Dopamine Nation

The book I read last week is “Dopamine Nation: Finding Balance in the Age of Indulgence“, by the American psychiatrist Anna Lembke.

The author may appear a little bit moralist and judgy and there are minor controversial issues on some “scientific” findings, but generally speaking I found it a valid book for a general public, giving a few insights on something that is (or at least should be) one of the major concerns in our society. We’re living with our “sensors” overwhelmed by too much stimuli, many of which are provided by addictive technology, since we’re constantly surrounded by products designed and distributed by addiction factories: I’m not surprised (nor should you) to read titles like: “Netflix’s biggest competition is sleep, says CEO Reed Hastings“. So it’s worth reading a book like “Dopamine nation” to understand how we are vulnerables and what we can try to do avoid (or at least limit) related risks.

“We are cacti in the rain forest”

(Author Anna Lembke attribuited this expression to Dr Tom Finucane
that was talking about diabetes in a world full of sugars)

A few concepts from the book

The Pursuit of Pleasure

• Once the availability of drugs increases, it’s easier to get in contact for a first try. Once you try, it’s easy to get addicted. It’s observable with alcool, drugs, technology (gambling, games, porn, social networks, even ordening something from Amazon just to unpack and then send back), poor fictional books (like the author admitted having wasted time into).
• We’re social animals: if we see abuse is common among friends and others, we’ll see it as “normal”.
• To motivate acts of kindness, it’s common to find people that make us seen them as a vehicle of our self well-being – NOTE: it was indeed part of the Science of Well-Being course (and actually there are studies that show us that kindness is, in a sense, due to selfish hidden reasons, read the book “The Elephant in the Brain: Hidden Motives in Everyday Life” by Kevin Simler and Robin Hanson” for more)
• We’re always looking to distract ourselves from ourselves, from pain and from reality, but it’s turning out that this leads to even more pain, we’re feeling more miserables.

The Pleasure-Pain Balance

• Dopamine neurotransitter is the main one in rewarding process: it’s linked to wanting, more than liking (without dopamine, a mouse can starve to death even with food in front of him). The more and the faster the dopamine release, the more addictive are the drugs.
• Studies with rats show that, if sex is a release of 100% dopamine, chocolate is 55% and amfetamine is 1000% (so let’s say equivalent to 10 orgasms).
• Pleasure and pain are co-located and balance is needed (after pleasure, it tends to reach pain).
• Tolerance (neuro-adaptation) explains why we experience less pleasure at a given dose, so craving for more (hedonic pleasure set point changes: pleasure goes down and pain goes up). This effect is also known in opioid-induced algesia (the more opioid we take, the more sensitive to pain we become).
• When we stop an addiction, after a period with anxiety, irritability and so on (see “dysphoria driven relapse”), our brain usually readapt to the absence of the drug
• A.A. associations says “people, places, and things”: the cue-dependent learning (Pavlov effect) tells us to avoid triggers – Note: if you want to profit from it for building new good habits and stop bad ones, there are specific books like “Atomic habits” and “The power of habit“.
• Physical effects on the brain (in the dendrites) can last forever: even a lifetime after a last dose (that induced more effects compared to the first one), a new dose will produce same effects as the last dose did.
• Even if the changes in the brain are irreversible (e.g. impairements on learning after drug abuse), after recovery it’s possible to create a new pathway for neurons (naturally, see Edie Sullivan studies on Alcohol recovery, or with optogenetics, see Vincent Pascoli studies).

Dopamine Fasting

• Author use the DOPAMINE acronyim:
  • Data (explore/gather data on the usage/abuse)
  • Objectives (why you are using the substance, to achieve what)
  • Problems (downsides or unintented consequences)
  • Abstinence (necessary to restore homeostasys, suggested at least one month – no swap to another substance and note: aging causes less plasticity, so more effort/time is needed)
  • Mindfulness (to observe thoughts, sensations and pain during the withdrawal and recovery phases)
  • Insight (abstince gives insight, impossible during (ab)use)
  • Nest steps (remember to control, since after abuse it’s almost impossible to come back to the substance without getting caught again in the trap)
  • Experiment (control on moderation and use)

Self-binding: Space, Time, and Meaning

• Self-binding refers to putting barriers between us and our drugs to make harder the access
  • physical (space)
    • distance/lock the drug
    • assume medical drugs (note that usually it won’t work alone without therapy)
  • chronological (time)
    • track time you spend with abuse (and its effects)
    • limit access (e.g.: only during weekend, a study with cocaine in rats showed that with limited time access they will indeed use less in a day)
    • note that time is distorted with addiction: “delay discounting” phenomen (Bretteville-Jensen et al. dimostred addicted people are more likely to accept less money if they have to wait less, compared to control group); temporal horizon shrinks for opioid users (they imagine “future” like avg 9 days instead of avg 4.7 years! see Warren Bickel)
    • in delayed reward, prefrontal cortex is implied (see Samuel McClure), so we are at risk of prefrontal cortex atrophy!
  • categorical (meaning)

A Broken Balance?

• In 90s, a common opinion for psychiatrists was that depressed/anxious/etc. people were born with a deficit of some chemical substance to “re-balance” (under the “nudge” of chemical industries), but there was little attention to the fact that any drug that presses on the pleasure side has the potential to be addictive.
• Despite increase of medical drugs prescription in the world (US one of the leaing Countries), no decrease in symptoms is observed. Moreover, Adderall and Ritalin prescription increase (due to more young people diagnosed with ADHD and similar) doesn’t lead to better scholarship or grades, just memory and attention in the short period (Gretcher Watson also observed the opposite: deterioration in academic and social functioning).
• More and more people are deciding to quit antideprexants: the lows are worth it to feel human! Worth to think, even if sad (but meaningful) questions.
• Opioids are too much prescribed to poor people (leading also to much more deaths due to drug overdose).
• Alternative exists: embracing pain.

The Pursuit of Pain

• Cold showers. There are evidences of level of dopamine and norepinephrine lasting even one hour after a cold shower: it’s like pain triggers body homeostatic regulation leading to pleasure (controversial: same mechanism applied to religious people flagelling to overcome flesh desire?)
• Cruel experiments on dogs showed that repeating a shock can shorten the initial response (pain) and increase the after-response (pleasure), leading into relaxation symptoms (like bradycardia)
• A little “harm” to the body can be healthy, like intermitted fasting (or maybe even a little bit of radiation, as some scientists studied on Japanese 1945 survivors, but not confirmed).
• Physical exercise (wether voluntary or induced) in rats seems to make them less likely to consume cocaine/alcohol. Same was observed in humans (the more they used to perform physical activity, the less they are prone to use drugs or the more are likely to recover).
• Generally speaking: exercise has positive effects on mood, anxiety, cognition, energy, sleep… more than some pills.
• Ancient medicine, with Hippocrates (circa 400 BC), said: “Of two pains occurring together, not in the same part of the body, the stronger weakens the other” – confirmed, in a sense, by Sprenger in 2011, founding also that naloxone (opioid receptor blocker) prevented this effect, so it’s like saying that another pain has more or less like the effect of a “body endogenous (self-made) opioid”.
• Liu Xiang found (2001) that the little pain of acupuncture inhibites greater pains!
• ECT (electroconvulsive therapt) can (under certain specific circumstances), with the human help of relaxants and paralytics drugs (that prevent painful muscle contractions) and anesthetics, work to re-balance homeostatis (in that case, it’s not the pain, but micro-neurochemical changes)
• Alex Honnold seems to have no fear in climbing mountains and he shows much less response to fear in amigdala; however, this kind of “fearless” brain is not trasversal (he has still some fears), but he just adapted to fear much less when climbing
• Downside: too much exposure to “natural high” (even if “natural” is something assisted by technology) leads to anhedonia too. Even phisical exercise can be addictive.
• Work addiction (workaholic people) is also dangerous: being in a state of flow is addictive and rewarding itself, so one must limit himself.

Radical Honesty

• Truth is painful, but radical honesty is good to recover from addiction and for a more balanced life:
  • promote awareness for our actions
    • honesty can also be solicited (Christian Ruff experiment) by electrostimulation (tDCS) of the prefrontal brain cortex, linked to decision-making, emotion regulation and future planning
  • fosters intimate connections
    • more intimacy may produce more oxytocin that can increase dopamine
    • also valid the inverse: whil truth-telling enhance human attachment, compulsive overconsumption of high-dopamine goods leads to isolation and indifference: a rat in nature would help a rat in a cage, unless the free rat has opportunity to self-administer heroine himself
  • leads to truthful autobiography (making us accountable for ourselves in present and future)
    • autobiographical narrative are an essential measure of lived time and also shape our future
    • victimism (our social trend) is bad: the victims are often unwell and remain unwell! Seeking and finding truth is searching for data, so insight, that allows us to make informed choices
    • instead of concentrate on childhood (when we had little control), think about adult responsibilities
    • a truthful narrative is important to be authentic and spontaneous, far from what Winnicott called “the false self“, a self-constructed persona in defense against intolerable external demands and stressors, exaggerated from the recent social media where we’re obsessed to expose a curated false narrative far from reality (in severe cases, it can lead to derealization and depersonalization). Remediation: the true self, against the false self.
  • truth is contageous and may prevent future addiction
    • commitment and keeping the promises lead to “plenty mindset”: people around us (especially children) observe that things will turn out okay; otherwise, lying engenders a “scarcity mindset”: we cannot rely upon in this dangerous world, so we’ll go to survival short-term mode (see experiment by Warren Bickel on delaying gratification after reading scarcity or plenty narrative)
    • social media exaggeration and “post-truth” politics can make us feel/think we’re in scarcity even if we’re living in a rich environment.

Prosocial Shame

• Guilt is about actions, adaptive emotion; whereas shame is about ourselves as people, a maladaptive emotion
• In compulsive consumption, shame can enhance or stop the bad behavior, it depends on how others reply to us, so we’ll have:
  • destructive shame if people abbandon or punish us: this will enforce a vicious cycle of feeling bad and consume more substances;
  • prosocial shame if they reply holding us closer and providing clear guidance for redemption/recovery: this will lead to acceptance and block the vicious cycle

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 away our 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 a plenty 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.

Some thoughts

• We’re social animals: if we see abuse is common among friends and others, we’ll see it as “normal”. It can explain why in certain societies, drinking alcohol in public with friends is considered normal or even nice, even if it’s a risky and unhealthy behavior. Over time, societies evolved to banish certain behaviors, so: why, now that we have more knowledge than before, we still allow (or even promote!) some substance consumption like alcohol? And why, even if we know that too much exposure to social media and electronic devices is completely unhealthy for small children, it’s common to observe babies let alone with those new “electronic babysitters”?
• It’s well known we’re a society where most of the people is searching for easy and quick solutions, a pill for everything; but luckily some psychiatrists are turning more into a new balance between pills and and other therapies, for a new positive psichiatry, focusing mostly on lifestyle instead of just prescribing drugs: changing our environment can be more powerful (and with more lasting effects) compared to changing our internal chemistry balances
• ECT (a.k.a. “Electroshock therapy”) is here seen like a general small “electrical reset” for the brain, but I’d suggest the author to be extremely careful when talking about some methods that, despite the fact they’re used since 1938, are still considered experimental due to the risk of exposure to severe side effects. I don’t want to limit the science exploration, but just remember cases like the terrible rising of Lobotomy after the WWII, a case I’d consider a near case of (extremely bad) Iatrogenesis.
• Be aware of the mainstream narrative: the continuous exposure to global news (everytime focusing on wars, scarcity, threats of every kind) and to the desire industry with their invasive ads telling you can be happier just buying their last product (and, to some extent, also exposing ourselves to obsession to be productive) are making us addicted to this toxic media consumption, trapping us in a vicious reinforced cycle.
• Just stop using social media and comparing yourself to others, because now it’s much worst than in the past: not only we’re seeing a terrible powerful world full of “false self” representations on the media, with their perfect life (obviously someone will post hundreds of pics taken during a 7days holiday abroad, but very few ones taken in the office where they spend the vast part of their life, giving the false impression to our mind that others are enjoing vacation 24/7), but few years ago someone compared him/herself to a very few geniuses of the past:

Now, instead, we’re living under the pressure of FOMO (fear of missing out) since we now that someone has achieved bigger results even years before our current age: