Summary of the book "Dopamine Nation" - By Anna Lembke

Key Concepts in this book:

1. We've all turned into pleasure addicts in this age of compulsive overconsumption.
2. Our misery arises from our attempts to escape being unhappy.
3. Pleasure is inextricably linked to suffering.
4. Abstinence leads to understanding.
5. Tipping the balances in favour of suffering can lead to pleasure in the end.
6. We are set free when we tell the truth.
7. Prosocial guilt provides us with the necessary dosage of humility.

Who can benefit the most from this book:

• People struggling to break bad habits.
• Family members of loved ones struggling with addiction.
• Anyone who can’t seem to put down their phone.

What am I getting out of it? Learn how to break free from compulsive overeating.

We live in a world marked by abundant abundance and excessive consumption. We can buy virtually anything at the touch of a button, from clothes to food, entertainment to sex, and yes, even drugs. In short, dopamine-producing experiences abound in our lives.

We look for these experiences to numb the pain in our lives and dopamine – a neurotransmitter that deals with reward-processing and motivation – is a perfect salve. However, the dopamine high is short-lived. Consider the craving you get after eating a bowl of ice cream or the desire to watch one more episode on Netflix.

Drawing from science and the wisdom gained from those who've suffered addiction, this summary offers ideas for finding a balance between pleasure and pain and overcoming our compulsive desire to consume.

In this summary, 

• you’ll learn the extent to which compulsive overconsumption rules our lives.
• How the pain-pleasure balance works in the brain.
• And key nuggets of recovery wisdom to help you lead a more balanced life.

1. We've all turned into pleasure addicts in this age of compulsive overconsumption.

When you hear the word addict, what comes to mind? Is that a sweating, thin addict exchanging crumpled cash for a bag of white powder? Is that a suburban mom furiously uncorking a bottle of rosé, or is it someone else? What about a man who stays up all night watching pornography? Or a college freshman who can't seem to put her phone down long enough to study?

Addiction is defined as the continued, obsessive use of a substance or behaviour – such as gambling, sex, or video games – even though it causes harm to you and others. And all of the preceding cases are addicts.

Since we're all battling with one or more poor habits, none of this should come as a surprise. In fact, the author, Anna Lembke, easily admits to being an addict herself, addicted to cliched romance books like Twilight and Fifty Shades of Grey, which she read on her Kindle in between sessions with patients.

The main point here is that we've all turned become pleasure addicts in an age of obsessive overconsumption.

Whether it's video games, page-turners, or cocaine, easy access is a big risk factor for addiction. For example, in the early 2000s, the over-prescribing of pain medicine contributed significantly to the current opioid epidemic in the United States.

And, even though the massive supply of drugs is more potent than ever – opioids are often pharmaceutical grade, and marijuana is nearly ten times stronger than it was in the 1960s — narcotics are only the tip of the iceberg when it comes to our dopamine economy. Consider this: not only are our foods more addictive – laden with large amounts of sugar and fat – but so is our technology, with its numerous clicks and unending scroll.

Addiction is on the rise, and risk factors including smoking, obesity, and lack of exercise are responsible for 70% of deaths worldwide. While the poor lack meaningful work and healthy prospects, they have no shortage of dopamine-inducing distractions. Overdose, suicide, and alcohol-related liver disease are the top three causes of mortality among undereducated middle-aged white Americans.

In the following concept, you'll learn how living for pleasure has resulted in us being in a lot more pain.

2. Our misery arises from our attempts to escape being unhappy.

During the 1800s, surgeons would do operations without using general anaesthetics, believing that pain stimulated the immune system and accelerated the healing process. Today's doctors adopt a completely different approach, focusing on healing, compassion, and pain relief.

Because of their aversion to discomfort, doctors are reaching for their prescription pads more than their stethoscopes. One out of every four Americans now takes psychiatric medication daily, and one out of every 10 uses antidepressants, with global use increasing as well. In the United States, the use of stimulants like Ritalin and Adderall increased between 2006 and 2016. The use of sedatives such as Valium and Xanax also increased by 67 per cent. In 2012, one bottle of tablets for every US resident was the rate of opioid prescriptions.

Clearly, we're attempting to alleviate the discomfort. But, if we live in an era of unprecedented freedom, affluence, and progress, why are we all in such pain?

The main point here is that our sorrow derives from our attempts to avoid being unhappy.

The pain we're fleeing isn't unbearable - it's not a shattered bone, and it's certainly not unanesthetized surgery. Rather, we can't seem to take even minor discomfort, preferring to divert and tune out, relying on entertainment to get us out of the present moment.

One of Lembke's patients, Sophie, is an excellent example. She was a Stanford undergrad who was depressed and anxious and spent most of her time on her phone. Sophie, Lembke believed, was producing her own problems by continually managing her attention environment and avoiding herself. As a result, she advised Sophie to take a stroll to class instead of listening to her customary podcast. While the concept may appear to be tedious, boredom forces us to consider our lives purpose. We allow thoughts to bloom by leaving a small empty space free of distractions.

And, despite our best efforts to avoid discomfort – whether through medicines or binge-reading romance novels — the pain is just getting worse. According to the World Happiness Report, Americans were less joyful in 2018 than they were in 2008. Belgium, Canada, Denmark, France, and Japan all experienced a downturn in the same way. According to other studies, wealthy countries have higher rates of anxiety and depression than their poorer neighbours.

Learning how pain and pleasure manifest themselves in our brains is the key to comprehending this phenomenon, and we'll uncover why the things that made us joyful finally ceased working in the blink of an eye.

3. Pleasure is inextricably linked to suffering.

Anna Lembke became so engrossed in the series that she read it four times. Unfortunately, the second time wasn't quite as nice as the first, and by the time she made her final pass, the thrill had worn off. She eventually moved on to more serious vampire-related entertainment. Her experience, however, exemplifies the pleasure-pain balance.

That's because all of that enjoyment isn't completely free. The areas of the brain that process pleasure and pain overlap and operate as a counterbalance to one another. So as soon as you get that dopamine rush and shift the scales in your favour, your brain goes into overdrive to restore balance. The balance, on the other hand, continues to tip to the side of agony.

The main point here is that pleasure is inextricably linked to pain.

This agony is usually expressed as a desire for more - one more mouthful, one more episode, one more hit. Isn't it true that if one person feels good, two people will feel even better? However, there is a stumbling block in the form of neuroadaptation. To put it another way, we develop tolerance. The more we are exposed to pleasurable stimuli, the lesser the pleasure becomes and the stronger the pain becomes.

This is why drug users gradually raise their dosage, and why Lembke sought even crazy romance stories. In a dopamine deficiency state, the scales eventually tip in favour of pain. This means that we are not only less able to experience pleasure, but we are also more sensitive to pain.

Reading had always been Lembke's greatest pleasure, but as she fell into the romance rabbit hole, that enjoyment vanished. Despite this, she continued to read, much like drug users who get high to prevent withdrawal. And having this pleasure-pain balance locked on pain is what drives many to relapse, merely to get rid of the withdrawal dysphoria.

The good news is that if we only wait a little while, the brain will rebalance and we will be able to enjoy life again without the need for that substance or destructive conduct. However, it should be noted that recuperation times for heavy and long-term users can be significantly longer, and in some cases, irreversible. And, while addiction-induced brain changes, such as those related to triggers and cravings, are permanent, our brains eventually develop alternative pathways to bypass those damaged areas, allowing us to make healthier choices.

4. Abstinence leads to understanding.

Our brains were designed to function in a world where there was a scarcity of resources. However, in today's society of wealth, our pleasure-pain balances have been tilted to the point where we are never content. While the idea of reaching for more appears to go hand-in-hand with the current productivity attitude, it has actually made us more vulnerable to suffering and less able to experience joy.

Clearly, the situation is untenable, but how do we turn things around?

We can begin by considering the valuable lessons learned from people who have struggled with addiction. Addicts, according to philosopher Kent Dunnington, are "modern prophets." Recovering alcoholics and drug addicts have discovered a knowledge that is well suited to a culture fueled by compulsive spending. And, like them, we must first cease to use to attain clarity.

The main point is this: Abstinence leads to understanding.

Delilah smoked pot every day to cope with anxiety, but the coping behaviour, like Sophie's inability to put down her phone, was likely the source of the symptoms in the first place. Delilah should go on dopamine fast — quit using pot for a month – to reset her reward circuitry, according to Lembke.

Why four weeks rather than two? Drug abusers with two weeks of sobriety exhibited a lower level of dopamine activity than healthy controls in a brain imaging study done by neurologist Nora Volkow. However, in a four-week study led by experimental psychology professor Marc Schuckit, 80 per cent of daily drinkers were no longer classified as clinically depressed just by abstaining from alcohol.

Another advantage of abstinence is that it can uncover hidden health problems. After a dopamine fast, about 20% of patients do not improve, indicating a psychological problem.

It's also worth noting that folks who have used heavy drugs for a long time will need lengthier dopamine fast. While withdrawal from video games or porn addiction is usually minor, withdrawal from other substances such as alcohol, benzodiazepines, and opioids can be fatal. Lembke never suggests a dopamine fast for those people; instead, withdrawal should be properly managed.

Delilah stated that her worry vanished after a month of abstinence. She not only learned a lot, but she also obtained a lot of knowledge. Delilah discovered how addicted she was to marijuana after it made her vomit, and that understanding gave her the strength to keep going. Delilah realized how her anxiety stemmed from organizing her life around smoking weed during her abstinence period. She was able to enjoy her life again after the medicine was removed from the equation.

5. Tipping the balances in favour of suffering can lead to pleasure in the end.

Another of Lembke's patients, Michael, realized that cold baths made him feel great after quitting narcotics. He soon began taking ten-minute ice baths every morning and night, describing the sensation as similar to bliss.

This is supported by science. An hour of cold-water immersion elevated dopamine levels in the blood by 250 per cent, according to a study conducted at Prague's Charles University.

Michael was exposing himself to something painful with his daily ice baths, which caused his brain to level out to the side of pleasure — an impact that is actually longer-lasting than a drug's pure dopamine hit.

The main takeaway is that tilting our scales toward pain might eventually lead to pleasure.

Similarly to how pressing on pleasure can cause the scales to become stuck on pain, gradually exposing ourselves to unpleasant stimuli makes us more pain resistant. This concept extends back to Socrates' time when he pondered the pleasant sensation that follows suffering. And we've all felt the same way. Consider the rush of running or the thrill of seeing a scary movie.

Moderate exposure to painful stimuli has also been shown in studies to make organisms more resilient. Worms that were exposed to greater temperatures, for example, were more likely to survive than those that were not. Japanese citizens who were exposed to low-dose radiation in 1945 had a slightly longer life expectancy and a lower cancer rate.

Intermittent fasting is a less extreme form of intermittent fasting that has been linked to a longer lifespan, lower blood pressure, and greater resistance to age-related disorders. Similarly, exercise is uncomfortable and stressful to our bodies in the short term. Nonetheless, it raises dopamine levels and is one of the simplest strategies to improve our health.

The pain was first used as a pain reliever by Hippocrates, who said, "Of two aches occurring simultaneously... the stronger diminishes the other." Acupuncture is a well-known use of this concept, and a study published in the medical journal Pain supported this with neuroimaging, demonstrating that the effect of one painful stimulus could be lessened by another.

Michael found happiness through subjecting himself to excruciating cold baths, which seemed contradictory at the time. In the end, pain can serve as a stepping stone to recovery.

6. We are set free when we tell the truth.

Maria, an alcoholic in recovery and a member of Alcoholics Anonymous, received a parcel addressed to her brother one day. Maria lied when her brother confronted her, then spent the night unable to sleep.

Maria made the decision the next morning to tell her brother the truth and ask for his forgiveness. She realized she no longer had to bear the weight of her lies, which had been everywhere while she was still drinking. And this act of honesty brought the two of them closer together.

Radical honesty is not just a cornerstone of every major religion, but it is also a cornerstone of recovery programs. That's because telling the truth – and sometimes exposing our flaws in the process - makes us more aware of our actions, keeps us accountable, and encourages intimacy.

The main point here is that telling the truth sets us free.

Telling the truth about our lives and our issues out loud, whether to a therapist or an AA sponsor, a priest or a close friend, allows us to see them in a fresh light. That's because we're on autopilot when it comes to addictive behaviour. We're so focused on the prize that we don't think about the ramifications. Or, to put it another way, we're in denial.

In a fascinating Swiss study, researchers discovered that electrical stimulation to the prefrontal cortex – the area of the brain responsible for decision-making and emotional regulation – enhanced participants' honesty reaction. As a result of these findings, Lembke hypothesized that telling the truth stimulates the prefrontal cortex and aids in emotional management. While there is no evidence to support this, recovery knowledge argues that adopting radical honesty can help us become more conscious of our compulsive overconsumption and learn to act differently.

Many of us are afraid to be honest because we believe that if others learned about our imperfections, they would flee. The vulnerability we demonstrate by disclosing our own imperfections, on the other hand, draws people closer to us. Because our shortcomings tend to mirror their own, admitting ourselves makes them feel less alone.

This type of sharing fosters intimacy, which makes us feel secure. We feel more secure about ourselves and our place in the world when we know we're surrounded by trustworthy and honest people. Finally, this gives us the assurance that everything will be well.

7. Prosocial guilt provides us with the necessary dosage of humility.

Our culture is a little more educated these days when it comes to shame. Slut-shaming, body shaming, and social media shaming are all forms of humiliation that are fiercely criticized. We know that destructive shame is damaging because it leads to painful isolation and, most likely, a recurrence of the activities that initially produced the shame.

Shame, on the other hand, is necessary for community formation and is the acceptable response to transgression behaviour. Unfortunately, most addicts and alcoholics have much to be embarrassed about, whether it's lying or stealing, overindulging or even peeing in bed.

Fortunately, Alcoholics Anonymous follows a model of prosocial shame, in which transgressions are greeted with compassion and plenty of chances to repent. People in recovery are accepted on the basis that we're all flawed and deserving of forgiveness, rather than being shunned for their horrible offences.

The main point is that prosocial guilt provides us with the necessary amount of humility.

Let's take a quick look at how harmful shame works. Lori, one of Lembke's patients, suffered from alcoholism and binge eating. She had also been a devout Christian her entire life. When she sought help from her church elders, though, they just stated they'd pray for her and requested her not to discuss her problems with the rest of the congregation. Lori's problems were met with scorn from the elders. Lori eventually made her way to AA, and in that setting of strict honesty and acceptance, Lori felt like she wasn't alone for the first time.

Prosocial shame, on the other hand, is beneficial energy since it both teaches humility and brings us closer to our support groups.

His mentor, who is also an AA member, described Lembke's rehabilitation as a "de-shaming process." He discovered that he wasn't alone by attending meetings, sharing his stories, and listening to others. Lembke's mentor told thousands of minor lies during his drinking years, and the disappointment he saw in his wife's eyes was a major reason for him to stay sober. He'd done plenty of things for which he should be embarrassed, but AA provided him with a way to make apologies and straighten out his life.

The AA concept of honest self-inventory helps people identify their own flaws while also increasing compassion for others. And compassion is a valuable trait, as we could all use a little more of it.

Everyone seems to be striving to meet unrealistic standards, whether they are self-imposed or imposed by others. It's no surprise that we need a break now and then. From trendy bars to limitless feeds, unlimited streaming to bottomless bowls, options for release appear to be everywhere.

Consider how different life would be if we didn't have to flee. What if we simply turned around to face it? This is Lembke's most important piece of advice for us: to appreciate the life we have, to pay attention to its many intricacies, and to seek balance in everything we do. Though these acts may not provide immediate results, our patience and perseverance will be rewarded with a life worth living.

Here's some more advice that you can put into practice:

Consider your usage over a longer period of time.

We tend to stay in the day when we suffer from compulsive overconsumption — whether it's drugs, food, or phone use - assuring ourselves we'll do better tomorrow. Take a step back and analyze our entire existence instead. Do you want to be living like this in a year? What will it be like in five years? Looking at the larger picture can help you develop a better understanding of how you operate on a daily basis and, perhaps, provide you with more incentive to change.