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

Keith Humphreys: Someone says, "I want to quit smoking," a good clinician will say, "Why would you want to do that?" Just say, "So tell me, what do you want to get out of this? Because it's work. I mean, I'm happy to work with you, but what is it? What are your motives?" And sort of, helping them build up, 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.

Keith Humphreys: You want to stop drinking? I would 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. I mean, everything shows that no matter what you're doing, "I'm losing weight. I'm exercising, or 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 on Tuesday, you weren't there. What's up? Are you going to be part of this group or not?" And that is helpful for people.

Andrew Huberman: Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Keith Humphreys. Dr. Keith Humphreys is a professor of psychiatry and behavioral sciences at Stanford 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.

Andrew Huberman: 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.

Andrew Huberman: Dr. Humphreys 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.

Andrew Huberman: 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 Humphreys 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-for-profit marketing and confusing health information.

Andrew Huberman: 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.

Andrew Huberman: In keeping with that theme, today's episode does include sponsors. And now, for my discussion with Dr. Keith Humphreys.

Andrew Huberman: Dr. Keith Humphreys, welcome.

Keith Humphreys: Good to meet you, Andrew.

Andrew Huberman: Addiction is a big topic, but I think for a lot of people it gets slotted into one small drawer. But if we were to compare it to, say, mental illness, many, many things, depression, manic bipolar, OCD, and on and on.

Andrew Huberman: 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 en masse at the level of policy, which we'll also talk about today? So, put simply, how do you frame addiction? And how should people think about it?

Keith Humphreys: Yeah, it's hard because it's a word, unlike, say... Maybe it's a little like schizophrenia, where people say, "Oh, you know, he's a schizophrenic person," what they actually mean is, 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, "I'm addicted to a TV show," or "I'm addicted to my phone," or that sort of thing. But it's not just stuff you do a lot, which we sometimes colloquially call addiction.

Keith Humphreys: It's the persistence of doing something that is harmful. So, like the classic animal study is, James Olds' study with rats done in the '50s, showing that you could give a rat 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 run out of water while they were next to water.

Keith Humphreys: That is what it was. It's not 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 sine qua non of addiction.

Andrew Huberman: I've tried to 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 tends to be progressive. I suppose it could be overnight. But is that true? I'm happy to revise the definition.

Keith Humphreys: Yeah, no, that is true. So 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, or my spouse, or my friends. I will stop going to work, which would normally generate the things I need to eat, or I'll give up my housing for the sake of this substance.

Keith Humphreys: 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, "Look, it's the only time I feel good is that moment when I take that hit."

Andrew Huberman: These days, there are a lot of industries that are an addiction for money, basically, industries.

Keith Humphreys: Yeah.

Andrew Huberman: And we're going to talk about all of them.

Keith Humphreys: Yeah.

Andrew Huberman: Nicotine, alcohol, cannabis, social media, all of these. 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? Let's start with maybe alcohol, for example.

Keith Humphreys: Yeah.

Keith Humphreys: Yeah, that's a great question. So, let me start by just getting rid of one myth, where we say people are born addicted. You'll sometimes read, you know, if Mom was addicted to fentanyl, then the baby is born addicted. That is not possible, because 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 addicted.

Keith Humphreys: But you can have risk from birth in your genes. And those shared estimates of how much of that is shared, it's actually quite a bit. We look at studies where kids were adopted out of families with parents who were addicted to alcohol, a much higher likelihood of developing an alcohol problem, even if they were raised by teetotalers, for example.

Keith Humphreys: How big is that? It varies across studies. It varies across substances, but it's large. It might be, like, 0.3, 0.4, 0.5, for most of them. And you can imagine that the same genes, some might be specific, and some might be more general. So, here's an example of a specific one. If you are born into a group like the Han Chinese 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.

Andrew Huberman: Mm-hmm.

Keith Humphreys: You can't break it down to acetaldehyde and acetic acid and all that sort of thing. But that wouldn't lower your risk for anything else, but at least be specific for alcohol. But other genes for things like impulsivity, that would put you at risk across substances. Being sensation-seeking, you're going to try more drugs. That means it's more likely that you're going to get exposed to one.

Keith Humphreys: Another thing we see happening, which is really fascinating and poorly understood, I, of course, know, doing what I do, lots of people are in recovery. And I've known people and had people in my studies who have been, say, clean and sober in their sense for 20 years, and then, all of a sudden, they develop a very strong sexual compulsion, or they gain 30 pounds because they're just eating and eating and eating. And it's like the underlying diathesis, 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.

Andrew Huberman: When it comes to alcohol, I've heard it's said that there's a subset of people with, I guess nowadays, they call it alcohol use disorder. Can we just call it alcoholism today?

Keith Humphreys: Sure.

Andrew Huberman: Okay. Sometimes people will lash back at me if I 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, because of their impressive recovery stories, and they all just say, "Just call it what it is," which is alcoholism. There's just so much splitting of names now. I don't want to put you in the position of saying something that's going to offend anyone, whereas I can do that.

Keith Humphreys: No, it's just worth getting into. So, use disorder is a much broader spectrum thing. So, if you diagnose someone 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 harm, but basically, life is still put together. And people in AA would be like, "You've got to be kidding me. That's your problem?" It's only when you get up to the severe end, where we see the things that looks like addiction. So, they aren't actually the same thing, addiction and use disorder. Use disorder is broader.

Andrew Huberman: Mm.

Keith Humphreys: And it was there to sort of move alcohol like other health behaviors that you might start addressing, particularly in primary care. So, just like we would like doctors to intervene when someone is 15 pounds overweight and has moderately high blood pressure, so that they don't, later, develop a more serious problem, that was the idea.

Keith Humphreys: Well, let's have a lower-severity problem that a doctor might, while the person still has a fair amount of control, advise you, "Hey, 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 comfortable talking about addiction. It's a good word. It's scientifically meaningful.

Andrew Huberman: Mm-hmm.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And it's something the public understands.

Andrew Huberman: Yeah, and if you go to an AA meeting, 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."

Keith Humphreys: Oh, that's right. Absolutely. Yeah, yeah.

Andrew Huberman: So, many people who are in recovery define, at some level of their identity, not their total identity as an alcoholic.

Keith Humphreys: Right.

Andrew Huberman: It's actually an important part of the 12-step 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, because sometimes these clinical and naming things are split, because of, quote unquote, "sensitivities" we don't want to offend, et cetera, and we don't want to offend. Okay, so alcohol.

Andrew Huberman: I've heard it's said that there's a subset of people, somewhere around 8% to 10%, for whom they drink alcohol, and they experience it very differently. They experience it more as a, for lack of a better term, kind of a dopaminergic, an energizing experience. And this could relate to tolerance, but they have a very different experience, subjectively, of alcohol than most everybody else, who can build up tolerance.

Andrew Huberman: Anyone can build up tolerance. And then it takes longer to get into the sedative effects, the depressive effects of alcohol. But I've heard it's 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, black out, crash their car, end up in jail, or dead. And so, in some sense, this 8 to 10% may be at greater risk than everyone else.

Keith Humphreys: Yeah.

Keith Humphreys: Yeah. So, Marc Schuckit, who's a superb psychiatrist who's based in Southern California for most of his career, did some wonderful studies of male 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 could measure that with a...

Andrew Huberman: Body sway?

Keith Humphreys: Yeah, like how much they move. How hard the alcohol hits them.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And they had fewer hangovers the next day.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And then, you might think, "Well, that's great. It doesn't hit you that hard, but you can drink a lot." And like, no, that's the problem because someone else would get the signal of like, "Whoa, 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 less punishing, more rewarding.

Keith Humphreys: And you see that across drugs. And this is almost surely genetic; how much people like different drugs, you know, varies enormously. I'll be personal about this. So, I had an injury. I broke my ulna, and I had to take Vicodin for the pain afterwards. I find taking opioids so unpleasant.

Keith Humphreys: I feel bound up, 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 learning history there, right?

Keith Humphreys: But there's something... I'm just wired differently for that particular drug than people who get in trouble with it are. And these don't necessarily go in groups, so someone can hate opioids, but love cannabis or love alcohol. And that, of course, is going to change their risk. How could it not?

Andrew Huberman: This is such an important point, and I didn't realize that it extended to things outside of alcohol. 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 unspoken point of friction, because some people really can drink five or six drinks, and then the next day, they're at work hammering away, and they're going to say, "Listen, my life's going great."

Keith Humphreys: Oh, yeah.

Keith Humphreys: Yup.

Andrew Huberman: And liver markers are still within range. Eventually, they'll decline; they'll get worse. But the conversation becomes very difficult to have because it sounds like it's highly individual how people will react. And there are the behavioral impacts. Like, for instance, 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.

Andrew Huberman: So, I find that some people will 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.

Keith Humphreys: Mm-hmm.

Keith Humphreys: Sometimes even then. Yeah.

Andrew Huberman: And so, maybe alcohol is the best template for talking about this, because it's socially acceptable in most places for adults anyway.

Keith Humphreys: It's legal, it's marketed. Yeah.

Andrew Huberman: It's legal, it's marketed, and yet, how does one know whether or not they have a predisposition? Because those people might want to avoid using something, because our colleague Anna Lembke has said that, you can't get addicted to something that you've never done or taken.

Keith Humphreys: Yeah. Yes.

Keith Humphreys: That is the most helpful advice, you know?

Andrew Huberman: Mm-hmm.

Keith Humphreys: So, I can never tell you if, in this game of "Russian Roulette," the bullet will not be in your chamber for sure. 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 risk. There's been a lot of work on kind of genotyping to try to figure out, could I tell people what their genetic risk is for alcohol?

Keith Humphreys: And nothing is as good as just saying, "Your parents alcoholic? Yeah, I don't know." And if they were, that's the most useful bit of information. Or, "Does the problem of drinking run in your family?" That kind of, as crude a question as it is, that's more useful than anything we have from SNPs or anything like that.

Andrew Huberman: Does it cross sex? So, if a daughter has a father who's an alcoholic, does it cross sex as readily as it goes from, say, father to son or mother to daughter?

Keith Humphreys: No. I mean, there is still risk there for sure, but the father-to-son link is the strongest one you see in genetic studies.

Andrew Huberman: Mm-hmm.

Keith Humphreys: Now, of course, in a sense, it's hard, right, because men drink more than women do, I mean, in our culture anyway. 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, where there's still a fair amount of women who don't drink or drink, I mean, hardly any.

Andrew Huberman: Mm-hmm.

Keith Humphreys: So, it's sort of like the thing, 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.

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Andrew Huberman: Women are drinking more or less now?

Keith Humphreys: Women, unfortunately, in the late '90s, early 'aughts, the alcohol industry figured out that women had more money, but they weren't drinking the way men were. So, they engaged in a long-term campaign to try to increase women's drinking. So, things like mommy wine juice, and those mommy wine chats online and all that, that was really engineered by them.

Keith Humphreys: Even some of the ones that look organic online were engineered by the industry, and it worked. Women's drinking went up a lot, and the damage per drink is more for women for most things than it is for men, partly due to body size, but also partly, probably, due to some hormonal things. And so, it's been an exploitation, as I see it, of women.

Keith Humphreys: And I notice a lot of young women now, like undergraduates I talk to, re-evaluating that, like looking at their mom's experience, and saying, "I don't think I want to do that." And I'm really encouraged by that. Not that I want to control the decisions we make, but I don't want them making them just because the industry slickly marketed to them, 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 yeah, you're shocked, yeah.

Andrew Huberman: 10% of the country drinks half the alcohol?

Keith Humphreys: 10% of the country drinks half the 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 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. Fundamentally, these industries, the more addiction there is, the better off they do financially.

Andrew Huberman: 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 the...

Keith Humphreys: Some statistics. Yeah, yeah.

Andrew Huberman: Some statistics.

Keith Humphreys: Something seems to have changed, and this may have something to do with this new generation.

Andrew Huberman: Mm-hmm.

Andrew Huberman: Mm-hmm.

Keith Humphreys: I mean, there's less risk behavior in lots of things over the last 10 years. So, cutting class, less chance of dropping out of high school, fewer unwanted pregnancies, all that stuff. That generation will probably be a drier generation than their parents were.

Andrew Huberman: 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 mind-altering substance.

Keith Humphreys: Yeah. With the legalization of cannabis, we certainly have seen a lot more use and a lot stronger products, but youth use really has only changed pretty slightly.

Andrew Huberman: Mm.

Keith Humphreys: 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 using cannabis.

Andrew Huberman: We'll get back to cannabis, but I want to parse the alcohol stats a bit more, also as it relates 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.

Andrew Huberman: 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 spirits versus two per week, it's sort of the upper limit for adult non-alcoholics that don't want to incur any additional health risk. The cancer risk is very clear.

Andrew Huberman: The disruption to sleep, which probably cascades into other things, such as inflammation, et cetera. But is zero better than any? Is two 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 frankly, I'm not tired of it, but it's almost getting funny, the extent to which the traditional media, not to poke on them, but they just keep flip-flopping.

Keith Humphreys: Yeah.

Andrew Huberman: 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.

Keith Humphreys: Oh, absolutely. So, a statement against interest, because I like red wine, I would love to believe it is healthy. It's not. And the whole thing about red wine, per se, by the way, was, it never made any sense. Why would there be a benefit to red wine that wasn't in other alcoholic beverages, right? And it came from a 60 Minutes story, I think it was in the '90s. It was about why French people, why do Mediterraneans live so long? It's the red wine. And red wine sales exploded. This is so great.

Andrew Huberman: Resveratrol was an argument.

Keith Humphreys: Yes, that's right.

Andrew Huberman: Yeah.

Keith Humphreys: There are such trace amounts that are just ludicrous, you know, in a grape skin. And so, that was just spread, and it was just so great for the industry. It's better for you than not drinking. And that's just not true. They would look at studies and say, "Well, look, the non-drinking group have higher mortality than the low-drinking group." And they famously call it the J-shaped curve, sort of like that.

Keith Humphreys: The problem is, non-drinkers include people who are like in Alcoholics Anonymous. That's why they don't drink. They had a wretched experience with alcohol. And so, they've had different kinds of damage to their bodies, maybe their health isn't as good, and they're not going to live as long. But it's not that they would be better off if they went back to drinking. Things would go to hell, basically, for them. And that just got marketed and spread, and it's not true. There might be some cardiac benefit, okay?

Keith Humphreys: But we don't get to live our lives as single organs. We have a whole body. You have to weigh that, if that is true, and it is wobbly, but if that's true, it's smaller than the cancer risk. So, your net is you're not going to get any mortality gain or mortality reduction from drinking alcohol.

Keith Humphreys: If you have two drinks a week, and by a drink I mean like a 12-ounce beer, a one-ounce shot, or a glass of wine, a four-ounce glass of wine, you have a slightly higher risk, but it is very, very, very small, and it's not the kind of thing... If I were giving health advice to the country, that would not be on my top 10 things to be really frightened about. I think it's very small. It's just not good for you. That's what science has overturned, the industry message that this will extend your life, and you'll be more healthy if you drink than if you don't. There's no way we can establish that as being true.

Andrew Huberman: You said it very clearly, but I'm going to just repeat it because I think it's super important for people to take note 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 had a lot of different responses. 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.

Andrew Huberman: The downstream effects of the disruption to sleep from alcohol and so on are probably part of the effect. It was very interesting as it relates to women, because many people, including some members of my family, really like their post-work glass of wine or want to drink to just kind of mark an end to the day and relax.

Andrew Huberman: 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 of cancer as it relates to alcohol, meaning if the breast cancer risk and other hormone...

Keith Humphreys: Ovarian cancer.

Andrew Huberman: And ovarian... Hormone-related cancers, and so forth. Not always hormone-related. But the moment that the... It's probably best to avoid alcohol entirely; the conversation moved into women-specific health. It had a very potent impact, which is interesting in its own, right?

Keith Humphreys: Mm-hmm.

Andrew Huberman: 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, how is it that people should frame what they know to be risky versus the other benefits of alcohol that clearly exist?

Andrew Huberman: Like, it helps people relax, it's social, they stress less, and so on and so forth.

Keith Humphreys: Mm.

Keith Humphreys: Mm.

Keith Humphreys: As I mentioned, I'm someone who drinks wine, and I know that, on average, it's not healthy. Why do I do that? It's like, well, because it creates other things, particularly with exactly that situation, that getting together with friends is enjoyable, enriching. Good food is enriching. Good food and good wine tastes good.

Keith Humphreys: And I value those things, and there are many other decisions we make like that where we endure some risk because we care about something else. It's dangerous for someone my age to hike up a mountainside, probably. But if the view is spectacular, I say, "Oh, I'm going to accept that risk, and maybe I'm more prone to twist my ankle or something, but this is just really beautiful." That's okay.

Keith Humphreys: 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?"

Andrew Huberman: If you don't drink at parties or you refuse an offer of alcohol, people think there's something wrong with you.

Keith Humphreys: Yeah, and you have to have an explanation, like, "Well, I got an exam tomorrow morning," or, "I've got a cold," or something. It's like, you shouldn't need an explanation. But people do feel that social pressure, and so that's one way health information can work. Why didn't the person just quit beforehand?

Keith Humphreys: Because they may not have had an explanation that worked in their circle, and now you could say, "Well, I see those data on ovarian cancer, and I just decided to quit drinking." And health is a reason people still accept, I think, as legitimate for changing behavior. You can make that because cancer is scary, and that may be why people quit. Same thing happened when the first Surgeon General's smoking thing came out.

Keith Humphreys: Everybody smoked. 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 expert to tell everybody, "Why are you not smoking anymore? Why don't you carry cigarettes anymore? I can't bum one off you anymore." It's like, "That's why."

Andrew Huberman: Why do you think people who drink feel uncomfortable about people not drinking around them? When people would ask me if I wanted to drink, and I'd say, "No," and they'd say, "Why?" They often say that.

Keith Humphreys: Yeah.

Andrew Huberman: I would say the truth, which is, "I'll say anything that's on my mind without drinking."

Keith Humphreys: Mm-hmm.

Andrew Huberman: "You don't want me to drink, because then I'll tell you everything that's on my mind."

Keith Humphreys: Oh, that's good.

Andrew Huberman: It's true. I mean, I will tell people what I'm thinking. I don't need to loosen up. I'm pretty relaxed in social settings.

Keith Humphreys: Mm-hmm.

Andrew Huberman: I don't have much social anxiety, but I realize some people might have trouble with social anxiety.

Keith Humphreys: Yeah. Yeah. I spent a little time in Japan when I was a young man, and there's this culture of going out after work, like the salary man going to work, and someone getting really, really drunk, and everyone's drinking, and you're vulnerable with each other. It's like a trust exercise, like that falling backwards thing, except it is that we're all drunk.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And if someone weren't doing it, it's like, "Why are you not undergoing any... So we're all going to be vulnerable, and you're not?"

Andrew Huberman: Mm-hmm.

Keith Humphreys: "Are you going to exploit us in some way? Or I'm going to say, 'I think I hate the boss,' and then you're going to repeat that at work, because you're the one person sober enough to remember I said that?" I think that is a real thing that people have anxiety about.

Andrew Huberman: Mm-hmm.

Keith Humphreys: Or I can imagine, say, what if a man and woman are on a date, and the guy keeps giving drinks to the woman and doesn't drink himself? What is the natural thing to think? "Are you trying to get me drunk? Are you going to take advantage of me because you're going to be with it, and I'm not, because I'm going to be drunk?"

Keith Humphreys: So those kinds of fears may be in the soup. Maybe that's 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 of, "What do you want?"

Andrew Huberman: Mm-hmm.

Keith Humphreys: And if he goes, "I want sparkling water," I just give you a glass of sparkling water, and don't say, "Why aren't you drinking this intoxicating beverage?" You shouldn't need to explain it to me.

Andrew Huberman: The trust piece is super interesting, so is the vulnerability piece. A couple of 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 I wasn't into that, and I wasn't judgmental. I actually kind of liked it, because by the third day of the meeting, I'm cranking, and I can tell they're all just bleary, and they're also aging much faster than I am. They would get "the tenured look" as we would call it, or as I would call it.

Keith Humphreys: Uh-huh.

Andrew Huberman: And you see them in five years, I'm like, "What happened to you? You aged 15 years." And these people tended to drink a lot, both at meetings and outside meetings. Alcohol was paid for, often, by the meeting fees. I'm not trying to point a finger here. And then a lot of the stuff that happened at meetings that turned out cost people jobs was always alcohol related.

Keith Humphreys: Yeah.

Andrew Huberman: In the instance of the man and woman on a date drinking or a group of people at work drinking together, in Japan, it sounded like it was men getting drunk with other men.

Keith Humphreys: It's men, yes.

Andrew Huberman: In my mental picture of the male-female dynamic in drinking, I'm going to simplify this: if she drinks, it makes her vulnerable. If he drinks, it makes him more stupid and impulsive.

Keith Humphreys: Mm-hmm.

Andrew Huberman: And so, in the world where she's drinking, and he's not, you gave the example that perhaps he would take advantage of her. If he's encouraging it, certainly there's that picture in one's mind.

Keith Humphreys: Yeah.

Andrew Huberman: He 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, drinking ends up being kind of a bad idea. I mean, not trying to be judgmental here, because I don't judge what people do. Do as you wish, but know what you're doing is my philosophy. But I just don't see a world where drinking with your coworkers or drinking on a date with somebody that you don't know very well, male or female, right?

Keith Humphreys: Mm-hmm.

Andrew Huberman: For either of them, it's just like a lack of safety all around. It just seems like a bad idea.

Keith Humphreys: As women move into more professions, that may have changed that norm of everybody goes out and gets drunk, because the consequences aren't the same. And I know a lot of professional women friends that say, "I don't want to do that."

Andrew Huberman: Mm-hmm.

Keith Humphreys: "I don't want to be around the boss when he's drunk. And so let's have a Christmas lunch together at work instead of drinks afterwards." So I definitely see that. I think in the dating, now of course, I haven't thankfully had to worry about dating for 40 years, but what I think most people would say is just the anxiety is intense for some people, and alcohol is anxiolytic, right?

Keith Humphreys: And so it's probably that that people are sort of feeling. They're too nervous. And whether they should or they shouldn't, that's just, I think, probably in the soup, one of those benefits people care about. And there are people, it has to be said, who are more socially 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 more appealing.

Andrew Huberman: It's interesting. We could 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. If we hear about some 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 other people's actions and vulnerabilities of one's own actions and words if drinking. And then people can make an informed decision. That's kind of how I feel about it.

Keith Humphreys: A good summary.

Andrew Huberman: Again, do as you wish, but know what you're doing is the purpose here. Let's talk about cannabis a bit, because eventually I'd like to weave back to how industries impact use and abuse. Cannabis, when I was growing up, was illegal. You'd go to jail for it.

Keith Humphreys: Mm-hmm.

Andrew Huberman: People still smoked pot. It happened. The idea was that it was much less potent. We can talk about that. But now it's a whole industry.

Keith Humphreys: Yes.

Andrew Huberman: And the edible industry has contributed to this greatly, because it bypasses the blowing of smoke, the smell, and a number of other things. So, what are your thoughts about cannabis as something that can be used, quote-unquote, "recreationally," "medicinally," 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?

Keith Humphreys: Yeah, so whenever I talk about it, I make a distinction between sort of old and new cannabis. So, if you go back to the '80s and '90s, when, as you mentioned, it was illegal everywhere, the THC content, that's the principal intoxicant, would be 3%, 4%, 5%, something like that on average.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And now studies of legal sales show the average product is about 20%. So that's dramatically stronger. The other point is how people use it is different, perhaps related to that high potency. Jonathan Caulkins 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.

Keith Humphreys: If you go back in the past, the more modal user might have been once or twice a week. So you put those things together, so you take somebody, what was like an '80s pot smoker. "Well, on weekends I'd smoke a joint at 5%." But now if it means every day I'm consuming 20%, you quickly realize their brain exposure is dramatically higher, about 65 times higher between the modes of those two experiences.

Keith Humphreys: So what does 65 times mean? Well, it coincidentally is also the potency difference between a coca leaf and cocaine. That is 65 times two. So it's a big difference.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And as you know, dose makes the poison. So, it is 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. Who cares if my 15-year-old is using it?" But that's kind of like saying you drank low alcohol beer and you're not concerned that your 15-year-old is guzzling vodka. That's kind of the difference.

Keith Humphreys: 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 medical applications? Almost surely. The cannabinoid receptor system, evolutionarily, is one of the oldest in the 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.

Keith Humphreys: 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 probably 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. There's a medication that is used in seizure disorders in kids. So, there'll be some other things like that, for sure.

Keith Humphreys: It's easier to study this than it has ever been before. About 2020, Congress changed the way research works, so it's a lot simpler to do it. So we'll figure those things out. But it is just a more dangerous drug than it was when I was a young person.

Andrew Huberman: Had a guest on the podcast who's a cannabis researcher, runs an animal lab, and we invited him on because I had released a solo episode about cannabis. We touched on some of the risks for psychosis in young men, and made some points about, frankly, concerns about cannabis because of the high THC content.

Keith Humphreys: Yeah.

Andrew Huberman: He was not happy with the things I said. He made that clear on social media. So, by the way, this isn't the way to get invited on the podcast, but we invited him on. And I think we had a very fruitful discussion where he clarified a few things for me.

Keith Humphreys: Okay.

Andrew Huberman: And one of the things that he claims 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, are very good at gauging the kind of level of high so that they don't go into paranoid modes.

Andrew Huberman: They don't surpass the plane of high that would make them feel paranoid or 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, often surpass the level at which they would be comfortable, meaning at which there's a psychotic episode or there's paranoia.

Andrew Huberman: So he was making this kind of soft argument for the fact that the elevated THC levels in cannabis are not such a problem because people are essentially taking less to offset the difference.

Keith Humphreys: Yeah, I think there's no evidence for that at all. And people are surprisingly bad, even experienced pot smokers, at judging in lab studies of 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. So when you smoke anything, you get that, that goes very efficiently to the brain. But when you eat something, it takes a while to have its effect.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And so, particularly when these products came out, and a lot of people were new to them, they would bite down on 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 a train. And that does happen.

Keith Humphreys: The other thing that is true is that a lot of these products are not well-made or they're not up to the standards you would have for a cookie. 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 in 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 whole enchilada, so to speak, because it's not evenly blended through. And there are some people who've gotten into trouble on that as well.

Andrew Huberman: Interesting. What about the psychosis risk?

Keith Humphreys: Yeah, so I was very skeptical of this literature for years. Not to say that the science was bad, but just it seemed to me there'd be lots of ways to explain it. And I'm a lot less skeptical now, candidly, because in the old studies, they would be those who were men who had used cannabis in teen years, and then they would have higher rates of psychotic disorders in adulthood. These were studies based on Swedish registries because everybody has to register for the military.

Keith Humphreys: And they would track people, and it's quite amazing data. It is a whole national data. That's good. But there are lots of reasons that could come about. Could be a common factor between those two things. But the evidence has gotten stronger as the drug has gotten stronger. And again, we've got to realize people are using it much more intensely.

Keith Humphreys: So if this effect is there, it's much more plausible that it would be from a much stronger drug used 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 probably something there, I am sad to say. I wish there weren't, but there probably is something there.

Keith Humphreys: I would not use cannabis if I had any first-degree relatives with any schizophrenia, schizoid personality, anything, bipolar disorder. I would not personally recommend that for anybody. I think that's probably quite risky.

Andrew Huberman: And 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, on cardiac health.

Keith Humphreys: 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 know the answer to that. I realize there's one point 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 when we're young.

Keith Humphreys: And so, a lot of these effects, the worst things are going to be because people start when they're in teen or late single digit. That's where addictions overwhelmingly start, and that is where, if there is 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'd worry about it less, for anything, initiating a substance when you're 50 is far less likely to end you up with an addiction or some other terrible thing than when you're young.

Andrew Huberman: I'm sure everyone knows at least one person or has heard of one person who's very productive in their life, healthy family, job, et cetera, high energy, who uses cannabis. In my observation, they are the rare exception. And there are a lot of examples of people who use cannabis who don't really go anywhere in life.

Andrew Huberman: 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 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, young men that fail to launch.

Keith Humphreys: Yeah.

Keith Humphreys: Yeah.

Andrew Huberman: And I want to be clear, 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 be 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.

Keith Humphreys: Yeah, absolutely true. I mean, for example, I did Ezra Klein's show. He's obviously a very successful guy, and he mentioned that he sometimes uses cannabis edibles.

Andrew Huberman: He has that look. No, I'm just kidding.

Keith Humphreys: Yeah.

Andrew Huberman: Sorry, Ezra. Just teasing.

Keith Humphreys: Yeah. There are very, very, very successful people who use cannabis, for sure. Overall, though, I mean, I'll steal a phrase from Jonathan Caulkins. It's like, we have performance enhancement drugs. It's kind of a performance-degrading drug. So it's not fentanyl. Your odds of your death being directly traced to it are extraordinarily low.

Keith Humphreys: 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 undermines their sort of motivation to do much of anything. I mean, the couch lock is a real thing.

Keith Humphreys: I know families in Palo Alto, where I'm from, a very achievey place, who had a straight-A son doing everything, starring on a sports team, whatever, who, six 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 that's pretty frightening.

Keith Humphreys: And all those things are not conducive to succeeding, again, in a modern world. If maybe back in an agrarian society, it didn't matter because everything was on muscle power, right? But to succeed in this society, you have to be able to do those things. And you are in competition. If you want a job computer coding, 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 and in Tokyo.

Keith Humphreys: And if you can't focus, or you're just slower, and you can't remember things, or you have trouble making sure you keep track of time, that is going to put you at a disadvantage. And you can end up at that stereotype of living in mom's basement. That, unfortunately, is true of a chunk of people who are heavy users of cannabis.

Andrew Huberman: Yeah, I worry a lot about examples of so-and-so is very high achieving, and they use cannabis. 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, sadly.

Keith Humphreys: Yeah.

Andrew Huberman: 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 real detriment to that messaging. Now, of course, you don't want people to cloak their reality, but it's complicated.

Keith Humphreys: Yeah, and it also has policy risks too. I mean, when you make up the rules, your laws and regulations, to think, "Well, I'm accomplished. 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 take a snort of cocaine or whatever, and you're still a state senator. That doesn't prove that that would be safe for everyone.

Keith Humphreys: And we know people have different levels of risk. They have different social capital. They have different incentives in their lives. And you can't overgeneralize from sort of a lucky life or a costed life. Sometimes you can do more of that than you can when there are not many nets sort of between the person and the ground.

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Andrew Huberman: I heard a wonderful talk that you participated in with one of the members of the Kennedy family. It wasn't Robert.

Keith Humphreys: Patrick?

Andrew Huberman: Patrick Kennedy, excuse me, who's been very open about his own recovery.

Keith Humphreys: Yeah.

Keith Humphreys: Yeah.

Andrew Huberman: So many gems in that talk. We'll put a link to it, and we'll touch on some of those things again, but it's such an important conversation. And 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.

Keith Humphreys: They talk about it themselves that way.

Andrew Huberman: Mm-hmm.

Keith Humphreys: If you get together with app developers, they'll say, "How do we make this more addictive?" 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.

Andrew Huberman: 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, that carries over into a number of things, one hopes, in school or even social media.

Keith Humphreys: Oh, yeah. Yeah.

Andrew Huberman: I've learned a lot from YouTube videos. Heck, I even watched that YouTube video of you and Patrick on YouTube.

Keith Humphreys: Yeah.

Andrew Huberman: So, there's this double-edged blade piece. But when it comes to alcohol and cannabis, what you told us earlier, getting women to drink more by making it seem like an important part of being a woman in the United States, to drink, that sounds diabolical.

Keith Humphreys: Mm-hmm. Yeah.

Keith Humphreys: Yeah.

Andrew Huberman: 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 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.

Keith Humphreys: Well, alcohol also kills about 150,000 Americans a year. So if that's our bar, we should have hand grenades in the drugstore. That would kill tens of thousands, but not 150,000. We should legalize drunk driving because 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.

Keith Humphreys: I mean, I'll be clear, 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 I think that is an important part for society to work, to have a private sector.

Keith Humphreys: And at the same time, you have to regulate addictive 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.

Keith Humphreys: And for that reason, to protect those people, but also to protect the rest of us from the consequences of that, that's why you need things like advertising restrictions. That's why taxes to which people are... Even heavy users respond to price. That's a really important tool to regulate them. I would do much more with cannabis, particularly just some of the promotion is so naked, and a lot of it is in places where kids are exposed, particularly.

Keith Humphreys: And this has just been a long-term fight. 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, they did work to make it more addictive. They worked to defeat any type of health regulation. They were marketing to kids, all that stuff. So, those are the economic incentives. And so, you should not be naive if you work in this space about what the financial incentives are if you're making an addictive product.

Keith Humphreys: More addiction is good for your bottom line. So us on the other side have to say, "All right, 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. When I was a kid, Pete Rose was not allowed to go into the Hall of Fame because he had once placed a bet on his own team.

Keith Humphreys: He wasn't even doing anything corrupt, but 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. 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 sports gambling, and we don't need this. We can do without it.

Andrew Huberman: The gambling thing's a real concern. We had a guest on this podcast who's a self-admitted gambling addict, and a friend of mine who treats gambling addicts said it's among the worst of the addictions because they live with the reality, it's true, that the next time really could change it all.

Keith Humphreys: Mm-hmm.

Andrew Huberman: And he said, eventually, they get addicted to the shame of losing. Winning becomes a thing of the distant past. I mean, this sounds crazy to the rest of us, but it's fascinating and disturbing.

Keith Humphreys: It's fascinating.

Andrew Huberman: And gambling addicts will say that every addiction is gambling.

Andrew Huberman: Yeah.

Keith Humphreys: That's good. There's a tremendous book, "Addiction by Design," and I'm afraid I'm going to mispronounce the name of the person who wrote it. I think it's Schüll, but I'm not sure, but I know the title, "Addiction by Design," about gambling, and she profiles people who play video poker, 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.

Keith Humphreys: They'll just sit there and watch in kind of a dissociative state as it just runs and runs and runs until their money is gone. It's really like zombification of this stuff. And that tech has been perfected to be addictive. I do go to Las Vegas once every couple years. Not for gambling, but I just enjoy the sort of pageantry, and the food and all that. It's very hard to see dealers at tables anymore because dealers don't give the perfect timing of reinforcement that machines can do.

Keith Humphreys: And you have to wait 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 your win or your loss. 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' tables, and now you're just playing with a machine.

Andrew Huberman: Incredible. I don't want to spill off into too many anecdotes on my side, but I will share something that was shared by a previous guest on the podcast you may find interesting. Michael Easter is at a university out in Las Vegas, and he got access to one of these... He wrote "The Comfort Crisis" about getting outdoors, getting away from things, and basically carrying a weight on your back and walking as a therapy of sorts.

Keith Humphreys: Mm-hmm.

Keith Humphreys: Uh-huh.

Andrew Huberman: An important one to do regularly. But he got access to one of these research casinos, and it turns out that slot machines used to be a small fraction of the income of casinos.

Keith Humphreys: That's right.

Andrew Huberman: Now, it's 80% or more.

Keith Humphreys: Yeah.

Andrew Huberman: And he said that that came about because 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. Now, if you play a slot machine, you think you're trying to win.

Andrew Huberman: Hear the ching, ching, ching, ching, ching, and the bells go off, and you won. You think that's the dopamine reward. But they've 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?

Andrew Huberman: 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.

Keith Humphreys: Yeah. Yeah.

Andrew Huberman: When I heard that, it changed my view of gambling. 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."

Andrew Huberman: And 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 it's a novel combination of things, 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.

Keith Humphreys: Yeah, there's an industry term for that. It's LDWs: Losses Disguised as Wins. So, you put in a dollar, and you get 100 credits, and then you pull the thing, and it does its thing, and then it goes like, da, da, da, da, da. 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 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.

Andrew Huberman: 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, because the brain is just so prone to these kinds of things. We all have these circuits.

Keith Humphreys: Absolutely. And it's interesting, to... Casinos are one of the few places where you can still smoke indoors, and you get free drinks, and so it's really an absolute dense pack of addictions. And a huge amount of people, problem gamers are problem drinkers, and also are addicted to cigarettes. And so, when I go to Las Vegas, it's almost like a anthropology experience for me. I just look at all this like, "Wow."

Keith Humphreys: And there was a story in Schüll'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.

Andrew Huberman: What a metaphor for society. Well, I just decided if I'm ever going to Las Vegas, I'm going with you.

Keith Humphreys: Okay. That'd be great.

Andrew Huberman: Sorry to invite myself, but you seem like a safe person to go there with.

Keith Humphreys: I'm pretty safe, yes. You may win or lose five bucks, and that'll be the end of it, so.

Andrew Huberman: Love it! So industries that drive this stuff, okay, alcohol, 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 its taxes on it?

Keith Humphreys: Yeah, it depends. Those are different regimes. 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 it's been a popular policy for a long time, and doesn't seem to really affect use that much. Maybe a little bit, but not a lot. Legalization is making the production, processing, marketing, and sale legal, bringing in a corporation.

Andrew Huberman: Mm.

Keith Humphreys: And that is fundamentally different, because the corporation is going to have very smart people who are good at selling, and they will increase consumption of the product. At this point, I don't know the exact state count, but it's most people in the United States, population-wise, have access at this point to recreational cannabis. And virtually every state, I believe, has something. If it's not recreational, it's medical.

Keith Humphreys: Or due to hemp, there was sort of a way, a mistake they made in regulation, there's a way to process hemp that you can make these delta-8s and delta-9s. So even in states that are prohibited, there's quite a bit of hemp-laced beverages, which are quite strong.

Andrew Huberman: Is cannabis a gateway drug? We were told that when we were in school.

Keith Humphreys: Yeah so, all drugs are gateway drugs. The lie in that was that cannabis had some unique role that was going to lead you to use heroin use. But the truth is anything, like, if you're a teenager and you start smoking or you start drinking or you start using cannabis or stealing prescription opioids from your parents or whatever, that will increase your likelihood of progressing to other substances for multiple reasons. One, you might like it.

Keith Humphreys: Say, "Okay, well, I guess I'm kind of [unintelligible]. Let me try some others." Two, your social networks may change. So you're around other people who do this, and so, 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 going on that makes drugs more rewarding.

Keith Humphreys: And there is some interesting work with identical twins in different states which seem to suggest that you could be starting some unfolding process when you expose a 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 mentioned people getting drunk at science conferences or health conferences.

Keith Humphreys: I have seen conferences, political events, where people spend all day demonizing drug users, and talking about the threat of drugs and how evil drugs are, and how we have to 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 just useful politically because, you could say, well, the big threat to kids is cannabis when it's much more likely a kid was going to get in trouble with alcohol than with cannabis.

Andrew Huberman: These days, there's a lot of discussion about psychedelics. Broad category of drugs. LSD, psilocybin.

Keith Humphreys: Yeah.

Andrew Huberman: MDMA is an empathogen, not a psychedelic, but somehow it's been lumped into it. Well, it's a methylenedioxymethamphetamine. MDMA, ecstasy, folks, it's methamphetamine with some modification. So, it's not a psychedelic. It's an empathogen. 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.

Andrew Huberman: Maybe we just put psilocybin and LSD on the table, and then talk about the empathogens and ketamine and all the rest separately, because so often these get lumped, and it leads to a lot of confusion.

Keith Humphreys: Mm-hmm.

Andrew Huberman: I know several people who feel they've benefited tremendously from doing clinical work, meaning with a guide in safe setting, et cetera, on high-dose psilocybin, maybe only two or three times total, and that's it.

Keith Humphreys: Mm-hmm.

Andrew Huberman: For treatment of depression, sometimes for alcohol issues and other issues. I'm not talking about microdosing. They do a high dose, so two to five grams.

Keith Humphreys: Mm-hmm.

Andrew Huberman: A lot of addicts who use other things are interested in or currently using or considering using psilocybin, LSD less so, as a means to get over their addiction. I'd like your thoughts about that, and your thoughts about these compounds specifically.

Keith Humphreys: Yeah, I mean, they're exciting in part because we haven't really made much progress in pharmacotherapy in the last 20 years. You know, for lots of things, for depression, for addiction. So the thought that these might work, and I think other than the GLP-1s, one of the... Probably say the second... I'd say put my second bet on that. I'd put my first one in GLP-1 agonist. There is an awful lot of hype, but real things can be hyped.

Keith Humphreys: So the fact that there are a lot of extravagant claims being made, and also again, talking about industry, there are people who are hoping to make a huge sum of money on these medications. But there's also something there. You could look at different pilot studies, small trials. They are encouraging, and I'm glad that it's a lot easier now to do these types of studies. We just had my friend Dr. Todd Korthuis down to Stanford; he's from Oregon. You know, Oregon is doing these things, probably similar experience to what your friend had, where you get... You know, you have preparation with a trained person.

Keith Humphreys: You get the medication, and then you do the integration session afterwards, and there are... And people would say, it was transformative for them. There are also people who have very bad experiences on them, too, though, it has to be said, and that's why we don't just say, "All right, let's just use this as our frontline med."

Andrew Huberman: You mean during the psychedelic experience and afterwards?

Keith Humphreys: Or afterwards, like flashbacks. You're driving along, and then you have a flashback, and that is both upsetting and depending on what you're doing at the time, could carry some risk to it. We don't know how well these or exactly how these drugs work, the sort of serotonergic kinds of drugs. The one thing we do know, good though, keeping on the topic of addiction, is thankfully, there's no evidence that people get addicted to psilocybin or to LSD.

Keith Humphreys: If they have abuse potential, it's extremely, extremely slight. So, I've always worried about them far less as a class of drugs than I do things like stimulants, which I know, and alcohol.

Andrew Huberman: My read of the literature, and this might have been updated since is that there is zero evidence that microdosing psilocybin has any benefit.

Keith Humphreys: Yeah. I think that's just silly.

Andrew Huberman: Mm-hmm.

Keith Humphreys: Yeah.

Andrew Huberman: 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, so they're to avoid exploitation conditions, because there has been some exploitation mainly in the MDMA trials.

Keith Humphreys: Mm.

Keith Humphreys: Right, and there has been some of that. Yeah.

Keith Humphreys: Yeah.

Andrew Huberman: And then follow-up, 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, get either significant relief or full remission after two full versions of what I just described at fairly high dosages.

Andrew Huberman: When I think about the negative impacts, certainly there's the, quote-unquote, "bad trip phenomenon." What I've observed quite a lot, and I hear from a lot of people in this psychedelic space, is that post-MDMA for trauma, post-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.

Keith Humphreys: Mm.

Andrew Huberman: And this, by the way, is separate from the very well-known trough that comes two days after MDMA use. We could talk about that. But you get high, and then there's a low.

Keith Humphreys: Yeah.

Andrew Huberman: You know, very well explained.

Keith Humphreys: As with stimulants.

Andrew Huberman: As with stimulants. Right.

Keith Humphreys: Yeah.

Andrew Huberman: I'm divided on this psilocybin to treat addiction thing.

Keith Humphreys: Mm.

Andrew Huberman: It seems very precarious because of the lack of kind of standardization of how this would be done outside a clinical trial.

Keith Humphreys: It's hard. It's hard.

Andrew Huberman: You know what I mean? You hear shaman, practitioner, guide, and because it's illegal, there's no Yelp reviews for these people.

Keith Humphreys: Mm-hmm.

Andrew Huberman: There's no board that's overseeing it.

Keith Humphreys: Well, there is in Oregon. That's actually what Todd was presenting at, which is...

Andrew Huberman: I see.

Keith Humphreys: Yeah, because it is legal.

Andrew Huberman: It's legal, not just decriminalized.

Keith Humphreys: Correct. Yeah. The state...

Andrew Huberman: Okay, because in Oakland, California, it's decriminalized. Psilocybin is decriminalized.

Keith Humphreys: Oh, yeah. Yeah.

Andrew Huberman: Yeah.

Keith Humphreys: Oakland's very different. Yeah, no, in Oregon, you are licensed by the state to do this.

Andrew Huberman: Yeah.

Andrew Huberman: Ah, I see. Okay.

Keith Humphreys: So, yeah. So that's what we'll find out. To me, this is like pretty... Probably this is a 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.

Andrew Huberman: Mm-hmm.

Keith Humphreys: It's really important to figure out if it works. We have really good methods to do that, so let's spend the dollars to get good people to do those studies.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And this is the NIDA view, the National Institute on Drug Abuse. They are funding quite a few studies of this sort. And I imagine NIAAA, which is the alcohol institute, is doing it also. I say good, because to me, it's really... I think people get a little scared of these drugs, and they sort of think, "Well, you can't use them in medicine." It's like, well, 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?

Andrew Huberman: Electric shock treatment.

Keith Humphreys: Oh, yeah. OxyContin, there's all kinds of things, right?

Andrew Huberman: Yeah.

Keith Humphreys: But we figured that out by running really good research, and 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.

Keith Humphreys: So, there's been some bad work in this area 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 about what the evidence said, and they sort of overclaimed what they found because they believed in themselves, 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.

Keith Humphreys: 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 you shouldn't be a spin doctor.

Andrew Huberman: Mm-hmm.

Keith Humphreys: That's not good.

Andrew Huberman: Fun little factoid, and then another note about psilocybin. I was curious as to why there's so few studies about LSD, and a colleague of mine who works in this space, he runs clinical trials at UCSF, said, "Oh, it's very straightforward." Most of the studies on LSD clinical trials are done in Switzerland, because the LSD trip can last up to 13 hours, and they'll work very long, hard hours. In the United States, it's hard to get the staff to come in two hours before a four to eight-hour psilocybin session, and then make sure that the person is okay enough and taken care enough to go.

Andrew Huberman: So, I'm not suggesting we extend work hours any more than we already have. But it's kind of interesting that... I mention it because sometimes practical issues drive the science. It's just as simple as that.

Keith Humphreys: Yeah. It would drive also a healthcare system.

Andrew Huberman: Mm-hmm.

Keith Humphreys: So if it took that long to do, the odds that this would ever be scaled up in the health system are pretty low, right?

Andrew Huberman: Mm-hmm.

Keith Humphreys: So there are real reasons why if you can do something in less time, you do it.

Andrew Huberman: And there is a movement now, meaning a solid effort in laboratories to figure out whether or not there are non-hallucinogenic, non-psychedelic experience-related compounds within these compounds, meaning the psychedelic experience may not actually be critical to the antidepressant effect.

Keith Humphreys: Yeah.

Keith Humphreys: Right. No, so that's one of the interesting things about ketamine. Like, if you blocked... Our late great friend, Nolan Williams, was looking at if you could block, like say, with some kind of naltrexone molecule, block the blink of lights and the visions and all that stuff, would it still have the same effect? That is a great question for science to figure out. Now, some people say, "But I like that part." It's like, okay, but a lot of people find that actually pretty upsetting.

Keith Humphreys: But they could take ketamine and not have that kind of vivid dissociation stuff, and they were depressed, and it helped them, that would be a good medicine to have, right?

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Andrew Huberman: SSRIs, Selective Serotonin Reuptake Inhibitors, and all the other antidepressants have gotten kind of a bad rap in recent years. There's the idea that all the school shooters were on SSRIs. Whether or not that can be separated from the data on how many kids are on SSRIs, you'll tell us. Talk therapy, SSRIs, and other prescription antidepressants, psilocybin, and any psychedelic for the treatment of depression, and on and on, all funnel into brain plasticity.

Andrew Huberman: If I sit in your office, and I tell you what's bothering me and you give me insights, and over time, I work with that, that's... And I get better, it's the consequence of brain plasticity.

Keith Humphreys: Mm-hmm.

Andrew Huberman: So, I think of all of these things, whether or not pharmacologic or talk therapy or a combination both.

Keith Humphreys: Or TMS.

Andrew Huberman: Or TMS, Transcranial Magnetic Stimulation. Thank you. Yeah, it's all about rewiring brain circuits.

Keith Humphreys: Mm-hmm.

Andrew Huberman: And so, it's not about the psychedelic experience. Where I get frustrated is when people say, "Oh, you know, these things open plasticity." I think to myself, "Oh, my God, as somebody who studied plasticity, David Hubel and Torsten Wiesel, who essentially got the Nobel Prize for it, were my scientific great-grandparents," they would be ro... I think Torsten's still alive, but David would be rolling over in his grave or like... No, you don't want to open plasticity because it can go in any direction.

Keith Humphreys: Yeah.

Andrew Huberman: You want directed plasticity. And so, while talk therapy is slower, while TMS might be slower, I mean, plasticity needs to be funneled. It just can't be, "Let's just open plasticity," and I think people are very intrigued by the idea of just opening plasticity as if that's going to solve the issue.

Keith Humphreys: Plasticity, which we have naturally the most when we're young, is absolutely a two-edged sword. So, if you try to learn French at my age, it's just reallly, really hard to pick up that new habit, whereas if you grow up speaking it or you try to learn as a second language when you're a teenager, you're going to have much more capacity to get it and retain it. That's true. It's also true that if you start smoking cigarettes in my age, you probably will not get addicted, and if you start smoking cigarettes when you're 13, you almost certainly will.

Andrew Huberman: Is that true?

Keith Humphreys: Yes, same thing. Plasticity. Almost all addictions start when people are young. And you can think of it as a learned, you know, it's maladaptive learning, but it is learning, that you acquire those things and you stay all the way through. It's why... Sometimes older people, I can remember getting mad, like shows they like got canceled, and people were watching them. I remember the show because my parents watched it, "Dr. Quinn, Medicine Woman." Well, why?

Andrew Huberman: Oh, yeah.

Keith Humphreys: Because old people watched it, and advertisers don't want to pay for old people. The advertisers want young people because...

Andrew Huberman: Want lifetime users.

Keith Humphreys: That's right. And to instill those habits when people are young is how you get them to do it for 50 years.

Andrew Huberman: Oh my gosh!

Andrew Huberman: Okay.

Andrew Huberman: Mm-hmm.

Keith Humphreys: You can't really persuade many people my age to start eating Cheerios or Frosted Flakes or whatever, but you start it when people are young, and that just underscores the point you're making of, like, if plasticity isn't good or bad, it's this capacity the brain has, and it can be used in very different ways.

Andrew Huberman: Maybe it explains why, despite some minimal effort, I can't get addicted to TikTok. It's just aversive to me, thank goodness.

Keith Humphreys: But maybe if you'd started when you were 13, it didn't exist then, but if it did, you might have. You might have found it far more engaging and picked up that habit.

Andrew Huberman: Chances are, based on what I observe, in knowing myself. You mentioned ketamine. Ketamine's an interesting one. A, not a psychedelic, dissociative anesthetic, has some proven benefit for depression, although maybe transient.

Keith Humphreys: Mm. Yeah.

Andrew Huberman: But high abuse potential, and here in Los Angeles, not six months goes by without hearing about some famous person dying of ketamine, which means that a lot more non-famous people are dying of ketamine, and we're not hearing about it.

Keith Humphreys: That's a good point. Yeah, and I don't know if you can post articles, but we did a review, Todd Korthuis and some other colleagues, of the potential therapeutic effect of this whole drugs. And the thing about ketamine that struck me, yes, it is FDA approved for treatment-resistant depression, so it is approved. There's a lot of negative trials for depression. I mean, it didn't vault over the efficacy thing. It cleared it. There are some positive trials, and I can say I know a couple people whose judgment I trust said it was very, very valuable to them in a deep depression.

Andrew Huberman: Mm-hmm.

Keith Humphreys: But I didn't view it as quite the knockout I thought it was going to be before I read all these studies. And then, you do have that problem. It is addictive. And so, we have a lot of people getting addicted, and then also the bladder damage you get from it. You get young people with sort of, 60-year-old bladders from ketamine. And like that is, I mean, most urologists have seen this now.

Andrew Huberman: Mm.

Keith Humphreys: It's like, why is someone at 25 coming in with this? It's like because their bladder's been damaged by ketamine. So those are significant side effects. So would not be the thing I would jump to. If I had treatment-resistant depression, which has got to be said, is a terribly challenging condition to deal with, I'd be far more likely to actually do the SAINT protocol that Nolan Williams developed with rTMS, because the effects of that for treatment-resistant depression are so much clearer in my view, and the downsides are, as far as I can see, virtually nil.

Andrew Huberman: Thanks for bringing it up again. TMS, Transcranial Magnetic Stimulation, is a non-invasive brain stimulation that can either activate or decrease neural activity in specific brain areas.

Keith Humphreys: Right.

Andrew Huberman: Very good data on this. How soon will that be available to folks in all parts of the country and the world?

Keith Humphreys: In our country, I mean, rTMS for depression is approved, and so you can get it at clinics that have this technology. These are big, expensive machines, so I'm sure there's lots of places where they're not local. But yeah, it's covered. I think Medicare actually covers it.

Keith Humphreys: Whether they cover the specific protocol that Nolan did, I'm honestly not sure, because there was a lower intensity one, and Nolan's genius was to compress this treatment. So, people would come in five days in a row and have 10 minutes on, 50 minutes off, I believe that's the rate, all day long, five days, and with a theta burst setting for rTMS.

Keith Humphreys: And I've seen some people's lives just absolutely changed by that. And you can see his tri... I mean, it's a trial. It's a good trial. Unlike with psychedelics, you really can fool people that they're getting rTMS. It's always tough to interpret psychedelic research because everybody knows when they've gotten a psychedelic drug.

Andrew Huberman: The people in the control experiment know they're in the control experiment.

Keith Humphreys: That's correct.

Andrew Huberman: Yeah.

Keith Humphreys: But not true in rTMS. You can put these coils on the head. I've actually tried it, and it feels like something's happening, and it's just a sham. And when you ask people at the end, "Guess which condition they are in," they can't guess. So, this is really some good science, and that's where I would go next if I were... I would look at the SAINT protocol is the name of it.

Andrew Huberman: Mm.

Keith Humphreys: Maybe we can... I don't know if we can put a link up.

Andrew Huberman: Yeah, we have links. We'll put links to any papers, any outlets.

Keith Humphreys: Terrific.

Andrew Huberman: You know, I hear from a lot of people with depression issues. People have become very wary of SSRIs, because of the side effect profiles, probably also because of what they've heard.

Keith Humphreys: Mm-hmm.

Andrew Huberman: I remind people that SSRIs have been very, very helpful to the community of people who suffer from true OCD. Not like, "Oh, they're so OCD," people who have debilitating levels of obsessions, excuse me, and compulsions. So I don't like to demonize any compound.

Keith Humphreys: No, we shouldn't do that. There's lots of people who benefit from SSRIs. There's no question.

Andrew Huberman: Yeah.

Keith Humphreys: Yeah.

Andrew Huberman: But maybe TMS would be something where people would want to explore. But as long as we're on SSRIs, do SSRIs make people shoot other people or themselves?

Keith Humphreys: No. No, I don't believe that the mass shooting thing. I mean, it doesn't fit the data where mass shootings are. There was just a mass shooting in Australia. Just think that is so rare that you see these in developed countries other than the United States. That was their first mass shooting in 30 years. There's plenty of people who take SSRIs in Australia. Why weren't there mass shootings? In Europe, many people take SSRIs. They don't have the level of mass shootings. So, I don't think that is the explanatory variable.

Keith Humphreys: I think the explanatory variable is that it's extremely easy to get high-powered weaponry in our country, and it's harder, pretty much in the rest of the developed world.

Andrew Huberman: Not pushing back for sake of pushing back, but I've seen data, I don't know how solid the data are, that something like 70-plus percent of the prescription drugs for depression are consumed by the United States, so that the relative percentages of a population, maybe that's a better way to frame it, taking SSRIs is much, much higher in the United States than it is, say, in Northern Europe, or in Australia.

Keith Humphreys: Yeah.

Andrew Huberman: So yes, they take SSRIs, but at a much lower frequency.

Keith Humphreys: Yeah. But if there were a significant risk, you wouldn't go 30 years without a mass shooting in a country. Australia, what does it have? They have 25-30 million people in it. Even at a lower rate, there would be... The disparity is so huge in where mass shootings occur that that's just not going to be the likely explanatory variable.

Andrew Huberman: Mm-hmm.

Andrew Huberman: What about suicides?

Keith Humphreys: There is some worry about adolescents on SSRIs. This has been a really hard-fought, debated issue for years, and it's tough because depression, of course, raises suicide risk, right? So by definition, if someone's getting an SSRI, they already have some risk present. I think there's some legitimate worry with teenagers. I would say it's non-zero, but to be honest, it's not completely in my wheelhouse, so I'm just going to leave it at that. There are people who've worked on this much more deeply than I can. Still, though, I would say there are many teenagers on these medications who benefit from them also. There's no doubt about that.

Andrew Huberman: Yeah, and folks who are interested in this, I'm working on an episode with a guest about some of these long-term effects of SSRIs that some people seem to experience. There is a cohort of people out there. This is one of the great things about the internet, who have rallied together and saying, "Hey we have the same constellation of symptoms.

Andrew Huberman: We don't have any bias against the medical industry, but we were prescribed SSRIs in our teen years and early 20s, and there's a constellation of mainly sexual side effects and mood-related side effects that don't seem to resolve even after coming off." We also see this with Finasteride, which was used to treat baldness.

Keith Humphreys: Oh, yeah.

Andrew Huberman: And our colleague, Michael Eisenberg, came on here and said, "Look, the data aren't really there, but I hear from a lot of young guys who were given these anti-hair loss drugs, and they come off the drugs, and they're still experiencing debilitating sexual side effects." And so, it is true that the medical profession sometimes takes 10, 20 years to catch up to what many people are experiencing.

Keith Humphreys: That is true. Yeah.

Andrew Huberman: So, I'm not trying to make an anti-SSRI statement here, but I think there are people walking around out there that are convinced one way or the other that SSRIs messed them up pretty bad, and they have loud voices.

Keith Humphreys: Mm-hmm.

Andrew Huberman: And so, I think that's where the concern comes from.

Keith Humphreys: Yeah. I honestly don't know what the evidence is in that particular case. I will say just something very general about medications, how we approve them. They're approved on short-term trials. I mean, if you look at the typical trial for opioids and pain, it's like 9 weeks or 12 weeks.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And there's lots of medications, and opioids are a good example, that doesn't necessarily mean that taking them for a year gives you the same effects, because, for example, you become tolerant to them, or you might become addicted to them and all that. And that is a general just challenge of how we regulate these medications.

Keith Humphreys: There are post-marketing studies that are done. But particularly if something is complicated and rare from a widely used medication, it's hard to figure that out. I mean, doctors will make reports. They get aggregated up, but that's hard. That's hard to figure out.

Andrew Huberman: Before moving on from the discussion about psychedelics, our late and indeed great colleague, Nolan Williams, sadly, he passed a few months ago. We may talk about that later, maybe not. Either way, I'll put a link to his information, because he's a critical figure in this general space around the treatment of depression. Because of his work on TMS, the "SAINT Protocol," as it's referred to, as well as ibogaine, which is a very unusual psychedelic. But he was running trials on veterans, mainly taking ibogaine out of the country, illegal in the United States, so he had to do it out of the country.

Andrew Huberman: It's a 22-hour-long psychedelic experience. You have to be heart rate monitored. Nobody does this recreationally, and nobody should do it recreationally. Sometimes it was followed up with DMT, sometimes no. But from my last discussion about Nolan before he passed, it seemed like the data were very encouraging, such that veterans who had PTSD and/or addiction issues would do ibogaine once under this intense supervision, sometimes followed by DMT, and would experience a total remission of everything bad, frankly. They're back to life. And it was pretty striking, at least the way it was being described.

Andrew Huberman: So much so that I was anticipating that ibogaine would be the first FDA-approved psychedelic, in part, because it's not the kind of thing you can just do hanging around with your friends, and you wouldn't want to. It involves a lot of scary experiences in there that one works through.

Andrew Huberman: What are your thoughts about the ibogaine work and ibogaine as a potential first through the legal door of psychedelics?

Keith Humphreys: Yeah. So, Nolan and I were office neighbors, and I really liked him. It was a huge loss. I think he was one of the great psychiatrists of his generation. Just enormous respect for him as a person and as a scientist. And I miss him every day when I walk by his office. I think what he's doing with ibogaine is really fascinating, in part because he did... The important thing, he imaged people. He neuroimaged them before and afterwards, and he was able to see a lot of these changes.

Keith Humphreys: And why does that matter? Because there's certain experiences people might have, described very enthusiastically and think they're really different, but they aren't in fact different. But he actually documents that it's different. So, I think that was really groundbreaking, and it's sad he's not going to get to continue that work. The thing to say is that this is an open-label trial with no control group. So, that's what we have so far.

Keith Humphreys: So, now the thing is to do a proper trial and see. There is a lot, also, sort of a ceremony around this. It's sort of like, as a colleague might describe it, "It's like the final mission for the soldiers. They go down to Mexico. They do this." There's a lot of camaraderie. There's a lot of other good stuff packed around it.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And so, is that part of the therapeutic experience? Or is it entirely a chemical experience? That's the thing you would find out in a trial. You know, you do all that other stuff, but you wouldn't have the ibogaine at the end. And absolutely worth studying. And newer hands will have to pick this up, but I really hope people will.

Andrew Huberman: Yeah. I'm very curious as to where that work is going to go now that... Because it really was Nolan spearheading that work. But there are people who are working hard to keep it going forward.

Andrew Huberman: Stimulants. I'm a heavy caffeine user.

Keith Humphreys: Okay.

Andrew Huberman: My caffeine tolerance is insanely high.

Keith Humphreys: Uh-huh.

Andrew Huberman: I mean, people have teased me online, "There's no way that's true, 800 milligrams a day of caffeine?" Child's play. Meaning, when I was a kid, I've got a photograph of me drinking Yerba Mate, my father's Argentine, out of the gourd, which is barely stimulatory, although nice, even, flat ride, you know? You can tell I like stimulants by the way I talk about them.

Keith Humphreys: Mm-hmm.

Andrew Huberman: When I was three or four years old, 800 milligrams of caffeine, no big deal. A gram of caffeine a day, that's kind of like where I'm nearing my limit. I can drink caffeine all day long. I stop around 2:00 PM so I can sleep well. Not a problem. I think 90% of the world uses caffeine, adult world uses caffeine. I'm asking this for my own reasons, is caffeine addictive? Is it dangerously addictive? It makes me more productive.

Andrew Huberman: I love life on caffeine. I can handle life without caffeine if I have a flu or cold.

Andrew Huberman: Otherwise, I'm not interested in finding out what life without caffeine is like.

Keith Humphreys: Mm-hmm.

Keith Humphreys: I'm probably the worst person to answer this because I love coffee. And as I like to say, I don't have a problem with coffee. If I had to choose between coffee and my children, I could make that decision.

Andrew Huberman: Sure.

Keith Humphreys: But I would really miss them.

Andrew Huberman: You got me with that one.

Keith Humphreys: I knew that was an okay joke to say because my sons laughed when I told it to them.

Andrew Huberman: Yeah.

Keith Humphreys: But, yeah, it's a stimulant, so it's rewarding, and it is potentially addictive. But what would you see if someone were addicted? Someone comes in and says, "I'm drinking so much, I'm retching. I'm having shooting stomach pains. I can't sleep." You say, "Are you going to stop?" You know, I've actually never met... But perhaps there are some people that say, "No, I can't seem to stop using." I was like, "Okay, that would be addictive."

Keith Humphreys: But I've never met a true, what I consider, a coffee addict person, because it's not that intense of a stimulant. And the things, you know, GI symptoms and things like that, that would be the main thing, or jitteriness and sleeplessness. But almost everybody who experiences those seems to quit.

Andrew Huberman: Mm-hmm.

Keith Humphreys: Or at least everyone I've met seems to quit. More generally on stimulants, I have to say, this is the biggest disappointment of my career in the addiction field. I started my career in the late '80s. And going into the Lower East Side of Detroit, which was very rough. The crack cocaine, it was everywhere. And the treatment offering to people who were addicted to crack cocaine then, in the late '80s, is not very different from what it is today, almost 40 years later.

Andrew Huberman: Which is?

Keith Humphreys: No pharmacotherapy at all. Nothing. No evidence of anything that works in pharmacotherapy. A lot of psychotherapies that don't really seem to work very well. And groups and stuff like that, which have sort of very, at most, modest effects. I'm talking about therapy groups. That's not a lot of development. And a lot of people have tried. I mean, they've tried all kinds of medications for stimulants and just not been able to succeed.

Keith Humphreys: The only thing that seems to work is contingency management, which are these things where you... Steve Higgins, I think, was the first person to do this, where he showed, against the idea that people have no control in addiction, which is, in fact, rare. They have impaired control, but not no control.

Keith Humphreys: He started experimenting with people who were addicted to cocaine, saying, "Well, you're coming into treatment. How about tomorrow we'll do a urinalysis when you come in, and if it's a negative urinalysis the first day, we'll give you two bucks, and the day after we'll give you four bucks, and the day after we give you eight bucks, the day after we give you sixteen bucks?" And he found out people stopped. They wanted those rewards, and that's managing a contingency.

Keith Humphreys: You can use that to change stimulant users' behavior. Also, for other things like, well, if you come in, there's some kind of reward, or if you fill out a job application, there's some kind of reward. That is the only thing that really looks good for stimulant use disorder. And it's fine as a behavioral technology, and I'm glad to say it's been expanded a lot. You can do it. It's covered by insurance now in most places.

Keith Humphreys: But it's just disappointing to me that if you took Keith 2025 back to the late '80s and talked to those same people I was meeting coming to treatment, they'd say, "Wow, what new things happened for people like me over the next 40 years, man from the future?" And I'd say, "I'm sorry, basically nothing." And that is really disappointing.

Andrew Huberman: What about all the prescription stimulants, Adderall, Vyvanse? I feel very lucky that those didn't exist when I was in high school and college and graduate school.

Keith Humphreys: Mm-hmm.

Andrew Huberman: Probably in part, because I like caffeine enough, that I worry that I might have liked them.

Keith Humphreys: Yeah.

Andrew Huberman: I've never taken any of the things I just mentioned.

Keith Humphreys: Yeah.

Andrew Huberman: Back then, we had ephedra and ephedrine pills and things like that, that were sold over the counter, and that always felt too stimulatory.

Keith Humphreys: Sure.

Andrew Huberman: Nowadays, I would say, yes, at least half of my friends with male children, those children are on amphetamines for the treatment of ADHD.

Keith Humphreys: Uh-huh.

Andrew Huberman: And they start them young, and then they call me because I have a network, not because I can treat. I'm not a clinician. But then they call me because they're worried about the growth stunting effects.

Keith Humphreys: Mm-hmm.

Andrew Huberman: They're worried their kids aren't going to achieve maximum height. Then they're worried that their kids aren't sleeping or eating. So, all the classic symptoms of stimulant addiction and general sets of issues. So, what are your thoughts about Adderall, Vyvanse, and similar?

Keith Humphreys: Those are tough calls for parents. There are kids whose lives are transformed positively by Ritalin, who cannot sit still, cannot do their homework, and it is transformative. They are, at the same time, I would say, over-prescribed. And maybe an example drug that is sometimes both under-prescribed and over-prescribed. There's probably people who could benefit who are not getting them, and there's a lot of people who are getting them that...

Keith Humphreys: I think there's just less tolerance for some variations in how all our brains worked in medicalizing everything. And I noticed that a lot, which makes parents anxious. Your kid has this thing, and all that, as opposed to it could be, "Well, he is kind of an active kid, or he doesn't pay that much attention, but he doesn't have an illness that needs to be medicated." I worry about that just very generally. I worry a kid can't be shy anymore.

Keith Humphreys: They have to be on the spectrum and carry a diagnostic label. And I think there's a lot of that going on, unfortunately. And I sympathize with the parents. I'm not judging any of them, because I know those calls are really, really tough to make. And again, I know some kids whose lives are meaningfully transformed by them. So, that's tough. That's tough.

Andrew Huberman: Tell me if you disagree with this, and forgive me for citing previous guests, because I'm not an expert. But I hosted a psychiatrist on here who's an expert in ADHD, and his claim is that non-treated ADHD poses a much greater risk for addiction than treating ADHD with substances that, in non-ADHD folks, are addictive. In other words, if a kid or adult has ADHD and doesn't medicate, they're at much greater risk of abusing drugs. If you do medicate, they're at much lower risk because it lowers the impulsivity.

Keith Humphreys: Yeah, that could well be true. It's not my core area, but it could well be true. There is a very high rate of ADHD among people, in adulthood, you see are alcohol addicted, which doesn't seem to be a coincidence, you know?

Andrew Huberman: Mm-hmm.

Keith Humphreys: So, that could well be true.

Andrew Huberman: So, when you look out on the landscape of energy drinks, and nicotine has made a big comeback.

Keith Humphreys: Yeah.

Andrew Huberman: Big comeback. Interesting stimulant because it's both a stimulant, but it also relaxes you to some extent.

Keith Humphreys: Yeah.

Andrew Huberman: I tried it for a bit, the gums. Despite my caffeine tolerance, I am very sensitive to drugs, so I can do like two milligrams of nicotine gum. And I noticed it gave me spasms in my throat when I wasn't taking it. And I was told that's because the muscarinic acetylcholine stimulation.

Keith Humphreys: Yeah.

Andrew Huberman: So, your throat starts spasming, then you feel like you need it. It's actually a physical sensation.

Keith Humphreys: Wow.

Andrew Huberman: Then the oral health folks tell me that it's bad for gum disease. And the skin folks... This always gets, typically women, but here in LA, men and women, it definitely ages skin faster because of the vasoconstriction in the skin.

Keith Humphreys: Yeah.

Andrew Huberman: So, it makes you look older, even though you're not smoking it, the oral nicotine. But here I just have to pepper with what I've heard. We have a Nobel Prize-winning colleague. I'll just name him, it's Richard Axel at Columbia, who told me long ago and many times, "Nicotine is protective against Parkinson's and Alzheimer's," which is why he chews, or did chew tons of Nicorette per day.

Andrew Huberman: So, what's the deal? Nicotine seems like it has some benefits. It might make you look older. Maybe you need to take better care of your teeth. It's a stimulant, but highly habit-forming and addictive. So, what's your view on nicotine as an industry and as a substance?

Keith Humphreys: Yeah. I mean, it's a poison. If you consumed all the nicotine in a carton of cigarettes, it would kill you. I mean, that's remarkable that it is so popular, because of that, it is exactly the reason you say. It's both I feel sharper and then yet I feel relaxed at the same time. I think a lot of people who use it are mistaking the treatment of withdrawal for a drug benefit.

Andrew Huberman: Can you elaborate on that?

Keith Humphreys: Yeah, sure. So, let's say you smoke. When you sleep, obviously, you're not smoking, and the nicotine blood level goes down, and you wake up feeling jittery and jangly and all that, and you have your first cigarette, and it feels great, because you're... But that doesn't mean, wow, cigarettes are really good for you. Look, you smoke, and you feel really good. What you're doing is just the withdrawal that makes you agitated and angry and annoying goes away, and you attribute that to the use of the nicotine.

Keith Humphreys: But it could just be you are dependent on this drug, and what you actually need to do is persist through the days where you will feel cognitively sludgy and maybe a little bit keyed up and all that. But then, once you go through the withdrawal, you won't need it to get to that point. I think there's a lot of people like that. It happens with cannabis a lot, too. I mean, a lot of people say, "I can't sleep without it." So, yeah, well, one sign of cannabis withdrawal is sleeplessness.

Keith Humphreys: So, are you sure that you've got a sleep disorder that you're treating and not that you, basically, just are trapped in a cycle of withdrawal and medicating withdrawal?

Andrew Huberman: Mm-hmm.

Keith Humphreys: Happens with opioids, too, is another example. People think, "My pain's coming back," and it's like, "My injury." And it's like, well, could be, but it could also be you're dependent on opioids.

Andrew Huberman: What's your advice to those people? To ride it out?

Keith Humphreys: There are treatments that can make withdrawal easier from different types of drugs. But yeah, I mean, if you can get past that point, you could be free of using it at all, and wouldn't that be nice to do? It's definitely worth running the experiment.

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Andrew Huberman: I'm certain a lot of people, including me, are interested in how to avoid getting addicted to things, and how to get over addiction to different things. And I'm very curious as to whether or not the field of addiction treatment has started to parse early, middle stage, and kind of late stage addiction, or whether or not it's all just considered addiction. Like, for instance, a number of people now are suspecting that they might be addicted to social media or their phone or texting or something electronic. They are suspecting that they might be too dependent on food.

Keith Humphreys: Mm-hmm.

Andrew Huberman: They might be addicted to X, Y, and Z. And I think that represents the great success of you and your colleagues, and people like Anna Lembke, and people being public advocates about what addiction is and isn't.

Keith Humphreys: Mm-hmm.

Andrew Huberman: But to me, it seems like independent of the substance or the behavior, if somebody is early in the experience of feeling like they're weighed down by something, and it's hurting them in some subtle way, very different than somebody who is raising a hand, hopefully, or thinking, hopefully not, about taking their own life because they're so hopelessly addicted to alcohol or drugs, they've lost everything. So, as a clinician, what's your approach if somebody says, "Hey, I think I might have a problem with X"?

Keith Humphreys: First off, you would say, "Wow, I'm so glad you told me. This is something that tens of millions of people experience, and many of them stay silent about it, and therefore people feel, and you may feel that you are strange or this is shameful or an odd experience when it is really an extremely common experience." And so, you're saying that so the person doesn't feel embarrassed, and they feel comfortable talking about it.

Keith Humphreys: The other thing is you convey optimism. You know, there are probably, in surveys, something like 24 million Americans are in recovery. We just don't notice them, because someone in recovery looks like anybody else. We notice them when they're actively addicted, but not when they're in recovery because they sort of return and they just look like, "Oh, that's just a schoolteacher, that's an accountant, that's a police officer, whatever." But there's a lot of reason for rational hope.

Keith Humphreys: And in the particular case you're talking about, when someone's just starting to worry, and it's early stage, the odds that they will recover are dramatically higher. So, it's much, much easier to sort of pull out before you've burned your life down around you.

Keith Humphreys: So, it's tough when people come in, and you say, "All right, well, do you have family support?" "Well, my family doesn't talk to me anymore." "Okay, do you have at least a safe place to live?" "No, I lost my... I'm sleeping on a couch right now." "Well, at work are you..." "No, I lost my job." That's tough for the person to rebuild everything.

Keith Humphreys: But if you still have those resources, there's still people who love you in your life, you still have a meaningful role where you're contributing, and you also have some accountability, that's going to help you make that behavior change. Whatever it is, I would say that about any behavior change, not just one connected to substances. And then what do we do when we work with people? Well, we always think about motivation.

Keith Humphreys: It's hard. This may seem strange, but if someone says, "I want to quit smoking," a good clinician will say, "Why would you want to do that?" You think, like, "Well, that's dumb." You should be saying, "Yeah, good. Great. Good." It's like, well, if you don't want to do it, it doesn't matter what I think, right? And also, there's quite a few people, if you push on it, they actually become less likely to do it. If you sort of nag them. Just say, "So tell me, why would you want to... What do you want to get out of this? Because it's work. I mean, I'm happy to work with you, but what is it? What are your motives?"

Keith Humphreys: And that's reflecting on that like, "Well, here's the thing. All my clothes stink, and I hate the way it..." "So, you would enjoy..." And help them elaborate, "So, you would get up, and your clothes would smell really good, and you'd feel good about yourself." Goes, "Yeah, yeah, yeah." It's like, "And I'm spending a lot of money." Say, "How much are you spending on?" Whatever. "It's 2000 bucks a year." "So, if you had 2000 bucks because you hadn't smoked in a year, what would you buy for yourself? What would be something you'd really enjoy? Tell me about it."

Keith Humphreys: And sort of helping them build up in their own mind, because again, this is about them, not you. What do you get? Because this is going to be tough. And maybe I want to do it today, but in three days I'm going to be in withdrawal, and I'm going to feel like I want to go back, and I need to think about, wait a minute, a year without smoking, I get that 2000 dollar trip to Cancun I've always wanted to take. So, that helps motivate them.

Keith Humphreys: And then you talk, and then we just do some sort of behavioral analysis of where do you use, how much do you use, what do you use? Are there cues to use? Often, for many people, there are. And also to non-use. Are there places where you would never use? "Oh, I'd never use at my mom's house." "Huh. Okay, that's good to know. Maybe you could visit your mom more often." Or "I never smoke on a holy day, and whatever my religion is."

Keith Humphreys: "Oh, okay. So, let's talk about that. How do you get through that day? What are the techniques you use there that we could try on other days? And also, what are the things that get you in trouble?" Like, "I'm trying to quit drinking." "Well, if I went into your house and opened up the cabinet, what would it be?" "Well, there'd be like 20 different types." I say, "So, could that go somewhere else? Could you give that away, so that it's behaviorally harder for you to get this? You'd have to go down the street and go to a liquor store, that kind of thing."

Keith Humphreys: Help people on stuff like that. And then, there's often practical skills in learning that. Like, how do I manage a social interaction without alcohol, for example? Or what do I do for fun? Things like that. Or how do I hang out with my friend who loves to drink and explain to him why I can't drink anymore? Those kinds of things as well. 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, this may seem like incredibly simple, almost dumb advice, but hang out with other people who are trying to make the same change.

Keith Humphreys: You want to start jogging? Join a jogging group. You want to stop drinking? I would suggest go check into an AA meeting, or one of the other fellowships we have, LifeRing Recovery or SMART Recovery. Having other people on the same journey is good for us. I mean, everything shows that, no matter what you're doing. I'm losing weight. I'm exercising. Whatever. I'm quitting smoking. Because it gives you two things. It gives you support, but it also gives you some accountability.

Keith Humphreys: It's like, "Hey, you were going jogging, and on Tuesday you weren't there. What's up? Are you going to be part of this group or not?" And that is helpful for people, the combination of the two. So, all those things we encourage people to do.

Andrew Huberman: That's wonderful to hear some concrete questions that one would ask, because I think people have heard of just quit. I think a lot of people who aren't familiar with addiction as a chemical brain circuit, hormonal, full-body, full-brain issue, but mostly a brain circuit issue...

Keith Humphreys: Sorry, it almost makes me laugh, just think like, someone's going to say, "My God, why didn't I think of that before? Thanks, doctor."

Andrew Huberman: Yeah.

Keith Humphreys: And stamp on a cigarette and walk out.

Andrew Huberman: I know.

Keith Humphreys: Well, yeah.

Andrew Huberman: It's wild, right? I mean, addiction used to be looked at as a character defect.

Keith Humphreys: Mm-hmm.

Andrew Huberman: And certainly, addicts have character defects, but I would argue at no greater rate than a non-addicts.

Keith Humphreys: Everybody has character defects.

Andrew Huberman: Everybody has character defects. Exactly. And part of the reason I think it was viewed as a character defect is that A, addictions vary, and susceptibility to them varies. So, if it's been easy for me to quit drinking alcohol and I wasn't aware of what addiction is, I might look at somebody who is having a hard time quitting drinking and just think, "Well, just quit. I did it."

Keith Humphreys: Yeah. Yes. Yeah

Andrew Huberman: "You can." This kind of thing. And just swap whatever substance or behavior for alcohol there.

Andrew Huberman: And then, I think the other reason is that, oftentimes, sadly, addicts hurt people around them in their addiction.

Keith Humphreys: Yeah.

Andrew Huberman: They lose money that wasn't theirs. They harm themselves or others psychologically or physically. And I mean, I know drug addicts that it had to come down to their kid getting into their drugs and almost dying before they finally quit. And even at that time, they were concerned that they might not be able to quit, even though they adore their children and wife.

Keith Humphreys: Yeah. Yeah.

Andrew Huberman: Fortunately, that person is still sober some years later. But it's like, you can imagine, from the outside, you can come up with some pretty good character defect arguments when you observe that kind of thing.

Keith Humphreys: Yeah.

Andrew Huberman: But when these people get sober, it's spectacular how the real person seems to emerge.

Keith Humphreys: Mm-hmm.

Andrew Huberman: Which points to the fact that the addiction masks something about who they truly are, not the other way around.

Keith Humphreys: No, I agree with that. And I think you're right that a lot of the explanations from addiction come from people who are hurt and angry, with good reason. They had an addicted parent, and that was hard for them.

Andrew Huberman: Mm-hmm.

Keith Humphreys: Or their marriage is disintegrating, and so they're mad, and so they're going to have a certain amount of venom in how they explain this, sort of understandably. And in addiction, people do things they would not otherwise do. I mean, like you're saying, lying about lots of things that they normally wouldn't lie about. Like, "I promise I'll show up to the baseball game and watch you play your game." Or, "Yeah, I'm going to save up some money and we're going to get the plumbing fixed," but I'm actually spending it on drugs, those types of things.

Keith Humphreys: And that hurts people. And it's very important to acknowledge that, because sometimes the language, the message that sometimes the government, public health people have given about addiction as a disease, sounds scolding to people who've been harmed by addicted people.

Keith Humphreys: Like I'm saying, "We don't feel sorry for you. We feel sorry for this person. They're ill." And it's almost like, "How dare you be angry at your mother? She was ill. It wasn't her fault." It's like, it still hurts. If someone who has dementia goes on an angry rant and says a lot of nasty things, it still hurts, it's still scary. The fact that it's a disease doesn't change your experience as a person. And so, I'm always trying, in public messaging, to acknowledge that the pain is enormous. It's really tough to live with an addicted person. It's hard.

Andrew Huberman: It's a complicated problem from public health and just psychologically. I mean, we're in the wake right now of Robert Reiner and his wife being killed by stabbing, which seems additionally violent and horrible, by their son, it seems, he's been charged anyway, who is an addict.

Keith Humphreys: Yeah.

Andrew Huberman: And the photos of him that are going up make him look quite angry and deranged, frankly.

Keith Humphreys: Mm-hmm.

Andrew Huberman: It's going to be interesting to see how that shapes people's views of addicts and addiction, and the fact that he was supported by his parents for a long time in that addiction. They even made a movie together, which wasn't a very good movie, and everyone knew it.

Keith Humphreys: Yeah.

Andrew Huberman: It felt like a desperate attempt to rescue his son through his profession, and it just descended as tragically as it possibly could.

Keith Humphreys: Mm-hmm.

Andrew Huberman: And then, we have this quote, unquote "homeless problem," which is perhaps also an addiction issue in part.

Keith Humphreys: In part, yes.

Andrew Huberman: Thanks for mentioning that addicts are in pain. But the people around them are in a lot of pain also.

Keith Humphreys: Mm-hmm.

Andrew Huberman: It'd be interesting if, in the future, addiction could be framed as a context, as opposed to a person. But it's hard to separate the behavior from the person.

Keith Humphreys: That's right. If you grow up with an addicted parent, as a kid, you won't understand all that anyway, right? You just know you're wanting love and attention, and you're not getting it. And that's a very common experience to grow up with an addicted parent. And that can generate lifelong negative feelings about it to people.

Keith Humphreys: And again, I say understandably, even if you do eventually come to the view that, "Yeah, dad had a disease," or "Mom had a disease," you still didn't get what you wanted at the time. And so, there will be grief and sadness about that.

Andrew Huberman: Asking why would you want to quit is a very interesting question.

Keith Humphreys: Yeah.

Keith Humphreys: Seems strange, doesn't it?

Andrew Huberman: Yeah, and I want to talk for a moment about the "carrots and the sticks."

Keith Humphreys: Mm-hmm.

Andrew Huberman: The sticks are kind of obvious, in most cases. Well, if I wasn't smoking, I wouldn't have to pay for cigarettes, I wouldn't smell bad, I wouldn't cough so much. The "carrots" are often a little more cryptic, and probably harder for people to think about, for the addict to think about, if they're very far into their addiction. Recently, I observed some spectacularly enormous, frankly, weight-loss achievements of some famous people.

Andrew Huberman: Country music singer Jelly Roll. Forgive me, that's his name. I didn't name him that. That was his name. He was a giant man. He was in excess of 400 pounds or something. Lost over 300 pounds, and he's a transformed human being. The way he talks about what he's doing, he's running 5Ks and half marathons. I mean, he's a completely different person.

Andrew Huberman: But for somebody who's still stuck in the very large body, they can't imagine those "carrots" because they've never really lived in them. And so, how do you make a "carrot" motivation, a positive motivation, feel real for a patient, in a way that it can really pull them forward, as opposed to just all the stuff that they're not going to feel? Because you have to be pretty close to losing it all for the "sticks" to really matter.

Keith Humphreys: Yeah. Yeah, so all people, to some extent, discount future rewards to some. So, we buy the five-dollar latte instead of putting it in our retirement, even though if we did that every day, we would have a million dollars when we were 65, right? And in addiction, they do it even more. So, in addition, if you ask people, would you take five dollars today or 20 dollars tomorrow? They're more likely to say five dollars right now. Almost as if tomorrow doesn't exist.

Keith Humphreys: So, this really is a problem, and you can't really say to people, "If you get in recovery, after five years, I bet you'll meet a nice person, and you'll get married and settle down. And then you'll go back to school and get a job." It's like that's all fantasy camp kinds of stuff, right? It's okay to have those long-term goals. Sometimes those are very motivating.

Keith Humphreys: But you want to focus on things that are immediate, because that's the world they're living in, a world of immediacy. For example, you will have more money every day. If you're using an illegal drug, your risk of arrest will drop to zero immediately once you stop engaging in these transactions. You will feel physically better very, very quickly than you feel right now. And social reinforcement really matters, too.

Keith Humphreys: There's this is one of the geniuses of the people who developed the 12-step fellowships. The fact that you get literal status by how many days, or years, you have not used the substance, and you get respect. And we care about those things for very good reasons. They've been central to the survival of the species. I've always thought it was clever of AA to have the "one-day-at-a-time" concept, which just maybe seems hokey, like a slogan.

Andrew Huberman: Mm-hmm.

Keith Humphreys: But you can't suddenly quit drinking for the rest of your life. It's not here yet, right? And that just seems inconceivable. But can you not drink today? Not drink today and go to a meeting and get some reward for that? Yeah, you can probably do that. And so, just do that every day, and then you will have 30 years, eventually. But you don't have to wait for all those rewards, because very, very few people can do that. And of the ones who really can, they're probably not very prone to addiction. People who are, think that far ahead all the time, and have extremely high self-control, seem to be less likely.

Andrew Huberman: And what about the addictions where people either believe or it's actually true that it helps them be more functional in other areas of their life? Less social anxiety with two or three drinks.

Keith Humphreys: Yeah.

Andrew Huberman: You know, taking a prescription stimulant, and get your work done. Maybe they are true ADHD, but not revealing anything that isn't already known. I mean, stimulants raise levels of alertness. Alertness is a prerequisite for focus, and you're out of the gate, whether it's caffeine or people who are taking... And I think even on our dear Stanford campus, I would bet that there are students who are not prescribed Adderall, Vyvanse, and other stimulants that take them in order to get work done.

Keith Humphreys: Surely, yeah.

Andrew Huberman: It's a very competitive place, and they're driven, and no one wants to feel tired when you got work to do.

Keith Humphreys: So, this is also part of when you look at motivation. So what some people think what you do is you say, "Drugs are bad. Look at all these things it's ruining. It does this. It's hurting you this way, that way, this way." In effect, you're kind of telling the person they're an idiot, right? If you actually do that. So you get them to articulate. Well, clearly you like some things about it. What are they?

Andrew Huberman: Mm-hmm.

Keith Humphreys: And put them on the table. "Well, it's just like, my friendship group has always drunk, and I would just love those hunting trips. We all get shit-faced together, and it's real fun." Okay, so that'd be one thing you're getting. What else? Tell me. And you're not framing this as a struggle between you, as the punishing force, that's going to deny that this person has enjoyed something about this, or gets something out of it socially. And you say, "So this is what we need to decide. These are the costs, and these are the benefits. It's your life, not mine. Do you want to go for this or not?"

Keith Humphreys: And you acknowledge the grief of those things. Like, "Man, I'm used to be so much closer to my college buddies, and now I had to skip our annual trip for the first time because I was afraid I would relapse." Like, "Wow, that is a real cost." I mean, that has to be grieved. And there are many things like that.

Keith Humphreys: I know people with relationships where one person nagged the other to quit drinking, and then, when the person got sober, left them. Because they changed a lot, in ways that they didn't like. And it turned out there were certain aspects of their drinking problem that worked for that other person. Whether it was, "Well, I had more control over the checkbook, because you were always drunk, and I got to make my spending decisions by myself."

Keith Humphreys: Or you know, "I find, now that we're talking more, I realize I don't like a lot of things you said before." And that's all real. I mean, those kinds of things happen. Drugs always work in some crude sense. I mean, they're certainly beneficial, but they have some function, right?

Andrew Huberman: Mm-hmm.

Keith Humphreys: And you got to figure that out, because that will change if this drug use changes..

Andrew Huberman: Yeah, the partner example is interesting, because there's this whole notion of co-dependents teaming up with, or partnering up with addicts. This is why things like "Co-Dependents Anonymous" and...

Keith Humphreys: Yeah, I think that's a bit overstated, honestly, but...

Andrew Huberman: You think so?

Keith Humphreys: Yeah, yeah. One of the really interesting study which was done by Ruth Cronkite. It was my colleague for a while. And it was of women who were married to alcoholic men, and did all the things that fit the co-dependent thing. But then, when the men got sober, and they went back and studied them a year later, the women looked exactly like women of men who had never been alcoholic.

Andrew Huberman: Hmm.

Keith Humphreys: So, a lot of the things that are attributed to the personality of the co-dependent person is actually a reaction to addiction.

Andrew Huberman: Mm-hmm.

Keith Humphreys: They're hyper responsible. They have to be, because the mortgage won't get paid. They're placating. Well, they have to be because they've got this volatile person, potentially dangerous person. That's where a lot of that comes from. And I think it was a bit unfair. I mean, obviously, the people have bad taste in partners. There's no doubt about that. But maybe a bit unfair to not appreciate a lot of things families do, are more reactive than something that was preexistent and fit with an addiction.

Andrew Huberman: That's a really important point, because I think most people think the addict-codependent pairing is almost like a prerequisite. And it actually reminds me of this whole literature, which I think is an important literature that became popular about avoidant attachment versus anxious attachment, and this idea that people always pair up along these dimensions.

Keith Humphreys: Mm-hmm.

Andrew Huberman: But the studies that have been carried out subsequent to those naming categories is that, put each of those people in a different context, and they behave very differently. And you can...

Keith Humphreys: Ah, yeah.

Andrew Huberman: So, we're more plastic in our psychologies, in our romantic pairings, than perhaps we assume.

Keith Humphreys: And it's also true that there are people who, 10 years into addiction, find they're not married to the person they married, because that person has changed an awful lot. So maybe they were originally pretty social, pretty competent, pretty honest, and then after 10 years of heroin use or whatever, they are none of those things.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And it feels like, to the married person, it's like this is just not the person I married in the first place. That's why we don't match, not because I picked the wrong person, but that person changed, yeah.

Andrew Huberman: In keeping with that, and the original question, which was different stages of addiction, perhaps, requiring different approaches, there's this idea, perhaps, trying to remove my neuroscientist lens here. But I believe, I'll just be open about this, I believe that at some point, if you use certain substances long enough, the brain is changed significantly enough, that the opportunity for recovery is different depending on whether or not you go to a meeting, which certainly works for, let's just say all of the addictions early on, probably most of them in the middle.

Keith Humphreys: Mm.

Keith Humphreys: Mm-hmm.

Andrew Huberman: But I know a few ex-heroin addicts. They're different.

Keith Humphreys: Mm-hmm.

Andrew Huberman: They're still different, even though they're sober. I knew them before. Now, it's not a perfect experiment because there was time, et cetera. But we know that certain drugs actually kill neurons.

Keith Humphreys: Oh, yeah.

Andrew Huberman: Certain drugs rewire the reward circuitry, and the person is different. It's not to say that they shouldn't quit.

Keith Humphreys: Mm-hmm.

Andrew Huberman: They should. But it's harder to imagine sitting down with someone who's been using heroin or methamphetamines for a number of years and say, "All right, let's think about how you're losing. Let's see what you could win in this circumstance." I mean, I hope that's the case.

Keith Humphreys: Mm-hmm.

Andrew Huberman: But it seems like they're rewired. They're a different beast.

Keith Humphreys: Yeah. Well, that is fundamental to the understanding of the disorder, i.e., a change in the brain. And you can call it a disease, you can call it a disorder. I often think of it as deeply maladaptive learning. I'm like that rat who really, really believes the most important next thing for me to do is to consume this powder. And when I'm ignoring all of the things that I'm evolved to do instead.

Keith Humphreys: So, it is definitely true. You see these changes, and you can observe them in the brain, and it's amazing. You can even predict things that the person can't even report on. So, we did some work myself, Claudia Padula, Brian Knutson, Kelly MacNiven, up at the VA in Menlo Park, of people who were in a residential program addicted to methamphetamine. All of them were off methamphetamine while they were in the residential, okay? And then, imaging them and showing them cues of meth-associated things, like the pipe or the powder and all that.

Keith Humphreys: And asking them, "How much do you like that? What do you feel towards that?" Well, independent of that, there's also nucleus accumbens activation that you can see. And that predicted who relapsed. Not what they said, but what was going on in their brain. They didn't even necessarily know it.

Andrew Huberman: We should say the nucleus accumbens is a critical node within the dopamine reward circuitry of the brain that underlies the path to addiction and many other things that initially feel good.

Keith Humphreys: Yeah. Yeah, that's right.

Andrew Huberman: So, the brain was report... Nucleus accumbens, let's just put in dopamine activation as a proxy.

Keith Humphreys: Yes, right, right. Right.

Andrew Huberman: So, levels of dopamine activation, so to speak, we're being neuroscience-y here, not technically precise, levels of dopamine activation predicted whether or not the person would relapse better than their own self-report of the subjective feeling of whether or not they would relapse.

Keith Humphreys: Yes. I crave this.

Keith Humphreys: I like this.

Andrew Huberman: Got it.

Keith Humphreys: I want this. And it helps explain why addicted people sometimes get an unfair rap in terms of, well, they lie about what their desires are. "I really, really want to stop using." Well, I would assume if they're in a residential program for 28 days, they do, in fact, want to stop using. But they don't have complete insight into what's going on inside the brain, like anyone else's.

Keith Humphreys: So, those two people would both say, "I really, really want to do this." And one goes out and relapses, and the other doesn't. It doesn't necessarily mean the one who relapsed lied. It may just be, "I didn't realize how deeply my brain has been changed, and it's pretty hard for me, given the neighborhood I live in, to walk around and see no one using drugs ever, to see no allusions to drugs in TVs or movies, to see no pipes, to see no powders, and I'm going to relapse because I have rewired my reward system."

Andrew Huberman: So, in 12-step, when they talk about your addict brain or one's addict brain, "That's my addict brain. That's your addict brain talking. That's not you," I think this study that you refer to, I think pinpointed the addict brain is, at least in part, nucleus accumbens dopamine reward circuitry activation.

Keith Humphreys: Cue-elicited, yes.

Andrew Huberman: Cue-elicited, so something that anticipates or predicts the use.

Keith Humphreys: Yep, that's right. And you think, particularly, when you get into legal products, that is a hugely important thing. It's very hard to watch TV and not see an ad for beer, for example.

Andrew Huberman: Or pharmaceuticals.

Keith Humphreys: Or pharmaceuticals, yes. Right.

Andrew Huberman: Yeah.

Keith Humphreys: And depending where you are around cigarettes, this is very driven by class, but there's still a lot of neighborhoods where quite a few people smoke, and it's pretty hard to get through the day without being exposed to the cue of the smell of tobacco smoke, or the smell of cannabis smoke, for that matter. And so, cue-elicited craving is going to be a driver of relapse, and that is clearly something that you were not born with. That is something that you learn through repeated exposure of your brain to a pretty powerful drug.

Andrew Huberman: So for folks listening, who pick up their phone and find themselves scrolling social media, knowing they have other things to do, or playing video games knowing there are other things they really need to do, and feel like they, quote-unquote, "can't stop," I think what you're pointing to really represents the divide between that inner voice that we think of as us telling us, "Oh why am I doing this? I know I shouldn't be doing this, but I feel like I'm compelled to do it," almost in a kind of automaton kind of way.

Keith Humphreys: It is extremely common experience just in life, right? "I know I shouldn't eat that Ho Hos. I've been trying to lose weight, but I'm tired today, and I'm going to have it." Just the fact that we have a contradiction between our idealized self in our own head and our behavior, that's probably just being a person. But when it gets to the point that, "I'm actually going to flunk this exam, which is important to me not to flunk, if I don't start studying, and I'm on my third hour of scrolling through TikTok, and I know, and I'm not..." Then you start to worry, right? Because now you're going to do damage to yourself for the purpose of consuming this brain candy, which has no nutritive value at all, but is clearly seductive.

Andrew Huberman: I'm out of the lab these days, but if I were to go back into the lab, I'd want to team up with clinicians like you and some of our engineering, bioengineering friends and develop something which would be similar to what Nolan and company developed for depression, right? Brain stimulation, not just willy-nilly, but of particular brain areas and circuits, to try and undo major depression.

Andrew Huberman: Wouldn't it be wonderful if there was a brain stimulation device that could tweak the reward circuitry in the presence of a cue, that predicted methamphetamine for the amphetamine addict, or alcohol for whatever, process, behavioral addictions, and wouldn't eliminate the ability to experience reward.

Keith Humphreys: Yep.

Andrew Huberman: But would eliminate, essentially, the bad addiction, or tamp it down, tamp down the rewarding properties of the bad addiction, and at the same time do an experiment, a parallel experiment, where you ramp up the reward circuitry in the presence of something that cued for a positive behavior?

Keith Humphreys: Mm-hmm.

Andrew Huberman: Because I don't think you can just tamp down reward circuitry. This is one of the challenges I have with the... Okay, obviously abstinence is going to be critical. But for somebody that has a nucleus accumbens, and we all do, it's going to want to latch onto something, and I've seen so many addicts pivot to the next thing. Sometimes it's a healthy thing.

Keith Humphreys: Mm-hmm.

Andrew Huberman: Many ultra runners are addicts.

Keith Humphreys: I've met people like that too, yeah.

Andrew Huberman: You can't go to a 12-step meeting, and this is somewhat cultural. But you can't go to a 12-step meeting and not see people with lots and lots of tattoos, if they have issues with... And I'm not demonizing tattoos. But if they have issues with drugs or alcohol, typically smoking will pop up in its place. They need something. We need something. And ideally, it would be school and family and connection and community and public service. Great.

Andrew Huberman: But a device that could help tune the specificity of reward, I don't think, is outside the realm of possible. I'm thinking like a Stanford guy now. We like to engineer everything.

Keith Humphreys: Yeah. Yeah.

Andrew Huberman: But why not? It's being done for OCD. It's being done for depression. It's being done for PTSD. It's being done for so many things. I mean, after all, it's plasticity that we're after.

Keith Humphreys: Yeah, I mean, and you're right that one of the challenges is, addiction is... It's not like it's introduced something new into the body. It's working on the very system we use to negotiate life. It is this thing we use for learning the acquisition of knowledge, the acquisition of skills. So, it's not like if we just didn't have that, we would be better off. We wouldn't be better off. We couldn't survive without it.

Keith Humphreys: The only neurosurgery patient at West Virginia University, who had a very uncontrollable addiction and got... I'm not exactly sure of the nature of the implant, if it's a stimulating implant. That's happened once. It was covered. People wanted to read about it. Lenny Bernstein, a friend of mine at the Washington Post, interviewed that patient and the team. But I think that it is likely that we will see something like that. I suspect we will see more rTMS, right? Transmagnetic stimulation, because it's not so invasive, not so expensive, and not so risky.

Keith Humphreys: We're about to start, led by Greg Sahlem, who's a really good psychiatrist, a multi-site study with rTMS to the dorsolateral prefrontal cortex for people who are cannabis use disorder, addicted to cannabis. There are lots of people working on these protocols for alcohol, for cocaine. Doesn't always work. rTMS is almost like saying, "We put them on pills," because there's "what brain region at what intensity," all that kind of stuff.

Andrew Huberman: Right.

Andrew Huberman: Sure.

Keith Humphreys: But that is a way to intervene far more directly to the brain than talk therapy, for example.

Andrew Huberman: Mm-hmm.

Keith Humphreys: So, I think that is certainly possible. In implants, made possible. This particular case was someone who was very, very, very... Had tried everything on earth and still couldn't stop. And interestingly, even with the implant, still needs medications, goes to lots of 12-step meetings. It didn't just make it disappear. Cancer, though, I mean, we haven't talked about GLP-1 agonist. If we want to get into that, that is maybe something that would have a lasting effect on changing what one wanted.

Andrew Huberman: I definitely want to talk about GLP-1s. I think just before we pivot there.

Keith Humphreys: Okay.

Andrew Huberman: When I think about the quote, unquote "homeless problem" living in California, you can't help but see this.

Keith Humphreys: Yes.

Andrew Huberman: I think of it as, at least, you tell me where my numbers are off, 50% an addiction problem, either first or also?

Keith Humphreys: Mm-hmm.

Keith Humphreys: In this economy, yeah.

Andrew Huberman: Yeah, I mean, those folks aren't going to go to 12-step meetings.

Keith Humphreys: Yeah.

Andrew Huberman: Maybe. Maybe. I would love for them to. They live outside my door, and I talk to some of them, and they're not going to 12-step meetings. No way.

Keith Humphreys: Hmm. Mm-hmm.

Andrew Huberman: And many of them, their brain circuitry is altered. Maybe it was altered before. This is not all homeless people. In fact, I don't even know if "homeless" is the right word. And I'm not going to the "unhoused" thing. They're homeless, okay? They don't have homes. I don't think we need to split hairs with the naming. Many of them have serious substance abuse issues and/or mental health issues that may have stemmed from that.

Keith Humphreys: Yeah.

Keith Humphreys: Yeah.

Andrew Huberman: I'm not asking you to solve the whole problem here in five minutes or less, but how do we wrap ourselves around the legislature?

Keith Humphreys: Yeah.

Andrew Huberman: I know you've been involved in things related to this. I mean, how do you get somebody on the street to understand what's going on and rescue themselves?

Keith Humphreys: Yeah. So first off, yeah, it is a very high rate of substance use and mental illness, higher now than in other periods, because unemployment is low. When the economy is really terrible, there are a lot more people who don't have anywhere to live, who just need a job, basically. They didn't fall out of a housing or a family. They just need work.

Andrew Huberman: Mm-hmm.

Keith Humphreys: But since unemployment is historically quite low now, so who's left are the people who cannot, even when we're near full employment, cannot find a shelter, and those tend to be people who have problems like mental illness, like addiction. You can do some things, and with good evidence, you can do some things by combining housing, nice housing that people would want, with a recovery culture.

Keith Humphreys: So, there's a model called Oxford House, which is run by the people who live there. And they all contribute a bit to the rent, and they have a culture, which is basically, you can't fight, you can't be violent, and you can't use substances or bring them in. But otherwise, that's it. And they have sort of recovery communities, like 10,000 of those things. Those kinds of things have really good evidence of benefit. So some people will, for that, leave the streets, and live there and make that trade.

Keith Humphreys: You can't use your drugs anymore. You can't drink anymore. But you can at least have a nice, clean place with nice people who like you and will support you. That can help people. Some people, in my opinion, have to; it will be a court-mandated thing, and there's two mechanisms for that. If someone is so impaired that they're imminently gravely disabled and an imminent threat to themselves or others, you can, through the civil commitment process, make them go to treatment.

Keith Humphreys: If someone has committed a crime, and many people do. Like, grab someone's iPhone, knock them over, and run away, and you get caught. That is a different type of leverage we can do through things like drug court, where you say, "Look you shoved that person. You assaulted them. You stole their phone. We could send you to jail for this. But we don't want to send you to jail. Instead, if you will comply with this treatment regimen, you will not have to serve the penalty for that, and we will expunge your record at the end." Those kinds of things are going to be necessary for some people.

Keith Humphreys: Now, there are many people who are uncomfortable with that. Like, you're going to use pressure to put someone into treatment? Isn't that really unethical? Well, if someone with Alzheimer's disease wanders away from a nursing home, we go find them, and we bring them back, whether they want to or not. Because we assume that the disease is affecting their judgment. So, if they think they can survive out there, they're wrong, and so we take them back, whether they want to or not. Well, the same thing is true, absolutely true of addiction.

Keith Humphreys: It dramatically changes our judgment, impairs our judgment. And without pressure, many people will not stop using it. There's a study I like to quote by Doug Polcin and colleagues of people seeking help for alcohol treatment, and why this is a good one is because alcohol is legal, right? So it's not the war on alcohol that made them go. Alcohol is legal. But he asked all of them, "Has anyone leaned on you, basically, to quit drinking in the past year?" And 91% of them said yes.

Keith Humphreys: The wife said, "I'm moving out with the kids if this continues." The boss said, "You show up drunk one more time, you're fired." My lawyer said, "This is your third drunk driving arrest. You'd better get into treatment, so the judge might take some mercy on you." They're pressed in, in a way you don't have to press people to seek care for, say, chronic pain. You know, chronic pain sucks. Everyone was happy to leave chronic pain. But people are ambivalent about giving up substances, because again, it's rewarding. That's why people do it.

Keith Humphreys: And so, that press is necessary. And so we're going to have to do that with the sort of criminally involved, homeless, addicted population. We're going to have to get comfortable with protections for sure, protections for civil rights, need to give them quality care, but to push them into treatment where they can regain their reason and then make better decisions for themselves.

Andrew Huberman: I know you've been involved in the legislature, and it's always nice when, I guess, I can say you did that under a Republican administration and a Democratic administration. So, we don't have to get into partisan politics here. Two administrations, opposite sides of the aisle. Your goal there was to get better legislation as it relates to addiction and treatment of addiction.

Keith Humphreys: Correct. Yep. Yep.

Andrew Huberman: So, where are we at? What do we need?

Keith Humphreys: Since 2008, up to the present moment, has been the best addiction treatment policy we've had as a country. And that was because 2008 is when parity legislation came in. This means, like Blue Cross, Aetna, and all those, when they cover stuff, they have to cover mental health and addiction too, at a comparable level. And those laws have expanded to cover more and more people on the private side.

Keith Humphreys: Then, on the public side, the expansion, particularly of Medicaid, has become the backbone of a substance abuse treatment system. Like in places where I'm from, West Virginia, I happen to know it's the biggest spender of the addiction treatment system. That is good. That has made treatment in better quality, easier to access. And because Medicaid is a mainstream healthcare player, it helps integrate addiction care better into the rest of the healthcare system.

Andrew Huberman: So, excuse me for interrupting, but practically speaking, so somebody's got a son or a daughter who's got an opioid issue or an alcohol issue, and they want help.

Keith Humphreys: Yeah.

Andrew Huberman: If they have insurance, they can go to a treatment center, and it will mostly or completely be covered by insurance.

Keith Humphreys: It depends on the plan. I wouldn't promise anyone in particular, but here's what used to be legal. It used to be a plan could say, "Your co-payment for an outpatient visit is five bucks, unless it's mental health or substance use. In that case, it's 25 bucks." Or, "You're allowed to have up to six months of hospitalization a year, unless it's mental health and substance use, and you're allowed to have 14 days." Those kinds of things, which made very skimpy benefits, are now illegal in almost all plans.

Andrew Huberman: Interesting.

Keith Humphreys: So, the odds, as a mom or dad, when you open up the plan today, that whatever you got through your work or wherever, will give your kids something that they need, is just way, way higher than it's ever been before. And that was due to advocacy and changing the law and changing the regulations, because obviously covering care costs money. Insurers don't like to cover care. They have to, but they also don't want to. And so, keeping the pressure on, they have to follow the law.

Keith Humphreys: So in that sense, we're in a better place on the private side. The challenge on the public side will be the contraction of Medicaid. So, the budget bill that was passed last year takes about a trillion dollars, roughly, out of Medicaid over the coming years. And a number of people on Medicaid have substance use problems. So, how they will get substance use care and other care that they need is not entirely clear. So, I'm quite worried about the impact of that, especially on low-income Americans who are dealing with addiction.

Andrew Huberman: What are the options for people without insurance and/or who don't want to go to a treatment facility? I'll just be direct about this. What's your opinion? What are the data on 12-step programs? Because 12-step programs have this phenomenal aspect to them, which is they're happening every day and night, online and in person. It is anonymous, every city, all over the world. If you go to a meeting and you don't like it, you leave, you find a different meeting.

Andrew Huberman: You don't have to pay for it. You can donate to support. I mean, there's just so many things about 12-step that make it arguably the most accessible addiction treatment program ever.

Keith Humphreys: Yeah. Yeah.

Andrew Huberman: And if anything, it's growing right now. But what are your thoughts? Does it work? Is it a cult? What's the upside? What's the downside?

Keith Humphreys: It is a not irrelevant that those programs were designed by people who have the problem, and therefore understood what it is, what you need when you've got that problem. So I think about this, where I am in Palo Alto. Let's say, some engineer wakes up in Palo Alto on a Saturday morning with his 20th or 30th or 40th beastly hangover of the year and says, "What am I doing? I've got this great life. I have this 200 million dollar one-bedroom condo that I really like, and I'm messing up my life with alcohol. Let's call Stanford Psychiatry Department, okay? And try to get some help."

Keith Humphreys: Well, they're closed on the weekend. You'll get a message. Then, on Monday, you can call back, and then you'll get on a waiting list, and eventually you might get in. So, for a condition characterized by ambivalence and impulsiveness, I want to quit now, two hours later, I don't, that's like this healthcare system's the worst possible design.

Keith Humphreys: Whereas, how is AA designed? Be like, "I'd like to go to AA." You can go on the AA website, look in the area. Oh my God, there's 15 meetings today. And not only are there 15 meetings, but there's a woman's meeting, a men's meeting, a spiritual focus meeting, an LGBT meeting, and you can just go. And at that moment, you have, "At this moment I want to change." You follow through. And then you can get an immediate reward, a social reward, for taking positive steps towards it.

Keith Humphreys: The treatment system will never be that good at sort of being that accessible. And of course, no health insurance, no paperwork, no preapproval. That's amazing. Does it actually work when people get there? So, I started my career. I didn't really know anything about addiction in my first job. I took it because I was literally flipping burgers, and there was a job that paid another dollar an hour in the medical school where I didn't have to wear a costume, a Wendy's outfit.

Keith Humphreys: So, that's why I got into the addiction field, and that's the truth. So, I didn't know anything about it. And while I was on this job, I met some people who said they were in AA, and I thought they were like the people who get your car battery for you on a cold... You know, that's what I think of when I think of AA, and I didn't know what AA was.

Keith Humphreys: And they explained it to me, and I talked to my mentors about it. And my mentors were professors in medicine, and they were very dismissive. They're like, "Well, they don't have doctors. They don't have medications. It's kind of folk medicine." Bit of professional snobbery there. But I wasn't so far along in my education that I was incapable of learning. So, I thought, "Well, will you take me? Can I go?" And they're like, "Well, you can't go to a closed meeting, but there are these openings." "Okay, because I want to see this."

Keith Humphreys: And I was so impressed with just the authenticity and the caring and the warmth and the wisdom. Really, just made me think, "Maybe there is something here." And so, I started doing research on it, as a number of other people were at that time. And it just keeps coming out really, really good in studies, you know? And so finally, a few years ago, me, John Kelly, and Marica Ferri did what's called a Cochrane Collaboration review.

Keith Humphreys: This is the crème de la crème, most rigorous review of evidence in medicine, as a method. And looked at all these studies of Alcoholics Anonymous, done by different people, with different viewpoints, in different cities and different countries, even. And it came out extremely well, relative to very good therapies, like the one I was trained to do, like cognitive behavioral therapy, motivational enhancement therapy.

Keith Humphreys: On abstinence outcomes, if you ask, do people stop entirely? AA and also 12-step facilitation kinds of counseling to help people get into AA was winning by 50% higher rates, routinely, of that. And then when you looked at other outcomes, like did the person at least cut their drinking or reduce the damage of drinking or less dependent or better family functioning, whatever, it was as good as. And that's amazing for something that's free.

Keith Humphreys: And so, anyone still left saying AA doesn't work, they really... And often people think there's no evidence. There's a ton of evidence. There's randomized trials all over. There are quasi-experimental studies. There are healthcare utilization studies. It's amazing. And so, I always say to anybody, whether it's a patient or just a person I care about, "If you want to stop drinking, that'd be a place to try." You know? It's really no harm to it, right?

Keith Humphreys: If you go to a bad movie, you're out an evening and 15 bucks. You go to a bad AA meeting, you're just out an evening. It's not like a high-risk endeavor to just give it a go. And there are some alternatives, too, by the way. They are smaller, but if you live in an area like the San Francisco Bay Area, where there's more choices, there's also "Smart Recovery" and "Women for Sobriety."

Keith Humphreys: And I'm forgetting some of the other names. But the choice is, if you don't like the particular AA model. But that experience of mutual support, people are on the same journey with me. They're further along the same journey, and they're doing well. It inspires hope. They've given me useful information. All of that is really potent. And that's why it's survived and thrived as an organization, and why 195 countries or something have AA in it?

Andrew Huberman: Just want to mention if people are interested in AA, and it's not like I've been sent here to advocate for AA, but they have, Keith mentioned open meetings. If you look up, an open meeting is one that anyone can go to, even if you are not an addict and you're just curious, or you have a different addiction and you want to go to an AA meeting because the AA meetings tend to be more established, and there are more of them than the other letter anonymous meetings, for gambling and other sorts of addiction.

Andrew Huberman: I've been to many meetings. I'm super impressed by how AA can do what it does. It's really just a shining example of humans self-organizing into something that keeps going, doesn't walk around with a basket. There's no GoFundMe...

Keith Humphreys: No tax dollars.

Andrew Huberman: No tax dollars. They just stay out of politics. It's really cool. And I know some people that couldn't get sober any other way that did it. I'm curious what the data are on the other addictions that are treated through the 12-step model. So, Narcotics Anonymous, Overeaters Anonymous, Gamblers Anonymous. There's so many of them now.

Keith Humphreys: Yeah.

Keith Humphreys: Yeah.

Andrew Huberman: And I imagine there aren't as many studies, but the model is pretty much the same.

Keith Humphreys: Mm.

Andrew Huberman: So, I wonder how they hold up.

Keith Humphreys: I was very interested in this question for the drug groups. There's very little on gambling and sexual addicts, those things. So, the other big pool of data we have, to the extent we have it, is on the NAC, Cocaine Anonymous, Narcotics Anonymous. There were a couple of things which were interesting. One is, it's harder to get people into those groups.

Keith Humphreys: So, we were looking at studies where there was, what's called 12-step facilitation counseling, so where you're in there, you've got somebody who knows the program, is introducing you to it, encouraging you to go, and then talking about how did the meeting go, and did you get a sponsor, and all that kind of stuff. And the uptake was much lower.

Keith Humphreys: So if you do that in an alcohol program, you get these doubling or tripling of the rate of patients going into AA, and the effect was much, much smaller with the illicit drugs to get people to attend CA. And we don't know why, but it wasn't as easy to get people in.

Keith Humphreys: Definitely, there were correlations pretty consistently that people who were going longer were doing better, but the evidence wasn't quite as strong from an external validity view, I'm sorry, an internal validity point of view. In other words, they're not the same kind of trials, randomized trials that we like to have, when we draw inferences. So, I characterize the evidence on 12-step groups for drugs as positive, encouraging.

Keith Humphreys: I would certainly try it, you know, certainly not harmful, but it's not as strong. I feel comfortable saying AA, I know positively, has a causal effect on alcohol; I have no doubt about it. And I'm less sure about that, whether that's true for the 12... Maybe in an interesting case, but on average, it was harder to demonstrate that effect.

Andrew Huberman: I was being somewhat facetious when I asked, whether you think AA is a cult, but one of the reasons why sometimes people will call it a cult is, I'm just going to be very blunt here, is that often, not always, but often enough, I should say, people who get into AA discover sobriety in the AA community or other 12-step communities, will talk a lot about it and how much it's changed their life, and they've got a new set of people they hang out with, and in the name of sobriety.

Keith Humphreys: Yeah.

Andrew Huberman: And then if it's not handled correctly, it can be seen as somewhat of a separator by people around them. That's one. There will always be instances where certain groups are not in a healthy dynamic, but I would say 95% of the time, it seems to be healthy dynamics.

Keith Humphreys: Mm.

Andrew Huberman: But there's this other piece that I think sometimes gets tucked away and no one wants to talk about, which is that a critical component of 12-step is that the addict acknowledge that they're not in control of everything. They certainly can't control other people, but perhaps they can't even control their own mind, and they have to have a higher power in notion. And I think some people interpret this to think that one has to suddenly become formally religious.

Keith Humphreys: A Christian. Yeah, yeah.

Andrew Huberman: Either Christian or to believe in God as an entity. But my understanding is that 12-step, well, I know because I've been to a lot of meetings, 12-step hinges on the acknowledgement of some sort of higher power, but people can self-assign what that higher power is.

Keith Humphreys: Right. Right.

Andrew Huberman: Some people say God, some people say Jesus Christ, some people will say nature, some people say the universe, some people will say the collective. So, I think that's not discussed often enough, and then people will say, "Well, I don't want to go to 12-step because it's going to be a bunch of Jesus freaks coming at me about, and I'm going to have to do a bunch of other things, and what's happening?"

Keith Humphreys: Yeah.

Keith Humphreys: Yeah.

Andrew Huberman: Yeah.

Keith Humphreys: So, there's a lot there in those questions. So on the cult thing, well, I wouldn't call it a cult. Cults do two things that AA doesn't do. One is cults take everybody's money. AA literally won't let you give them money. I mean, it's amazing they've survived as an organization. Rockefeller offered money. They said, "No, we should limit that. That would be too grandiose."

Andrew Huberman: Mm.

Keith Humphreys: You know, they're perpetually broke by design.

Andrew Huberman: Mm-hmm.

Keith Humphreys: They have just enough to keep going.

Andrew Huberman: They pass the hat.

Keith Humphreys: They pass the hat.

Andrew Huberman: You can give if you want to or not. But if you don't, you are not looked down upon.

Keith Humphreys: Yes, they give away the literature, so they don't do that.

Andrew Huberman: Yeah.

Keith Humphreys: The other thing is they don't stop anybody from leaving. Literally, any meeting, you can literally stand up and say, "I'm going to go get drunk." It goes, "Bye." And that's different than a cult.

Andrew Huberman: You just can't show up drunk. This is important.

Keith Humphreys: Yeah.

Andrew Huberman: A desire to quit drinking or the other behavior or substance, and you can't show up intoxicated.

Keith Humphreys: You can't.

Andrew Huberman: Yeah.

Keith Humphreys: They will usually let people sit as long as they're quiet, if they're drunk, rather than throw them out.

Andrew Huberman: Mm.

Keith Humphreys: If they start talking drunk, then that's a different thing.

Andrew Huberman: Yeah.

Keith Humphreys: But usually, they will.

Andrew Huberman: Yeah.

Keith Humphreys: And relapse is a normal part of recovery, and nobody knows that better than people in AA. I mean, they appreciate that, even though they don't want to hear from a drunk person, obviously. But then the religious thing, yeah, they got the word God there, right? And so, there are people who just have had bad experiences, and just that word is a repellent to them.

Keith Humphreys: In a sense, it doesn't even matter if they know how the organization defines it. They're just like, "Look, I went to Catholic school. I hated Catholic school. I hate religion, and this sounds like religion, so I don't want to go." Some of those people might be happier than in programs like Smart Recovery, which doesn't have that component to it. But yeah, it is incredibly flexible in terms of how it's like... That's why it's really a spiritual, not religious organization.

Keith Humphreys: It says in the text, the 12-steps are but suggestions, okay? Can you imagine that in a Christian church saying, "Jesus was the Son of God, or maybe he wasn't. Who knows? It's really up to you," right? That's what, in a religion, no, he was, period. That's a non-negotiable point. AA, everything is negotiable other than what you believe. It's what you do. You go to meetings, stay sober. They don't really care. My friend, Barry Rosen, passed away too young, unfortunately. He was an addiction psychiatrist.

Keith Humphreys: He would say to people, "Look, the God in AA can be anything. It could be Buddha. It could be Jesus. It could be your group. It could be the doorknob. It just can't be you, you narcissistic SOB." And that's what they were really concerned about with the people who founded it, is that it was the hubris, the ego of "I am in control, and I don't need any help. I am the God, basically." And breaking that belief. It's like, no, you're whipped. You have lost your control out of the sub... And admitting that is the critical point. How you end up explaining the spiritual part is really up to you, but that part is non-negotiable.

Keith Humphreys: Why else would you be there? If you thought, "No, I can still control my drinking." They would say, "Well, then you shouldn't come here because we can't. That's why we're here."

Andrew Huberman: Bill and Bob, the founders, were good psychologists. They understood the juxtaposition of the narcissism and the shame that is addiction.

Keith Humphreys: Yeah.

Keith Humphreys: Yeah. Yeah, yeah. They were really great Americans. They changed the country.

Andrew Huberman: Before moving on from this, again, if you're curious, you can go to an open AA meeting if you want to. It's interesting, and when they go around the room, and people say, "I'm so-and-so. I'm an alcoholic," some people say, "I'm so-and-so, and I'm their first name only," of course, and they're an addict. But if you're a visitor, you just say... You could say nothing. You could say pass. No one would pay much mind to it, or you could say your name and just say, "I'm just here to learn."

Keith Humphreys: Mm-hmm.

Andrew Huberman: And I've seen that a number of times, and it's usually family members of addicts or family members that want someone in their family or a friend to go to 12-step, and this is an interesting little trick tool. Sometimes it's easier to get someone to go to 12-step if you yourself have gone, and if you're not an addict, and you want someone to go, saying, "I went."

Keith Humphreys: Yeah.

Andrew Huberman: "And I'll go with you," right? I mean, this sounds kind of hokey on the one hand, but I've seen the incredible things that 12-step can do. And it's so awesome, it's free.

Keith Humphreys: Yeah.

Andrew Huberman: How many things are completely free, accessible all the time? It's wild. It's a wild invention.

Keith Humphreys: John Kelly, my friend who did the review, said, "It is the closest thing we have to a free lunch in public health."

Andrew Huberman: Speaking of lunch, let's talk about GLPs.

Keith Humphreys: Okay.

Andrew Huberman: I'm struck by how many people have lost a lot of weight who couldn't lose weight previously. I'm also delighted, thrilled, so, so relieved that I don't have to look at these stupid arguments online anymore about whether or not obesity was the consequence of some other thing besides overconsumption of calories relative to caloric expenditure.

Keith Humphreys: Mm-hmm.

Andrew Huberman: You know, there's no blame in that statement, but people are going back and forth and back and forth, and the laws of thermodynamics apply. We now know, thanks to GLPs, if you eat less than you burn, you lose weight. It's just very hard for people who are very overweight to eat less and burn more.

Keith Humphreys: Mm-hmm.

Andrew Huberman: And it runs against all the evolutionarily hardwired circuitry of desiring overconsumption.

Keith Humphreys: Yeah.

Andrew Huberman: So, here we are at a time where there are these peptides that people can take to lose significant amounts of weight. The cost on those peptides is coming down now, through the compounding pharmacies, and people are taking half doses. By the way, people are sharing their GLPs. People are splitting them. Not supposed to do that. It's illegal. That's not a suggestion. It's incredible how low a dose of GLP is required for people to get the desired effect, and people are picking up on this. The pharmaceutical companies hate this.

Keith Humphreys: Mm-hmm.

Andrew Huberman: But people are getting them through compounding pharmacies. They're extending their dosages. They're sharing their... Don't share prescriptions, but they're doing it, and people are just losing weight easily.

Keith Humphreys: Mm-hmm.

Andrew Huberman: Some are losing muscle, and everyone gets inflamed about that, but you can do some resistance training to offset that, and they're awesome weight loss drugs.

Keith Humphreys: Yeah, they're amazing. And they...

Andrew Huberman: I'm not on them, by the way, but I would take them if I needed them. You know?

Keith Humphreys: Yeah. And they may have other benefits too. We haven't fully figured it out. Yeah, so I'm extremely interested in their effects on substance use. I have a friend who's an addiction psychiatrist. She said, "What my patients desire is they want not to want."

Andrew Huberman: Mm-hmm.

Keith Humphreys: So, which is different than, "I want to conquer my desire. I just wish I didn't desire this drug as much as I do." And I think that was something a friend of mine said to me over lunch. A friend of mine, whom I noticed had lost a lot of weight, and I said, "Wow, you've lost a lot of weight." And he goes, "Yeah, I'm on GLPs." And he said, "I used to spend all day not eating, and now I don't think about it." You know, it was effortful all day long. Don't eat, don't eat, don't eat, don't eat, and now, that voice is just gone.

Keith Humphreys: And so, what if we could do that for, say, cocaine or alcohol? They are sort of in the same kind of family of behaviors, and there are some interesting studies. Now, to be clear, there's some studies that are negative. Nothing ever works out perfectly for everybody. But when I look through animal studies, small trials, and opportunistic epidemiological studies. So, when you go through the hospital, here's 10,000 people who had a diagnosis of cocaine use disorder, and let's see if the ones on GLPs went to the emergency room less, something like that.

Keith Humphreys: They're vulnerable to different kinds of selection effects, but still, I see this pattern particularly with Semaglutide, which is the GLP that is in Wegovy and Ozempic, and alcohol, drops in alcohol use.

Keith Humphreys: And so, the other thing I think is perhaps important and what I'm working now with the VA and Novo and a philanthropist to do something like this, is that alcohol is the most like-eating of drug behaviors, right? So to the extent these drugs create a sense of satiety and fullness, right?

Andrew Huberman: Mm-hmm.

Keith Humphreys: To me, that seems more likely to change, swallowing something, a drink, versus, say, injecting myself or snorting a powder. And eating-like behavior. And so, that's why I was optimistic, but at least that's where I want to start. If that works, it'd be fantastic. Because if you have a drinking problem, you're about 70% more likely to also be overweight, and Americans are already pretty overweight. Just think of the two-fer benefit of this for transforming people's lives. You know, lose 30 pounds and stop your drinking problem.

Keith Humphreys: And last, when you mentioned my dear friend, Anna Lembke and my colleague, she said, "What's great is there are patients like, 'I don't really want to stop drinking, but I just love losing weight.' So, because I've been overweight my whole life, and so I will take the Ozempic here in the addiction clinic, not because I'm that motivated for the addiction part, but boy, when it comes with this other thing I really value, then I'm going to do it.'" And then they get the benefit. They stop, and their drinking cuts back. So, it's really thrilling.

Keith Humphreys: Another nice thing is these are old drugs. They've been around like 20 years. People don't realize that. And millions and millions of people have taken them. So that makes it less likely that there's some awful side effect that doesn't show up for 10 years to them. So, there's just a lot of potential upside here, and I think the next couple of years of science in this area are going to be super exciting.

Andrew Huberman: What aspect of alcohol craving is sugar craving?

Keith Humphreys: I don't think very much. I mean, maybe some. I mean, certainly the lore is, you know, when are you likely to relapse? In fact, AA people say this: "Hungry, angry, lonely, tired." And some people feel that way, like if they... Actually, they also sometimes feel this way about carbs. When they are short of carbs, they want a beer. So maybe it's something in there, but I don't think that's the fundamental thing that is the driver. I think it's more the subjective effect of consuming.

Andrew Huberman: There's a movement toward removing advertisements for pharmaceuticals on television, online.

Keith Humphreys: Mm-hmm.

Andrew Huberman: I mean, on television. Does anyone watch television anymore? Yeah.

Keith Humphreys: That's a good question.

Andrew Huberman: Yeah.

Keith Humphreys: Yeah.

Andrew Huberman: I don't know what effect it's going to have now that so few people watch television, but what are your thoughts on that? I mean, and of course, there are medications for hives and allergies and all these things, so it's a broad category. But I'm specifically thinking of things that have an addictive potential.

Keith Humphreys: The Lancet Commission on... Stanford Lancet Commission that I led, a partnership between The Lancet and the medical school, that was one of the points we made is that there's only two countries on Earth that have television ads all the time, which is us and New Zealand. I have no idea why New Zealand, but it's just that.

Andrew Huberman: Mm.

Keith Humphreys: And when people from other countries come here, that's always a jolt to them. They're like, "What?" You come, and you go to your Super Bowl party, and like, "God, all these ads for? Ask your doctor about this. Ask your doctor about this. Ask your doctor about this." I think it can create, and I can't prove this, but I think it can create a sense that everything is perfectible if you just bully your doctor enough, and that is just not the truth.

Keith Humphreys: So, that's the downside, I think, to worry about them, particularly for... We don't have, thankfully, OxyContin ads on television, but we do have bank shot commercials. So by that I mean, there was one actually in the Super Bowl, an ad for opioid-induced constipation. So, who is that really for? I mean, that's a way of bringing up the subject of, "Are you on opioid painkillers?" But mostly we don't have that, and I think that's good.

Andrew Huberman: Mm-hmm.

Keith Humphreys: We need opioids, clearly. I've worked in hospice for 10 years. No one needs to tell me how incredibly valuable they are. But at the same time, over-promotion was clearly part of what triggered the opioid crisis. And by that, I don't just mean TV, I mean everything. I mean, people, gifts, and other types of promotions, gifts to schools, that weren't separated enough from the industry. All those things, we highlighted in the Lancet Commission.

Andrew Huberman: Social media probably doesn't have its own 12-step yet. It probably will soon. Social media is here to stay. Let's be blunt. I'm sure there's been discussions in the past about television is ruining society, and now everyone's staring at a box in the evening. You know what I'm saying?

Keith Humphreys: Yeah.

Andrew Huberman: I mean, this has happened multiple times throughout history. But do you see true social media addicts or video game or YouTube addicts? Do you ever observe an intervention working? What does that look like, given that it's not quite like eating, meaning you have to eat at some point? But to tell a young person, or an older person, but to tell a young person, "Look, you can't ever be on social media," isn't reasonable. It's like saying, "You're not going to talk to your friends unless they're standing right in front of you," and it's not going to work. It's just...

Keith Humphreys: So, I will quote a perceptive Stanford freshman who said to me, "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, and I think lots of people are in there. And I read another study actually, on the plane coming here of how much would you have to... Well, how much would you demand if you had to leave social media? And people will say a certain money.

Andrew Huberman: Mm.

Keith Humphreys: But you say, "If everybody else were leaving it," the same people would say, "I would pay money to be one of them." So, that is why things like the Australian social media ban are going to be really interesting, because it's not really an individual punishment. You're not being exiled from the party. It's more of life is going to happen in person for teenagers. And so, that will make that real life more appealing than being online.

Andrew Huberman: Mm-hmm.

Keith Humphreys: So I'm really fascinated, I mean, we don't know what's going to happen, but really fascinated to see what happens. We do see all across the country, more people coming in with these types of problems, feeling like they can't stop looking at their phone, or games, or pornography is a really big one, delivered through these media, and of course, there are now gambling apps you can use on your phone, and that kind of thing.

Keith Humphreys: And really have extremely difficult lives. I mean, they really have become absolutely consuming for them. We don't know yet of what the natural course is of this, because it's new. Like, so what is the five-year course of social media? That's really, literally impossible to answer at this moment. For what portion of people is a developmental thing that they will get out of?

Keith Humphreys: For example, if you go into a college campus, you'll see a lot of people drinking at levels that would qualify them for some level of alcohol use disorder, and a huge number of them, five years later, will be married and have a job and drink very little. I mean, those kinds of maturing-out effects. Is there a maturing-out effect of social media or not? For me, it was easy to... I used to do a lot of X, and then I stopped, or I just do a teeny bit now.

Keith Humphreys: That was particularly easy. But of course, I had 40 years of my brain not touching it. Will that be as easy for whatever the most popular thing with kids, probably TikTok or Instagram or something. If you've been doing that, again, thinking in that plastic, neuroplasticity from the time you were 8, 9, 10, 11, 12, is it developmental? When you're 25, will you be ignoring your kids? Or will you not have kids because you don't have sex because you don't have a date because you're all day looking at the phone? What will that course be? We don't know that yet.

Andrew Huberman: Yeah, I see a lot of adults addicted to social media. I don't know if I'm addicted. I don't think so. Because if I say I'm not, it sounds like an addict, right? So I'm just going to say I don't think so. But I found great benefit to taking an old phone when I upgraded my phone, which I do far too seldom. But I finally upgraded my phone, and I took my old phone, and I put X and Instagram on that phone. And it remains, much of the time, in a supermax prison lockbox that you can't code out of.

Andrew Huberman: So you put like one day or 19 hours or something, and you click that, and you'd have to saw it open, and that wouldn't even work. And it's very helpful because once it's locked away and there's no opportunity to look at it, if people send me things, I can't open it on my other phone, and the impulse to pick it up is blocked. It's very useful. It's a portable box, and it doesn't require...

Keith Humphreys: Right.

Andrew Huberman: I mean, the box costs 30 bucks. I'm sure I recovered more than that in work output and recreation output, and just hanging out with my girlfriend and not looking at my phone.

Keith Humphreys: Yeah. I know other people who've done things like that or switched back to a dumb phone, to avoid the constant bing notification, da, da, da, da.

Andrew Huberman: Yeah.

Andrew Huberman: Mm-hmm.

Keith Humphreys: Or there's also software you can get that will suppress a lot of that stuff unless you specifically go in and enter a code and say, "Bring it all to me." And those are useful things. Like, it's so new, right, that we haven't got a lot of social norms about it. But think of something like drinking before noon, right? There's no law against drinking before noon, and yet a huge number of people abide by that norm, right?

Keith Humphreys: And they are like, "Oh, well, I don't want to do it. It's not noon, da, da, da." And we might, over time, evolve some kinds of things about social media, I would hope. Like, things that we all find sensible, like don't do social media at the dinner table, would be, I think, a good one. Or don't do social media in a restaurant or whatever. I hope we'll do something like... Because you can't solve this problem just through individual clinical medicine. That's crazy.

Keith Humphreys: I mean, there has to be some... Just like, "We've built a lot of norms around alcohol, we've built norms. Don't drink and drive." That's one that most people now broadly find believable. Building some about social media, I think, is going to be a sort of task of this generation that has grown up with them.

Andrew Huberman: Yeah. I have three real-life examples of young guys whose parents I know, who essentially contacted me because different situation for each, but I'll just describe the overlap. Each one of them was looking like a failure to launch. You know, graduated high school, was not highly motivated to go off to college, or went to community college, then stopped doing that, was working, then lost their job, or they were not in a career path that was going to sustain them independently.

Andrew Huberman: YouTube or video game enthusiasts, to say the least, and all were convinced they had ADHD, all medicated. By now, I'm happy to say, with some explanation of reward circuitry in Anna's book, giving them Anna's book, "Dopamine Nation," and obviously, really hard work on their part, is really what did it. All three of them, in higher education situations, great universities, off medication.

Andrew Huberman: They all had to quit video games or YouTube for some extended period of time, and recapture their attentional capabilities, and, most importantly, recapture their sense that they have agency in the world, that they can make things happen for themselves.

Keith Humphreys: Yeah.

Andrew Huberman: Not incidentally, all of their parents are reasonably high-achieving, and none of them have patterns of addiction that would've predicted any of this. So, there is a way to escape the vortex of this stuff. But I mention those stories because I think, A, they're success stories, and I'm proud of those guys, but oftentimes it's multi-factorial. I can't say, "Oh, it's the medication," or, "Oh, but the medication didn't rescue them," or, "Oh, it's YouTube," or, "Oh, it's video games." There's a sort of pattern of progressive languishing that's set in this context of media. They weren't talking to me about porn, although I suspect that was in the backdrop of some of these cases. And they're kicking butt right now.

Keith Humphreys: Good.

Andrew Huberman: All three of them in healthy relationships, working hard, working out, happy, which is the most important thing. I mean, one kicked cannabis, the other doesn't drink, the other one can drink, it seems without any issues. I mean, when I think about what they have to deal with, relative to what I had to deal with growing up, when we didn't even really understand what addiction was, and there's just so many more things coming at them to impair them.

Keith Humphreys: Mm-hmm.

Andrew Huberman: It's like they've unshackled themselves from five or six different ball and chain.

Keith Humphreys: That's great. And the point you make, too, about there's so many pathways out of this, you see that everywhere. Many, many pathways to recovery. I mean, I know people who, like a dear friend of mine, just tried to quit smoking for years and years and years, and just felt totally defeated by it until he saw his baby. As soon as he was a father, he was just like, "Man, I've got to stay around for this beautiful being," and quit that day.

Keith Humphreys: There's changes in the sort of homo-racial system because of life changes. I have another friend, a dear friend, who was going to prison, which is a terrible thing. You think how would anybody benefit from being in prison? But he said, "I just needed many, many months off of methamphetamine for my brain to heal," and I sort of realized, "Wow, that was really crazy." And he didn't get any treatment. It was just being away from the drug for an extended period.

Keith Humphreys: And there's an infinite number of stories like that, because this is a condition experienced by tens of millions of people, right? So, there's going to be lots and lots of pathways out. That is one thing, by the way, surprises a lot of people. Of people who had a substance problem and are now doing well, in big representative surveys, very few of them actually went to see anybody like Stanford Psychiatry. That is an unusual pathway to go through addiction treatment.

Andrew Huberman: Hmm.

Keith Humphreys: People change in all kinds of ways for all kinds of reasons.

Andrew Huberman: Yeah, one of our team members here has been open about this, so I feel comfortable saying it, who he managed to kick alcohol and a pretty, almost lifelong alcohol and cannabis addiction. Didn't go to meetings, but made the decision, and lost a bunch of weight, too. He was already super productive. He was doing well enough that it wasn't a forced thing, but he was just tired of being tired, as they say.

Keith Humphreys: Yeah. Yeah.

Keith Humphreys: Yep.

Andrew Huberman: And he flipped the switch in one day, has never gone back. And I remember asking him recently, I was like, "Well, did you go to meetings?" And he's like, "No, I went to the gym." He found a replacement behavior, he got healthy, he kept doing all the other things he was doing. And I don't want to take the words out of his mouth, but he's gone on a few podcasts talking about the relationship with his kids, improving tremendously professionally, and his relationship to himself, and broke a long family line of alcoholism.

Andrew Huberman: I mean, I think that's what sometimes people forget, is that you can break the chain in one generation, which is really spectacular.

Keith Humphreys: Yeah. Genes are a risk, they're not destiny, and that's very important. Even if you come from 100 generations' worth, that doesn't mean that your life is necessarily going to come out that way. And you're raising another point too, about what is beautiful for a lot of people about recovery, is then you start acquiring more reasons not to use, that you didn't have at the moment you started, because you burned those relationships out, or you'd never formed them because you have been living in your mom's basement smoking cannabis and being online all day.

Keith Humphreys: And then you start to get like, oh wow, having a job where I'm respected and I feel important is nice. Getting paid is nice. Being mentally present instead of high all the time is nice. And then it just makes it easier month by month, year by year, to just live the rest of your life that way.

Andrew Huberman: There was a question that I forgot to ask earlier.

Keith Humphreys: Okay.

Andrew Huberman: And it's a somewhat of a touchy subject.

Keith Humphreys: Okay.

Andrew Huberman: I've observed, and I've heard that sometimes the smarter the person is, or the more intellectual they tend to be, or ideas-oriented, the worse 12-step works for them.

Keith Humphreys: Hmm.

Andrew Huberman: Whereas people who just kind of go, "Okay," like, "Chop wood, carry water, I can do that. Follow step one, follow step two, follow step three. Step four is pretty uncomfortable. I'll do that. Okay, fine, that one's harder than the other ones," and they just kind of do it. They don't overthink it. I've observed this quite a lot.

Keith Humphreys: Mm-hmm.

Andrew Huberman: And I don't want to get into notions of IQ. I think it's just some people have this prefrontal cortex that lets them see five different strategies simultaneously. Other people are more plug and chug.

Keith Humphreys: Yeah.

Andrew Huberman: And neither is better or worse, it's just different. And I have observed that for people who just kind of ratchet into the work and don't overthink it, what's this about? Is it a cult? What do they want? But there's this one instance will I ever drink... They don't think about it too much. They just do the steps, and they're out.

Keith Humphreys: That is what AA asks. I mean, one expression is, "Your best thinking got you here." And in other words, keep it simple.

Andrew Huberman: That's a good one.

Andrew Huberman: Mm-hmm.

Keith Humphreys: You don't have to do a philosophical critique of the 12 steps. You just have to, don't drink, go to meetings. Don't drink, go to meetings.

Andrew Huberman: Mm-hmm.

Keith Humphreys: It's that. And it is an action program. So, it's different in that sense from a lot of psychotherapy styles, which are more intellectual and analytical and less focused on you're actually going to do certain behaviors. And so, if you dislike that, yeah, I can see why AA would bother you. I mean, that said, AA is just not one thing.

Keith Humphreys: So, you can find, I'm sure, within a few miles of where we are sitting, you can find an AA meeting over a gas station with guys who are smoking tobacco and have jailhouse tattoos who are talking about the steps, and you will find meetings with professionals who will talk about angst and things like that. And you sort of find your own people.

Keith Humphreys: And I've known some very intellectual people, like professors, who go to an AA meeting with other people like that, and they're still working the steps and all that, but they are also they're going to talk about Kierkegaard. And again, like AA's, "Fine, you can talk about Kierkegaard. Just remember, don't drink and go to meetings." You can talk about whatever you want, and you need to find your peeps.

Keith Humphreys: And that's also why when people are thinking of going, I say, "Think of this like dating." You wouldn't go on one date and say, "I didn't like that person, I guess I'm going to be alone the rest of my life." You go on a group of dates, right? So, pick some different meetings at different times of day and different places, and they will be different.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And then go back to the one that felt like home.

Andrew Huberman: Speaking of carrots, there's no wisdom like the kind of wisdom you can get from a really good share from someone at an AA meeting that you thought when they stood up and started their share that you had nothing in common with this person. You are from two different universes, and inevitably, there's some kernel of truth for you or something that you disagree with, and therefore, you have insight. It's a spectacular thing, really.

Keith Humphreys: Yeah, I mean, and they were very conscious about that. And if you read, it's called "The Big Book." It's actually just "Alcoholics Anonymous." It was called "The Big Book" because it was printed on cheap paper, so it was sort of fat and pulpy. This was back in the Depression, right? It says flat out, "This book is mostly stories, and we tell stories in the hopes that something in them will catch you and say, 'Gosh, that life is like mine, and look where he or she is. Boy, I wish I were there.' Well, if they're kind of like me and they got to that good spot, maybe I can get to that good spot."

Andrew Huberman: Mm-hmm.

Keith Humphreys: And so, it's a conscious and very, I think, clever organizational strategy to tell people, "There's a place for you here. There's people like you here."

Andrew Huberman: I want to ask you about death.

Keith Humphreys: Okay.

Andrew Huberman: You worked in hospice.

Keith Humphreys: Great experience.

Andrew Huberman: As Americans, we're not comfortable talking about death. It evokes sadness, fear, but I think there's a lot to learn about it from hearing about someone who's been close to it a lot. And one can't live very long without losing someone, and we're all going to go eventually, and that's hard truth. But why did you go into hospice, and then what did you learn about in hospice that has informed your sense of life and death?

Keith Humphreys: Yeah. So, I loved being a hospice counselor. I did it for about 10 years. And there's so many beautiful things about it. First off, when I tell people, they go like, "Oh, God, that must be really depressing." Hospice staff were the most upbeat people I've ever worked with.

Andrew Huberman: Hmm.

Keith Humphreys: Optimistic, compassionate, seen everything. And in a way, I could sort of understand it because it's accepted the person's going to die, so what's the worst that could happen, right? You don't think like, "Oh, if I say the wrong thing, maybe in our sessions, it'll take an extra three months to develop more trust." They're not going to be alive that long. We've accepted the worst, right? And so, then we can just do well and help this person have a good death, and help their family have a good death, and work through their grief experience.

Keith Humphreys: And so, they're just very upbeat. And so, I never found it depressing at all. I did it partly because I had shifted to doing more research, and I just missed taking care of patients. The obvious thing would've been, well, why didn't I just do more addiction thing? I thought, "Well, I'll just do something different." And the other part was I was scared of death, and I don't like being afraid. I'm a counter-phobic person. I am not brave, but I'm afraid of being afraid, so I do things that look brave.

Keith Humphreys: And I know about phobia. Like, the most basic thing is exposure reduces fear and anxiety. Running away from things makes them scarier. So, I thought, "All right. I'm scared of death. So, how do I solve that problem? I'm going to spend as much time around death as I can." And it's a very intimate experience. You're in people's homes. It's not like when they're sitting in your office.

Keith Humphreys: But people's bedroom could have, like, "What is that?" "Well, that's my... I was a high school baseball player. We won the nationals." Or, "What's that?" "That's my wedding picture. That's my wife and I, 40 years ago." It's very intimate and sweet.

Keith Humphreys: And being the last friend somebody ever makes is an incredible honor. And I always felt that when I had to say goodbye, I had been honored by them in that way, the last friend they made. So, I just found it profoundly a moving experience. And it took away that fear, and then I was able to help other people get free of that fear.

Keith Humphreys: Because when you've been around it for a while, and then the family comes in, and they're scared, or maybe some of these doctors are scared of death, you can be the person who says, "This is what's going on. This is what your mom, your dad, your uncle's going through. Here's what's going to happen, likely. Here's how long he's likely to live. Here's what we're doing for him." And then that helps them because you are radiating that acceptance that they need to come to, which is hard.

Keith Humphreys: So, I'm just so glad I did that, and I really would recommend that to anybody who wants to give back to community but also just come to a place of peace with dying. The way to do that is to be with the dying, not to run from them.

Andrew Huberman: You got me. Man, maybe it's because we both know Nolan. I think I was just feeling your feelings. Yeah, death is, the way you describe it, it's heavy, and you wove some lightness in there, which clearly I'm not a hospice worker. I don't have that relationship to death. But thank you for sharing that.

Andrew Huberman: I think it is a universal experience. And being in there with people alongside them, clearly something that I think many people, young and old, run from. It's like...

Keith Humphreys: Yes.

Andrew Huberman: Yeah. There's something there that...

Keith Humphreys: And we can, in this society. I've done work in developing countries. You can't not see death. People die in the street, literally. And so, oddly enough, there is more death and less fear than there is in our advanced technological society, where death is hidden and denied. So, Americans, I find, are much more terrified of it than people I met in Iraq, for example.

Andrew Huberman: Mm-hmm.

Keith Humphreys: So, that's why you really have to make an effort to get past those norms and those structures if you want to be in companionate connection to people who are dying.

Andrew Huberman: I didn't anticipate asking what I'm about to ask, but it's been on my mind a very long time, and it's directly related to the two major topics we've covered, which are addiction and death. I've heard it said by a gambling addict that all addiction is gambling of some sort. Am I going to get in trouble this time? Am I going to get fired this time? And I've thought a lot about addiction, and I've wondered if all addiction is an attempt to escape our fear of death.

Keith Humphreys: Hmm.

Andrew Huberman: And this is not an attempt to get philosophical or deeply psychological, but I mean, it's a weird thing... We don't know what other species think, but it's a weird thing that the portions of our brain that let us think into the future and plan and build technologies and that made us the curators of the earth and not the house cats or the elephants or something, can logically know that we're going to die someday.

Andrew Huberman: And if we really drop into that feeling, for most people, it is scary. It's really scary and really sad. And I think if any of us dropped really deeply into that, and we've created any sort of connection to anything or anyone, it's deeply terrifying.

Keith Humphreys: Mm-hmm.

Andrew Huberman: And one thing I can say about addiction is that the states of being high, whatever the thing is for that person, they have a timelessness to them. You're out of the real world, or you're operating in the real world as if you had superpowers, I mean, in one's mind. And so, I wonder whether or not the fear of death is something that addicts, in particular, are running from.

Andrew Huberman: And that raises the question, is embracing death as a very real thing, overcoming that fear, the counter-phobia? Do you think that perhaps could be used to help treat addiction or avoid it?

Keith Humphreys: Well, that's a really interesting idea. I mean, I think very broadly speaking, a lot of heavy substance use is some desire for oblivion, to get away from unpleasant truths. And I think one of those is death and suffering, but I think it's broader than that.

Keith Humphreys: So, it could be, "I just can't be in this PTSD anymore," or, "I was sexually abused as a child, and I just need to stamp out those visions and those memories for an hour and step outside them."

Keith Humphreys: "My marriage has disintegrated, and I'm miserable, and my spouse and I hate each other, and this is the one moment where I am above that or unconcerned about that," that oftentimes there's something awful, and frightening, or humiliating, or painful, that this is the escape from.

Andrew Huberman: Mm-hmm.

Keith Humphreys: And they do provide that, at least in the short-term. The high-term costs are hard. But in the short-term, everything could be falling down around you, and if you're high on a stimulant, you can still feel euphoria, at least for that brief moment. And what can be tough about recovery is when you stop using, those things are not gone. You're still going to die. If your marriage is bad, your marriage is bad. If you were abused, you were still abused.

Keith Humphreys: And that is enough to persuade some people never to stop, because it's a lot harder to actually deal with those things head-on than avoiding them through intoxication.

Andrew Huberman: Thank you so much for this discussion. You shed so much light on substances, routes to sobriety, stages of addiction. Very interesting work on the GLPs, 12-step. We'll provide links to all these resources and papers. If you're willing, before we walked in here, I solicited X, of all places, for questions about addiction.

Keith Humphreys: Oh, sure.

Andrew Huberman: So, thanks to you, most of the questions that were asked are already answered by material covered before.

Keith Humphreys: Right.

Andrew Huberman: But there were three that I think are worth touching in on that weren't. And the first one is, are men getting addicted to things more than women, or are they just showing up for help more often?

Keith Humphreys: Men are larger consumers of addictive substances in every culture on earth and are over-represented in all the major addictions. Opioids, probably four men to every one woman. Alcohol, probably about 60/40. It used to be higher, but women have been drinking more. The one thing you see in clinics that is close, the one is prescription medication, that those are a little closer to 50/50. But otherwise, it's predominantly male.

Andrew Huberman: Why the relationship between addiction and lying, and not just lying about the addiction? Anna Lembke, our colleague, has talked about this before.

Keith Humphreys: Mm-hmm.

Andrew Huberman: Is there overlapping circuitry there?

Keith Humphreys: No, I don't think so. I think it's just you end up in these situations that aren't possible to cover over without lying. So, you know, you were supposed to... "Dad, you were supposed to pick me up after school. Where were you?" "I was drunk," right? But I don't want to say that. So, I say, "All right, I had car trouble, I couldn't do it." Or the boss, "What happened to the money for the..." "Oh, yeah, it was an unexpected tax bill," because I'm not going to say I stole it. And so I think that is why.

Keith Humphreys: The other thing, of course, is sometimes we make addicted people lie. I always point this out to residents that if you watch how doctors sometimes ask people about their substance use, it's absolutely clear the correct answer. If I say, "You don't drink, do you?" Or, "You don't use drugs, do you?" And when you're addicted, you get very good at reading people. Like, what is this person going to say if I tell them that I use methamphetamine?

Keith Humphreys: And sometimes they lie, not because they want to, but because they know they'll get a negative reaction from the person asking them.

Andrew Huberman: The other question was about relapse. Is it the case that relapse can occur just as easily when things are going well, as opposed to when they're going poorly? What do you see in your clinic?

Keith Humphreys: Yeah, I mean, people relapse in both ways. A friend of mine in college, I remember his dad, after years and years of drinking, got sober and just miraculously got an extremely high-paying, respected job, despite incredibly erratic work history, and immediately relapsed, went out and drove the wrong way on a highway, and killed himself.

Keith Humphreys: And just think, how could... Everything was going right, but you see that a lot. It's sort of like, I got money in my pocket, I'm happy, I know I'm okay now, the problem's behind me, and so I'm going to do what I always did, and then be shocked that I got the same result I always did. You see that.

Keith Humphreys: Broadly speaking, though, relapse is most likely in times of stress. Whether that's a transitory stress like a spat with the spouse or with the boss, or I was exhausted, didn't sleep well a couple nights in a row, that kind of thing, or something bigger, like maybe my kid's addicted also, and I'm dealing with that, and that makes me more likely to relapse.

Andrew Huberman: Last question is from me.

Keith Humphreys: Okay.

Andrew Huberman: I'm just curious. You're a dad of two college-aged boys. What advice did you give them, or do you give them, about addiction? Not assuming that they're particularly prone, but just they're in life, and to be in life now means that you're prone to addiction, period.

Keith Humphreys: I can hear them rolling their eyes even from Southern California, because they've said, "Oh, another talk about addiction." So, I talk to them a lot about fentanyl, because I've known so many families where kids like them, you'd say like nice family, middle-class kid, have died from fentanyl that they took in the form that looked like something else.

Keith Humphreys: And this is happening on college campuses, it's happening in high schools, these printed pills that look exactly like an Ativan or an Adderall. "I think I'm going to try that," and you don't realize you're taking fentanyl, and you die.

Keith Humphreys: So, I always warn them about that, like never to take anything. You can't know what it is. If you didn't personally acquire it, you can't know what it is. And then the other thing I told them is the point that you're going to have to make these decisions yourself, but the only thing I can tell you is you will never get addicted to something that you choose never to use. That is your maximal point of control. And what happens after that point, once you've started using, is something I can't know, more importantly, something you can't know.

Andrew Huberman: Thank you. Well, Dr. Keith Humphreys, thank you so much for coming here today to share.

Keith Humphreys: Thank you. I really enjoyed the discussion.

Andrew Huberman: I mean, it's obvious to everyone that you have immense knowledge about this area, and the fact that you have not just knowledge, but that you're a clinician and you help people get into and through recovery and stay sober in all these different dimensions is itself amazing.

Andrew Huberman: But I think I'm certain I'm not alone in saying that what's so awesome about the work you do and you, and that became evident today, is that you combine incredible expertise with incredible compassion for people. You didn't have to say it. It's just in every aspect of what you shared. And it's an honor to have you here. It's an honor to be colleagues and to meet you finally.

Andrew Huberman: But mostly I'm just grateful that we were able to create an environment where you could share your knowledge and your compassion, and I'm certain that it's going to help a lot of people understand themselves, understand people around them, and hopefully take action if they need to. So, thank you so much.

Keith Humphreys: Thank you, Andrew. It was a real pleasure to be on your show.

Andrew Huberman: Thank you for joining me today for my discussion with Dr. Keith Humphreys. To learn more about his work, please see the links in the show note caption. If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero-cost way to support us. In addition, please follow the podcast by clicking the follow button on both Spotify and Apple. And on both Spotify and Apple, you can leave us up to a five-star review. And you can now leave us comments at both Spotify and Apple. Please also check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast.

Andrew Huberman: If you have questions for me, or comments about the podcast, or guests or topics that you'd like me to consider for the Huberman Lab podcast, please put those in the comments section on YouTube. I do read all the comments. For those of you that haven't heard, I have a new book coming out. It's my very first book. It's entitled "Protocols: An Operating Manual for the Human Body." This is a book that I've been working on for more than five years, and that's based on more than 30 years of research and experience.

Andrew Huberman: And it covers protocols for everything from sleep, to exercise, to stress control, protocols related to focus and motivation. And, of course, I provide the scientific substantiation for the protocols that are included. The book is now available by presale at protocolsbook.com. There, you can find links to various vendors. You can pick the one that you like best. Again, the book is called "Protocols: An Operating Manual for the Human Body."

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Andrew Huberman: You simply go to hubermanlab.com, go to the Menu tab in the top right corner, scroll down to Newsletter, and enter your email. And I should emphasize that we do not share your email with anybody. Thank you once again for joining me for today's discussion with Dr. Keith Humphreys. And last but certainly not least, thank you for your interest in science.

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