In August 2021, while promoting her new book “Dopamine Nation,” the Stanford psychiatrist Anna Lembke discussed addiction with NPR’s Terry Gross. Dr. Lembke explained that the neurotransmitter dopamine is the “common pathway for all pleasurable, intoxicating, rewarding experiences.” The more dopamine an experience or substance releases, and the faster it does so, she argues, the more addictive it is. In her book, she says recovery from addiction requires a radical reset that should often include a “dopamine fast” — basically, avoiding pleasures to help rebalance the brain.
Dr. Lembke is far from alone in promoting puritanism as an addiction cure. In recent years, the idea that a dopamine fast — which typically includes abstaining from drugs, sugar, porn and social media but can extend to avoiding healthy highs like socializing — is beneficial has spread rapidly through Silicon Valley and on sites like TikTok. Proponents contend that like alcohol and other drugs, phones, video games, shopping, highly processed food and gambling desensitize people to dopamine, making it harder to resist further indulgence. They claim corporate giants in pharma, tech and food are using dopamine science to hook people on their products. To fight back, we must abstain from having fun as much as possible. We’ve breached our pleasure credit limit and need to get back under budget.
The problem with this neuroscience shorthand is that hedonistic excess isn’t the cause of addiction, and dopamine’s role in the brain is not all about pleasure. While dopamine does play an important role in addiction, it’s not what traps people in self-destruction. Americans aren’t facing an addiction crisis because we get too much dopamine from overabundant cheap thrills. Our problem, instead, is a lack of connection, community and purpose.
It’s easy to understand why people mistakenly believe that the pursuit of pleasure drives addiction. Films and addiction memoirs frequently describe drugs like heroin as being better than orgasm multiplied by a thousand, or like “kissing God,” as Lenny Bruce once said.
But although people compare social media’s addictiveness to crack or opioids, no one calls compulsively scrolling TikTok sublime.
In the brain, pleasure and addiction are incredibly complex. When released in certain neural circuits, dopamine is critical to making us want to repeat behaviors that feel good, which tend to be linked to experiences that led to the survival and reproductive success of our ancestors.
But dopamine also affects neural circuits that control movement. That’s why a genuine dopamine fast would be a terrible idea. People with Parkinson’s disease know this firsthand: Their condition is caused by the progressive destruction of dopamine-containing neurons, especially those controlling movement. This causes tremors and difficulty moving. But while Parkinson’s can cause depression and apathy, it doesn’t always.
Dopamine is linked with creating a desire to repeat actions that previously led to pleasure, rather than causing the feeling of pleasure itself. To complicate things further, there are also at least two different types of pleasure: the experience of desire and anticipation (labeled “wanting” by researchers), and the experience of satiation, comfort and contentment (known as “liking”).
This difference is most vivid in sexual behavior. The thrill of excitement and attraction is quite distinct from the pleasure of orgasm and afterglow. Dopamine drives wanting. But liking and satisfaction are more associated with the release of the brain’s natural opioids.
Dopamine motivates us to learn about the world by helping predict what produces positive experiences and encouraging us to repeat them. Addiction, however, is driven more by the compulsion to repeat an experience than by the intensity of the pleasure that’s felt.
When casual drug use turns into an addiction, different dopamine circuits in the brain are activated. Initially, the parts of the brain associated with the buzz of desire (dopamine) and the bliss of satisfaction (endorphins) are most active. But once someone is addicted, the activity shifts to a part of the brain where dopamine is linked with repeated behavior — nearly uncontrollable habits that are now difficult to change. In other words, addiction is about heedless compulsion, not hedonism.
My experience of cocaine addiction illustrates this perfectly. My initial use elicited feelings of capability, confidence and elation. But chronic injecting, especially in roughly the last year of doing so, brought the opposite of pleasure. I constantly craved more, even when each shot only escalated my anxiety and fear. What I wanted was completely dissociated from what I liked. Horrifically, despite my knowing that I now hated the effects of coke, it took going to rehab before I could stop my brain from engaging the “inject more cocaine” programming.
As we contend with technology and other potentially addictive experiences, we should focus on what causes compulsions, not worry about what gives people pleasure. Compulsive craving is what makes social media, cellphones and all the rest seem like crack. The rewards are nowhere near as intense as drug experiences. But because the platforms dish them out almost randomly they can capture the brain’s dopamine “wanting” circuitry as it seeks to forecast reward.
Such unpredictable patterns of reward are fundamental to all types of addiction. Thankfully, however, even among those who try the riskiest substances or activities, only a minority get hooked. People who are vulnerable to addiction are typically at risk because they aren’t coping well — perhaps because of mental illness they can’t manage, the experience of trauma, the despair of economic and social dislocation or some combination thereof. (In my case, it was an attempt to mitigate depression and autism spectrum disorder). Addiction isn’t about seeking extra pleasure; it’s about killing excess emotional pain.
Consequently, America’s problem isn’t that we’re a bunch of hedonists hooked on capitalism’s “dopamine hits” — it’s that so many of us aren’t able to get our social, physical and emotional needs met in healthy ways. The solution, then, isn’t to ban or quit potentially addictive escapes, though they should be regulated to minimize harm. Instead of a dopamine fast, what we really need is a dopamine feast — one that makes us want experiences we actually like, rather than compulsively responding to cravings.
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