Human beings are programmed to approach pleasure and avoid pain. It’s an instinct that dates back millions of years, to a time when people needed to actively seek food, clothing, and shelter every day, or risk death.
But psychiatrist Anna Lembke says that in today’s world, such basic needs are often readily available — which changes the equation.
“Living in this modern age is very challenging. … We’re now having to cope with: How do I live in a world in which everything is provided?” Lembke says. “And if I consume too much of it — which my reflexes compel me to do — I’m going to be even more unhappy.”
Lembke is the medical director of addiction medicine at Stanford University and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. Her new book, Dopamine Nation, explores the interconnection of pleasure and pain in the brain and helps explain addictive behaviors — not just to drugs and alcohol, but also to food, sex, and smartphones.
Lembke says that her patients who are struggling with substance abuse often believe their addictions are fueled by depression, anxiety, and insomnia. But she maintains that the reverse is often true: Addictions can become the cause of pain — not the relief from it. That’s because the behavior triggers, among other things, initial response of the neurotransmitter dopamine, which floods the brain with pleasure. But once the dopamine wears off, a person is often left feeling worse than before.
“They start out using the drug in order to feel good or in order to experience less pain,” Lembke says. “Over time, with repeated exposure, that drug works less and less well. But they find themselves unable to stop, because when they’re not using, then they’re in a state of a dopamine deficit.”
In ‘Dopamine Nation,’ Overabundance Keeps Us Craving More