In ‘Dopamine Nation,’ Overabundance Keeps Us Craving More

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Human Brains Have Evolved Unique ‘Feel-Good’ Circuits

Lembke is the medical director of addiction medicine at Stanford University and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. Her new book, Dopamine Nation, explores the interconnection of pleasure and pain in the brain and helps explain addictive behaviors — not just to drugs and alcohol, but also to food, sex and smart phones.

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‘Drug Dealer, M.D.’: Misunderstandings And Good Intentions Fueled Opioid Epidemic

Lembke says that her patients who are struggling with substance abuse often believe their addictions are fueled by depression, anxiety and insomnia. But she maintains that the reverse is often true: Addictions can become the cause of pain — not the relief from it. That’s because the behavior triggers, among other things, an initial response of the neurotransmitter dopamine, which floods the brain with pleasure. But once the dopamine wears off, a person is often left feeling worse than before.

«They start out using the drug in order to feel good or in order to experience less pain,» Lembke says. «Over time, with repeated exposure, that drug works less and less well. But they find themselves unable to stop, because when they’re not using, then they’re in a state of a dopamine deficit.»

Interview Highlights

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Penguin Random House

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Smartphone Detox: How To Power Down In A Wired World

It’s important to recognize that addiction is a spectrum disorder, and it is possible to be a little bit addicted. Also, the same brain mechanisms that mediate severe addiction also mediate our minor addictions. … I don’t think that anybody is immune from this problem. And I do believe that smartphones are addictive. They’ve been engineered to be addictive and … we don’t really need more studies to show that that’s true. All you need to do is go outside and look around.

On how the pandemic has affected various addictions

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I think it’s important for me to tell you that I’ve also had a lot of patients who have done better during quarantine. And what they tell me is that the world is kind of a hyperstimulated, triggering place for them. And quarantine forced them to slow down and also eliminated a lot of the types of interactions and stimuli that would typically trigger relapse or reuse for them. So I would say I’ve seen sort of a bimodal distribution in terms of the COVID response in my patient population. Again, for some people, it’s been absolutely terrible. Of course, we’ve seen an uptick in overdose-related deaths, including some of my own patients. And that’s absolutely tragic. … I’ve also seen more people spend more time on their screens and really struggle and wonder about how to manage compulsive overconsumption of their digital devices. But again, I think it’s important to say that some patients are doing much, much better — have found it easier not to drink alcohol, for example, because there aren’t so many parties where people are consuming large amounts of alcohol. It’s been an interesting mix.

Sam Briger and Kayla Lattimore produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the web.

  • Brain research
  • dopamine
  • substance abuse
  • addiction
  • psychiatry
  • Cell phones
  • social media


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