I finished this book last month. For me, it was similar to the book Breath and The Power of Habit in that it changed my perspective on the world in some fundamental way, and as a result my behavior has changed for the better (at least, for now ;)
Amazon link: https://www.amazon.com/Dopamine-Nation-Finding-Balance-Indulgence-ebook/dp/B08KPKHVXQ
Here are too many interesting highlights from the book, all copied verbatim:
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one of the most remarkable neuroscientific findings in the past century is that the brain processes pleasure and pain in the same place. Further, pleasure and pain work like opposite sides of a balance.
In short, I became a chain reader of formulaic erotic genre novels. As soon as I finished one e-book, I moved on to the next: reading instead of socializing, reading instead of cooking, reading instead of sleeping, reading instead of paying attention to my husband and my kids. Once, I’m ashamed to admit, I brought my Kindle to work and read between patients.
“After that I start a new ritual,” he said. “Every time I go into hotel room, I place sticky notes all around—on the bathroom mirror, the TV, the remote control—saying, ‘Don’t do it.’ I don’t even last one day.”
Prohibition led to a sharp decrease in the number of Americans consuming and becoming addicted to alcohol. Rates of public drunkenness and alcohol-related liver disease decreased by half during this period in the absence of new remedies to treat addiction.
Our dopamine economy, or what historian David Courtwright has called “limbic capitalism”
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.
polypharmacy—that is, using multiple drugs simultaneously or in close proximity—has become the norm.
Even acts of kindness toward others are framed as a strategy for personal happiness. Altruism, no longer merely a good in itself, has become a vehicle for our own “well-being.”
“Yes, that’s true,” I said. “Boredom is not just boring. It can also be terrifying. It forces us to come face-to-face with bigger questions of meaning and purpose. But boredom is also an opportunity for discovery and invention. It creates the space necessary for a new thought to form, without which we’re endlessly reacting to stimuli around us, rather than allowing ourselves to be within our lived experience.”
By this accounting, one hit off a meth pipe is equal to ten orgasms.
pleasure and pain are processed in overlapping brain regions and work via an opponent-process mechanism.
I tend to imagine this self-regulating system as little gremlins hopping on the pain side of the balance to counteract the weight on the pleasure side. The gremlins represent the work of homeostasis:
the control group, the pathological gamblers showed a marked increase in dopamine levels when they lost money.
The more they lose, the stronger the urge to continue gambling, and the stronger the rush when they win—a phenomenon described as “loss chasing.”
I was also assuaging my grief at never having another baby, something I wanted and my husband did not, creating a tension in our marriage and in our sex life that hadn’t existed before.
“A week would be good, but in my experience, a month is usually the minimum amount of time it takes to reset the brain’s reward pathway.”
I remember standing in the kitchen in 2001 holding my newborn baby in my arms and experiencing an intrusive image of smashing her head against the refrigerator or the kitchen counter and watching it implode like a soft melon.
Cigarette smokers are more likely than matched controls to discount monetary rewards (that is, they value them less if they have to wait longer for them). The more they smoke, and the more nicotine they consume, the more they discount future rewards. These findings hold true for both hypothetical money and real money.
They found that when participants chose immediate rewards, emotion- and reward-processing parts of the brain lit up. When participants delayed their reward, the prefrontal cortex—the part of the brain involved in planning and abstract thinking—became active. The implication here is that we are all now vulnerable to prefrontal cortical atrophy as our reward pathway has become the dominant driver of our lives.
By contrast, the amount of leisure time in the United States today increased by 5.1 hours per week between 1965 and 2003, an additional 270 leisure hours per year. By 2040, the number of leisure hours in a typical day in the United States is projected to be 7.2 hours, with just 3.8 hours of daily work. The numbers for other high-income countries are similar.
“Leisure Luxuries and the Labor Supply of Young Men,” “Younger men, ages 21 to 30, exhibited a larger decline in work hours over the last fifteen years than older men or women. Since 2004, time-use data show that younger men distinctly shifted their leisure to video gaming and other recreational computer activities.”
In the spring of 2015, Muhammad committed to abstaining until he passed his qualifying exam, however long it took. For the next year, he abstained from cannabis and worked harder than ever before. His final report was over 100 pages long. “It was,” he told me, “one of the most positive and productive years of my life.”
Mitch was able to use categorical binding to mitigate the risk of relapse to sports betting. There’s something tragic and touching about having to ban yourself.
The well-worn American tradition of dieting—vegetarian, vegan, raw vegan, gluten-free, Atkins, Zone, ketogenic, Paleolithic, grapefruit—is one example of categorical self-binding.
A gluten-free diet, which previously had effectively limited consumption of high-calorie processed foods such as cakes, cookies, crackers, cereal, pastas, and pizzas, now no longer does.
The evolution of the gluten-free diet illustrates how attempts to control consumption are swiftly countered by modern market forces, just one more example of the challenges inherent in our dopamine economy.
Cigarettes became vape pens and ZYN pouches. Heroin became OxyContin. Cannabis became “medical marijuana.” No sooner have we committed to abstinence than our old drug reappears as a nicely packaged, affordable new product saying, Hey! This is okay. I’m good for you now.
She removed all alcohol save one beer, which she left in her refrigerator. She called it her “totemic beer,” which she regarded as the symbol of her choice not to drink, a representation of her will and autonomy. She told herself that she only needed to focus on not drinking that one beer rather than the more daunting task of not drinking any beer from the vast quantity available in the world.
Then he tried opioids for the first time, which was easy to do in Arkansas in 2009, when opioid manufacturers and distributors were pumping millions of opioid pain pills into the state. In that same year, doctors in Arkansas wrote 116 opioid prescriptions per 100 persons living in Arkansas.
Patients with pain who take opioids daily for more than a month are at increased risk not only for opioid addiction but also for worsened pain. As mentioned earlier, this is the process called opioid-induced hyperalgesia, that is, opioids making pain worse with repeated doses.
Worse yet, have psychotropic medications become a means of social control, especially of the poor, unemployed, and disenfranchised? Psychiatric drugs are prescribed more often and in larger amounts to poor people, especially poor children.
“I got into a routine where I immersed myself in ice water for five to ten minutes every morning and again just before bed. I did that every day for the next three years. It was key to my recovery.”
“For the first five to ten seconds, my body is screaming: Stop, you’re killing yourself. It’s that painful.” “I can imagine.” “But I tell myself it’s time limited, and it’s worth it. After the initial shock, my skin goes numb. Right after I get out, I feel high. It’s exactly like a drug . . . like how I remember ecstasy or recreational Vicodin. Incredible. I feel great for hours.”
Using blood samples, the researchers showed that plasma (blood) dopamine concentrations increased 250 percent, and plasma norepinephrine concentrations increased 530 percent as a result of cold-water immersion.
We’ve all experienced some version of pain giving way to pleasure. Perhaps like Socrates, you’ve noticed an improved mood after a period of being ill, or felt a runner’s high after exercise, or took inexplicable pleasure in a scary movie. Just as pain is the price we pay for pleasure, so too is pleasure our reward for pain.
Among Japanese citizens living outside the epicenter of the 1945 nuclear attack, those with low-dose radiation exposure may have shown marginally longer lifespans and decreased rates of cancer compared to un-irradiated individuals.
Exercise has a more profound and sustained positive effect on mood, anxiety, cognition, energy, and sleep than any pill I can prescribe.
He argued that the efficacy of acupuncture is mediated through pain, with needle insertion as the primary mechanism: “The needling, which can injure the tissue, is a noxious stimulation inducing pain . . . inhibiting great pain with little pain!”
adult hippocampal neurogenesis.” This refers to the discovery some decades ago that contrary to previous teaching, humans can generate new neurons in the brain into middle and late adulthood.
Use of the wheel was not limited to wild mice. There were also shrews, rats, snails, slugs, and frogs, most of whom demonstrated intentional and purposeful engagement with the wheel.
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.
By 2002, the top-paid 20 percent were twice as likely to work long hours as the lowest-paid 20 percent, and that trend continues. Economists speculate that this change is due to higher rewards for those at the top of the economic food chain.
“If stimulating the prefrontal cortex causes people to be more honest, is it also possible that being more honest stimulates the prefrontal cortex? Might the practice of telling the truth strengthen activity and excitability in the parts of the brain we use for future planning, emotion regulation, and delayed gratification?” I asked.
But if the therapist can help the patient take responsibility if not for the event itself, then for how they react to it in the here and now, that patient is empowered to move forward with their life. I have been deeply impressed with AA philosophy and teachings on this point. One of the preeminent AA mottos, often printed in bold type on its brochures, is, “I am responsible.”
Shame makes us feel bad about ourselves as people, whereas guilt makes us feel bad about our actions while preserving a positive sense of self. Shame is a maladaptive emotion. Guilt is an adaptive emotion. My problem with the shame-guilt dichotomy is that experientially, shame and guilt are identical.
Once I know a patient’s story—the forces that shaped them to create the person I see before me—animosity evaporates in the warmth of empathy. To truly understand someone is to care for them.
In particular, those behaviors that seem excessive, gratuitous, or even irrational in existing religious institutions, such as wearing certain hairstyles or certain clothing, abstaining from various foods or forms of modern technology, or refusing certain medical treatments, are rational when understood as a cost to the individual to reduce free riding within an organization.
AA and other 12 Step groups have been maligned as “cults” or organizations in which people trade their addiction to alcohol and/or drugs to an addiction to the group. These criticisms fail to appreciate that the strictness of the organization, its cultishness, may be the very source of its effectiveness.
But the lived experience of my patients suggests that prosocial shame can have positive, healthy effects by smoothing some of narcissism’s rougher edges, tying us more closely to our supportive social networks, and curbing our addictive tendencies.
I urge you to find a way to immerse yourself fully in the life that you’ve been given. To stop running from whatever you’re trying to escape, and instead to stop, and turn, and face whatever it is.
