PDF Summary:Dopamine Nation, by Anna Lembke

Is there something you indulge in more often than you'd like? Maybe it's checking social media, eating junk food, or binging shows and movies on streaming platforms. In Dopamine Nation, addiction treatment specialist Anna Lembke explores what causes these behaviors and how you can take back control. She explains both the neurological and emotional causes of overindulgence and provides clear actionables to help you stop.

In this guide, you'll learn about how pleasure and pain motivate you to consume, strategies for keeping your brain’s natural chemicals in balance, and solutions to the psychological reasons so many people have a hard time stepping away from their favorite indulgence. Our guide supplements Lembke’s advice with targeted strategies while placing her principles in context with broader conversations on the nature of addiction.

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Solution #2: Use Therapeutic Pain

Lembke’s second strategy for restoring a neutral homeostasis is to intentionally press on the “pain” side of the seesaw. Because your brain strives for equilibrium, feeling pain will cause your brain to take weight away from the pain side. This will undo the effects of your high tolerance for pleasure, leaving you with a neutrally balanced seesaw and a “normal” default state, instead of a painful default state that compels you to seek pleasure for equilibrium. Lembke recommends finding a safe way to experience physical pain, like regularly taking ice water baths or cold showers.

However, she warns, pressing on the pain lever can itself become an addiction. If you experience pain too much or too often, your brain will homeostatically balance its seesaw in the other direction—adding weight to the pleasure side and making you feel good in response to pain. (This is the reason many endurance athletes feel a high after completing a triathlon.) Be careful not to simply substitute one pattern of indulgence for another.

The Difference Between Chronic and Acute Pain

At first, it may seem counterintuitive that pain is beneficial to your well-being. However, pain researchers shed further light on the benefits of pain by dividing it into two categories: acute and chronic. You experience acute pain in direct response to your environment—for example, the pain you feel if you put your hand in cold water. Your receptivity to acute pain is essential to your health, as it compels you to avoid damage to your body. Conversely, chronic pain is something you experience over long spans of time in response to something internal, such as a back injury. Chronic pain does not provide a clear health benefit and often interferes with your life.

Using this distinction, we see that Lembke's strategy is to treat chronic pain with acute pain: The "pain weight" on your seesaw is internal and long-term (chronic), whereas the ice water bath is external and short-term (acute). Each experience of acute pain causes your brain to rebalance itself through homeostasis. This takes weight off the pain side so that a chronic experience of "pain weight" is no longer your default.

The Difference Between Therapeutic Pain and Self Harm

Lembke writes that self-administered pain can reset your seesaw and change your habits of overindulgence. However, there's a sharp distinction to be drawn between experiencing pain in ways that are safe and ways that are harmful.

Though often hidden and stigmatized, between 13 and 23% of teenagers have practiced some form of self-harm such as cutting, burning, or puncturing their skin. This is often done to alleviate emotional pain or express self-hatred. Self-harm can also be addictive as it can create pleasurable feelings.

While some people find that self-harm creates some of the same neurological responses as therapeutic pain, there is a huge difference in the risk. Taking an ice-cold shower isn’t going to put you in the hospital. On the other hand, self-harm-related injuries are one of the most common reasons teenagers go to the emergency room.

Part #4: Overcoming Emotional Obstacles

As you recall, overindulgence is driven by both neurochemical and emotional factors. In the previous section, we explored the neurochemical factors. In this final section, we'll explore four of the most common emotional obstacles to breaking out of the overindulgence cycle, as well as Lembke’s solutions for overcoming each.

Obstacle #1: Prioritizing Long-Term Rewards

Lembke’s first obstacle to overcoming overindulgence is the difficulty of choosing long-term rewards over short-term ones. Most people prefer the short-term rewards of indulgence because they are easier to obtain and they feel good right away—only feeling bad in the long run. On the other hand, stopping your overindulgence and going through withdrawal feels terrible in the short run, and only feels good after about two to four weeks.

Lembke goes on to clarify why we’re primed to ignore positive long-term effects for short-term gains. She explains that the pursuit of long-term and short-term rewards is handled by separate parts of the brain. Pursuing short-term rewards relies on emotional parts of the brain such as the amygdala. Pursuing long-term rewards requires effort by the prefrontal cortex, the part of the brain involved in logic, conceptual thinking, and long-term planning. In other words, you can chase what is in front of you by acting on emotional impulse, but prioritizing a delayed reward requires thinking logically about your goals.

While prioritizing long-term rewards may be hard for most people, those who compulsively overindulge are placed at a particular disadvantage because overindulging rewires their brains over time. Researchers have found that people who compulsively overindulge have lower-than-average connectivity between the reward pathways and the prefrontal cortex. (Shortform note: Recall, reward pathways are the channels your motivational chemicals, such as dopamine, take through your brain toward the various goals your brain sets for them.) This means that the prefrontal cortex is less likely to interject with a logical argument when you pursue a short-term reward at the expense of a long-term one.

Why Is It So Hard to Prioritize Long-Term Rewards?

In Predictably Irrational, Dan Ariely explains why prioritizing long-term rewards over short-term ones is a struggle for most people. He draws a distinction between “cool-state decisions” and “warm-state decisions.” You’re in a cool state when you feel calm and collected and in a warm state while experiencing intense emotions. It’s relatively easy to pursue long-term rewards and make rational decisions when you’re in a cool state. However, when you’re in a warm state—such as when your brain is flooded with dopamine—it’s difficult to ignore your emotions or act rationally. He writes that most people are very poor at predicting how they will react in a warm state—they expect they’ll be able to stick to their cool-state decisions even when emotionally aroused.

He suggests that the solution to overcoming this gap isn’t a pledge to make better decisions but to prevent yourself from having to make decisions in a warm state at all. For example, Lembke’s suggestion to create physical distance from your desired indulgence helps to make the decision not to indulge for you.

How Does Your Behavior Change Your Brain?

Lembke’s discussion of connectivity between the prefrontal cortex and the brain’s reward pathways is related to the science of neuroplasticity.

Neuroplasticity is your brain’s capacity to create new connections, learn, and change itself. Neuroscientists have learned this process happens continually based on how you use your brain. Your neurons grow and form connections in the areas of your brain you use the most, while they shrink and lose connections in the parts of your brain you use the least. For example, a musical instrument becomes easier to play the more you practice. But stop practicing for long enough and it becomes hard again. This is because the act of practicing uses your neurons involved in playing music, and they grow and shrink in response.

How does this relate to the pursuit of short- and long-term rewards? If you always pursue the short-term emotional reward right in front of you, it strengthens the connection between the emotional parts of your brain and the reward pathways. Meanwhile, because you aren’t using your prefrontal cortex to think about long-term goals, the lack of activity causes those neurons to shrink and become disconnected from the reward pathways. Therefore you're less likely to pursue long-term goals because your brain hasn't built up a strong connection between prefrontal cortex and reward pathway required to do so.

The Solution: Restore Connectivity With the Prefrontal Cortex

Lembke’s solution is to reinforce the connection between your prefrontal cortex and your brain's reward pathways through deliberate use of your prefrontal cortex. She advises you to make an effort to think about your future. Lembke found that just thinking about what you want your life to look like 10 years down the road activates your prefrontal cortex, helping you gain perspective and find motivation to change your behavior.

Strategies for Prioritizing Long-Term Rewards

Lembke's solution to the challenge of prioritizing long-term rewards is to practice using your prefrontal cortex so that you gradually develop a stronger capacity for long-term thinking. However, this solution only yields results after a significant time investment. Dan Ariely (Predictably Irrational) offers some practical solutions for prioritizing long-term rewards that you can start applying immediately.

• Make pre-commitments. When building habits, commit to things that are hard to back out of. If you’re committing to abstaining from pleasure, you can create accountability by doing it with a friend.

• Minimize distractions. Create an environment that limits your access to distractions. If your attention is constantly being pulled in new directions, it’s easier to lose focus and fall back into automatic behaviors.

• Reward yourself. You can reinforce the behaviors that are most important to you by tying them to a reward. If you're cutting back on social media, set a weekly goal and treat yourself with a meal out if you achieve it

Obstacle #2: Recognizing and Accepting Your Patterns of Behavior

Lembke names difficulty in accurately recognizing and accepting your patterns of behavior as the second emotional obstacle. Often, it's hard to see how your behaviors fit together in a pattern. This once again has to do with the eroded link between the reward pathways and the logic center of the brain.

Recall that when you repeatedly pursue short-term and emotionally driven rewards, you decrease the connectivity between your reward pathways and your prefrontal cortex—the part of your brain responsible for long-term planning. The prefrontal cortex also narrates your experiences in real time and keeps you aware of your behaviors, which plays an essential role in self-awareness. The less internal running commentary you have on your daily actions, the less aware you are of your behavior.

Furthermore, even if you are aware of your behavior and recognize the extent of your patterns of overindulgence, it can be difficult to accept that you have a problem. Most people don’t want to see themselves as lacking self-control and maintain their positive self-image by minimizing, ignoring, or discounting their patterns of behavior.

How Bad Is Your Cycle of Overindulgence?

Lembke writes that the difficulty in recognizing your patterns of behavior lies largely with a lack of self-awareness or unwillingness to acknowledge the pattern. A good place to start gaining clarity about your behavior or acknowledging the existence of a pattern may be comparing your behavior to standards used by psychologists to diagnose addiction. Psychologists see addiction as a process with three sequential stages. As you read, consider whether any of these sound familiar.

• Misuse: Someone misuses a pleasurable activity when they are using it to alleviate or distract from emotional or physical pain. Pay close attention to why you are indulging in your high-dopamine activity. For example, are you having an alcoholic drink to have fun with your friends or because you had a hard day at work?

• Abuse: This stage is characterized by heavier overindulgence to maintain the pain alleviation effects. You may be at this stage if you notice that you've built up a tolerance to your pleasurable activity. Are you engaging in the activity for longer periods than you used to, or ingesting higher doses of a substance?

• Addiction: A repetitive cycle of abuse becomes a full-blown addiction once someone begins putting great effort into accessing their pleasurable activity. They also begin to suffer the consequences of their overindulgence in their relationships, mental health, and financial well-being. To understand if you’ve reached this stage, ask yourself two questions. How did you respond the last time you weren’t able to access your pleasurable activity? Secondly, what has pursuing this activity cost you (financially, emotionally, and socially)?

The Solution: Tell the Truth

Lembke argues that to recognize and accept your patterns of behavior, you must make a practice of telling the truth. By this, she means committing to honesty—even when it feels painful, uncomfortable, or shameful. This practice offers four distinct benefits in changing your patterns of overindulgence.

1. Recognition. By honestly calling your behavior to your attention, it will be easier to see your patterns of compulsive consumption as they really are. The more you commit to acknowledging each instance of indulgence, the more you will perceive that they are part of a pattern and not just isolated incidents.

(Shortform note: Lembke writes that practicing greater honesty highlights behavioral patterns, but this may not be enough: Recognizing patterns of behavior may also require a strong memory or record of your ongoing behaviors. In The Bullet Journal Method, Ryder Carroll asserts that keeping a log of your daily activities will help you better remember your behaviors, their frequency, and their context—creating new opportunities for self-reflection when your own memory may fall short.)

2. Strengthening the mind. By honestly acknowledging your behavior, you will gradually reforge the linkage between your prefrontal cortex and your reward pathways. As your brain gets used to paying more attention to your decisions, it will naturally rewire itself to make this practice easier. This increased connectivity will then allow you to be more mindful and make better decisions when facing an opportunity to indulge.

(Shortform note: Lembke writes that you can strengthen your prefrontal cortex by practice—the more you use it, the stronger it gets. But this may not be the only way. Neuroscience has shown you can also strengthen your prefrontal cortex through mindfulness activities that don’t necessarily require you to honestly assess yourself. In The Willpower Instinct, Kelly McGonigal writes that a daily mindfulness practice like meditation increases blood flow to the prefrontal cortex. Additionally, people who meditate regularly have been shown to have more gray matter in their prefrontal cortex. When trying to break your pattern of overindulgence, consider making mindfulness a part of your daily routine.)

3. Accountability. Honesty gives you a greater ability to take responsibility for your actions. By admitting when your decisions lead to overindulgence, you can find opportunities to interrupt the cycle. Lembke writes that an honest account of your own behavior is the first step toward taking control of your decisions.

4. Agency. The final benefit of truth-telling is an improved sense of agency. As you recognize your own role in your overindulgence, you will see that you have the power to change it. People who see themselves as the ones making decisions and leading their own lives often have greater faith in their capacity to change.

Lembke writes that one of the most important ways to strengthen your agency is to be aware of how you tell your life story. People who tell stories that focus only on what has happened to them, while overlooking their own decisions, may have a limited sense of their own capabilities. On the other hand, people who tell life stories that emphasize their own choices tend to see themselves as having more control over their future choices. This gives them a greater ability to exercise that control and change their habits of overindulgence.

A Better Way to Tell Your Life Story

Lembke writes that telling your life story honestly and with a focus on your own agency will provide a sense of empowerment and accountability to overcome your patterns of indulgence. But how can you go about changing the way you tell your life story? Psychologists offer three tips.

• Avoid binary or absolute language. Phrases like, "There was nothing I could do," or, "It's impossible to fix this" create a story where you are powerless. This language not only frames you as having less agency, but it also undermines your accountability for your own actions by rendering the situation as something out of your hands.

• Use simple and direct language to approach difficult subjects. You don't need to approach your most sensitive topics with strong judgments and opinions. Simple and direct language will make it easier to lower the emotional barriers to acknowledging painful or difficult truths. For example, instead of saying, “I made the stupid decision to try a cigarette when I was younger and idiotic,” simply say, “I decided to try a cigarette when I was 20.”

• Think about the life story you would like to have. Reflecting on your greater narrative arc can help inspire you to tell a new story. Is it a story of growth, resilience, and healing? Or is it a story of frustration and despair?

Obstacle #3: Isolation

Lembke identifies isolation from others as a third emotional obstacle to overcoming overindulgence. She explains that your overindulgent behaviors may leave you cut off from family and friends for two main reasons: 1) shame about your overindulgence and 2) choosing dopamine over your relationships.

1) Shame: When you compulsively overindulge, you may feel ashamed of your behavior, which can lead you to conceal it from others. The more time you spend hiding from other people, the less time you will spend connecting with them. Furthermore, maintaining the façade that you don’t have a struggle with overindulgence may make it harder to be open and fully yourself around others. This will erode your ability to connect, leaving your relationships less rewarding.

Shame also creates an obstacle to overcoming overindulgence because it can prevent you from reaching out for help since doing so would require disclosure. When shame becomes an obstacle to connection, you may find yourself struggling to break out of your behavior patterns alone.

2) Choosing dopamine over relationships: The second reason compulsive overindulgence alienates you has to do with the lifestyle it requires. Lembke writes the more time and energy you invest in pursuing high-dopamine rewards, the less time and energy you have to invest in relationships.

(Shortform note: While Lembke focuses on the ways overindulgence can leave you more isolated from others, there is also strong evidence that emotional isolation may be the root cause of your overindulgence in the first place. People who grew up without secure and nurturing relationships with their parents are far more likely to struggle to build strong relationships later in life. This leaves them far more vulnerable to turning towards overindulgence as a substitute for intimacy.)

Furthermore, Lembke argues, isolation can deepen the cycle of overindulgence. Recall that the neurological relationship between pleasure and pain creates a cycle by adding weight to the “pain side” of the seesaw. Isolation feeds into this cycle because loneliness is painful and therefore creates new incentives to indulge. The lonelier you feel, the greater reason you have to indulge and feel better in the short run. This will likely leave you more isolated and feeling worse again, deepening the cycle of indulgence.

(Shortform note: Lembke writes that loneliness is emotionally painful and thus creates a further incentive for overindulgence. However, this might understate the case. Health researchers have found that chronic loneliness not only causes emotional pain but can also result in physical pain and severe damage to your bodily health. Chronic loneliness increases your risk for high blood pressure, heart attack, stroke, and cognitive decline. It also worsens the symptoms and length of illness when you are sick. By increasing your physical pain alongside your emotional pain, loneliness adds even more weight to the “pain side” of the seesaw.)

The Negative Beliefs Underpinning Shame

Lembke writes that shame may isolate you and make it harder to change your behavior. Others have pointed out that your shame may be the result of negative beliefs about yourself that you must first overcome. In The Power of Vulnerability, Brené Brown writes that people struggle to break down barriers of shame when they believe they are uniquely undeserving of love. She writes this is the result of two underlying false assumptions.

• The source of shame is unrelatable. If you think no one else has gone through your experiences, then it raises the stakes of sharing them. It's a very small risk to reveal a weakness or fault that is commonly shared, whereas it's a large risk to reveal a weakness or fault that makes you stand out from others.

• The source of shame negates self-worth. If you are convinced your value as a person is conditional on being successful, moral, or respectable, then anything that goes against those qualities can leave you feeling worthless and irredeemable.

When it comes to patterns of overindulgence, both of these beliefs are false. Recall that compulsive overindulgence is a widespread problem that many people struggle with, and no one's value as a human is diminished by it. If you struggle with either of these underlying beliefs, recognizing their falsehood can make it easier to overcome the shame that may isolate you in a pattern of indulgence.

Solution #1: Form Relationships Through Authentic Sharing

Lembke encourages breaking out of isolation by authentically sharing with others. Recall that you must be honest with yourself to restore your sense of accountability, agency, and self-awareness. You must also be honest with others to form closer connections. By being yourself with others, you create opportunities to bond while overcoming the shame and isolation of overindulgence.

Lembke writes that forming closer relationships through authentic sharing can help you overcome overindulgence in three distinct ways.

• When you have higher-quality relationships, you will feel less of a need to pursue dopamine-heavy rewards to cope with loneliness.
• Discussing your behavior with others can help you find solutions. Your friends and family may offer input and advice to help you change your patterns of behavior.
• By articulating your patterns of overindulgence to others, you may develop a more honest and realistic assessment of your habits.

Is Authentic Sharing Enough?

Many psychologists agree with Lembke's assertion that close relationships can play a vital role in alleviating loneliness, gaining advice, and developing a more honest assessment of behavior. But some argue that while authentic sharing may be necessary for rebuilding relationships, it may not be enough. If your patterns of indulgence have seriously damaged your relationships, you may need to utilize other forms of relationship repair, like conflict resolution or relationship counseling, to rebuild.

This is especially important to understand, because psychologists have found that relationships can be a major source of stress in life, and therefore an obstacle to overcoming indulgence. The added stress of a relationship characterized by broken trust or frequent arguments can provide strong incentives to fall back into overindulgence. Furthermore, traditional treatment programs often overlook relationship stress because addressing these issues can appear like deferring responsibility and blame. Therefore, it is important to remain aware of the health of your relationships and to seek remedies as needed.

Solution #2: Find a Supportive Community

Lembke notes that your willingness to share is only part of the solution—you also need a listener who accepts you, no matter what you share. Finding the right listener is vital: Some people may be put off by your disclosures, and sharing with someone who rejects you will only deepen your feelings of shame and discourage future disclosures.

If the people around you don't accept you and your struggles, you may need to seek out new relationships. Fortunately, there are support groups specifically designed to help those who compulsively overindulge, such as Alcoholics Anonymous and Narcotics Anonymous. These communities are full of people who share your struggle—and therefore won’t judge you and will have tried and true advice for changing your patterns of behavior. These communities also provide accountability, because you will be expected to share if you find yourself falling back into patterns of overindulgence.

How to Minimize the Impact of Rejection

Lembke stresses that rejection can deepen your pain and leave you feeling isolated. However, you can minimize the pain of rejection if you can respond to it in a healthy, resilient way. If rejection doesn't hurt you, it won’t discourage future disclosure or cause further isolation. In The Subtle Art of Not Giving a F*ck, Mark Manson writes that handling rejection is an essential social skill. The better people are at hearing and saying no, the stronger their relationships will become because they will feel less need for superficial acceptance. Psychologists recommend three steps for handling rejection.

1. Acknowledge your pain and let yourself grieve. Feeling rejected hurts. Recognize your feelings and let yourself process.

2. Don't put the blame on yourself. If you're rejected, it's easy to assume it’s because there’s something wrong with you. There are many reasons someone might reject you—many of them having more to do with them than with you.

3. Take this as an opportunity to practice resiliency. If you frame your experience as an opportunity to practice processing and recovering from rejection, you may see it in a more positive light and therefore be more accepting of it.

Should Everyone Attend Support Groups?

On the surface, Lembke's advice about support groups may not seem applicable to everyone. However, recall that Lembke's thesis throughout this book is that the solutions that help addicts have important things to teach everyone about controlling milder forms of overindulgence. Here, we'll talk about some of the benefits support groups provide, and how you might find these benefits through your “everyday” relationships.

1. Non-judgmental listening: One of the core benefits of support groups is that you can feel heard without feeling judged. Try talking to your friends and family about your attempts to overcome overindulgence. See if any of them really make you feel heard.

2. Accountability: Support groups keep you accountable. Having to admit to others when you falter creates a strong incentive to change your habits. Try creating accountability by making an agreement with someone you trust that you’ll disclose when you fall short of changing your habits.

3. Advice: Support groups allow you to benefit from the wisdom of people who have already made a lot of progress in changing their habits. Try seeking out someone in your social circle or online community who has already overcome a similar form of overindulgence.

4. Encouragement: Lastly, support groups provide motivating encouragement and positive reinforcement for your success. As you talk to friends and family, see if you can find someone who is rooting for you to change your patterns of overindulgence—spending more time with them will help keep you motivated.

Obstacle #4: Escapism

Lembke’s final obstacle to overcoming overindulgence is escapism. People often find their own lives boring, and so they turn to overindulgence to make their lives more interesting and forget feelings of dissatisfaction. Lembke’s solution is to discover something new and enriching in your life—something you may have previously overlooked. She explains that when breaking habits of overindulgence, it helps to find a new hobby or outlet for your passions that will help you take more interest in your own life.

How to Have a More Satisfying Life

Lembke writes that people often fall into patterns of overindulgence because they find their lives unsatisfying and boring. Here we'll discuss the root causes of boredom and the four activities psychologists recommend to get more satisfaction out of life.

Many writers have attempted to create a definition of boredom. In A Theory of Fun for Game Design, Raph Koster describes boredom as the opposite of learning. You are bored when you aren’t receiving new information to reinforce new habits or ways of being. Brené Brown (Atlas of the Heart) describes boredom as wanting to do something fulfilling but not being able to—a sense of being cut off from purpose. Finally, in Atomic Habits, James Clear defines boredom as the state when you are no longer challenged or excited by the things you’re doing.

To find more satisfaction in life, you’ll want to seek challenges, learn continuously, and do something you consider meaningful and important. Psychologists recommend four specific courses of action you can take to align your life with these factors and find enrichment.

1. Volunteer. Find opportunities in your community to help people out. Many find it fulfilling to know that they are helping others, and this could provide you with a sense of meaning and purpose you were missing.

2. Start a new project. Taking on a long-term project could provide a sense of challenge that may have been missing. You might take on the challenge of remodeling your kitchen, or set a goal to read one book every week.

3. Learn something new. You can stimulate your mind and challenge yourself by making an effort to learn. Try learning a new language, taking a cooking class, or reading a book on something you know little about.

4. Express yourself. Seek out a way to challenge yourself while gaining a sense of meaning and purpose as you share your feelings and story with others. Try finding a creative outlet like music, visual art, or creative writing.