Dopamine Nation — Anna Lembke

“You may find some of these stories shocking, but to me they are just extreme versions of what we are all capable of.”

Part 1: The Pursuit of Pleasure

• One of the biggest risk factors for getting addicted to any drug is easy access to that drug.
  Decreasing the supply of addictive substances decreases exposure and risk of addiction and related harms.
• But we are exposed to a plethora of addictive substances, food, behavior, digital stimuli of various types and forms which exponentially increased recently in terms of potency and availability.
  And it is becoming increasingly difficult to protect young ones from these explicit behaviors and content.
• Running from pain: We are surrounded by choices of pleasure, and lost the ability to tolerate even minor forms of discomfort (infinite appetite for distractions and pleasure).
• Pleasure-Pain Balance: Our brains want to remain equilibrium (homeostasis).
  With repeated exposure, pleasure gets weaker, causing our brains to reset balance to the side of pain (dopamine deficit state).
• Paradox of hedonism is that it leads to anhedonia: inability to enjoy pleasure of any kind, and decreases our capacity to tolerate pain.
  This causes people to relapse, just to feel (briefly) normal again.
  The good news: If we wait long enough, our brains usually readapt allowing us to appreciate simple pleasures.
  The bad news: Severe addiction can alter the brain forever. It is possible to slip right back into compulsive use after years of abstinence.

Part 2: Self-Binding

“I paused to notice the sun glinting on her hair. She was the picture of health despite [her excessive compulsion.]
Youth, I thought, compensates for so much.”

• High dopamine clouds our judgment of cause and effect.
  Young people, even heavy users, are more immune to the negative consequences of use.
  As we age, however, the unintended consequences of chronic use multiply.
• Abstinence is necessary to restore homeostasis.
  Data suggests we need at least 4 weeks for any noticeable effect.
• Mindfulness is simply the ability to observe what our brain is doing while it’s doing it, without judgment.

“What I’m asking you to do is tolerate the pain.”
- Gulp.

• Physical Self-Binding: Physical separation against the addictive substance or behavior.
• Chronological Self-Binding: Restricting consumption to certain times of the day, week, month, or year.
  Another variable contributing to overconsumption is the growing amount of leisure time we have today, and with it the ensuing boredom.

Just this once, and then not again.
But then, he was using daily.
He wasn’t governed by reason; he was governed by the pleasure-pain balance.

• Categorical Self-Binding: Limiting consumption of a whole category of addiction including its triggers

Part 3: The Pursuit of Pain

What if taking psychotropic drugs is causing us to lose some essential aspect of our humanity?
There is a cost to medicating away every type of human suffering.
An alternative path might work better: embracing pain.

• With intermittent exposure to pain, we become less vulnerable to pain and more able to feel pleasure over time.
• Radical honesty: Telling the truth about things large and small is essential to a more balanced life in our reward-saturated ecosystem.
  Radical honesty promotes awareness of our actions, fosters intimate human connections, leads to a truthful autobiography which holds us accountable to our present and future selves.
• Compulsive overconsumption of high-dopamine goods is the antithesis of human connection.
  It leads to isolation and indifference, as the drug comes to replace the reward obtained from human relationships.
• Prosocial shame: When a person opens up with radical honesty, instead of shunning them (destructive shame), we must act with acceptance and empathy, coupled with a set of required actions to make amends.
  We are all flawed, capable of making mistakes, and in need of forgiveness.
• The rewards of finding and maintaining balance are neither immediate nor permanent.
  They require patience and maintenance.

Fun facts:

• East Asians commonly have a genetic mutation that causes negative reactions (e.g., nausea, vomiting) and therefore negative perception, leading to lower rates of alcohol addiction.
  Scientists discovered that those who drink anyway are at higher risk of related cancers.
• Exercise reduces the likelihood of using and getting addicted to drugs.
• The deep concentration during work is a drug in it-self found in workaholics, making them difficult to stop while working.
  This can be a trap when it keeps us from the intimate connections with friends and family in our lives.