Dopamine Nation

Is Our Addiction to Pleasure Ruining Our Capacity for Joy?

Dr. Anna Lembke, medical director of Stanford Addiction Medicine, asks us in her new book Dopamine Nation: Finding Balance in the Age of Indulgence,

Why, in a time of unprecedented wealth, freedom, technological progress, and medical advancement, do we appear to be unhappier and in more pain than ever?

Lembke opens by telling a story of one of her therapy patients, Jacob, a man in his sixties who seemed very nervous to be in counselling. In her account of their first session, Jacob explained his long infatuation with masturbation, and confessed that he had even created a “masturbation machine” made out an old record player to provide a maximal “preorgasm” state that would last for hours. Lembke writes that she was admittedly repulsed by the story at first and assumes her readers will be too.  However, the episode granted her somewhat of an epiphany about how modern Americans spend much of their lives, and she writes pointedly, “We are all, of a sort, engaged with our own masturbation machines.” Lembke posits that we are drowning in a radically skewed imbalance between pleasure and pain. We are pursuing pleasure to the point that it is prohibiting us from experiencing the full range of human emotions, including real joy. This pursuit of pleasure, through drugs, television, social media, pornography, etc., leads to an array of negative consequences. Lembke notes,

With repeated exposure to the same or similar pleasure stimulus, the initial deviation to the side of pleasure gets weaker and shorter and the after-response to the side of pain gets stronger and longer…. With repetition, our gremlins get bigger, faster, and more numerous and we need more of our drug of choice to get the same effect.

This process, called “neuroadaptation,” causes us to need the drug more intensely after every use but with ever diminishing returns. I’ve heard people point this out many times about pornography addiction. The longer one watches pornography, the more the user needs hardcore material to deliver the same “hit.” But after each use, the sense of emptiness and even pain is palpable, creating a terribly addictive cycle. Lembke relates this problem to the opioid crisis, writing about patients who seemed to be experiencing more pain after taking such drugs:

Exposure to opioids had caused their brain to reset its pleasure-pain balance to the side of pain. Now their original pain was worse, and they had new pain in parts of their body that used to be pain free.

While of course some patients do have psychiatric disorders that require such medication, Lembke believes that many people are making their problems far worse by “self-medicating.” She notes how one teenager came to her with anxiety about her cannabis addiction, but in fact it was the pot and her dependency on it that was causing her real issues. The teen, Delilah, said, “I put so much time and mental effort into organizing my next high, rushing off to do it. It’s such a relief not to have to do that anymore.” Lembke connects this adolescent experience to her adult patients’ addiction to opioids and other pain-relieving drugs.

In her review of Lembke’s book, Naomi Shaefer Riley writes,

Have we lost sight of the importance of feeling the full range of human emotions, of understanding that boredom and sadness and anger are all part of life? For one thing we have stopped training our children to handle them. Parents rush to fix every problem, to solve every complaint, to always entertain are training kids to jump from one pleasurable experience to another. And by the time they are adults they are only used to mountains, not valleys.

Lembke encourages readers to abstain from the sources of dopamine overload for at least a month to regain their pleasure/pain balance, and to “immerse yourself fully in the life you’ve been given. To stop running from whatever you’re trying to escape, and instead to stop, and turn and face whatever it is.” In facing the pain and discomfort, we find meaning, wonder, joy, and a deeper understanding and appreciation for life in all its variety.