Dopamine Nation: Finding Balance in the Age of Indulgence
Anna Lembke 2021
We all like to think that we have free will and all of our choices are reasonable, personal, and proper. But experiments on lab animals shows that our brains aren't much different and can be manipulated thanks to a certain chemical reward pathway that can control many of our choices. We want things, sometimes obsessively, and can't explain why.
When we eat something delicious, feel relaxed after ingesting various chemicals, or experience a pleasant surprise, a powerful chemical named dopamine surges through our brain to tell us "Hey- that was pretty good. Do that some more!" Dopamine, in proper proportions, helps us survive as a species and find the things we need to stay happy and healthy. Our world today has become too dependent on dopamine rewards, to the point where most of us experience addiction in one way or another that hampers our lives. If you have something in your life that you couldn't go even one day without (besides the obvious things like Oxygen and Water), you probably have an addiction.
Dopamine Nation is a look at the ways we get addicted to the good feelings and pleasure that comes with hits of dopamine, and why they never seem to last. Our dependence on alcohol and drugs, especially has disrupted the pain/pleasure balance that keeps us on an even keel. Anna Lembke is a Psychiatrist at Stanford University and a national expert on the opioid epidemic. Lembke uses the book to describe her own experiences with addicted patients, including her bizarre experiences of being addicted to trashy romance novels that apparently took over her life for a while.
People can get addicted to almost anything that provides a sudden hit of pleasure. Alcohol and drugs are the main target of this book, but sex, gambling, cell phones, smoking, social media, food, exercise, and shopping are other behaviors where people have gotten caught in the dopamine trap. The problems gets worse when the brain and body begin to build up a tolerance for the addictive behavior. The same things don't bring pleasure anymore, and the lack of that high brings on withdrawal symptoms that can be more painful than anything that may have come before.
Once tolerance builds, higher and higher levels of stimulation become necessary to reach the same high. With drugs, that means higher and more frequent dosages. With gambling, that means bigger and more risky bets. The pain threshold goes down and pleasure tolerance goes up, as a vicious cycle begins that eventually consumes addicts in desperate attempts to find the next fix while neglecting the rest of their lives.
It doesn't help that capitalist consumerism pushes the pleasure principle to the max while offering more and more avenues to avoid and treat pain, boredom, and addictive personalities. Casinos, big pharma, big tech, and many large businesses rely on their customers becoming more and more dependent on their products and services.
Lembke offers a set of ten ideas to help combat the dopamine traps. To tame dopamine means finding a new balance that keeps it under control. Here is a summary from the end of the book:
1- The pursuit of only pleasure leads to pain. The two are like a see saw, and putting extra weight on the pleasure side invites a backlash of pain.
2- Recovery from addiction begins with abstinence. Only by getting the drugs out of your body or the temptations out of your environment can you begin the healing process.
3- Abstinence resets the brain's reward pathways. This can take time, but it is achievable for many people.
4- Self-binding creates space between desire and consumption. Self-binding is your making an agreement ahead of time to remove all possible temptations. Lock up the cell phone and make it unattainable. Remove all drugs and booze from the house. Don't keep the most tempting, unhealthy foods where you can reach them. For this, many need help from others to keep them honest.
5- Medications can help restore balance, but recovering addicts must be willing to experience some pain in the process. Pain is unavoidable in any recovery.
6- Press on the pain side of the equation to help with the reset to pleasure. People who voluntarily make themselves a bit uncomfortable, (cold water baths, exposure therapy, fasting and exercise) can experience natural spikes in dopamine that help reset the balance.
7- BUT- Be careful with number 6. Too much pain could result in pain addiction and very unhealthy behaviors.
8- Practice radical honesty- don't be afraid to tell the awkward, painful truth to yourself and others. While dishonesty repels others, honesty and vulnerability attracts them, and we all ultimately need human connection to get past our own shortcomings. Radical honesty promotes awareness, intimacy, and a plentiful mindset.
9- Use prosocial shame in the model of the 12-step program for AA. Antisocial thoughts make people isolate and go down the addiction rabbit hole. Finding a group of like-minded souls can be healing, and the acceptance and belonging of having a group or a sponsor gives our socially- motivated brain a reason to get better.
10- Escape the Dopamine addiction trap by immersing yourself in the world, not running away from it.
I've been fortunate not to be addicted to drugs or alcohol, but find myself in the thralls of social media and screens on occasion. Is it an addiction? There's clearly some withdrawal if I don't go on my phone for a day, so it probably is. But the more aware I become about my compulsions, the better my choices can be in the future. Because I want to live a life that I choose, not one that's chosen for me by a drug company or tech company.
This book and others like it open up the discussion about what addiction is, what causes it, and how to treat it. In our increasingly addicted world, that discussion is more important than ever.