Dopamine Nation: Finding Balance in the Age of Indulgence

Nonfiction | Book | Adult | Published in 2021

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Summary

Background

Chapter Summaries & Analyses

Part 1, Introduction-Chapter 1

Part 1, Chapter 2

Part 1, Chapter 3

Part 2, Chapter 4

Part 2, Chapter 5

Part 2, Chapter 6

Part 3, Chapter 7

Part 3, Chapter 8

Part 3, Chapter 9-Conclusion

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Themes

The Opioid Epidemic

Throughout the book, Lembke indirectly refers to the opioid epidemic and often uses it in examples to help make various points. For example, she mentions that “[o]ne of the biggest risk factors for getting addicted to any drug is easy access to that drug. When it’s easier to get a drug, we’re more likely to try it. In trying it, we’re more likely to get addicted to it” (18). The author describes how opioid medication was routinely overprescribed, citing one data point showing that in 2009, “doctors in Arkansas wrote 116 opioid prescriptions per 100 persons living in Arkansas” (124). This is one state, in one calendar year. The sheer amount of opioids made available to the population is staggering and, as Lembke points out, increased the prospect that a vast number of those taking the drugs would acquire an addiction.

Lembke cites the Arkansas data in the context of detailing the story of her patient Chris. While the author doesn’t probe into the epidemic’s complexities, she uses Chris’s example to show what flooding the market with such a product can do to people. Although Chris was a somewhat sensitive individual contending with some personal problems, he didn’t simply wake up one day and decide to compulsively take opioids. Like many others, he just stumbled down the wrong path, and because opioids were so widely available, it became easier for him to stay on that path, which led to a substance use disorder.

One of the great ironies of the opioid epidemic is that the general public didn’t commonly understand what opioids do and their highly addictive properties. Opioids are medications intended to help people manage severe pain. The more they were prescribed, the clearer their effect became: “Although there’s no evidence I know of showing that pain in fact speeds up tissue repair, there is emerging evidence that taking opioids during surgery slows it down” (38). One takes an opioid to help manage pain—but it isn’t a wonder substance that helps people heal and in fact may prolong healing. A disconnect existed between how many perceived these drugs and exactly what they actually do. Further complicating the scenario, people often misunderstood the extremely addictive qualities of these medications, and coupled with their overprescription, this created the environment for a full-scale drug epidemic, which is exactly what transpired.

The Danger of Digital Drugs

Lembke, who appeared in the documentary The Social Dilemma (2022), examines this topic in more detail in this book. She raises the question of whether technology and social media trigger the same kind of dopamine-seeking behavior as chemical substances like drugs and alcohol. Lembke indicates that in her view, technology devices tap into the same reward pathways: “Technology itself is addictive, with its flashing lights, musical fanfare, bottomless bowls, and the promise, with ongoing engagement, of ever-greater rewards” (23). The last part of the passage is critical in light of Lembke’s primary concern in the book. Once people who use technology suspect that further rewards are just a click away, they’re susceptible to engaging in compulsive behavior. Anyone with a smartphone recognizes how easy it is to mindlessly scroll and search through social media apps. In some ways, it’s a reflexive action wherein those using social media seek the next hit of dopamine. Lembke likens the use of tech devices to gambling and the ways that people who gamble experience dopamine release in the anticipation of whether they win or lose. Searching for “likes” on a social media app is the same kind of behavior. Anticipation of a “like” provides the greatest release of dopamine. Effectively, once people with an addiction to social media receive a “like,” they’re almost immediately searching for the next one: “I suspect something similar is going on with social media apps, where the response of others is so capricious and unpredictable that the uncertainty of getting a ‘like’ or some equivalent is as reinforcing as the ‘like’ itself” (62). The pattern of behavior is similar to that during substance misuse and other compulsive behaviors, and it’s striking to consider how those who use social media apps have been led to believe that using them is an entirely beneficial experience. These companies promote social media as almost indispensable in modern life yet don’t provide the informed consent that those who use technology deserve.

Lembke holds that, like the oversaturation of opioids and how increased access heightens the risk of addiction, the same dynamic is at play for technology and social media. The author unambiguously makes the link between tech and drug use, commenting, “The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation” (1). For this reason, and because she senses similar patterns between media consumption and the opioid epidemic, she notes that “as digital drugs like smartphones have become embedded into so many aspects of our lives, figuring out how to moderate their consumption, for ourselves and our children, has become a matter of urgency” (88).

The Necessity of Pain

Lembke’s book conveys the sense that pain—like pleasure—is an essential ingredient in life. When one thinks rationally about that idea, it makes natural sense, yet the medical and technological advancements of the modern era often lead people to believe that they can somehow escape this natural truth. However, Lembke doesn’t offer this as a criticism of society. In fact, she tends to be much more compassionate toward average people who simply seek to live their best life than she does toward entities who exploit this fundamental human desire. In any case, Lembke provides cause for people to reflect on their own perceptions of what pain is and to what extent they try to avoid it in their own lives. In addition, she clearly shows that regarding dopamine, the body has its own built-in programs for keeping itself in balance. This usually results in a recalibration toward pain once dopamine is released and the person feels pleasure, particularly pleasure that comes artificially or is induced by external stimuli. To elaborate, Lembke makes the following point: “Science teaches us that every pleasure exacts a price, and the pain that follows is longer lasting and more intense than the pleasure that gave rise to it” (66).

The inherent lesson here is that when people seek pleasure, whether in the form of a chemical enhancement or in the form of some reward-chasing compulsive behavior, they inevitably incur the consequences as the body attempts to recalibrate, and they experience a “coming-down” period. Their moods likely decrease from the elation they felt during the pleasurable moments. Naturally, they seek a return to the elevated mood state they were in. Thus begins a pattern of behavior that, without checks and balances, can segue into an addiction. People must tread with caution and consider this fact. Lembke notes, “We’ll do almost anything to distract ourselves from ourselves. Yet, all this trying to insulate ourselves from pain seems only to have made our pain worse” (44). Implicit in her comment is that people must find healthier means for coming to terms with the nature of pain. People must learn to better accept that it’s a fundamental component of life and that when they experience pain, it’s often a temporary feeling—just like pleasure. In time, it dissipates.