New Book: 'Dopamine Nation,' Overabundance Keeps Us Craving More

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Last edited Thu Oct 21, 2021, 03:13 PM - Edit history (1)

- NPR, Aug. 25, 2021.- Ed. (*Today the author is a guest on the Thom Hartmann program on FSTV).

Human beings are programmed to approach pleasure and avoid pain. It's an instinct that dates back millions of years, to a time when people needed to actively seek food, clothing and shelter every day, or risk death. But psychiatrist Anna Lembke says that in today's world, such basic needs are often readily available- which changes the equation. "Living in this modern age is very challenging.. We're now having to cope with: How do I live in a world in which everything is provided?" Lembke says. "And if I consume too much of it- which my reflexes compel me to do- I'm going to be even more unhappy."

Lembke is the medical director of addiction medicine at Stanford Univ. & chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. Her new book, Dopamine Nation, explores the interconnection of pleasure & pain in the brain and helps explain addictive behaviors- not just to drugs & alcohol, but also to food, sex & smart phones. Lembke says that her patients who are struggling with substance abuse often believe their addictions are fueled by depression, anxiety & insomnia. But she maintains that the reverse is often true: Addictions can become the cause of pain — not the relief from it.

That's because the behavior triggers, among other things, an initial response of the neurotransmitter dopamine, which floods the brain with pleasure. But once the dopamine wears off, a person is often left feeling worse than before.

"They start out using the drug in order to feel good or in order to experience less pain," Lembke says. "Over time, with repeated exposure, that drug works less and less well. But they find themselves unable to stop, because when they're not using, then they're in a state of a dopamine deficit." Dopamine is a neurotransmitter that sends signals from one neuron to another, and it's probably the most important neurotransmitter in our experience of pleasure, motivation and reward.. Dopamine is the final common pathway for all pleasurable, intoxicating, rewarding experiences.

[An] experiment has been done in rats, for example, putting a probe in their brain, measuring the amount of dopamine released in response to different types of substances. Now, remember, we all have a baseline release of dopamine that's sort of always there. And then when we ingest certain substances or engage in certain behaviors, our dopamine either goes up or down in response to that substance or behavior.
So, for example, chocolate increases dopamine above baseline about 50%. Sex is about a 100%. Nicotine is about 150%. And amphetamines is about 1,000%...

- Read More & *Listen to Terrry Gross interview Dr. Lembke at the Link,
https://www.npr.org/sections/health-shots/2021/08/25/1030930259/in-dopamine-nation-overabundance-keeps-u-s-craving-more
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- Kirkus Reviews, 'Dopamine Nation,' - Excerpts:
https://www.kirkusreviews.com/book-reviews/anna-lembke/dopamine-nation/

.. Nerves along brain pathways that process rewards (i.e., pleasure) use dopamine as a “neurotransmitter”—to deliver signals. The more dopamine an experience releases, the more we enjoy it. However, dopamine processes pain as well as pleasure, and a healthy brain maintains a balance.

Most of us stop eating when we feel full. Coffee often provides all the stimulation we need. Gambling, drinking, shopping, or watching pornography are intermittent activities. Addiction, the mark of an unhealthy brain, is a compulsive behavior that continues despite the harm it causes, and it’s a worldwide epidemic. The biggest risk factor is easy access.

History books proclaim Prohibition a failure, but it produced a big drop in alcoholism, public drunkenness, and alcohol-caused liver disease, which rose again after repeal. Today, it seems, all indulgences are accessible.
Since around 2000, the rampant overprescription of narcotics has produced skyrocketing addiction and death.
The internet allows us to engage in social as well as unseemly activities in private.

Popular medical books rely on vivid case histories, and Lembke offers plenty. Her first is a lifelong masturbation addict who was ultimately able to achieve control. There follow accounts of other types of addicts, and she describes her treatment strategy based on the acronym DOPAMINE: data, objectives, problems, abstinence, mindfulness, insight, next steps, and experiment. Most readers will find it reasonable, and the author does not trumpet its success rate. Some of the most insightful passages involve lying...