Source: The Dopamine Expert: Doing This Once A Day Fixes Your Dopamine! What Alcohol Is Doing To Your Brain! (Podcast Interview with Dr. Anna Lembke by Stephen Bartlett)
Link https://open.spotify.com/episode/4lTzUsyYpJB1NyUd0qU7ov
Date: January 02, 2025
Purpose: This article summarizes the core concepts related to dopamine, addiction, and the challenges of modern life presented by Dr. Anna Lembke, a leading expert in addiction, during a podcast interview. This briefing aims to provide a clear understanding of how dopamine works, why we’re susceptible to addiction, and practical steps individuals can take to regain balance in their lives.
Dopamine: The Survival Chemical
- Fundamental Role: Dopamine is crucial for survival, driving motivation and reward-seeking behaviors. As Dr. Lembke explains, “dopamine is fundamental to our survival, right so it’s the chemical that we make in our brain that tells us this is something we should approach explore investigate so it’s it’s really almost the survival chemical.”
- Motivation Over Pleasure: Dopamine is argued to be more important for the motivation to do things than the pleasure itself, “it may be even more important for the motivation to do things than it is for the pleasure itself.”
- Experiment Illustration: To demonstrate the importance of dopamine, Lembke references the experiment with rats engineered without dopamine: “if they put food in the rat’s mouth the rat would eat but if you put the food even a body length away the rat will starve to death,” proving dopamine is essential for pursuing needed resources.
Dopamine, Pleasure, and Pain
- Collocation: Pleasure and pain are processed in the same parts of the brain, operating like opposite sides of a balance. “One of the most exciting findings in Neuroscience in the past 75 years is that the same parts of the brain that process pleasure also process pain.”
- Homeostasis: The brain strives for balance (homeostasis), always trying to remain level. “The balance wants to remain level, it does not want to be tilted very long to the side of either pleasure or pain.”
- Neuroadaptation: When pleasure is experienced (e.g., through drugs), the brain compensates through “neuroadaptation” --- decreasing dopamine transmission, resulting in a tilt towards pain. This can involve the “Gremlins” hopping on the pain side of the balance. These ‘Gremlins’ don’t stop at levelling out, they continue to overshoot the balance tipping us in a negative direction (come down or hangover.)
- Dopamine Relativity: Dopamine is neither inherently good nor bad, but acts as a signal, relating to both pleasure and pain. “Dopamine is neither good nor bad it’s a signal to tell us whether or not something that we’re doing is potentially useful for our survival.”
The Modern World and Addiction
- Overabundance of Rewards: We live in a world with an overabundance of readily available pleasurable substances and behaviors that overwhelm our reward system. “We live in a world of overwhelming overabundance and so there is a mismatch between this ancient wiring that has us relentlessly pursuing pleasure in order to survive and a world that’s so infused with pleasure and so many rewarding stimuli that now we’re overwhelming our reward system and our brains are reeling in response to try to compensate.”
- Synthetic Dopamine: “Synthetic” pleasures from alcohol, social media, pornography and gaming, among other things, create more dopamine than what we’re evolved to handle. Our current society has caused a ‘mismatch’ between our primitive brain and our over-stimulated world.
- Addiction as a Spectrum: Addiction is a spectrum disorder ranging from mild to severe, with many dabbling in compulsive overconsumption. “I would say the vast majority of us like 90 probably 95% have some degree of compulsive over consumption.”
- Harm as Definition of Addiction: Addiction is defined by compulsive use of a substance or behavior despite harm to self and/or others, “the definition of addiction is the continued compulsive use of a substance or a behavior despite harm to self and or others.”
The Addicted Brain
- Altered Set Point: Addicted brains have a “changed honic or Joy set point to the side of pain”. Now requiring more and more of the addictive substance or behavior to simply feel “normal.”
- Withdrawal: Withdrawal is the experience of the balance tilted towards the pain side, characterized by anxiety, irritability, insomnia, depression, and cravings. “When we’re not using, we’re walking around with a balance tilted toward the side of pain experiencing the universal symptoms of withdrawal from any addictive substance or behavior which are anxiety irritability insomnia depression and craving”.
- Disconnected Brain Pathways: Addiction is associated with a disconnect between the prefrontal cortex and limbic areas of the brain, severing circuits that are usually connected.
The Impact of Trauma & Stress
- Stress and Addiction: Extreme stress or trauma can be a catalyst to re-ignite the urge to participate in harmful addictive behaviors, triggering immediate reversion to drug-seeking behaviors even after an extended period of abstinence.
- “If they’re then exposed to a very painful foot shock right so a very extreme physical pain which you could equate to a serious life stressor the first thing the rat will do is run over to the lever and start pressing for cocaine.”
- Stressors such as “Halt” (Hungry, Angry, Lonely, Tired) can all trigger the desire to use.
- Trauma: Trauma, especially early childhood trauma, increases vulnerability to addiction, often as a form of self-medication. “There’s a very interesting series of experiments in rodents mice and rats where they first of all rodents very easily get addicted to cocaine…if they’re then exposed to a very painful foot shock…the first thing the rat will do is run over to the lever and start pressing for cocaine.”
Examples of Addiction
- Lembke’s Personal Experience: Dr. Lembke details her own addiction to romance novels, showcasing how an activity that was previously a source of harmless pleasure became addictive and harmful.
- Work Addiction: Work can also be an addiction due to potent rewards, social praise, and the endless nature of work and accessibility of work in modern society. “Work never ends there’s like no natural stopping point for work.”
- Digital Addiction: Digital devices and media are designed to be addictive, creating a cycle of scrolling and tapping, beyond what is pleasurable. “These devices and platforms were designed to be addictive that is to keep us scrolling and tapping long beyond what we plan for or what we want or even what’s pleasurable.”
- Pornography Addiction: Pornography is “one of the biggest addictions and the most silent and the most shameful,” with significant impacts on perceptions of sex and relationships.
The Importance of Perspective in Narratives
- The Narrative of the Victim: People who tell their stories in a way that make them always the victim, are generally not doing well and are not likely to do better in the future unless they acknowledge how they’ve contributed to the problem. “When people come into the room and they tell their life story in such a way that they’re always the victim of other people and circumstance in the world those are people who are number one not doing well and number two not going to do well going forward unless they change that narrative to acknowledge what they’ve contributed to the problem”.
- Taking Responsibility: When people with addiction begin to take responsibility for their own part in their problems and their own actions, that is often an indication of genuine progress.
- The Hero’s Journey Narrative: People who have a “hero’s journey” narrative can often feel that that story doesn’t capture the fullness of who they are.
Solutions: Toward Balance & Recovery
- Embrace Discomfort: It’s important to realize that life is fundamentally uncomfortable. “Be here now means be here now and be uncomfortable and be okay with being uncomfortable and being okay with not being able to control my pleasure or my pain or my comfort level but just being open to whatever comes.”
- Intentional Pain: “If we intentionally press on the pain side of the balance for example with exercise or an ice cold water bath or intermittent fasting those Gremlins will hop on the pleasure side of the balance.” Dopamine can be obtained indirectly by engaging in activities that require upfront effort.
- Dopamine Fasting: A 30-day break from a problematic substance or behavior to reset reward pathways, recognizing that “you will feel worse before you feel better”
- Self-Binding: Create barriers between oneself and the addiction, both physical and mental, by anticipating the desire before the desire takes hold.
- Professional Help: Seeking help from addiction specialists is critical for individuals who cannot manage addiction on their own.
Implications and Considerations
- Societal Shift: Our culture needs to re-evaluate its pursuit of constant pleasure and acknowledge the importance of discomfort.
- Preventative Measures: Protecting young people’s brains from exposure to addictive substances and behaviors at an early age is imperative.
- Empathy: The scale metaphor helps create empathy for addicts, and helps them see what they are dealing with.
- Personal Responsibility: The narrative of victimhood doesn’t serve well, whereas taking responsibility can help you move forward.
Conclusion
Dr. Lembke’s insights highlight the intricate role of dopamine in our lives, demonstrating how modern society has created conditions ripe for addiction. Understanding the relative nature of pleasure and pain, and embracing discomfort, are critical steps towards creating a balanced, healthy life. This requires awareness, honest self-assessment, and a willingness to take action. By addressing our addictive tendencies we can learn to live more fully in the present moment.