Dopamine Nation Review
Book written by Anna Lembke
This book has been on my radar for a while now. Hearing an interview that Andrew Huberman gave on this very topic as well as seeing an interview with Joe Rogan gave me the initial desire to check out what her work and research are about.
During the read, I could not help but compare this to “Why We Sleep” by Matthew Walker. I do believe that Walker presents more evidence of scientific research throughout his book, yet Lembke prioritizes the stories she has heard about others struggling with addiction. The two careers they possess largely have to do with how the books are structured; sleep science is largely dependent on measuring brainwave activity while the person is under, and psychiatry puts the focus on listening to patients’ addictions.
The book starts out with a captivating story about a man whose addiction has left him with multiple relapses after some periods of sobriety. But the relapses continue to tarnish his relationship with his family. Otherwise, he is a completely normal, high-functioning human being. By starting the book with this account, the reader’s perspective shifts toward expecting difficult-to-read stories about one’s struggles with having control over one’s actions. Which is why it was surprising for Lembke to not necessarily focus on the importance of the goal for people to become sober, which I had thought was to take control of one’s actions and not be deterred from any external influence? In the end, Lembke discusses the importance of striking an important balance between pain and pleasure, which in general I think everyone can agree is a logical conclusion.
I needed to find the reason for this book existing, rather than recounting stories about patients Lembke has seen. The lessons learned obviously make for good advice for people in general, but I personally needed an “a-ha” moment.
Lembke describes in the first chapter the statistics of how people’s lives have changed due to habits that are “attributable to modifiable behavioral risk factors” (29). The examples given are smoking, physical inactivity, and diet, impacting up to seventy percent of world global deaths. As such, this issue impacts a large number of people. But the real intended purpose for me to keep reading this book, solely, was the argument that those who have been addicted to something else (drugs, porn, alcohol, sugar, and the like) may have some insight into how we can stop ourselves from being addicted to our everyday handheld devices, social media, video games, and the like.
Such a powerful argument ensured I would read everything she had to say. It seems obvious, but from a biological standpoint, does the pleasure mechanism in our brains follow the same pattern of dopamine activation, or does it follow another mechanism? In my opinion, that could be a very hot topic of research down the road. Additionally, how likely do you think it will be for people to see an expert about their addiction to social media, video games, and other technologically related impulses? Certainly, I would expect much less likely, amid already an unlikely scenario for patients who struggle with addiction to see a therapist. Unfortunately, the “pursuit of pleasure” as Lembke notes, is something that weighs on our conscience so great because it provides escape, stress relief, and in some cases group membership. This last idea was not touched on greatly in this book in light of drug-using, as opposed to people who were trying to accomplish sobriety. Lembke does take into account the importance of AA meetings’ mission in allowing participants to come forward with their anxiety, guilt, shame, and goals for life. But, what about the participants who take drugs together for social reasons? It would have helped to elaborate on this dynamic more. Why would group membership in one context be better than group membership in another?
Chapter 3 and beyond opened up research taken by scientists. To start, she illustrated Pavlovian conditioning, seemingly the fundamental psychology-biology experiment. Then, experimenting with rats yielded many interesting results that dealt with measuring dopamine levels to various stimuli from running wheels and electric shocks to even providing drugs to the rats. Those findings showed that traits we consider important to functioning in a healthy society, such as empathy, dopamine regulation, plasticity, and prefrontal cortex functioning (prefrontal cortex functioning mainly dealt with how we could measure one’s ability to inhibit impulses and if one could delay gratification). One example was administering methamphetamine. Rats “before entering the enriched environment, they fail to show the synaptic changes seen previously with exposure to the enriched environment.” This reflected how a drug impacted the rat’s neuroplasticity and in effect, learning.
But what do we make of rats who stopped taking the drugs? It turns out, that some brain changes are irreversible, but that “it is possible to detour around these damaged areas by creating new neural networks” (64). This may deliver some hope to those who can recover and still keep functioning.
Then again, haven’t we heard that alcoholism withdrawal syndrome exists? The review done by Sachdeva et al. discusses symptoms of withdrawal for previous alcohol addicts, citing
mild to moderate tremors, irritability, anxiety, or agitation, among others. The most severe manifestations of withdrawal include delirium tremens, hallucinations, and seizures. These happen due to alcohol-induced imbalances in the brain which result in excessive neuronal activity if the alcohol is withheld.”
The theory that the brain drastically changes by such a pernicious habit that does not solely impact the pleasure-reward mechanism in the brain, complicates this issue further.
In doing so, I argue this book is not so much a holistic review of addiction, but a new perspective in addressing the topic. A popularization of the subject may have been the key motivation after all. If that was the case, then the mission was successful. If the motivation was to provide a holistic case that provides crucial findings, shares vital scientific experimental data and brings us into the mind of an addict, I would say that this book only partly accomplishes the mission.
But it’s an easy read that should not take you more than ten hours total to read it. You’ll learn something from it, which is the overall aim of reading a book such as this.
Lastly, I will share a good excerpt from the book that I found significant:
From pg 192:
When our lived experience diverges from our projected image, we are prone to feel detached and unreal, as fake as the false images we’ve created. Psychiatrists call this feeling derealization and depersonalization. It’s a terrifying feeling, which commonly contributes to thoughts of suicide. After all, if we don’t feel real, ending our lives feels inconsequential.”
Powerful stuff indeed.
Works Cited
Lembke, A. (2021). Dopamine Nation: Finding Balance in the Age of Indulgence. Dutton.
Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of clinical and diagnostic research : JCDR, 9(9), VE01–VE07. https://doi.org/10.7860/JCDR/2015/13407.6538
