知足之路

你知道，我接触过很多家庭，孩子们沉迷于电子游戏或社交媒体。

You know, I deal with a lot of families where the kids are, you know, addicted to video games or social media.

而家长会说，我不明白为什么他就是停不下来或她就是停不下来。

And the parents like, I don't know why he just won't stop or she just won't stop.

与此同时，他们家里装的是光纤高速网络。

Meanwhile, their house is like, you know, fiber optic, high speed Internet.

每个房间、每间卧室都有屏幕。

They've got a screen in every room, in every bedroom.

每个人都有12台电子设备。

Everybody's got 12 devices.

我是说，这怎么可能戒得掉。

You know, I mean, how that no.

对吧？

Right?

不可能。

No.

在学校里，这同样是个大问题。

And also at school, it's huge problem.

比如，你知道的，孩子们被允许在课堂上使用手机。

Like, you know, the kids are allowed to have their phones during class.

老师怎么可能竞争得过YouTube呢？

How can a teacher possibly compete with YouTube?

根本不可能。

There's no way.

所以你提出的最激进建议之一——激进在于对许多人来说这显得非常反直觉且难以接受——就是应对强迫性过度消费的方法，是主动寻求其对立面。

So one of the most, radical suggestions that you have, and radical in the sense that I think it would appear to many people to be very counterintuitive and hard to digest, is that one way to deal with compulsive overconsumption is to actively seek out its opposite.

你说我们应该刻意寻求痛苦和艰辛的体验。

You say that we should deliberately seek out experiences of pain and hardship.

而我们大多数人都在竭力避免痛苦。

Now most of us try our best to avoid pain.

为什么要主动选择将痛苦引入生活？

Why would we choose to deliberately invite pain into our lives?

是的。

Yeah.

我知道这听起来很疯狂，但这背后其实有科学依据。

I know this sounds really wackadoodle, but there's actually science behind it.

这就是毒物兴奋效应的科学。

It's the science of hormesis.

Hormesis在希腊语中是‘启动’的意思。

And hormesis is Greek for to set in motion.

我们讨论的是非常轻微到中等剂量的适应性或健康疼痛，以可耐受为限。

And what we're talking about is very mild to moderate doses of adaptive or healthy pain as tolerated.

如果你不喜欢‘疼痛’这个词，也许可以用‘不适’、‘挑战’或类似的词。

And if you don't like the word pain, maybe use the word discomfort or challenge or something along those lines.

虽然这通常确实涉及一些身体上的压力。

Although often it does involve, you know, some physical duress.

以适当的剂量来上调我们自身的愈合机制，但不要多到造成不可逆的伤害。

At the right doses to upregulate our own healing mechanisms, but not so much that it causes irreversible harm.

激素科学在人类和动物研究中表明，当生物体暴露于轻度至中度剂量的疼痛、毒性或有害刺激时，实际上会使该生物体更健康、更具适应力、更加强健。

And what the science of hormesis shows in humans and in animals is that if you expose an organism to mild to moderate doses of painful, toxic or noxious stimuli, you will actually make that organism healthier, more resilient, more robust.

我们有大量证据支持这一点，通过运动研究得出的压倒性证据，同时也有一些新兴证据支持冰水浸泡疗法。

And we have evidence for that, overwhelming evidence for that through exercise, but also some emerging evidence for ice cold water plunges.

还有证据表明祈祷和冥想——这些行为虽然不一定带来痛苦，但确实需要专注投入和某种并非即时愉悦的注意力集中——也能产生类似效果。

There's also some evidence showing that prayer and meditation, which, you know, are not necessarily painful but do require effortful engagement and a certain kind of concentration which is not immediately necessarily pleasurable.

所有这些行为同样会释放多巴胺。

All that all that those behaviors also release dopamine.

诸如暴露疗法这类迫使自己进行心理不适活动的行为，

Things like exposure therapy, forcing ourselves to do things that make us psychologically uncomfortable.

这些都是初始体验艰难，但本质上触发身体感知伤害的行为。通过感知伤害，我们的身体开始上调保护性激素（如内源性阿片类物质），最终都导致多巴胺的释放。

These are all things that are hard in the initial experience but essentially trigger our body to sense injury and in sensing injury, our bodies start to up regulate our protective hormones like again our endogenous opioids, all ultimately leading to the release of dopamine.

因此这是从根本上重置我们快乐阈值（向愉悦方向偏移）的绝佳方式，这意味着我们对疼痛更具韧性，整体上也更快乐。

So it's a really great way to overall reset our hedonic or joy threshold to the side of pleasure, which means that we're more resilient in the face of pain and we're generally happier.

让我总结一下您说的内容，确保我理解正确。

Let me summarize what you're saying and have make sure I'm understanding this correctly.

你基本上是在说，你的核心观点是大脑中存在一个试图维持稳态的系统。

You're basically saying your central argument here is that there is a system in the brain that tries to maintain homeostasis.

当我们压下天平中快乐的一侧时，大脑中的小精灵就会跳到痛苦的一侧试图补偿并恢复平衡。

When we press down on the pleasure side of the balance, the brain gremlins get on the pain side of the balance to try and compensate it and recover equilibrium.

但如果我们压下天平中痛苦的一侧，稳态就会开始以某种方式对我们有利，因为小精灵会跳到快乐的一侧，基本上让我们进入一个比之前平均感觉更好的状态？

But if we were to press down on the pain side of the balance, now homeostasis starts to work in some ways in our favor because the gremlins hop onto the pleasure side of the balance, and they basically get us to a state where we're feeling better on average than we were doing before?

完全正确。

That's exactly right.

而且有大量证据支持这一点。

And there is overwhelming evidence to support this.

例如我们知道，如果你追踪多巴胺水平以及其他让人感觉良好的神经递质，如内源性血清素、去甲肾上腺素、内源性阿片类物质、内源性大麻素，你会发现当人们刚开始运动时，这些神经递质水平很低。

So for example, we know that if you track dopamine levels as well as other feel good neurotransmitters like endogenous serotonin, norepinephrine, endogenous opioids, endogenous cannabinoids, what you find is that initially when people engage in exercise, those neurotransmitters are low.

但在运动的后半段，它们会慢慢开始上升。

But over the latter half of exercise, they slowly start to rise.

当运动停止后，这些神经递质水平会在之后数小时内保持升高状态。

And then when the exercise is stopped, those neurotransmitter levels remain elevated for hours afterwards.

当然，这就是我们所说的跑步者高潮。

And of course, this is our runner's high.

最终这些升高的多巴胺水平会回归到稳态基线水平，但绝不会陷入多巴胺匮乏状态。

And then eventually those elevated levels of dopamine will go back down to baseline levels homeostasis, but without ever going into that dopamine deficit state.

换句话说，通过预先支付多巴胺，我们就能获得那些我们需要的愉悦体验，对吧？

In other words, by paying for our dopamine upfront, we get those feel good experiences, which we need, right?

我们是人类啊。

We're humans.

我们不可能永远停留在稳态中，但可以在不动用多巴胺储备的情况下获得那些美好感受，这么说吧。

We can't just like hang out in homeostasis, but we can get those good feelings without ever having to go into our cash dopamine reserves, so to speak.

你刚才做了个有趣的类比，我想特别强调一下，就是我们在使用大脑和理财方式之间存在某种相似性。

You made an interesting analogy a second ago, and I want to just draw attention to it, which is that there is an analogy here between the way we engage with our brains and the way we engage with money.

你可以用信用消费，有时候这样做既明智又有价值。

You can buy things on credit, and that is sometimes valuable and smart to do.

但这确实意味着你先享受好东西，之后再为之付出代价。

But it does mean that you're getting the good stuff first and then paying for it later.

这就是我们有意触发大脑中多巴胺时的做法。

So that's what we do when we intentionally trigger dopamine in our heads.

我们现在获得了愉悦感，但之后必须为此付出代价。

We're getting the good feelings now, but have to deal with it later.

你主张关注等式中的痛苦面，正如你所说，相当于预先支付多巴胺。

You're arguing that focusing on the pain side of the equation in some ways is, as you say, paying for the dopamine upfront.

你现在做困难的事，以换取未来的回报。

You're doing the difficult thing now in exchange for the for the reward down the road.

正是如此。

Exactly.

而且你会发现，实际上我们的支付方式让我们更容易上瘾。

And you can see the ways in which, actually, the way we pay for things makes us all more vulnerable to addiction.

因为现在有了这些信用卡，你甚至不需要实时支付。

Because now they have these credit cards where you don't even have to pay for them in real time.

你可以之后付款，这简直糟透了。

You can pay for them later, which is just terrible.

我在想，对许多人来说，这听起来是否像是你在提倡一种近乎苦行僧式的生活。

I'm wondering if it will sound to many people that you're almost recommending a life of, you know, asceticism here.

安娜，你是在建议人们成为苦行僧吗？

Are are you recommending that people become ascetic, Anna?

我提倡的是适应现代的新型苦行主义。

I'm recommending a new form of asceticism for the modern age.

我的意思是，我们正生活在一个前所未有的时代，面对极易上瘾的物质和行为泛滥的冲击，我认为我们的生存将取决于如何在这个过度丰裕的世界中找到平衡。

And what I mean by that is we are living in an unprecedented time of overwhelming access to highly reinforcing drugs and behaviors such that I think that our existence is going to be reliant upon figuring out how to navigate this world of overabundance.

因此事实上，为了保持健康，我们必须刻意偏向痛苦一侧，通过隔绝部分快乐来维持平衡。

And so in fact, in order to be healthy, we actually have to intentionally veer slightly to the side of pain and insulate ourselves from pleasure in order to preserve balance.

你自己实践过这种方式吗？

Have you done this yourself?

当然，我定期就会这样做。

Oh yeah, I do this on a regular basis.

你具体会做些什么呢？

What do you do?

嗯，我喜欢以痛苦开启一天，通常是做些运动，主要是散步或游泳，毕竟我五十多岁了。

Well, I like to start my day with pain, namely doing some kind of exercise, mainly walking or swimming because I'm in my fifties now.

但每天早上醒来时，相信我，我根本不想起床，但绝大多数时候我都会强迫自己起来，因为我知道之后会感觉好很多。

But I every morning, you know, when I wake up, trust me, I do not want to get out of bed, but I absolutely force myself to do it most of the time because I know I'll feel so much better afterwards.

这对我来说是极好的抗焦虑剂和情绪稳定剂。

And it's just a great anxiolytic and mood stabilizer for me.

我们养育孩子时也安排了许多强制行军和野外生存体验，这些都是充满挑战和困难的。

And then we've raised our family with a lot of, you know, forced marches and outdoor wilderness experiences, which were challenging and difficult.

我们在数字媒体方面做了隔离，家里直到大女儿上高中前都没有任何电子设备或Wi-Fi，甚至家里都没有Wi-Fi。

We've insulated ourselves from digital media in the sense that we didn't have any devices or Wi Fi, even Wi Fi to the home until our eldest went to high school.

然后她回来说，家里没有Wi-Fi，她基本上无法正常完成高中学业。

And then she came back and said that she essentially couldn't function as a high school student without Wi Fi in the home.

他们每天都会调整课表。

They changed the schedule every day.

你必须登录查看所有信息，才能知道应该去哪个教室上课。

You have to log on everything just to know what class you're supposed to go to.

这太疯狂了。

It's crazy.

所以我真的很沮丧，因为现在我们有了WiFi和光纤，这让我个人更难控制自己的使用习惯，比如晚上我会养成看YouTube的坏习惯。

So I'm really sad because now we have, you know, Wi Fi and fiber optic, and it makes it a lot harder for me personally to manage my consumption because, like, I'll get into these bad YouTube watching habits in the evenings.

你可以想象一下。

You know, you can just imagine.

但不管怎样，这是我们做过的事。

But anyway, that's something that we did.

我们经常骑自行车去很多地方而不是开车。

We bike a lot of places instead of driving.

事实上，我们有一辆25年车龄的小型货车，只跑了7.5万英里。

In fact, we have one twenty five year old minivan, which has 75,000 miles on it.

当我丈夫尝试重新办理保险时，他们不相信这辆车只跑了7.5万英里。

And when my husband tried to reregister for the insurance, they didn't believe us that it only had 75,000 miles.

他们甚至让我们签了份宣誓书。

They made us like get an affidavit.

是啊。

Yeah.

安娜，这种生活方式给你带来了什么回报？

What is the reward for living this way, Anna?

你在生活中看到了什么变化？

What do you see in your life?

你觉得这对你的心智、大脑产生了影响吗？

Do you think you're seeing effects in your mind, on your brain?

噢，当然。

Oh, yeah.

你知道吗，我曾经以为生活太艰难才导致我不快乐。

You know, I used to think that my life was really hard and that that was the source of my unhappiness.

但现在我意识到，其实我的生活一直都太安逸了，这才是我不开心的原因。

But now I actually think that all along my life was actually too easy and that's why I was unhappy.

关于成瘾故事最引人深思的一点是，它们往往伴随着日益严重的社交孤立。

One of the most striking things about stories of addiction is that they often involve increasing levels of social isolation.

想象一下，凌晨四点独自在公寓里没完没了玩第一人称射击游戏的人，或是偷偷大量观看色情内容的人，还有沉迷大麻的年轻女性。

Think of the person who is up playing endless first person shooter video games in an apartment by himself at 04:00 in the morning, Or the furtive heavy consumer of pornography, the young woman addicted to pot.

安娜，我觉得在这次对话中我们可能把多巴胺描绘得过于负面了。

Anna, I feel like we may have painted an overly negative picture of dopamine in this conversation.

是的，你可能会与多巴胺建立不健康的关系，但问题不在于多巴胺本身，而在于我们触发它的方式。

Yes, you can have an unhealthy relationship with dopamine, but the problem is not with dopamine per se, but the ways we go about triggering it.

你说人际关系是以健康方式触发多巴胺的强大途径。

You say that relationships are a powerful way to trigger dopamine in a healthy fashion.

能详细谈谈这个观点吗？

Can you talk about that idea?

是的，我在斯坦福的同事罗伯·马伦卡是位神经科学家。

Yeah, so my colleague Rob Malenka here at Stanford is neuroscientist.

他和同事们已经证明，催产素——我们的爱情荷尔蒙——会与奖励通路中释放多巴胺的神经元结合。

He and his colleagues have shown that oxytocin, which is our love hormone, binds to dopamine releasing neurons in the reward pathway.

这很合理，因为我们知道坠入爱河时会感到兴奋，对吧？

So that makes a lot of sense because we know when we fall in love, we feel high, right?

那是一种美妙的感觉。

That's a great feeling.

从生存或进化的角度来看，我们的大脑希望我们与他人建立联系，因为这样更可能找到伴侣，更可能抵御捕食者，更可能管理稀缺资源。

And from a survival point of view or an evolutionary point of view, our brains want us to make connections to other people because we're more likely to find mates, more likely to be able to protect ourselves from predators, more likely to be able to steward scarce resources.

因此，我们的大脑通过释放多巴胺来促使我们建立这些联系，并确保这过程令人愉悦。

So our brains get us to make those connections by releasing dopamine and making sure that it feels good.

成瘾的问题在于，我们选择的物质或行为实质上取代了这些人际联系。

The problem with addiction is that essentially our substance or behavior of choice comes to replace those human connections.

于是我们越来越陷入孤立，通过毒品而非深厚的人际关系来满足这些基本需求。

And so we move further and further into isolation and we meet those basic needs through our drug rather than through making deep human connections.

因此，戒除成瘾的部分意义在于走出孤立，尝试与他人建立深厚且有意义的亲密联系。

And so part of getting into recovery from addiction means moving out of isolation and trying to make deep and rewarding intimate connections with other people.

因为这本质上才是我们真正寻求的东西。

Because essentially that's what we're really looking for.

但我们被这类虚假的人际关系替代品所蒙蔽了。

But we get fooled by these kinds of, you know, false stand ins for human connection.

我想知道您能否简单介绍一下社区在这里的作用。

I'm I'm wondering if you can tell me a little bit about the role of community here.

有许多团体如雨后春笋般涌现来对抗成瘾问题，比如AA（匿名戒酒会）、NA（匿名戒毒会）或赌徒匿名会等组织。

There are many groups that have sprung up to try and fight addictions, you know, groups like AA or or NA or Gamblers Anonymous for example.

请谈谈这些团体扮演的角色——某种程度上，这是否与我们讨论的人类关系在对抗成瘾中的作用属于同一范畴？

Tell me about the role that they play and in some ways is it part of the same equation that we're looking at here, the role of human relationships in in battling addiction?

是的。

Yeah.

在我看来，匿名戒酒会（AA）和匿名戒毒会（NA）堪称过去百年间最杰出的社会运动之一。

So, you know, AA, Alcoholics Anonymous, and Narcotics Anonymous, in my opinion, are among the most remarkable social movements of the last one hundred years.

这些由成瘾者组成的草根组织令人惊叹，他们致力于帮助其他成瘾者。

These are amazing grassroots organizations composed of people with addiction trying to help other people with addiction.

对于积极参与的人来说，这些组织的成效非常显著。

And it's remarkably successful for those who actively participate.

虽然现在媒体上常有文章说AA和其他12步康复组织无效，但这并不符合实际证据。

So you'll read a lot in the media now about how AA and other 12 step organizations don't work, but that's not really a faithful representation of the evidence.

确实有很多人不会参与或从中获益，但对那些积极参与的人来说，参加AA和其他12步小组的效果与专业治疗相当，甚至可能更有效。

There are many people who will not participate or get anything out of it, but for those who actively participate, engagement in AA and other 12 Step groups is as effective and possibly even more effective than professional treatment.

那么这些12步小组的秘诀是什么呢？

So what is the secret of these 12 Step groups?

首先，它们提供了一个清醒的社交网络。

Well, first of all, they provide a sober social network.

它们为康复提供了一条明确的路径。

They provide a specific path for recovery.

但重要的是，它们真正消除了羞耻感，因为你会意识到'哇，原来我不是唯一一个'。

But importantly, they're also really de shaming because you realize, oh wow, I'm not the only one.

就像我大脑出现这种情况是因为我是人类。

And like I have this thing that happened to my brain because I'm human.

我有这种特定的脆弱性，而其他人也经历过并做过类似的事情来追求他们的毒品。

And I have this particular vulnerability and and other people have experienced and done similar things that I have done in pursuit of their drug.

这能带来一种难以置信的亲密感爆发，没错，还有多巴胺。

And that is an incredible burst of intimacy and yes, dopamine.

对吧？

Right?

我们因此得以融入理解并接纳我们所有缺陷的志同道合者的群体中。

That we get then from being taken into the fold of like minded individuals who understand us and accept us in all our brokenness.

安娜在生活中采纳的一个重要理念，与AA和NA等团体的宗旨产生了强烈共鸣。

One important idea that Anna has adopted in her own life powerfully resonates with the message of groups such as AA and NA.

改变始于说出真相。

Change begins with telling the truth.

是的。

Yeah.

这确实是我从患者身上学到的。

So this was really something that I learned from my patients.

通过多年观察重度成瘾患者康复的过程，我注意到那些似乎康复得最好、能保持最久清醒状态的人，都是致力于说真话的人。

Over many years of seeing patients get into recovery from severe addictions, what I noticed was that those who seemed to get into the best recovery and be able to maintain recovery the longest were those who were committed to telling the truth.

这对他们而言是核心价值，被视为保持清醒与康复的关键所在。

That was a central value for them, which they saw as just pivotal for maintaining sobriety and recovery.

我觉得这非常有趣。

And I thought that was really interesting.

诚实讲述究竟有什么魔力，能够促成康复并让人们保持康复状态？

Like what is it about truth telling that enables recovery and enables people to stay in recovery?

因为这确实是一个反复出现的主题。

Because it just was such a consistent theme.

无论他们是通过AA或NA的12步疗法，还是通过自己的个人旅程进入康复阶段，他们最终都会意识到：是的，我不能说谎。

Whether they got into recovery through 12 steps like AA or NA, or just through their own, you know, journey, it inevitable that they would be like, oh yeah, no, I can't lie.

当他们这么说时，不仅仅是指不能对自己的成瘾行为撒谎，而是指不能对任何事情撒谎。

And when they said that they weren't just talking about I can't lie about my addictive behaviors, they meant they couldn't lie about anything.

说谎行为本身对他们来说就像是堤坝的第一道裂痕，他们必须在所有事情上保持诚实才能维持康复状态。

That the lying itself was sort of the first breach in the dam for them, and that they had to be truthful in all things in order to maintain recovery.

所以这让我觉得非常有意思。

So that was really interesting to me.

于是我开始从科学角度探索这个问题，同时也尝试在自己的生活中践行这一原则。

And I began to explore that both, you know, from a scientific perspective, as well as try to employ it in my own life.

安娜，这次谈话中让我印象特别深刻的一点是，你每天都在帮助病人。

One of the things I find so striking about this conversation, Anna, is that you're someone who spends her day helping patients.

但我并没有感觉到你认为自己比那些你试图帮助的人更优越，甚至不觉得自己与他们不同。

But I'm not getting the sense that you see yourself as as better or even different from the people you're trying to help.

我知道你是哲学家马丁·布伯的追随者，他探讨过如何真正与他人建立联系。

I understand that you're a fan of the philosopher Martin Buber, who has talked about what it's like to truly engage with another person.

他谈到过'我与你'的相遇时刻，他认为只要两个人都努力全然地临在于彼此，这种时刻就可能发生在任何人之间。

He he talks about this I and thou moment, which he believed can occur between any two individuals who just make the effort to be fully present with each other.

那是个神圣的时刻，其他一切都会褪去。

And it's a divine moment, right, where everything else falls away.

这不是性化的爱。

It's not sexualized love.

而是某种类似爱的存在。

It's something akin to love.

但'我与你'这个概念最有趣的地方在于，它可以在一瞬间与任何人达成。

But what's so interesting about this I and Thou concept is that it can be achieved in a nanosecond with anybody.

你可以与陌生人达成这种境界。

You could achieve it with a stranger.

这种相遇的理念在于，当我们完全开放且脆弱地面对共同的人性时，我们才能真正看见彼此。

This idea of being that when we kind of come to the encounter fully open and vulnerable in our shared humanity and we see each other.

那是一种非常特别且非凡的体验。

That's a really special and remarkable experience.

我努力在与患者的工作中创造这种相遇，因为仅此本身就具有治愈力。

And I try to create that in my work with patients because that alone is healing.

我从患者身上学到的可能比我给予他们的回报更多。

I've probably learned more from my patients than I think I've given them in return.

我真心认为从严重成瘾中康复的人们是现代先知——这些人在多巴胺过载的世界里不得不重新理解快乐、痛苦与消费，而且这是生死攸关的课题。

I really see people in recovery from severe addictions as modern day prophets Because these are folks who have had to figure out pleasure and pain and consumption in a dopamine overloaded world, and they've had to do it as a matter of life and death.

而他们成功做到了。

And they've been able to do it.

因此他们确实为我们其他人提供了一条充满深刻智慧的路线图。

And so they really provide this roadmap of deep wisdom for the rest of us.

稍后回来，我们将回答您的问题。

When we come back, your questions answered.

我们将重新探讨听众关于安娜·莱姆克研究的提问。

We revisit listener questions about Anna Lemke's research.

您正在收听《隐藏的大脑》。

Are listening to Hidden Brain.

我是尚卡尔·韦丹塔。

I am Shankar Vedanta.

这里是《隐藏的大脑》。

This is Hidden Brain.

我是尚卡尔·韦丹塔。

I'm Shankar Vedanta.

今天的节目中，我们听到了2023年与精神病学家安娜·莱姆克对话的部分内容。

In today's episode, we heard part of our twenty twenty three conversation with psychiatrist Anna Lemke.

她是《放纵时代中的平衡之道》一书的作者。

She is author of the book Finding Balance in the Age of Indulgence.

我们讨论了大脑中痛苦与快乐之间的平衡，以及现代生活可能如何打破这种平衡。

We talked about the balance between pain and pleasure in our brains and how our modern lives may be throwing off that balance.

当安娜的节目首次播出时，我们收到了大量听众的问题和评论。

We received a flood of listener questions and comments when our episodes with Anna first aired.

现在我们将进入‘你的问题解答’环节，这是在那些节目播出后不久发布的片段。

We're going to turn now to Your Questions Answered, the segment that we released not long after those episodes came out.

我首先询问安娜，她是否对这个话题引起广泛公众兴趣感到惊讶。

I started by asking Anna if she was surprised at the widespread public interest in the topic.

非常惊讶。

Very surprised.

就在节目播出前，我和一位同事交谈，他问：‘这节目是关于什么的？’

So I was talking with a colleague just before it came out, and he said, Well, what's it about?

我说：‘基本上，这是一本关于痛苦对我们有益的书。’

And I said, Well, basically it's a book about how pain is good for us.

他开始大笑，然后说：‘哦，那肯定会成为《纽约时报》畅销书。’

And he started laughing and he said, Oh, that'll be a New York Times bestseller.

我说，没错，正是这样。

And I said, right, exactly.

而令我惊讶的是，它确实如此。

And to, you know, my surprise, it was.

不过我认为，这其实是一个非常古老的观念。

So I think though that, you know, this is a very old idea, really.

它已有数千年的历史。

It's thousands of years old.

这也是许多人一直在探讨的观点。

And it's also an idea that many other people have been putting out there.

但不知为何，我觉得这个观点正合时宜。

But but somehow it's an idea that I think is ripe for our times.

我认为很多人都意识到自己生活在物质丰富的海洋中，但焦虑和抑郁的比率却在上升。

And I think many people are seeing that they live in a sea of plenty, and yet there are rising rates of anxiety and depression.

人们都看到了这一点。

People see this.

人们看到了这个悖论。

People see the paradox.

是的。

Yeah.

在某种程度上，我认为你正在给他们提供解决这个悖论的方法。

And in some ways, I think you are giving them a way to resolve that paradox.

是的。

Yeah.

解决它，命名它，至少在某种程度上理解它，并提供一些可操作的步骤，关于如何应对它。

To resolve it, to name it, to, at least to some extent, to understand it, and also some actionable items, in terms of what to do about it.

正如我所说，我们收到了许多关于成瘾本质的问题。

So as I said, we received a number of questions about the nature of addiction.

让我从一位名叫米歇尔的听众的问题开始。

Let me start with this one from a listener named Michelle.

我想知道的是，为什么一个人可以毫无顾忌地参与某些成瘾活动，却对其他活动上瘾？

What I would love to know is why is it that one person can engage in certain addictive activities with impunity but become addicted to others?

例如，我一生中都能毫无问题地使用尼古丁缓解产品。

For example, I've been able to take relief nicotine throughout my life.

你知道，即使我定期吸烟，也不会对它产生渴望。

You know, even if I smoked it regularly, I would not crave it.

然而我每天都离不开咖啡，却必须完全戒酒。

Yet a day doesn't go by that I don't drink coffee and I have to completely abstain from alcohol.

我还认识一些人，他们可能偶尔娱乐性地使用硬性毒品，可以随时戒掉，但他们可能有购物成瘾或性爱成瘾的问题。

And I know others who used perhaps hard drugs recreationally and could take it or leave it, but they may have had shopping addictions or sex and love addictions.

那么，是什么让一个人对某种成瘾行为产生依赖，而非另一种呢？

So what is it that draws one person to a certain type of addiction as opposed to another?

你怎么看，安娜？

What do you think, Anna?

是否有什么原因导致某些人容易被特定成瘾源吸引，而对其他则不然？

Is there a reason why some people are drawn to some sources of addiction and not to others?

这是个很好的问题。

This is a great question.

而且这个问题在科学界的研究出奇地少。

And it's a question about which there's remarkably little science.

这方面还需要更多的研究。

And there needs to be a lot more.

我们称之为‘首选药物’的概念，即对某人大脑极具诱惑力的东西，对另一个人可能完全无效，反之亦然。

We call this the concept of drug of choice, which is to say what is highly reinforcing for one person's brain may not be so for another and vice versa.

当我从进化角度思考这个问题时，我认为这实际上是自然母亲在确保整个族群能在群体层面上获得生存所需的一切。

And when I think about this from an evolutionary perspective, I think, well, this is actually mother nature ensuring that the tribe gets everything it needs to survive on a population level.

如果我们都去争夺同一片浆果丛，那么我们最终会得到很多浆果，但却没有足够的肉类、住所、伴侣或其他生存必需品。

If we were all going for the same berry bush, then we would end up with a lot of berries, but not enough meat, not enough shelter, not enough partners or whatever it is that we need to survive.

通过确保我们每个人的大脑回路都略有不同，自然母亲保证了在资源匮乏的世界里，我们作为一个整体能够获得生存所需的一切。

But by ensuring that we're all wired just a little bit differently, what mother nature has done is made sure that in a world of scarcity, we are collectively getting everything that we need.

顺便说一句，请重新审视当今世界那些严重成瘾者——在资源匮乏的世界里，他们本应是群体生存至关重要的关键人物。

And by the way, do reframe people with severe addiction in today's world as people who would have been absolutely crucial for survival of the group in a world of scarcity.

我的意思是，在一个需要付出极大努力才能获得最微薄回报 酬的世界里，你会需要那些对获取特定物质异常执着的人。

I mean, a world where we have to work very hard to get even the merest of rewards, you would want people who were very very tenacious about getting a particular substance.

但‘首选药物’这一概念与我们当前时代的独特性也密切相关。

But this whole concept of drug of choice is also really relevant for what is unique about the time that we live in now.

就拿我自己举例来说吧。

I mean, I'll just use myself as an example.

我曾以为家族中的成瘾基因跳过了我，因为酒精从未给我带来任何快感，也没有缓解焦虑的作用。

I used to think that the addiction gene skipped me in my family because alcohol never really gave me any kind of euphoria, wasn't an anxiolytic.

甚至连咖啡因也提不了我的神。

Even caffeine doesn't wake me up.

我当时想，无论这种成瘾性是什么，我肯定没有遗传到。

I thought, well, whatever this addiction thing is, I must not have inherited it.

但事实是我尚未遇到我的‘首选药物’，直到中年时才发现——比如这种小说化的浪漫小说，在我拥有Kindle后能即时获取和阅读。

But the truth was I just hadn't yet met my drug of choice, and it wasn't until midlife when I discovered, you know, this kind of drugified novel, the romance novel when I got a Kindle so there could be this immediate access and delivery.

随后我便深陷其中而不自知，这很重要，因为它表明：即便我们这些曾对成瘾问题免疫的人，如今也因世界将看似无害的行为变得极具强化性和可及性而变得脆弱。

And then I was off and running, completely caught up in it unawares, which is important because what it says is that though those of us who previously have been immune to the problem of addiction are now vulnerable because of the ways in which our world has taken even seemingly innocuous behaviors and made them highly reinforcing, highly accessible.

尽管如此，仍需承认我们天生对成瘾的易感性存在程度差异。

All of this being said, it's still important to acknowledge that we do come into this world with different degrees of vulnerability to addiction.

因此我们中有些人天生就比其他人更容易受到成瘾问题的困扰。

So there are some of us who are much more vulnerable in general to the problem of addiction than others.

这些人几乎会对所有物质和行为都产生依赖。

And those individuals will struggle with almost every substance and behavior.

换句话说，那种不顾有害后果而强迫性过度消费的倾向，确实是某些人无论面对何种药物都会与之抗争的问题。

In other words, the kind of tendency to compulsively over consume despite harmful consequences, is something that some individuals really do struggle with no matter what the drug is.

这些人很可能会发展成非常严重的成瘾症状。

And those are individuals who, you know, will go on to develop very severe addictions potentially.

这部分人群大约占总人口的10%到15%。

And that's probably about ten to fifteen percent of the population.

但我想再次强调，由于现代生活环境的影响，受成瘾问题困扰的人群比例正在增长。

But again, I think the segment of the population struggling with addiction is growing because of our modern ecosystem.

从某些方面来说，安娜，你刚才已经预见到了听众罗恩的下一个问题：是否有些人天生更容易对事物上瘾？

In some ways, think, Anna, you just anticipated the next question, which comes from listener Ron, who is asking the question, are some people more vulnerable to addictions in general?

现在让我们听听他的提问。

Here he is.

为什么有些人似乎更容易具有成瘾性人格，而另一些人却能饮食有度，从不陷入成瘾循环，永远不会成为成瘾者？

Why is it that some people seem to be more of the addictive personality type, while other people seem to be able to eat or drink and never develop the addictive cycle, never become addicts?

这是怎么回事呢？

How is that?

有没有什么方法可以解释，为什么有些人天生倾向于一种方式，而另一些人则倾向于另一种方式？

And is there any way we can explain why some people are simply hardwired one way and some people the other way?

非常感谢。

Thank you so much.

我真的很喜欢这个节目。

I really enjoy the show.

那么安娜，你认为原因是什么，为什么我们中有些人似乎更容易有成瘾倾向，而另一些人则少得多？

So what do you think the reason is, Anna, that some of us seem to have a greater tendency towards addiction and others have much less?

确实，不同的人对成瘾问题的易感性各不相同。

It's true that different people have different vulnerabilities to the problem of addiction.

我们过去称之为成瘾性人格。

We used to call this the addictive personality.

现在我们使用成瘾疾病这一说法，有些人比其他人更容易受到成瘾疾病的影响。

Now we use the language of the disease of addiction and some people are more vulnerable to the disease of addiction than others.

成瘾是一种复杂的生物心理社会疾病，这意味着有生物学因素、心理学因素和社会环境因素的共同作用。

Addiction is a complex biopsychosocial illness, meaning that there are biological contributors, psychological contributors, and social contextual contributors.

当我们观察成瘾的生物学或遗传方面时，确实发现那些有生物学父母或祖父母（特别是对酒精成瘾）的个体，即使在不饮酒的家庭中长大，也比普通人群更容易对酒精产生依赖。

So when we look at the biological or inherited aspect of addiction, we do know that individuals who have a biological parent or grandparent addicted to alcohol in particular are more vulnerable than the general population of becoming addicted to alcohol themselves, even if raised out of that alcohol using home.

这一点很重要，因为心理层面的因素是：如果我们在一个看护者明示或默许物质使用或其他成瘾行为的家庭中长大，我们自己更容易上瘾。

So that's important because the psychological piece is that if we are raised in a home where our caregivers are either explicitly or implicitly condoning substance use or other addictive behaviors, we are more likely to get addicted ourselves.

因此这种心理或养育方面的影响也具有生物学意义，即表观遗传学——我们的经历会开启或关闭某些基因，产生特定蛋白质，这些变化还可能遗传给下一代。

So then you have this kind of psychological or nurture aspect which is also biological in the sense that of epigenetics and how our experiences will turn on and off certain genes making certain proteins, which also can potentially be passed on to the next generation.

这就是为什么像多代创伤这样的因素也会增加成瘾风险。

This is why things like multi generational trauma, for example, also increase the risk of addiction.

最后还有社会或环境因素，比如简单的可获得性。

And then finally you have social or contextual factors, which is, for example, simple access.

如果你生活在毒品容易获取的环境中，你更可能尝试它们，从而更容易上瘾。

If you live in an environment where drugs are readily available, you're more likely to try them and hence more likely to get addicted to them.

当然，这正是《多巴胺国度》一书的核心主题。

And of course, that's what Dopamine Nation is all about.

稍后回来，我们将探讨健康热情与不健康成瘾之间的界限在哪里？

When we come back, where's the line between a healthy passion and an unhealthy addiction?

您正在收听的是《隐藏的大脑》。

You're listening to Hidden Brain.

我是尚卡尔·韦丹塔。

I'm Shankar Vedanta.

这里是《隐藏的大脑》。

This is Hidden Brain.

我是尚卡尔·韦丹塔。

I'm Shankar Vedanta.

精神病学家安娜·莱姆克提出，快乐与痛苦就像我们大脑中的跷跷板两端。

Psychiatrist Anna Lemke argues that pleasure and pain exist on opposite ends of a seesaw in our minds.

我们中有太多人过于频繁地按压着快乐那一端的跷跷板。

Many of us are pressing down too hard and too often on the pleasure side of the seesaw.

我们通过购物、游戏和赌博给自己带来短暂的小愉悦。

We give ourselves little jolts of pleasure through shopping, gaming, and gambling.

这会迫使大脑通过跷跷板的痛苦端进行补偿，导致成瘾、自残和焦虑率上升。

That can force our brains to compensate by pressing down on the pain side of the seesaw, leading to higher rates of addiction, self harm, and anxiety.

现在，安·莱姆克正在回答你们关于如何平衡这个跷跷板的问题。

Now, Anu Lemke is answering your questions about how to balance that seesaw.

安娜，我们最初交谈时让我印象深刻的一点是，当一个人真正上瘾时，往往很难意识到自己已深陷其中。

Anna, one of the things that jumped out at me in our initial conversation is that it can be very hard to recognize that you're in the grip of an addiction when you are in fact addicted.

这里有一条来自听众汉娜的留言。

Here's a message we received from a listener named Hannah.

我的第一个问题是，热情与多巴胺过量有什么区别？

My first question is, what is the difference between passion and too much dopamine?

例如，如果你对冲浪或滑雪充满热情，或者你热衷于在职业生涯中晋升，什么时候它会变成一种不健康的多巴胺反应？

For example, if you're passionate about surfing or skiing or you're passionate about rising the ranks of your career, At what point does it become like an unhealthy dopamine response?

你如何区分这两者，特别是当你试图成为某个领域的专家时？

How do you distinguish between the two, especially if you are trying to be an expert at something?

那么，在这些不同活动中投入的时间与可能被视为不健康的行为之间，界限在哪里？

So what's the line between the time that you invest in in all of these different activities and something that might be considered unhealthy?

我的第二个问题是，如何避免成为卢德分子？

My second question is how do you avoid being a Luddite?

如果你在回避多巴胺触发因素，但又不想在社会中落后？

If you're avoiding dopamine triggers but you don't want to fall behind in society?

安娜，这里有两个问题。

So two questions here, Anna.

第一个是，热情与成瘾之间的区别是什么？

The first is, what's the difference between passion and addiction?

第二个观点是，当你看到周围所有人每周工作九十小时以求在事业上领先时，你如何在事业上取得进步而不让它变成一种执念？

And the second idea here is, you know, if you see all the people around you, you know, working ninety hour weeks to get ahead in their careers, how do you try and get ahead in your career without it becoming an obsession?

对。

Right.

当我使用‘成瘾’这个词时，是指一种精神病理学或精神疾病的表现形式。

So addiction, when I use that word, is intended to denote a form of psychopathology or mental illness.

必须明确一点，成瘾并没有脑部扫描、血液检测或其他客观测量手段可以确诊。

And it's always important to clarify that there is no brain scan or blood test or other objective measure of addiction.

我们依据现象学做出诊断。

We base the diagnosis on phenomenology.

即持续强迫性使用行为模式，尽管对自身或他人造成伤害。

That is to say patterns of behavior of continued compulsive use despite harm to self or others.

因此，热情何时转变为成瘾，实质上是判断这种行为是否对自身和/或他人有害的问题。

So the question of when a passion, gives way to an addiction is really the question of whether or not it's harmful to self and or others.

这种伤害可能包括个体自身尚未意识到、但他人已察觉到的危害。

And that could include harm that the individual him or herself doesn't recognize, but that others recognize.

话虽如此，由于文化因素对‘功能失调’或‘有害’的定义不同，判断何时跨越界限变得极为复杂。

Having said that, the question of when we cross that Rubicon is very complex because of the cultural aspects in terms of who defines what is dysfunctional or harmful.

来电者提到工作，这引申出一个问题：何时算工作狂，何时只是对事业全心投入？

You know, the caller referred to work, which implies a question, well, when are you a workaholic and when are you just really invested in your career?

当代英雄形象往往是那些长时间工作、几乎为事业牺牲一切的人——有时是为了金钱，有时是为了名声。

And our, you know, our modern day heroes are people who work a lot of hours and sacrifice almost everything to career, in some instances to money, in some instances to fame.

而这些人正是我们心目中的英雄。

And those are our heroes.

所以我们并不认为这些人是在进行病态行为。

So we don't recognize those individuals as engaging in pathological behaviors.

于是现在我们就面临社会认知层面的问题。

So now we have the issue of the societal overlay.

社会规范会告诉我们：这是非法毒品。

What society says is, okay, this is an illegal drug.

这是合法药物。

This is a legal drug.

这是健康行为。

This is a healthy behavior.

这是不健康行为。

This is an unhealthy behavior.

我认为当行为走向极端时，很多人都会认同说：'没错，这个人对X、Y或Z上瘾了'——无论是冲浪、滑雪还是工作，当他们超越了身体承受极限，无法维系健康人际关系，不能照顾好自己和所爱之人，违背了自身价值观的时候。

I think when taken to the extremes, I think many people would be able to say, oh, yeah, that person is addicted to x, y, or z because they keep surfing or skiing or working beyond the point where it's good for their bodies, beyond the point where they're able to foster healthy relationships, take care of themselves and the others that they love, live according to their values.

所有这些都隐含了我们对价值观和美好生活的理解。

Implicit in all of these are ideas we have about values and what makes for the good life.

就卢德主义的问题而言，关于不想落后以及数字媒体如何渗透到我们生活的每个角落。

I'd say in terms of the Luddite question and not wanting to fall behind and the extent to which digital media is interwoven into every aspect of our lives.

当我们思考数字媒体和数字毒品的过度消费时，我们究竟该如何定义它？

When we're thinking about over consumption of digital media and digital drugs, You know, how on earth do we define that?

我们该如何摆脱它？

How do we get away from it?

这些都是非常重要的问题，我认为我们现在都应该提出这些问题，而我不敢妄言拥有答案。

And these are really important questions that I think we should all be asking now, and I wouldn't presume to have the answers to.

我认为我们正处于一场宏大社会人类实验的前沿。

I think we're, you know, at the forefront of a grand social human experiment.

我对数字媒体在我们生活中的作用做出了一些假设，即尽管它带来了诸多好处，但也存在危害。

And I've made certain assumptions about digital media in our lives, namely that for all the good that it's done, there are harms.

因此我建议，每天或每周抽出一段时间远离数字媒体和电子设备——目前还没有数据表明具体多长时间才算过度。

So I'm suggesting that disconnecting from digital media and from our devices for a period of time every day, or maybe a day, a week, or what have you, there's, you know, there's no data on this amount of time is too much.

如果你把时间限制在这个范围内，那就没问题。

And if you limit it to that amount of time, you're Okay.

不过我们有数据显示，随着上网时间逐渐增加，我们更可能出现焦虑、抑郁、失眠和注意力不集中等症状。

Except to say that we do have information that shows that as we progressively spend more and more time online, we are more likely to manifest symptoms of anxiety, depression, insomnia, inattention.

显然这两者之间存在关联。

So there's clearly a correlation between these two things.

根据我的假设，我认为还存在因果关系——正是我们花在网上的大量时间导致了我们的不快乐。

And as I hypothesize, I think there is also causation, that it is the enormous amount of time that we're spending online that's contributing to our unhappiness.

我得出这个结论部分基于我们的临床干预经验，我们看到许多患有焦虑、抑郁等问题的患者消费了海量的数字媒体。

And I base that in part on the interventions that we do clinically, where we see people who come with anxiety, depression, what have you, consuming enormous amounts of digital media.

我们会要求他们戒断一段时间。

We ask them to abstain for a period of time.

结果发现，在没有进行任何其他干预的情况下，许多人感觉好多了。

And what we find is that many of them feel better without our doing any other intervention.

因此我将此与毒品和酒精类比，当患者能够长期戒断毒品和酒精时，我们看到了类似的益处。

And so I make this analogy to drugs and alcohol, and the same kinds of benefits that we see in our patients when they can abstain from drugs and alcohol for long enough.

这基本上就是我的观点来源。

And that's kind of, you know, where I'm coming from with that.

考虑到'成瘾'这个词带有负面含义，安娜，我担心某种程度上人们可能会用这个词来标记那些他们不认同的行为。

You know, given the fact that the term addiction has a negative connotation, Anna, I'm worried that in some ways people may use the term really as a way of marking people whose behavior that they don't agree with.

比如说，我不是铁人三项运动员，所以我可以看着参加铁人三项的人说：看啊，这个人已经走火入魔了。

So for example, I am not a triathlete, and so I can look at someone running triathlons and say, look, this person is obsessed.

这几乎就是一种成瘾。

It borders on an addiction.

他们确实应该减少训练量，进行更有节制的运动。

They really should be scaling back and, you know, exercising much more moderately.

我们该如何制定成瘾的定义，而不让它沦为单纯的谩骂工具？特别是针对我们的对手或意见相左的人时。

How do we come up with definitions of addiction that don't just devolve into name calling, especially when it comes to people who are our opponents or people who we might disagree with?

我同意你的观点。

I agree with you.

我认为这里确实存在过度概括、贴标签的危险，甚至可能通过滥用'成瘾'概念来淡化真正的成瘾疾病。

I think there's a real danger here of overgeneralizing, of labeling, of in fact trivializing the disease of addiction by using it in instances where it doesn't really apply.

要知道，我们在临床上诊断成瘾症时，不会草率行事。

You know, when we diagnose addiction clinically, we don't do that casually.

我们会与患者长谈，与其家属沟通，力求获得全面的360度视角，既要了解主观感受，也要收集客观数据来判断行为是否真正有害。

We talk to patients at length, we talk to their family members, we try to get a full three sixty degree view, we get the subjective encounter, but we also try to get non subjective data that might help inform us whether or not this behavior is really harmful.

因为我同意你的观点，某些人参与活动的强烈程度对他们而言可能恰恰是健康的，对吧？

Because I agree with you, you know, you're absolutely right that the level of intensity that some people will engage in activities may be for them really healthy, right?

人们在气质上对活动强度和参与度本就有着不同的需求。

People have, I mean, just temperamentally different needs for intensity and engagement.

我特别不希望传递出'任何高强度投入都是成瘾'这样的信息。

And I would hate to send the message that any kind of intense engagement is an addiction.

这完全不是我要表达的意思。

That's not at all what I'm saying.

我认为这会让成瘾症这种不仅使人衰弱、甚至危及生命的疾病显得无足轻重。

And I think it trivializes the disease of addiction, which can be not just debilitating, but also life threatening.

是否可以说：当问题者意识到自己有问题时，这种情况就更符合成瘾症的特征？

Is it the case that we can say if the person with the problem recognizes they have a problem, that makes it a good candidate for it to be an addiction?

虽然我这么说的时候意识到，成瘾的一个作用就是剥夺我们的洞察力。

Although as I'm saying this, I'm realizing, of course, one of the things that addiction does is rob us of insight.

没错。

That's right.

正是如此。

Exactly.

唉，我多希望我们能把这个作为判断标准，但这会极具误导性，因为当我们沉迷于这类高度强化的行为时，很容易看不清真正的因果关系。

Oh, I wish that it were that we could use that as a criteria, but that would be incredibly misleading because it's very easy to lose sight of true cause and effect when we are engaging in these types of highly reinforcing behaviors.

事实上，成瘾领域对此有个术语众所周知，就叫否认。

And in fact, it's so well known in the field of addiction that there's a term for it, denial.

否认是一种极其强大的力量。

And it's a powerful, powerful thing, denial.

一个深刻的事实是，即使严重成瘾者也可能对其行为造成的伤害认知非常有限，尽管对周围所有人来说这都显而易见，哪怕他们已经因此遭受了严重的健康后果、人际关系后果和法律后果。

It's profoundly true that even people with very severe addictions can have very limited awareness of the harm that their behavior is causing, even though it's patently obvious to everyone around them, even if they've gotten to the point where they've incurred serious health consequences, relationship consequences, legal consequences.

当然，并非所有成瘾者都是这样。

So, you know, and that's not true for everybody with addiction, obviously.

但对足够多的人来说确实如此，这已成为该领域的常见说法。

But it's true for enough people that it's a common trope in the field.

事实上，我曾有位病人告诉我，否认(denial)这个词其实是个缩写，意思是'甚至不知道自己正在撒谎'。

In fact, I had a patient say to me that denial is actually an acronym for don't even know I am lying.

我们收到了大量听众的反馈，他们想了解ADHD（注意力缺陷多动障碍）与成瘾之间的关系。

We received a large number responses from listeners who wanted to know about the relationship between ADHD and addiction.

这个问题来自瑞士苏黎世的史黛西。

This question comes from Stacy in Zurich, Switzerland.

关于成瘾的问题，我想探讨神经多样性因素，因为我觉得很多时候我们只关注神经典型人群对多巴胺的反应。

My question regarding addiction is regarding neurodiversities because I feel like a lot of the time we're just dealing with neurotypical people and how they respond to dopamine.

然而，当像我或我的孩子这样患有ADHD时，对多巴胺刺激的渴望会强烈得多。

However, when you have something like ADHD, like myself or my children, the urge to have a dopamine hit is so much stronger.

我注意到自从开始服用ADHD药物后，我对YouTube、Facebook或Instagram这些产生多巴胺事物的成瘾程度降低了。

And I've noticed that since I've begun taking medication to treat my ADHD, I find myself less addicted to dopamine producing things like YouTube or Facebook or Instagram.

我只是好奇神经多样性在其中扮演的角色是否比人们意识到的更重要，我们是否应该提供更多关于神经多样性如何影响成瘾的培训或信息。

And I just wonder if neurodiversity is playing a larger role in this than people are really realizing and whether we should have more training or more information available about the way that neurodiversities affect us in regards to addiction.

谢谢。

Thank you.

真有意思。

Fascinating.

娜娜，ADHD与成瘾之间有什么联系？

What's the connection between ADHD and addiction, Nana?

目前已有相当可靠的流行病学证据表明，被诊断患有ADHD的儿童日后发展成瘾行为的风险更高。

So there's fairly reliable evidence, epidemiologic evidence to show that children who are diagnosed with ADHD are at increased risk of developing addiction later in life.

虽然具体原因尚不明确，但通过测试可发现，与成瘾发展相关的一个持久性格特征就是冲动性。

And it's not clear why that is, but one of the enduring character traits that you can test for that is also associated with the development of addiction is impulsivity.

冲动性是指在产生某个行为念头与实际执行之间难以按下暂停键的倾向。

And impulsivity is the tendency to have difficulty putting a pause between the thought of doing something and actually doing it.

如果ADHD确实是前额叶皮层连接差异导致个体控制冲动或理解延迟后果的能力受限，那么这些人在成长过程中更容易受到成瘾问题影响就说得通了。

So if ADHD is indeed a difference in prefrontal cortex wiring that limits a person's ability to, let's say control their impulses or appreciate delayed consequences, then it makes sense that those individuals might be more vulnerable to the problem of addiction getting older.

另外据我所知——虽然我对这方面不太熟悉——有研究指出，就多巴胺释放而言，ADHD患者在奖励通路中的基础多巴胺释放水平可能本来就较低。

There's also I believe, although I'm not really familiar with this literature, a literature suggesting that when it comes to dopamine firing, that people with ADHD might at baseline actually have lower levels of dopamine firing in the reward pathway.

我的意思是，他们可能在某种程度上对奖励不敏感。

And by that I mean, might be to some degree reward insensitive.

因此可能在基线状态下需要更强烈的奖励才能感受到奖励效果。

So might at baseline need more potent rewards to feel the rewarding effects.

不过我认为有一点很重要需要让公众了解，这个观点大约二十年前在该领域被提出，基于早期分析表明：如果你把一群ADHD儿童分成两组，一组用兴奋剂治疗ADHD，另一组不用兴奋剂治疗，那么接受兴奋剂治疗的儿童成年后发展成瘾的风险会降低。

One of the things that I think is important though to get out into public awareness is this idea that was promulgated in the field about twenty years ago based on, you know, early analyses that suggested that if you take a group of kids with ADHD and you give half of them stimulants to treat the ADHD and the other half you don't give those stimulants, The idea was that the kids that you give stimulants to will have a decreased risk of developing addiction in adulthood.

这个观点认为兴奋剂会以某种方式保护他们免受成瘾问题困扰。

The idea being that somehow the stimulants would protect them from that problem.

这个观点基本上已经被推翻。

That has essentially been debunked.

最新的荟萃分析并不支持这个观点。

So you know a more recent meta analysis does not give credence to that idea.

因此治疗ADHD的药物看起来并不能预防日后生活中出现成瘾问题。

So medications to treat ADHD looks like it's not protective in terms of later life development of addiction.

而在我的临床实践中——当然我的专业领域就是成瘾治疗，所以这本身就带有某些固有偏见。

And in my practice, and of course my practice is an addiction practice, so you know it comes with some inherent bias there.

但在我的临床实践中，我看到的是那些为治疗ADHD而接触兴奋剂、随后对这些兴奋剂上瘾的个体。

But in my practice, what I see is individuals who are exposed to stimulants to treat their ADHD and then become addicted to those stimulants.

显然，并非所有因ADHD接受兴奋剂治疗的人都会如此。

So that's obviously not going to be, you know, everybody who gets stimulants for ADHD.

但再次强调，如果你接触某种药物，当这种药物改变你的大脑时，它可能会以让你变得更加脆弱的方式改变你的大脑。

But again, if you're exposed to a drug, if that drug then changes your brain, it may change your brain in a way that actually makes you more vulnerable.

许多听众对孩子们花在手机和其他设备上的时间表示担忧。

Many listeners voiced concerns about kids and the amount of time they spend on cell phones and other devices.

我们收到了来自伊利诺伊州芝加哥的吉赛尔的这个问题。

We received this question from Giselle in Chicago, Illinois.

我在一所高中工作，这是我目前遇到的最大挑战。

I work at a high school, and it's by far the biggest challenge I encounter.

尽管我们制定了关于收起手机的各种规定和持续提醒，但孩子们每次坚持不到五分钟就会重新拿起手机。

Kids cannot stay off their phone for more than five minutes at a time despite all the rules and policies we have about putting phones away and constant reminders.

孩子们就是无法摆脱手机，这种成瘾现象是真实存在的。

Kids just cannot get off it and the addiction is real.

我担心我们作为一个机构，没有把这个问题当作严重的成瘾行为来对待。

And I worry that we're not as an institution not addressing it as the serious addiction it is.

我担心孩子们的心理健康，也担心他们无法学习，因为他们一次最多只能集中注意力五到十分钟。

I worry that about kids mental health, and I worry about them also not learning because they can't focus for more than five, ten minutes at a time.

你有什么建议？或者在高中学段我们应该采取什么解决方案来让孩子们远离手机？

What do you recommend or what solution should we do at the high school level to keep kids off their phones?

谢谢。

Thanks.

安娜，你怎么看？

What do you think, Anna?

嗯，这也是我非常担忧的问题，尤其是我认为有一个相当不错的解决方案，那就是我认为学校——从小学到初中再到高中——都应该实行自上而下的政策，在上课期间禁止使用手机。

Well, this is a very, dire concern of mine as well, especially because I feel like there is a pretty good solution for it, which is to say, I believe that schools, from elementary to middle school to high school should have top down policies where phones are not allowed during school hours.

这种自上而下的政策意味着每个人都必须远离手机。

And this top down policy means that everybody has to be off of their phone.

这样就消除了FOMO（害怕错过）的问题，这是促使孩子们不断回到网上的重要驱动力，更何况这些设备本身就具有极强的强化作用和成瘾性。

You eliminate the problem of FOMO or fear of missing out, which is a big driver of what gets kids, you know, going back online in addition to the fact that these devices are just inherently highly reinforcing and addictive.

但当你实施这些自上而下的政策时，对孩子们来说其实是一种解脱。

But when you have these top down policies, it's a relief for kids.

每个人都不再使用手机。

Everybody's off their phone.

他们必须这么做。

They have to be.

这是规定。

It's the rule.

现在有些学校正在实施一些非常聪明的做法。

And there are some really clever things that schools, some schools are doing now.

比如有些学校使用一种专用袋——孩子们早上到校时把设备放进袋子里，袋子会被密封或上锁。这样孩子们虽然随身带着手机，但在上学期间无法收发信息。

For example, there are these pouches that in some schools kids, when they come to school in the morning, they put their device in the pouch, the pouch is sealed or locked, then the kid keeps their phone with them, but they can't receive or transmit during the school day.

放学时设备会被解锁，孩子们就能拿回手机重新使用。

And at the end of the school day, the device is unlocked and kids can have their phones back and go back on their phones.

实施这种措施的学校反馈说，校园里又恢复了喧闹声。

And schools that are doing this are reporting that schools are noisy again.

为什么学校变得吵闹了？

Why are they noisy?

因为孩子们正在互相交流。

Because kids are interacting with each other.

马萨诸塞州还有一所私立学校——巴克斯顿学校，他们没收了高中生的手机。

There's also was a private school in Massachusetts, the Buxton School, that took phones away from their private high school students.

他们注意到学生心理和情绪健康有了巨大改善。

And they noticed huge improvements in psychological and emotional well-being.

我觉得这既充满希望又十足可悲——我们竟然没有大规模地将这项政策从小学一直贯彻到十二年级作为标准。

And I just think this is just both hopeful and also completely tragic that we are not on mass, you know, making this just standard policy for primary schools all the way up through twelfth grade.

这对孩子们不公平。

It's not fair to kids.

这对教师不公平。

It's not fair to teachers.

这些极具诱惑力的设备创造了让人难以专注学习的环境，这对所有人都不公平。

It's not fair to anybody that these incredibly compelling devices, you know, create the kinds of environments that make it really difficult for folks to learn.

当然，我们不会因噎废食。

And of course, you know, we're not gonna throw the baby out with the bathwater.

智能手机和这种互联性确实有很多优点。

There are a lot of great things about smartphones and about this kind of connectivity.

但天啊，我们需要与技术建立更健康的关系。

But gosh, like, let's get a healthier relationship with the technology.

某种程度上，这让我想起我们初次交谈时你说过的话，安娜——虽然成瘾是个体面临的问题，但有时不能指望个体独自解决这些成瘾问题。

In some ways, think this echoes something that you told me when we talked first, Anna, which is that even though addictions are a problem that individuals face, there are times when individuals can't be held responsible for fixing those addictions.

有些成瘾需要在结构层面解决，需要机构和社会的力量。

Some of those addictions need to be fixed at the structural level, at the level of institutions, at the level of society.

完全正确。

Absolutely.

就拿酒精举例来说吧。

I mean, let's just take alcohol as an example.

大多数饮酒的人并不会最终对酒精上瘾。

The majority of people who drink alcohol are not going to go on to become addicted to alcohol.

但约有10%到15%的人会在生命中的某个阶段发展出酒精使用障碍。

But about ten to fifteen percent of individuals will at some point in their lives develop an alcohol use disorder.

这些人天生就对酒精成瘾问题具有更高的易感性。

Those are people who just innately have increased vulnerability to the problem of alcohol addiction.

因此，作为一个社会，，我们认识到酒精可能造成危害，并制定了相关法规。

Hence we've recognized as a society that alcohol can do harms and we've made rules and regulations around how alcohol can be consumed, how it can be sold, how it can be marketed.

我们尤其要保护儿童。免受酒精侵害。

Especially we're looking out for children.

儿童在达到一定年龄前不能购买酒类。

Children can't buy alcohol until a certain age.

酒类不能以特定方式进行营销。

Alcohol can't be marketed in a certain way.

这些都是我们需要采用的措施——在思考数字设备和数字媒体时，我们需要实施这类干预措施、政策以及最基本的思考过程。

These are the types of things that we need to employ, the types of interventions and policies and just plain old thought process we need to employ when we're thinking about digital devices and digital media.

稍后回来时，我们将讨论对健康事物上瘾的悖论。

When we come back, the paradox of becoming addicted to things that are healthy.

您正在收听《隐藏的大脑》节目。

You're listening to Hidden Brain.

我是尚卡尔·韦丹塔。

I'm Shankar Vedanta.

这里是《隐藏的大脑》。

This is Hidden Brain.

我是尚卡尔·韦丹塔。

I am Shankar Vedanta.

今天我们将与精神病学家安娜·莱姆基探讨痛苦与快乐的话题。

Today we are discussing pain and pleasure with psychiatrist Anna Lemke.

安娜正在解答听众关于成瘾问题及其各种最有效治疗方式的提问。

Anna is answering your questions about addiction and the most effective ways to treat various forms of it.

安娜，许多听众指出对健康事物的成瘾同样可能带来问题。

Anna, many listeners pointed out that addictions to things that are healthy can also be problematic.

因此，对食物或运动的成瘾与可卡因或海洛因的成瘾不同，因为食物和运动实际上对我们有益。

So being addicted to food or exercise is not the same thing as an addiction to cocaine or heroin because food and exercise are in fact good for us.

但一位名叫南希的听众表示，希望能探讨运动成瘾这个话题。

But a listener named Nancy said, I would like the topic of exercise addiction to be explored.

我一生中大部分时间都受此困扰。

I've had this addiction for most of my life.

我今年65岁，相信并非只有我一人如此。

I'm 65, and I'm sure I'm not alone.

每天都有运动需求既是福报也是诅咒。

It's both a blessing and a curse to feel the need to exercise every day.

我们还收到宾夕法尼亚州听众肯德尔的问题。

We also received a question from a listener named Kendall in Pennsylvania.

老实说，我觉得所有进食体验都令人着迷，无论食物种类。

If I'm honest, I find all eating experiences compelling, regardless of the type of food.

那么当我需要靠进食维持生命时，该如何戒除食物成瘾呢？

So how can I recover from food addiction if I need to eat to be a person and live?

我实在怀疑经过三十年，自己能否在内心找到平衡，寻得可以信赖的那部分心智。

I'm just doubtful that after thirty years, I can find balance in my mind and find a part of my mind I can trust.

安娜，你怎么看？

What do you think, Anna?

某种程度上，我认为这位听众确实触及了要点——当你对本质上健康的事物上瘾时，会形成极其复杂的困境。

In some ways, I think the listener is on to something, which is when you're addicted to something that is also, for the most part, healthy, it creates a very complicated situation.

是的，那通电话确实令人动容。

Yeah, that was a really touching call.

我的理解是，她直接反驳了多巴胺戒断或彻底戒除问题物质/行为的理念。

The way that I heard it is that she was pushing back directly on this idea of dopamine fasting or cutting out, the particular substance or behavior that's problematic.

我听到她的核心意思是：所有食物对我来说都是问题。

And what I heard her saying is that all food is problematic for me.

这并非只是戒掉纸杯蛋糕、饼干和薯片那么简单。

It's not a matter of cutting out cupcakes and cookies and potato chips.

就算你给我沙拉，我也有可能暴食沙拉。

Even if you gave me a salad, I have the potential to binge eat on salad.

所以我认为这一点很关键——当涉及食物这类必需品时（就像已深度融入生活的科技产品一样），情况会变得尤为复杂。

So that I think is a really important point that when it comes to something like food, and I think food can be easily analogized also to the technology that's so embedded in our lives.

从某种程度上说，我们无法对那些生存必需或现代生活必需的事物进行多巴胺戒断，这使得控制这类不健康的消费行为变得异常困难。

There is on some level not a way to dopamine fast from something that we need in order to survive or to make our way through modern life and making it just way way more difficult to get a handle on those kinds of unhealthy consumptive behaviors.

现在你基本上可以对任何事物上瘾。

You can basically binge on anything now.

我个人认为，我的专业经验也印证了这一点。

I personally think and my professional experience speaks to this.

这时就需要寻求他人帮助，尤其是那些面临相同问题的人——无论是通过'食物成瘾者匿名会'或'暴食者匿名会'这类十二步互助小组，还是其他形式的同侪支持。

That's where getting help from others, especially from other individuals struggling with the same problem either through twelve step peer support like food addicts anonymous or overeaters anonymous, or other forms of support from people who are struggling with the same or similar problem even if it's not twelve step.

在消费行为调节方面与他人建立联系非常有帮助，或者说具有极大的潜在帮助。

Connecting with others around regulation of our consumptive behaviors is hugely helpful or has the potential to be hugely helpful.

这是一种我们可以参与的协同调节：首先对他人彻底坦诚问题，认识到我们并不孤单，然后与他人同步行动，共同分享挣扎过程，从而找到平衡之道。

This is a kind of co regulation that we can engage in first by being radically honest about the problem with others, recognizing we're not alone, And then in tandem with others and sharing our struggles together, I'm finding you know, a way to get into balance.

我还认为某些心理技巧在这里会很有帮助。

I also think that this is where certain psychological techniques can be helpful.

正念经常被提及，现在甚至出现了'正念饮食运动'。

Mindfulness is often talked about and there's a sort of a mindful eating movement.

你知道，这很有趣，因为正念饮食运动的倡导者在某种程度上反对任何形式的限制，他们的论点是限制任何食物类别会导致或助长那种禁欲限制、然后暴食、再重新开始的循环。

You know, it's interesting because the mindful eating movement folks, I think, on some level, push back on any kind of restrictions, because their argument is that restricting any food group leads or contributes to the cycle of sort of abstinence restricting, and then bingeing, and then starting all over again.

而且我认为，这其中确实有一定道理，但我想说的是，认识到我们对食物的态度可能是一种成瘾非常重要，因为我们已经将食物供应药物化，使其更具强化作用。

And and I think, you know, that that there is some truth to that, except that what I would say is that I think it's really important to recognize that our orientation with food is potentially an addiction because we've drugified our food supply and made it so much more reinforcing.

因此，戒除成瘾性食物确实有助于打破这个循环。

So that cutting out addictive foods can really help with this cycle.

这也更广泛地回应了你关于健康行为如何变得令人上瘾的问题或评论。

And that speaks to also just your the question or comment more broadly about how healthy behaviors have become addicted.

我认为这才是这里的核心观点。

I think that's really the central point here.

那些我们确实认为是健康的事情，比如阅读、下棋、吃饭、做爱。

That things that really we do think of as healthy, like reading, like playing chess, like eating food, like having sex.

我们生活在一个科技已将原本健康的行为转变为对某些易感人群可能具有成瘾性的世界里。

We live in a world now in which the technology has turned these otherwise healthy behaviors into something that is potentially addictive for certain vulnerable individuals.

因此，基于这种认知重新构建我们的消费行为，我认为如果我们能找到方法去除这些行为和物质中的药物化特性，将会很有帮助。

And so reconceptualizing our consumptive behaviors around that knowledge, I think can be helpful if we can identify you know, ways to to de drugify those behaviors and substances.

许多听众提出的一个问题是关于如何避免用一种成瘾行为替代另一种。

One question that many listeners asked has to do with how to avoid swapping one addiction for another.

我们收到了听众Amritha的这个问题。

We received this question from listener Amritha.

在我逐渐戒除第一种成瘾时，如何防止另一种成瘾行为取而代之？

How do I prevent one addiction from replacing another one as I wean myself off of the first one?

我是否需要终身保持警惕，持续监控这类行为，并忍受多巴胺匮乏的日常状态？

Do I need to be constantly on the lookout for these kind of behaviors and go through routines of dopamine starvation for the rest of my life.

Anna你怎么看？

What do you think Anna?

是的，这种用一种成瘾替代另一种的现象非常普遍。

Yeah, so this phenomenon of switching one addiction for another is very well known.

有时也被称为交叉成瘾。

It's sometimes referred to as cross addiction.

大量动物研究表明，当最初依赖的药物无法获得时，对一种药物成瘾的动物会更容易对另一种药物上瘾。

There are lots of animal studies showing that an animal who gets addicted to one drug will more easily get addicted to another drug when that first drug is made unavailable.

所以，即使第一种药物没有被禁用，一旦我们上瘾，我们某种程度上就已经为这种行为做好了准备，或者说我们可能会为这种行为做好准备。

So or even if the first drug isn't made unavailable, like once we become addicted, we sort of are primed then for that that kind of behavior, or we can be primed for that kind of behavior.

因此，我对这位来电者的建议是，第一步就是要意识到交叉成瘾的问题。

So my answer to this caller would be the first step is just being aware of the problem of cross addiction.

在临床工作中，我们会对患者说：'这个月你打算戒掉大麻，那么...'

In clinical work what we say to patients is something like, well now you're going to try to give up cannabis for this month.

要非常小心，不要因此增加了含糖食品的摄入量，你也提到过这对你有强化作用。

Be really careful that you don't now increase consumption of sugary foods, which you've also talked about as something that's reinforcing for you.

所以就是要开诚布公地讨论并承认这个问题。

So just sort of openly talking about it and acknowledging it.

再者，我认为通过心理和精神层面的练习，学会与渴望和冲动共处，认识到将这种冲动从一个强化物转移到另一个的倾向。

And then again, I think psychological and spiritual practices around learning to sit with the craving and the urges to recognize the tendency to want to switch that urge from one reinforcer to another.

我确实觉得现代社会中我们围绕奖励来安排时间的方式很耐人寻味。

I do think it's really fascinating the way in which we organize time in the modern world around our rewards.

对我们许多人来说，包括某种程度上我自己，整个白天都是围绕着'我什么时候才能做完不想做的事，好去做想做的事'这个想法来安排的。

So our entire day for many of us, including myself on some level is structured around this idea of well, am I going to be done with this thing that I don't want to be doing so that I can do the thing that I want to be doing?

这就是我们如今的生活方式。

It's just the way we live now.

我认为这里有几件事非常有用：首先要认识到我们的欲望是无限的，某种程度上，无论获得多少美好回报，我们永远不会满足。

So a couple things that I think are really helpful here is to just recognize that our desire is infinite, and that on some level, we will never be satisfied no matter how much of those good rewards we get.

然后学着与这种状态共处。

And then just sort of learning to sit with that.

有时我也会做这样的思想实验：想象自己度过一整天，却不用任何惯常的奖励来犒劳自己。

Sometimes I also think that in certain thought experiments, like imagine going through your whole day and not rewarding yourself with any of your usual rewards.

当我进行这个思想实验时，发现它确实能让我更专注于当下，因为我不再时刻期盼着获得回报的那个瞬间。

And what I find that does when when I engage in that thought experiment is that it really allows me to be much more present in the moment because I'm not in the moment looking forward to the moment when I'm gonna get my reward.

有听众提问：如果我发现自己正走向看似成瘾的道路，该如何打破这个循环？

Some listeners have asked the question, if I notice that I'm heading down a path that looks like it's on a path to addiction, how do I break this cycle?

这是一位名叫安德莉亚的听众提出的问题。

Here's a question we received from a listener named Andrea.

你好，安娜。

Hi, Anna.

我明年要结婚了，在网上看婚纱很快就变成了网购各种东西。

I'm getting married next year, and looking for wedding dresses online has become online shopping for all sorts of things really quickly.

我能察觉到这种情况，但我想问你，怎样才能按下停止键？

I can see it happening, but I wanted to ask you, how do you hit stop?

如何让你的大脑停止这种行为？

How do you make your brain stop doing this?

或者当你及早发现时，如何与你的大脑合作来停止这种行为？

Or how do you work with your brain to stop doing this when you're catching it early?

非常感谢。

Thank you so much.

安娜，你怎么看？

What do you think, Ana?

当你感觉自己正走向不好的方向时，有什么方法能让自己转向更积极的道路吗？

When you feel like you're on the road to someplace bad, is there something you can do to nudge yourself in a more positive direction?

是的。

Yeah.

我认为确实有很多可以做的。

I I think there's a lot you can do.

首先，我认为像安德莉亚那样坦诚面对并明确指出问题，会非常有帮助。

First of all, I think just being open about it, like Andrea has done, and naming it, can be really helpful.

这能以新的方式让我们意识到问题，而不是让它在我们脑海的阴暗角落无声蔓延。

It can bring it into our awareness in a new way that it's not necessarily going to be if it's just sort of pinging around in the dark recesses of our minds.

所以，我为她能公开谈论这件事而鼓掌。

So, you know, I applaud her for being open about it.

但对于其他听众，你可以告诉别人你正在做什么行为。

But for other listeners, you know, you can tell somebody else what behavior you're engaging in.

我还是要说，即使我们隐约知道自己有这种行为，往往只有当我们向另一个人大声说出来时，才能真正意识到它的存在。

And again, I'll just say that even if we kind of know that we're doing that behavior, it's often not until we've said it out loud to another human being that it becomes really real to us.

而一旦我们真正意识到，就再也无法视而不见了。

And then once it's become real to us, we kind of can't unsee it.

这种觉知能让我们开始产生改变行为的动力。

And then that allow that aware, that awareness allows us then to begin to create the motivation to want to change the behavior.

事实上，多巴胺戒断项目可能最适合那些尚未完全成瘾、但已注意到自己正走向成瘾的人。

In fact, it may be true that the dopamine fasting project is best suited for individuals who are not yet fully addicted, but who notice that they're on their way to addiction.

所以要有意识地设定一个具体的戒断日期，决定何时放弃那种物质或行为，将那种物质或接触途径移出家门，或制定其他自我约束策略来限制消费或增加获取难度。

So you know, then with intention, setting a specific quit date for when you're going to give up that substance or behavior, getting that substance or access to that behavior out of the house or creating other self binding strategies to sort of limit consumption or make it harder to get access.

这些都是你可以提前规划和实施的事情。

Those are all things you can plan and do in advance.

告诉别人你要进行多巴胺戒断，找个伙伴一起做，真正投入其中，不要把它视为剥夺，而要看作是为自己做一些积极健康事情的机会。

Tell people you're gonna be dopamine fasting, do it with somebody else, and then really commit to it and frame it not as deprivation, but as an opportunity to really do something positive and healthy for yourself.

阿尔娜，我们之前聊过，'成瘾'这个词有时会被当作一种骂人的方式，用来描述我们不喜欢的人或活动。

You know, we talked earlier in the conversation, Arna, about how, you know, the term addiction can get used as a form of name calling, where we're just describing people whom we don't like or activities we don't like.

我们给他们贴上'成瘾'的标签。

We brand them as addictions.

但我们也讨论过，有成瘾问题的人往往缺乏自知之明，意识不到自己正在走向成瘾。

But we also talked about how people who have addictions often don't have the insight to know that they are on the road to addiction.

几位听众提出了这样的问题：如果我看到生活中的某人——朋友、家人或同事——正走向看似不健康的道路，该怎么办？

And a few listeners have asked the question, what if I can see someone in my life, a friend, a family member, a coworker heading down a path that looks like it's an unhealthy path?

我该如何提出这个问题？

How do I bring that up?

我该如何开启这个艰难的对话，让对方意识到自己是否有问题？

How do I launch that very difficult conversation to have the person say, do I have a problem?

是的。

Yeah.

我经常被问到这个问题。

So I get this question all the time.

当然，每个情况都是独特的。

And of course, every situation is unique.

所以很难给出一个放之四海皆准的答案。

So it's difficult to give a one size fits all answer.

但我认为我们始终可以从同情和共情开始，只是向我们在乎的人表达：我们想和他们谈论一些难以启齿的事情，但这源于爱，简而言之就是基于我们观察到的某些行为而对那个人的关心。

But I think the place we can always start is with compassion and empathy, and just expressing to the person that we care about, that we'd like to talk with them about something that's difficult to talk about, but it's coming from a place of love, which is just very simply our concern for that individual, given certain behaviors that we've observed.

所以要在你和所爱之人都平静的时候，而不是在你作为父母、配偶或朋友处于焦虑失调状态时，也不是在他们正在使用的时候。

So in a time when when you are calm, and your loved one is calm, and not in a time when you're in a state of anxious dysregulation as a parent or a spouse or a friend, and not a time when they're using.