Dopamine Nation

Starred review from June 28, 2021
Finding a balance between pain and pleasure is “essential for a life well lived,” writes psychiatrist Lembke (Drug Dealer MD) in this eye-opening survey on pleasure-seeking and addiction. Drawing on her experiences treating patients with various addictions, Lembke explains how the human brain’s pleasure center works and the effects of feel-good neurotransmitter dopamine, and suggests the brain is “perfectly adapted to a world of scarcity.” However, the modern world is one marked by an “overwhelming abundance” (“The smartphone is the modern-day hypodermic needle,” she writes, “delivering digital dopamine 24/7”) and, as such, those who struggle with addiction “have evolved a wisdom perfectly suited to the age we live in now.” To break the cycle of addiction, Lembke recommends beginning with periods of abstinence and reminds readers that chasing pleasure and avoiding suffering leads, in the long run, to more pain. “We must be willing to move forward,” she writes, “despite being uncertain of what lies ahead.” Readers looking for balance will return to Lembke’s informative and fascinating guidance. Agent: Bonnie Solow, Solow Literary.

July 1, 2021
An addiction specialist discusses her patients' problems and how she deals with them, and it's an unsettling picture. Lembke, medical director of the Stanford Addiction Medicine clinic, begins with a lesson in neuroscience. 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, a malignant process in a cooperative society but essential to maintaining addictive behavior. Many people believe that honesty--unmasking our flaws--will drive people away, but it does the opposite. A good education on addiction, fascinating case histories, and a sensible formula for treatment.

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