Dopamine Nation - Anna Lembke, MD


Most people think of addiction in terms of substance or alcohol abuse. This book broadens that scope and reveals how any activity that produces a dependence on dopamine production in the brain can be addictive.

Lessons of the Balance

The following ten statements summarize all the lessons in this book, and the following sections expand on the highlighted lessons that resonated with me.

  1. The relentless pursuit of pleasure (and avoidance of pain) leads to pain.
  2. Recovery begins with abstinence.
  3. Abstinence resets the brain’s reward pathway and with it our capacity to take joy in simpler pleasures.
  4. Self-binding creates literal and metacognitive space between desire and consumption, a modern necessity in our dopamine-overloaded world.
  5. Medications can restore homeostasis, but consider what we lose by medicating away our pain.
  6. Pressing on the pain side resets our balance to the side of pleasure.
  7. Beware of getting addicted to pain.
  8. Radical honesty promotes awareness, enhances intimacy, and fosters a plenty mindset.
  9. Prosocial shame affirms that we belong to the human tribe.
  10. Instead of running away from the world, we can find escape by immersing ourselves in it.

Pleasure Pain Equilibrium

Pleasure can be directly associated with the production of Dopamine in the brain.

The equilibrium between pleasure and pain in our brain is the source of our need for dopamine. In the book, the author illustrates this as a see-saw.

We sometimes seek pleasure in an attempt to escape from pain. However, if this becomes a habit (addiction), we lose the ability to deal with and process pain. The constant pleasure builds tolerance toward pain and the need for more pleasure.

Science teaches us that every pleasure exacts a price, and the pain that follows is longer lasting and more intense than the pleasure that gave rise to it. With prolonged and repeated exposure to pleasurable stimuli, our capacity to tolerate pain decreases, and our threshold for experiencing pleasure increases.

On the flip side, it was interesting to learn that pain, or pushing on the pain side, can cause the body to release dopamine. This, too, builds tolerance and can be addictive. Examples of this include training hard and taking baths in subfreezing water.

A study of skydivers compared to a control group (rowers) found that repeat skydivers were more likely to experience anhedonia, a lack of joy, in the rest of their lives.

The numerous research listed in this book supports these statements on the equilibrium between pleasure and pain. Most of the research involved the study of mice and the effects of dopamine production in their brains when subjected to various stimuli.

Effects of Drugs on Neural Pathways

Drugs affect neural pathways. A detox or abstinence is necessary to reverse the damage to the neural pathways.

Research has shown that the continued damage can become permanent, and the only solution is for the brain to create new pathways. This thought alone is scary.

Radical Honesty

The lesson on Radical Honesty asks us to be honest with ourselves and others regarding our addictions.

I liked his answer because it implied that practicing radical honesty might strengthen dedicated neural circuits the same way that learning a second language, playing the piano, or mastering sudoku strengthens other circuits.

In fact, the opposite happens. People come closer. They see in our brokenness their own vulnerability and humanity. They are reassured that they are not alone in their doubts, fears, and weaknesses.

Immerse ourselves in the World.

Sometimes, addictions stem from the need for a distraction from something uncomfortable. In this last “Lesson,” the author gives us some “Just Do It” advice on facing the world. By being distracted from the discomforts, we also miss out on the comforts that the world may hold.

There is not much to explain here, except that, ultimately, it is really on us to choose whether we want to give in to our addictions continually.

What if, instead of seeking oblivion by escaping from the world, we turn toward it? What if instead of leaving the world behind, we immerse ourselves in it?

The author explains how this advice helped her in her addiction to Romance novels.

I made a conscious decision to reimmerse myself in patient care, focusing on the aspects of my work that had always been rewarding: relationships with my patients over time, I was also more successful in my work, but my success was an unexpected byproduct, not the thing I was seeking.

Overmedicated Children

Perceiving children as psychologically fragile is a quintessentially modern concept.

The author describes how a new generation of children has been raised to be pain averse. I first learned about this phenomenon from the book - The Coddling of the American Mind.

Consequently, they quickly turn to medication to abate their pain and quickly become addicted to medications and drugs. There is a strong dependency on medications and drugs even when they counteract each other.

I learned of the rising trend of phantom pain in young people, where there is physical pain without actual cause. These patients got respite via pain medication or narcotics.

Physical pain too is increasing. Over the course of my career, I have seen more patients, including otherwise healthy young people, presenting with full body pain despite the absence of any identifiable disease or tissue injury. The numbers and types of unexplained physical pain syndromes have grown: complex regional pain syndrome, fibromyalgia, interstitial cystitis, myofascial pain syndrome, pelvic pain syndrome, and so on.

The cannabis of today can quickly cause a person to build up a tolerance, requiring the person to consume more or to switch up to a more potent drug.

Today’s cannabis is five to ten times more potent than the cannabis of the 1960s and is available in cookies, cakes, brownies, gummy bears, blueberries, “pot tarts,” lozenges, oils, aromatics, tinctures, teas . . . the list is endless.


The “flow” of deep concentration is a drug in itself, releasing dopamine and creating its own high.

I hadn’t realized that there would be pleasure or a high derived from working, but I like most people, HAVE certainly been there.