Dopamine Nation: Living in an addicted world

Hosted by

“One of the things that I say to people who maybe don't have any personal experience with addiction is [to] try putting your phone away for 24 hours,” says Anna Lemke. “That means no screens, no touching it for any reason at all. And then observe in yourself, what goes on in your mind, the feelings of anxiety, even sheer terror, that might make up my arise for you.” Photo by Shutterstock.

Is it becoming easier than ever to get addicted?  Whether it’s coffee, video games, or our phones, we live in a society where so many behaviors and substances have become readily accessible and increasingly addictive. 

So when does a behavior become an addiction? And what drives that craving? The secret lies in the brain, with the neurotransmitter dopamine — a chemical pathway that makes us feel good.  The higher the levels of dopamine produced in our brains, the better we feel and the more likely we are to continue or repeat using that substance or behavior to maintain or duplicate that great feeling. 

Addiction specialist Dr. Anna Lembke explains the role of dopamine in addiction this way: “With an addictive drug, a whole lot of dopamine gets released all at once — really much more than our brains have evolved to adapt to,” she says.  “In order to compensate for that huge increase in dopamine, the brain downregulates dopamine production and transmission and that's the state of craving. When we are in that state and we have immediate access to our drug of choice, we will naturally reach for it again, in order to bring ourselves just even back up to baseline or what neuroscientists call ‘homeostasis.’”

Lembke is Director and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. In her book “Dopamine Nation: Finding Balance in the Age of Indulgence,” she  says that we are living in a world that has become increasingly “drug-ified” and is “making us all more vulnerable to the problem of addiction than previously.”  

And, Lembke cautions, “if you're not addicted yet, it's coming soon to a website near you. It's a matter of drug-of-choice, but we've all got our thing.  Once we have access to that, it’s very hard to manage our consumption. Digital products today are a great example of that.” 

In “Dopamine Nation: Finding Balance in the Age of Indulgence,” Dr. Anna Lembke describes how our relentless pursuit of pleasure has led to even greater pain — and offers advice on how to keep our addictions  in check.  Photo courtesy of Penguin Random House. 

 Delve deeper into life, philosophy, and what makes us human by joining the Life Examined discussion group on Facebook.

Jonathan Bastian talks with Lembke about how the constant pursuit of pleasure is producing the opposite effect, and whether it's possible to moderate or abstain from a constant pleasure high. Lembke often recommends that her patients try a dopamine “fast,” or abstinence, as a way to redirect the craving. 

“A month is about the average amount of time it takes to reset reward pathways,” she explains. “Let's have you stop and then see how you feel after a month. And, of course, [in] doing that, we know that patients will feel worse before they feel better.” 

Lembke also talks about her research into the opioid epidemic and the increasing use of fentanyl. She dismisses the idea that anyone can responsibly use highly addictive drugs. 

“The idea that access and the drug itself play no role is an oversimplification, because it underestimates the ways that these drugs can hijack our brains,” Lembke says. “Even when our lives are great, even when we have meaningful work, a good social network, a supportive spouse, and kids we love … these drugs can take over in a way that's really insidious, that people themselves are not aware of.”

"I was seeing more and more patients coming into my practice as a psychiatrist who seemed to have all of the good things that we associate with life,” Lembke says. “They had loving families, interesting work, relative wealth, access to all kinds of things that we associate with a good life, and yet they were extremely unhappy.” Photo courtesy of Anna Lembke. 

Lembke offers advice on how to curb our compulsive overconsumption and suggests that one pathway to peace and serenity is via truth telling. 

“One of the things that I've really changed in my life is I tried to go through every day and not lie. And it turns out, it's really hard, “ she says. We're often very afraid to reveal to others our mistakes, our acts of selfishness, and the way we've harmed others, because we're afraid that people will go running when they find out we're not perfect. But in fact, the opposite happens. When we honestly reveal ourselves in this way, people see their own shared brokenness. They feel closer to us. And that intimacy is a wonderful and healthy source of dopamine.” 

Delve deeper into life, philosophy, and what makes us human by joining the Life Examined discussion group on Facebook.



  • Anna Lembke - Author; Director of addiction medicine, Stanford University; Chief, Stanford Addiction Medicine Dual Diagnosis Clinic - @StanfordMed


Andrea Brody