Philosopher's Notes Dopamine Nation
Dopamine Nation
Finding Balance in the Age of Indulgence
About the Book
304 pages
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Brian's take
I got this book years ago when it first came out, and I went hunting for it again after Jonathan Haidt quoted its unforgettable line in The Anxious Generation: “The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation.” Anna Lembke, the medical director of Stanford Addiction Medicine, delivers a clear, compassionate, deeply practical look at how pleasure and pain work in the brain, why abundance is frying our reward systems, and what we can do about it. Her core message is simple and sobering: ==every pleasure has a cost, repeated indulgence raises our dopamine set point, and we become “cacti in the rain forest,” drowning in stimulation while becoming more sensitive to pain and less capable of real joy.== The antidote is not vague willpower, it’s wise constraints, strategic “self-binding,” dopamine fasting to restore balance, and the courage to tell the truth about what we’re doing and why. Big Ideas we explore include The Pleasure-Pain Balance, Dopamine Fasting (D-O-P-A-M-I-N-E), Self-Binding (space, time, meaning), Radical Honesty, and Prosocial Shame.
“I’ve seen a similar paradox in many of my patients over the years: They use drugs, prescribed or otherwise, to compensate for a basic lack of self-care, then attribute the costs to a mental illness, thus necessitating the need for more drugs.”
Hence poisons become vitamins.
Anna Lembke, MD
“The reason we’re all so miserable is because we’re all working so hard to avoid being miserable.”
Anna Lembke, MD
==“The trick is to stop running away from painful emotions, and instead allow ourselves to tolerate them.”==
==When we’re able to do this, our experience takes on a new and unexpected rich texture. The pain is still there, but somehow transformed, seeming to encompass a vast landscape of communal suffering, rather than being wholly our own.==
Anna Lembke, MD
“Please don’t misunderstand me.”
These medications can be lifesaving tools and I’m grateful I have them in clinical practice. But there is a cost to medicating away every type of human suffering, and as we shall see, there is an alternative path that might work better: embracing pain.
Anna Lembke, MD
“With intermittent exposure to pain, our natural hedonic set point gets weighted to the side of pleasure, such that we become less vulnerable to pain and more able to feel pleasure over time.”
Anna Lembke, MD
“As I tell my patients, just walking in your neighborhood for thirty minutes a day can make a difference.”
That’s because the evidence is indisputable: Exercise has a more profound and sustained positive effect on mood, anxiety, cognition, energy, and sleep than any pill I can prescribe.
Anna Lembke, MD
“Mutual honesty precludes shame and presages an intimacy explosion, a rush of emotional warmth that comes from feeling deeply connected to others when we’re accepted despite our flaws.”
It is not our perfection but our willingness to work together to remedy our mistakes that creates the intimacy we crave.
Anna Lembke, MD
“Although difficult in practice, this handy little tool—telling the truth—is amazingly within our reach.”
Anyone can wake up on any given day and decide, ‘Today I won’t lie about anything.’ And in doing so, not just change their individual lives for the better, but maybe even change the world.
Anna Lembke, MD
25:34
Cacti in a Rainforest
Introduction
From the book
“This Book is about Pleasure.
It’s also about pain. Most important, it’s about the relationship between pleasure and pain, and how understanding that relationship has become essential for a life well lived.
Why?
Because 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. The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation. If you haven’t met your drug of choice yet, it’s coming soon to a website near you.
Scientists rely on dopamine as a kind of universal currency for measuring the addictive potential of any experience. The more dopamine in the brain’s reward pathway, the more addictive the experience. …
This book aims to unpack the neuroscience of reward and, in so doing, enable us to find a better, healthier balance between pleasure and pain. But neuroscience is not enough. We also need the lived experience of human beings. Who better to teach us how to overcome compulsive overconsumption than those most vulnerable to it: people with addiction. …
Whether it’s sugar or shopping, voyeuring or vaping, social media posts or The Washington Post, we all engage in behaviors we wish we didn’t, or to an extent regret. This book offers practical solutions for how to manage compulsive overconsumption in a world where consumption has become the all-encompassing motive of our lives.
In essence, the secret to finding balance is combining the science of desire with the wisdom of recovery.”
Brian's Notes
I got this book years ago when it first came out.
And… I hunted through my stack of books to find it after Jonathan Haidt referenced wisdom from it in his brilliant book The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness.
The quote from this book that grabbed me in his book?
The same one that grabbed me when I read it on the first page of the book:
“The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation.”
Anna Lembke, MD, is one of the world’s leading “clinician scholars” on the science of addiction. Among many other things, she is the medical director of Stanford Addiction Medicine. She has published over 100 peer-reviewed papers, book chapters, and commentaries in the most prestigious outlets and has received numerous awards for outstanding research in mental illness, for excellence in teaching, and for clinical innovation in treatment.
If you or a loved one is going through challenging times with an addiction (it’s hard to imagine anyone for whom that won’t be the case!), I think you will find this book incredibly empowering. (Get a copy here.)
The book is packed with wisdom. I’m excited to share some of my favorite Big Ideas so let’s get straight to work.
BIG IDEA
Cacti in a Rainforest
From the ==book==
==“Science Teaches Us that Every Pleasure Exacts a Price, and the Pain that Follows is Longer Lasting and More Intense than the Pleasure that Gave Rise to It.==
With prolonged and repeated exposure to pleasurable stimuli, our capacity to tolerate pain decreases, and our threshold for experiencing pleasure increase. … By raising our neural set point with repeated pleasures, we become endless strivers, never satisfied with what we have, always looking for more.
But herein lies the problem. Human beings, the ultimate seekers, have responded too well to the challenge of pursuing pleasure and avoiding pain. As a result, we’ve transformed the world from a place of scarcity to a place of overwhelming abundance.
Our brains have not evolved for this world of plenty. As Dr. Tom Finucane, who studies diabetes…, said, ‘We are cacti in the rain forest.’ And like cacti adapted to an arid climate, we are drowning in dopamine.
The net effect is that we now need more reward to feel pleasure and less injury to feel pain. This recalibration is occurring not just at the level of the individual but also at the level of nations. Which invites the question: How do we survive and thrive in this new ecosystem? How do we raise our children? What new ways of thinking and acting will be required of us as denizens of the twenty-first century?”
Brian's Notes
The book has three parts.
We start with Part I called “The Pursuit of Pleasure” in which we learn about the shocking rates of addiction and mental health issues along with the underlying causes.
Then we move on to Part II called “Self-Binding” in which we explore techniques to deal with addictions.
Then we move on to Part III called “The Pursuit of Pain” in which we explore paradoxical ways to reset our pleasure-pain balance by, you guessed it, PURSUING pain!
That passage above is from a chapter called “The Pleasure-Pain Balance.”
Anna starts the book by walking us through a case study of a man with a SEVERE addiction.
Families listen to these Notes together so I’ll skip the details but let’s just say it’s a shocking, humbling look at the challenges one man faced that serves as a common humanity reminder of the challenges we ALL face.
Anna also shares her own stories of addiction with romance novels to further cement the fact that we ALL have our own issues.
As she says: “We’re all running from pain. 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 the pain worse.”
In that chapter, she also gives us a quick overview of how dopamine works.
She tells us: “Dopamine is not the only neurotransmitter involved in reward processing, but most neuroscientists agree it is among the most important. Dopamine may play a bigger role in the motivation to get a reward than the pleasure of the reward itself. Wanting more than liking. Genetically engineered mice unable to make dopamine will not seek out food, and will starve to death even when food is placed just inches from their mouth. Yet if food is put directly in their mouth, they will chew and eat the food, and seem to enjoy it.
Debates about differences in motivation and pleasure notwithstanding, dopamine is used to measure the addictive potential of any behavior or drug. The more dopamine a drug releases in the brain’s reward pathway (a brain circuit that links the ventral tegmental area, the nucleus accumbens, and the prefrontal cortex), and the faster it releases dopamine, the more addictive the drug.”
There’s so much more we can discuss, but I want to highlight one of the most poetically beautiful metaphors I’ve ever read that perfectly captures the challenges we face in modernity: “Our brains have not evolved for this world of plenty. As Dr. Tom Finucane, who studies diabetes…, said, ‘We are cacti in the rain forest.’ And like cacti adapted to an arid climate, we are drowning in dopamine.”
Check out our Notes on Scarcity Brain by Michael Easter for more on that.
P.S. Anna echoes the theme of a number of books we’ve been exploring lately on the challenges our younger Heroes are facing when she tells us: “Perceiving children as psychologically fragile is a quintessentially modern concept. … I worry that we have oversanitized and overpathologized childhood, raising our children in the equivalent of a padded cell, with no way to injure themselves but also no means to ready themselves for the world.
By protecting our children from adversity, have we made them deathly afraid of it? By bolstering their self-esteem with false praise and a lack of real-world consequences, have we made them less tolerant, more entitled, and ignorant of their own character defects? By giving in to their every desire, have we encouraged an age of hedonism?”
Those are the EXACT themes we explore in our Notes on Jonathan Haidt’s The Coddling of the American Mind and David Yeager’s 10 to 25: The Science of Motivating Young People.
BIG IDEA
Dopamine Fasting via D-O-P-A-M-I-N-E
From the book
“My Conversation with Her Was Guided by a Framework I’ve Developed over the Years for Talking with Patients about the Problem of Compulsive Overconsumption.
This framework is easily remembered by the acronym DOPAMINE, which applies not just to conventional drugs like alcohol and nicotine but also to any high-dopamine substance or behavior we ingest too much of for too long, or simply wish we had a slightly less tortured relationship with. Although originally developed for my professional practice, I’ve also applied it to myself and my own maladaptive habits of consumption.”
Brian's Notes
As we discussed, in Part I Anna establishes the challenge.
In Part II she shares the first three techniques to solve the challenge.
That passage is from the chapter on her first tip called “Dopamine Fasting.”
Let’s take a quick look at the DOPAMINE process of shining a spotlight on our less-than-awesome habits so we can do our best to conquer them.
D Stands for Data. We begin by establishing the simple facts of consumption. What are you doing? How often? Etc. No judgment. Just a simple gathering of data.
O Stands for Objectives. Then we check in on the benefits we’re receiving by engaging in the behavior. “Even seemingly irrational behavior is rooted in some personal logic.”
P Stands for Problems. Then we check in on unintended consequences of our behavior. “High-dopamine drugs always lead to problems. Health problems. Relationship problems. Moral problems. If not right away, then eventually.”
We want to get clarity on the negative consequences because that “can be a point of leverage for getting them to stop. And stopping, even if just for a period of time, is essential for getting them to see the true cause and effect.”
A Stands for Abstinence.“Abstinence is necessary to restore homeostasis, and with it our ability to get pleasure from less potent rewards, as well as see the true cause and effect between our substance use and the way we’re feeling.” Of course, get the book for details and know that FOUR WEEKS of abstinence is what Anna recommends.
IMPORTANT NOTE: “I never suggest a dopamine fast to individuals who might be at risk to suffer life-threatening withdrawal if they were to quit all of a sudden, as in cases of severe alcohol, benzodiazepine (Xanax, Valium, or Klonopin), or opioid dependence and withdrawal. For those patients, medically monitored tapering is necessary.”
M Stands for Mindfulness. We need to expect to feel WORSE before we feel BETTER and that requires mindfulness which Anna defines as “simply the ability to observe what our brain is doing while it’s doing it, without judgment. This is trickier than it sounds.” The trick is to stop running away from our problems. We need to learn how to allow ourselves to tolerate them.
I Stands for Insight. This is where we learn from our abstinence. “I have seen again and again in clinical care, and in my own life, how the simple exercise of abstaining from our drug of choice for at least four weeks gives clarifying insight into our behaviors. Insight that simply is not possible while we continue to use.”
N Stands for Next Steps. After the abstinence period, it’s time to check in on what we’ll do next. Anna discusses the fact that *most* people want to go back to using the substance but they want to use it differently (and less!) than before. She says total abstinence isn’t the *only* pathway forward for everyone but we want to be honest with ourselves and…
E Stands for Experiment.“This is where patients go back out into the world armed with a new dopamine set point (a level pleasure-pain balance) and a plan for how to maintain it.” It’s time to experiment and, through trial and error, see what works and what doesn’t.
Say it with me now…
D-O-P-A-M-I-N-E =
D ata.
O bjectives.
P roblems.
A bstinence.
M indfulness.
I nsight.
N ext Steps.
E xperiment.
And, remember that the ultimate goal of the dopamine fast “is to restore a level balance (homeostasis) and renew our capacity to experience pleasure in many different forms.”
BIG IDEA
Self-Binding: Space, Time, and Meaning
From the book
“Self-binding Is the Term to Describe … the way We Intentionally and Willingly Create Barriers between Ourselves and Our Drug of Choice in order to Mitigate Compulsive Overconsumption.
Self-binding is not primarily a matter of will, although personal agency plays some part. Rather, self-binding openly recognizes the limitations of will.
The key to creating effective self-binding is first to acknowledge the loss of voluntariness we experience when under the spell of a powerful compulsion, and to bind ourselves while we still possess the capacity for voluntary choice.
If we wait until we feel the compulsion to use, the reflexive pull of seeking pleasure and/or avoiding pain is nearly impossible to resist. In the throes of desire, there’s no deciding. But by creating tangible barriers between ourselves and our drug of choice, we press the pause button between desire and action. …
I ask my patients, ‘What kind of barriers can you put into place to make it harder for you to get easy access to your drug of choice?’ I have even used self-binding in my own life to manage problems of compulsive overconsumption.
Self-binding can be organized into three broad categories: physical strategies (space), chronological strategies (time), and categorical strategies (meaning).”
Brian's Notes
That’s from the second chapter in Part II on Self-Binding called “Space, Time, and Meaning.”
Self-binding.
It’s the word-phrase Anna uses to describe what we’ve always called “pre-commitment.” She uses the same example we always come back to: Odysseus and his sailors in The Odyssey.
Remember what they did on their journey home from the Trojan War to avoid the Sirens and their enchanted songs?
His sailors plugged their ears with beeswax so they couldn’t hear the Sirens while Odysseus had them BIND him to the mast of the ship.
Anna tells us there are THREE different ways we can “self-bind” ourselves to good behavior in the future:
We can create physical SPACE from the source of our compulsion, we can create TIME constraints for when we can engage in the behavior, and/or we can create categorical constraints based on MEANING we give to our new choices.
Physical constraints are pretty straight-forward and what we talk about the most. In Atomic Habits, James Clear tells us we need to kill the Habit Loop of bad behaviors by making the “cue/trigger/prompt” INVISIBLE. Throw it away. Lock it up in your closet. Whatever you can do to make it physically distant and therefore harder to engage in.
(Check out Habits 101, Willpower 101 and Willpower by Roy Baumeister and Tiny Habits by BJ Fogg for more.)
For time constraints, Anna tells us: “By restricting consumption to certain times of the day, week, month, or year, we narrow our window of consumption and thereby limit our use. For example, we can tell ourselves we’ll consume only on holidays, only on weekends, never before Thursday, never before 5:00 p.m., and so on.”
Categorical constraints “help us avoid not only our drug of choice but also the triggers that lead to craving for our drug. This strategy is especially useful for substances we can’t eliminate altogether but that we’re trying to consume in a healthier way, like food, sex, and smartphones.”
The example she uses here is a patient who was addicted to sports gambling. He had lost a million dollars and basically needed to stop watching sports altogether.
Note: Anna tells the story about her addiction to romance novels. One of the big things she did was getting rid of her Kindle.
I used to be addicted to ESPN. My new rule: I can check out what’s going on in the sports world but not on ESPN. I haven’t read an article on ESPN in a decade.
P.S. The thing I’ve ALWAYS loved most about the Sirens? They sing a different song for every sailor. Another thing I learned from Anna? Odysseus had to listen to the Sirens in order to tell the story about it. It was the only way to vanquish them—to survive the ordeal and talk about it.
BIG IDEA
Radical Honesty
From the book
“Every Major Religion and Code of Ethics Has Included Honesty as Essential to Its Moral Teachings.
All my patients who have achieved long-term recovery have relied on truth-telling as critical for sustained mental and physical health. I too have become convinced that radical honesty is not just helpful for limiting compulsive overconsumption but also at the core of a life well lived.”
Brian's Notes
That’s from a chapter in Part III called “Radical Honesty”—which is one of the THREE things Anna recommends we do in “The Pursuit of Pain.”
The first thing she recommends is to find some hormetic stressors—things like cold showers, exercise, time restricted eating and other things that introduce a bit of “pain” into our lives that help us reset our pleasure-to-pain balances.
She tells us that we ALL lie (a LOT! hah) and that “Radical honesty—telling the truth about things large and small, especially when doing so exposes our foibles and entails consequences—is essential not just to recovery from addiction but for all of us trying to live a more balanced life in our reward-saturated ecosystem. It works on many levels.
First, radical honesty promotes awareness of our actions. Second, it fosters intimate human connections. Third, it leads to a truthful autobiography, which holds us accountable not just to our present but also to our future selves. Further, telling the truth is contagious and might even prevent the development of future addiction.”
From the book
“Prosocial Shame is Predicated on the Idea that Shame is Useful and Important for Thriving Communities.
Without shame, society would descend into chaos. Hence, feeling shame for transgressive behaviors is appropriate and good.
Prosocial shame is further predicated on the idea that we are all flawed, capable of making mistakes, and in need of forgiveness. The key to encouraging adherence to group norms, without casting out every person who strays, is to have a post-shame ‘to do’ list that provides specific steps for making amends. This is what AA does with its 12 steps.
The prosocial shame cycle goes like this: Overconsumption leads to shame, which demands radical honesty and leads not to shunning, as we saw with destructive shame, but to acceptance and empathy, coupled with a set of required actions to make amends. This results in increased belonging and decreased consumption. …
The key here is accountability with compassion. These lessons apply to all of us, addicted or not, and translate to every type of relationship in our everyday lives.”
Brian's Notes
That’s from the final chapter called “Prosocial Shame” in which Anna walks us through her thoughts on the whole “shame is bad” narrative that is currently dominant in our culture.
She tells us, basically, “Yes, and…”
Shame can be bad.
Or…
It can be good.
The difference is in how we and those around us respond to our inevitable (!) transgressions.
The first thing we need to remember is that (I REPEAT!!) there are NO PERFECT HUMAN BEINGS and, I repeat (!), you and I (tragically;) won’t be the first perfect human beings. PERFECT.
Let’s use the Data in our D-O-P-A-M-I-N-E process to get a little better and run the next experiment. And remember that the key is “accountability with compassion.”
As Anna beautifully says: “It is not our perfection but our willingness to work together to remedy our mistakes that creates the intimacy we crave.”
With all that in mind, here’s to owning our perfectly imperfect lives and leaning into pain as we do the hard work to get our dopamine regulated so we can give the world all we’ve got! TODAY.
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