痛苦是共存的，这意味着大脑中处理快乐的部分也处理痛苦，并且它们像平衡一样工作。
So, when we feel pleasure or balance tips one way, when we feel pain, it tips in the opposite direction.
因此，当我们感到快乐或平衡向一种方向倾斜时，当我们感到痛苦时，它就会向相反的方向倾斜。
And one of the overriding rules governing this balance is that it wants to stay level, so it doesn't want to remain tipped very long to pleasure or to pain.
控制这种平衡的首要规则之一是它想要保持水平，所以它不想长时间保持快乐或痛苦的状态。
And with any deviation from neutrality, the brain will work very hard to restore a level balance, or what scientists call homeostasis.
一旦偏离中立状态，大脑就会非常努力地恢复水平平衡，即科学家所说的体内平衡。
And the way the brain does that is with any stimulus to one side, there will be a tip in equal and opposite amount to the other side.
大脑这样做的方式是，一侧受到任何刺激，另一侧就会产生相等且相反数量的提示。
Andrew Huberman
安德鲁·休伯曼
It's like the principal laws of physics.
这就像物理的主要定律。
Dr. Anna Lembke
安娜·伦布克博士
Yes, right.
是的，没错。
Andrew Huberman
安德鲁·休伯曼
Yeah.
是的。
Dr. Anna Lembke
安娜·伦布克博士
So, I like to watch YouTube videos.
所以，我喜欢看 YouTube 视频。
When I watch YouTube videos of American Idol, it tips to the side of pleasure, and then when I stop watching it, I have a come down, which is a tip to the equal and opposite amount on the other side, and that's that moment of wanting to watch one more YouTube video.
当我观看《美国偶像》的 YouTube 视频时，它会向快乐的一侧倾斜，然后当我停止观看时，我会感到沮丧，这是向另一侧的同等和相反的量倾斜，这就是想要再看一个 YouTube 视频的那一刻。
It's not something that consciously happens, or that we're aware of unless we really begin to pay attention.
这不是有意识地发生的事情，也不是我们意识到的事情，除非我们真正开始注意。
And of course, one way to combat that is to do it more, and more.
当然，解决这个问题的方法之一就是做得越来越多。
So, I think that is really what I want people to tune into and get an awareness around, because once you tune into it, you can see it a lot.
所以，我认为这确实是我希望人们关注并提高认识的内容，因为一旦你关注它，你就能看到很多东西。
And if you keep the model of the balance in mind, I think it gives people kind of a way to imagine what they're experiencing on a neurobiological level, and understand it, and in that understanding, get some mastery over it, which is really what this is all about.
如果你牢记平衡的模型，我认为它为人们提供了一种方式来想象他们在神经生物学层面上正在经历的事情，并理解它，并在这种理解中，掌握它，这才是真正的意义所在。
Because ultimately, we do need to disengage.
因为最终，我们确实需要脱离。
We can't live in that space all the time.
我们不能一直生活在那个空间里。
We have other things we need to do.
我们还有其他事情需要做。
And there are also serious consequences that come with trying to repeat and continue that experience or that feeling.
试图重复和继续这种经历或感觉也会带来严重的后果。
Andrew Huberman
安德鲁·休伯曼
Yeah.
是的。
So, if I understand this correctly, when we find something that we enjoy that feels pleasureful, social media, food, sex, gambling, whatever happens to be, there's some dopamine release when we engage in that behavior.
所以，如果我理解正确的话，当我们发现我们喜欢的东西让我们感到愉快时，社交媒体、食物、性、赌博，无论发生什么，当我们从事这种行为时，就会释放一些多巴胺。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Andrew Huberman
安德鲁·休伯曼
And then what you're telling me is that very quickly and beneath my conscious awareness, there's a tilting back of the scale where pleasure is reduced by way of increasing pain.
然后你告诉我的是，很快，在我的意识之下，天平出现了向后倾斜，快乐随着痛苦的增加而减少。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Andrew Huberman
安德鲁·休伯曼
And I've heard you say before that the pain mechanism has some competitive advantages over the pleasure mechanism, such that it doesn't just bring the scale back to level.
我以前听你说过，痛苦机制比快乐机制具有一些竞争优势，因此它不仅仅使规模恢复到水平。
It actually brings pain higher than pleasure.
它实际上带来的痛苦高于快乐。
Dr. Anna Lembke
安娜·伦布克博士
Mm.
嗯。
Dr. Anna Lembke
安娜·伦布克博士
Mm.
嗯。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
What happens right after I do something that is really pleasurable and releases a lot of dopamine is, again, my brain is going to immediately compensate by down-regulating my own dopamine receptors, my own dopamine transmission, to compensate for that, okay?
在我做了一些真正令人愉快的事情并释放大量多巴胺之后，我的大脑将立即通过下调我自己的多巴胺受体、我自己的多巴胺传输来补偿，好吗？
And that's that come down or the hangover, that after effect, that moment of wanting to do it more.
这就是那种下降或宿醉，那种后遗症，那种想要做得更多的时刻。
Now, if I just wait for that feeling to pass, then my dopamine will re-regulate itself, and I'll go back to whatever my chronic baseline is.
现在，如果我只是等待这种感觉过去，那么我的多巴胺就会重新调节自身，我就会回到我的长期基线。
But if I don't wait, and here's really the key, if I keep indulging again and again, ultimately, I have so much on the pain side, that I've essentially reset my brain to what we call an anhedonic, or lacking-in-joy type of state, which is a dopamine deficit state.
但如果我不等待，这真的是关键，如果我一次又一次地沉迷，最终，我会感到非常痛苦，以至于我基本上将我的大脑重置为我们所说的快感缺乏或缺乏快乐的状态，即多巴胺缺乏状态。
Dr. Anna Lembke
安娜·伦布克博士
So that's really the way in which pain can become the main driver, is because I've indulged so much in these high-reward behaviors or substances, that my brain has had to compensate by way down-regulating my own dopamine such that even when I'm not doing that drug, I'm in a dopamine deficit state, which is akin to a clinical depression.
所以这确实是疼痛成为主要驱动因素的方式，因为我沉迷于这些高回报的行为或物质，我的大脑不得不通过下调我自己的多巴胺来补偿，这样即使我不服用这种药物，我也处于多巴胺缺乏状态，这类似于临床抑郁症。
I have anxiety, irritability, insomnia, dysphoria, and a lot of mental preoccupation with using again, or getting the drug.
我有焦虑、烦躁、失眠、烦躁不安，并且在精神上全神贯注于再次使用或获取药物。
Andrew Huberman
安德鲁·休伯曼
I see.
我明白了。
Dr. Anna Lembke
安娜·伦布克博士
So, in general, what we want is some kind of flexibility in that balance, and the ability to easily reassert homeostasis.
因此，总的来说，我们想要的是这种平衡的某种灵活性，以及轻松恢复体内平衡的能力。
We don't wanna break our balance, which is possible if we overindulge for enough period of time, and end up with a balance tipped to the side of pain, this dopamine deficit state we've been talking about.
我们不想打破我们的平衡，如果我们过度放纵足够长的时间，最终平衡会向疼痛一侧倾斜，这是我们一直在谈论的多巴胺缺乏状态，这是可能的。
We want a flexible, resilient balance, which can be sensitive to things going on in the environment, which can experience pleasure and approach, which can experience pain and recoil.
我们想要一种灵活的、有弹性的平衡，它可以对环境中发生的事情敏感，它可以体验快乐和接近，它可以体验痛苦和反冲。
This is all adaptive and healthy and necessary and good.
这都是适应性的、健康的、必要的和好的。
We would never want a balance that doesn't tilt.
我们永远不会想要一个不倾斜的天平。
Andrew Huberman
安德鲁·休伯曼
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
That would be a disaster, we wouldn't be human, and we wouldn't want that.
那将是一场灾难，我们就不是人类了，我们也不想这样。
It'd be really boring.
真的会很无聊。
On the other hand, what people in recovery from addiction talk about is, to some extent, having to learn to live with things being a little boring a lot of the time.
另一方面，从某种程度上来说，从成瘾中恢复的人们谈论的是必须学会忍受很多时候有点无聊的事情。
So, trying to avoid some of this intensity, and thrill-seeking, and escapism, that really is at the core of addictive tendencies.
因此，试图避免这种强度、寻求刺激和逃避现实，这确实是成瘾倾向的核心。
Andrew Huberman
安德鲁·休伯曼
Right.
对。
Andrew Huberman
安德鲁·休伯曼
So, along those lines, I've heard you say that in order to reset the dopamine system, essentially in order to break an addictive pattern, 30 days of zero interaction with that substance, that person, et cetera.
所以，沿着这些思路，我听你说过，为了重置多巴胺系统，本质上是为了打破成瘾模式，30 天与那种物质、那个人等等零互动。
Is that correct?
这是正确的吗？
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
And 30 days is, in my clinical experience, the average amount of time it takes for the brain to reset reward pathways for dopamine transition to regenerate itself.
根据我的临床经验，30 天是大脑重置多巴胺过渡奖赏路径以实现自我再生所需的平均时间。
By depriving ourselves of this high dopamine, high reward substance or behavior, we allow our brains to regenerate its own dopamine for the balance to re-equilibrate, and then we're in a place where we can sort of enjoy other things.
通过剥夺自己这种高多巴胺、高奖励物质或行为，我们可以让大脑再生自己的多巴胺，以达到重新平衡的平衡，然后我们就可以享受其他事情了。
Andrew Huberman
安德鲁·休伯曼
So, I'd like to dissect out that 30 days a little more finely.
所以，我想更仔细地剖析一下这 30 天。
So, days 1 through 10 I would imagine will be very uncomfortable.
所以，我想第一天到第十天会非常不舒服。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Andrew Huberman
安德鲁·休伯曼
Anxiety, trouble sleeping, physical agitation, and to the point where maybe impulsive, angry.
焦虑、睡眠困难、身体烦躁，甚至可能冲动、愤怒。
Should one expect all of that?
人们应该期待这一切吗？
Should the-
应该-
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Yep.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
So, what I say to patients, and it's a really important piece of this intervention, is that you will feel worse before you feel better.
因此，我对患者说的是，在感觉好转之前，您会感觉更糟，这是该干预措施中非常重要的一部分。
Andrew Huberman
安德鲁·休伯曼
For how long?
持续多久？
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
So-
所以——
Andrew Huberman
安德鲁·休伯曼
This is probably the first question they ask, right?
这可能是他们问的第一个问题，对吧？
Dr. Anna Lembke
安娜·伦布克博士
Right, yes.
对，是的。
And I say, "Usually in my clinical experience you'll feel worse for two weeks, but if you can make it through those first two weeks, the sun will start to come out in week three.
我说：“根据我的临床经验，通常你会在两周内感觉更糟，但如果你能熬过前两周，第三周太阳就会开始出现。
And by week four most people are feeling a whole lot better than they were before they stopped using their substance." So, it's a hard thing.
到了第四周，大多数人感觉比停止使用药物之前好多了。”所以，这是一件很难的事情。
You have to sign up for it.
你必须注册它。
Andrew Huberman
安德鲁·休伯曼
Then days 21 through 30, dopamine is starting to be released in response to the taste of a really good cup of coffee, for instance.
例如，在第 21 天到第 30 天，多巴胺开始释放，以响应一杯好咖啡的味道。
Dr. Anna Lembke
安娜·伦布克博士
Yes, exactly.
是的，完全正确。
Andrew Huberman
安德鲁·休伯曼
Whereas before it was only to insert addictive behavior.
而之前它只是插入令人上瘾的行为。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Andrew Huberman
安德鲁·休伯曼
One thing I've seen over and over again, sadly often in the same individuals, is they get sober from whatever, they're doing great, and then all of a sudden you get this call, "So-and-so's back in jail.
我一遍又一遍地看到一件事，可悲的是，经常在同一个人身上看到，他们从任何事情中清醒过来，他们做得很好，然后突然你接到这样的电话：“某某人又回到监狱了。
So-and-so's wife is gonna leave him because he drank two bottles of wine and took a Xanax at 7:00 AM, crashed his truck into a pole, has got two beautiful kids." How did this happen again?
某某的妻子要离开他了，因为他在早上 7:00 喝了两瓶酒，还服用了 Xanax，他的卡车撞上了一根柱子，而且还有两个漂亮的孩子。”怎么又出现这种情况了？
To the point where by the fourth and fifth time, people are just done.
到了第四次、第五次的时候，人就完了。
And so, what I'd like to talk about in this context is, what sorts of things help other people that we know that are addicted?
因此，在这种情况下，我想谈谈的是，什么样的事情可以帮助我们认识的其他上瘾的人？
What really helps?
什么真正有帮助？
And are there certain people for whom it's hopeless?
对于某些人来说，这是没有希望的吗？
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
So, there are people who will die of their disease of addiction, and I think conceptualizing it as a disease is a helpful frame.
因此，有些人会死于成瘾疾病，我认为将其概念化为一种疾病是一个有用的框架。
There are other frames that we could use, but I do think given the brain physiologic changes that occur with sustained heavy drug use, and what we know happens to the brain, it is really reasonable to think of it as a brain disease.
我们还可以使用其他框架，但我确实认为，考虑到持续大量吸毒所发生的大脑生理变化，以及我们所知道的大脑发生的情况，将其视为一种脑部疾病确实是合理的。
Dr. Anna Lembke
安娜·伦布克博士
And for me, the real window of, let's say, being able to access my compassion around people who are repeat relapsers, even when their life is so much better when they're in recovery.
对我来说，真正的窗口是，可以说，能够对那些复发的人表达我的同情心，即使他们在康复期间的生活好多了。
Andrew Huberman
安德鲁·休伯曼
Oh, yeah.
哦，是的。
Yeah.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yeah, it's a no-brainer, right?
是的，这是理所当然的，对吧？
Is to conceptualize this balance and the dopamine deficit state and a balance tilted to the side of pain, and to imagine that for some people after a month, or six months, or maybe even six years, their balance is still tipped to the side of pain.
就是将这种平衡和多巴胺缺乏状态以及向疼痛一侧倾斜的平衡概念化，并想象对于某些人来说，一个月、六个月、甚至六年后，他们的平衡仍然向疼痛一侧倾斜。
That on some level, that balance, has lost its resilience and its ability to restore homeostasis.
在某种程度上，这种平衡已经失去了弹性和恢复体内平衡的能力。
Andrew Huberman
安德鲁·休伯曼
It's almost like the hinge on that balance is messed up.
就好像平衡的铰链被搞乱了。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Exactly.
正是如此。
Imagine that you had an itch somewhere on your body, okay?
想象一下你身体某个地方很痒，好吗？
We've all had that.
我们都有过这样的经历。
Whatever the source.
无论来源如何。
If you really focus, you could go for a pretty good amount of time not scratching it.
如果你真正集中注意力，你可以花很长一段时间不抓挠它。
But the moment you stopped focusing on not scratching it, you would scratch it, and maybe you'd do it while you were asleep, right?
但一旦你不再专注于不去抓它，你就会抓它，也许你会在睡着的时候这样做，对吗？
And that is what happens to people with severe addiction.
这就是重度成瘾者的情况。
That balance is essentially broken.
这种平衡基本上被打破了。
Homeostasis does not get restored despite sustained abstinence.
尽管持续禁欲，体内平衡仍无法恢复。
They're living with that constant specter, that pull.
他们生活在那种持续不断的幽灵和吸引力之中。
It never goes away.
它永远不会消失。
Dr. Anna Lembke
安娜·伦布克博士
So let me say, there are lots of people with addiction for whom that does go away, and it goes away at four weeks for many of them, but in severe cases, that's always there and it's lingering and it's the moment when they're not focusing on not using, it's like a reflex.
所以让我说，有很多上瘾的人确实会消失，对于他们中的许多人来说，这种情况会在四个星期后消失，但在严重的情况下，这种情况一直存在并且挥之不去，当他们不专注于不使用时，这就像一种条件反射。
They fall back into it.
他们又陷入其中。
It's not purposeful.
这不是有目的的。
It's not because they wanna get high.
这并不是因为他们想要嗨起来。
It's not because they value using drugs more than they do their family, none of that.
这并不是因为他们比家人更重视使用毒品，都不是。
It's that really they cannot not do it when given the opportunity and that moment when they're not thinking about it.
而是当他们有机会并且没有想到的那一刻，他们确实不能不这样做。
Does that make sense?
这有道理吗？
Andrew Huberman
安德鲁·休伯曼
That's a great description, and actually in that description I can feel a bit of empathy, because the way you describe scratching an itch in your sleep.
这是一个很棒的描述，实际上在那个描述中我能感受到一点同理心，因为你描述的在睡梦中抓痒的方式。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Andrew Huberman
安德鲁·休伯曼
I've done that with mosquito bites.
我曾经用过蚊子叮咬的方法。
In summer you're scratching, and you wake up scratching that mosquito bite?
夏天你会抓痒，醒来后会抓到被蚊子咬的地方吗？
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Andrew Huberman
安德鲁·休伯曼
And I also have to admit that I've experienced not feeling like I want to pick up my phone because it's so rewarding but just finding myself doing it.
我还必须承认，我经历过不想拿起手机的感觉，因为它是如此有益，但只是发现自己在这样做。
Dr. Anna Lembke
安娜·伦布克博士
Yes, of course.
是的，当然。
Yes.
是的。
Andrew Huberman
安德鲁·休伯曼
Like, "I'm not going to use this thing, I'm not going to use this thing." And then just finding myself doing it.
就像，“我不会使用这个东西，我不会使用这个东西。”然后我发现自己正在这么做。
Like, "What am I doing here?" Sort of the "How did I get back here again?"
就像，“我在这里做什么？”有点像“我怎么又回到这里了？”
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Right.
正确的。
Right.
正确的。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Right.
正确的。
Andrew Huberman
安德鲁·休伯曼
And I know enough about brain function to understand that we have circuits that generate deliberate behavior, and we have circuits that generate reflexive behavior.
我对大脑功能有足够的了解，知道我们有产生故意行为的回路，也有产生反射性行为的回路。
And one of the goals of the nervous system is to make the deliberate stuff reflexive so you don't have to make the decision because decision-making is a very costly thing to do.
神经系统的目标之一是使深思熟虑的事情成为反射性的，这样你就不必做出决定，因为决策是一件成本非常高的事情。
Decision-making of any kind.
任何类型的决策。
Dr. Anna Lembke
安娜·伦布克博士
Exactly.
正是如此。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Andrew Huberman
安德鲁·休伯曼
Why is it then that people will relapse not just after getting fired from a job or their spouse leaving them, but when things are going really well?
那么，为什么人们不仅在被解雇或配偶离开后，而且在事情进展顺利时，也会旧病复发呢？
Is it this unconscious mechanism?
是这种无意识的机制吗？
Because I've seen this before, is they have a great win.
因为我以前见过这样的情况，他们取得了一场伟大的胜利。
I have a friend who's a really impressive creative, I don't wanna reveal any more than that and relapsed upon getting another really terrific opportunity to create for the entire world.
我有一个朋友，他的创意非常令人印象深刻，我不想透露更多，但在获得另一个为整个世界创造的绝佳机会后，我又旧病复发了。
And I was like, "How can that happen?" But now I'm beginning to wonder, was it the dopamine associated with that win, that opened the spigot on his dopamine system?
我当时想，“怎么会发生这种事？”但现在我开始怀疑，是不是与那场胜利相关的多巴胺打开了他多巴胺系统的水龙头？
Because, it happened in a phase of a really great stretch of life.
因为，它发生在人生的一个非常伟大的阶段。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Mm.
嗯。
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Triggers are things that make us want to go back to using our drug.
触发因素是让我们想要重新使用药物的因素。
And the key thing about triggers, whatever they are, is they also release a little bit of dopamine.
触发器的关键在于，无论它们是什么，它们也会释放一点多巴胺。
So just thinking about, whatever the trigger is that we associate with drug use, or just thinking about drug use, can already release this anticipatory dopamine, this little mini spike.
因此，只要想一想，无论我们与吸毒相关的触发因素是什么，或者只是想到吸毒，就已经可以释放出这种预期的多巴胺，这种小小的尖峰。
But here's the part that I think is really fascinating.
但这是我认为真正令人着迷的部分。
That mini spike is followed by a mini deficit state.
小幅飙升之后是小幅赤字状态。
So, it goes up and then it doesn't go back down to baseline, it goes below baseline tonic levels.
因此，它会上升，然后不会回到基线，而是低于基线的紧张水平。
And that's craving, right?
这就是渴望，对吗？
So, that anticipation is immediately followed by wanting the drug.
因此，这种期待之后立即就会想要这种药物。
And it's that dopamine deficit state that drives the motivation to go and get the drug.
正是这种多巴胺缺乏状态驱动了去服用药物的动力。
So many people talk about dopamine as not really about pleasure but about wanting and about motivation.
很多人谈论多巴胺并不是真正的快乐，而是想要和动力。
And so it is that deficit state that then drives the locomotion to get it.
因此，正是这种赤字状态驱动了获得它的动力。
Andrew Huberman
安德鲁·休伯曼
And earlier, your description of dopamine being involved in the desire for more, giving the sense of reward but also movement.
早些时候，你对多巴胺的描述涉及对更多的渴望，给人一种奖励的感觉，也给人一种运动的感觉。
I have to assume that those things are braided together in our nervous system for the specific intention of when you feel something good, then you feel the pain.
我必须假设这些东西在我们的神经系统中编织在一起，目的是当你感觉良好时，你就会感到痛苦。
Or maybe you don't notice it.
或者也许你没有注意到它。
And then the next thing you know, you're pursuing more of the thing that can deliver pleasure.
接下来你知道，你会追求更多能够带来快乐的东西。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Yes.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
And I love the way you used the word braided together.
我喜欢你使用编织这个词的方式。
That's beautiful.
那好美丽。
There are people for whom bad life experiences, loss in any form, stress in many different forms, that's a trigger.
对于有些人来说，糟糕的生活经历、任何形式的损失、各种不同形式的压力都是触发因素。
But there are absolutely people for whom the trigger is things going well.
但绝对有一些人的触发因素是事情进展顺利。
And the things going well can be the reward of the things going well, but very often what it is, is the removal of the hypervigilant state that's required to keep their use in check.
事情进展顺利可能是事情进展顺利的回报，但通常情况下，它是消除控制其使用所需的过度警惕状态。
So, it's this sense of, "I want to celebrate," or "This reward happened, I want to put more reward on there." And it's really fascinating because when people come to that realization about themselves, that they're most vulnerable when things are going well, see that's really a valuable insight.
所以，这是一种“我想庆祝”或“这个奖励发生了，我想在那里放更多奖励”的感觉。这真的很有趣，因为当人们认识到自己，当事情进展顺利时，他们是最脆弱的，这确实是一个有价值的见解。
Because then they can put some things in place or barriers in place or go to more meetings or whatever it is that they do to protect themselves.
因为这样他们就可以采取一些措施或设置障碍，或者参加更多的会议，或者采取任何措施来保护自己。
Andrew Huberman
安德鲁·休伯曼
I wanted to just touch on something that you mentioned, which is the shame.
我想谈谈你提到的一些事情，这就是耻辱。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Andrew Huberman
安德鲁·休伯曼
I heard you say in an interview with somebody else recently that truth-telling and secrets are sort of at the core of recovery.
我听到你最近在接受别人采访时说，说实话和秘密是康复的核心。
And yeah, tell us more about that.
是的，请告诉我们更多相关信息。
Dr. Anna Lembke
安娜·伦布克博士
Yeah, so one of the things that I found really fascinating about working with people in recovery was how telling the truth, even about the merest detail of their lives, was central to their recovery.
是的，所以我发现与康复中的人们一起工作真正令人着迷的一件事是，如何说出真相，即使是他们生活中最微小的细节，对他们的康复至关重要。
Dr. Anna Lembke
安娜·伦布克博士
It's not even just not lying about using drugs.
这甚至不仅仅是在吸毒问题上不撒谎。
I have to not lie about anything.
我不能对任何事情撒谎。
I can't lie about why I was late to work this morning, which we all do.
我不能对我今天早上上班迟到的原因撒谎，我们都会这样做。
"Oh, I hit traffic." No, I didn't hit traffic, I wanted to spend two more minutes reading the paper and drinking my coffee, right?
“哦，我撞车了。”不，我没有堵车，我想再花两分钟看看报纸，喝杯咖啡，对吗？
So, people with addiction will get into the lying habit where they're lying about random stuff because they're sort of in the habit of lying, and how recovery is really about telling the truth.
因此，上瘾的人会养成说谎的习惯，他们会随机地撒谎，因为他们有点撒谎的习惯，而康复实际上就是说实话。
Dr. Anna Lembke
安娜·伦布克博士
And there's really interesting neuroscience behind it that suggests that when we tell the truth, we actually potentially strengthen our prefrontal cortical circuits and their connections to our limbic brain and our reward brain.
它背后有非常有趣的神经科学表明，当我们说实话时，我们实际上有可能加强我们的前额皮质回路及其与边缘脑和奖励脑的联系。
And of course, these are the circuits that get disconnected when we're in our addiction.
当然，当我们沉迷其中时，这些电路就会断开。
Our balance in our reward pathway, or limbic brain, or emotion brain is doing one thing, and our cortical circuits are completely disengaged from that, ignoring what's happening.
我们的奖励通路、边缘脑或情感脑的平衡正在做一件事，而我们的皮质回路完全脱离了那件事，忽略了正在发生的事情。
Which is easy to do because it's reflexive.
这很容易做到，因为它是反射性的。
We don't need to think about that balance for the balance to be happening.
我们不需要考虑这种平衡就能实现平衡。
But we have to reengage those circuits, anticipate future consequences, think through the drink.
但我们必须重新启动这些回路，预测未来的后果，仔细考虑饮料。
Not just, "How am I going to feel now if I use?" But "How am I gonna feel tomorrow or six months from now?" And that telling the truth is in fact a way to do that, to make these connections stronger.
不仅仅是“如果我使用的话我现在会有什么感觉？”但是“明天或六个月后我会感觉如何？”事实上，说实话是实现这一目标的一种方式，可以使这些联系更加牢固。
And there, I talk about some studies in my book that kind of indirectly show that.
在那里，我在书中谈到了一些间接表明这一点的研究。
So, I find that really fascinating.
所以，我觉得这真的很有趣。
Dr. Anna Lembke
安娜·伦布克博士
Plus, the just being open and honest with people really does create very intimate connections.
另外，只要对人开诚布公，确实能建立非常亲密的联系。
And those intimate connections create dopamine.
这些亲密的联系会产生多巴胺。
You think people are going to run away from you if you tell them about all your weird neuroses, but really they don't.
你认为如果你告诉他们你所有奇怪的神经症，人们就会逃离你，但实际上他们不会。
What they're like is, "Oh, thank God, I'm not the only one."
他们的感觉是，“哦，感谢上帝，我不是唯一一个。”
Andrew Huberman
安德鲁·休伯曼
I love that there's neuroscience being done on truth-telling and the value of truth-telling.
我喜欢神经科学正在研究说真话和说真话的价值。
I hope they'll continue to do more work.
我希望他们继续做更多的工作。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Andrew Huberman
安德鲁·休伯曼
I want to ask you about using drugs to treat drug addiction.
我想问你有关使用药物治疗毒瘾的问题。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Andrew Huberman
安德鲁·休伯曼
This is a vast area, right?
这是一个广阔的区域，对吧？
Different chemistries for different drugs and different purposes.
不同的化学物质用于不同的药物和不同的目的。
But the rationale as I understand it, is take people who are in a pattern of addiction, launch them into an experience that's also chemical and extreme, often of the extreme serotonin and/or extreme dopamine type.
但据我了解，其基本原理是让处于成瘾模式的人进入一种化学和极端的体验，通常是极端的血清素和/或极端的多巴胺类型。
So MDMA, ecstasy, for instance.
例如摇头丸、摇头丸。
Tons of serotonin dumped.
大量的血清素被倾倒。
Tons of dopamine dumped.
大量的多巴胺被倾倒。
How neurotoxic?
神经毒性有多大？
If neurotoxic, debatable, et cetera.
如果有神经毒性、有争议等等。
Not a topic for now, but a lot.
现在不是一个话题，但是很多。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Andrew Huberman
安德鲁·休伯曼
And then somehow that extreme experience wrapped inside of a supported network in there, whether or not there's just someone there, or whether or not they're actively working through something with the patient, is supposed to eject the person into a life where drug use isn't as much of interest.
然后，不知何故，那种极端的体验被包裹在一个受支持的网络中，无论那里是否只有一个人，或者他们是否正在积极地与患者一起解决某些问题，都应该将患者带入一种对吸毒不那么感兴趣的生活中。
This violates everything we've talked about in terms of dopamine biology.
这违反了我们在多巴胺生物学方面所讨论的一切。
It would, if this arrangement is the way I described it, cause more addiction.
如果这种安排是我所描述的那样，它会导致更多的上瘾。
It is anything but a dopamine fast.
它绝不是多巴胺禁食。
It's a dopamine feast.
这是一场多巴胺盛宴。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Mm-hmm.
嗯嗯。
Andrew Huberman
安德鲁·休伯曼
So, we hear about successful transitions through this, at least anecdotally, and maybe some clinics, what is going on?
因此，我们至少听说过通过此成功过渡的消息，也许还有一些诊所，到底发生了什么？
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Mm-hmm.
嗯嗯。
Andrew Huberman
安德鲁·休伯曼
What is going on?
这是怎么回事？
Doesn't make any sense to me.
对我来说没有任何意义。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
So, I think it's good that you're skeptical.
所以，我认为你持怀疑态度是件好事。
I think we all should be skeptical.
我想我们都应该持怀疑态度。
Having said that, there are clinical studies showing, and these are small studies and they're short duration, small number of subjects, but taking people, for example, who are addicted to alcohol and then having them have this, let's say psychedelic experience in a very controlled setting.
话虽如此，有临床研究表明，这些都是小型研究，持续时间短，受试者数量少，但以酗酒成瘾的人为例，然后让他们在一个非常受控的环境中获得迷幻体验。
Andrew Huberman
安德鲁·休伯曼
So, either, typically it's a high dose psilocybin or three dose, as I saw it for the map study of MDMA, of ecstasy.
因此，通常是高剂量裸盖菇素或三剂量，正如我在 MDMA 和摇头丸地图研究中看到的那样。
Those seem to be the kind of bread and butter of this kind of work.
这些似乎是这类工作的面包和黄油。
Yeah.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Dr. Anna Lembke
安娜·伦布克博士
The typical.
典型的。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
But the thing to really keep in mind is that this is completely interwoven with regular psychotherapy, and that these are highly selected individuals.
但真正要记住的是，这与常规心理治疗完全交织在一起，而且这些人都是经过精心挑选的个体。
Andrew Huberman
安德鲁·休伯曼
Right.
对。
And clinical trials.
和临床试验。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Right.
正确的。
And legal clinical tr-
和合法的临床治疗
Andrew Huberman
安德鲁·休伯曼
Right, we're referring to legal clinical trials.
是的，我们指的是合法的临床试验。
Right.
正确的。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Right.
正确的。
Dr. Anna Lembke
安娜·伦布克博士
When it works, it's a transformational experience because it gives the person another lens through which to view their lives.
当它起作用时，这将是一种变革性的体验，因为它为人们提供了另一个审视自己生活的镜头。
Which I think for some people is positive and powerful, because they can come back from that and be like, "Oh my gosh, I care about my family and I want X, Y, or Z for them, and I realize that my continuing to drink is not going to achieve that." So, it's almost like a spiritual or values-based.
我认为这对某些人来说是积极而有力的，因为他们可以从中恢复过来，然后说：“天哪，我关心我的家人，我想要他们得到 X、Y 或 Z，但我意识到我继续喝酒并不能实现这一目标。”所以，它几乎就像是一种精神或价值观基础。
So, I think it can be very powerful.
所以，我认为它可能非常强大。
But having said that, I truly am quite skeptical, because addiction is a chronic relapsing and remitting problem.
但话虽如此，我确实很怀疑，因为成瘾是一个慢性复发和缓解的问题。
It's hard for me to imagine that there's something that works very quickly short-term, that's going to work for a disease that's really long-lasting.
我很难想象有一种药物可以在短期内快速发挥作用，对治疗真正持久的疾病也有效。
Andrew Huberman
安德鲁·休伯曼
Mm-hmm.
嗯嗯。
Yeah, the two addicts I know that did MDMA-assisted psychotherapy as part of this thing, both got worse.
是的，我认识的两个瘾君子在这件事中接受了摇头丸辅助心理治疗，结果都变得更糟。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Andrew Huberman
安德鲁·休伯曼
But the people I know who had severe trauma, who did this, who took this approach, seem to be doing better.
但我认识的那些遭受过严重创伤、做过这种事、采取这种方法的人似乎做得更好。
Dr. Anna Lembke
安娜·伦布克博士
Uh-huh.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Okay.
好的。
Interesting.
有趣的。
Andrew Huberman
安德鲁·休伯曼
And so I think that the discussion as we hear it now is just sort of psychedelics, which is a huge category that includes many different drugs and compounds or different effects.
因此，我认为我们现在听到的讨论只是迷幻药，这是一个巨大的类别，包括许多不同的药物和化合物或不同的效果。
And we hear about trauma and addiction lumped together.
我们听说创伤和成瘾混为一谈。
And I think it's going to be important for people to know that this is definitely not a one-size-fits-all kind of thing.
我认为让人们知道这绝对不是一刀切的事情很重要。
But it sounds like it may have some utility under certain conditions.
但听起来它在某些条件下可能有一些用处。
Dr. Anna Lembke
安娜·伦布克博士
Right.
对。
Dr. Anna Lembke
安娜·伦布克博士
Mm-hmm.
嗯嗯。
Dr. Anna Lembke
安娜·伦布克博士
Yeah, I think so.
是的，我想是的。
I'm trying to be very open-minded about its potential utility for certain individuals.
我试图对它对某些人的潜在效用持非常开放的态度。
But I can tell you in my clinical work, what is very concerning, unintended consequence of this narrative, is I have a lot of people who are looking for some kind of spiritual awakening, who on their own, not in the context of any kind of therapeutic psychological work, microdose, or want to try, psilocybin or MDMA with a friend or wherever, so they can have this spiritual experience that they can figure out their lives.
但我可以在我的临床工作中告诉你，这种叙述的令人担忧的、意想不到的后果是，我有很多人正在寻找某种精神觉醒，他们靠自己，而不是在任何类型的心理治疗工作、微剂量的背景下，或者想与朋友或任何地方尝试裸盖菇素或摇头丸，这样他们就可以获得这种精神体验，从而弄清楚自己的生活。
That's a disaster and almost never works out well.
这是一场灾难，而且几乎永远不会有好的结果。
And I can just tell you that the downstream effect for the average person is that they've misconstrued the data on the use of psychedelics for mental health conditions, to this idea that they're safe or that anybody can take them in any circumstance and have this kind of awakening.
我可以告诉你，对普通人的下游影响是，他们误解了使用迷幻药治疗心理健康状况的数据，认为它们是安全的，或者任何人都可以在任何情况下服用它们并获得这种觉醒。
And that's not what the data show.
数据显示的并非如此。
The data are these highly controlled settings.
数据是这些高度受控的设置。
Andrew Huberman
安德鲁·休伯曼
There are a couple other things I just want to touch on, but they all relate to social media.
我只想谈谈其他一些事情，但它们都与社交媒体有关。
Dr. Anna Lembke
安娜·伦布克博士
Okay.
好的。
Andrew Huberman
安德鲁·休伯曼
I have to imagine that we need to regulate, not necessarily eliminate this behavior.
我不得不想象我们需要监管，而不一定要消除这种行为。
How addicting is it and what is healthy social media behavior?
它有多成瘾？什么是健康的社交媒体行为？
Dr. Anna Lembke
安娜·伦布克博士
The first message I would want to get across about social media is that it really is a drug, and it's engineered to be a drug.
关于社交媒体，我想传达的第一条信息是，它确实是一种药物，而且它是被设计成一种药物的。
Which doesn't mean that we can't use it, but we need to be very thoughtful about the way we use it.
这并不意味着我们不能使用它，但我们需要非常仔细地考虑我们使用它的方式。
And so that means with intention and in advance, planning our use.
因此，这意味着有意识地提前规划我们的使用。
And trying to use it as a really awesome tool to potentially connect with other people and not to be used by it, or get lost in it.
并尝试将其用作一个真正很棒的工具，以潜在地与其他人联系，而不是被它使用，或迷失其中。
Dr. Anna Lembke
安娜·伦布克博士
We do need to figure out how to make this tool something that's going to be good for us, and not ultimately harmful.
我们确实需要弄清楚如何使这个工具对我们有利，而不是最终有害。
As more and more of us are spending more and more time on social media, we're divesting our libidinous energies, et cetera, from real-life interactions.
随着越来越多的人在社交媒体上花费越来越多的时间，我们正在将我们的性欲能量等从现实生活的互动中剥离出来。
So, I think our collective challenge, and it should be our mission, is to make sure that we are preserving and maintaining offline ways to connect with each other.
因此，我认为我们的集体挑战，并且应该是我们的使命，是确保我们保留和维持彼此之间的线下联系方式。
Dr. Anna Lembke
安娜·伦布克博士
So, this is the key.
所以，这是关键。
You have to, with intention, prior to being in that situation, think of literal physical and metacognitive barriers that you can put between yourself and your phone or whatever your drug is, to create these intentional spaces where you're not constantly interrupting yourself essentially, and distracting yourself.
在陷入这种情况之前，你必须有意识地考虑在自己和手机或任何药物之间设置的实际物理和元认知障碍，以创造这些有意的空间，使你不会不断地打扰自己并分散自己的注意力。
Because I really do think we're losing the ability to have a sustained thought.
因为我确实认为我们正在失去持续思考的能力。
We get so far, and then you get to that point in the thought where it's a little bit hard to know what's coming next, and it's very easy to check your phone or check your email or look something up on the internet.
我们到目前为止，然后你就会想到，有点难以知道接下来会发生什么，而检查你的手机或检查你的电子邮件或在互联网上查找一些东西是很容易的。
And then you never get that opportunity to finish that thought, which is really the source of creative energy and an original thought.
然后你就永远没有机会完成这个想法，而这确实是创造性能量和原创想法的源泉。
You're not just reacting to what's coming at you.
你不只是对即将发生的事情做出反应。
Andrew Huberman
安德鲁·休伯曼
Right.
对。
Andrew Huberman
安德鲁·休伯曼
And something that could contribute to the world.
以及可以为世界做出贡献的东西。
Andrew Huberman
安德鲁·休伯曼
I know a number of people are going to have questions and want to get in contact with you.
我知道很多人都会有疑问并希望与您联系。
You are not on social media.
你不在社交媒体上。
Dr. Anna Lembke
安娜·伦布克博士
That's correct.
这是正确的。
Yes, an-
是的，一个——
Andrew Huberman
安德鲁·休伯曼
Okay.
好的。
You are true to your ideology.
你忠于你的意识形态。
That's great.
那太棒了。
Dr. Anna Lembke
安娜·伦布克博士
Yes.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Dr. Anna Lembke
安娜·伦布克博士
Yeah.
是的。
Andrew Huberman
安德鲁·休伯曼
Thank you so much for sharing this information, and I know I learned a ton and I know everyone else is going to learn a lot more about addiction and the good side of dopamine.
非常感谢您分享这些信息，我知道我学到了很多东西，我知道其他人也会更多地了解成瘾和多巴胺的好处。
Dr. Anna Lembke
安娜·伦布克博士
That's right.
没错。
Thank you for having me.
谢谢你有我。
It's been really great to talk with you.
与你交谈真是太好了。