How to Overcome Addiction to Substances or Behaviors | Dr. Keith Humphreys

Someone says I want to quit smoking. A good clinician will say why why would you want to do that? So say so tell me why would you want what do you want to get out of this because it's work. I mean I'm happy to work with you but you know what is it? What are your what are your motives? And and sort of helping them build up you know in their own mind because again this is about them not you. What do you get? And that's what the therapist does. The other thing that's really important is that like any other anytime you're making a behavior change hang out with other people who are trying to make the same change. You want to start jogging? Join a jogging group. you want to stop drinking, I would, you know, suggest go check into an AA meeting or one of the other fellowships we have. Having other people on the same journey is good for us. It I mean everything shows that no matter what you're doing, I'm losing weight. I'm exercising. I'm more whatever. I'm quitting smoking because it gives you two things. It gives you support, but it also gives you some accountability. It's like, hey, you were going jogging and uh Tuesday, you weren't there. What's up? Are you going to be part of this group or not? And that is uh helpful for people. Welcome to the Huberman Lab podcast where we discuss science [music] and science-based tools for everyday life. [music] I'm Andrew Huberman and I'm a professor of neurobiology and opthalmology at Stamford School of Medicine. My guest today is Dr. Keith Humphre. Dr. Dr. Keith Humphre is a professor of psychiatry and behavioral sciences at Stamford School of Medicine. And he is one of the world's foremost experts on addictive substances and behaviors and how to overcome addictions of all kinds. He is also an expert on how science, commercial marketing, lobbying, and the legal system interact to create what are called addiction for-profit businesses. The alcohol, food, and opioid industries come to mind as just a few examples of these, and he's an expert on how all of that shapes things like legal policy. Today we discuss all the major addictions to give you the most up-to-date information on alcohol, cannabis, opioids, gambling, and much more. Dr. Humphre gives us the unbiased facts, and more importantly, he explains how to think about the health risks of any substance or behavior in a logical way. For instance, while it may be true that a certain amount of alcohol could afford you some heart health benefits, we hear this, then we hear it's not true. It goes back and forth. He explains that any heart benefits that exist from alcohol are greatly offset by the increased cancer and other risks of alcohol. And with respect to cannabis, he explains who may be okay to use it, but who should absolutely not. We also discuss the most effective ways to get over any addiction. That includes alcohol, pornography, stimulants, and much more. As you'll soon see, Dr. Keith Humphre is no ordinary scientist or psychologist or addiction expert. He has the big picture on addiction and what it means to try and navigate life nowadays in an ocean of addiction forprofit marketing and confusing health information. I assure you that today he doesn't tell you what to think or what to do about various substances and addictive behaviors, but rather how to think about them and in doing so how to avoid and overcome essentially any addiction. It's a powerful conversation that I'm certain will help millions of people make better decisions. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public. In keeping with that theme, today's episode does include sponsors. And now for my discussion with Dr. Keith Humphre. Dr. Keith Humphre, welcome. Good to meet you, Andrew. Addiction is a big topic but I think for a lot of people it gets slotted into one small drawer. Uh but if we were to compare it to say mental illness many many things depression manic bipolar OCD and on and on. How do you parse this thing that we call addiction in thinking about how best to possibly treat addiction especially when it comes to trying to treat addiction in mass at the level of policy which we'll also talk about today. So uh put simply how do you frame addiction uh and how should people think about it? Yeah it's hard because it's a word unlike say you know maybe it's a little like schizophrenia where people say like ah you know schizophrenic person what they actually mean is you know he's a person with different moods and that sort of thing. addiction is even more like that. It's in common parlance. People say, you know, I'm addicted to, you know, you know, uh, a TV show or I'm addicted to my my phone or that sort of thing. But, you know, it's not just stuff you do a lot, uh, you know, which we sometimes, you know, colloally call addiction. It's the persistence of doing something that is harmful. So like the classic animal study, you know, is, you know, James's old study with rats done in the 50s showing that you could give a a rat uh uh the opportunity to give itself brain stimulation, which they enjoy, and that they would continue to do that even as they were starving to death next to a pile of food pellets or or run out of water while they were next to water. That is what it was. It's not the doing the things over and over or even being compulsive about things. It's doing them to the point of destruction when you would normally, you know, any other behavior you would think, well, you would just stop doing that. But people don't and that's the sinquan of addiction. I've tried to uh create a definition for addiction, which is that it's a progressive narrowing of the things that bring one pleasure that it doesn't happen all at once. Like someone doesn't take heroin once and then stop doing everything else. It's a tends to be progressive. I suppose it could be overnight, but um is that true? I'm happy to revise the definition. No, that that is true. So, you see um the other types of rewards, particularly natural rewards, start to fall away from the person's life. So, I'll sacrifice, you know, my relationship with my my parents or my my spouse or my friends. I will stop going to work when I, you know, which uh would normally generate the things I needed to to eat or I'll I'll give up my housing for the sake of this substance. And then you become not only more physically dependent on it, but essentially you're psychologically dependent on it because it's the one thing left that is still rewarding. Everything else has been stripped away. And that makes it easier to understand why people would still hang on to it in that situation when it feels like it's look, it's the only time I feel good is that that moment when I take that hit. These days there are a lot of industries that are um addiction for money basically industries and we're going to talk about all of them. Nicotine, alcohol, cannabis, social media, all of these. Um but for the time being, do you think that there is truly something to the quote unquote genetic bias for becoming an addict? And is it very substance or behavior specific? Um let's start with maybe alcohol for example. Yeah, that's a great question. So, let let me start by just um getting rid of one myth where we say people are born addicted. You'll sometimes read, you know, uh if if mom was addicted to fennel, then the baby is born addicted. That is not possible because, you know, a a fetus has no association between their behavior and the exposure to the drug. So, they can be physically dependent, meaning they'll go through withdrawal upon birth, but they're not they're not addicted. But you can have risk from birth in your genes. And those those shared the estimation of you know how much of that shared it's actually quite a bit. You know we look at studies where kids were adopted out of families with parents who you know were addicted to alcohol. Much higher likelihood of developing an alcohol problem even if they were raised by tea toters for for example. How big is that? You know it varies across you know studies. It varies across uh substances but it's large. It might be like you know 3 point4.5 uh for for most of them and you know you you can imagine that the same gene some might be specific and some might be more general. So here's an example of a specific one. Um, if you are born into a group like Honchinese are and you lack the enzyme or don't have much of a particular enzyme that is used to metabolize alcohol, it is just a less enjoyable experience to drink. You, you know, you can't break it down acetal alahhide and acetic acid and all that sort of thing. And so that one is but that would lower your risk for anything else but at least specific for alcohol. But other genes for things like impulsivity um that that would put you at risk for you know across substances being sensation seeking um you're going to try more drugs that means it's more likely that you know you're going to get exposed to one another thing we see happening which is really fascinating and poorly understood I've I of course know doing what I do lots of people are in recovery and I've uh known people and had people in my studies who have been say clean and sober in their you sense for 20 years and then all of a sudden they develop like a very strong sexual compulsion or they gain 30 pounds because they're just eating and eating and eating and it's like, you know, the the underlying diiathesis, whatever it is, has found a new phenotypic expression because it was never actually resolved. What was resolved was the particular set of behaviors that went with the addictions they had when they got into recovery. When it comes to alcohol, I've heard it said that there's a subset of people with um I guess nowadays they call alcohol use disorder. Can we just call it alcoholism today? Sure. Okay. Sometimes people will lash back at me if I call refer to someone as an alcoholic. But I have enough friends who are alcoholics. That joke is only on them by the way who are recovered. So I can make the joke um because they're impressive recovery uh stories and they all just say just call it what it is which is alcoholism. There's just so much splitting of names now. Are you I don't want to put you in a position of saying something that's gonna offend anyone whereas I I can do that. This is worth getting into. So use disorder is a much broader spectrum thing. So you know when when you if you diagnose them with alcohol use disorder, it can be mild, moderate or severe. And the people at the mild end, everyone at AA would laugh at, you know, this is a person who occasionally drinks too much, has some harms, but basically life is still put together. They would, you know, and people would be like, you got to be kidding me. that's that's your problem. It's only when you get up to the severe end where we we see the things that it looks like addiction. So, they aren't they aren't actually the same thing. Addiction and use disorder. Use disorders is broader. And it was it was there to sort of um move alcohol like other health behaviors that you might start addressing particularly in like primary care. So you know just like we would like you know doctors to intervene when someone is 15 pounds overweight and has moderate high blood pressure so that you they don't you know later you know develop a more serious problem. That was the idea well let's have you know a lower severity problem that a doctor might while the person still has a fair amount of control advise you hey you know if you could just cut back a bit now you could avoid a lot of suffering later. That's where that came from. But I'm I'm comfortable talking about addiction. It's a good word. It's scientifically meaningful and it's something the public understands. Yeah. And if you go to an AA meeting, uh they go around the room saying, "I'm so and so and I'm an alcoholic." They don't say, "I'm so and so and I have alcohol use disorder." Oh, that's right. Yeah. So many people who have who are in recovery um define at some level of their identity, not their total identity, as an alcoholic. It's actually an important part of the 12step recovery process, which we'll talk about. In any case, not to split hairs here, but I'm grateful that you're willing to embrace that nomenclature. And thanks for clarifying that why it was split. Um, because sometimes these clinical uh and naming things are split because of quote unquote sensitivities. We don't want to offend etc. And we don't want to offend. Okay. So, alcohol. Um, I've heard it said that there's a subset of people somewhere around 8 to 10% for whom they they drink alcohol and they experience it very differently. They experience it more as a, for lack of a better term, kind of a dopamineergic, you know, energizing experience for um, and this could relate to tolerance, but that they have a very different experience subjectively of alcohol than most everybody else who can build up tolerance. anyone can build up tolerance. Um, and then it takes longer to get into the sedative effects, the depressive effects of alcohol, but I've heard it said that this 8 to 10% are particularly susceptible to becoming alcoholics because they drink and they feel spectacularly good and they can keep drinking in a way that many other people either pass out, blackout, crash their car, end up in jail or dead. And so in some sense this 8 to 10 percent may be at greater risk than everyone else. Yeah. So uh Mark Shookett who's a superb psychiatrist was based in Southern California for most of his career did some wonderful studies of male uh children of alcoholic fathers. And one of the things he showed is that when given alcohol, their body sway is less at a level you can't even perceive, but he couldn't measure that, you know, yeah. Like how much they moved, like how how hard the alcohol hit them. And they had uh fewer hangovers the next day. And then you might think, well, that's great. It doesn't hit you that hard, but you know, you can drink a lot. Like, no, that's the problem because someone else would get the signal of like, whoa, I I you know, I'm feeling kind of dizzy here. I must have had too much to drink or the next morning they get up and go, "Oh god, I'm never doing that again." They don't get that signal. It's, you know, less less punishing, more rewarding. And you see that across drugs. Uh, and this is almost surely genetic. Um, how much people like different drugs, you know, varies enormously. I I'll be personal about this. So, I uh, you know, had an injury. Uh, I broke my, you know, I I had to take Vicodin for the pain afterwards. I find taking opioids so unpleasant. I feel bound up, you know, miserable, groggy that I just took one and said, "Pain is better than this." I have worked with people clinically who say the first time I had an opioid, it was like a hole in my chest that had been there my whole life filled up for the very first time. That has everything to do with genes. There's no, it's not due, there's no learning history there, right? But there's something, you know, I'm just wired differently for that particular drug than people who get in trouble uh with it is. And these don't necessarily go in groups. So someone can, you know, hate opioids, but you know, love cannabis or love alcohol. Um, and that of course is going to change their their risk. How could it not? This is such an important point, and I didn't realize that it extended to things outside of alcohol. uh because oftentimes when a discussion starts to surface about addiction and whether or not zero is better than any, whether or not things can be done in moderation, I think this is actually a big um unspoken point of friction because some people really can drink five or six drinks. Oh yeah. And then the next day they're at work hammering away and they're going to say, "Listen, my life's going great." Yep. And you know, liver markers are still within range. Eventually they'll decline. you know, they'll get worse, but the conversation becomes very difficult to have because it's high, it sounds like it's highly individual how people will react. And there are the behavioral impacts. Like for instance, um I've heard the statistic that one of the greatest risks for becoming an alcoholic is if your first drink is before the age of 14. So I find that some people will, you know, have their first drink like you said and it's like a magic elixir for their physiology. And there are very few things that can get somebody like that to stop drinking except the risk of losing everything and sometimes even then. Sometimes even then. And so maybe alcohol is the best, you know, template for for talking about this because it's socially acceptable in most places for adults anyway. It's legal. It's marketed. It's legal. it's marketed and um and yet how does one know whether or not they have a predisposition um because those people might want to avoid using something because our colleague Anna LMK has said that um you can't get addicted to something that you've never done or taken. Yes, that that is the most helpful advice, you know. So I I can never tell you if you know in this game of Russian roulette, the bullet will not be in your chamber for sure. You know, I can say like you're less likely for this, more likely for that. But the only way to determine that a substance will not damage your life is to never use it in the first place. There's always going to be some some risk. There's been a lot of work on like kind of genotyping to try to figure out could I tell you tell people, you know, what their genetic risk is for alcohol. And nothing is as good as just saying your parents alcoholic yeah or no. And if they were, that's like the most useful bit of information. or does you know does problem drinking run in your family? That kind of is crude to question as that is that's more useful than anything we have from snips or anything like that. Does it cross sex? So like if if a a daughter uh um has a father who's alcoholic, does it cross sex as readily as it goes from say father to son or mother to daughter? Uh no. I mean there is there is still risk there for sure, but the father to son link is the is the strongest one you see in in genetic studies. Now, of course, there's in a sense it's hard, right? Because men drink more than women do. I mean, in in our culture anyway. And and they drink to excess more than women do anyway, whether they've got an alcohol problem or not. So, if you think this is some sort of unfolding process, right, then men carrying risk would be more likely to have that risk realized through the behavior than a woman would. Well, there's still a fair amount of women who don't drink or or drink, you know, hardly any. food. So, it's sort of like the thing if you, you know, if you had all the genetic loading for cocaine in 1800, it didn't matter. There was no cocaine. If you had all the genetic loading for alcohol and you've never drank, then it's really irrelevant. I'd like to take a quick break and acknowledge one of our sponsors, David. David makes a protein bar unlike any other. It has 28 g of protein, only 150 calories, and zero gram of sugar. That's right, 28 gram of protein and 75% of its calories come from protein. That's 50% higher than the next closest protein bar. These bars from David also taste amazing. Right now, my favorite flavor is the new cinnamon roll flavor, but I also like the chocolate chip cookie dough flavor, and I also like the salted peanut butter flavor. Basically, I like all the flavors. They're all delicious. Also, big news. David bars are now back in stock. They were sold out for several months because they are that popular, but they are now back in stock. By eating a David bar, I'm able to get 28 grams of protein in the calories of a snack, which makes it very easy for me to meet my protein goals of 1 gram of protein per pound of body weight per day and to do so without eating excess calories. I generally eat a David bar most afternoons and I always keep them with me when I'm away from home or traveling because they're incredibly convenient to get enough protein. As I mentioned, they're incredibly delicious and given that 28 grams of protein, they're pretty filling for just 150 calories. So, they're great between meals as well. If you'd like to try David, you can go to davidproin.com/huberman. Again, that's davidprotein.com/huberman. Today's episode is also brought to us by BetterHelp. BetterHelp offers professional therapy with a licensed therapist carried out entirely online. I've been doing therapy for many years now, and I can tell you that it's a lot like physical workouts. There are days when I want to do it, and there are days when I don't want to do it. But every time I finish a therapy session, I come away feeling much better and knowing that the time was very well spent. Typically, when I finish a therapy session, I come away with at least one valuable insight or perspective on something that I'm working through, whether that's with work, relationships, or my personal life, or just simply my relationship to myself. There's just so much benefit that comes through effective therapy. And with BetterHelp, they make it very easy to find an expert therapist who can provide you with the benefits that come from effective therapy. With over 30,000 therapists, BetterHelp is one of the world's largest online therapy platforms, having served over five million people globally. And it works with an average rating of 4.9 out of five for a live session based on over 1.7 million client reviews. Also, because BetterHelp is done entirely online, it's extremely timeefficient. There's no driving to a therapist's office, looking for parking, etc. If you'd like to try BetterHelp, you can go to betterhelp.com/huberman to get 10% off your first month. Again, that's betterhelp.com/huberman. Women are drinking more or less now. Women, unfortunately, um you know, in the late 90s, early odds, the alcohol industry figured out that uh women had more money and but they weren't drinking the way men were. So they uh engaged in a long-term campaign to try to increase women's drinking. So things like, you know, mommy mommy wine juice and those wine wine mommy wine chats online and all that that was really engineered by them. Even some of the ones that look organic online were engineered by the industry and it worked. Women's drinking went up a lot. Um and the damage per drink is more for women for most things than it is for men for partly due to body size but also partly probably due to some hormonal things. And so it's been you know a exploitation as I see it you know of women and I notice a lot of young women now like undergraduates I talked to re-evaluating that like looking at their mom's experience and saying you know I don't think I want to do that and I I'm really encouraged by that. I not not that I want to control you know the decisions we make but I don't want them making them just because the industry slickly marketed to them um because the industry's sole interest is always going to be to generate profit and you do that with addiction because you know something like what 10% of our country drinks about half the alcohol so you have yeah you're shocked yeah 10% of the country drinks alcohol alcohol right United States so if you're running the industry you want that group to be as big as possible you do not make money off people who have a, you know, half a bottle of wine on special occasions. You make your money on the people who drink drink the equivalent of multiple bottles of wine every single day. So you have a fundamentally these industries, the more addiction there is, the the better off they do financially. Wow. There's a lot there. The statistics say that drinking is at an all-time low in the United States right now. At least some statist Yeah. Yeah. statistics something seems to have changed and and this may have something to do with this new generation. You know there there's less risk behavior in lots of things on you know over the last 10 years. So uh you know less uh you know cutting class less uh less chance of uh dropping out of high school u fewer unwanted pregnancies all that stuff. So there is that generation will probably be a drier generation than their parents were. Is cannabis use higher in that group? Everyone likes to just default to well cannabis is up so alcohol is down implying that you have to do something that people have to be using some sort of mindaltering substance. Yeah. With the legalization of cannabis um we certainly have seen a lot more use and a lot stronger products but youth use really has only changed pretty slightly. So the growth has really been among adults including adults who probably stopped at some point and have now gone back in later life to uh using cannabis. We'll get back to cannabis, but I want to um parse the alcohol stats a bit more also as it relates to uh to women. Maybe we can just either put to rest or not this argument that some amount of alcohol, typically it's red wine is couched this way, is more beneficial for you than not drinking at all. My read of the data, and we covered this in a long episode on alcohol a few years ago, was that zero is better than any. And that two per week, two drinks per week, and that's getting very specific about ounces for, you know, spirits versus two per week is sort of the upper limit for adult non-alcoholics that um don't want to incur any additional health risk. Um the cancer risk very clear the uh disruption to sleep which probably cascades into other things inflammation etc. But is zero better than any is too safe for non-alcoholic adults because every week it seems I see a new article that says zero is better than any. No wait it turns out there's some benefit from two drinks per week and I'm getting frank I'm not tired of it but it's almost getting funny. Yeah. the extent to which the uh it's traditional media, not to poke on them, but they just keep flip-flopping. And then the questions that always come up are, well, did the alcohol industry sort of encourage this study? Because if we're honest, there's a lot of advertising of alcohol in traditional media outlets. Oh, absolutely. So, uh, statement against interest because I like red wine. I would love to believe it is healthy. It's not. Uh and the whole thing about red wine per se by the way was never made any sense like why would there be a benefit to red wine that wasn't you know in other alcoholic beverages right and it came from a 60-minute story I think it was in the '9s was about why do French people why do why why do Mediterranean the red wine red wine cells exploded you know you know this is so great resveratrol was an argument yes that's right you know there's such trace amounts that just like ludicrous you know in a grape skin um and so that was just spread and it was just so great for the industry it's better for you than not drinking. Um, and you know, that's just not true. Uh, you know, it's it's um when you look at they would look at studies and say, well, look, you know, the the the non-drinking group have higher mortality than the low drinking group and the famous called the J-shaped curve, you know, like that. Problem is non-drinkers include people who are like in alcoholic synonymous. That's why they don't drink. They had a, you know, a wretched experience with alcohol. And so, um, you know, they had they've had different kinds of damage to their bodies. Maybe their health is isn't as good. They're not going to live as long, but it's not that they would be better off if they went back to drinking. They would things would would go to hell basically for them. And, uh, that just got, you know, marketed and and and spread. And it and it's not true. There might be some cardiac benefit, okay? But, you know, we don't we don't get to, you know, live our lives as single organs. We have a whole body. You have to weigh that if that is true. And it is wobbly. If that's true, it's smaller than the cancer risk. So your net is you're not going to get any mortality gain from mortality reduction from drinking alcohol. If you have two drinks a week, and by a drink I mean like a 12 ounce beer, uh a a 1 oz shot or a uh a glass of wine, a 4 oz glass of wine, you you have slightly higher risk, but it is very very very small. And you know, it's not the kind of thing if I, you know, if I were giving health advice to the country, that would not be on my top 10 things to be, you know, really frightened about. I think it's it's very small. It's just not good for you. That's what science has overturned the industry message that this is will extend your life and you'll be more healthy if you drink than if you don't. There's there's no way we can establish that as being true. You said it very clearly, but I'm going to um just repeat it because I think it's super important for people to take note of that the cardiac benefit is less than the cancer risk. And I think that's a very important way to view these stats. The episode that we did about alcohol um had a lot of different responses. U there's obviously a selection bias in the responses. Many people gave up drinking who I later learned wanted to quit drinking. They didn't like it. the downstream effects of the disruption to sleep from alcohol and so on. Probably part of the effect. Um it was very interesting as it relates to women because um many people including some members of my family really like their post-work glass of wine or want a drink to just kind of mark an end to the day and and relax. Um my observation was that many women who stopped drinking either because of that discussion about alcohol or others that they had heard did so when they learned that women have a particular risk to cancer as it relates to alcohol meaning if the breast cancer risk and other hormone um ovarian cancer hormone related cancers and so forth not always hormone related but the moment it move that the it's probably best to avoid alcohol entirely conversation moved into women's specific health. It had a a very potent impact. Uh which is interesting in its own right. Um and it speaks to what's perhaps required to override some of the marketing because let's be fair, it's nice to relax with friends. And if people think relaxing with friends is easier to do over a glass of wine or two, then that's a great not just marketing scheme, it's also somewhat true for them until there's counter evidence. And so what I'm really getting at here is, you know, how is it that people should frame what they know to be risky versus the other benefits of alcohol that clearly exist like helps people relax. Um it's social, they stress less and so on and so forth. You know, as I mentioned, I'm someone who drinks wine and I know that it is, you know, on average, you know, it's not healthy. Um why do I do that? It's like well because it creates other things particularly with exactly that situation that you know uh getting together with friends is enjoyable uh enriching good food is enriching good food and a and a good wine tastes good uh and I value those things and there are many other decisions we make like that where we endure some risk because uh we care about something else. you know, it's it's dangerous to, you know, for for someone my age to, you know, hike up a mountain side probably. Um, but, uh, if if the view is spectacular, I can I say, I'm going to accept that risk. You maybe I'm more prone to twist my ankle or something, but this is just really beautiful. That that's okay. I think I think what the place we got in alcohol that was bad was needing an explanation to stop. So, how often have you ever said to someone at a party or seen someone say at a party, "Why are you drinking?" I've never heard that, but I've certainly heard a million times, "Why aren't you drinking?" If you don't drink at parties or you refuse an offer of alcohol, people think there's something wrong with you. Yeah. And you have to have to have an explanation like, "Well, I I got a exam tomorrow morning or uh I've got a cold or or or something." It's like, you shouldn't need an explanation. Um, but people do feel feel that social pressure. And so that's one way health information can work. Why didn't a person just quit beforehand because they may not have had an explanation that worked in their uh their circle and now you can say well you know I I see those data on uh you know ovarian cancer and uh you know I just I decided to quit drinking. Um and you know that is you know health is a reason people still accept I think as a uh legitimate for changing behavior. you can make that you know because you know cancer is scary and that may be why uh people quit. Um, you know, same thing happened when, you know, first surgeon general smoking, uh, thinking about everybody smoked. You had to to sort of fit in at work, you had to smoke. And when that came out, there were a lot of people who just quit immediately. They clearly were capable of quitting, wanted to quit, but they needed some exp to tell everybody, why are you not smoking anymore? Why can't Why don't you carry cigarettes anymore? I can't bum one off you anymore. It's like that that's why. Why do you think people who drink uh feel uncomfortable about people not drinking around them? When people would ask me uh if I wanted to drink and I'd say no and they'd say why. They often say that I would say the truth which is I'll say anything that's on my mind without drinking. You don't want me to drink cuz then I'll tell you everything that's on my mind. Oh good. It's true. I I mean like I I will tell people what I'm thinking. Uh I don't need to like loosen up. I'm pretty relaxed in social settings. I don't have much social anxiety, but I realize some people might have trouble with social anxiety. Yeah. You know, I I I spent a little time in Japan when I was a young man and there's this, you know, culture of getting going out after work like the salary man go to work and and someone getting really really drunk and everyone's drinking and you're vulnerable with each other and you and then you know that I will I will it's like a trust exercise like that falling backwards thing except it is that we're all drunk and if someone weren't doing it's like why why are you not undergoing any so we're all going to be vulnerable and you're not and like are you going to exploit us in some way or I'm going to say you I think I hate the boss and then you're going to repeat that at work because you know you you're you're the one person sober enough to remember I said that. I think that is a real thing that that people have anxiety about. Or I can imagine you say what what if uh you know a uh a man woman are on a date and the guy keeps giving drinks to the woman and doesn't drink himself like you know what is the natural thing to think are you trying to get me drunk? Are you going to take advantage of me because you you know you're going to be with it and I'm not because I'm going to be drunk. So those kinds of fears may be in the soup. Um but I I don't think you know so say maybe that's you know rational at some level but I don't think that should drive our sort of routine social interaction with our friends. It should just be a non-issue you know of what do you want? And if you I want sparkling water I just give you a glass of sparkling water and don't say why haven't you why aren't you drinking this intoxicating beverage? You know you shouldn't need to explain it to me. The trust piece is super interesting. So is the vulnerability piece. Um, a couple thoughts about this and they're just editorial thoughts, so forgive me, but one is for years I thought how crazy it was. I would go to these meetings with doctors and scientists who ostensibly were working on issues related to health and everyone would just get trashed at the bar and [clears throat] I wasn't into that. Um, and I wasn't judgmental. I actually kind of liked it cuz by the third day of the meeting I'm cranking and they're all just I can tell they're all just blery and they and they're also aging much faster than I am. They they they would get what the tenur look as we would call it or as I would call it like you see them in five years. I'm like what happened to you? You aged 15 years. And and I these people tended to drink a lot both at meetings and outside meetings. Alcohol was paid for often by the meeting fees. Gets a little I'm not trying to, you know, point a finger here. And then a lot of the stuff that happened at meetings that turned out cost people jobs was always alcoholrelated. Yeah. In the instance of the the man and woman on a date drinking or a group of uh people at work drinking together in Japan, it sounded like it was men getting drunk with other men. Yes. In my mental picture of the the male female dynamic and drinking, I'm going to simplify this. If she drinks, it makes her vulnerable. If he drinks, it makes him more stupid and impulsive. Mhm. [clears throat] And so in the the world where she's drinking and he's not, you gave the example that perhaps, you know, he would take advantage of her if he's encouraging it. Certainly there's that picture in one's mind. He's also can get her home safely. If he's drinking, he can't get her home safely and he might say or do something really dumb. So I feel like no matter how the math is arranged, it always ends up drinking ends up being kind of a bad idea. I mean, not trying to be judgmental here, like I because I'm not I don't judge what people do. do as you wish, but know what you're doing is my my philosophy. But I just don't see a world where drinking with your co-workers or drinking on a date with somebody that you don't know very well, male or female, right, [clears throat] for either of them. It's just like a lack of safety all around. Um it just seems like a bad idea. As women move into more professions that may have changed that that norm of, you know, everybody goes out and gets drunk because the consequences aren't the same. and and you know I I know a lot of you know professional women and friends I don't want to do that you know um you know I don't want to be around the boss when he's drunk you know and so let's let's have a Christmas lunch together at work instead of you know uh drinks afterwards so I I definitely see that I think in the dating now of course I'm haven't thankfully had to worry about dating for 40 years I but what I I I think most people would say is just the anxiety you know is you know intense for some people and alcohol is anxolytic right and so it's probably that that people are you know sort of feeling uh you know it's just it's you know they're too nervous you know and whether they should or they shouldn't that's just I think probably probably in the soup one of those benefits people people uh care about and there are people it has to be said who are more socially uh engaging when they've had a drink than when they haven't because they're kind of wound up people when they relax some other stuff comes out and they may seem uh more appealing. It's interesting. We could uh dissect it a number of ways, but I think that's enough contour for people to be able to think about whether or not they have a genetic predisposition, understand that zero is better than any. um if we hear about some uh cardiac benefit to weigh that against the cancer risk and not just take it as an independent piece of information and then to think about vulnerabilities of um other people's actions and vulnerabilities of one's own actions and words uh if drinking and then people can make an informed decision. That's kind of how I a good summary how I uh feel about it. Again, do as you wish but know what you're doing is like the the purpose here. Let's talk about cannabis a bit. Uh because eventually I'd like to weave back to how industries impact use and abuse. Um cannabis when I was growing up was illegal. You could go to jail for it. Mhm. People still smoke pot. It happened. Um the idea was that it was much less potent. We can talk about that. But now it's a whole industry. Yes. And the edible industry has contributed to this greatly because it bypasses the um the [clears throat] blowing of smoke um the the smell um and a number of other things. So what are your thoughts about cannabis as something that can be used quote unquote recreationally, medically, and its potential for abuse? and then let's talk about how those things have been amplified or reduced by the fact that it's essentially legal or decriminalized. So what are your thoughts on cannabis? Yeah, so I whenever we talk about I I make a distinction between sort of old and new cannabis. So, you know, if you go back to the 80s and 90s, uh, when, as you mentioned, it was illegal everywhere, the THC content, that's the principal intoxicant, would be, you know, 3, four, 5%, something like that on average. And now, you know, studies of legal sales show the average product is about 20%. So, it's dramatically stronger. The other point is how people use it is different, perhaps related to that high potency. uh Jonathan Caulkins uh pulled together a lot of really interesting data that got a lot of play and it showed that about 40 I think it's 42% of people who use cannabis use it every day or almost every day that is also different so back if you go back in the past you know the more modal user might have been once or twice a week so you put those things together some so you take somebody you know what was like an 80s pot smoke well on weekends you know I'd smoke a joint at you know 5% but now if it's means every day I'm consuming 20% % you quickly realize like their brain exposure is dramatically higher about 65 times higher uh between the modes of those two two uh experiences and what you know what so what is 65 times mean well it coincidentally is also the potency difference between a cocoa leaf and cocaine that is that is 65 times two so it's a big difference and as you know you know you know dose makes the poison so so it is a just a really different drug than what was back there and this is very hard to get across to parents because their view is like ah I smoked weed you know is is is you know who cares if my you know 15-year-old is using it. It's like but that's kind saying you drank low alcohol beer and you're not you're you're not concerned that your 15-year-old is guzzling vodka. That's that's kind of the difference and it's just a bigger deal than it used to be. Even when you take away the fact that you have an industry really pushing it just the drug is stronger, more addictive. Does it have any uh medical applications? Almost surely you know the canabonoid receptor system evolutionarily is you know one of the oldest in the the uh in history of homo sapiens. It is both in the brain but it's also in the body. There are clearly going to be some applications for pain. Um you know you know there's many people would say they spontaneously get relief. It's hard to tell always what that means because sometimes that's just relief from withdrawal, but but you know, probably some some type of medical applications for pain will come out of this plant. We do have some out of the CBD, which is the non- intoxicating part is a medication that is used uh in seizure disorders in kids, you know. So, there'll be some other things like that for sure. Um and you know, you know, the it's easier to study this than has ever been before. um you know that um about 2020 Congress changed the way uh research works. So it's a lot a lot simpler to to uh do it. So we we'll we'll figure those things out. Um but it is just a more a more dangerous drug than it was, you know, when I was a young person. I had a guest on the podcast uh who's a cannabis researcher, runs an animal lab. Um and we invited him on because I had released a solo episode about cannabis. We touched on some of the risk for psychosis. Yeah. In uh young men um and made some points about frankly concerns about cannabis because of the high THC content. Uh he was not happy with the things I said. He made that clear on social media. So um by the way, this isn't the way to get invited on the podcast, but we invited him on and I I think we had a very fruitful discussion where he clarified a few things for me. And one of the things that he claims uh is that despite the higher THC content that there's a distinct difference between smoked versus edible cannabis whereby people who smoke cannabis even the high THC cannabis um are very good at gauging the kind of level of high so that they don't go into paranoid modes. they don't surpass the the plane of high that would make them feel paranoid or um put them into a psychotic episode, but that people who take edibles because it's harder to gauge where you're at if you can just swallow an edible or even nibble on an edible um often surpass the level at which they would be comfortable, meaning at which there's a psychotic episode or there's paranoia. So he was making this kind of um soft argument for the fact that the elevated T THC levels in cannabis are not such a problem because people are essentially taking less to offset the the difference. Yeah, I think there's no evidence for that at all. In fact, and and uh people are surprisingly bad, even experienced pot smokers at judging in lab studies of like how strong different cannabis is. I don't agree with that part, but I do agree we should think about the edibles differently because of the onset is different through the gut, you know. So when you smoke anything you know you get that that goes very efficiently you know to the brain but when you eat something you know it takes a while you know to have its effect and so particularly when these products came out and a lot of people were uh new to them they would uh you know bite down on you know one piece of the whatever the bar the cookie or whatever five minutes later I feel the same take another bite still feel the same and then just eat the whole thing and then it would all hit them like like a train. And you know that that does happen. The other thing that is true is that a lot of these uh products are not wellmade or they're not up to like the standards of like you would have a cookie. You would you would never open up a bag of chocolate chip cookies in the United States and find all the chocolate chips at one end and just dough and the rest. But that does happen with cannabis products in legal markets. And so if you just bite on the wrong part, you're getting the, you know, the whole enchilada, so to speak. um that because it's not evenly blended through and there are some people who've gotten gotten into trouble uh on that as well. Interesting. What about the psychosis risk? Yeah. So, I was very skeptical of this literature for years. Not not to say that the science was bad, but just like it seemed to me there were lots of ways to explain it. Um, and I'm a lot less skeptical now, candidly, because, you know, in the in the old studies, they would be there men who had used cannabis in teen years and then they would have higher rates of of uh psychotic disorders in adult. These were studies based on like Swedish uh registries because everybody has to register for the uh the military, you know, um and um they would track people and it's quite amazing data. So it is a whole national data that's good but there's lots of reasons that could come about you know could be a common factor between those two things um you know but um the evidence has gotten stronger as the drug has gotten stronger and again we got to got to realize people are using it um much more intensely. So if this effect is there it's much more plausible that it would be from a much stronger drug used you know every day could generate higher rates of psychosis. It's hard to test this because it's a rare thankfully condition, but I think there is, you know, probably something there. I am sad to say. I wish it I wish there weren't, but there probably is something there. Um, I would not use cannabis if I had any first-degree relatives with any, you know, schizophrenia, schizoid personality, anything in the psych bipolar disorder. I would not personally uh recommend that for anybody. I think that's probably uh probably quite risky. What about the cardiac risk and other health risks? I've heard recently that there's a direct risk of cannabis even if it's not smoked or vaped uh on cardiac health. I'm not sure of that of non-smoked cannabis in the heart. I mean, I haven't looked at that literature, so I don't I don't know the answer to that. Um I realize there's some one point uh I should touch on that you also raised earlier about first drinking which is everything is different when the brain is plastic and our brains are most highly plastic um you know when we're young and so a lot of these effects the worst things are going to be because people start when they're in teen or you know late late single single digit. That's where addictions overwhelmingly start. And that is where if there is a a psychotic risk, it's almost surely then during that period of brain development before people get their first psychotic break, which tends to be around 18, 19, 20, 21. I worry about it less for anything. You know, initiating a substance when you're 50 is far less likely to end you up with an addiction or some other terrible thing than uh when you're young. I'm sure everyone knows at least one person or or has heard of one person who's uh very productive in their life, healthy family, job, etc. Um high energy who uses cannabis. Um in my observation, they are the rare exception. Um and there are a lot of examples of people who use cannabis who um don't really go anywhere in life. They they don't go through the normal developmental progression of finding a job that can sustain them, right? Of organizing their life, their relationship life, their professional life. And clearly there are other aspects to life, but those are key ones, right? And um what are the data on high THC or just frequency of cannabis use as it relates to life progression? Failure to launch we call it now for typically it's guys that young men that fail to launch. Um and I want to be clear uh not for political reasons but I want to be clear when I say fail to launch. I don't mean that every kid has to go to college and, you know, be a, you know, a varsity athlete or any of this, but just moving out of one's home eventually, getting a regular job, keeping the job, hopefully having healthy relationships of various kinds and being self- sustaining. That's what I'm talking about. Yeah, absolutely true. I mean, for example, I did Ezra Klein show. He's obviously a very successful guy and he mentioned that he sometimes uses cannabis edibles. I mean, he has that look. No, I'm just kidding. Sorry, Ezra. Just teasing. Yeah. I mean, so yeah, there's and you know, you could there are very very very successful people who use cannabis for sure. Overall though, I mean, I'll steal a phrase Caulkins. It's like, you know, we have performance enhancement drugs. It's kind of a performance degrading drug. So, it's not it's not fentanyl. you know, your your your odds of your death being directly tra traced to it are extraordinarily low. But it does with regular use undermine certain things that you need to succeed in the modern world like short-term memory and concentration and being able to keep track of details. And for some people also, it it undermines their sort of motivation to do much of anything. I mean, the couch lock is a real thing. Um, you know, I I know families in Palo Alto, where I'm from, very achiev uh, you know, a straight A son, you know, doing everything, starring on sports, whatever, who, you know, 6 months later was just smoking cannabis all day and had no interest in the team he used to star on and the math he used to be great on. And like, that's that's pretty frightening. And all those things are not conducive to succeeding in in again in a modern world. If maybe back in an agrarian society, it didn't matter because we you know everything was on muscle power, right? Um but you know to succeed in in this society, you have to be able to do those things. And and you you are in competition, you know, if you want a job, you know, computer coding, you're you're in competition not just with the smartest kids in your neighborhood. you're in competition with the smartest kids who are in Mumbai, you know, and and in Tokyo. And if you can't focus or you're just slower and you can't remember things, um or you have trouble like making sure you uh keep track of time, um that is going to put you at a disadvantage. uh and and uh you can end up that stereotype of you know living in mom's basement that unfortunately is true of a a chunk of people who are heavy users of cannabis. Yeah. I worry a lot about examples of so and so is very high achieving and they use cannabis. Um I had a friend growing up who desperately wanted to be a professional golf player and he would cite all these professional golf players who were heavy drinkers. He ended up just being good at the heavy drinking part. Yeah. Um sadly, um I think he turned his life around at some point. But these examples of people who can use very addictive substances and are open about that and are very high achieving. I think there's a there's a real detriment to that messaging. Now, of course, you don't want people to cloak their reality, but it's it's complicated. Yeah. And and it also has policy risk, too. I mean, you know, when you make up the rules, uh, you know, you know, your laws and regulations to to think, well, you know, I'm I'm accomplished. I I'm able to use this, so that must mean it's pretty safe. It's like, that just doesn't follow logically. The fact that you occasionally, you know, take a snort of cocaine or whatever, and and you're still a state senator. Uh, that doesn't prove that that would be safe for everyone. And, you know, we we know people have different levels of risk. They have different social capital. they have different incentives in their lives and um you you can't overgeneralize from a sort of a lucky life or a costed life. Sometimes you can do more of that than you can when you know there's not many uh you know uh nets sort of between the person and the you know and the ground. By now I'm sure that many of you have heard me say that I've been taking AG1 for more than a decade. And indeed that's true. The reason I started taking AG1 way back in 2012 and the reason why I still continue to take it every single day is because AG1 is, to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the market. 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If you'd like to try AG1 and try these new flavors, you can go to drink a1.com/huberman to claim a special offer. Right now, AG1 is giving away six free sample packs of AGZ, which is AG1's new sleep formula, which by the way is fantastic. It's the only sleep supplement I take. It eliminates the need for all these pills and my sleep has never been better. The special offer gives you six free samples of that AGZ as well as three AG1 travel packs and a bottle of vitamin D3 K2 with your first subscription. Just go to drinka1.com/huberman to get started. I heard a wonderful talk that uh you participated in um with uh one of the members of the Kennedy family. it wasn't Robert Patrick Kennedy, excuse me, who's been very open about his own recovery and so many gems in that talk. We'll put a link to it and we'll touch on some of those things again, but just as such an important conversation. Um, and you know, it came up in that discussion that many industries are industries of addiction, alcohol, cannabis, gambling. Nowadays, I was thinking about what you guys were talking about. And nowadays, it's very difficult to look at any industry and not see it that way at some level. They talk about it themselves that way, you know, they they'll if you get together with app developers, they'll say, "How do we make this more addictive?" You know, so it's it's and it and it is good for business. There is no customer like an addicted customer. So, of course, that's going to be appealing if you're trying to sell something. I guess the question is healthy addictions or adaptive addictions or things that fall outside the progressive narrowing of the things that bring you pleasure because a kid getting quote unquote addicted to a learning app uh that carries over into a number of things one hopes um in school and uh or even social media. I've learned a lot from YouTube videos. Heck, I even watched that YouTube video of you and Patrick uh you know uh uh on YouTube. So there's this double-edged blade piece. Uh, but when it comes to alcohol and cannabis, what you told us earlier, like getting women to drink more by making it seem like an important part of being a woman in the United States to drink. Yeah. That sounds diabolical. Convincing people that cannabis is going to make them more creative and it's not as bad as alcohol, that to me is very diabolical. And I and I worry about this. Well, it's not as bad as alcohol argument because I mean shooting yourself in the head is way worse than stabbing yourself in the head. Well, alcohol also kills, you know, about 150,000 Americans a year. So, if that's our bar, we should have hand grenades in the drugstore there. You know, that killed tens of thousands but not 150,000. You know, we should legalize drunk driving because, you know, that only kills 10,000 people. I mean, that's just a crazy thing to set as the well, as long as it kills less than 150,000 people a year, it sounds great to me. No, that doesn't make any sense. I mean, I I am clear like economically I am a capitalist. I'm glad we have companies. I love living in Silicon Valley. I love all the things people create there. And um and I think that is an important part for society to work to have a private sector. Um and at the same time, you have to regulate addictive uh goods. temptation goods very intelligently and tightly because you can't count on the sort of rational consumer to protect themselves like you can when you're dealing with cabbage or lettuce which nobody ever overdoses on. But we do see people burning down their lives over all these drugs. And for that reason, you know, to pro to protect those people, but also to protect the rest of us from the consequences of that, that's why, you know, you need things like advertising restrictions. That's why taxes to which people are people, even heavy users respond to price. Um, you know, that's a really important tool to regulate them. I would do I would do much more with cannabis particularly, you know, just some of the promotion is so naked and a lot of it is in places where kids are exposed particularly and this has just been a long-term fight. You know, we had it with the tobacco industry. Almost any nasty thing you could say about the tobacco industry turned out to be true. I mean, you know, they did work to make it more addictive. They worked to defeat uh any type of health regulation. They were marketing to kids, all that stuff. So, that those are the economic incentives. And so you you you should not be naive um if you work in this space about what the financial incentives are if you're making an addictive product. More addiction is good for your bottom line. So us on the on the other side have to say we're going to put in laws and regulations so that that is harder to achieve. Never going to get rid of all of it. But you can make it a lot lot harder. Gambling is a great example. I mean, I'm just amazed that we have just given up on any restrictions on gambling now. I mean, when I was a kid, Pete Rose was not allowed to go into the Hall of Fame because he had once placed a better on his own team. He wasn't even doing anything corrupt, but he was he bet on his own team would win. He was kept out of the Hall of Fame. Now, you can't watch a sporting event without having gambling ads shoved in your face. Like, that's an example of something that should just not be the case. That is terrible for anyone who's trying to quit gambling. It's terrible. A lot of young men particularly, but not just young men, are just ruining themselves economically over over sports gambling. And we we did we don't need this. We we can we can do without it. The gambling thing is a real concern. We had a guest on this podcast who's a self-admitted uh gambling addict. And um a friend of mine who treats gambling addicts said uh it's among the worst of the addictions because they live with the reality. It's true that the next time really could change at all. And he said eventually they get addicted to the shame of losing. They just get so winning becomes a thing of the distant past. I mean, this sounds crazy to to the rest of us, but it's fascinating. Um, it's fascinating and it um and disturbing. Um, and gambling addicts will say that every addiction is gambling. Yeah, that's good. That's good. There's a tremendous book uh Addiction by Design and I'm afraid I'm going to mispronounce the the name of the person who wrote I think it's Schull but I'm not sure but I know the title Addiction by Design about gambling and she profiles people who play video poker uh many of whom work in the casino. They basically get paid and then they go pay the casino back by giving it away. But some of them will take a toothpick and bend it and force the bet button down and they won't even touch it. They'll just sit there and watch in kind of a dissociative state as as it just runs and runs and runs until their money is gone. You know, that's like, you know, it's like zombification, you know, of this stuff. And that tech has been perfected to be addicted. If you I do I do go to Las Vegas like once every couple years. I just find I not for gamma, but I just enjoy the sort of pageantry and the food and all that. Um it's very hard to see dealers at tables anymore because dealers don't give the perfect timing of reinforcement that machines can do and you know they don't you know you have to wait you know for your reward and all that kind of thing and you wait till you find out and there's a social component. Well that all slows down the process whereas a machine can give you exact timing between your press the button and then you get your reward or or you know your your win or your loss. Uh and you and it can just go infinitely 24 hours a day unlike a dealer never gets tired. And so all the casinos like chopped up dealers and now you're just playing with a machine. Incredible. Um I don't want to spill off into too many anecdotes on my side. Um but I will share uh something that was shared by a previous guest on the podcast you may find interesting. Um Michael Easter is uh is at a university out in Las Vegas and he got access to one of these. Um he wrote the comfort crisis about getting outdoors, getting away from things and basically carrying weight on your back and walking as a therapy of sorts. Um an important one to do regularly. Um but he got access to one of these uh research casinos. And it turns out that slot machines used to be a small fraction of what the of the income of casinos. Now it's 80% or more. Yeah. And he said that that came about because um a father who worked for the casino industry was at home watching his kids play video games. And he realized that the kids weren't playing to win. They were playing for the novelty of what was on the next screen. And the kids didn't realize this, but it became clear to him. So now, and I think this will help people. This is why I'm taking the time to share this once again. Uh now, if you play a slot machine, you think you're trying to win. and hear that ching ching ching ching ching ching and the bells go off and you and you won. You think that's the dopamine reward. But they figured out that unlike the old rotor machines where you have some cherries and bells and stuff in the electronic landscape, you could have an infinite amount of novelty through novel combinations. So now they figured out that people will play to win 50 cents on the dollar. So they lost 50 cents, right? and they know that rationally or they could know that rationally, but they'll continue to play until it's all gone as long as you give them novelty. So, people aren't even really playing for the money anymore. They think they are. They're actually just being stimulated with enough novel combinations that their bank account gets drained, the house takes it all. When I heard that, I it changed my view of gambling and because I always thought it was about winning money and leaving. It's actually more about playing and it's more about the novelty that's introduced in each quote unquote hand or spin. And the I think knowing that carries over certainly to sports and the excitement that you're feeling about the potential that you could win, but that that it's a a novel combination of things um might prevent hopefully somebody from becoming a gambling addict or might help people realize that what they're addicted to, if not already shame, might actually just be the novelty. And that's why they're losing all their money. Yeah. There's an industry term for that. It's LDWS, losses disguised as wins. So, you know, you put in a dollar and you get a hundred credits and then you pull the thing and it, you know, it does its thing and then it goes like, you know, d you you've matched this way, you've won 10 and it goes off and you've matched that way 20. Oh my god, I've won again 40. I've won 40 20 and 10 with all these exciting things. I just lost, you know, 30% of what I put in. But it feels like a win. And they realized, as you say, people will keep playing even while objectively they're just pouring money down a sewer. [snorts] So glad I'm not addicted to gambling. But I could see how I could be. Even though I would like to say I couldn't be, I could see how I could be. Um because the brain is just so prone to these kinds of things. We all have these circuits. Absolutely. And uh it's interesting too, you know, casinos are one of the few places where you can still smoke uh you know, indoors and uh you get free drinks. And so it's it's really like um absolute dense pack of of addictions and and a huge number of people problem gamers are problem drinkers and and also are addicted to cigarettes. Um and and so when I when I go to Las Vegas, it's almost like a anthropology experience for me. I just look at all this like, wow. And there there was a story in Scho's book which I just found amazing with a bunch of people playing playing playing playing and somebody had a heart attack at one of the machines fell over on the floor in a group of them and none of them even reacted. They just kept playing as this person died. What a metaphor for society. Well, I just decided if I'm ever going to Las Vegas, I'm going with you. Okay. Sorry to invite myself, but you seem like a safe person to go. I'm pretty safe. Yes. You you may win or lose five bucks and that'll be the end of it. Love it. So, industries that drive this stuff, okay, alcohol, um, cannabis, it's going to be very interesting to see what happens with cannabis now and going forward. Is it the case that in states where it's legalized or decriminalized that the state collects it taxes on it? Yeah, it depend depends. Those are different regimes and and this is a really important point to get into when you think about policy. So, decriminalization is about the user and that's to say, look, we're not going to punish you for using pot. Okay? And that is a pretty popular it's always it's been a popular policy for a long time and doesn't it seem to really affect use that much you know maybe a little bit but not a lot. Legalization is making the production processing marketing and sale legal bringing in a corporation and that is fundamentally different um you know because the corporation is going to have very smart people who are you know good at selling and they will increase you know consumption of the product. Um it at this point, you know, I I don't know the exact state count, but it's mo most people in the United States population-wise have access at this point to a recreational uh cannabis. And virtually every state, I believe, has something if it's not recreational, it's medical or there were these uh due to hemp, there was sort of a way mistake they made in regulation. There's a way to process hemp that you can make these like delta 8s and delta 9. Even in states that are prohibited, there's quite a bit of like, you know, hemp laced beverages which are quite strong. Is cannabis a gateway drug? We were told that when we were in school. Yeah. So, all drugs are gateway drugs. The the lie in that was that you know cannabis had some unique role um you know that was going to lead you to use heroin use. But the truth is anything like you know if you're a teenager and you start smoking or you start drinking or you start uh you know using cannabis or or you know stealing prescription opioids from your parents or whatever that will increase your likelihood of progressing to other substances you know for multiple reasons you know one you might like it say okay well I guess I'm convers let me try some others two your social networks may change so you're around other people who do this and so they're you're comfortable with them they're comfortable with you and they're also more likely to have something else you might want to try. And then the third thing is it could be some brain sensitization you know going on uh that you know makes you know drugs more rewarding and there is some interesting work with like identical twins and different states which seem to suggest that you could be starting some unfolding process when you expose a young young brain to it. So all those processes is how gateways work. The lie was that it was just cannabis. And this actually fits with the general lie I would say is that alcohol is a drug and we pretend that it isn't. So you you know you you mentioned like people getting drunk at science conferences or health conferences. I have seen conferences, political events where people spend all day demonizing drug users and talking about, you know, the threat of drugs and how evil drugs are and how we have to, you know, destroy all drugs and then they all go to the bar and get drunk as if they are not drug users. not wanting to admit that alcohol is a drug is a very useful for the industry but it was also disuseful politically because you know you could say well the big threat to kids is cannabis when you know it's much much more likely a kid was going to get in trouble with alcohol than with cannabis these days there's a lot of discussion about psychedelics broad category of drugs LSDs psilocybin MDMA is an empath not a psychedelic but somehow it's been lumped into it mmethyl uh it's a methylene dioxymeth Methamphetamine, MDMA, ecstasy, folks, it's methamphetamine with some modification. So, it's not a psychedelic. It's an impathogen. Um, but it gets lumped with that. Ketamine gets lumped with it. Dissociative anesthetic. It's not a psychedelic. So, if we're going to have a conversation about psychedelics, I want to be really clear. Um, maybe we just put psilocybin and LSD on the table and then talk about the impathogens and ketamine and all the rest separately because so often these get lumped and and it leads to a lot of confusion. I know several people who feel they've benefited tremendously from doing clinical work meaning with a guide in safe setting etc on highdose [snorts] psilocybin maybe only two or three times total and that's it. For treatment of depression sometimes for alcohol issues and other issues. I'm not talking about micro doing they do a high dose to two two to five grams. Mhm. A lot of addicts who use other things are interested in or currently using or considering using psilocybin LSD less so uh as a means to get over their addiction. I'd like your thoughts about that and your thoughts about these compounds specifically. Yeah, I mean they're exciting uh in in part because we haven't really made much progress in pharmarmacothotherapy in the last 20 years, you know, for lots of things for depression, for for addiction, you know. So the thought that these might work and I think there other than the GLP1s, you know, one of the, you know, probably say the second I'd say my second bet on that, I put my first one in GP1 agonist. Um there is an awful lot of hype. Um but real things can be hyped. um you know so the fact that there are a lot of extravagant claims being made and also again talking about industry you know there are people who are you know hoping to make a huge sum of money on these on these medications um but there's also something there um you know you you can look at different pilot studies um you know small trials they are encouraging um and uh I'm glad that um you know it's a lot easier now to do these types of studies you know we just had my friend Dr. Todd Coris down to Stanford you know he's from Oregon you know Oregon is doing these things probably similar experience to what the you know your your friend had where you get you know you have a prep you have preparation you with a with a trained person you get the medication and then you do the integration session afterwards and there are again people would say it's you know is transformative for them um there are also people who have very bad experiences on them too though it has to has to be said and that's why we don't just say all right let's just use this as our front line you mean during the psychedelic experience end afterwards or afterwards like flashbacks, you know, you're driving along and then you have a flashback, you know, and you know that that is both upsetting depending what you're doing at the time, you know, could could carry some risk to it. Um, we don't know that well how well these exactly how these drugs work, you know, the sort of seroteneric kinds of kinds of drug. The one thing we do know good though, keeping on the topic of addiction is thankfully um you know there's no evidence that people get addicted to psilocybin or uh to LSD if they have abuse potential. It's extremely extremely slight. So I' I've always worried about them far less uh as a class of of drugs than I do things like stimulants which I know and you know and alcohol. My read of the literature and this might have been updated since uh is that there is zero evidence that micro doing psilocybin has any benefit. Yeah, I think that's just silly. Um there is solid evidence that in a clinical setting as you pointed out and thank you for pointing it out. We're talking about at least two or three talk sessions without psilocybin then a psilocybin journey that's typically two guides for safety purposes. Now that's kind of how it's being explored. M so they're um to avoid exploitation conditions because there has been some exploitation mainly in the MDMA trials but um and then followup that it's been somewhere between 60 and 70% of people who go into that sort of thing with major depression that hasn't been resolved by other approaches um get either significant relief or uh full remission after two full versions of what I just described at fairly high dosages. is when I think about the negative impacts I certainly there's the quote unquote bad trip um phenomenon what I've observed quite a lot and uh I hear from a lot of people in the psychedelic space is that post MDMA for trauma posts psilocybin for major depression and addiction issues there's the not euphoria but the feeling that something significant has changed in the weeks and months afterwards and then some period of time later a significant sudden drop in mood and that frightens them and that they're able to recover from, but that it's a real thing, a real trough. And this, by the way, is separate from the very well-known trough that comes 2 days after MDMA use. We could talk about that, but um you get high and then there's a low, you know, very well explained as with stimulants. As with stimulants, right? I'm divided on this psilocybin to treat addiction thing. Um it seems very precarious because of the lack of kind of standardization of how this would be done outside a clinical trial. It's hard, you know. I mean, you hear about some you hear shaman practitioner guide and there's no because it's illegal. There's no Yelp reviews for these people. There's no board that's overseeing it. Well, there is in Oregon. That's actually what Todd was presenting at, which is Yeah. Um because you It is legal. Um, it's legal, not just decriminalized. Correct. Yeah. Okay. Because in Oakland and California, it's decriminalized. Silicon is Yeah. Oak Oakland's very different. Yeah. No, in Oregon, you actually you you are licensed by the state to do this. I see. So, yeah. So, that that's what we'll find out. I mean, to me, this is like pretty probably this is case where it's easy to be a scientist. Sometimes it's annoying to be a scientist. Makes life harder. Makes it easier. It's like I don't know if this works. It's really important to figure out if this works. We have really good methods to do that. So let's spend the dollars to get good people to do those studies and and they this is the night of view you know national institute on drug they are funding quite a few studies you know of this sort um and I I imagine NIA which is the alcohol institute is doing it also um I say good because to me it's really I I think people get a little scared of these drugs and sort of like uh think um well you know you can't use them in medicine it's like well you we use lots of things in medicine that are a lot riskier than this, right? It's just a question of what is the effect on the patient? What is the balance? Electric shock treatment. Oh, yeah. I mean, you know, you know, um, Oxycontton, you know, you know, there's all kinds of things, right? But we figured that out by running really good research and that's that's what this area needs and I'm glad it's getting the investment. It's getting a fair amount of philanthropic investment, too. Another important thing is that the people doing the studies are at equipoise. So um you know there's been some bad work and it you know in this area you know over the last 50 years or so because it was people who were super enthusiastic to the point that they weren't careful and critical uh you know about you know what the evidence said and they sort of overclaimed what they found because they believed in themselves. You maybe because they'd had very positive experiences themselves and just like that is not in the long run a good way to do science. You know, you really want people who design a good study and then let the chips fall where they may and then tell us all and then we can decide, but they don't. They're not, you know, shouldn't be a spin doctor. That's not good. Fun little factoid. And then uh another note about psilocybin. I was curious as to why there's so few studies about LSD. And [snorts] uh a colleague of mine who works in this space, he runs clinical trials at UCSF said, "Oh, it's it's very straightforward. Most of…

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