Dopamine Nation: Finding Balance in the Age of Indulgence

Stanford psychiatrist Anna Lembke writes in this 2021 book:

* 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 our pain worse.

* 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 increases.

* Mindfulness is simply the ability to observe what our brain is doing while it’s doing it, without judgment.

* Self-binding is the term to describe Jacob’s act of throwing out his machine. It is 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.

* My patient Mitch was addicted to sports betting. He had lost a million dollars gambling by the time he was forty. Participating in Gamblers Anonymous was an important part of his recovery. Through his involvement in Gamblers Anonymous, he learned that it wasn’t just betting on sports he had to avoid. He also had to abstain from watching sports on TV, reading the sports page in the newspaper, surfing sports-related Internet sites, and listening to sports radio. He called all the casinos in his area and had himself put on the “no-admit” list. By avoiding substances and behaviors beyond his drug of choice, Mitch was able to use categorical binding to mitigate the risk of relapse to sports betting.

* What if taking psychotropic drugs is causing us to lose some essential aspect of our humanity?
In 1993, the psychiatrist Dr. Peter Kramer published his groundbreaking book Listening to Prozac , in which he argued that antidepressants make people “better than well.” But what if Kramer got it wrong? What if instead of making us better than well, psychotropic drugs make us other than well ?
I’ve had many patients over the years who have told me that their psychiatric medications, while offering short-term relief from painful emotions, also limit their ability to experience the full range of emotions, especially powerful emotions like grief and awe.

* Hormesis is a branch of science that studies the beneficial effects of administering small to moderate doses of noxious and/or painful stimuli, such as cold, heat, gravitational changes, radiation, food restriction, and exercise.

* 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.

* Telling the truth draws people in, especially when we’re willing to expose our own vulnerabilities. This is counterintuitive because we assume that unmasking the less desirable aspects of ourselves will drive people away. It logically makes sense that people would distance themselves when they learn about our character flaws and transgressions.
In fact, the opposite happens. People come closer. They see in our brokenness their own vulnerability and humanity. They are reassured that they are not alone in their doubts, fears, and weaknesses.

* Any behavior that leads to an increase in dopamine has the potential to be exploited. What I’m referring to is a kind of “disclosure porn” that has become prevalent in modern culture, where revealing intimate aspects of our lives becomes a way to manipulate others for a certain type of selfish gratification rather than to foster intimacy through a moment of shared humanity.
At a medical conference on addiction in 2018, I sat next to a man who said he was in long-term recovery from addiction. He was there to tell his recovery story to the audience. Just before he went up on stage, he turned to me and said, “Get ready to cry.” I was put off by the comment. It bothered me that he anticipated how I would react to his story.
He indeed told a harrowing story of addiction and recovery, but I was not moved to tears, which surprised me because I am usually deeply affected by stories of suffering and redemption. In this case, his story seemed untrue for all that it may have been factually correct. The words he spoke didn’t match the emotions behind them. Instead of feeling that he was granting us privileged access to a painful time in his life, it felt like he was grandstanding and manipulating. Maybe it was just a matter of his having told it so many times before. In repetition, it may have grown stale. Whatever the reason, it didn’t lift me.
There is a well-known phenomenon in AA called “drunkalogues,” referring to tales of intoxicated exploits that are shared to entertain and show off rather than teach and learn. Drunkalogues tend to trigger craving rather than promote recovery. The line between honest self-disclosure and a manipulative drunkalogue is a fine one, including subtle differences in content, tone, cadence, and affect, but you know it when you see it.

* Patients who tell stories in which they are frequently the victim, seldom bearing responsibility for bad outcomes, are often unwell and remain unwell. They are too busy blaming others to get down to the business of their own recovery. By contrast, when my patients start telling stories that accurately portray their responsibility, I know they’re getting better.

* When our lived experience diverges from our projected image, we are prone to feel detached and unreal, as fake as the false images we’ve created. Psychiatrists call this feeling derealization and depersonalization. It’s a terrifying feeling, which commonly contributes to thoughts of suicide. After all, if we don’t feel real, ending our lives feels inconsequential.
The antidote to the false self is the authentic self. Radical honesty is a way to get there. It tethers us to our existence and makes us feel real in the world. It also lessens the cognitive load required to maintain all those lies, freeing up mental energy to live more spontaneously in the moment.
When we’re no longer working to present a false self, we’re more open to ourselves and others. As the psychiatrist Mark Epstein wrote in his book Going on Being about his own journey toward authenticity, “No longer endeavoring to manage my environment, I began to feel invigorated, to find a balance, to permit a feeling of connection with the spontaneity spontaneity of the natural world and with my own inner nature.”

About Luke Ford

I've written five books (see My work has been covered in the New York Times, the Los Angeles Times, and on 60 Minutes. I teach Alexander Technique in Beverly Hills (
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