The Truth About Addiction: We're Hooked on Control, Not Substances

We usually think of addiction as dependence on a substance or behavior—alcohol, nicotine, social media, gambling. But Dr. Anna Lembke, an addiction medicine expert at Stanford University, offered a颠覆性的 perspective on the Huberman Lab podcast: in the most severe cases of addiction, what people are truly hooked on isn't the substance itself, but the sense of control.

Dr. Lembke is the director of the Dual Diagnosis Addiction Clinic at Stanford University School of Medicine and a leading global expert in addiction and dopamine dynamics. In a recent interview, she and neurobiologist Andrew Huberman dove deep into the latest science of addiction and how "radical surrender" can break the cycle.

The Nature of Addiction: A Simplified World

When describing the addicted state, Dr. Lembke used a vivid metaphor: an addicted person is like a rat in a cage with only one lever. Through addictive behavior, they create a "world within a world," where attention narrows and everything else fades. "I've simplified things—I have only this one lever. As long as I can press it, I know I can change how I feel."

This fixation on control stems from our evolutionary instinct to reduce uncertainty. In a chaotic world of famines, floods, and fires, prediction and control were key to survival. Yet the modern world offers too many levers of control—we optimize relationships, careers, appearance, count steps, sleep, calories, and even try to control others. Dr. Lembke points out that we have become addicted to control itself.

Dopamine and the Pleasure-Pain Balance

To understand addiction, you must understand dopamine and homeostasis. Dr. Lembke uses the "pleasure-pain balance" to explain: when we experience pleasure, the balance tips toward pleasure, and the brain immediately activates neuroadaptation mechanisms (which she calls "gremlins") to restore equilibrium. These "gremlins" jump to the pain side to level the balance, but they don't leave immediately—they stay there until the balance tips equally toward pain—that's the "hangover" or "crash" moment.

With continued use of an addictive substance or behavior, these "gremlins" multiply and strengthen, eventually settling on the pain side. At this point, the pleasure set point shifts, and more, stronger substances are needed just to feel normal. When use stops, the balance remains tilted toward pain, causing anxiety, irritability, insomnia, depression, and craving—the classic withdrawal symptoms.

Animal research cited by Dr. Lembke shows vast differences in dopamine elevation across substances: chocolate raises it relatively little, sex more, nicotine more still, and methamphetamine can boost it by up to 1000%. Although these data come from rodents, the reward pathway mechanisms in the human brain are similar.

Dopamine is often mislabeled the "pleasure molecule," but a more accurate description is a "reward prediction error" signal—it encodes "unexpected good things," not pleasure itself. Dopamine neurons are mainly located in the ventral tegmental area (VTA) of the midbrain and project to the nucleus accumbens (reward and motivation) and prefrontal cortex (decision-making), forming the mesocorticolimbic pathway. Addictive substances release far more dopamine through this pathway than natural rewards via different mechanisms: cocaine blocks dopamine reuptake, amphetamine reverses dopamine transport, and opioids indirectly disinhibit dopamine cells by suppressing GABA interneurons. Repeated exposure leads to receptor downregulation and synaptic plasticity changes—the neural basis of tolerance and withdrawal.

The Digital Age: The New Frontier of Addiction

Dr. Lembke foresaw the spread of social media addiction early on. Today, at the Stanford adolescent clinic, about 50% of referrals are for digital media addiction. What's unique about social media and online addiction is that they are deeply embedded in professional and social connections, making "opting out" extremely difficult.

She compares the digital media problem to pollution: individuals can try to reduce use (like using cloth bags instead of plastic), but that's far from enough—government, schools, and companies must set "top-down guardrails." The "enshittification" of tech products—initially adding value, then gradually extracting it from users—worsens the problem.

Radical Surrender: The Antidote to Control Addiction

Dr. Lembke's new book, Radical Surrender, explores how giving up control can lead to true freedom. She notes that in severe addiction, people are hooked on the sense of control, and surrender—acknowledging the limits of control and handing one's will over to a higher power—can activate different neural pathways in the brain.

She cites neuroscience research showing that when the control network (prefrontal cortex) is active, the spiritual network (centered on the periaqueductal gray) is suppressed. Only when we stop trying to control does the spiritual network activate, bringing calm, hope, and new strategies. The proliferation of 5-HT2A serotonin receptors seems to prepare the brain for this shift.

Dr. Lembke shared her own experience: after her son died of leukemia, she realized she had been addicted to control—even trying to dictate how her husband should grieve. Through radical surrender, she found a new way to live. She suggests that even non-religious people can try prayer: simply acknowledge the limits of control and seek help from outside.

The periaqueductal gray (PAG) is a gray matter structure surrounding the midbrain aqueduct, traditionally known for its role in pain modulation, defensive behavior, and autonomic responses. Recent neuroimaging studies suggest that the PAG, especially its ventrolateral and dorsal subregions, is often activated during meditation, prayer, near-death experiences, and psychedelic use, and is associated with subjective experiences like "dissolution of self-boundaries" and "connection to a higher power." The "control network–spiritual network" mutual inhibition model cited by Lembke can be understood as a dynamic competition between top-down cognitive control by the prefrontal cortex and subcortical-limbic systems centered on the PAG: when the intention to control weakens, PAG-related circuits can dominate, bringing calm and a sense of meaning.

Codependency: The Addiction to Controlling Others

Codependency is another form of addiction—trying to control others' behavior to manage one's own emotions. In addicted families, loved ones may become enablers with good intentions. Dr. Lembke emphasizes that when codependents learn to let go, the addicted person often enters recovery faster. "It's like tug-of-war—you let go of your end, and the other person lets go too."

She points out that modern technology exacerbates codependency: we constantly check messages, interpret emojis, track each other's whereabouts, trapped in a continuous codependent loop.

New Tools in Clinical Practice

The interview also covered other addiction treatment topics:

• Ketamine: FDA-approved for treatment-resistant depression but addictive. The Montreal model, which combines ketamine with psychotherapy in a clinical setting, has shown positive effects for depression and alcohol use disorder.
• GLP-1 receptor agonists: Some patients with severe alcohol addiction have successfully recovered using GLP-1s, even when all other methods failed. The mechanism may involve reducing dopamine release in the nucleus accumbens, lowering interest in addictive substances.
• Psychedelics: Dr. Lembke acknowledges that psychedelics like psilocybin can be transformative for some, but warns that as use increases, so do emergency room visits and hospitalizations related to harms including psychosis, suicide, and persistent hallucinations.

GLP-1 receptor agonists (such as semaglutide and liraglutide) were originally developed for diabetes, mimicking the incretin GLP-1 to enhance insulin secretion, delay gastric emptying, and suppress appetite. Their effects in the brain extend beyond the hypothalamic feeding center: GLP-1 receptors are also expressed in the VTA and nucleus accumbens, and their activation can reduce dopamine neuron firing rates and dopamine release, thereby weakening motivation for reinforcers like food and alcohol. In clinical observations, some patients with alcohol use disorder report that their "alcohol craving disappeared" after starting the medication, but current evidence comes mostly from case reports and retrospective studies; randomized controlled trials are still needed to confirm efficacy and appropriate patient populations.

Practical Advice for Daily Life

Dr. Lembke shared her own daily practices:

1. Start the morning with prayer: lying in bed, consciously acknowledging the limits of control and asking for help.
2. Don't touch any screens upon waking until completing morning routines (exercise, breakfast, making the bed, etc.).
3. Use devices consciously: treat devices as tools, not mood regulators. She particularly limits video consumption because video is a potent "drug" for her.
4. Practice surrender throughout the day: when interacting with others, seeing patients, or feeling uncertain, seek guidance from outside rather than looking inward for answers.

Dr. Lembke concludes that we live in a "dopaminized" world where almost everything is more accessible and more reinforcing. But the hope lies in the fact that by letting go of our attachment to control, we can reconnect with our inner spiritual network and find a path beyond addiction. As she says: "We can only exist for life unfolding—that's all there is."

One-line Summary

Stanford addiction expert Lembke points out that the essence of severe addiction is a fixation on control, and radical surrender can break the cycle.

Paragraph Summary

Dr. Anna Lembke, an addiction medicine expert at Stanford University, proposed on the Huberman Lab podcast that in the most severe addiction cases, people are truly hooked on the sense of control rather than the substance itself. She uses the "pleasure-pain balance" to explain dopamine homeostasis: continued use of addictive substances shifts the pleasure set point, causing anxiety and craving during withdrawal. Digital media addiction is rising sharply among adolescents, with about 50% of referrals at the Stanford adolescent clinic related to it. In Radical Surrender, Lembke argues that giving up control and turning to a higher power can activate the brain's spiritual network, thereby breaking the addiction cycle. The interview also covers codependency, ketamine, GLP-1 receptor agonists, and psychedelics as new treatment tools and their risks.