In this video, discover the essence of “Dopamine Nation: Finding Balance in the Age of Indulgence” by Anna Lembke. This book is essential for anyone living in a high-dopamine environment, and in today’s world, that includes most people with a smartphone. High-dopamine rewards such as morning coffee, the first text message, evening wine, and Netflix, as well as substances like fentanyl and activities like video games, are all part of this book’s thought-provoking exploration.
As we get into this discussion, we’ll discuss three important things. First, we’ll examine how our brains process pleasure and pain using Anne Lembke’s extended metaphor of a balance. Then, we’ll talk about the Plenty Paradox, which shows how our old instincts and ancient brains don’t fit our modern lives. Finally, we’ll consider ways to tackle these challenges, including Lembke’s simple three-step dopamine reset process.
Big Idea #1 – The Pleasure-Pain Balance
The pleasure-pain balance has been one of the hottest topics in neuroscience in the past 75 years. One of the cool things scientists found is this pleasure circuit in our brains called The Reward Pathway. They also discovered that dopamine plays a significant role as a human neurotransmitter.
So, dopamine isn’t the only neurotransmitter involved in feeling pleasure, reward, and motivation, but it’s the main pathway for all things that feel good. The more something feels rewarding, the more dopamine it releases in the reward pathway and the faster it’s released.
A conglomerate of studies with rodents found that when they eat chocolate, their dopamine firing goes up by 55% above average. With sex, it’s 100%, nicotine 150%, cocaine 200%, and amphetamine a whopping 1,000%. But that doesn’t mean amphetamines are more addictive than chocolate because it depends on the person. What makes your brain release a lot of dopamine might not have the same effect on mine, and vice versa.
So, how do we deal with pleasure and pain, you ask? Well, we’re wired to chase pleasure and steer clear of pain without even thinking about it. What’s cool in neuroscience is that pleasure and pain are in the same neighborhood in the brain.
Think of the brain processing pleasure and pain like a teeter-totter balance in a kid’s playground. When you do something pleasurable, it tips one way; when you do something painful, it tips the other. But specific rules govern the balance, and I will tell you three.
The first and most important rule is that the balance wants to remain level, or what neuroscientists call homeostasis, so with any deviation from neutrality, our brains will work very hard to restore a level balance. How do they do that? First, by tilting an equal and opposite amount to whatever the initial stimulus is. That’s called neuroadaptation.
Lembke compares it to pesky little gremlins in our brains. These gremlins jump onto the side of pain to level things out. But they don’t leave right away; they stick around until we’re tilted by an equal amount in the opposite direction. That’s that moment of wanting a second chocolate chip cookie or wanting to watch one more YouTube video.
If we wait long enough, those pesky gremlins disappear, and our body returns to normal. But if we keep on taking our drug of choice day after day, those gremlins start to multiply, and before we know it, we’re dealing with an addicted brain.
This is what an addicted brain looks like. Those “gremlins” are now settled on the side of pain, setting up tents and having barbecues. We now need our drug of choice not to feel pleasure but to balance things out and stop feeling pain.
When we first encounter something super rewarding that causes a massive spike in dopamine, dopamine levels drop dramatically afterward, going even lower than the average baseline. This can make us crave even while enjoying that chocolate chip cookie. We’re already thinking about the next one. If we resist, those gremlins disappear, and our dopamine levels return to normal.
When we keep doing the same thing over and over, the initial buzz we get starts to fade away. But then, our craving for it keeps getting stronger and lasting longer. Eventually, we end up in a place where we’re always short on dopamine, and that’s what addiction is all about.
In a famous study by neuroscientist Nora Volkow, who used to head NIDA, the brain scans of the healthy control subjects showed plenty of red color in their nucleus accumbens or the reward pathway, meaning sound, healthy dopamine transmission.
However, in the brain scans of people who used addictive substances for a long time and then stopped for two weeks, the scans show deficient dopamine transmission, indicating a chronic dopamine deficit state. It’s important to note that two weeks isn’t enough time to reverse this state.
How long does it take for things to get back to normal? According to Lembke’s and other’s clinical observations, it usually takes about four weeks after we’ve stopped using our drug of choice – whether it’s alcohol, Xanax, chocolate chip cookies, fentanyl, video games, or whatever – before we can get our dopamine levels back to normal.
Alright, so you’ve got the first two rules. The first one is the Opposing Process Mechanism. We balance things out by leaning equally and oppositely towards the side of pain. This means that we pay a price for every pleasure.
The second rule is that when someone is repeatedly exposed to the same or similar drug, the initial reaction becomes weaker and shorter. However, after the body responds to the dopamine deficits, the reaction becomes stronger and lasts longer.
The third rule of balance is that our brains remember things forever. This means that even if we manage to get rid of certain bad habits or addictions, they can still come back when triggered. That’s why people with severe addictions can relapse with just one exposure to their drug of choice, even after years of staying away from it.
This means that we can be triggered not just by the drug but by reminders of the drug. A rat has been trained to know that if it sees a light, it can go to a lever, press it, and get intravenous cocaine. You can see dopamine levels through that process.
Let’s check out the right side of the graph. You can see a significant spike in dopamine when someone uses cocaine. But what I want to talk about is what happens when we’re just reminded of the drug. It’s like a little high, a small dopamine spike, and then right after that, there’s this craving, like a mini dopamine deficit. That’s why it’s so important to stay away from not just the drug itself but also things that remind us of it.
One of my clients can get triggered just by thinking about the alcohol they used to drink. When we expect a reward and it doesn’t happen, our dopamine levels drop significantly. Not getting a scheduled reward feels worse than not getting one we never expected. This is similar to some modern digital experiences that can have effects like drugs.
Teenage girls who post something online might get loads of likes. But the next time, they might not get any likes or even get a bunch of hate. It’s not just a neutral feeling for them. For someone vulnerable to getting hooked on the dopamine/validation they get online, this can make them feel like they need more dopamine/validation rather than making them stop.
So, this brings us to the plenty paradox. Lembke’s point is that we’re all super unhappy because we bust our butts trying not to be dissatisfied. Having too much of everything is one of the primary sources of stress in modern life.
Dr. Lembke has noticed a growing number of people over the past 25 years coming in for help with severe anxiety, depression, chronic pain, and thoughts of suicide despite having what seems like extraordinary lives. They have loving parents, a solid social circle, access to top-notch education, and overall good physical health, but they struggle to get out of bed in the morning.
What’s happening here? Lembke thinks we’re all in a constant state of low dopamine because we’re exposed to many things that give us a quick high, from our morning coffee to the texts we read and the Netflix binges at night. This makes it hard for us to enjoy the simple things in life and leads to more anxiety and depression.
If we look at those happiness surveys worldwide, it’s pretty clear that people, including those in the US, are not as happy as they were in the last 20 years. Surprisingly, even in the wealthiest nations, people seem most unhappy. Also, rates of anxiety, depression, and chronic pain are on the rise everywhere, with the most affluent nations seeing the highest increases. This weird situation can be explained by the idea that all of us might be going through some dopamine shortage.
So, how do we deal with this problem? It’s easy to remember because it rhymes. Lembke says to abstain, maintain, and seek out pain. So, what’s the first thing to do? We need to lay off our drug of choice long enough for our brains to reset and get back to normal.
Why does any of this matter? It lets us enjoy the little things and understand what’s happening. After that dopamine hit, we can’t see the true causes and effects. We’ve got to step back from our drug of choice to see how it’s impacting our lives, relationships, and mental well-being. So, it’s very important.
We start by taking a break. How long? On average, it takes about four weeks to reset our reward pathways. If four weeks seems like too much, try for two weeks. If that’s not doable, aim for a week. If a week feels like a stretch, take a break for 24 hours. Even though this might not be long enough to reset our reward pathways, it’s still long enough to feel the withdrawal symptoms. The common symptoms of withdrawal from any addictive substance include anxiety, irritability, insomnia, depression, and craving.
The next thing we need to do is after our dopamine fast. We need to figure out how to maintain these gains and reenter into a healthy relationship with our drug of choice. Or we need to figure out how to continue abstinence depending upon what we decide.
The important thing is to set up some literal and metacognitive barriers between ourselves and the things we crave so we can stop and think before indulging instead of just relying on willpower.
Geographical self-binding is about getting rid of temptations around you, like throwing away the potato chips and putting your phone away.
Chronological self-binding is like intermittent fasting for your brain — only checking your phone between 9 a.m. and 5 p.m., giving your brain a break outside those hours.
Categorical self-binding might mean switching to a different game or activity instead of the one you’re hooked on.
Chemical self-binding involves using medications like Ozempic, which can help with weight loss and possibly with controlling behaviors like alcohol consumption, based on some early studies.
Finally, we seek out pain because those gremlins don’t care about what caused the pain in the first place. If we deliberately focus on the painful side of things, they’ll move to the pleasurable side and stay there until we’re balanced. This whole thing is called hormesis, which means setting things in motion in Greek.
What are we setting in motion? Our body’s natural upregulating mechanisms increase our feel-good neurotransmitters like dopamine, serotonin, and norepinephrine. Exercise, ice-cold water baths, fasting, prayer, and meditation are healthy ways to get our dopamine indirectly by paying for it upfront.
You can see what happens when we start doing something difficult. Let’s take exercise, for example. We slowly ramp up our dopamine levels as we get further into the routine, and then after we finish, our dopamine levels stay high for hours before returning to normal. This way, we never have to deal with a dopamine shortage.
Lembe’s challenge is to think of something you always use and have difficulty stopping. Try to give it up for just 24 hours. Plan for it, maybe do it with a friend, and see how it goes for both of you. Please pay attention to how you feel during the withdrawal and try to make it through. Afterward, consider the relationship you want with that thing in the future, including your phone.
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