Dopamine Nation: 3 Takeaways
“The paradox is that hedonism, the pursuit of pleasure for it's own sake, leads to anhedonia. Which is the inability to enjoy pleasure of any kind.”
-Anna Lembke
Anna Lembke is the Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University and a psychiatrist with 30 years of clinical experience. She wrote Dopamine Nation: Finding Balance in the Age of Indulgence to provide, as she puts it, “practical solutions for how to manage compulsive overconsumption in a world where consumption has become the all-encompassing motive of our lives.” She pulls from anthropology, neurobiology, and her own patients’ stories to paint a compelling picture of modern society's unique relationship with pain and pleasure.
The takeaways I list below focus on the mechanisms and interplay between dopamine and our own behaviors. Understanding this groundwork will change the way you think about everything you do.
At times the points are drawn out but these tend to be due to her extensive knowledge of the topic and the histories of the patients she's worked with. It's a great read that I'd recommend to everyone regardless of whether they think they have a healthy relationship with dopamine or not.
Dopamine Nation Takeaways
What Exactly Is Dopamine?
In the pop-sci world, dopamine can be interchanged with mini excitement. “That social media like gave you a hit of dopamine.”
Dopamine’s role, in actuality, is larger and way more consequential. Dopamine, a neurotransmitter discovered not too long ago in 1957, plays a much bigger role in the wanting to get the reward rather than just the reward itself.
Let’s break it down.
When you eat a Reese’s cup for the first time you get a massive boost in dopamine, among other neurotransmitters. The next time you even see that Reese’s you get a pre-reward dopamine spike. From there, the conditioning of the mind continues. If you have your Reese’s cup at the same time every day then the time alone may produce a dopamine spike. Alternatively, the environment where you eat it might provide an anticipatory spike. If you get the spike but don't see the Reese's cup then you're on a mission. This is considered a craving and while cravings get a bad wrap, they're the reason we're on this earth today.
To demonstrate the impact of dopamine on cravings and desires, researchers artificially diminished the dopamine levels of rats. The rats were then set loose in the same environments they had known before but shortly thereafter, they all died. The lack of dopamine caused the rats to have so little desire that they didn't even seek out food or water.
Dopamine is the reason our ancestors sought food, water, sex, social events, and everything else that's necessary for life. Essentially dopamine played a huge part in the survival and propagation of our species.
2. The Pain-Pleasure Balance
So with a hit of dopamine, you get a reward for liking something. Sounds good. What's the catch? The brain processes pleasure and pain in the same spot meaning that dopamine is perpetually interlocked with pain.
On one side of the see-saw is pain and on the other is pleasure. Your body loves when the seesaw is level-- homeostasis--but we're constantly trying to throw all of our weight on one side (yes, that side) to create a neurotransmitter imbalance.
When you get pleasure from that Reese’s cup (or sex or compliments or drugs) then the seesaw tips to one side: the pleasure/dopamine side. When this happens the self-regulating mechanisms of the brain attempt to level it out again, like a reflex. This is called the opponent process theory. In this attempt, it actually causes a righting not back to baseline but below the baseline. This mini-dopamine deficit enters into the pain territory which causes us to seek out pleasure through things like cravings. See where this is going? As Anna Lembke writes:
“The phylogenetically uber-ancient neurological machinery for processing pleasure and pain has remained largely intact throughout evolution and across species. It is perfectly adapted to a world of scarcity. Without pleasure, we wouldn’t eat, drink, or reproduce. Without pain, we wouldn’t protect ourselves from injury and death. By raising our neural set point with repeated pleasures, we become endless strivers, never satisfied with what we have, always looking for more.”
We, humans, have a mismatch of the world we live in (one of abundance) and the world we primarily evolved in (one of scarcity). “We need more reward to feel pleasure and less injury to feel pain.” We’re too good at finding pleasure in the age of instant access to food, porn, and gambling, and the even more immediate split-second feedback, comments, responses, and likes on our phones.
Defying logic, we now have more cravings, more addictions, more pain, more unhappiness, worse relationships, and less control over our emotions than at any time in history.
She provides an example of this through gambling.
"Gamblers have the highest level of dopamine when their odds of winning are 50/50. This is the maximum amount of uncertainty. Those with gambling addictions often say that they are is a desire to lose because that leads to a stronger urge to continue gambling, and the stronger the rush when they win. This is called loss chasing. This presents in social media apps where the uncertainty of getting a “like” or some equivalent is as reinforcing as the like itself."
3. Pain & Dopamine
Lembke says:
“Thirty-four percent of Americans felt pain often or very often in the last 4 weeks compared to nineteen percent in the next closest country. Maybe the reason we're physically and emotionally so miserable is because we're working so hard to avoid being miserable."
Using this reverse logic and 30+ years of experience with patients, she explains that patients who have no red flags for the cause of illness or distress are flooding her office. People who check all of the boxes of a good quality of life (social support, good family, good education, good health, financial stability, etc.) are encumbered with debilitating depression, anxiety, and physical pain, and have difficulty just getting out of bed in the morning. She highlights a number of reasons including the effort for pain management in our healthcare system in recent years with frequent medications.
While I don't have the years of experience that she has, the longer I've been treating patients the more I see this "drive for more" which we associate with pleasure, however, it’s the pain part of the equation that’s more difficult to wrap our heads around.
Everyone can agree that an orgasm and a compliment fall under the "pleasure" side of the see-saw but it's more difficult to rationalize that a craving and a desire to look at your phone are in the same category as torture and a paper cut. This might be one reason we fail to see the error in our ways when these seemingly benign behaviors lead to addictions that interfere with our lives.
More dopamine in the reward pathway means that the experience is more addictive. While most pleasures can be done in healthy doses, the consistent desire to smoke pot, watch TV, drink, shop, game, have sex, vape, eat, or workout is where the issue arises.
When does it go from "not a big deal" to an addiction?
A lack of awareness of the increasing use of any pleasure leads to a building of tolerance which leads to the need for more (insert desire here) but it lacks the satisfaction we anticipated which just leads to less happiness. It's almost like a keeping up with the Jones’ type of dissatisfaction….but you're the Joneses.
