Ryan Soave on Understanding & Treating Addiction

In this episode of the Huberman Lab Podcast, Dr. Andrew Huberman speaks with Ryan Soave, a renowned expert in addiction treatment and trauma recovery. With decades of experience, Soave has helped individuals overcome substance addictions (alcohol, drugs) and behavioral addictions (gambling, video games, pornography). The discussion delves into the nature of addiction, its deep-rooted connections to trauma, and practical, evidence-based protocols for recovery. Soave shares insights from his extensive clinical work, offering zero-cost tools that leverage neuroplasticity to help individuals initiate and maintain sobriety. The episode is highly relevant for anyone directly or indirectly affected by addiction, or those interested in the mechanisms of addiction, recovery, and mental well-being.

Key Insights / Core Messages

• Addiction is often a maladaptive solution to underlying stress, pain, or trauma. While it initially provides relief, it eventually becomes a significant problem in itself, creating a cycle of escalating distress and dependence.
• A crucial self-assessment for addiction is the question: "Does it have you, or do you have it?" This prompts an honest look at the control a substance or behavior exerts over one's thoughts, actions, and life priorities.
• Effective recovery involves more than just cessation of the addictive behavior; it fundamentally requires building distress tolerance—the capacity to experience and navigate discomfort and negative emotions without resorting to the addictive substance or behavior for immediate relief.
• Early life experiences and trauma often shape adaptive strategies that, while once necessary for survival, can become maladaptive in adulthood and contribute to addictive patterns. Understanding these origins is key to healing.
• Zero-cost, accessible tools can significantly aid in recovery and self-regulation. Practices like the "Emotional Weather Map" (a daily inventory of gratitude, plans, emotional state, and intentions) and Yoga Nidra/Non-Sleep Deep Rest (NSDR) help build self-awareness and calm the nervous system.
• Community, connection, and shared experience are vital for overcoming addiction. Platforms like 12-step programs, therapy, and trusted relationships offer support, reduce shame, and foster a sense of belonging, which is antithetical to the isolation often accompanying addiction.
• Many addictive behaviors provide rapid, high-amplitude dopamine release with minimal effort. Recognizing and being wary of such easily obtained "rewards" is important, as they can quickly establish detrimental craving cycles. True, sustainable well-being often comes from effortful engagement.

Understanding Addiction: Beyond the Diagnosis

Ryan Soave begins by distinguishing the common term "addiction" from formal diagnostic criteria like "Substance Use Disorder" found in the DSM (Diagnostic and Statistical Manual of Mental Disorders). He emphasizes that not everyone who experiences a period of substance use disorder is necessarily an "addict" for life, as circumstances can play a role. However, a history of such disorders suggests a predisposition. Soave broadens the definition of addiction with a pivotal question he asks clients: "Does it have you, or do you have it?" This question probes whether the behavior or substance is driving the individual's life and decisions.

A core tenet of Soave's approach is that addiction is often not the primary problem but rather a "solution" to some underlying stressor or pain. Humans instinctively seek to alleviate discomfort, and when stress becomes overwhelming, individuals may turn to substances or behaviors that offer quick, potent relief. This relief, Dr. William Silkworth (an early supporter of Alcoholics Anonymous) noted, is what people essentially seek. The critical question then becomes: what are they seeking relief from? While initially a solution, this coping mechanism inevitably becomes deeply problematic, creating a cycle of dependence and negative consequences. This concept extends beyond illicit drugs and alcohol to seemingly mundane behaviors like binge-watching TV, which can become addictive if used consistently to avoid uncomfortable feelings.

The Initial Approach to Treatment

When an individual enters treatment, especially in an acute state (e.g., severe intoxication or withdrawal), the immediate priority is medical stabilization. Soave, as Chief Clinical Officer for Guardian Recovery, explains that medical and nursing assessments precede any deep psychological exploration. In some cases, emergency room care is necessary before admission to a detox facility.

Once physical safety is ensured, the reality for many is that life doesn't immediately improve with cessation. Emotionally, it can worsen as the "medicine" (the addictive substance or behavior) is removed, leaving the individual to face raw emotions and life's challenges without their usual coping mechanism. The initial phase of treatment focuses on understanding the person's biological, psychological, and social landscape, including patterns of use and life impacts.

Motivation for treatment varies. Some individuals arrive desperate for help, while others are resistant. Soave finds that initial struggle can sometimes lead to deeper, more sustained recovery, akin to pulling an arrow further back on a bow for a longer flight. Resistance itself provides valuable information about the individual. Treatment, which can last from seven to 90 days or more, aims to create a microcosm of the client's social universe, allowing them to experience and process stressors in a supported environment. A key turning point is often an "internal existential crisis," where the individual confronts the reality of why they were using substances or behaviors in such a destructive manner, even if they feel "great" in the moment of sobriety within the treatment bubble.

Soave challenges the notion that addiction is purely a choice, or if it is, questions why someone would repeatedly choose a path that harms themselves and others. The focus shifts to understanding the "causes and conditions" that led to the addictive behavior.

Building Distress Tolerance: The Core of Recovery

A central aim of Soave's therapeutic approach is to help clients "learn how to feel bad." This isn't about seeking misery, but about building "distress tolerance"—the capacity to experience difficult emotions, pain, and discomfort without resorting to addictive behaviors for immediate, short-term relief. He posits that by becoming available for the depths of discomfort, individuals also become more available for the heights of joy and satisfaction.

This process involves examining and challenging limiting beliefs that often drive addictive behaviors. These beliefs are frequently rooted in early life experiences and "shapings," which Soave frames as a form of trauma. This isn't always about a single, major traumatic event, but can also be the cumulative effect of adaptive strategies developed in childhood to survive particular family, school, or social environments. These strategies, such as fight-or-flight responses, might have been appropriate then but become maladaptive when carried into adult life and applied to situations where they are no longer suitable or healthy. The Jellinek Curve for alcoholism is mentioned as a model illustrating the progression into addiction (crucial and critical phases with increasing problems and then decreasing tolerance) and the subsequent path to recovery, which involves rebuilding life, finding pleasure from life itself rather than substances, and increasing stress tolerance, ultimately moving towards self-actualization.

Identifying Addictive Patterns and Reordering Loves

Soave offers a practical litmus test for identifying if a behavior "has you": try to abstain for a significant period, like a month. If thoughts are consumed by either doing the behavior or by how to stop doing it, it's a strong indicator of an addictive pattern. The impact on various life areas—relationships, motivation, overall engagement—is also critical to assess.

The discussion touches on how modern technology, like video games or social media, can create a "hot fudge sundae" effect, making ordinary life seem underwhelming by comparison due to the intense sensory input and immediate rewards. This relates to dopamine dynamics: the brain's reward system is driven by the pursuit of reward. Frequent, high-intensity dopamine spikes from easily accessible sources (like online shopping, pornography, or even some forms of work) can lead to tolerance (needing more for the same effect) and a significant "trough" or low feeling afterward. Individuals then chase the memory of the initial good feeling, even if the behavior no longer provides it.

This leads to the idea of people forming "spiritual relationships" with their addictions, where the substance or behavior makes them feel whole or connected. Soave references Augustine's concept of needing to "reorder your loves," suggesting that whatever one loves most becomes their higher power. If this "higher power" is something fallible like money, relationships, or even one's children (if they become the sole source of a parent's identity and fulfillment, placing an undue burden on the child), it will eventually lead to suffering. The healthiest approach involves orienting towards a truly resilient higher power, allowing other aspects of life to fall into their proper place.

Practical Tools for Self-Regulation and Recovery

Soave champions several zero-cost, accessible tools for daily self-regulation and building distress tolerance:

The Emotional Weather Map/Forecast: This daily practice involves:

1. Gratitude: Listing things one is grateful for, including challenges, to foster a mindset of acceptance.
2. Plan for the Day: A brief outline of the day's activities.
3. Current Emotional State: Identifying present feelings (fear, resentment, peace, etc.).
4. What to Watch For: Based on the day's plan and current emotional state, predicting potential character liabilities or defects that might arise (e.g., impatience if travel delays are likely).
5. What to Strive For: Identifying desired states or virtues to cultivate (e.g., patience, kindness).

This tool helps individuals anticipate emotional disturbances and consciously choose more adaptive responses, rather than being surprised or overwhelmed by reactions. Sharing this "map" with trusted others enhances accountability and connection.

Yoga Nidra / Non-Sleep Deep Rest (NSDR): Soave learned about Yoga Nidra (which means "yogic sleep") at the Amrit Yoga Institute and witnessed its profound effects. NSDR is a guided meditation typically done lying down, designed to induce deep relaxation while maintaining a state of conscious awareness. It often involves body scans, breath awareness, and sometimes intention setting. Soave highlights its power in activating the parasympathetic (rest-and-digest) nervous system, distinct from merely deactivating the sympathetic (fight-or-flight) system. Studies, including one mentioned by Huberman, show NSDR can significantly increase baseline dopamine levels. Regular practice (ideally morning and late afternoon/evening, or anytime possible) helps build the capacity to quickly shift from a dysregulated to a regulated state and makes other mindfulness practices easier.

Breathwork: Quoting one of his teachers, "the breath is the mind made visible," Soave emphasizes that changing one's breath pattern (e.g., employing long, slow exhales) is a quick way to influence mental and emotional state by engaging the parasympathetic nervous system. Even taking seven conscious breaths can be a powerful micro-intervention.

Proactive vs. Reactive Tools: Soave distinguishes between proactive (scheduled) practices like meditation, NSDR, or exercise, which build baseline resilience, and reactive tools used in moments of acute stress. The cold plunge is mentioned as a proactive tool that trains distress tolerance by exposing individuals to controlled, intense discomfort (adrenaline release) and teaching them to maintain cognitive control.

Addressing Specific Addictions and Seeking Help

The conversation touches on several types of addiction:

• Alcohol: Its social acceptability makes it challenging. The stigma of not drinking can be a barrier. Soave, who is sober, notes the importance of community (like 12-step programs such as AA) in providing a new, supportive social framework. AA's first step, admitting powerlessness over alcohol and that life has become unmanageable, is framed as a crucial realization that allows individuals to find genuine power by ceasing to fight a losing battle.
• Gambling: Soave describes this as particularly insidious because the "next hit" genuinely *could* solve all financial problems, a false hope not usually present with substance addictions. It's associated with high suicide rates and is increasingly accessible, especially to youth, through online platforms and sports betting.
• Stimulants (Cocaine, Amphetamines): These don't typically cause the same physical withdrawal as opioids or alcohol but lead to intense psychological addiction and obsession. They can acutely match a user's internal state of agitation with their physical energy, sometimes paradoxically calming individuals with ADHD.
• Pornography: Soave notes its powerful impact, particularly on young men, potentially equating its effect on the brain to that of crack cocaine. It can create unrealistic expectations of sex and intimacy, negatively impact real-life sexual function and relationships, and foster shame. Accessibility is a major factor. Recovery involves acknowledging the problem, seeking accountability (therapy, 12-step groups like SA or SAA, software blockers), and addressing underlying drivers.

Regarding psychedelics (like ibogaine and psilocybin) for addiction, Soave acknowledges promising research and anecdotal success. He views them as potentially powerful tools for helping individuals experience different states of consciousness, breaking them out of "survival mode" or stuck patterns. However, he stresses the critical importance of ethical guidelines, proper screening, therapeutic support during and after the experience ("integration"), and avoiding the trap of seeing them as a magic bullet without follow-up work to build new life structures.

For those wanting to help someone struggling with addiction, Soave advises open, non-shaming communication. If unsure how to approach, seeking help for oneself first (e.g., through Al-Anon for families of alcoholics, or consulting a treatment professional) is recommended. Offering to attend an "open" 12-step meeting with the person can be a supportive gesture. Guardian Recovery and similar organizations offer resources for families and can guide them toward appropriate levels of care, including virtual and in-home options for resistant individuals.

The founding story of Alcoholics Anonymous by Bill Wilson and Dr. Bob Smith is highlighted as an example of the profound power of connection and mutual help in overcoming addiction. One man's decision to make a phone call instead of going to a bar led to a worldwide movement.

Audience Questions: Expert Insights on Addiction

Dr. Huberman posed several audience questions to Ryan Soave:

• Is addiction the problem or a solution? Soave reiterated it's both: initially a solution to discomfort that becomes a problematic cycle, where the addiction itself becomes a new source of trauma and stress.
• GLP-1 agonists (Ozempic, etc.) for addiction? Soave mentioned initial research suggesting potential for reducing cravings. He noted anecdotal links between stable blood sugar and reduced relapse risk in diabetics with alcoholism, aligning with the "HALT" (Hungry, Angry, Lonely, Tired) relapse triggers.
• Addiction to stress? Soave believes people can become accustomed to high levels of stress/activation to feel "normal" or alive, particularly observed in combat veterans whose nervous systems are trained for extreme environments. This could be termed an "intensity addiction."
• Social behavior addictions (social media, coffee, sugar, work)? While not meeting formal DSM criteria for substance use disorder, Soave affirms these can absolutely be addictions if they "have you" rather than "you having them," especially if they involve progressive negative impacts despite attempts to control them. Sugar, in particular, is often cited as a primary addictive behavior.

Conclusion

Ryan Soave's discussion with Andrew Huberman paints a comprehensive picture of addiction as a multifaceted issue, deeply intertwined with trauma, stress, and the human search for relief. The core message is one of hope: recovery is not merely about abstinence but a profound journey of building self-awareness, developing distress tolerance, and forging new, healthier ways of navigating life's challenges. The episode underscores the immense value of accessible, often zero-cost tools like mindful daily inventories and practices like NSDR, alongside the indispensable support of community and connection. By understanding the underlying drivers of addiction and embracing proactive strategies for emotional regulation, individuals can move beyond shame and actively create lives of greater freedom and fulfillment.