Dopamine, Decision Making, and Addiction

Persons with severe addictions are among those contemporary prophets that we ignore to our own demise, for they show us who we truly are.

A great book on the human body, addiction, and the mental and chemical processes that happen behind the scenes of decision makings. If you'd prefer watching the movie instead of reading the book there's also this episode on the rational reminder podcast where the author discusses her book with the hosts.

As Aldous Huxley said in Brave New World Revisited, “the development of a vast mass communications industry, concerned in the main neither with the true nor the false, but with the unreal, the more or less totally irrelevant... failed to take into account man’s almost infinite appetite for distractions.” Along similar lines, Neil Postman, the author of the 1980s classic Amusing Ourselves to Death, wrote, “Americans no longer talk to each other, they entertain each other. They do not exchange ideas, they exchange images. They do not argue with propositions; they argue with good looks, celebrities, and commercials.”

Try and notice the trees.

My patient Sophie, a Stanford undergraduate from South Korea, came in seeking help for depression and anxiety. Among the many things we talked about, she told me she spends most of her waking hours plugged into some kind of device: Instagramming, YouTubing, listening to podcasts and playlists.

In session with her I suggested she try walking to class without listening to anything and just letting her own thoughts bubble to the surface.

She looked at me both incredulous and afraid.

“Why would I do that?” she asked, openmouthed.

“Well,” I ventured, “it’s a way of becoming familiar with yourself. Of letting your experience unfold without trying to control it or run away from it. All that distracting yourself with devices may be contributing to your depression and anxiety. It’s pretty exhausting avoiding yourself all the time. I wonder if experiencing yourself in a different way might give you access to new thoughts and feelings, and help you feel more connected to yourself, to others, and to the world.”

She thought about that for a moment. “But it’s so boring,” she said.

“Yes, that’s true,” I said. “Boredom is not just boring. It can also be terrifying. It forces us to come face-to-face with bigger questions of meaning and purpose. But boredom is also an opportunity for discovery and invention. It creates the space necessary for a new thought to form, without which we’re endlessly reacting to stimuli around us, rather than allowing ourselves to be within our lived experience.

The next week, Sophie experimented with walking to class without being plugged in.

“It was hard at first,” she said. “But then I got used to it and even kind of liked it. I started noticing the trees.”

We’re all running from pain. Some of us take pills. Some of us couch surf while binge-watching Netflix. Some of us read romance novels. 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.

The brain is just not equipped to deal with the continuous bombardment of tiktoks, reels, shorts, memes, notifications, and content.

The phylogenetically uber-ancient neurological machinery for processing pleasure and pain has remained largely intact throughout evolution and across species. It is perfectly adapted for a world of scarcity. Without pleasure we wouldn’t eat, drink, or reproduce. Without pain we wouldn’t protect ourselves from injury and death. By raising our neural set point with repeated pleasures, we become endless strivers, never satisfied with what we have, always looking for more.

But herein lies the problem. Human beings, the ultimate seekers, have responded too well to the challenge of pursuing pleasure and avoiding pain. As a result, we’ve transformed the world from a place of scarcity to a place of overwhelming abundance. Our brains are not evolved for this world of plenty. As Dr. Tom Finucane, who studies diabetes in the setting of chronic sedentary feeding, said, “We are cacti in the rain forest.” And like cacti adapted to an arid climate, we are drowning in dopamine.

The net effect is that we now need more reward to feel pleasure, and less injury to feel pain.

This is a fantastic book that I have way too many highlights of and would prefer not to copy and paste the whole book over here. I will return at some point to put together the lessons from this book in my own words.

Dopamine Nation on Apple Books here

Lessons of the Balance

• The relentless pursuit of pleasure (and avoidance of pain) leads to pain.
• Recovery begins with abstinence.
• Abstinence resets the brain’s reward pathway and with it our capacity to take joy in simpler pleasures.
• Self-binding creates literal and metacognitive space between desire and consumption, a modern necessity in our dopamine-overloaded world.
• Medications can restore homeostasis, but consider what we lose by medicating away our pain.
• Pressing on the pain side resets our balance to the side of pleasure.
• Beware of getting addicted to pain.
• Radical honesty promotes awareness, enhances intimacy, and fosters a plenty mindset.
• Prosocial shame affirms that we belong to the human tribe.

Instead of running away from the world, we can find escape by immersing ourselves in it.