https://www.smh.com.au-By Sarah Berry
Temptation is everywhere we look and although it’s pleasurable, it can also make us feel worse.Credit:Getty
Our relentless pursuit of pleasure has made us all vulnerable to compulsive overconsumption, and it is ultimately causing us pain. This is the premise of a “Dopamine Nation”, a New York Times bestselling book by Stanford University psychiatrist, Dr Anna Lembke.
In recent years, much has been written about how technology is designed to keep us clicking.
But slavery to our screens is only part of the problem. Processed foods are also designed to be hyper-palatable; alcohol and drugs have become more potent and more available; shopping and gambling, sex and pornography are all bountiful. And this high-reward, high-dopamine stimuli is instantly accessible 24 hours a day, just the click of a button away.
We never have to sit in sadness or boredom or discomfort, or even get up off the couch because distraction and a hit of dopamine is at our fingertips.
It’s at odds with the way we are wired as humans.
Take, for instance, dopamine, the neurotransmitter responsible for motivation and reward-driven learning, which evolved in response to effort. Among other things, it inspired us go out and walk for long periods each day searching for the limited supply of food.
“The way that, evolutionarily, we were able to survive in a world of scarcity was to be eternal seekers,” Lembke says, explaining that our brains ensured we kept seeking by giving us progressively less pleasure when exposed to the same type of stimulus.
Even more powerfully, immediately after the spike of pleasure from any stimulus we receive, our dopamine levels drop below baseline.
This means that, when we get a “hit” that requires no effort, our dopamine spikes and crashes, provoking us to seek another quick hit to lift us back up.
“Essentially there’s a cost for every pleasure and that cost is pain. If we continue to inundate our reward pathway with pleasurable substances and behaviours we don’t just end up at net-zero, we end up with a balance tilted towards pain where we are in a dopamine-deficit state.”
This state, she says, is the hallmark of the addicted brain: “We use not just to feel good, but just to restore a level balance.”
While transcribing my interview with Lembke I checked my phone half a dozen times and the fridge multiple times for the chocolate I’d already established wasn’t there.
This kind of compulsive seeking of pleasure and consumption is at the less pointy, pathological end of addiction, but causes problems nevertheless.
“We’re now titillating ourselves to death,” she argues. “Seventy per cent of the world’s deaths are due to modifiable risk factors – the top three are poor diet, lack of exercise and smoking. And I do think that the rising rates of anxiety and depression, especially in rich nations, is primarily a function of our dopamine deficit state brought about by overindulgence in too many feel-good substances and behaviours.”
“To figure out what the good life is we have to dial it back – we have to intentionally invite challenging circumstances.”
Dr Anna Lembke
She continues: “There is no natural stopping point and [everything has] been engineered to release a whole lot of dopamine all at once making them, for those reasons, much more addictive.”
The problem, she argues, is not us, it’s the world we live in:
“You can have the most perfect life and still get addicted because we have brains that are naturally wired to seek out pleasure and avoid pain and because we live in a world that is full of ubiquitous access to these highly reinforcing drugs.”
Over a Zoom call from her office in California, Lembke explains that her revelations came partly from working with people experiencing chronic pain and opioid addiction: “That was really like ‘oh my goodness, these opioids that are taken for pain are giving people worse pain because of the process of neuroadaptation’.”
But, they also came from her life experiences, including a brief addiction to romance novels facilitated by technology, despite a happy and trauma-free life.
“Once I got a Kindle and access to a world of infinite romance novels I was off and running to the point where I was neglecting my kids and my husband and my work and my health.”
So what hope is there for any of us when even the addiction specialist is vulnerable to addiction?
“To figure out what the good life is we have to dial it back – we have to intentionally invite challenging circumstances. We have to intentionally eschew easy pleasures,” says Lembke.
Recommending people do activities we find “a little bit painful” is “unorthodox” she admits in a space where relieving discomfort is often the focus.
According to the National Drug Institute: “Research shows that when treating addictions to opioids [for instance]… medication should be the first line of treatment, usually combined with some form of behavioural therapy or counselling.”
Lembke advocates for the “hard things” first, whether it’s getting up and exercising when we don’t feel like it, engaging in mentally or creatively challenging tasks and pushing out of our comfort zones regularly.
Effortful tasks create a more sustained and slow rise in dopamine levels.
We also have to resist the urge for the instant hit, and learn to be OK with discomfort.
“If you abstain from your drug of choice you’re going to reset reward pathways,” Lembke says. “That period of abstinence can also be a wonderful opportunity to appreciate how addictive we all have become.”
According to data, 30 days is typically enough to reset the dopamine-deficit state in people abusing their “drug” of choice, whether that’s sugar or gambling, shopping or social media, alcohol or opioids. After a period of abstinence, we can experiment with how or whether we can engage in a way that is not compulsive.
“It’s much easier to go from using a lot to using nothing to using in moderation than it is to go from using a lot to using in moderation because if you go from a lot to less, you never restore homeostasis – you’re still operating out of a deficit,” she explains.
Though we can’t stop eating or being online for 30 days, we can avoid daily use of certain foods for instance, have days away from our digital devices (over the weekend, for instance) and try to condense the amount of time we spend on them to discrete periods: “It’s really good to have a digital sabbath to reset reward pathways, so we’re not always chasing dopamine, and we’re not always ending up in a further deficit state.”
Lembke adds that “there’s a fundamental misunderstanding” about how to live a life that minimises our suffering. We believe that if we’re uncomfortable or unhappy or if we’re in any kind of distress we need to make ourselves more comfortable and to seek out something to take away our struggles.
“This is so deeply embedded in our reflexive response to suffering in the modern age. I really wanted people to understand from a neuroscience lens why that doesn’t work.”
The paradox is that to feel good in the long term requires us to lean into discomfort and pain and resist the many pleasures that surround us. It requires us to start acting and stop reacting because regardless of the cause of our pain “if you don’t change your behaviour, you’re not going to change your life.”