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How To Use DOPAMINE As A Superpower To TREAT ADDICTION! | Anna Lembke

Do you think you have an addiction, or perhaps an unhealthy relationship with a certain behaviour? It may be a behaviour that you have tried to stop in the past that you keep returning back to despite your best intentions.

Anna LembkeguestDr. Rangan Chatterjeehost

Dec 1, 20211h 31mWatch on YouTube

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CHAPTERS

Chapter summaries

What Dopamine Is and What It Does
Anna Lembke explains that dopamine is a brain chemical that signals what to approach, work for or pay attention to. It is central to motivation, movement and the process of getting addicted, and it is not released only in response to pleasure.
- •Dopamine informs us about changes in environment and body state and drives approach behavior
- •It is released by highly reinforcing, pleasurable activities
- •It can also be released in response to aversive stimuli that matter
- •It is involved in movement and is depleted in Parkinsonism
- •Our brains evolved to approach pleasure and avoid pain
The Pleasure-Pain Balance and the Dopamine Deficit State
Lembke describes pleasure and pain as a balance, like a teeter-totter, that works to stay level. Repeated use leaves neuroadaptation "gremlins" on the pain side, resetting the joy set point and creating a chronic dopamine deficit with withdrawal symptoms.
- •The brain tips an equal and opposite amount toward pain after pleasure
- •Repeated use shifts the hedonic set point toward pain
- •Once in deficit, the drug is needed just to feel normal
- •Withdrawal symptoms include anxiety, irritability, insomnia, depression and intrusive thoughts of using
- •Rangan restates this seesaw idea for sugar, coffee and Instagram
How the Internet and Smartphones Drugified Our World
Rangan asks what the internet has done to our propensity for addiction. Lembke says the smartphone is a reinforcing device and a portal to old drugs, and that the internet has also created new ones such as video games and social media.
- •Screens and tapping or swiping are inherently reinforcing
- •Phones make drugs like pornography and cocaine far more accessible
- •Video games and social media are drugs that did not exist before
- •Enumerating likes and rankings makes things more potent and releases more dopamine
Pornography Addiction, Stigma and Opening the Book with It
Rangan describes a young patient with pornography addiction and asks why Lembke opened her book with a sex addiction case. She talks about stigma, her patients' courage, and the parallel with her own compulsive reading of romance novels.
- •Sex addiction carries more stigma and misconceptions than other addictions
- •Pornography use has become normalized, which hides how compulsive it can be
- •Lembke's patient was a kind, brilliant scientist, father and spouse
- •She saw parallels with her own compulsive romance reading, which began with the Twilight saga
- •Rangan describes his publisher questioning a section on pornography in his own book
Tolerance and Defining Addiction with the Four Cs
Lembke explains that repeated exposure shortens the pleasure response and lengthens the after-effect, producing tolerance. She then defines addiction using the four Cs and lists socially accepted addictions such as caffeine, alcohol, devices and work.
- •Repeated exposure gives less pleasure and a longer, stronger come-down
- •Cannabis users can end up with paranoia or vomiting instead of the original effects
- •Addiction is continued compulsive use despite harm, described by control, compulsion, craving and consequences
- •Psychological withdrawal can occur without physical dependence
- •Work and email are normalized, socially rewarded addictions, and Lembke takes a weekly digital Sabbath
Self-Binding and Cheap Versus Expensive Dopamine
Rangan raises intentional phone use, and Lembke introduces self-binding strategies as barriers between us and our drug of choice. Rangan's story about his son's snooker coach leads to Lembke's observations on young people retreating into devices.
- •Rangan suggests deciding what you want a smartphone for and keeping email off it
- •Self-binding strategies create a pause that can help us decide not to use
- •A snooker coach observed that fewer kids will work hard for their dopamine
- •Lembke sees growing numbers of privileged kids narrowing their world to their rooms and devices
- •Pressing on the pain side, such as walking outside, can help the brain upregulate its own dopamine
The Dopamine Fast: A One-Month Experiment
Lembke describes her first intervention: removing the drug of choice for a month so dopamine returns to baseline. Patients feel worse for two weeks and then better, gain insight, and see it as an experiment, with medical caveats for dangerous withdrawals.
- •A month is typically the minimum time for dopamine to return to healthy baseline
- •The first two weeks are harder, and by weeks three and four patients feel better
- •Patients gain insight into the true effect of their use
- •Lembke frames it as an experiment the patient runs on their own life
- •Alcohol, benzodiazepine and opioid users may need medically supervised tapering
The Range of Addictions and Asceticism in an Age of Abundance
Lembke lists the substances and behaviors she has applied the dopamine fast to, from alcohol and opioids to gambling, crypto trading apps and online content. She argues for a modern asceticism and cites rising unhappiness in rich nations.
- •Substances range from alcohol and cannabis to stimulants, opioids and benzodiazepines
- •Behavioral addictions include food, gambling, crypto trading apps, pornography and online games
- •Asceticism may simply mean walking outside unplugged for 30 minutes
- •Happiness surveys across 128 countries showed people unhappier in 2018 than in 2008, most of all in rich nations
Resetting Reward to Enjoy Simple Pleasures Again
Rangan asks how to handle smartphone addiction when phones are hard to avoid. Lembke says abstinence resets reward pathways so modest pleasures like camping or a ripe peach feel rewarding again, and that the goal is moderation rather than avoiding all pleasure.
- •Abstaining from a phone for a month restores healthy dopamine pathways
- •Modest pleasures cannot compete while we are hooked on highly dopaminergic things
- •Afterward, use rewarding things in modest doses and leave time between uses
- •Rangan compares processed food making a ripe peach seem bland
- •Pleasure and pain are relative as the brain constantly recalibrates
Parenting in a Dopamine-Overloaded World
Rangan describes his rules for his 11-year-old son's phone and his decision to avoid gaming, and asks if his "dopamine cave" at home is sound. Lembke endorses changing the immediate environment, delaying devices until 10 to 12, and recognizing that kids differ in vulnerability.
- •Rangan's rules include no phone in his son's room and use only in shared spaces
- •Lembke recommends keeping high-dopamine substances and behaviors out of reach
- •Children under 10, and arguably 12, should not have their own devices
- •A rat maze experiment shows methamphetamine pretreatment blocks learning from a rich environment
- •Lembke's youngest of four kids could not handle a phone, and she says 10 to 15% of kids may get into real trouble
Recovery, Humility and Addiction as Modern Plague
Rangan praises the book and raises the Kent Dunnington quote about people with addiction as prophets. Lembke speaks about her patients and colleagues in recovery as spiritual heroes, and they discuss low-grade addiction, preventable deaths, and isolation including during COVID.
- •Lembke calls people in recovery her spiritual heroes for their courage and humility
- •A physician speaking openly of his cocaine addiction at a conference moved her
- •Rangan sees low-grade addiction underlying many lifestyle problems in primary care
- •Lembke says 70% of global deaths come from modifiable risk factors and calls addiction the modern plague
- •Isolation breeds addiction and addiction breeds isolation, and quarantine was devastating for some and a respite for others
Radical Honesty and the Prefrontal Cortex
Lembke explains why honesty is central to recovery. Telling the truth builds intimacy, creates a truthful life narrative and may strengthen the prefrontal cortex's link to the reward pathway, while Rangan shares his experience with a fractured identity and white lies.
- •People in recovery often say they cannot lie about anything, even trivial things
- •Radical honesty creates true intimacy, which itself releases dopamine
- •A truthful narrative lets us own our part and make informed decisions
- •A transcranial magnetic stimulation study suggests prefrontal stimulation reduces lying, and Lembke speculates that lying less might strengthen the prefrontal cortex
- •The false self is exhausting and alienating, and being authentic is freeing
Vulnerability in Writing and Closing Reflections
Rangan asks how hard it was for Lembke to be so open in her book, and she describes her anxiety and her mother's response. They conclude that getting dopamine from intimacy and finding balance matters, Lembke is optimistic about Gen Z, and she urges listeners not to give up.
- •Lembke felt panic before publication but thought it would be disingenuous not to share her own story
- •Her mother read the book and said Lembke had it about right
- •Vulnerability can be a powerful gift to others
- •Dopamine isn't good or bad; the question is where we get it from
- •Lembke is optimistic, and advises self-compassion and persistence, including a month-long break to recalibrate