Dopamine Nation by Dr. Anna Lembke

“The paradox is that hedonism, the pursuit of pleasure for it’s own sake, leads to anhedonia. Which is the inability to enjoy pleasure of any kind.”

In her book Dopamine Nation, Anna Lembke helps us better understand our human nature and why we seek pleasure but avoid pain. These two traits are deeply rooted in our evolutionary history and a better understanding of them will help us become better at resisting addictive habits.

In a world where free dopamine is more abundant than ever before, it is crucial that we become more aware of its effects and methods of regulation.

You should by all means read this book for yourself. Below, I have written out my book notes, but I couldn’t cover hundreds of pages in just a couple of bullet points. That is why I highly encourage you to create your notes whilst going through the book, and for the time being use mine as a guide on what this book is about.

For more books check out Best Self-Improvement Books or Best Classic Books, and for a full self-improvement guide, you can also take a look at my Roadmap to Overman.

Book Notes

Dopamine’s ancient role in physical movement relates to its role in motivation: To obtain the object of our desire, we need to go get it.

Dopamine is not the only neurotransmitter involved in reward processing, but most neuroscientists agree it is among the most important. Dopamine may play a bigger role in the motivation to get a reward than the pleasure of the reward itself. Wanting more than liking. Genetically engineered mice unable to make dopamine will not seek out food, and will starve to death even when food is placed just inches from their mouth. Yet if food is put directly into their mouth, they will chew and eat the food, and seem to enjoy it.

In addition to the discovery of dopamine, neuroscientists have determined that pleasure and pain are processed in overlapping brain regions and work via an opponent-process mechanism. Another way to say this is that pleasure and pain work like a balance.

When we experience pleasure, dopamine is released in our reward pathway and the balance tips to the side of pleasure. But here’s the important thing about the balance: It wants to remain level, that is, in equilibrium. It does not want to be tipped for very long to one side or another. Hence, every time the balance tips toward pleasure, powerful self-regulating mechanisms kick into action to bring it level again. The relentless pursuit of pleasure (and avoidance of pain) leads to pain.

With repeated exposure to the same or similar pleasure stimulus, the initial deviation to the side of pleasure gets weaker and shorter and the response to the side of pain gets stronger and longer, a process scientists call neuroadaptation. The paradox is that hedonism, the pursuit of pleasure for its own sake, leads to anhedonia, which is the inability to enjoy pleasure of any kind.

Our sensory perception of pain (and pleasure) is heavily influenced by the meaning we ascribe to it.

a twenty-nine-year-old construction worker who walked into the emergency room after landing foot first on a fifteen-centimeter nail, which was sticking up out of the top of his construction boot, having penetrated through leather, flesh, and bones. “The smallest movement of the nail was painful [and] he was sedated with fentanyl and midazolam,” powerful opioids and sedatives. But when the nail was pulled out from below and the boot removed, it became apparent that “the nail had penetrated between the toes: the foot was entirely uninjured.”

We are drowning in dopamine. The net effect is that we now need more reward to feel pleasure, and less injury to feel pain.

DOPAMINE framework:

• The d in DOPAMINE stands for data. I begin by gathering the simple facts of consumption. What, how much and how often.
• The o in DOPAMINE stands for objectives for using.
• The p in DOPAMINE stands for problems related to use.
• The a in DOPAMINE stands for abstinence.
• The m of DOPAMINE stands for mindfulness. It is the mindfulness practices such as meditation.
• The i of DOPAMINE stands for insight. simple exercise of abstaining from our drug of choice for at least four weeks gives clarifying insight into our behaviors.
• The n of DOPAMINE stands for next steps.
• The e and final letter of DOPAMINE stands for experiment. This is where patients go back out into the world armed with a new dopamine set point (a level pleasure-pain balance) and a plan for how to maintain it. Whether the goal is continued abstinence or moderation.

Three types of self-biding:

• Physical self-biding
• Chronological self-biding
• Categorical self-biding: Categorical self-binding limits consumption by sorting dopamine into different categories: those subtypes we allow ourselves to consume, and those we do not.

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.

Pressing on the pain side of the balance can lead to its opposite—pleasure. Pressing on the pain side resets our balance to the side of pleasure. Unlike pressing on the pleasure side, the dopamine that comes from pain is indirect and potentially more enduring. Examples are cold shower, hard work rewarded by results and feeling of accomplishment for the day, flow state due to hard work, runners high, exercise,…

With intermittent exposure to pain, our natural hedonic set point gets weighted to the side of pleasure, such that we become less vulnerable to pain and more able to feel pleasure over time.

We can use pain to treat pain. Anxiety to treat anxiety.