Dopamine Nation is a fascinating book by Dr. Anna Lembke. She addresses how living in a dopamine-saturated world affects us and our relationship with addiction. We discuss topics such as how dopamine affects us, the relationship between pleasure and pain, radical self-honesty, ‘club goods’, and the importance of community in recovery and parenting kids.
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I’ve been on the front lines, working in clinics as the opioid epidemic raged.
I was always confused about why this issue wasn’t getting any attention.
Why wasn’t the news saying anything about it? Why was the government silent? Why weren’t any doctors speaking out?
so I’m glad that our guest today Dr. Anna Lembke was one of the rare people on the other side, speaking out about the line that connects doctors’ office prescriptions and street-level addiction.
Dr. Anna Lembke is an American psychiatrist, a specialist on the opioid epidemic, and the author of Drug Dealer MD and the book we’re talking about today: Dopamine Nation: Finding Balance in the Age of Indulgence.
I commend her bravery because even today she’s still feeling the effects and the backlash for speaking out and maintaining her stance against prescription opioids.
What is dopamine?
Dopamine is a chemical in your brain that is involved in the feeling of pleasure, motivation, and reward.
You get a surge of it when something pleasurable happens, but then it goes back to normal.
When you use drugs or alcohol, you get a massive surge of dopamine, which leads to a massive dip as it tries to go back to normal.
The problem happens when you try to attain that massive surge again with more drinking or taking more drugs, but it never happens.
What’s worse, your dopamine triggers get desensitized, and you’ll need more and more drugs and alcohol just to get back to normal – and much much more to cause a surge – which brings you deeper and deeper into addiction.
Addiction is not a death sentence
Having an addiction and going into sobriety doesn’t mean that your life is ruined permanently.
It doesn’t mean you’ll never enjoy things again because your brain is now rewired to be desensitized to all pleasure.
According to Dr. Anna, your brain will be out of balance for a while, tipping more towards pain than pleasure.
But over time your brain should start to regenerate and rebalance dopamine production.
But the brain remembers
In order to learn to ride a bike, your brain created neural pathways, linking to that learning process.
This is why if you stopped riding for decades, once you get on, it will all come right back to you.
That’s the same for addiction.
Just because you’re able to recover and enjoy normal life activities again doesn’t mean that your brain is healed to the point where you will be able to approach drinking and drug use like the first day you picked it up.
It will pick up from where you left off, and that could mean a dangerous relapse.
Some other topics we discuss in this episode:
- The societies preoccupation with avoiding all types of pain, while pain and pleasure are two sides of the same coin,
- The connection between telling the truth and maintaining sobriety,
- Managing our children’s pain and the lessons that teach us,
- How to introduce pain into your life in a controlled and beneficial way,
- The concept of “club goods” and what makes AA so effective.
About Dr. Anna Lembke
Anna Lembke, MD is a professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic.
In 2016, she published Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press, 2016), which was highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic (Zuger, 2018).
Dr. Lembke appeared on the Netflix documentary The Social Dilemma, an unvarnished look at the impact of social media on our lives. Her new book, Dopamine Nation: Finding Balance in the Age of Indulgence (Dutton/Penguin Random House, August 2021), an instant New York Times bestseller, explores how to moderate compulsive overconsumption in a dopamine-overloaded world.
Pain and pleasure
Pain and pleasure are two sides of the same coin.
Yet we’ve become so preoccupied as a society and as a civilization with avoiding pain at all costs.
Our lives have been engineered around that ideal. We use endless scrolling on social media to avoid the pain of boredom. We ghost people instead of having difficult and painful conversations. We swipe on a dozen dating apps to avoid the pain of rejection and being alone.
But what we eventually learn is that to know pleasure is to know pain.
To understand the heights of a really good, compatible, and fulfilling relationship, we have to understand the depths of a draining and sad one.
Maybe we should inject more pain into our lives, in a controlled way in a way that’s beneficial to us. Like taking ice baths or cold showers, exercising and getting our muscles sore, walking up to that person you’ve had your eye on, or walking to the store instead of driving.
Some pains are worth the risk.
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