Dopamine Nation
Finding Balance in the Age of Indulgence
By Anna Lembke
Category: Science | Reading Duration: 24 min | Rating: 4.4/5 (847 ratings)
About the Book
Dopamine Nation (2021) explores the connection between pleasure and pain. Our modern world is filled with more dopamine-inducing stimuli than ever – including everything from drugs and sex to smartphones and shopping. Citing years of clinical experience and patients’ stories, this book helps to understand addiction and explains how to achieve a healthy balance in our lives.
Who Should Read This?
- People struggling to break bad habits
- Family members of loved ones struggling with addiction
- Anyone who can’t seem to put down their phone
What’s in it for me? Learn how to recover from compulsive overconsumption.
We live in a world of profuse abundance and overconsumption. At the touch of a button, we can purchase virtually any product – everything from clothes to food, entertainment to sex, and yes, even drugs. In short, our lives are flooded with dopamine-inducing experiences. We look for these experiences to numb the pain in our lives and dopamine – a neurotransmitter that deals with reward-processing and motivation – is a perfect salve.
But the dopamine rush doesn’t last long. Think of that craving that comes after a bowl of ice cream or that desire to stream just one more episode. Drawing from science and the wisdom gained from those who've suffered addiction, this summary offer ideas for finding balance between pleasure and pain and overcoming our compulsive desire to consume.
In this summary, you’ll learn - the extent to which compulsive overconsumption rules our lives;
- how the pain-pleasure balance works in the brain; and
- key nuggets of recovery wisdom to help you lead a more balanced life.
Chapter 1: In an age of compulsive overconsumption, we’ve all basically become pleasure addicts.
What do you picture when you hear the word addict? Is it a sweaty, skinny junkie handing over a crumpled bill in exchange for a bag of white powder? Or is it a suburban mom frantically uncorking a bottle of rosé? How about a man pulling an all-nighter to watch pornography?
Or a college sophomore who can’t put down her smartphone long enough to study? Broadly speaking, addiction is the sustained, compulsive use of a substance or behavior – such as gambling, sex, or video games – even though it causes harm to you and those around you. And all of the examples mentioned earlier are addicts. Probably none of that sounds that shocking since all of us are struggling with one bad habit or another. In fact, Anna Lembke, the author, readily admits that she was an addict too – hooked on derivative romance novels like Twilight and Fifty Shades of Grey – compulsively reading them on her Kindle in between sessions with patients. The key message here is: In an age of compulsive overconsumption, we’ve all basically become pleasure addicts.
Whether our drug of choice is video games, page-turners, or cocaine, a major risk factor for addiction is easy access. For instance, the opioid epidemic currently ravaging the United States was caused in large part by the over-prescribing of pain medication in the early 2000s. And even though the vast supply of drugs is more potent than ever – opioids tend to be pharmaceutical grade and marijuana is almost ten times stronger than it was in the 60s – narcotics are just the tip of the iceberg when it comes to our dopamine economy. For instance, consider that not only are our foods more addictive – loaded with vast amounts of sugar and fat – but with its countless clicks and endless scroll, so is our technology.
The rates of addiction are rising; and globally, 70% of deaths are caused by risk factors such as smoking, obesity, and lack of exercise. While the poor suffer from lack of meaningful work and healthy opportunities, they have a plentiful supply of dopamine-inducing escape. Similarly, among undereducated middle-aged white Americans, overdose, suicide, and alcohol-related liver disease are the top three causes of death. In the next blink, you’ll learn how the consequence of living to seek pleasure has left us in a lot more pain.
Chapter 2: Our misery stems from trying to avoid being miserable.
In the 1800s, surgeons would perform operations without general anesthesia – the thinking was that pain increased the immune response and sped up the healing process. Doctors today take a much different approach, focusing on healing, compassion, and eliminating pain. This aversion to pain has caused doctors to reach for their prescription pads more often than their stethoscopes. Now, one in four Americans takes a psychiatric medication daily and one in ten uses antidepressants – with global use rising also.
Between 2006 and 2016, the use of stimulants like Ritalin and Adderall doubled in the United States. And the use of sedatives like Valium and Xanax rose by 67%. In 2012, opioid prescriptions rates equated to one bottle of pills for every US citizen. Clearly, we’re trying to numb the pain. But if we’re living in a time of unparalleled freedom, wealth, and progress, why do we all hurt so bad? The key message here is: Our misery stems from trying to avoid being miserable.
The pain we’re running from is not extreme – it’s not a broken bone, much less unanesthetized surgery. Rather, we can’t seem to tolerate slight moments of discomfort, choosing instead to distract and tune out, reaching for entertainment to escape the present moment. Sophie – one of Lembke’s patients – is a prime example. An undergrad at Stanford, she was suffering from depression and anxiety, and spent most of her time on her phone. Lembke thought that by constantly controlling her attention environment, and by avoiding herself, Sophie was actually causing her own symptoms. So she suggested that Sophie walk to class without listening to her usual podcast.
While the idea sounded boring, boredom also makes us confront the question of purpose in our lives. By leaving a little empty space, without distractions, we allow thoughts to bloom. And even though we’re all working so hard to avoid feeling pain – whether by taking drugs or bingeing romance novels – the pain is only getting worse. The World Happiness Report stated that Americans were less happy in 2018 than in 2008.
Belgium, Canada, Denmark, France, and Japan all saw a similar decline. Other studies found that wealthier nations showed higher rates of anxiety and depression than their less well-off neighbors. The key to understanding this phenomenon is learning how pain and pleasure express themselves in our brains – and in the next blink, we’ll learn why the things that made us happy eventually stopped working.
Chapter 3: Pleasure inevitably leads to pain.
Anna Lembke was so hooked that she read the entire Twilight saga four times. Unfortunately, the second time was not quite as good as the first – and on her final pass, the pleasure was pretty much gone. Ultimately, she sought out stronger forms of vampire-based entertainment. But her experience succinctly illustrates the pleasure-pain balance.
That’s because all that pleasure isn’t free. The brain regions that process pleasure and pain overlap and actually act to balance each other. So as soon as you get that dopamine hit and tip the scales to the side of pleasure, your brain reflexively kicks in to level things out again. However, the balance keeps going and tips equally to the side of pain. The key message here is: Pleasure inevitably leads to pain. Typically, this pain comes in the form of craving – one more bite, one more episode, one more hit.
If one felt good, two would feel even better, right? However, there’s a problem: neuroadaptation. In other words, we build up a tolerance. And the more we expose ourselves to a pleasurable stimulus, the weaker the pleasure and the stronger the pain. This is why addicts increase their drug intake over time – and why Lembke sought out even crazier romance novels. Eventually, the scales come to rest on the side of pain in a dopamine deficit state.
This means that not only is our ability to feel pleasure decreased, but we are also more sensitive to pain. For Lembke, reading had always been her greatest joy, but when she went down the romance rabbit hole, that pleasure stopped working. And yet she kept reading, just like the drug addicts who get high to avoid withdrawal. And having this pleasure-pain balance permanently stuck on pain is what leads people to relapse, just to alleviate the dysphoria of withdrawal.
However, the good news is that if we simply wait a bit, the brain balances itself out, and we’re again able to enjoy life without the need for that drug or destructive behavior. However, it should be said that for heavy and long-term users, the recovery time can be much longer, sometimes permanent. And although addiction-induced brain changes are permanent, like those dealing with triggers and cravings, over time, our brains find new pathways to avoid those damaged areas and help us make healthier choices.
Chapter 4: Abstinence leads to insight.
Our brains were wired to live in a world of scarcity. But now, in a world of abundance, our pleasure-pain scales are tipped so that we’re never satisfied. And while the idea of striving for more seems to go hand-in-hand with the productivity mindset that’s popular nowadays, it’s actually left us more susceptible to pain and less able to feel pleasure. Clearly, the situation is unsustainable, but how do we correct our course?
We can start by looking at the valuable lessons gained from people who’ve suffered addiction. The philosopher Kent Dunnington once stated that addicts are “contemporary prophets. ” Recovering drug addicts and alcoholics have tapped into a wisdom that is perfectly geared to a world fueled by compulsive overconsumption. And just like them, we first need to stop using in order to gain some clarity. The key message here is: Abstinence leads to insight. Delilah smoked weed every day to cope with anxiety, but just like Sophie, who couldn’t seem to put down her phone, the coping behavior was probably causing the symptoms in the first place.
Lembke recommended that Delilah go on a dopamine fast – stop smoking weed for a month – in order to reset her reward pathway. But why four weeks and not two? In a brain imaging study conducted by neuroscientist Nora Volkow, drug addicts with two weeks of abstinence still showed a decreased level of dopamine activity compared to healthy controls. But in a four-week study conducted by experimental psychology professor Marc Schuckit, 80% of daily drinkers no longer qualified as being clinically depressed simply through abstinence alone. Another benefit of abstinence is that it can reveal underlying health conditions. Around 20% of patients don’t improve after a dopamine fast, indicating a psychiatric disorder.
It’s also important to state that people who’ve been using hard drugs for a long time will require a longer dopamine fast. And while withdrawal is usually mild for video game or porn addiction, for other substances – like alcohol, benzodiazepines, and opioids – it can be life-threatening. For those individuals, Lembke never recommends a dopamine fast; instead, withdrawal needs to be medically supervised. After a month of abstinence, Delilah reported that her anxiety disappeared.
Not only that, but she also gained a lot of insight. After marijuana withdrawal made her vomit, Delilah realized how strongly addicted she was and that realization gave her the strength to keep going. And during her abstinence period, Delilah saw how the anxiety stemmed from organizing her life around smoking weed. With the drug out of the picture, she felt able to enjoy her life again.
Chapter 5: Tipping our scales toward pain can ultimately lead to pleasure.
After quitting drugs, Michael, another of Lembke’s patients, discovered that cold showers made him feel really good. Soon enough, he was taking ten-minute ice baths every morning and every night, describing the feeling as comparable to taking ecstasy. Science backs this up. A study done at Prague’s Charles University found that an hour of cold-water immersion increased dopamine levels in the blood by 250%.
With his daily ice baths, Michael was exposing himself to something painful, which caused his brain to level out to the side of pleasure – an effect that is actually longer-lasting than the straight dopamine hit of a drug. The key message here is: Tipping our scales toward pain can ultimately lead to pleasure. Just as pressing on pleasure can cause the scales to be stuck on pain, gradual use of painful stimuli makes us more immune to pain. This idea dates back to the time of Socrates, who mused on the pleasurable feeling that follows pain. And we’ve all had the same feeling. Just think of a runner’s high or the thrill of watching a scary movie.
Studies also show that moderate exposure to painful stimuli can make organisms more resilient. For instance, worms that were exposed to higher temperatures were later more likely to survive such exposure than those that weren’t. And Japanese citizens who were exposed to low-dose radiation back in 1945 actually showed a slight increase in lifespan and a drop in cancer rates. Intermittent fasting is a less extreme example and has been linked with a longer lifespan, reduced blood pressure, and stronger resistance to age-related diseases. Likewise, exercise itself is painful and, in the short term, traumatic to our system. And yet, it also increases dopamine levels and it’s one of the easiest ways to promote our well-being.
The intentional use of pain as a pain-reliever goes all the way back to Hippocrates, who wrote, “Of two pains occurring together… the stronger weakens the other. ” Acupuncture is a familiar example of this idea in practice and a study, published in the medical journal Pain, backed this up with neuroimaging, showing that the effect of one painful stimulus could be reduced by another. Though counterintuitive, Michael found happiness by exposing himself to painful ice baths. So ultimately, pain can be used as a stepping stone toward healing.
Chapter 6: Telling the truth frees us.
One day, Maria, a recovering alcoholic and member of Alcoholics Anonymous, opened a package that was addressed to her brother. When her brother confronted her, Maria lied and then spent the night unable to sleep. The next morning, Maria decided to tell her brother the truth and ask for his forgiveness. In doing so, she realized that she no longer had to carry the burden of her lies – lies that popped up everywhere when she was still drinking.
And this act of truth-telling helped the two of them get closer. Not only is radical honesty essential to every major religion, but it’s also a cornerstone of recovery programs. That’s because telling the truth – and potentially exposing our shortcomings in the process – makes us conscious of our actions, helps keep us accountable, and promotes intimacy. The key message here is: Telling the truth frees us. Whether talking to our therapist or our AA sponsor, to a priest or a close friend, telling the truth about our lives and our problems – out loud – allows us to see them in a new light. That’s because when it comes to addictive behavior, we sort of run on autopilot.
We’re so focused on a reward that we don’t stop to consider the consequences. Or, more accurately, we’re in denial. In an interesting Swiss study, researchers found that electrical stimulation to the prefrontal cortex – the decision-making and emotional regulation part of the brain – increased the participants’ honesty response. These findings led Lembke to posit whether the reverse could be true – that telling the truth stimulates the prefrontal cortex and aids in emotional regulation. While there’s no data for this, the wisdom of recovery suggests that by practicing radical honesty, we gain awareness around our compulsive overconsumption, and learn how to act differently. Many of us feel scared to be honest, feeling that if people knew our character flaws, they’d run for the hills.
However, the vulnerability we show by exposing our own flaws actually makes people feel closer to us. That’s because our flaws tend to mirror their own and by revealing ourselves, we help them to feel less alone. This kind of sharing is a form of intimacy, which helps us to feel safe. When we know that we’re surrounded by reliable and honest people, we actually feel more secure about ourselves and our place in the world. And ultimately, this helps us feel that everything’s going to be ok.
Chapter 7: Prosocial shame gives us the dose of humility we need.
When it comes to shame, our culture is a bit more enlightened these days. Destructive forms of shame, such as slut shaming, body shaming, and social media shaming are strongly condemned. We know that destructive shame is harmful because it leads to painful isolation and, most likely, a repetition of the actions that caused the shame in the first place. The thing is, shame is actually quite important for building community, and it’s the appropriate reaction for transgressive behavior.
Unfortunately, whether it’s lying or stealing, over-indulging or just peeing the bed, most addicts and alcoholics have plenty to be ashamed of. Luckily, Alcoholics Anonymous embraces a model of prosocial shame, in which transgressive acts are met with understanding and plenty of opportunities for redemption. Instead of being ostracized for their shameful transgressions, people in recovery are accepted under the premise that we’re all imperfect and worthy of forgiveness. The key message here is: Prosocial shame gives us the dose of humility we need. Let’s quickly take a look at destructive shame in action. One of Lembke’s patients, named Lori, struggled with alcohol abuse and overeating.
She was also a life-long churchgoer. But when she sought help from her church elders, they simply said that they’d pray for her and asked her not to mention her issues to the other church members. The elders responded to Lori’s issues by shunning her. Eventually, Lori found her way to AA; and in that environment of rigorous honesty and acceptance, Lori finally felt like she wasn’t alone. On the other hand, prosocial shame is a positive force, because it both fosters humility and unites us with our support groups. Lembke’s mentor, himself a member of AA, described his recovery as a “de-shaming process.
” By attending meetings, sharing his experiences, and listening to others, he learned that he wasn’t alone. During his years of drinking, Lembke’s mentor told thousands of little lies and cites the disappointment he saw in his wife’s eyes as a prime motivator for getting sober. He’d done plenty of things to be ashamed of, but AA gave him a pathway to make amends and straighten out his life. AA’s model of honest self-inventory helps people gain an understanding of their own failings and gives them greater compassion for others. And compassion is a priceless asset, since all of us could use a bit more of it.
Final summary
It seems all of us are trying to live up to impossible standards – whether they be self-enforced or set by others. So it’s no wonder we want a break every now and then. And opportunities for release seem to be everywhere – from trendy bars to endless feeds, and unlimited streaming to bottomless bowls. But consider what life could be like if we didn’t need to escape?
What if we just turned to face it? This is Lembke’s ultimate advice for us – to embrace the life we have, to pay attention to its myriad of nuances, and to strive for balance in all things. Though these actions won’t bear fruit right away, our patience and perseverance will be met with a great reward: a life worth living. And here’s some more actionable advice: Consider your use on a longer timeline. When we struggle with compulsive overconsumption – whether it be drugs or food or phone use – we tend to stay in the day, telling ourselves we’ll do better tomorrow. Instead, take a step back and consider your whole life.
Do you want to be living this way a year from now? Five years from now? Looking at the big picture allows you to gain a better perspective on how you act in the day-to-day and, hopefully, will give you greater motivation to change.
About the Author
Anna Lembke is a clinical scholar, award-winning researcher, and the chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She has won awards for both her research and her teaching, published countless articles and peer-reviewed papers, and authored two previous books about addiction and the drug epidemic.