How to Overcome Addiction to Substances or Behaviors | Dr. Keith Humphreys
Dr. Keith Humphreys and Andrew Huberman dive deep into the science and psychology of addiction, covering everything from alcohol and cannabis to gambling and social media. They break down how genetics influence susceptibility, expose the tactics of "addiction-for-profit" industries, and provide evidence-based tools for recovery, ranging from 12-step programs to new pharmaceutical options like GLP-1 agonists. The discussion emphasizes that while biological risks exist, recovery is possible through compassionate, community-based approaches and a clear understanding of one's own motivations.
1. Defining Addiction and Genetic Risk
What is Addiction?
Dr. Humphreys clarifies that addiction is not just about doing something repeatedly or compulsively. The true definition revolves around the persistence of a behavior despite harmful consequences. While a normal person stops a behavior when it begins to destroy their life, an addict continues.
He offers a profound definition of addiction: A progressive narrowing of the things that bring one pleasure.
"You see the other types of rewards, particularly natural rewards, start to fall away from the person's life. So, I'll sacrifice my relationship with my parents... I will stop going to work... I'll give up my housing for the sake of this substance."
Eventually, the substance or behavior becomes the only thing that provides relief or pleasure, making it incredibly difficult to quit because the rest of life has been stripped of joy.
Genetic Predisposition
It is a myth that babies are "born addicted." They can be born physically dependent, but addiction is a behavioral and psychological relationship with a substance. However, genetic risk is real and significant.
- If your parents struggled with addiction, your risk is higher (roughly 40-50% heritable).
- Specific Genes: Some people (like certain Asian populations) lack the enzyme to metabolize alcohol, making drinking unpleasant—this is a protective gene.
- Impulsivity Genes: General genes for sensation-seeking or high impulsivity increase the risk for all addictions, not just one specific drug.
"The only way to determine that a substance will not damage your life is to never use it in the first place."
2. Alcohol: Myths, Marketing, and Health
The "Alcoholic" Label
While the medical field often uses "Alcohol Use Disorder," Dr. Humphreys and Dr. Huberman agree that the term alcoholic is still useful and widely understood, especially within recovery communities. It helps people identify a specific relationship with the substance.
The Genetic "Sweet Spot" for Alcoholism
There is a subset of people (about 10-15%) who experience alcohol differently. When they drink:
- They feel more energized (a dopaminergic response) rather than sedated.
- They experience less body sway and motor impairment.
- They get fewer hangovers.
While this sounds like a "superpower," it is actually a huge risk factor. Because they don't get the punishing signals (dizziness, hangovers) to stop, they can drink massive amounts, leading to severe addiction.
Targeting Women
The alcohol industry realized years ago that men were drinking to capacity, but women were an untapped market. They launched campaigns (e.g., "mommy wine culture") to frame drinking as essential to female relaxation and bonding. As a result, alcohol consumption and related damages among women have skyrocketed.
"You do not make money off people who have half a bottle of wine on special occasions. You make your money on the people who drink the equivalent of multiple bottles of wine every single day."
The "Health Benefits" Myth
Dr. Humphreys debunks the popular idea that moderate drinking (like red wine) is good for your heart. The science shows that zero alcohol is better than any.
- The Trade-off: Even if there is a tiny cardiac benefit (which is debated), it is vastly outweighed by the increased risk of cancer (especially breast cancer in women) and other health issues.
- The Bottom Line: If you drink, do it because you enjoy it, but don't delude yourself into thinking it's a health choice.
"If that is true [cardiac benefit], it's smaller than the cancer risk. So your net is you're not going to get any mortality gain... from drinking alcohol."
3. The New Cannabis Landscape
Potency and Risk
Comparing modern cannabis to the weed of the 80s or 90s is impossible.
- Old Cannabis: ~3-5% THC.
- Modern Cannabis: ~20% THC (flower) to 90% (concentrates).
- Usage: People use it much more frequently (daily vs. weekly).
This massive increase in potency means the brain exposure is about 65 times higher than in the past. This is not the same drug anymore.
Psychosis and Life Impact
Dr. Humphreys notes that the link between high-potency cannabis and psychosis (schizophrenia-like symptoms) is becoming undeniable, especially for young men.
- Adolescent Brain: Using high-potency cannabis while the brain is developing (teens/early 20s) carries the highest risk.
- Failure to Launch: While cannabis doesn't kill you like fentanyl, it is a performance-degrading drug. It affects memory, motivation, and focus.
"It's kind of a performance degrading drug... Your odds of your death being directly 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."
4. The Business of Addiction: Gambling & Tech
Gambling: The Perfect Addiction Machine
Dr. Humphreys highlights gambling as a prime example of an industry aggressively deregulated to the detriment of public health.
- Losses Disguised as Wins (LDWS): Modern slot machines are designed to flash lights and play victory music even when you win back less than you bet (e.g., bet $1.00, win $0.40). The brain registers this as a win, keeping you playing while you slowly bleed money.
- Novelty: People aren't just playing to win money; they are addicted to the novelty of the next spin.
"There is no customer like an addicted customer."
The Casino Environment
Casinos are engineered to remove friction. They remove dealers (who slow down the game) in favor of machines that provide instant dopamine hits. They allow smoking and provide free alcohol to lower inhibitions. It is a dense pack of addictive triggers.
"Someone had a heart attack at one of the machines, fell over on the floor... and none of them even reacted. They just kept playing as this person died."
5. Psychedelics and Emerging Treatments
Psilocybin and Therapy
There is cautious optimism about psilocybin (magic mushrooms) for treating depression and addiction, but context matters.
- Clinical Settings: High doses administered with preparation and integration therapy show promise (e.g., 60-70% remission in some depression trials).
- Microdosing: Dr. Humphreys states there is zero evidence that microdosing works. It appears to be mostly placebo.
- Risks: "Bad trips" and flashbacks are real risks, which is why professional guidance is crucial.
Ibogaine
Dr. Huberman and Dr. Humphreys discuss the late Dr. Nolan Williams' work on Ibogaine for veterans with PTSD and addiction. It is a heavy, intense experience (often 22+ hours) that seems to "reset" the brain.
- Not Recreational: No one takes Ibogaine for fun; it is a difficult physical and mental ordeal.
- Potential: It shows incredible promise for breaking opioid addiction and healing trauma, but needs more rigorous study.
"There's no evidence that people get addicted to psilocybin... I've always worried about them far less as a class of drugs than I do things like stimulants."
6. Stimulants: Caffeine, ADHD Meds, and Nicotine
- Caffeine: Generally safe. While people can be dependent (get headaches without it), true life-destroying addiction is rare.
- ADHD Medications (Adderall/Vyvanse): A double-edged sword. For kids with true ADHD, they are transformative. However, they are often overprescribed to kids who are just naturally active, or used as performance enhancers by students.
- Nicotine: A poison that we have historically loved. Dr. Humphreys points out that much of the "relaxation" smokers feel is actually just the relief of withdrawal symptoms.
- The Cycle: You sleep $\rightarrow$ nicotine levels drop $\rightarrow$ you wake up agitated (withdrawal) $\rightarrow$ you smoke $\rightarrow$ you feel "normal" again and mistake it for a benefit.
"If you consumed all the nicotine in a carton of cigarettes, it would kill you... That it is so popular [is] remarkable."
7. How to Approach Recovery
The Motivational Interview
If you or someone you know is struggling, the approach isn't to shame them. A good therapist asks, "Why do you want to quit?"
- The motivation must come from the individual (e.g., "I want to save money for a trip," "I want to smell better," "I want my kids to respect me").
- Focus on Immediate Rewards: Addicts struggle with long-term planning. Focus on what gets better today or tomorrow (e.g., no risk of arrest today, saving money today).
Social Connection is Key
The single best thing you can do when changing a behavior is to hang out with people trying to make the same change.
- Support: They understand your struggle.
- Accountability: They notice if you don't show up.
"You want to start jogging? Join a jogging group. You want to stop drinking? I would... suggest go check into an AA meeting... Having other people on the same journey is good for us."
8. The Power of 12-Step Programs (AA)
Why It Works
Dr. Humphreys defends Alcoholics Anonymous (AA) against its critics, citing rigorous reviews (Cochrane Collaboration) showing it is as effective or more effective than expensive clinical therapies for achieving abstinence.
- Accessibility: It is free, available 24/7 globally, and requires no insurance or paperwork.
- The "Cult" Myth: Unlike a cult, AA doesn't want your money (they refuse large donations), and they don't stop you from leaving.
- The "God" Issue: The "Higher Power" concept is flexible. It can be nature, the group, or the universe. It is essentially an admission that "I am not in control of this addiction" (breaking the ego/narcissism).
"It is the closest thing we have to a free lunch in public health."
Social Architecture
AA works because it provides a new social network. You lose your drinking buddies, but you instantly gain a group of friends who celebrate your sobriety.
9. GLP-1 Agonists: The New Frontier?
Drugs like Ozempic and Wegovy (GLP-1 agonists) are showing fascinating side effects. Originally for diabetes/weight loss, patients report that they "lose the noise" regarding food. They just stop thinking about it.
- Potential for Addiction: Early evidence suggests these drugs might also reduce cravings for alcohol and potentially other substances.
- Mechanism: Alcohol addiction is behaviorally similar to overeating (consuming a substance for satiety/relief).
- Hope: If these drugs can help people "want not to want," they could be a revolution in addiction treatment.
"I have a friend who's an addiction psychiatrist. She said what my patients desire is they want not to want... That voice is just gone."
10. Social Media and the "Failure to Launch"
Dr. Huberman shares stories of young men stuck in a "failure to launch" state—addicted to video games/YouTube, medicated for ADHD, and unemployed.
- The Solution: In these cases, recovery involved getting off social media/games entirely (dopamine detox) and getting off unnecessary medication to rediscover their own agency.
- The Trap: Social media is unique because there is no natural "stopping point" (unlike eating or drinking).
- Tools: Using "dumb phones" or lockboxes for smartphones can be effective strategies to regain focus.
"I hate social media. I think it's bad for my mental health, but I have to be on it because everybody else is. And that is really tragic."
11. Facing Death and Finding Meaning
In a moving conclusion, Dr. Humphreys discusses his 10 years working in hospice care. He did it to conquer his own fear of death.
- Addiction as Escape: He theorizes that severe addiction is often a desire for oblivion—an attempt to escape the pain of reality, trauma, and the existential fear of death.
- The Lesson of Hospice: Hospice workers are often the most upbeat people because they have accepted the worst (death) and focus on making the remaining time meaningful.
- The Honor: Sitting with the dying removes the fear of it.
"Being the last friend somebody ever makes is an incredible honor."
Conclusion
Recovery from addiction is not a matter of willpower alone; it requires a shift in environment, biology, and community. Whether through 12-step programs, medical interventions like TMS or GLP-1s, or behavioral changes like locking away a phone, the path out involves finding connection and purpose that outweighs the addictive substance. As Dr. Humphreys advises his own children: "You will never get addicted to something that you choose never to use."
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