如何克服对物质或行为的成瘾 | 基思·汉弗莱斯博士

与激素相关的癌症等等，但并不总是与激素相关。

Hormone related cancers and so forth, not always hormone related.

但当讨论转向女性特定健康问题时，关于最好完全避免酒精的说法产生了非常强烈的影响，这本身就很有趣。

But the moment that the it's probably best to avoid alcohol entirely conversation moved into women's specific health, it had a very potent impact, which is interesting in its own right.

这说明了可能需要什么来对抗某些营销手段。

And it speaks to what's perhaps required to override some of the marketing.

因为说实话，和朋友一起放松是很惬意的。

Because let's be fair, it's nice to relax with friends.

如果人们认为和朋友一起喝一两杯酒更容易放松，那么这不仅是一种营销策略，对他们来说在没有反面证据之前也确实如此。

And if people think relaxing with friends is easier to do over a glass of wine or two, then that's a great, not just marketing scheme, it's also somewhat true for them until there's counter evidence.

所以我真正想说的是，人们应该如何权衡他们所知道的风险与酒精带来的其他明显好处，比如帮助放松、社交、减轻压力等等。

And so what I'm really getting at here is, how is it that people should frame what they know to be risky versus the other benefits of alcohol that clearly exist, like helps people relax, it's social, they stress less, and so on and so forth.

正如我提到的，我是喝酒的人，我知道葡萄酒平均来说并不健康。

As I mentioned, I'm someone who drinks wine, and I know that it is, on average, it's not healthy.

那我为什么还要喝呢？

Why do I do that?

因为这会带来其他东西，尤其是在那种情况下。

Well, because it creates other things, particularly with exactly that situation.

与朋友聚会是愉快且充实的。

Getting together with friends is enjoyable, enriching.

美食是充实的。

Good food is enriching.

美食配上好酒，味道很好。

Good food and a good wine tastes good.

我珍视这些事物。

And I value those things.

我们还有很多其他决定也是如此，为了追求其他重要的东西而承受一些风险。

And there are many other decisions we make like that where we endure some risk because we care about something else.

以我这个年纪来说，爬山可能有危险，但如果景色壮丽，我会说：我愿意接受这个风险，也许我更容易扭伤脚踝，但这一切真的太美了。

Know, it's dangerous for someone my age to hike up a mountainside probably, but if the view is spectacular, I can say, I'm going to accept that risk, and maybe I'm more prone to twist my ankle or something, but this is just really beautiful.

这没关系。

That's okay.

我认为我们曾经喝到过劣质酒精，那时需要一个解释来停止。

I think the place we got an alcohol that was bad was needing an explanation to stop.

所以，你曾经在派对上对别人说过，或者见过别人问过：‘你为什么喝酒？’吗？

So how often have you ever said to someone at a party or seen someone say at a party, Why are you drinking?

我从来没听过这种话。

I've never heard that.

但我确实听过无数次：‘你为什么不喝酒？’

But I've certainly heard a million times, Why aren't you drinking?

如果你在派对上不喝酒，或者拒绝酒精邀请，人们会觉得你有问题。

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

是的，你必须给出一个解释。

Yeah, and you have to have an explanation.

比如，明天早上要考试，或者我感冒了，之类的理由。

Like, well, got an exam tomorrow morning, or I've got a cold, or something.

其实，你根本不需要解释。

It's like, you shouldn't need an explanation.

但人们确实感受到这种社会压力，因此这是健康信息发挥作用的一种方式。

But people do feel that social pressure, and so that's one way health information can work.

为什么这个人之前不直接戒掉呢？

Why didn't the person just quit beforehand?

因为他们可能没有一个在他们社交圈里能说得通的理由，而现在你可以说：我看到了关于卵巢癌的那些数据，所以我决定戒酒。

Because they may not have had an explanation that worked in their circle, and now you can say, well, I see those data on ovarian cancer, and I decided to quit drinking.

我认为，健康仍然是人们认可的、改变行为的正当理由。

And health is a reason people still accept, I think, as legitimate for changing behavior.

你可以这么说，因为癌症很可怕。

You can make that, because cancer is scary.

这可能就是人们戒酒的原因。

And that may be why people quit.

当第一位卫生总监还在吸烟时，也发生过同样的情况，想想看。

Same thing happened when the first surgeon general was smoking, think about it.

当时人人都吸烟，你在工作中必须融入，必须抽烟。

Everybody smoked, you had to sort of fit in at work, had to smoke.

当这个消息公布时，很多人立即戒掉了。

And when that came out, were a lot of people who just quit immediately.

他们显然有能力戒掉，也想戒掉，但他们需要向所有人解释：你为什么不再吸烟了？

They clearly were capable of quitting, wanted to quit, but they needed to tell everybody, Why are you not smoking anymore?

你为什么不再随身带香烟了？

Why don't you carry cigarettes anymore?

我不能再向你讨烟抽了。

I can't bum one off you anymore.

就是这样。

It's like, that's why.

你认为为什么喝酒的人会对周围不喝酒的人感到不舒服？

Why do you think people who drink feel uncomfortable about people not drinking around them?

当人们问我是否想喝酒，我说不喝时，他们就会问：为什么？

When people would ask me if I wanted to drink and I'd say no, and they'd say, why?

我通常会说实话，就是我说任何不喝酒时脑子里想到的事。

They often say I would say the truth, which is I'll say anything that's on my mind without drinking.

你不想让我喝酒，因为那样我会把心里想的全都告诉你

You don't want me to drink because then I'll tell you everything that's

都在我脑子里。

on my mind.

哦，这很好。

Oh, that's good.

确实如此。

It's true.

我的意思是，我会直接告诉别人我在想什么。

I mean, like I will tell people what I'm thinking.

我不需要先放松一下。

I don't need to like loosen up.

我在社交场合中挺放松的。

I'm pretty relaxed in social settings.

我没什么社交焦虑，但我意识到有些人可能在社交焦虑方面有困难。

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

是的。

Yeah.

你知道吗，我年轻时在日本待过一段时间，那里有一种下班后外出喝酒的文化，比如上班族下班后，有人喝得酩酊大醉，大家都喝酒，彼此敞开心扉。

You know, I spent a little time in Japan when I was a young man and there's this, culture of going out after work, like the salaryman, out work, and someone getting really, really drunk, and everyone's drinking, and you're vulnerable with each other.

然后我知道，这就像一种信任练习，就像向后倒下的那种，只不过我们都喝醉了。

Then you know that I will It's like a trust exercise, like that falling backwards thing, except it is that we're all drunk.

如果有人不这么做，大家就会想：你为什么不参与？我们都在敞开心扉，你却不是？

And if someone weren't doing it, it's like, why are you not undergoing any So we're all gonna be vulnerable and you're not?

你是不是打算利用我们？

Like, are you gonna exploit us in some way?

或者我会说：我讨厌老板，而你作为唯一清醒的人，记住了这句话，然后回公司去说。

Or I'm gonna say, I hate the boss, and then you're gonna repeat that at work because you're one person sober enough to remember I said that.

我认为这才是人们真正感到焦虑的事情。

I think that is a real thing that people have anxiety about.

或者我可以想象，假设一对男女在约会，男方不断给女方倒酒，自己却不喝？

Or I can imagine, say, what if a man and woman are on a date and the guy keeps giving drinks to the woman and doesn't drink himself?

那么，最自然的想法是什么呢？

Like, what is the natural thing to think?

你是在想把我灌醉吗？

Are you trying to get me drunk?

你会不会趁我醉了、你清醒的时候占我便宜？

Are you gonna take advantage of me because you're gonna be with it, and I'm not, because I'm gonna be drunk?

所以这些恐惧可能存在于背景中，但我觉得，虽然在某种程度上这可能是合理的，却不应该主导我们与朋友的日常社交互动。

So those kinds of fears may be in the soup, but I don't think, so maybe that's rational at some level, but I don't think that should drive our sort of routine social interaction with our friend.

这应该只是一个无关紧要的问题：你想要什么？如果他说他想要气泡水，你就给他一杯气泡水，别问：‘你为什么不喝这种让人醉的饮料？’

It should just be a non issue of what do you want, and if he goes, I want sparkling water, just give you a glass of sparkling water, don't say, why aren't you drinking this intoxicating beverage?

你知道，你不需要向我解释。

You know, you shouldn't need to explain it to me.

信任这一点非常有趣。

The trust piece is super interesting.

脆弱性这一点也很有意思。

So is the vulnerability piece.

关于这个，我有几个想法，只是些个人看法，请包涵。

A couple thoughts about this, and they're just editorial thoughts, so forgive me.

但多年来，我一直觉得这太疯狂了。

But one is for years I thought how crazy it was.

我会参加一些医生和科学家的会议，他们表面上是在研究健康相关的问题，但每个人都在酒吧里喝得烂醉。

I would go to these meetings with doctors and scientists who ostensibly were working on issues related to health and everyone would just get trashed at the bar.

而我对这种事并不感兴趣。

And I wasn't into that.

我也并不评判别人。

And I wasn't judgmental.

实际上，我还挺喜欢这样，因为到了会议的第三天，我精神抖擞，而他们全都昏昏沉沉，我能看出来他们状态很差，而且衰老得比我快得多。

I actually kind of liked it because by the third day of the meeting, I'm cranking and they're all just, I can tell they're all just bleary and they, and they're also aging much faster than I am.

他们会获得那种所谓的‘终身教职式’状态，或者说我称之为的那种状态。

They, they would get what, you know, the tenured look as we would call it, or as I would call it.

五年后再见到他们时，我会想：你这是怎么了？

And like you see them in five years, I'm like, what happened to you?

你一下子老了15岁。

You age 15 years.

这些人不仅在会议期间，也在会议之外大量饮酒。

And these people tended to drink a lot, both at meetings and outside meetings.

酒精费用通常由会议费用支付。

Alcohol was paid for often by the meeting fees.

我不是想指责谁，你知道的。

Schiz I'm not trying to, you know, point a finger here.

后来，许多在会议上发生并导致人们丢掉工作的事情，都与酒精有关。

And then a lot of the stuff that happened at meetings that turned out cost people jobs was always alcohol related.

是的。

Yeah.

在男人和女人约会喝酒，或一群人工作时一起喝酒的情况下，日本似乎都是男人和男人一起喝醉。

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

就是男人。

It was men.

是的。

Yes.

在我对男女互动与饮酒的心理图景中，我会简化一下。

In my mental picture of the the male female dynamic and drinking, I'm gonna simplify this.

如果她喝酒，就会让她变得脆弱。

If she drinks, it makes her vulnerable.

如果他喝酒，就会让他更愚蠢和冲动。

If he drinks, it makes him more stupid and impulsive.

而且

And

在她喝酒而他不喝的世界里，你举了例子，也许他会鼓励她喝酒并趁机占她便宜。

so in the world where she's drinking and he's not, you gave the example that perhaps, you know, he would take advantage of her if he's encouraging it.

当然，人们脑海中确实有这种画面。

Certainly, there's that picture in one's mind.

他也可以安全地送她回家。

He also can get her home safely.

如果他喝酒，就无法安全送她回家，可能会说或做些非常愚蠢的事。

If he's drinking, he can't get her home safely, he might say or do something really dumb.

所以我觉得，不管怎么算，喝酒最终总归是个不太好的主意。

So I feel like no matter how the math is arranged, it always ends up drinking ends up being kind of a bad idea.

我的意思不是想评判什么，因为我并不评判别人的行为。

I mean, not trying to be judgmental here, like, because I'm not I don't judge what people do.

你想怎么做就怎么做，但要清楚自己在做什么，这是我的信条。

Do as you wish, but know what you're doing is my my philosophy.

但我就是看不到任何一种情境，能让和同事喝酒，或和不太熟悉的人（无论男女）约会时喝酒变得安全——对双方来说，这都充满风险。

But I just don't see a world where drinking with your coworkers or drinking on a date with somebody that you don't know very well, male or female, right, for either of them, it's just like a lack of safety all around.

这看起来就是个糟糕的主意。

It just seems like a bad idea.

随着女性越来越多地进入某些职业，这种‘大家都出去喝醉’的常态可能已经改变了，因为后果不再相同。

As women move into more professions that may have changed that norm of, you know, everybody goes out and gets drunk because the consequences aren't the same.

我认识很多职业女性朋友说，我不想那样做。

I know a lot of professional women friends say, I don't want to do that.

我不希望在老板喝醉的时候和他待在一起。

I don't want to be around the boss when he's drunk.

所以，我们不如在公司一起吃圣诞午餐，而不是之后去喝酒。

And so let's have a Christmas lunch together at work instead of drinks afterwards.

我确实能理解这一点。

So I definitely see that.

我认为在约会方面，当然，幸运的是，我已经四十年没担心过约会了，但我想大多数人会说，对一些人来说，焦虑感非常强烈，而酒精有缓解焦虑的作用，对吧？

I think in the dating, now of course, I haven't thankfully had to worry about dating for forty years, what I think most people would say is just the anxiety is intense for some people, and alcohol is anxiolytic, right?

所以，人们可能就是觉得太紧张了。

And so it's probably that, that people are sort of feeling, they're too nervous.

至于他们应该或不应该这样做，我认为这不过是其中一项人们在意的好处，混在各种考量里。

And whether they should or they shouldn't, that's just, I think, probably in the soup, one of those benefits people care about.

必须指出的是，有些人喝了一点酒后比没喝时更善于社交，因为他们本来就是紧张型的人。

And there are people, it has to be said, who are more socially engaging when they've had a drink than when they haven't, because they're kind of wound up people.

当他们放松下来，一些其他的东西就显露出来，他们可能显得更有吸引力。

When they relax, some other stuff comes out and they may seem more appealing.

这很有趣。

It's interesting.

我们可以从多个角度来分析它

We could dissect it in

但我觉得这些信息已经足够让人思考自己是否有遗传倾向，并理解零摄入优于任何摄入。

a number of ways, but I think that's enough contour for people to be able to think about whether or not they have a genetic predisposition, understand that zero is better than any.

如果我们听说饮酒对心脏有益，就应该将其与癌症风险进行权衡，而不是将其视为独立的信息。

If we hear about some cardiac benefit to weigh that against the cancer risk and not just take it as an independent piece of information.

然后要考虑他人在饮酒时的行为和言语漏洞，以及自己在饮酒时的漏洞。

And then to think about vulnerabilities of other people's actions and vulnerabilities of one's own actions and words if drinking.

这样人们就能做出明智的决定。

And then people can make an informed decision.

这大概就是我的观点——

That's kind of how I-

很好的总结。

A good summary.

我对它的感受。

How I feel about it.

再说一遍，随你便，但要知道你所做的是为了什么目的。

Again, do as you wish, but know what you're doing is like the purpose here.

我们来谈谈大麻吧，因为最终我想回到产业如何影响使用和滥用的问题上。

Let's talk about cannabis a bit, because eventually I'd like to weave back to how industries impact use and abuse.

我小时候，大麻是非法的。

Cannabis, when I was growing up, was illegal.

你会因此坐牢。

You go to jail for it.

人们仍然吸大麻。

People still smoke pot.

这种事情确实发生了。

It happened.

当时人们认为它的效力低得多。

The idea was that it was much less potent.

我们可以谈谈这个。

We can talk about that.

但现在它已经变成一个完整的产业了。

But now it's a whole industry.

是的。

Yes.

而食用制品产业对此贡献巨大，因为它避开了吸烟、气味以及其他一些问题。

And the edible industry has contributed to this greatly because it bypasses the blowing of smoke, the smell, and a number of other things.

那么，你对大麻作为可以‘娱乐性’或‘医疗性’使用的物质，以及其滥用潜力有什么看法？

So what are your thoughts about cannabis as something that can be used quote unquote recreationally, medicinally, and its potential for abuse?

然后我们再谈谈，由于大麻基本合法化或非刑事化，这些情况是如何被放大或减弱的。

And then let's talk about how those things have been amplified or reduced by the fact that it's essentially legal or decriminalized.

那么，你对大麻有什么看法？

So what are your thoughts on cannabis?

是的，每当我们谈论它时，我都会区分旧式和新型大麻。

Yeah, so whenever we talk about it, I make a distinction between sort of old and new cannabis.

所以，你知道，如果你回溯到80年代和90年代，正如你提到的，那时 everywhere 都是非法的，THC含量——也就是主要的精神活性成分——平均只有3%到5%左右。

So, you know, if you go back to the '80s and '90s, when, as you mentioned, it was illegal everywhere, the THC content, that's the principal intoxicant, would be 34%, 5%, something like that, on average.

而现在对合法销售产品的研究显示，平均产品的THC含量约为20%。

And now studies of legal sales show the average product is about 20%.

这要强大得多。

That's dramatically stronger.

另一个区别在于人们的使用方式不同，或许与这种高 potency 有关。

The other point is how people use it is different, perhaps related to that high potency.

乔纳森·卡金斯整理了大量非常有趣的数据，这些数据广受关注，显示大约有42%的大麻使用者每天或几乎每天都在使用。

Jonathan Calkins pulled together a lot of really interesting data that got a lot of play, and it showed that about forty, I think it's forty two percent of people who use cannabis use it every day or almost every day.

这一点也不同。

That is also different.

所以如果回溯过去，更典型的使用者可能每周只使用一两次。

So if you go back in the past, the more modal user might have been once or twice a week.

所以你把这些因素综合起来：过去的人可能只是在周末抽一支5%的烟，但现在如果每天都要摄入20%的产品，你很快就会意识到，他们的大脑暴露量显著提高，两种使用模式之间的大脑暴露量差异大约是65倍。

So you put those things together, so you take somebody, what was like an 80s pots, well, on weekends I'd smoke a joint at 5%, but now if it means every day I'm consuming 20%, you quickly realize their brain exposure is dramatically higher, about 65 times higher between the modes of those two experiences.

那么，65倍意味着什么？

And so what does 65 times mean?

巧合的是，这正好相当于古柯叶和可卡因之间的效力差异。

Well, coincidentally, it's also the potency difference between a coca leaf and cocaine.

那是65倍的两倍。

That is 65 times two.

所以这是一个巨大的差异，正如你所知，剂量决定毒性。

So it's a big difference, and as you know, dose makes the poison.

因此，这和过去那种药物已经完全不同了。

So it is just a really different drug than what was back there.

这很难向父母们解释清楚，因为他们的观念是：‘我当年也吸过大麻，谁在乎我的15岁孩子用不用呢？’

And this is very hard to get across to parents, because their view is like, Ah, I smoked weed, know, who cares if my 15 year old is using it?

这就好比说，你当年喝的是低度啤酒，却不担心你的15岁孩子狂饮伏特加。

It's like, that's kind of saying you drank low alcohol beer, and you're not concerned that your 15 year old is guzzling vodka.

这就是其中的差别。

That's kind of the difference.

这比以前重要多了。

And it's just a bigger deal than it used to be.

即使不考虑有行业在大力推动，这种药物本身也更强烈、更具成瘾性。

Even when you take away the fact that you have an industry really pushing it, just the drug is stronger, more addictive.

它有任何医疗用途吗？

Does it have any medical applications?

几乎肯定有。

Almost surely.

大麻素受体系统，在人类进化史上是最古老的系统之一。

The cannabinoid receptor system, evolutionarily, is one of the oldest in the history of homo sapiens.

它既存在于大脑中，也存在于身体中。

It is both in the brain, but it's also in the body.

显然，它在止痛方面会有一些应用。

There are clearly going to be some applications for pain.

许多人表示，他们自发地获得了缓解。

Many people would say they spontaneously get relief.

很难总是弄清楚这意味着什么，因为有时这仅仅是戒断症状的缓解，但这种植物很可能会产生一些用于止痛的医疗应用。

It's hard to tell always what that means, because sometimes that's just relief from withdrawal, but probably some type of medical applications for pain will come out of this plant.

我们确实已经从大麻二酚（CBD）——即非致幻成分中开发出了一些药物，用于治疗儿童的癫痫发作。

We do have some out of the CBD, which is the non intoxicating part, as a medication that is used in seizure disorders in kids.

所以肯定还会有其他类似的应用。

So there'll be some other things like that, for sure.

而且现在研究这种物质比以往任何时候都更容易了。

And it's easier to study this than it has ever been before.

大约在2020年，国会改变了研究的运作方式，使得开展研究变得简单多了。

About 2020, Congress changed the way research works, so it's a lot simpler to do it.

所以我们终将弄清楚这些问题。

So we'll figure those things out.

但这种药物比我在年轻时要危险得多，你知道的。

But it is just more dangerous drug than it was, you know, when I was a young person.

我曾在播客上邀请过一位大麻研究者，他经营着一个动物实验室。

I had a guest on the podcast who's a cannabis researcher, runs an animal lab.

我们邀请他来是因为我之前发布了一期关于大麻的单独节目。

And we invited him on because I had released a solo episode about cannabis.

我们谈到了年轻男性患精神病的一些风险，并坦率地表达了对大麻高THC含量的担忧。

We touched on some of the risk for psychosis in young men and made some points about frankly concerns about cannabis because of the high THC content.

他对我说的话并不高兴。

He was not happy with the things I said.

他在社交媒体上明确表达了这一点。

He made that clear on social media.

顺便说一句，这并不是获得邀请上节目的方式，但我们还是邀请了他。

So by the way, this isn't the way to get invited on the podcast, but we invited him on.

我认为我们的讨论非常有成效，他为我澄清了一些事情。

And I think we had a very fruitful discussion where he clarified a few things for me.

他声称，尽管THC含量更高，但吸食大麻和食用大麻之间存在明显差异：吸食大麻的人，即使是吸食高THC的大麻，也能很好地判断自己的兴奋程度，因此不会陷入偏执状态。

And one of the things that he claims is that despite the higher THC content, that there's a distinct difference between smoked versus edible cannabis, whereby people who smoke cannabis, even the high THC cannabis, are very good at gauging the kind of level of high, so that they don't go into paranoid modes.

他们不会超过那种可能引发偏执或精神病发作的兴奋水平。

They don't surpass the plane of high that would make them feel paranoid or put them into a psychotic episode.

但那些食用大麻的人，因为很难判断自己的状态，如果只是吞下一颗大麻食品，甚至只是咬一口，常常会超过自己感到舒适的剂量水平，从而引发精神病发作或偏执。

But that people who take edibles, because it's harder to gauge where you're at, if you can just swallow an edible or even nibble on an edible, often surpass the level at which they would be comfortable, meaning at which there's a psychotic episode or there's paranoia.

所以他实际上是在温和地论证，大麻中THC含量升高并不是大问题，因为人们本质上会减少摄入量来抵消这种差异。

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

是的，我认为这完全没有任何证据支持。

Yeah, I think there's no evidence for that at all.

即使是经验丰富的大麻吸食者，在实验室研究中也出人意料地难以判断不同大麻产品的强度。

And people are surprisingly bad, even experienced pot smokers, at judging and lab studies of how strong different cannabis is.

我不认同这一部分，但我同意我们应该对大麻食品采取不同的看法，因为它们通过肠道起效的方式不同。

I don't agree with that part, but I do agree we should think about the edibles differently because the onset is different through the gut.

所以当你吸烟时，有效成分会非常高效地到达大脑，但当你食用时，其效果则需要一段时间才能显现。

So when you smoke anything, you get that, that goes very efficiently to the brain, but when you eat something, it takes a while to have its effect.

因此，当这些产品刚推出时，许多新手会咬一口大麻棒、大麻饼干或其他任何东西。

And so, particularly when these products came out and a lot of people were new to them, they would bite down on one piece of the, whatever, the bar, the cookie or whatever.

五分钟后感觉没变化，再咬一口，还是没感觉，于是干脆把整个都吃掉，结果所有药效一下子像火车一样袭来。

Five minutes later, feel the same, take another bite, still feel the same, and then just eat the whole thing, and then it would all hit them like a train.

这种情况确实会发生。

And that does happen.

另一个事实是，许多这类产品制作不佳，或者达不到像饼干那样的标准。

The other thing that is true is that a lot of these products are not well made, or they're not up to the standards of like you would have a cookie.

你绝不会在美国打开一袋巧克力曲奇，发现所有巧克力豆都集中在一端，其余全是面团，但在合法市场中，大麻产品确实会出现这种情况。

You would never open up a bag of chocolate chip cookies in The United States and find all the chocolate chips at one end and just dough and the rest, but that does happen with cannabis products in legal markets.

所以如果你咬到了错误的部分，你就会一次性摄入全部剂量，因为成分并没有均匀混合。

And so if you just bite on the wrong part, you're getting the whole enchilada, so to speak, because it's not evenly blended through.

也有人因此而陷入麻烦。

And there are some people who've gotten into trouble on that as well.

有意思。

Interesting.

那精神 psychosis 的风险呢？

What about the psychosis risk?

是的，多年来我一直对这方面的研究持怀疑态度。

Yeah, so I was very skeptical of this literature for years.

并不是说科学本身有问题，但在我看来，有很多方式可以解释这一现象。

Not to say that the science was bad, but just like it seemed to me there were lots of ways to explain it.

坦率地说，我现在怀疑得少多了，因为在以往的研究中，那些是在青少年时期使用大麻的男性，成年后患精神病性障碍的比例更高。

And I'm a lot less skeptical now, candidly, because in the old studies, those were men who had used cannabis in teen years, and then they would have higher rates of psychotic disorders in adult.

这些研究基于瑞典的登记数据，因为每个人都要登记参军。

These were studies based on Swedish registries, because everybody has to register for the military.

他们追踪了这些人，这是一组非常惊人的数据。

And they would track people, it's quite amazing data.

所以这是全国性的完整数据，这很好，但其中可能有多种原因。

So it is a whole national data, that's good, but there's lots of reasons that could come about.

这两者之间可能存在一个共同的诱因。

It could be a common factor between those two things.

但随着大麻效力的增强，证据也变得更强了。

But the evidence has gotten stronger as the drug has gotten stronger.

而且我们必须意识到，人们现在使用大麻的强度要高得多。

And again, we've got to realize people are using it much more intensely.

所以，如果这种效应确实存在，那么更有可能是因为每天使用更强效的毒品，从而导致精神病发病率升高。

So if this effect is there, it's much more plausible that it would be from a much stronger drug used every day, could generate higher rates of psychosis.

很难验证这一点，因为这种病症很罕见，幸运的是，但我不得不遗憾地说，我认为其中很可能确实存在某种关联。

It's hard to test this, because it's a rare, thankfully, condition, but I think there is probably something there, I am sad to say.

如果不存在就好了，但很可能确实存在某种关联。

I there weren't, but there probably is something there.

如果我有任何一级亲属患有精神分裂症、分裂型人格障碍或任何精神病性双相障碍，我本人不会使用大麻，也不会推荐任何人使用。

I would not use cannabis if I had any first degree relatives with any schizophrenia, schizoid personality, anything in the psychotic bipolar disorder, I would not personally recommend that for anybody.

我认为这很可能非常危险。

I think that's probably quite risky.

那么心脏风险和其他健康风险呢？

What about the cardiac risk and other health risks?

我最近听说，即使不吸烟或不使用电子烟，大麻也会直接对心脏健康造成风险。

I've heard recently that there's a direct risk of cannabis, even if it's not smoked or vaped, on cardiac health.

我不确定非吸烟形式的大麻对心脏是否有影响。

I'm not sure of that, of nonsmoked cannabis in the heart.

我的意思是，我并没有看过这方面的文献，所以我不知道答案。

I mean, I haven't looked at that literature, so I don't know the answer to that.

我意识到有一个点我应该提一下，那就是你之前提到的关于初次饮酒的问题：当大脑具有可塑性时，一切都会不同。

I realize there's one point I should touch on that you also raised earlier about first drinking, which is everything is different when the brain is plastic.

我们的大脑在年轻时可塑性最强。

And our brains are most highly plastic when we're young.

因此，这些影响中最糟糕的情况往往发生在人们十几岁或刚满十岁出头时开始使用。

And so a lot of these effects, the worst things are going to be because people start when they're in teen or late single digit.

成瘾绝大多数都是在这个阶段开始的，如果存在精神错乱的风险，几乎肯定也是在这个大脑发育阶段，也就是人们首次出现精神病发作之前，而首次精神病发作通常发生在18、19、20或21岁左右。

That's where addictions overwhelmingly start, and that is where, if there is a psychotic risk, it's almost surely then during that period of brain development before people get their first psychotic break, which tends to be around 18, 19, 20, 21.

我对其他任何情况都担心得少一些。

I'd worry about it less for anything.

你知道，50岁才开始使用某种物质，比年轻时开始使用，不太可能导致成瘾或其他严重问题。

You know, initiating a substance when you're 50 is far less likely to end you up with an addiction or some other terrible thing than when you're young.

我相信每个人至少认识一个人，或者听说过这样一个人：他们生活很有成效，家庭健康，工作稳定，精力充沛，同时还在使用大麻。

I'm sure everyone knows at least one person or has heard of one person who's very productive in their life, healthy family, job, etcetera, high energy, who uses cannabis.

据我观察，他们是极少数的例外。

In my observation, they are the rare exception.

有很多使用大麻的人，人生并没有取得什么成就。

And there are a lot of examples of people who use cannabis who don't really go anywhere in life.

他们没有经历找到一份能养活自己的工作的正常发展过程，对吧？

They don't go through the normal developmental progression of finding a job that can sustain them, right?

没有组织好自己的生活、感情生活和职业生涯。

Of organizing their life, their relationship life, their professional life.

当然，生活中还有其他方面，但这些是关键的方面，对吧？

And clearly, are other aspects to life, but those are key ones, right?

关于高THC含量或大麻使用频率与人生发展之间的关系，有什么数据吗？

And what are the data on high THC or just frequency of cannabis use as it relates to life progression?

我们现在称之为‘无法独立’，通常是指那些年轻男性无法独立起步。

Failure to launch, we call it now for typically it's guys that young men that fail to launch.

我想明确一点，这不是出于政治原因，而是我想说清楚。

And I want to be clear, not for political reasons, but I want to be clear.

当我说到‘无法独立’时，并不是说每个孩子都必须上大学，或者成为校队运动员之类的，而是指最终能搬出家门、找到一份稳定的工作、保住这份工作，最好还能建立各种健康的人际关系，并实现经济自立。

When I say fail to launch, don't mean that every kid has to go to college and, you know, be a, you know, a varsity athlete or any of this, but just moving out of one's home eventually, getting a regular job, keeping the job, hopefully having healthy relationships of various kinds and being self sustaining.

我说的就是这个意思。

That's what I'm talking about.

是的，完全正确。

Yeah, absolutely true.

比如，我做过伊扎·克莱因的节目。

I mean, for example, I did Ezra Klein show.

他显然是个非常成功的人，他提到自己有时会食用大麻食品。

He's obviously a very successful guy and he mentioned that he sometimes uses cannabis edibles.

我的意思是，他

Mean, so- He

有那种神情。

has that look.

不，我只是在开玩笑。

No, I'm just kidding.

抱歉，Ezra。

Sorry, Ezra.

只是开玩笑。

Just teasing.

是的。

Yeah.

我的意思是，确实有很多非常成功的人使用大麻。

I mean, so, yeah, and you know, there are very, very, very successful people who use cannabis, for sure.

不过总的来说，我会借用Jovlin Calkins的一句话，我们有增强表现的药物，而大麻算是一种削弱表现的药物。

Overall, though, I mean, I'll steal a phrase from Jovlin Calkins, it's like, you know, we have performance enhancement drugs, it's kind of a performance degrading drug.

但它不是芬太尼。

So it's not fentanyl.

你因它直接致死的概率极低。

Your odds of your death being directly traced to it are extraordinarily low.

但长期使用确实会削弱你在现代社会取得成功所需的一些能力，比如短期记忆、专注力和把握细节的能力。

But it does, with regular use, undermine certain things that you need to succeed in the modern world, like short term memory and concentration and being able to keep track of details.

对一些人来说，它还会削弱他们做任何事情的动力。

And for some people, also, undermines their sort of motivation to do much of anything.

我的意思是，‘沙发锁’确实是真实存在的。

I mean, the couch lock is a real thing.

我知道在帕洛阿尔托——我家乡这样一个追求成就的地方——有些家庭，他们的儿子原本成绩全优，参与各种体育活动，但六个月后，却整天吸大麻，对曾经擅长的球队和数学完全失去了兴趣。

I know families in Palo Alto, where I'm from, very Achieve y place, who had a straight A son doing everything, starring a sports suit, whatever, who six months later, was just smoking cannabis all day and had no interest in the team he used to star on and the math he used to be great on.

这相当可怕。

And that's pretty frightening.

而所有这些因素都不利于在现代社会中取得成功。

And all those things are not conducive to succeeding in, again, a modern world.

如果在农业社会，这可能无关紧要，因为一切都靠体力，对吧？

If maybe back in an agrarian society it didn't matter because everything was on muscle power, right?

但要在这个社会中取得成功，你就必须能够做到这些事。

But to succeed in this society you have to be able to do those things.

而你正处于竞争之中。

And you are in competition.

如果你想找一份计算机编程的工作，你不仅要和你 neighborhood 最聪明的孩子竞争，还要和孟买、东京最聪明的孩子竞争。

If you want a job, computer coding, you're in competition not just with the smartest kids in your neighborhood, you're in competition with the smartest kids who are in Mumbai and in Tokyo.

如果你无法集中注意力，或者反应迟钝、记不住东西，或者难以掌控时间，这会让你处于劣势。

And if you can't focus, or you're just slower, and you can't remember things, or you have trouble making sure you keep track of time, that is going to put you at a disadvantage.

你最终可能会陷入那种刻板印象——住在妈妈的地下室里，不幸的是，这对许多大麻重度使用者来说确实是真实写照。

And you can end up, that stereotype of, you know, in mom's basement, that unfortunately is true of a chunk of people who are heavy users of cannabis.

是的，我非常担心那些所谓非常成功的人也使用大麻的例子。

Yeah, I worry a lot about examples of so and so is very high achieving and they use cannabis.

我小时候有个朋友，他极度渴望成为职业高尔夫球手，他总是引用那些酗酒严重的职业高尔夫球员作为例子。

I had a friend growing up who desperately wanted to be professional golf player, and he would cite all these professional golf players who were heavy drinkers.

但他最后只擅长了酗酒这一部分。

He ended up just being good at the heavy drinking part.

是啊。

Yeah.

真遗憾。

Sadly.

我觉得他后来扭转了人生。

I think he turned his life around at some point.

但那些能够使用高度成瘾性物质、公开承认这一点并且成就非凡的人的例子，我认为这种信息传递实际上是有害的。

But these examples of people who can use very addictive substances and are open about that and are very high achieving, I think there's a real detriment to that messaging.

当然，你并不希望人们掩盖自己的真实情况，但这很复杂。

Now, of course, you don't want people to cloak their reality, but it's complicated.

是的，这还涉及政策风险。

Yeah, and it also has policy risks too.

我的意思是，当你制定规则、法律和监管时，如果认为‘我很有成就，我能用这个，所以它一定很安全’，这种想法是不对的。

I mean, know, when you make up the rules, know, your laws and regulations, to think, well, you know, I'm accomplished, I'm able to use this, so that must mean it's pretty safe.

这种逻辑根本站不住脚。

Like that just doesn't follow logically.

你偶尔吸一点可卡因之类的，但依然能当上州参议员，这并不能证明对每个人来说都是安全的。

The fact that you occasionally take a snort of cocaine or whatever, and you're still a state senator, that doesn't prove that that would be safe for everyone.

我们知道，人们的风险承受能力不同，社会资源不同，生活中的激励因素也不同。

And we know people have different levels of risk, have different social capital, they have different incentives in their lives.

你不能从一种幸运的生活或侥幸的生活里做出过度概括。

And you can't overgeneralize from a sort of a lucky life or a costed life.

有时，当一个人与地面之间没有太多保障时，你反而能做更多的这类事情。

Sometimes you can do more of that than you can when there's not many nets sort of between the person and the ground.

到目前为止，我相信你们很多人都听过我说，我已经服用AG1十多年了。

By now, I'm sure that many of you have heard me say that I've been taking AG1 for more than a decade.

确实如此。

And indeed, that's true.

我早在2012年就开始服用AG1，至今仍每天坚持服用，是因为据我所知，AG1是市场上质量最高、最全面的基础营养补充剂。

The reason I started taking AG1 way back in 2012, and the reason why I still continue to take it every single day is because AG1 is to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the market.

这意味着它不仅含有维生素和矿物质，还包含益生菌、益生元和适应原，以弥补你饮食中的任何不足，同时为紧张的生活提供支持。

What that means is that it contains not just vitamins and minerals, but also probiotics, prebiotics, and adaptogens to cover any gaps that you might have in your diet while also providing support for a demanding life.

由于AG1含有益生菌和益生元，它还有助于维持健康的肠道菌群。

Given the probiotics and prebiotics in AG1, it also helps support a healthy gut microbiome.

肠道菌群由数万亿个微小微生物组成，它们分布在你的消化道内，影响你的免疫状态、代谢健康、激素健康以及其他诸多方面。

The gut microbiome consists of trillions of little microorganisms that line your digestive tract and impact things such as your immune status, your metabolic health, your hormone health, and much more.

坚持服用AG1有助于我的消化，保持免疫系统强壮，并确保我的情绪和精神专注力始终处于最佳状态。

Taking AG1 consistently helps my digestion, keeps my immune system strong, and it ensures that my mood and mental focus are always at their best.

AG1现在有三种新口味：浆果味、柑橘味和热带水果味。

AG1 is now available in three new flavors, berry, citrus, and tropical.

虽然我一直很喜欢AG1的原味，特别是加一点柠檬汁，但我现在特别喜欢新的浆果味。

And while I've always loved the AG1 original flavor, especially with a bit of lemon juice added, I'm really enjoying the new berry flavor in particular.

味道很棒。

It tastes great.

不过话说回来，我确实很喜欢所有口味。

But then again, I do love all the flavors.

如果你想尝试AG1和这些新口味，可以访问drinkag1.com/huberman领取特别优惠。

If you'd like to try AG1 and try these new flavors, you can go to drinkag1.com/huberman to claim a special offer.

目前AG1正在免费赠送六包AGZ试用装，这是AG1的新款睡眠配方，顺便说一句效果很棒。

Right now, AG1 is giving away six free sample packs of AGZ, which is AG1's new sleep formula, which by the way is fantastic.

这是我唯一服用的睡眠补充剂。

It's the only sleep supplement I take.

它消除了我服用这么多药片的需要，我的睡眠从未如此好过。

It eliminates the need for all these pills and my sleep has never been better.

这个特别优惠包括六份免费的AGZ样品，以及您的首次订阅附赠三份AG1旅行装和一瓶维生素D3K2。

The special offer gives you six free samples of that AGZ, as well as three AG1 travel packs and a bottle of vitamin D3K2 with your first subscription.

只需前往drinkag1.com/huberman即可开始。

Just go to drinkag1.com/huberman to get started.

我听说了你与肯尼迪家族一位成员参与的一场精彩对话。

I heard a wonderful talk that you participated in with one of the members of the Kennedy family.

不是罗伯特。

Wasn't Robert.

抱歉，是肯尼迪，他一直非常坦诚地分享自己的康复经历。

Kennedy, excuse me, who's been very open about his own recovery.

那场对话中有太多精彩之处。

So many gems in that talk.

我们会放上链接，并再次提及其中的一些内容。

We'll put a link to it, we'll touch on some of those things again.

但这是一场非常重要的对话。

But just such an important conversation.

而且，在那次讨论中提到，许多行业都是成瘾性行业。

And, you know, it came up in that discussion that many industries are industries of addiction.

酒精、大麻、赌博。

Alcohol, cannabis, gambling.

现在，我在想你们之前讨论的内容，如今几乎很难找到任何一个行业，不觉得它在某种程度上具有成瘾性。

Nowadays, I was thinking about what you guys were talking about, and nowadays it's very difficult to look at any industry and not see it that way at some level.

他们自己就是这么谈论的。

They talk about it themselves that way.

如果你和应用程序开发者聚在一起，他们会说：我们怎样才能让这个产品更具成瘾性？

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

这对生意有好处。

And it is good for business.

没有比成瘾的客户更好的客户了。

There is no customer like an addicted customer.

所以，如果你想要推销什么东西，这自然会很有吸引力。

So of course that's gonna be appealing if you're trying to sell something.

我想问题在于，什么是健康的成瘾、适应性的成瘾，或者那些超出了带来愉悦感的事物逐渐窄化范围之外的东西。

I guess the question is healthy addictions or adaptive addictions or things that fall outside the progressive narrowing of the things that bring you pleasure.

因为一个孩子对学习应用上瘾，这可能会带来许多积极的结果，这也是我们所期望的。

Because a kid getting addicted to a learning app, that carries over into a number of things one hopes.

哦，没错，没错。

Oh yeah, yeah.

还有学校，甚至社交媒体。

School and even social media.

我从YouTube视频中学到了很多东西。

I've learned a lot from YouTube videos.

说实话，我甚至看过你和帕特里克在YouTube上的那个视频。

Heck, I even watched that YouTube video of you and Patrick, you know, on YouTube.

所以这是一把双刃剑。

So there's this double edged blade piece.

但当谈到酒精和大麻时，你之前告诉我们，比如通过营造一种观念，让女性觉得在美國喝酒是成为女性的重要部分，从而促使女性饮酒。

But when it comes to alcohol and cannabis, what you told us earlier, like getting women to drink more by making it seem like an important part of being a woman in The United States to drink.

是的。

Yeah.

这听起来太邪恶了。

That sounds diabolical.

是的。

Yeah.

说服人们大麻能让他们更有创造力，而且比酒精危害小，这在我看来非常邪恶。

Convincing people that cannabis is gonna make them more creative and it's not as bad as alcohol, that to me is very diabolical.

我担心这种‘没酒精那么糟’的论调，因为我的意思是，朝自己头部开枪显然比捅自己头部更致命。

And I worry about this, well, it's not as bad as alcohol argument because I mean, shooting yourself in the head is way worse than stabbing yourself in the head.

酒精每年也会导致大约十五万美国人死亡。

Well, alcohol also kills about one hundred and fifty thousand Americans a year.

所以如果我们以这个为标准，那药店里应该放手榴弹，它们能杀死数万人，但不是十五万。

So if that's our bar, we should have hand grenades in the drugstore that killed tens of thousands, but not one hundred and fifty thousand.

我们应该合法化酒后驾驶，因为那每年只造成一万人死亡。

We should legalize drunk driving because that only kills ten thousand people.

我的意思是，把这当作标准简直疯狂——只要每年死亡人数少于十五万，听起来就很不错。

I mean, that's just a crazy thing to set as the, well, as long as it kills less than one hundred and fifty thousand people a year, it sounds great to me.

不，这完全说不通。

No, that doesn't make any sense.

我明确地说，从经济上讲，我是个资本主义者。

I I am clear, economically, I am a capitalist.

我很高兴我们有公司。

I'm glad we have companies.

我喜欢住在硅谷。

I love living in Silicon Valley.

我喜欢那里人们创造的一切。

I love all the things people create there.

我认为私营部门是社会正常运转的重要组成部分。

And I think that is an important part for society to work, to have a private sector.

同时，你必须非常聪明且严格地监管成瘾性商品和诱惑性商品，因为你不能指望理性消费者像对待卷心菜或生菜那样保护自己——毕竟没人会过量食用这些蔬菜。

And at the same time, you have to regulate addictive goods, temptation goods, very intelligently and tightly, because you can't count on the sort of rational consumer to protect themselves like you can when you're dealing with cabbage or lettuce, which nobody ever overdoses on.

但我们确实看到有人因为这些药物而毁掉自己的人生。

But we do see people burning down their lives over all of these drugs.

因此，为了保护这些个体，也为了保护我们其他人免受其后果的影响，这才需要诸如广告限制之类的措施。

And for that reason, to protect those people, but also to protect the rest of us from the consequences of that, that's why you need things like advertising restrictions.

这就是为什么需要征税——即使重度使用者也会对价格做出反应。

That's why taxes to which people, even heavy users, respond to price.

这是一种非常重要的监管工具。

That's a really important tool to regulate them.

我会在大麻问题上采取更多措施，尤其是因为很多宣传太过直白，而且很多都出现在儿童容易接触到的地方。

I would do much more with cannabis, particularly just some of the promotion is so naked, and a lot of it is in places where kids are exposed particularly.

这一直是一场长期的斗争。

And this has just been a long term fight.

我们曾与烟草行业打过这场仗。

We had it with the tobacco industry.

你所能想到的关于烟草行业的任何恶劣行为，最终都被证实是真的。

Almost any nasty thing you could say about the tobacco industry turned out to be true.

我的意思是，他们确实努力让产品更具成瘾性，竭力阻止任何形式的健康监管，还向儿童进行营销，所有这些事情都属实。

I mean, they did work to make it more addictive, they worked to defeat any type of health regulation, they were marketing to kids, all that stuff.

所以，这些就是经济激励因素。

So those are the economic incentives.

因此，如果你在这个领域工作，就不要对生产成瘾性产品时所存在的财务动机抱有天真幻想。

And so you should not be naive, if you work in this space, about what the financial incentives are if you're making an addictive product.

更多的成瘾意味着更好的利润。

More addiction is good for your bottom line.

所以，我们这边必须说：我们要制定法律和监管措施，让这种行为变得更难实现。

So us on the other side have to say, we're going to put in laws and regulations so that that is harder to achieve.

不可能完全消除所有这些行为，但可以让它变得困难得多。

Never gonna get rid of all of it, but you can make it a lot, lot harder.

赌博就是一个很好的例子。

Gambling is a great example.

我的意思是，我简直难以置信，我们现在竟然完全放弃了对赌博的任何限制。

I mean, I'm just amazed that we have just given up on any restrictions on gambling now.

我的意思是，我小时候，皮特·罗斯因为曾为自己球队下注，而被禁止进入名人堂。

I mean, when I was a kid, Pete Rose was not allowed to go into the Hall of Fame because he had once placed a bettor on his own team.

他甚至没有做任何腐败的事，只是赌了自己的球队会赢。

He wasn't even doing anything corrupt, but he bet on his own team would win.

他因此被拒之名人堂门外。

He was kept out of hall of fame.

现在，你几乎无法观看任何体育赛事而不被强制塞入赌博广告。

Now you can't watch a sporting event without having gambling ads shoved in your face.

这本就不该是这种情况。

That's an example of something that should just not be the case.

这对任何试图戒赌的人来说都是灾难。

That is terrible for anyone who's trying to quit gambling.

这对很多年轻男性尤其糟糕，但不仅仅是年轻人，很多人正因体育赌博而毁掉自己的经济生活。

It's terrible for a lot of young men particularly, but not just young men, are just ruining themselves economically over sports gambling.

我们不需要这个。

And we don't need this.

我们可以没有它。

We can do without it.

赌博确实是个大问题。

Gambling thing's a real concern.

我们这个播客曾经请过一位自认是赌博成瘾者的嘉宾。

And we had a guest on this podcast who's a self admitted gambling addict.

我一位治疗赌博成瘾者的朋友说，这是最严重的成瘾之一，因为患者每天都活在现实里。

And a friend of mine who treats gambling addicts said it's among the worst of the addictions because they live with the reality.

确实，下一次赢钱可能真的会改变一切。

It's true that the next time really could change at all.

他说，最终他们会沉迷于输钱带来的羞耻感。

And he said, eventually they get addicted to the shame of losing.

赢钱对他们来说已经成了遥远的过去。

They just get so Winning becomes a thing of the distant past.

我的意思是，对我们其他人来说这听起来很疯狂，但是

I mean, this sounds crazy to the rest of us, but

这很有趣。

It's fascinating.

这既有趣又令人不安。

It's fascinating and disturbing.

赌徒会说，每一种成瘾都是赌博。

And gambling addicts will say that every addiction is gambling.

是的，说得好，说得对。

Yeah, that's good, that's good.

有一本很棒的书叫《设计成瘾》，我怕我会念错作者的名字，我觉得是舒尔，但我不确定，不过我知道书名，是关于赌博的《设计成瘾》。

There's a tremendous book, Addiction by Design, and I'm afraid I'm going to mispronounce the name of the person, I think it's Schull, but I'm not sure, but I know the title, Addiction by Design, about gambling.

她采访了玩视频扑克的人，其中许多人就在赌场工作。

And she profiles people who play video poker, many of whom work in the casino.

他们基本上领了工资，然后又把钱输回给赌场。

They basically get paid, and then they go pay the casino back by giving it away.

但有些人会拿一根牙签，把它弯曲并强行按下下注按钮，自己甚至都不碰它。

But some of them will take a toothpick and bend it and force the bet button down, and they won't even touch it.

他们只是坐在那里，处于一种解离状态，看着机器不停地运行、运行、运行，直到他们的钱花光为止。

They'll just sit there and watch in kind of a dissociative state, as it just runs and runs and runs until their money is gone.

你知道，这简直就像是这种东西的僵尸化。

You know, that's like, you know, it's literally like zombification of this stuff.

而这种技术已经被完善到让人上瘾的程度。

And that tech has been perfected to be addicted.

我每隔几年会去一次拉斯维加斯。

I do go to Las Vegas, like, once every couple of years.

我只是喜欢那种盛大的场面、美食等等，而不是为了赌博。

I just find, not for Gamma, but I just enjoy the sort of pageantry and the food and all that.

现在很难在赌桌上看见荷官了，因为荷官无法像机器那样提供完美的强化节奏。

It's very hard to see dealers at tables anymore, because dealers don't give the perfect timing of reinforcement that machines can do.

你必须等待你的奖励，所有这些都需要时间，而且还有社交成分。

And you have to wait for your reward and all that kind of thing, and you wait till you find out, and there's a social component.

但这会减慢整个过程，而机器却能精确控制你按下按钮与获得奖励、赢或输之间的间隔时间。

Well, that all slows down the process, whereas a machine can give you exact timing between your press the button and then you get your reward or your win or your loss.

而且它可以全天候无限运行，而荷官却不会不知疲倦。

And it can just go infinitely twenty four hours a day, unlike a dealer who never gets tired.

因此，所有赌场都拆除了荷官的赌桌，现在你只是在和机器玩。

And so all the casinos like chopped up dealers tables, and now you're just playing with a machine.

不可思议。

Incredible.

我不想过多地讲我自己的轶事，但我还是会分享一下。

I don't wanna spill off into too many anecdotes on my side, but I will share it.

一位之前做客你播客的嘉宾分享过一件事，你可能会觉得有趣。

Something that was shared by a previous guest on the podcast you may find interesting.

迈克尔·伊斯特在拉斯维加斯的一所大学里，获得了接触其中一台机器的机会。

Michael Easter at a university out in Las Vegas, and he got access to one of these.

他写了《舒适危机》一书，讲述如何走出户外、远离尘嚣，通过负重行走等方式作为一种疗法，而且这是定期进行的重要活动。

He wrote The Comfort Crisis about getting outdoors, getting away from things and basically carrying weight on your back and walking as a therapy of sorts, an important one to do regularly.

但他获得了其中一个研究型赌场的访问权限。

But he got access to one of these research casinos.

结果发现，老虎机曾经只是赌场收入的一小部分。

And it turns out that slot machines used to be a small fraction of the income of casinos.

现在则占到了80%或更多。

Now it's 80% or more.

没错。

Yep.

他说，这种情况的出现是因为一位在赌场行业工作的父亲在家看着自己的孩子玩电子游戏。

And he said that that came about because a father who worked for the casino industry was at home watching his kids play video games.

他意识到，孩子们玩并不是为了赢。

And he realized that the kids weren't playing to win.

他们玩的是为了看下一屏会出现什么新奇内容。

They were playing for the novelty of what was on the next screen.

孩子们自己并没有意识到这一点，但对他来说却变得很清楚。

And the kids didn't realize this, but it became clear to him.

所以现在，我认为这会帮助人们。

So now and I think this will help people.

这就是为什么我再次花时间分享这一点。

This is why I'm taking the time to share this once again.

现在，如果你玩老虎机，你会以为自己在试图赢钱。

Now if you play a slot machine, you think you're trying to win.

听到叮叮叮叮叮叮的声音，铃声响起，你就赢了。

Hear the ching ching ching ching ching ching and the bells go off and you and you won.

你以为那是多巴胺的奖励。

You think that's the dopamine reward.

但他们发现，与老式转轮机器不同，老式机器上只有些樱桃、铃铛之类的东西，而在电子环境中，可以通过无限多的新颖组合带来无限的新鲜感。

But they figured out that unlike the old rotor machines where you have some cherries and bells and stuff, in the electronic landscape, you could have an infinite amount of novelty through novel combinations.

所以现在他们发现，人们会为了赢取每投入一美元中的50美分而继续玩。

So now they figured out that people will play to win 50¢ on the dollar.

所以他们输掉了50美分。

So they lost 50¢.

对吧？

Right?

他们从理性上知道，或者本可以理性地知道。

And they know that rationally, or they could know that rationally.

但只要你提供新奇感，他们就会一直玩下去，直到输光为止。

But they'll continue to play until it's all gone as long as you give them novelty.

所以人们其实已经不是真的为了钱在玩了。

So people aren't even really playing for the money anymore.

他们以为自己是。

They think they are.

他们实际上只是被足够多的新奇组合所刺激，导致账户被掏空，赌场赢走一切

They're actually just being stimulated with enough novel combinations that their bank account gets drained, the house takes it

所有。

all.

是的。

Yeah.

嗯。

Yeah.

当我听到这个时，它改变了我对赌博的看法，因为我一直以为赌博是为了赢钱然后离开。

When I heard that, it changed my view of gambling because I always thought it was about winning money and leaving.

实际上，赌博更关乎玩的过程，更关乎每一手牌或每一次转轮中引入的新鲜感。

It's actually more about playing, and it's more about the novelty that's introduced in each hand or spin.

我认为，了解这一点同样适用于体育博彩，你感受到的兴奋源于你可能赢钱的希望，但这种由新颖组合带来的刺激，或许能帮助人们避免成为赌博成瘾者，或者帮助人们意识到，如果他们已经上瘾，那上瘾的可能不是羞耻感，而是这种新鲜感。

And that I think knowing that carries over certainly to sports and the excitement that you're feeling about the potential that you could win, but that it's a novel combination of things might prevent, hopefully, somebody from becoming a gambling addict or might help people realize that what they're addicted to, if not already shame, might actually just be the novelty.

这就是为什么他们会输掉所有钱。

And that's why they're losing all their money.

嗯。

Yeah.

这个行业里有个术语来形容这种现象。

There's an industry term for that.

它叫‘伪装成赢的输’，简称LDWs。

It's LDWs, losses disguised as wins.

所以你知道，你投一美元，就能得到一百个积分，然后你拉下把手，机器就开始运作，接着它会显示：你匹配了这种方式，赢了十块，然后又显示：你匹配了那种方式，赢了二十块，天啊，我又赢了，赢了四十、二十和十，所有这些令人兴奋的奖励。

So, you know, you put in a dollar and you get a 100 credits, and then you pull the thing and it does its thing, and then it goes like, you've matched this way, you've won 10, and it goes off, you've matched that way, 20, oh my God, I've won again, 40, I won forty, twenty and ten, with all these exciting things.

但我实际上已经输掉了投入资金的30%。

I just lost 30% of what I put in.

但感觉却像是赢了。

But it feels like a win.

他们意识到，正如你所说，即使客观上人们只是把钱往无底洞里扔，他们还是会继续玩。

And they realized, as you say, people will keep playing even while objectively they're just pouring money down a sewer.

幸好我没有赌博成瘾。

So glad I'm not addicted to gambling.

但我能理解自己为什么会上瘾。

But I could see how I could be.

尽管我想说我不可能上瘾，但我确实能理解自己为什么会上瘾。

Even though I would like to say I couldn't be, I could see how I could be.

因为人的大脑本来就很容易被这类机制吸引。

Because the brain is just so prone to these kinds of things.

我们都有这些神经回路。

We all have these circuits.

确实如此。

Absolutely.

而且有趣的是，你知道，赌场是少数几个还能在室内吸烟的地方，而且还能免费喝酒。

And it's interesting too, you know, casinos are one of the few places where you can still smoke, you know, indoors and you get free drinks.

所以这简直就是成瘾行为的密集集中地。

And so it's really like absolute dense pack of addictions.

大量的问题赌徒同时也是酗酒者，并且也吸烟成瘾。

A huge number of people problem gamers are problem drinkers and also are addicted to cigarettes.

所以当我去拉斯维加斯时，这对我来说几乎就像一场人类学体验。

And so when I go Las Vegas, it's almost like an anthropology experience for me.

我只是看着这一切，心想：哇。

I just look at all this and like, wow.

在舒尔的书里有一个故事，我觉得特别震撼：一群人不停地玩，突然有个人在机器旁心脏病发作，倒在了地上，但周围的人竟没有一个有所反应。

And there was a story in Scholl's book, which I just found amazing, with a bunch of people playing, playing, playing, playing, and somebody had a heart attack at one of the machines, fell over on the floor in a group of them, and none of them even reacted.

他们只是继续玩着，而这个人却死了。

They just kept playing as this person died.

这真是社会的一个隐喻。

What a metaphor for society.

好吧，我决定，如果我以后去拉斯维加斯，就跟你一起去。

Well, just decided if I'm ever going to Las Vegas, I'm going with you.

好的。

Okay.

抱歉擅自邀请自己，但你看起来是个靠谱的人

Sorry to invite myself, but you seem like a safe person to

去吧，我挺靠谱的。

go I'm pretty safe.

是的。

Yes.

你可能会赢或输五美元，然后就结束了。

You may win or lose $5, and that'll be the end of it.

所以推动这些东西的产业。

So industries that drive this stuff.

好的。

Okay.

酒精、大麻。

Alcohol, cannabis.

现在和未来，看看大麻会发生什么将会非常有趣。

It's going to be very interesting to see what happens with cannabis now and going forward.

在那些大麻被合法化或非刑事化的州，州政府是否会对其征税？

Is it the case that in states where it's legalized or decriminalized that the state collects its taxes on it?

是的，这要看情况。

Yeah, it depends.

这些是不同的制度。

Those are different regimes.

当你思考政策时，这是一个非常重要的点。

And this is a really important point to get into when you think about policy.

所以非刑事化是针对使用者的，也就是说，我们不会因为你使用大麻而惩罚你，明白吗？

So decriminalization is about the user, and that's to say, look, we're not going to punish you for using pot, okay?

这一直是一项相当受欢迎的政策，长期以来都是如此，似乎对使用率影响不大，也许有一点影响，但并不大。

And that is a pretty popular, it's been a popular policy for a long time, and doesn't seem to really affect use that much, maybe a little bit, but not a lot.

合法化是指使生产、加工、营销和销售变得合法，引入企业。

Legalization is making the production, processing, marketing, and sale legal, bringing in a corporation.

这从根本上不同，因为企业会聘请非常聪明、擅长销售的人，他们会增加产品的消费量。

And that is fundamentally different, because the corporation is going to have very smart people who are good at selling, and they will increase consumption of the product.

目前，我不清楚确切的州数量，但就人口而言，美国大多数人都已经可以接触到 recreational 大麻。

At this point, I don't know the exact state count, but most people in The United States, population wise, have access at this point to recreational cannabis.

我认为，几乎每个州都有某种形式的政策。

And virtually every state, I believe, has something.

如果不是娱乐用的，那就是医疗用的。

If it's not recreational, it's medical.

或者由于大麻汉麻，监管上出现了一个失误，有一种加工汉麻的方法，可以生产出这种 delta-8 和 delta-9 物质。

Or there were these, due to hemp, there was sort of a way, mistake they made in regulation, there's a way to process hemp that you can make, these delta 8s and delta 9s.

所以即使在禁止的州，也有很多添加了大麻的饮料，而且效力很强。

So even in states that are prohibited, there's quite a bit of hemp laced beverages, which are quite strong.

大麻是入门毒品吗？

Is cannabis a gateway drug?

我们上学时就被这样告知过。

We were told that when we were in school.

是的，所有毒品都是入门毒品。

Yeah, so all drugs are gateway drugs.

这个说法的谎言在于，大麻被赋予了一种独特的作用，认为它会把你引向使用海洛因。

The lie in that was that cannabis had some unique role that was going to lead you to use heroin use.

但事实是，任何行为——比如青少年开始吸烟、饮酒、使用大麻，或者偷父母的处方阿片类药物——都会增加你进一步尝试其他物质的可能性，原因有多个。

But the truth is anything, like if you're a teenager and you start smoking, or you start drinking, or you start using cannabis, or stealing prescription opioids from your parents or whatever, that will increase your likelihood of progressing to other substances for multiple reasons.

第一，你可能喜欢这种感觉，于是想：好吧，既然我试了这一种，那我也试试其他的。

One, you might like it, say, okay, well, I guess I'm a converse of life stroke, let me try some others.

第二，你的社交圈可能会改变，你会接触到其他也这么做的人，你们彼此都感到自在，而他们也更有可能拥有你可能想尝试的其他东西。

Two, your social networks may change, so you're around other people who do this, and so you're comfortable with them, they're comfortable with you, and they're also more likely to have something else you might want to try.

第三点是，大脑可能会出现某种敏感化，使药物更具奖励性。

And then the third thing is there could be some brain sensitization going on that makes drugs more rewarding.

有一些关于不同州同卵双胞胎的有趣研究，似乎表明当你让年轻的大脑接触这些物质时，可能会启动某种逐渐展开的过程。

And there is some interesting work with identical twins in different states, seem to suggest that you could be starting some unfolding process when you expose a young brain to it.

所有这些机制共同解释了‘入门药物’是如何起作用的。

So all those processes is how gateways work.

谎言在于，它只是大麻。

The lie was that it was just cannabis.

这实际上符合一个普遍的谎言，我认为：酒精是一种药物，但我们却假装它不是。

And this actually fits with the general lie, I would say, is that alcohol is a drug, and we pretend that it isn't.

你提到人们在科学会议或健康会议上喝醉。

So you mentioned people getting drunk at science conferences or health conferences.

我见过一些会议、政治活动，人们整天贬低吸毒者，谈论药物的威胁，说药物多么邪恶，我们必须摧毁所有药物。

I have seen conferences, political events, where people spend all day demonizing drug users and talking about the threat of drugs and how evil drugs are and how we have to destroy all drugs.

然后他们却都去酒吧喝酒，仿佛自己不是吸毒者。

And then they all go to the bar and get drunk, as if they are not drug users.

不愿意承认酒精是一种药物，一方面对行业非常有利，但政治上也有害，因为你可以说，对孩子最大的威胁是大麻，而实际上孩子更可能因为酒精而惹上麻烦，而不是大麻。

Not wanting to admit that alcohol is a drug is, A, very useful for the industry, but it was also dis useful politically because you could say, well, the big threat to kids is cannabis, when it was much more likely a kid was gonna get in trouble with alcohol than with cannabis.

如今，关于致幻剂的讨论很多。

These days, there's a lot of discussion about psychedelics.

这是一个广泛的药物类别，包括LSD、裸盖菇素，还有MDMA这种共情剂——虽然它不是致幻剂，但却被归入其中。

Broad category of drugs, LSD, psilocybin, MDMA as an empathogen, not a psychedelic, but somehow it's been lumped into it.

甲基。

M methyl.

它的全称是亚甲二氧基甲基苯丙胺。

It's a methylene dioxymethamphetamine.

MDMA，也就是大家说的迷幻药，其实是经过改造的甲基苯丙胺。

MDMA, ecstasy folks, it's methamphetamine with some modifications.

所以它并不是致幻剂。

So it's not a psychedelic.

它是一种共情剂，但总是被归到致幻剂一类里。

It's an empathogen, but it gets lumped with that.

氯胺酮也被归入这一类。

Ketamine gets lumped with it.

解离性麻醉剂，不是致幻剂。

Dissociative anesthetics, not a psychedelic.

所以如果我们打算讨论致幻剂，就需要非常明确。

So if we're going to have a conversation about psychedelics, want to be really clear.

也许我们只把裸盖菇素和LSD放在桌面上，然后单独讨论致幻剂、氯胺酮以及其他物质。

Maybe we just put psilocybin and LSD on the table and then talk about the pathogens and ketamine and all the rest separately.

因为这些物质经常被混为一谈，导致大量混淆。

Because so often these get lumped and and it leads to a lot of confusion.

我认识一些人，他们通过在安全环境中由引导者协助进行高剂量裸盖菇素治疗（总共只进行两到三次），在治疗抑郁症、有时也用于酒精问题和其他问题上获得了极大的益处。

I know several people who feel they've benefited tremendously from doing clinical work, meaning with a guide in safe setting, etcetera, on high dose psilocybin, maybe only two or three times total, and that's it for treatment of depression, sometimes for alcohol issues and other issues.

我不是在谈论微剂量，而是指高剂量，大约两到五克。

I'm not talking about micro dosing, but they do a high dose, so two to five grams.

许多使用其他物质的成瘾者对裸盖菇素感兴趣，或正在使用，或考虑使用裸盖菇素来戒除成瘾，LSD则相对少一些。

A lot of addicts who use other things are interested in or currently using, or considering using psilocybin LSD less so as a means to get over their addiction.

我想听听你对这一点的看法，以及你对这些化合物的具体看法。

I'd like your thoughts about that, and your thoughts about these compounds specifically.

是的，我的意思是，这些化合物令人兴奋，部分原因是过去二十年我们在药物治疗方面几乎没有取得什么进展，比如治疗抑郁症、成瘾等问题。

Yeah, I mean, they're exciting, in part because we haven't really made much progress in pharmacotherapy in the last twenty years, you know, for lots of things, for depression, for addiction, you know.

所以，人们认为这些药物可能有效，我认为除了GLP-1之外，它们可能是我最看好的第二类药物，我会把第一选择放在GLP-1激动剂上。

So the thought that these might work, and I think they're, other than the GLP-1s, one of the, you know, probably say the second, I'd say my second bet on that, I'd put my first one on GLP-one agonist.

目前确实存在大量炒作，但真实的事物也可能会被夸大。

There is an awful lot of hype, but real things can be hyped.

因此，尽管有很多夸张的主张，而且同样地，谈到产业界，确实有人希望靠这些药物赚取巨额利润。

So the fact that there are a lot of extravagant claims being made, and also again, talking about industry, there are people who are hoping to make a huge sum of money on these medications.

但这些药物确实也有其真实价值。

But there's also something there.

你可以看看不同的试点研究和小型试验。

You could look at different pilot studies, small trials.

这些研究结果令人鼓舞，我很高兴现在进行这类研究变得容易多了。

They are encouraging, and I'm glad that it's a lot easier now to do these types of studies.