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The Dose Transcript for February 1, 2024

Host: Brian Goldman

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. I have a confession to make. There are days when I spend too much time looking at social media on my smartphone, just as there are times when I drink too much coffee. Call them what they are, behaviours that are close to, if not manifestly addictive. Like you, I'm looking for a hit of dopamine. Recently, though, I looked at a study that spoke to me personally. The study shows how you might be able to reset your brain's reward centre by doing something called dopamine fasting. So this week, we're asking, what do I need to know about dopamine fasting? Hi, Patricia. Welcome to The Dose.

PATRICIA DI CIANO: Hi. Thank you.

BRIAN GOLDMAN: Have you ever had a moment like me when you thought, hey, I can use a dopamine fast?

PATRICIA DI CIANO: Certainly, I think we all spend too much time on our phones. Most people do. And certainly, there are times when I think, oh, I need to break away from the games or the Instagram searches or the Facebook chats, you know? For sure, there are times when I think it would be good to disconnect from all the technology.

BRIAN GOLDMAN: Have you ever detoxed from your phone?

PATRICIA DI CIANO: I haven't, but I'm pretty good at compartmentalizing my phone, so I don't tend to look at it when I'm at work. I tend to do it after dinner at night, so I haven't. But it's an interesting idea.

BRIAN GOLDMAN: And you have obviously found a way to control your use, which is probably as good a prevention tactic as any. So I think you're somebody who can offer some advice on this important subject. Before we begin, though, can you give us a hi, my name is? Tell us what you do and where you do it. Just adlib.

PATRICIA DI CIANO: Hi, my name is Patricia Di Ciano. I'm a scientist at the Centre for Addiction and Mental Health in Toronto, and I'm also an assistant professor at the Dalla Lana School of Public Health at the University of Toronto and the Department of Pharmacology at the University of Toronto.

BRIAN GOLDMAN: Before we get to talking about dopamine fasting or cleansing or detoxing, let's explain first of all what dopamine is.

PATRICIA DI CIANO: Dopamine is a neurochemical in the brain. So that means it's a chemical in the brain that helps neurons communicate. So it sends chemical signals from one neuron to the next. We all are familiar with the idea that dopamine is involved in reward or the pleasure or the hedonics. I think that's really captured the imagination of the media, and that's really where people are thinking what dopamine is doing. That theory goes back about 40 years, and it's been a great theory. Like any good theory, it's generated a lot of hypothesis driven research over the years. But there were some challenges to the theory over the years. So in the 90s, for example, some data was published showing that after receiving a reward, dopamine can actually go down. So that sort of got people thinking a little bit about what dopamine is doing. And in parallel, there have been some other ideas about what dopamine is doing. One of the earlier ones, I believe, was that it's involved in learning or sort of stamping in learning or reinforcement, as we like to call it in psychology. There are also ideas that dopamine is involved in motivation. So sort of the wanting or the seeking out of rewarded earned points. Some people also think it's involved in effort. So the amount of behaviour you put into something. So that more dopamine is required to make more responses. And then of course, a more recent idea that it's involved in some kind of prediction error. So it helps people or animals bridge the gap between when they expect to get a reward and when they get a reward. Relevant to the dopamine fasting idea, there's a lot of evidence that dopamine is involved in stimulus control. So the way stimuli in the environment control behavior. so signals and cues from around you.

BRIAN GOLDMAN: Clearly, dopamine is important in helping to shape human behaviour.

PATRICIA DI CIANO: Yes, it's involved in many different processes. It's found in many different parts of the brain. So it isn't just doing one thing. Just to put it into some context, some illnesses that it's involved in. For example, Parkinson's is known to be a disorder of very low dopamine levels in one of the brain areas where dopamine works. And another sort of set of illnesses, of course, is any substance abuse disorder. So all drugs of abuse ultimately work on the dopamine system. They all converge on dopamine. So those are two very different illnesses that are both controlled by dopamine.

BRIAN GOLDMAN: What do we mean by a dopamine hit or a rush?

PATRICIA DI CIANO: The popular idea of a dopamine hit or a dopamine rush really gets back to the idea that it's involved in reward or hedonics. It excites or it produces a sense of reward or pleasure. Dopamine hit, dopamine rush can do a number of different things. So a dopamine rush, we know that when we give a surge of dopamine, it can really help to stamp in what happened previously. So it can help in learning. So it can help to sort of cement or build our understanding or our knowledge about rewards and outcomes in our world.

BRIAN GOLDMAN: You mentioned hedonics. And I assume when you talk about hedonics, you're talking about the pleasure that you feel. Does everybody feel the same amount of pleasure per dose, per hit of dopamine?

PATRICIA DI CIANO: Any kind of subjective account, whether it be pleasure or pain, is very relative. So everybody will have a different way of rating pleasure or pain. It's notoriously difficult to assess. If one person gives you a rating of 10 out of 10 for pleasure, doesn’t mean the same as somebody else who's given a rating of three out of 10 for pleasure. What we do know is that your amount of pleasure or hedonics can vary based on your experience with an outcome. So people who use a lot of recreational drugs, a lot of cocaine, a lot of alcohol, for example, will experience what's called tolerance so that the drug has less of an effect or you need more of the drug to produce the same effect. So in those kinds of people, we can see an adaptation. So the amount of pleasure that they experience will be less than when they first used the drug.

BRIAN GOLDMAN: What are some of the most powerful triggers of a release of dopamine in the brain?

PATRICIA DI CIANO: Clearly, one of the best triggers of dopamine in the brain would be some of these recreational drugs. So drugs like cocaine and amphetamine have a direct impact on dopamine. So when somebody has a hit of cocaine or amphetamine, dopamine in the brain will go very, very high. With the respect to the dopamine fasting, I think what's perhaps more relevant is the sort of the cues in the environment. So these conditioned cues. We know from probably over a century now of research that these stimuli in the environment are very good at producing responses. So we all know the term Pavlov's bell. So going back to the early 20th century, when Pavlov discovered by accident that a bell that predicts food is really good at eliciting a salivation response. So food on its own causes a dog to salivate. But when a tone predicts the food, the tone also after learning produces salivation. We know that after this kind of learning, whether it be to food, sex or drugs, which are the three primary rewards that elicit dopamine, that these kinds of cues can also produce an increase in dopamine, depending on how they're presented.

BRIAN GOLDMAN: So it's not just the drink of alcohol, it's the bar where you had that first drink.

PATRICIA DI CIANO: Precisely. It's the bar that's a contact. So the room where you've had the drink. So somebody who is using heroin, for example, may often use the drug in the same room, and that room will become a conditioned stimulus. It's also logos. So we all know logos for famous restaurants or coffee shops. You know, when you're walking down the street, if you see a logo, you may approach that restaurant or that coffee shop because it reminds you of the food or the coffee and you’re motivated to seek it. It can also be something that you work for. So for example, with internet stimuli, Instagram, Facebook, we spend a lot of time searching through these apps. And there's nothing inherently rewarding about those apps, but those apps remind you of reward. They signal that reward could be coming, so we're working for those kinds of rewards.

BRIAN GOLDMAN: Is it fair to divide up or to categorize some of the triggers of dopamine as being helpful versus unhelpful? Because I'm thinking about, you know, getting a runner's high. And I guess unless you're running to the point at which you're destroying your ankles and your knees, that would be considered a helpful trigger for a dopamine rush.

PATRICIA DI CIANO: Well, certainly, dopamine most likely from an evolutionary perspective with respect to rewarded behaviour and motivated behaviour would help animals or organisms orient towards environments that help them to survive. So a stimulus that predicts food will elicit an approach response to the location of food. So clearly, they’re evolutionary adaptive, this process. So dopamine can help people learn about where to obtain food, sex, you know, whatever they need to survive, and it can also signal that we've received something that is important for our survival. So yes, it can be adaptive. Where it can be maladaptive, of course, is in the case of a situation where you're overusing or misusing one of these products. So in the case of an addiction to food, sex or drugs, changes in dopamine could potentially be maladaptive simply because the way the dopamine system works over time can change.

BRIAN GOLDMAN: The thing itself, the substance itself is neither helpful nor unhelpful. The context is really important.

PATRICIA DI CIANO: That's right. It's about the learning and the way that you've adapted to the situation.

BRIAN GOLDMAN: How do smartphones and other tech play into this dopamine rush concept?

PATRICIA DI CIANO: So if you think about your phone, a lot of what you see on your phone is a conditioned stimulus. So the example that Cameron Sepah used in one of his interviews was these push notifications that people get. You're sitting at your desk or you're sitting by your TV, and suddenly, you get a notification that you have an email or a friend has liked one of your posts and that, you know, you reach for your phone because you want to see what is waiting for you after you've got the signal from a notification. That notification in itself inherently has no value. I mean, if you show a notification to a child, that doesn't mean anything. But because we've learned over time that the notification brings us something that we're seeking or something rewarding, that notification becomes a signal or a stimulus in the environment.

BRIAN GOLDMAN: What do we make of a notification that advises you that somebody dislikes what you've posted? And I get those frequently on X.

PATRICIA DI CIANO: What's important to note is that learning about these kinds of stimuli, contrary to what we think and sort of what we think is intuitive, our learning about these stimuli is a lot more ingrained and a lot harder to undo when the reward or the reinforcement is intermittent. So if every time you receive a notification and you look at the notification and it's always something that is rewarding and there's always something good, you're more likely to unlearn that than if the reward is sort of infrequent. So intermittent associations tend to be better at stamping in these kinds of responses. So in that situation, potentially, you could be learning more about that outcome if it's an intermittent type of reinforcement.

BRIAN GOLDMAN: Clearly, there's two ways that this can go. Broadly speaking, you could learn that if you get a lot of disapproval, that you stay away from social media and then you feel better as a result. Or you could do the opposite. You could redouble your efforts to post something that will be liked. I think gamblers who are trying to make that next bet and hope that they can make up all the money that they've lost would understand what I'm trying to do when I'm in the hole, as it were, on being disapproved for posting and now I'm trying to double down and either explain myself to reacquire approval or come up with something else that will make people approve me instead.

PATRICIA DI CIANO: Yes, you could try to gain approval or you could stop posting. One of the things about conditioned stimuli is if you stop getting the desired outcome, that stimulus will lose its ability to produce that response. So if you don't get rewarded, that stimulus will lose its value. Similarly, if it's always positive and then suddenly you receive a negative outcome, the value of that stimulus can be decreased. Your learning about that. Stimulus can change depending on what happens when that stimulus is presented.

BRIAN GOLDMAN: Which leads us very nicely into a discussion about dopamine fasting. I know you didn't invent the term, but what do you think they mean by it?

PATRICIA DI CIANO: My understanding of dopamine fasting, and I'll admit that I'm seeing very different interpretations of what it means out there in the media, my understanding is that it's about we learning your behaviours. It uses cognitive behavioural techniques to change your maladaptive behaviours. And I think how people have interpreted it is to sort of deprive yourself of anything that releases dopamine. So to deprive yourself of food, sex, drugs, social interactions, just go into sort of a vacation mode and put everything away and sort of distance yourself from anything that's rewarding and try to compartmentalize the way that you interact with these stimuli.

BRIAN GOLDMAN: In order to gain a new perspective on what the stimulus actually means to you.

PATRICIA DI CIANO: So it's to learn a new response. Part of the reason why we approach these stimuli is because the stimuli are rewarding. But also, the reward relieves a negative sense of stress that we feel, because we see something and we feel a sense of loss and we need to get that stimulus, the double whammy. So we're learning a different outcome to our behaviour. So we're learning that our behaviours don't produce the response that we like, and we're learning to sort of fragment the various stimuli in our environment.

BRIAN GOLDMAN: It sounds from the description like you need a long enough kind of period of abstinence or separation from that, from that stimulus to begin to either reset and then hopefully learn more about why you do it and what's the downside of doing it. How long do you think you need to be separated or stop doing the behaviour in order to, in order to begin that process?

PATRICIA DI CIANO: This is where I think that there's a challenge for the dopamine fasting. This idea of taking a vacation from rewards is where I'm left wondering how successful dopamine fasting would be, simply because we know that with stimuli in the environment, if you take a vacation, so I'll go back to the example of a logo for a coffee shop or a restaurant. If we go on vacation to a country where those restaurants or coffee shops don't exist, we'll come back and we may have forgotten about it for a little while, but that stimulus will eventually return and become very powerful. But by contrast, if you go to that restaurant or that coffee shop and you have food or coffee and it makes you ill, nauseous, that will definitely affect the way that the logo motivates you in the future. So it's not just about taking a vacation, it's about re learning your responses and re learning the importance of stimuli in the environment. With respect to dopamine, we know that from a number of different sort of avenues of research, when we take a vacation from a stimulus, that our responses to that stimulus can actually get bigger over time. It's called incubation or sensitization. We need to do more than just take a vacation. Taking a vacation can actually make it worse. So we need to find a way to change what those stimuli are doing and how they're affecting our behaviour, as opposed to just taking a vacation from them.

BRIAN GOLDMAN: How challenging is it for people to make that first attempt to break away, to start the vacation, as it were?

PATRICIA DI CIANO: We certainly know that this kind of technique is used in our everyday lives. In some ways, it's common sense. We do it for alcohol. You know, we have alcohol only available in certain stores in this country. We tend to drink only at night or on weekends. You know, we compartmentalize other types of behaviours that can become problematic. So in theory, that could be done for phones and other technology.

BRIAN GOLDMAN: What is happening inside the brain and the body as you attempt to break away from the behaviour, whether it's being on your smartphone or avoiding a certain food, avoiding coffee, etc., what was happening immediately prior to the abstinence, and then what happens as you then abstain?

PATRICIA DI CIANO: We know that two different things can happen to the dopamine system when we stimulate it repeatedly. So there's this idea of tolerance that when you stimulate with a high potency drug like cocaine or amphetamine, for example, and people take a lot of these drugs, they experience a tolerance. And that can cause the dopamine system to become less responsive. So that drug will have less of an effect or you need more of the drug to get the same effect. When it comes to intermittent exposure, so if the exposure tends to be intermittent, and if we take a holiday or vacation from the exposure, what tends to happen is our dopaminergic response can get bigger. We can actually get more of a dopamine hit from the drug or the stimulus. If it's given intermittently and if there's a vacation in there, we can see more of a hit from the dopamine.

BRIAN GOLDMAN: What do we know right now about the research behind dopamine fasting?

PATRICIA DI CIANO: Based on my reading of the literature on dopamine fasting, what I'm finding is that there aren't a lot of published studies looking at dopamine fasting and how it affects our interaction with technology or any other maladaptive behaviours. I also didn't find any clinical trials currently in progress or database where clinical trials are registered. So I don't think there's a lot of empirical support for dopamine fasting. However, I do believe that the techniques that it's based on, cognitive behavioural therapy, is very well-established in the literature. For many different types of mental illness and addictions, it tends to be very effective. CBT is very effective, but I don't know if it's really been applied to dopamine fasting.

BRIAN GOLDMAN: Still, it's an idea that would probably not be harmful to most people. Is it worth a try?

PATRICIA DI CIANO: Certainly. Like I said, compartmentalizing behaviours. But again, I would suggest that people would speak to their health care professional about this before trying anything.

BRIAN GOLDMAN: So just to be clear, what's the other component that you think is really important? If somebody were to, for instance, attempt to detox from whatever behaviour is triggering dopamine release or perhaps triggering a diminished dopamine release, what else needs to happen? You mentioned the cognitive behavioural therapy approach. Can you say more about that?

PATRICIA DI CIANO: Based on the pure research, I would say that what needs to happen is not just that we take a vacation from what is causing us harm or distress. I would say that we need to rethink our learning about those events in our environment. You gave the example of notifications signaling something is negative. We need to learn that these notifications are not rewarding or don't bring us the outcome we're hoping for. We need to relearn our relationship with these outcomes, not just take a break. That's based on the literature around conditioned stimuli and how these stimuli work and how they affect our behaviour.

BRIAN GOLDMAN: Patricia Di Ciano, thank you so much for speaking with us.

PATRICIA DI CIANO: Thank you very much.

BRIAN GOLDMAN: Patricia Di Ciano is an independent scientist with the Institute for Mental Health and Policy Research and an assistant professor in the Department of Pharmacology and Toxicology at the University of Toronto. Here's your dose of smart advice. Dopamine is an important neurochemical in the brain. At one time, it was known exclusively as the brain's pleasure chemical. But newer thinking and research have suggested that dopamine plays a more complex role in shaping behaviour by providing incentives to things like learning and memory. There are many potential triggers to dopamine release. Illicit drugs like crack cocaine, crystal meth and fentanyl are among the most powerful. Food, sex, gambling and behaviours associated with eating disorders also trigger dopamine. Smartphones and social media can be powerful triggers of dopamine release as well. It's important to add, though, that it's not just the coffee, but the coffee shop itself that triggers a rush of dopamine. Whatever the behaviour, it triggers dopamine release, which induces feelings of pleasure. But hitting the dopamine system again and again triggers less and less dopamine, and thus less and less pleasure. The idea behind a dopamine fast is that you may be able to reset the dopamine system by taking a break from whatever you do to trigger it. We don't know this for sure, but to do it effectively, you probably need at least four weeks abstaining from the triggering behaviour. To make the change permanent, you need to pay attention to the downside of the behaviour you're trying to curb. If it's coffee, focus on how queasy you feel in your stomach or how nervous and irritable you are when you drink too much. We need evidence from studies before concluding that dopamine fasting works. But absent that, there's little harm in taking a holiday from a behaviour you have come to see as harmful. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you like this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Sameer Chhabra and Stephanie Dubois. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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Dopamine fasting: What should I know? - Transcript

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