A review of Dopamine Nation: Finding Balance in the Age of Indulgence by Anna Lembke, MD
Anna Lembke’s appreciation for science and storytelling makes Dopamine Nation a fascinating read as well as a useful guide for 21st-century life.
In a world where we can have everything, anytime, our primitive brains struggle. Dopamine is a brain chemical in our reward pathways. As ancient humans, it drove us to do hard things that we needed to survive. It was the payoff we got for getting off our arses to find food or procreate.
Today, quick dopamine hits are everywhere – from opioids to online shopping. When we remove the hard part and jump straight to reward, we break the system. The dopamine receptors in a meth addict show up dark in a brain scan. And although some addictions can create permanent changes in the brain, like well-worn grooves, the reward centre of the brain can repair.
Lembke uses the image of a seesaw to illustrate the relationship between pleasure and pain. Our body seeks homeostasis, balance. So when we load one side of the seesaw with easy dopamine, our bodies respond. Lembke describes little gremlins jumping on the other side of the seesaw. The more gremlins on the right side of the seesaw, the more quick dopamine we need on the left. Eventually, these gremlins become permanently camped on the seesaw and we become immune to pleasure and more vulnerable to pain. This is the dopamine-deficient state that shows up on the brain scans of addicts.
So how do we fix it? Lembke has built a handy acronym from the word DOPAMINE. Data is the first step – gathering the facts. O is for objectives, asking: what does this addiction do for you? Answers will be along the lines of … It helps me … or I need it to … P is for problems, or asking what the downsides are. A is abstinence, which means four weeks off – enough time to get through the two weeks of withdrawal to see what life is like without it on the other side. M for meditation is observing yourself separate from your thoughts, watching the pain and taking note. I is for insight, which will arrive through the process and which is not possible while we’re engaging in the addictive behaviour. N is next steps, which might be carrying on with abstinence or might be a new, more moderate behaviour. And E is experiment, which is trying different ways to find balance – either through moderation or continuing abstinence.
Self-binding is one of the core tools for this experimentation. This might be leaving your phone in another room at night to avoid doomscrolling or freezing your credit card in a block of ice to avoid impulsive shopping. It’s about creating time or space between you and the thing you’re trying to control.
Sometimes, medication can help restore balance if the scales are permanently damaged. But Lembke has an interesting take on this, with Brave New World vibes: “What if taking psychotropic drugs is causing us to lose some essential aspect of our humanity?” Namely, the part that feels things. Lembke asks if antidepressants and anti-anxiety drugs might make us indifferent to circumstances that we should be emotional about. “Worse, yet, have psychotropic medications become a means of social control, especially of the poor, unemployed, and disenfranchised?”
Pressing on the pain side helps the body to press back on the pleasure side – this explains ice bathing (and jogging).
Lembke advocates for radical honesty and suspects a link between this and frontal lobe development. (A Swiss study of lying found that lying weakened the frontal lobe so the converse is also likely true.) And the final chapter of the book looks at the role of “prosocial shame” which is when others hear your radically honest failures and accept you anyway – a key concept for AA meetings and parenting.
The book finishes with 10 handy “lessons of the balance”.
- The relentless pursuit of pleasure (and avoidance of pain) leads to pain.
- Recovery begins with abstinence.
- Abstinence resets the brain’s reward pathway and with it our capacity to take joy in simpler pleasures.
- Self-binding creates literal and metacognitive space between desire and consumption, a modern necessity in our dopamine-overloaded world.
- Medications can restore homeostasis, but consider what we lose by medicating our way through pain.
- Pressing on the pain side resets our balance to the side of pleasure.
- Beware of getting addicted to pain.
- Radical honesty promotes awareness, enhances intimacy, and fosters an abundance mindset.
- Prosocial shame affirms that we belong to the human tribe.
- Instead of running away from the world, we can find escape by immersing ourselves in it.
That’s an overview of the science, but it’s the stories that keep the pages turning in this book, from Jacob’s addiction to his electronic masturbation machine to Lori’s realisation that her church’s shame was limiting her own acceptance of her addictions. Lembke starts the book by acknowledging how much she’s learned from her patients. “You may find some of these stories shocking, but to me they are just extreme versions of what we are all capable of.”
The book delivers on its page 3 promise of “practical solutions for how to manage compulsive overconsumption in a world where consumption has become the all-encompassing motive of our lives.”
“In essence, the secret to finding balance is combining the science of desire with the wisdom of recovery.”
Lembke does this beautifully.