Dopamine Nation: Finding Balance in the Age of Indulgence

Image of Dopamine Nation: Finding Balance in the Age of Indulgence
Release Date: 
August 24, 2021
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“Authoritative, compassionate, and valuable, this book provides a fresh understanding of the many dangers of addiction . . .”

“We’re all running from pain,” writes Dr. Anna Lembke, medical director of Stanford Addiction Medicine. “Some of us take pills. Some of us couch surf while binge-watching Netflix. Some of us read romance novels. We’ll do almost anything to distract ourselves from ourselves. Yet all this trying to insulate ourselves from pain seems only to have made our pain worse.”

In Dopamine Nation, the psychiatrist-author, herself a former “chain reader” of erotic genre novels that provided “mounting sexual tension,” offers a candid overview of the addictive potential of everything from food and hard drugs to porn and gambling, and ways to manage overconsumption.

Drawing on revealing patient stories, Lembke makes clear the lengths to which we will go in pursuit of personal happiness.

One patient gets high on “the cycle of searching for and buying products online.” Another binges on Adderall pills. Yet another concocts a “masturbation machine,” involving a metal rod, a record player and a coil wrapped around his penis. By adjusting the speed of the coil by adjusting the speed of the record player, he would “bring himself to the edge” for several hours a day.

However repulsive and perverted it may be, the patient’s machine signals “something crucial about the way we live now: We are all, of a sort, engaged with our own masturbation machines,” writes the author.

The payoff for any addictive behavior is delivered by the brain chemical dopamine, a neurotransmitter first identified in 1957. Dopamine may actually play a bigger role in the motivation to get a reward than the pleasure of the reward itself, writes the author. “Wanting more than liking.” The chemical is used to measure the addictive potential of any behavior or drug.

“We’ve transformed the world from a place of scarcity to a place of overwhelming abundance: Drugs, food, news, gambling, shopping, gaming, texting, sexting, Facebooking. Instagramming, YouTubing, tweeting . . . the increased numbers, variety, and potency of highly rewarding stimuli today is staggering,” she writes. “The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation.”

Writing in plain English, Lembke devotes much of her book to explaining how the brain processes pleasure and pain. Both feelings are processed in the same place, acting like opposite sides of a balance. The trick for all of us is to find a better, more healthful balance between pleasure and pain.

Lembke says this is best achieved through “dopamine fasting.” A month of fasting usually allows the body to “reset the brain’s reward pathway,” restoring our ability to get pleasure from less potent rewards. It also encourages the pleasure-pain balance to return to the level position.

The author details patient experiences with fasting and makes clear the outcomes may depend on various factors, such as the potency of the addictive substance and whether there is an underlying depression.

“I’ve seen patients who need less than four weeks to reset their reward pathway, and others who need far longer,” she says. She stresses that medical monitoring is necessary for individuals with severe alcohol, benzodiazepine (Xanax, Valium, or Klonopin), or opioid dependence.

She urges readers to “immerse yourself fully in the life that you’ve been given. To stop running from whatever you’re trying to escape, and instead to stop, turn, and face whatever it is.”

Authoritative, compassionate, and valuable, this book provides a fresh understanding of the many dangers of addiction in our “hyper-medicated, overstimulated, pleasure-saturated world.”