Are We All Getting High? (Part One)

“Dopamine Nation: Finding Balance in the Age of Indulgence” by Dr. Anna Lembke

Eric Huffman: Hello and welcome to a brand new season of the Maybe God podcast. The team and I are so excited to start bringing you all new episodes. And now for the first time ever, you're going to be able to catch videos of my full-length, uncut interviews with the guests that you hear on the show.

So we're filming these interviews in our brand new podcast studio, and we're posting them to Maybe God's YouTube channel. So after listening to our amazing guests and the experts in this episode, I hope you'll head over to YouTube.com/maybegodpodcast to watch those full-length interviews. And then I hope you'll subscribe and ring the notification bell to find out when all the new exclusive content comes out on our channel. So thank you in advance.

We're so glad to be back and so excited. Now, let's go ahead and get started with our all-new episode of the Maybe God podcast.

On this episode of Maybe God, Russell Dixon was well on his way to realizing his childhood dream of becoming a major league ballplayer for his hometown team, the Houston Astros.

Russell Dixon: I just had to work out of my life. I feel like 92 from the outfield and then they give you like 20 swings and I hit like probably eight balls out and like three of them were in the upper deck and they were like, "Okay, we'll take you."

Eric Huffman: But the pressure of being a professional athlete led to an addiction that nearly cost him his life.

Russell Dixon: I thought, I'm prescribed to this. I was never going and snorting coke or smoking weed or anything like that because those were like-

Eric Huffman: You get this at the pharmacy.

Russell Dixon: Right, exactly. It was kind of like my white-collar drug.

Eric Huffman: Also, one of the world's leading experts on the neuroscience of addiction breaks down exactly what's happening inside the brains of 40 million Americans who are dealing with some form of unhealthy compulsion.

Dr. Anna Lembke: If we wait long enough between ingesting intoxicants, our body recovers and, you know, we go back to baseline. But if we don't wait, and we don't have to wait now because TikTok is infinite, then what happens is over time, we eventually end up in this chronic dopamine deficit state, which is the addicted brain or essentially titillating ourselves to death.

[Maybe God intro]

Eric Huffman: You're listening to Maybe God. I'm Eric Huffman. Most of us like to think of drug addiction as something far away and foreign. We all know drug addicts exist. We like to think that they're living in our cities, just not in our neighborhood or under our bridges, but not under our roofs, that they're part of our culture, but not part of our churches. We convince ourselves that they are not us. But the numbers tell a different story. Forty million Americans admit to struggling with addiction to drugs and alcohol. That's over 15% of the adult population in our country. And those are just the people who admit they're struggling. No doubt there are countless other addicts who suffer in silence.

Drug overdoses are the number one cause of accidental death in the United States. In 2021, over 170,000 Americans died from overdose, the highest number of drug fatalities ever recorded in a single year. Overdoses kill more people in this country every year than guns, car accidents, and breast cancer combined. And experts estimate that only about one in ten addicts who need help will ever seek treatment and recover. And in recent years, things have only gotten worse. As COVID-19 brought the world to a halt, 42 out of 50 states saw increases in overdose deaths, and some communities have reported 30% to 40% spikes in overdose-related 911 calls since 2020.

As much as we'd like to believe that drug abuse is someone else's problem, our first guest is a living reminder that we can't keep lying to ourselves. An all-American kid who excelled in life and in America's pastime, he always strived to keep it between the lines. When he was growing up, no one who knew him could have guessed that he'd grow up to struggle with a life-threatening drug addiction.

I've got the real honor of being joined in studio by Russell Dixon, who is a former minor league baseball player, drafted by the Houston Astros, my favorite team. Your favorite team?

Russell Dixon: It's still my favorite team.

Eric Huffman: That's good. Russell, thanks for being here.

Russell Dixon: It's an honor to be here.

Eric Huffman: Russell was born and raised here in Houston. His father is one of the pastors at Second Baptist Church, just a few miles from Maybe God's new studio, where he has served for almost 30 years. Second Baptist is one of the largest churches in the country with over 83,000 members.

Russell Dixon: So think of Six Flags and think of church all meeting, a.k.a. Six Flags over Jesus is what some people affectionately call it.

Eric Huffman: It's got a big school attached to it.

Russell Dixon: Big school. And that's where I went all growing up. So I was definitely immersed in the bubble is another way of describing it.

Eric Huffman: Why did they call it a bubble? What are you bubbled in from?

Russell Dixon: In some ways you're bubbled in from some of the things that the world throws your way. It was all I knew. I mean, it was kind of the world I lived in, and had friendships that I've known for my entire life, like my three best friends who we've been friends since we were in pre-K.

Eric Huffman: I mean, on top of that and that bubble, you lived in the bubble inside a bubble, being a preacher's kid.

Russell Dixon: That's right.

Eric Huffman: Was that a typical preacher's kid experience where, like, you're lifted up on a pedestal and you're not supposed to, like, get in trouble like other kids do? Did you feel that pressure?

Russell Dixon: Definitely. Especially because my dad's role at the church is kind of also been the disciplinarian, if you will. My dad's the guy that don't get in trouble or Mr. Dixon's going to find out.

Eric Huffman: Would you call him an intimidating or imposing person?

Russell Dixon: Just because of his size, he six-four, about 240, always carries a gun, so, I mean, just those things alone-

Eric Huffman: That'll do it.

Russell Dixon: That'll do it. So he's definitely a teddy bear at heart, especially now that he's a granddad. But you're a PK-

Eric Huffman: I am.

Russell Dixon: So we definitely have that kind of looking over our shoulder feeling like our dads are watching and they're going to find out that we're in trouble even before we knew we're in trouble.

Eric Huffman: That's right. You made a lot of deals-

Russell Dixon: That's right.

Eric Huffman: ...with people that caught you doing stuff.

Russell Dixon: That's right.

Eric Huffman: "You don't tell dad, I'll give you some bubblegum or whatever." Like you got to negotiate.

Russell Dixon: Totally.

Eric Huffman: Yeah. And it can breed kind of resentment over the years, I guess.

Russell Dixon: Definitely.

Eric Huffman: That's why preacher's kids are notorious.

Russell Dixon: That's right.

Eric Huffman: Despite his father's position at church and his admittedly sheltered upbringing inside the Christian bubble in Houston, Texas, Russell says his parents gave him and his three sisters some freedom to choose how involved they became at church. His mom and dad cared more about encouraging their kids to love God than they cared about forcing their kids to act religious.

Russell Dixon: Really, one of the biggest things I learned from my dad is how to live out your faith. He was never one that was doing a whole lot of the preaching, but he was always the one doing the serving. When the bottom of people's life has fallen out over the years, he's been the first person that they've called.

Eric Huffman: Is that right?

Russell Dixon: So I think I've learned a lot from that. The shepherd side of ministry, I learned a lot watching him do that.

Eric Huffman: So did their strategy, their parental strategy work on you when you were young? Like, did you stay out of trouble?

Russell Dixon: For the most part. I mean, I don't know if that's because I'm a first child or rule follower in some ways. I think as I look back, I mean, I say I gave my life to Jesus when I was eight years old and I believe I knew intellectually what salvation meant. I believe that there was a level of heart transformation there. Although when you're eight, it's not like you're living way off in the world. But I think I knew the gospel and really strived to live it out through high school. So I think that they really did a good job of setting that example of what it meant to really know and love Jesus through how you live.

Eric Huffman: Russell loved two things as a kid: Jesus and baseball.

Russell Dixon: My mom says that when I was probably three years old, she just was flipping a little softball in our living room and I just couldn't get enough of swinging the bat all day, every day. So that was really all I ever dreamed of being was a big league ballplayer. So from a young age I just kind of fell in love with it.

Eric Huffman: By the time Russell was a freshman in high school, he was already starting for the varsity squad at Second Baptist.

Russell Dixon: My sophomore year is when I took a big jump physically, took a big jump developmentally, and that's where I kind of started to emerge as, okay, I'm not just a good player, but also someone who could be a Division 1 type player.

Eric Huffman: As you got better at baseball and you started to really carve out sort of an identity with baseball, how did that affect your character? Did it change you at all?

Russell Dixon: Yeah. I don't think I realized it in the moment. You know, my parents always told me, you know, baseball is what you do, it's not who you are. They always told me the right things and taught me the right things. But inevitably, when you have a passion for something and then mixed in with a talent for something, the natural temptation is to find yourself having your identity gravitate towards that.

Eric Huffman: Sure.

Russell Dixon: With that, you know, baseball is a very fun game, but it also can be a very humbling game. When you're one of the best hitters in the game and you only succeed three out of ten times, it can bring you to your knees pretty quickly. So I definitely rode the emotional roller coaster, if you will, of good game, bad game.

Eric Huffman: Midway through his sophomore season, Russell began receiving calls and letters from coaches and recruiters. And by the end of his junior year, he was hearing from some of the best collegiate baseball programs in the country. Russell committed to Auburn University, where he received an athletic scholarship to play baseball for a premier Division 1 school in a major conference. Auburn's great school, party school.

Russell Dixon: Mm-hmm.

Eric Huffman: Party school kind of.

Russell Dixon: It is. It is.

Eric Huffman: Were you mostly a good kid coming out of high school, like in terms of party life?

Russell Dixon: I was. Looking back, I don't know if it was because only because I love Jesus or if it was because I was terrified of getting in trouble. It was probably more the latter.

Eric Huffman: Yeah, yeah, probably. You know what they say about Southern Baptists?

Russell Dixon: What's that?

Eric Huffman: Is the only way to keep them from drinking your beer-

Russell Dixon: Bring two of them with you?

Eric Huffman: ...invite another one.

Russell Dixon: Yeah. 

Eric Huffman: So they don't turn on each other.

Russell Dixon: That's it. You just bring one with you, all your beer will be gone.

Eric Huffman: Yeah. Man, I've found that to be true. I know a lot of Southern Baptists.

Russell Dixon: I have too, and I was one of those for a season.

Eric Huffman: At least y'all have some shame. I come from Methodist Church where it's all just party, party, party.

Russell Dixon: Party, party. Yeah, totally.

Eric Huffman: And you're proud of it.

Russell Dixon: Totally.

Eric Huffman: So you go to college, what changed for you there?

Russell Dixon: So my freshman year, I really tried to stay strong with my faith, but I immediately was thrown in that baseball world, which is a party, party, party world, and immediately started to feel the peer pressure. And just slowly that being only surrounded by people that were not really pursuing their faith at all, that starts to wear on you. You know, my dad used to say, "Hey, you know, just you have to be cognizant... I'm not saying you can't hang around with those guys at all but if you're not going and building some relationships outside of the baseball circle, if you're not getting involved in a local church or a local ministry, you're eventually going to find yourself being pulled down." And that came to fruition in my life. And really it was probably towards the end of my freshman year going into my sophomore year where I kind of went out and I mean, frankly, got drunk for the first time in my life-

Eric Huffman: Really?

Russell Dixon: ...and I was like, "What have I been missing?" You know? I mean, sin is fun at first, you know?

Eric Huffman: That's right. Always.

Russell Dixon: But then you get to the other side of it and realize how empty and how vain it is. So that sent me into a full-on, not an alcoholic type tailspin, but I definitely became a party animal. You know, it was just kind of a wild and crazy scene. So over a period of time, I got to the point where if you looked at my life, there was nothing about my life that matched up with the Christian faith.

Eric Huffman: Really?

Russell Dixon: If someone knew that I was a Christian, they would probably say, "You're a total hypocrite."

Eric Huffman: Huh?

Russell Dixon: So, I-

Eric Huffman: Were you still praying and stuff?

Russell Dixon: I was praying and I would kind of pop into church from time to time and I would go to baseball chapel. But in some ways, it was kind of more of what I would call a... I heard Lance Berkman use this term "a rabbit's foot Jesus theology, where if I go to church, if I go to chapel, then God will help me get three hits. I would never openly admit that, but deep down that's absolutely how it felt.

Eric Huffman: Rabbit's foot Jesus.

Russell Dixon: Yeah. Yeah.

Eric Huffman: Almost like a genie [inaudible 00:12:29].

Russell Dixon: Totally, you know. So there was cracks in my faith. You know, without even realizing it, there was just not a proper sense of who God is and what His plans were for me.

Eric Huffman: In 2005, Russell played 53 games as a freshman, finishing the season with a very respectable 289 batting average. His production improved in 2006 when he started 50 games as Auburn's right fielder and hit 313 with a team-high 19 doubles. Before the beginning of his junior season, however, Russell suffered his first serious injury, a broken thumb.

Russell Dixon: It actually was a good opportunity for me to step back and really evaluate the program just as far as, you know, our coaches' leadership and just all the different things that were going on. So I set out my junior year and I think, "Okay, if I only have two years of baseball left, do I really want them to be spent here?" I asked myself the hard question, like, Okay, I don't think that's really where I want them to be spent. As soon as I finish the semester of school, went home to Houston.

Eric Huffman: Russell's plan was to transfer to the University of Houston until he was invited to pre-draft workouts for two big league teams, the Pittsburgh Pirates and the Houston Astros. He decided to attend the workouts just to see how far he could get.

Russell Dixon: Nationals was at Minute Maid, and I just had the workout of my life. I mean-

Eric Huffman: Really?

Russell Dixon: ...ran a six-four in the 60, which is probably about a four-four 40.

Eric Huffman: That's crazy.

Russell Dixon: And then they clock your arm from the outfield and I feel like 92 from the outfield. And then they give you like 20 swings and I hit like probably eight balls out and like three of them were in the upper deck

Eric Huffman: Come on.

Russell Dixon: And they were like, "Okay, we'll take you."

Eric Huffman: June 7th, 2007, Major League Draft Day, Russell watched from a hotel room in Eau Claire, Wisconsin, where he was playing in a summer league. He made a deal with himself: if a team drafted him by the fifth round, he'd go for it.

Russell Dixon: Then go in the fifth round. Then next day the first round is the sixth round. Thought I was going to go in the sixth round and my agent's like, "I think they're taking the sixth." They don't take me. And I literally almost walked out of the room to go get breakfast because I was like, "This is not going to happen." He said, "Just hang tight. I think that this might happen." And then sure enough, in the seventh round, we're watching it on the Draft Tracker and I get a call and they said, "Hey, we want to take you with our seventh round pick." And then I see a pop-up and it was just kind of a surreal moment, the moment you've always dreamed of as a baseball player.

Eric Huffman: Yeah of course. Even though Russell was the Astros' seventh-round pick, the club didn't have any picks in the first three rounds, which meant Russell was the Astros' fifth selection, just as he'd hoped. They offered him a signing bonus of $123,000.

Russell Dixon: So I sign, I get to go to Minute Maid and they give you a jersey, which because they took me in the seventh round, they gave me a jersey with number seven on it, which this was exactly-

Eric Huffman: That's Biggio's number.

Russell Dixon: Exactly.

Eric Huffman: Come on.

Russell Dixon: And I have pictures of me and Biggio when I'm like eight years old. He's still playing at the time.

Eric Huffman: What?

Russell Dixon: I'm literally like Wayne's World. I'm like, "We're not worthy. We're not worthy."

Eric Huffman: Wow.

Russell Dixon: I literally went up to him and showed him the picture. He's like, "Wow, you're making me feel old." I was like, "I just want you to know that they gave me this and I don't feel right wearing this, but I'm going to wear it for today."

Eric Huffman: So at that point, you're thinking you're going to be just like a major league ballplayer.

Russell Dixon: Mm-hmm.

Eric Huffman: Like you're set.

Russell Dixon: Right. And I thought I was going to, you know, try to use that as my platform to be a light for Jesus.

Eric Huffman: So you'd come full circle with faith at that time?

Russell Dixon: I had. And I really feel like in ProBall. And again, I don't know. I wish I could tell you I was fully confident it was solely because I wanted to be fully devoted to following Jesus. But also there was this other element of not wanting to jeopardize my career. So in ProBall, I really felt like I tried to walk that line of being in the world and not of it. I still would go out with the guys and I would still casually drink, but it was not to the craziness level that it was in college.

Eric Huffman: Russell's first assignment as an Astro was playing for the Tri-City Valley Cats in Troy, New York. Although it wasn't the majors, he did get a taste of the big league experience, including having his picture taken by Topps for his first-ever baseball card. Russell expected to move quickly through the minor leagues on his way to play in Houston, and he had a strong debut season, after which he was promoted to the Astros High-A team in Lexington, where he played his second full season of pro baseball.

But Russell struggled mightily in Lexington, where he hit just 237 and struck out 120 times in 118 games. His production continued to plummet in the beginning of his third season, so the Astros sent Russell back to the Low-A team in Troy.

Russell Dixon: It was an immense pressure. And a lot of it was what I put on myself. I mean, being a Houston kid, I always kind of dreamed of being the future face of the franchise and that kind of stuff. There was even some conversations in the front office just because I grew up here, like, you know, we could see him being kind of our next, you know, golden boy kind of thing. So I put a lot of pressure on myself. But it was almost the more pressure I put on myself, the worse I did.

Eric Huffman: Russell lasted just three years in the Astros organization. He was released during spring training of 2010, after which he spent a year playing in independent leagues in the hopes of catching on with another big league club. During that year, Russell made just $1200 a month and lived with host families that were arranged by his team.

Russell Dixon: It seemed like every door that opened immediately shut. So I guess flash forward to May of 2011, I finally realized it's time to hang it up. I'd signed with the indie team in Roswell, New Mexico. I mean, weird place. Really weird place. The downward spiral I think was starting for me. I was starting to run back to alcohol.

Eric Huffman: Were you?

Russell Dixon: Yeah. It wasn't

Eric Huffman: Coping?

Russell Dixon: Coping. And it wasn't quite to the full-blown alcoholic level yet, but it was definitely heading in that direction.

Eric Huffman: Did you know it?

Russell Dixon: I felt it. I remember thinking and being around the wild baseball guys and like they're all passed out and I'm still boozing and I'm like, "This isn't normal. These are the wildest guys of the bunch and I'm running laps around them and taking pride in it." So I felt like, Okay, enough's enough.

Eric Huffman: One day after another unspectacular practice in Roswell, New Mexico, Russell decided it was time to retire. Since he had always imagined himself becoming a baseball coach, he accepted a coaching job at Hardin Simmons University in Abilene, Texas in the fall of 2011. He was 26 years old.

Russell Dixon: And I ended up just throwing fuel on the fire.

Eric Huffman: What do you mean?

Russell Dixon: Just the pending addiction and alcoholism. I'm a single guy, I'm frustrated about my baseball career being over and I'm in Abilene, Texas. It's not exactly a thriving metropolis with great single-Christian groups.

Eric Huffman: I hear you. 

Russell Dixon: And I was in this weird place of, like, not being one of the college players so I've got to keep a little bit of a distance from those guys because I'm their coach. But also I'm not going home to a family every night. And obviously because it was ultimately because I was choosing to turn to an empty vessel, why I was heading down this way.

Eric Huffman: What do you mean?

Russell Dixon: Just alcohol. And then I was prescribed Adderall when I played.

Eric Huffman: Why?

Russell Dixon: ADD, ADHD. Some of our coaches noticed some ADD tendencies in the outfield. I would kind of space out. It wasn't so much at the play, but I would kind of space cadet and not be paying attention. So they suggested that I go talk to a doctor. And I never taken it growing up. My mom just kind of always stayed on me and worn me out about school stuff in a good way.

Eric Huffman: Wait, I thought Adderall was considered a performance-enhancing drug.

Russell Dixon: It can be if you're not prescribed to it and been approved. So Major League Baseball around that time started instituting what they call a TUE, which is a therapeutic use exemption.

Eric Huffman: Okay.

Russell Dixon: So if you go to a doctor and go through the whole process, then you have it. I had a TUE. Because when I was in ProBall, I generally took it as prescribed. Occasionally I would take like a half of one more if I felt like I needed a little more. It just helps you focus, it gives you energy. Again, I was not abusing it at that point. But then when I'm done playing and I'm applying for college coaching jobs, it's 3:30 and I'm like, "I can have a beer. It's not a big deal. It's 5:00 somewhere."

Eric Huffman: Right.

Russell Dixon: And then that turns into... what I would do is I'd have to take more Adderall to come down off of the vicious booze cycle. And then I eventually read and hear somewhere that if you pop an Adderall before you go out and you can drink all night. So I started doing that. I mean-

Eric Huffman: It counteracts the alcohol?

Russell Dixon: Yeah. Because it's the chemical breakdown is an amphetamine. It's basically like you're taking prescribed meth.

Eric Huffman: Just in tiny doses, theoretically.

Russell Dixon: Right. But then, you know, what I'm prescribed to do is to take one twice a day and I'm taking like four first thing in the morning-

Eric Huffman: Four?

Russell Dixon: I mean, pretty quickly. It eventually became taking an Adderall at night and then staying up all night drinking. It's this weird state of like night becomes day, day becomes night. And I'm getting a month prescription and burning through it in a week if that gives you-

Eric Huffman: How would you get more prescriptions?

Russell Dixon: Doctor shop. This was back before they really tightened up on things. So if you paid cash, if you go to another doctor, they would write you a prescription and you go fill it.

Eric Huffman: Bro.

Russell Dixon: Yeah. It was bad. I mean, I was going to a doctor in Abilene. You buy it off the street off somebody else that was prescribed to it. So it never trickled outside of that. But I think that was a dangerous place for me because that's how I justified it. You know, I thought I'm prescribed to this. I was never like going and snorting coke or smoking weed or anything like that because those were like-

Eric Huffman: You get this at the pharmacy.

Russell Dixon: Right, exactly. It was kind of like my white-collar drug. So that started in the fall of '11, six, seven, eight, nine months downward spiral.

[Music]

Dr. Anna Lembke: Such a classic pattern. I mean, I hate to say it but even sports has become drugified, not just for the athletes, but for spectators, too.

Eric Huffman: That's Dr. Anna Lembke, one of the world's leading experts on the neuroscience of addiction. You've likely heard her voice before if you watched the hit Netflix documentary The Social Dilemma, an alarming film about the effects of social media on our brains. She's a professor of psychiatry at Stanford School of Medicine and the chief of the Stanford Addiction Clinic.

Dr. Anna Lembke: There's enormous pressure and monetization of athletes such that whatever their original joy in the sport was, it often gets leeched of that experience and then it's all about their reputation and their social media profile and, you know, how much money they're making and whether they are recruited for collegiate athletes.

And then if there's some sort of wrench in the works, like, you know, they don't make it to the pinnacle that they thought. Or worth yet they do and they get that big trophy and then they have to experience the kind of letdown of sort of, Well, what now? Addiction, you know, is looped into all of that, even before you add in drugs, right?

Eric Huffman: Yeah.

Dr. Anna Lembke: Like that whole cycle and the way that people's whole definition of self and identity becomes part of that. And not just for themselves. I would say spectators, too. I mean, it is really remarkable to see how social media and quantification, leaderboards and rankings, and stats have taken that thing that I think most of us could manage and moderate and turn it into something that can just completely overwhelm our lives.

Eric Huffman: Dr. Anna Lembke is the author of the instant New York Times bestseller, Dopamine Nation: Finding Balance in the Age of Indulgence, a book that explores the intersection of pleasure and pain in the brain and helps explain addictive behaviors. As a pastor, I've always been concerned about people who struggle with more mainstream addictions like drugs and alcohol, or even addictions relating to food and sex.

But in recent years, I've been overwhelmed by the number of people whose lives are being torn apart by newer addictions that seem to be flying under the radar in our culture. Addictions that don't require any dealers, but instead are supplied by the phones in our own pockets and purses. That's what really got my attention about Dr. Lembke.

Much of her most recent research and writing has raised red flags about the reality that we're enabling an entire generation of dopamine junkies whose brains react to notifications, likes, and comments on social media much like a heroin addict's brain responds to an eightball. Ironically, when Dr. Lemke began her career in psychiatry, she did everything she could to avoid patients who were struggling with addictions.

Dr. Anna Lembke: It was mainly because I had learned very little in medical school about how to screen or intervene for substance use disorders. I didn't really learn very much in my psychiatry residency either, so that when I started in clinical practice in the early 2000s, I said to the intake coordinators here at Stanford, I said, "I'll see any kind of patient, just not patients with drug and alcohol problems."

I mean, I'm embarrassed to admit that now. But, you know, that was not atypical even for psychiatrists, because we really did have this notion that addiction was not a disease, that it was not a medical problem, that it was some kind of social problem, and that patients had to go to Betty Ford Clinic and get it taken care of and then come back and see us about their anxiety, depression, etc.. Which looking back is completely absurd. It would be like sending a manic bipolar patient away to deal with their mania before coming back to get treatment for their bipolar disorder.

Eric Huffman: Yeah. Why were we ever treating addiction like a social problem or a character flaw rather than a disease?

Dr. Anna Lembke: Well, there's a long history to that. So for most of the last 2,000 years, the problem of addiction came under the purview of religious organizations. So, you know, churches, mosques, temples. These were the organizations that essentially helped that particular vulnerable population. And then in the early 1900s, with the increasing secularization of our society and also the increasing medicalization of social problems, it came more under the purview of the House of Medicine. But even then it was marginalized despite the efforts of physicians, beginning with Benjamin Rush in the 1800s, arguing for addiction to be categorized as a medical disease or brain disease and to be treated as such.

But it's really taken about 200 years for the medical community to finally embrace this idea. And the tipping point was the opioid epidemic. The medical community had to own their part and their responsibility in that problem, and at the same time then also try to be part of the solution.

Eric Huffman: Dr. Lembke was one of the first in the medical community to sound the alarm about the opioid epidemic and more specifically about physicians overprescribing opioids. In 2016, she published her bestselling book on the prescription drug epidemic, Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop. She paid a price professionally for calling out her peers.

Dr. Anna Lembke: Reading it now, it seems as if it's all sort of self-evident. But at the time that it came out, it was a pretty contrarian message and I got a lot of pushback. But I guess I've been able to endure it just because I'm so deeply convinced that the way that we are prescribing psychotropics and opioids has been largely harmful to patients and that we really need to take a hard look at it. That's not to say that opioids and psychotropics have no utility. That's not my message at all and never has been.

Eric Huffman: Sure.

Dr. Anna Lembke: I'm very grateful for all of those tools. But we have certainly engaged in overprescribing to the detriment not just of patients, but also any teenager who has access to a medicine cabinet.

Eric Huffman: And when you talk about these drugs being prescribed, what are the names that our listeners would recognize?

Dr. Anna Lembke: So opioids include things like Oxycodone, OxyContin, Percocet, Vicodin, prescription, fentanyl, morphine. In terms of psychotropics, one in four American adults takes a psychiatric medication, either anti-depressant, anxiolytic. Some of the most common classes of medications prescribed are the benzodiazepines, things like Xanax, Valium, Ativan. These are highly addictive medications that work short-term but have no reliable evidence to support long-term use.

Stimulants, also Adderall, methylphenidate. You know, when you compare children with attention deficit disorder who receive stimulants versus with those who don't, what you find is that if you follow them prospectively and assess their school function, that there's no difference in elementary, junior high and high school levels.

Eric Huffman: Dr. Lembke admits that there's a silver lining to the opioid crisis. Over the past 20 years, she's seen a huge improvement in the education of physicians and other healthcare providers around the problem of addiction. But there's still very little infrastructure set up to treat addiction in the medical establishment. For example, most residential treatment programs, both for-profit and nonprofit, operate outside of mainstream medicine.

Dr. Anna Lembke: We still don't have enough healthcare providers who are trained and educated and incentivized to treat addiction. It's getting better but we have a long way to go when you look at the number of healthcare providers who have these skills and the prevalence of this problem, you know, on a national scale.

Eric Huffman: It's really interesting to hear you talk about the incentivizing of treatment and on the... I guess that's on the back end of the problem. But on the front end of the problem, are there still incentives to overprescribe these drugs that lead to the addiction problem we're talking about?

Dr. Anna Lembke: Unfortunately, the answer is yes. So our health care system highly incentivizes and rewards prescribing pills and performing procedures. We are a health care system that primarily pays doctors for encounters, not for necessarily getting patients well. There are efforts to reform that, but capitalism and medicine are merged. And the kind of slow medicine that takes time and requires educating our patients, that involves nonpharmacologic interventions that must be repeated as behaviors over many months to years.

Number one, it's hard to get patients to do those things because they're very effortful. And number two, we don't pay health care providers for those types of things, whether it's psychotherapy, physical therapy, mind-body work, you know, you name it, all the types of sort of slow medicine that ultimately we know works best for chronic mental health disorders.

Eric Huffman: I've heard you say that the addiction problem in America is growing, and yet we're talking about more than just opioids, right? We're talking about more than just even when I was growing up, it was like crack or cocaine and weed and alcohol. Is that accurate?

Dr. Anna Lembke: Yeah, that's the underlying premise of my book, Dopamine Nation: Finding Balance in the Age of Indulgence. The idea being that almost every human endeavor has now become drugified, meaning that it's made more accessible, more potent, has more variety, and is more abundant than ever before in the history of human civilization, such that all kinds of behaviors that were previously considered healthy and adaptive, like making human connections, has now become drugified through digital drugs like social media. Such that not only are we seeing higher rates of addiction among the population that was previously vulnerable to this problem, but we're now seeing addiction in populations that we had long thought were immune to or protected from the problem of addiction.

So, for example, women historically, rates of alcohol addiction, men to women for hundreds of years has been about 5 to 1. In the last 30 years, we've seen a massive telescoping of addiction rates in women such that addiction to alcohol has increased 80% in women in the past 30 years. And now millennial women have rates of alcohol addiction equal to millennial men. And we're seeing many, many people who are essentially telling me that they don't really and have never had a problem with addiction to traditional drugs like nicotine, cannabis, alcohol, opioids, who are now getting addicted to all kinds of digital drugs, video games, online pornography, social media, online gambling, online reading, show watching, you name it. These drugs are taking over our lives.

Eric Huffman: Yeah. Like, how do you define an addiction? How do you know if you're a video game addict or you just really like to play video games?

Dr. Anna Lembke: Quantity and frequency really matter. So if you're a daily user of any particular drug or behavior, and I use the term drug very broadly-

Eric Huffman: Sure.

Dr. Anna Lembke: ...to include behaviors, but I always like to qualify that, and finding that your youth is interfering with your goals, dreams, relationships, work, values, then you need to consider the possibility that you're tipping over into the realm of addiction. Addiction is defined broadly as the continued compulsive use of a substance or behavior despite harm to self and or others.

The addiction is an interesting disease because its intersection with culture and society and normative behaviors is very strong. So, for example, in our culture, we value workaholism and we don't really identify that as an addiction. We got legal drugs like nicotine and alcohol. We've got illegal drugs which are in fact no more harmful necessarily to a given individual than nicotine and alcohol, and yet they're not legal. So we've got all these kinds of conundrums and hypocrisies and these changes through time. But I think the key message here is that we have more access to traditional drugs and new drugs that never existed before in an unprecedented way in human history. So we're all become more vulnerable to this problem of compulsive overconsumption.

Eric Huffman: This is where I think the conversation about addiction gets really interesting as we look at the science behind our habits and our addictions. In her latest book, Dopamine Nation, Dr. Lembke explains how human beings are programmed to approach pleasure and to avoid pain. It's an instinct that dates back thousands of years to a time when people needed to actively seek food and clothing and shelter every day, their only alternative was to risk death.

Dopamine is the feel-good hormone that gives us a sense of pleasure and also the motivation to do something that feels good. It's part of our reward system that historically has kept human beings motivated to stay alive. Thankfully, most of us don't have to kill our own food or run for our lives anymore and yet we don't seem to be getting any happier. So I asked Dr. Lembke why it is that the more comfortable we get as a society, the more addicted and unhappy we become.

Dr. Anna Lembke: So our reward circuitry was evolved for a world of scarcity and ever-present danger. And essentially it was evolved for having to pay for our dopamine up front, which is another way of saying working for our dopamine, walking tens of kilometers to find food, clothing, shelter, a mate. And it's beautifully engineered for that kind of thing. And it's also what's made us strivers. Right? We're never satisfied with what we have. As soon as we get it, we feel the comedown and we want more.

So, you know, in that kind of environment, an environment of scarcity, people with the addiction gene would be some of the most adaptive, successful, valuable people in a tribe because they're the ones who won't give up. Right? Everybody else's like, "I had it. That's a no." And they're like, "No, let's keep going. Just a little bit further. It's right around the next corner."

But, you know, in this world where we have all of our survival needs met and way above and beyond, we're at the touch of a fingertip without any work at all, we don't even have to get up off the couch and our reward comes to us. And the result is that we're more miserable than ever. That hedonism or this relentless pursuit of pleasure ultimately leads to what we call anhedonia, which is the inability to experience pleasure in anything that we do.

Eric Huffman: So the reason to start what becomes an addiction is because it feels good. And ironically enough, what initially felt good or a relief from pain or some elation or high, eventually, by the time it becomes a problem, isn't feeling good anymore. Like it doesn't make you feel the same way anymore. How do you explain that neurologically?

Dr. Anna Lembke: All intoxicants mimic a chemical that we already make. And we make that chemical in our brains, whether it's our endogenous opioids or endogenous cannabinoids, all of which work on dopamine as the final common pathway. We make those chemicals as a healing mechanism in response to a painful injury and also as a signal for approach or a void. But what happens is that these same chemicals that our bodies naturally make as signals to us, they're also made in nature.

For example, opioids are made in the poppy plant. Cannabis is made in the cannabis plant. And we now have been able to engineer these exogenous or external mimics into these highly potent forms, such that when we ingest them we get this explosion of dopamine far exceeding what our brains have evolved to tolerate. And the result is this incredible comedown where we go sudden increase in dopamine, followed by dopamine freefall, not just to baseline firing levels, but actually below baseline levels before going back to baseline.

But the bottom line is that for every intoxicant that we ingest and I include here TikTok, Netflix shows, YouTube, you know, you name it, League of Legends, for every intoxicant that we ingest, we will have to pay a price. It's the equalizing force of the universe. And that price is a calm down. And we may not consciously be aware of it, but it is there. If we wait long enough between ingesting intoxicants, our body recovers and you know, we go back to baseline. But if we don't wait, and we don't have to wait now because TikTok is infinite, then what happens is over time, we eventually end up in this chronic dopamine deficit state, which is the addicted brain.

And once we get there, we need to use not to feel good or feel high, but just to feel normal, just, you know, barely bring ourselves back up to baseline. And when we're not using, we're in this subthreshold state of withdrawal.

Eric Huffman: Goodness gracious. I mean, I've experienced that myself, and I think I've seen others experiencing it, too, where, yeah, you're not using to get high, you're just using to survive or get back to your old self, your normal.

Dr. Anna Lembke: That's right.

Eric Huffman: And that's a really sad place to be in.

Dr. Anna Lembke: Yeah, it is. And it happens insidiously and it happens without our really even realizing it's happened. Our brains are such powerful storytelling machines that we will look around us and find a million reasons why we feel crappy that's not related to our drug.

Eric Huffman: Oh yeah.

Dr. Anna Lembke: Because we don't want to give that up.

Eric Huffman: That's right. Dr. Lembke, what would you say is wrong with us? This problem still doesn't make sense to me that addiction is so rapidly on the rise in our culture when we are more fortunate than anyone has ever been. And it would seem like we would get our act together more. But we're more of a mess in this way. Are we all chasing after a Holy Grail that doesn't exist?

Dr. Anna Lembke: Well, before I answer that specific question, I really want to emphasize that I really don't see this problem as something wrong with us. I see it as a mismatch between how our brains have evolved and the world we live in now. Because I think there's some danger in like locating the problem in our brains as if we have something defective with the brain.

Eric Huffman: Sure.

Dr. Anna Lembke: The brain is actually working just the way it was meant to. We are instinctively and deeply wired to approach pleasure and avoid pain, and we do that iteratively through every second of our day, which again works great if you are living in a subsistence environment where just to survive, you better be relentlessly thinking about where you're going to get your next bite to eat. But it's a complete and colossal disaster in a world where we have everything.

So if we're then thinking more to your question on the meta-level, then what happened? How did we get here? I mean, this is really the dark side of capitalism, right? Capitalism is a wonderful system to incentivize, you know, the maximizing of human potential consumption initiative. But we have reached now this tipping point where we're essentially titillating ourselves to death. Right? We're consumption machines. We don't really know how to live unless we are consuming. And consumption is everywhere.

Eric Huffman: If you've been listening to this podcast for a while, you know that we like to end our episodes on a positive note by giving you something uplifting, some reason to hope. But for this episode, we thought we'd try something a little bit different. One thing that's becoming painfully apparent is that in 2022, all of us are junkies of some kind. We're strung out on steady streams of dopamine.

For years now, most of us have filled every uncomfortable space and every awkward silence with another look at our devices in search of an escape. And if we're ever going to overcome this addiction, it will be by learning to dwell in the tension of silence and discomfort without needing to escape it. On the other side of that discomfort, there is hope for us all. But I don't think we'll ever get to the future God wants for us by escaping the present moment we're in now. A week from now, we're going to drop part two of this episode and you'll hear the rest of Russell's story about how he hit rock bottom-

Russell Dixon: Most doctors said I should have gone into cardiac arrest. I didn't sleep a wink. By this point, I'm incoherent and it just... I was the epitome of strung out.

Eric Huffman: ...and the unexpected path that he took toward healing. We're also going to hear more from Dr. Lemke about how to overcome our most persistent and dangerous addictions. And just a little hint, this is one of those beautiful intersections between science and faith that we get so excited about.

Now, I know you're going to be encouraged by part two, but for now, what I'd like to do is invite you to join me and the rest of the Maybe God community as we learn to lean into the discomfort of the moment. Let's all spend the next week honestly reflecting about the escapes and addictions that we've been struggling with so that as we listen to part two together, our hearts and our minds will be more prepared to pursue the changes that we all know we need to make. As always, thanks for listening to Maybe God.

Julie Mirlicourtois: This episode of Maybe God was produced by Julie Mirlicourtois, Andrea Gentle, and Eric and Geovanna Huffman. Our talented editors are Brittany Holland, Shannon Stephan, and Justin Mayer, and our social media guru is Kat Brough. For more information about Maybe God and to sign up for exclusive updates and content, head to maybegodpod.com today. And don't forget to follow and engage with us on Facebook, Instagram, and YouTube. Thanks for listening, everyone.