Are we Happy when there is too much Happiness? Introducing “Dopamine Nation” by Anna Lembke M.D.
Introduction
When you read the title, you probably were already leaving the page. “How illogical is this sentence?” But wait, I want you to imagine a drug addict, when he was snorting cocaine, he gets a huge amount of pleasure, right? Is he happy? I believe for most of us the answer is no, because we can imagine he has no control over it, and it will ruin his family, career and life when he doesn't get the drug. What if I tell you that the same thing is happening, albeit less serious than drug addiction, in your life? In the US, the prescription of opioids quadrupled from 1999 to 2012. More and more Americans are getting easier access to these drugs in the name of medical treatment. However, due to the nature of our nervous system, consuming too much of such drugs might develop a similar addiction like taking illegal drugs like cocaine. What’s worse, addiction is not limited to drugs, it could be masturbation, eating food, or even instagram and reading novels.
Who is Dr. Anna Lembke?
Dr. Anna Lembke, M.D, is clinical psychiatrist and researcher on addiction. She has developed a popularity among readers of psychology related books. She also contributed much to the documentary “Social Dilemma” and “The Pharmacist”, which reminds us how close we are from getting social media addiction now, and opioids addiction in the past. In this book, she has presented numerous other behaviors that we wouldn’t have thought to be addictions in our lives.
Dr. Lembke on Huberman's Podcast
Addiction broadly defined is the continued and compulsive consumption of a substance or behavior (gambling, gaming, sex) despite its harm to self and/or others. Dr. Anna shared her story of “romance novel addiction” She started with Twilight, that gave her the excitement from the thriller, romance and fantasies. One novel after another, tame love stories no longer satisfies her craving for excitement, that’s why she started to read those with more graphical and erotic content. She realized it was a problem when her life is disturbed by the obsession, which made her stay up till 2:00 am reading all these novels. This seems to be trivial compared with those who lost their job, family and health through drug/gambling addiction. Yet it is a representation of the compulsive overconsumption problem now, as the internet is accessible for all. If you haven’t had any addiction, it is probably because you haven’t found the drug for you. To understand why that is, we shall look at the neuroscience of the human brain.
The Pleasure-Pain Balance
Through advances in biochemistry, neuroscience has developed a more sophisticated understanding of the mechanism of pleasure and pain. The main functioning cell in the brain is neurons, they communicate with each other by electrical signals and neurotransmitters. At the end of one neuron, the axon, releases a neurotransmitter to the other neuron’s dendrites so that two neurons can communicate through chemical messengers. We shall focus on Dopamine, the neurotransmitter related to pleasure-pain balance.
Dopamine is involved with the system that processes motivation and reward processing. When a person expects there will be a reward (e.g. food, money… etc), the dopamine level in the brain increases, no matter if the person received that reward afterwards or not. When the reward is actually obtained by the person, depending on the substance he consumed, the brain releases more dopamine to different parts of the brain. This is how the reward pathway works in the brain. The more and faster the substance triggers dopamine releases, the more addictive the substance is.
How addictive are the drugs? Here are some experimental data collected from the dopamine level increase in mice’s brain after consuming various substances. The dopamine level increases by 50% when chocolate is provided to it, by 100% when sex is provided, and 150% for nicotine, 225% for cocaine, 1000% for amphetamine. Unfortunately, this pleasure comes with great cost.
As the title suggests, there is literally a pleasure-pain balance in the brain. This is suggested by the neuroscientists that pain works in the same way as pleasure, in the same area of the brain. Furthermore, pleasure and pain are at a homeostasis relationship, which states any living system to maintain physiologic equilibrium. When we gain pleasure from drugs, there will be more pain afterwards because the brain wants to balance out these feelings.
Overtime, the drug no longer feels as pleasurable as it was in the beginning. This is because we could develop tolerance over the drug. The pleasure gets weaker and shorter after repeated stimulus, and the pain gets stronger and longer. That is why an addicted person will crave for more of the substances over a long time of consumption. Eventually, those with addiction will break the hedonic seesaw, which makes them less sensitive towards natural rewards like ordinary people. The contradiction in hedonism is that seeking only what makes you happy would ultimately lead to anhedonia, the inability to enjoy pleasure of any kind. In the world that pleasurable activities(online shopping, gaming, porn… etc) are accessible, it is so easy for anyone to be addicted. Luckily, Dr. Lembke have suggested some ways that we could fight back addiction.
Method 1: Dopamine-Detox
This method is the most straight-forward one that anyone can try to do, which literally asks you to stay away from the thing that you are addicted to for at least a month. This sounds impossible, because modern day society requires us to use the internet and smartphone everyday. But it is actually a science-based practice for those who want to get rid of addiction.
As the author states, the dopamine level of a drug addict is below normal level until the first two weeks of drug abstinence. It is painful at first, but the dopamine deficit state will only last for less than a month for most people, and then their dopamine level will rise to that of normal people. She also referred to a study in Schuckit on depressed men who are addicted to alcohol. After four weeks of abstinence from alcohol, 80% of the patients no longer met the criteria for clinical depression.
In the book, the author has provided a more sophisticated framework of how people should quit addicting substance or behaviors, which includes identifying your bad habits, the problems caused by it, and mindfulness of your mood after the dopamine detox has started. Please refer to the book for more details.
Method 2: Pressing on the Pain Side
Did someone tell you they liked cold showers? Perhaps you have seen some video on youtube that advocates taking cold showers. You are probably as skeptical as me about whether doing that will change your life.
Turns out, it could be true that taking a cold shower will help you restore balance of pain and happiness. A study conducted at Charles University in Prague conducted an experiment in which ten men volunteered to submerge themselves in cold water. The data shows that both dopamine and norepinephrine levels increase in the brain of the participants. This could be the opposite of addiction, which you press on the pleasure side and pain kicks in later. You voluntarily press on the painful side, and pleasure kicks in later.
There is a study on how beneficiary small and moderate doses of painful stimuli are, called Hormesis. For example, cold, heat, food restriction and exercise are some stimuli or activities that are painful at the moment, yet those who adapt to it will gain more benefits. Specifically, Exercise is immediately toxic to cells, it raises temperature, deprives oxygen and glucose. But it actually helps reduce drug addictions. When rats regularly exercise by running on wheels, he is less likely to be addicted to cocaine six weeks later. Exercise is also proven to increase many of the neurotransmitters involved in positive mood regulation, which is the reason why people who exercise more are less likely to get addicted, as those addiction only triggers dopamine release in the brain.
Final reminder, it is also possible for people to get addicted to pain, or work. As they share the same kind of reward pathway. The same kind of anhedonia is also shown on people addicted to extreme sports like skydiving. It is about not overconsuming anything, even if it is pain.
Method 3: Radical Honesty
These are probably the most insightful chapters in the book about addiction. It shares a story about a housewife who is an alcoholic, who managed to quit doing so by honestly revealing his behavior to his husband.
The author has pointed out that being honest about addiction can increase your awareness of your actions. When people are addicted to something, they are only partially aware of it, and sometimes even when they notice it, excuses could be made to justify the whole conduct. This half-conscious state is typical in addiction, and it shows a disconnect of one’s action from their higher cortical brain regions.
Lying is reduced when the prefrontal cortex is more excited. One study found that when people are given electrical treatment to enhance the neuronal excitability of the prefrontal brain cortices, more people tell the truth.
This is because the prefrontal cortex involves decision-making, emotional-regulation, and future planning. The most important feature is probably story-telling ability. The research above have concluded that personal moral beliefs or self-interest are less related to truth-telling, rather, how well one’s prefrontal cortex performs relates to it more.
Luckily, the prefrontal cortex can be trained, by truth-telling. It is like learning a second language or riding a bike, through repeated learning and practice, the neural connection in the brain’s prefrontal cortex is strengthened. “What fires together wires together” This quote shows how addiction, compulsive overconsumption and delayed gratification is easier to perform if people try to do them more.
There are more benefits to being honest, like it could make you have a better relationship with others, that would also produce dopamine and other hormones, like oxytocin, involved in falling in love, parental relationship, that could be rewarding in another way. Also, truth-telling is also contagious. If your couple tells more truth, the other will also tell more truth, vice versa.
More importantly, telling the truth makes one accountable. He no longer tells lies about his life, and does not have a false self conception. Which is also important in fighting back addiction.
Some Personal Thoughts
I myself have suffered from various forms of addiction when I reflect upon it. Some of them I am too embarrassed to tell everyone about, so I will only disclose some: internet/social media addiction (I surfed the web at least 2-3 hours a day), food addiction (especially sugary, cheesy, and deep fried fast food) and binge watching too many films. This has caused me a great deal of suffering in my university life, for I feel unmotivated all the time, be it academic or social life. Upon reading this book, I have gained insights about how addiction works in a holistic manner. The detailed suggestion is also giving me no excuses to quit these addiction. Perhaps this would take a long time to completely get rid of these addiction, but I want to live a flourishing life with dignity and happiness. If you also have some of the problems I mentioned above, I definitely recommend you to check this out.
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