In the modern world, we all have a huge tendency to become addicted, says American psychiatrist Anna Lembke, head of the chemical dependency clinic at Stanford University.

A reality of abundance and constant offers leads us to pursue instant rewards for our desires.

For those who want to understand the mechanisms behind this frantic search for happiness, beware: Lembke’s latest book may come as a cold shower. I’ll explain in a moment.

But first, let’s summarize Lembke’s main argument in a few words: more is less, supply is demand, avoiding is attracting, happiness involves suffering – and vice versa for all of this.

In the same line of unifying opposites, Lembke’s oldest book in Brazil is the most recent. Dopamine Nation explains why the constant pursuit of pleasure ultimately leads to its counterpart, pain.

Thanks to its success, the publisher Vestígio released subsequently Black Label Nation, which is actually the first book she wrote in 2016, and refers to the opioid epidemic that has plagued the United States since the turn of the millennium.

In Dopamine Nation, she addresses addiction in a more comprehensive – and inclusive – way, mixing scientific explanations with clinical patient cases (including her own).

The theme couldn’t be more current. Addictions like the frenzy of online gambling, cell phone and social media dependence, the power of sugar, the obsession with sex, streaming marathons of TV series – everything starts with dopamine, a neurotransmitter that our brain produces and is linked to pleasure.

Back in the 90s, however, it was discovered that dopamine doesn’t act so much on gratification, but on desire. In other words: it makes us crave what will give us pleasure.

Genetically altered mice, unable to produce dopamine, seemed to still enjoy food if it was put in their mouths – but they didn’t seek it out.

The more dopamine a drug releases in the brain’s pleasure pathway, and the faster that release is, the psychiatrist writes, the greater its power to addict. Why?

Because in the brain there is a kind of balance between pleasure and pain, which longs to remain level. When experiencing a pleasure rush, your brain will activate self-regulating mechanisms of… sadness.

When pleasure is very intense and very frequent, says Lembke, the body develops tolerance; soon the individual will need a larger amount of the substance to feel the same effect.

The book’s key point is to extend this conclusion to other modern habits.

Cell phones, 15-second internet videos, TV series, masturbation and pornography, cheap romances, almost anything able to form a habit is seen by Lembke as a potential escape mechanism that can be faced as a drug.

The solutions she proposes are based on another recent discovery from neuroscience: that the brain processes sensations of pleasure and pain in the same region. She suggests that the two poles are much more connected than traditionally thought.

And this is where the cold shower from the beginning of the text comes in. One of the experiments mentioned by Lembke indicates that the discomfort caused by an hour-long plunge in very cold water results in a 250% increase in dopamine concentration shortly after.

Subjected to a bad sensation, she infers, the body reacts by enhancing its ability to produce pleasure. “Just as pain is the price we pay for pleasure, pleasure is also our reward for pain,” she writes.

Lembke obviously recommends caution in administering pain. Worms exposed to temperatures slightly above what they are used to lived longer (in an experiment); but if the exposure is prolonged, the effect is reversed and they die earlier.

In the end, her recipe for modern ills is not much different from the conservative recommendation: abstinence, self-control, and something that is not very fashionable nowadays: taking responsibility for your actions, and not portraying oneself as a victim.

It’s not a bad recipe, as evidenced by the success of Alcoholics Anonymous, from which she draws some lessons.

For most modern widespread addictions, however, Lembke acknowledges that completely distancing oneself is not possible. Who can live without a cell phone?

Even exercise, a healthy practice, can be addictive. And it wouldn’t make sense to give them up. The answer lies in a series of strategies like self-commitment – creating spontaneous barriers between yourself and the drug of your choice.

This barrier can be chronological (“I will only check messages twice a day,” or “I will practice intermittent fasting”) or, in more drastic cases, categorical.

One of Lembke’s patients, addicted to gambling, stopped watching sports on TV, reading sports news, listening to game broadcasts on the radio, and asked all casinos in the region to put him on the “not admitted” list.

In summary, Lembke says, “the relentless pursuit of pleasure (and the avoidance of suffering) leads to suffering,” and recovery begins with abstinence, which “reconfigures the brain’s reward circuitry and, with it, our ability to find joy in the simplest pleasures.” The recommendations make sense… but are they correct?

Lembke faced two types of criticism. The first is from those who see her recommendations as a right-wing political agenda that blames addicts for intrinsic system ills. It’s not worth discussing this view.

But the second type of criticism, yes. It comes from other scientists who point out that the book’s conclusions are a bit hasty. It is not proven, for example, that video games or pornography cause the tolerance phenomenon in the brain in the same way that drugs do. Compared to drugs, modern ills (social media, junk food, TV series, etc.) release a much lower amount of dopamine.

“Taking a break from video games or social media may be a good idea,” said Vijay Namboodiri, assistant professor of neurology at the University of California, San Francisco, to The New York Times. “But it’s not because you need to reconfigure your dopamine system.”

Perhaps the book is indeed a bit exaggerated. The percentage of people who can’t control their pursuit of pleasures in daily life doesn’t justify calling it a “dopamine nation.”

But we all need to be alert against abuse, that’s hard to deny. If you walk away from the reading with a good “dopamine notion,” it’s already worth it.


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