Dopamine Nation

Why Our Addiction to Pleasure is Causing Us Pain

Smart Next Actions

Continue to encourage others to read spiritual books as a matter of urgency.
Continue to encourage others to master their productivity and effectiveness as a matter of urgency.
Encourage others to read this book and book review as a matter of urgency, so that they know how bad things are likely to be in years to come.
Review “Feel the Fear and Do It Anyway” for others as soon as possible.
Review “The Four Agreements” for others as soon as possible.
Continue to become increasingly immersed in the life story that you are creating to full effect.
Refer immediately to this book review for techniques when addressing any form of addictive behaviour.
Continue to encourage others to develop a consistent physical training programme as a matter of urgency, to curb all forms of addictive behaviour.
Create a video book review talking about digital drugs and the new digital drug-dealers (content creators).
Continue to create digital assets to leer others away from the new destructive digital drug-dealers.
Continue to be cautious of the judgement of others who have highly addictive habits.
Continue to be cautious of the judgement of others who are on highly addictive forms of medication.
Perfect your understanding of the pleasure-pain balance (seesaw).
Insert the pleasure-pain seesaw balance pictures into this book review (page 145).
Continue to strive to live the most spiritual life and reject the possible pursuit of pleasure.
Continue to abstain from things you find addictive until you return back to your true balanced baseline (not needing anything to feel normal).
Continue to ensure that you ignore the number of likes and views when opening Instagram in order to by-pass its built-in drug addiction mechanism.
Continue to practice detachment in order to experience true, and continued, internal peace.
Insert the dopamine abbreviation picture into this book review.
Continue to ensure that others are focused on carrying out deep work everyday (3 hour strategic blocks) to strengthen their brain’s prefrontal cortex and eradicate any addictive behaviour.
Remember that when dealing with people there will always be a drug at work or in play.
Remember that it will always be pointless overtraining (inducing pain) as it will stop the production of endorphins (pleasure).
Remember that it is radical honesty with self that allows a person to produce a powerful and truthful autobiography (hence Malcolm X).
Continue to acknowledge that the majority of people are addicted to something which will continue to blind their judgement.
Continue to ensure you maintain a sufficient amount of personal privacy to allow yourself room to continue growing and being your genuine self.
Stop making specific reference to Involgizers in a way that can be interpreted, unnecessarily, to exclude others.
Continue to explain to others that Involgize is being tested on a small sample in order to create something of high quality that they may later find valuable.
Consider writing a book about each Involgizer’s unique super-intelligence journey.
Continue to create digital assets that create systems for Involgizers to learn and transition in record time.
Acknowledge that Involgize’s cultishness is the key to its ability to be of true value to others (effectiveness).
Continue to assess and ensure that others are truly ready before being integrated into any wider Involgize group (play it safe, rather than sorry).

Smart Learning Points

(Elaboration)

This book mentions the key problem succinctly: “we are looking at our phones too much, eating too much, drinking too much. Our world is addicted to fleeting distracting pleasures that get us nowhere.” So one of the central challenges for Involgize is to be able to assist others to break these addictions quickly, and as effortlessly, as possible. It is something that, on reflection, we are already doing well by showing Involgizers how to plan their week, and dramatically increase their productivity (read “Eat That Frog”). That said, the question is how can we help them to do this more effortlessly in record time?

(a) Well for starters, we can place more emphasis on the importance of productivity than we are currently doing.

(b) I can look more into the best techniques and methods that are allowing people to break addictions quickly.

(c) I can draw attention to the problem of addiction early so that others are aware of the dangers in advance.

(d) We can continue to show others the things that we do everyday in order to function with the highest levels of discipline, focus, and consistency in spite of the addictive nature of social media and other stuff.
The importance of learning about how our brains work, and our potential capacity, from people who have severe addictions.
It seems that creating and living a balanced life is truly the key to being able to manage and control any form of addictive behaviour. With the reverse also being true. The failure to live with full engagement: train regularly every week, enjoy quiet and alone time everyday, consume spiritual knowledge daily, develop ourselves intellectually, and connect with others and a purpose bigger than ourselves consistently will inevitably result with us forming some form of addictive behaviour.
Probably the number 1 form of addictive behaviour that we are all going to experience and have to learn to manage will concern sex and masturbation. In fact, the way we successfully, or unsuccessfully, deal with our sexual desires will most likely, ultimately, determine what we can and cannot achieve in our lives. This is because it will determine if we can be sufficient focus and consistent every single day (the elephant in the room).
We will all have a… “problem of compulsive overconsumption that we all face… even when our lives are good.”
Keeping away the things that we find addictive is an important part of being able to prevent addiction (self-binding).
The fact that Fentanyl, a synthetic opioid, is fifty to one hundred times more potent than morphine absolutely blows my mind. I guess this is the reason why the addicts that I saw on Youtube in Philadelphia seem so possessed and unable to break free from the drug.
I found reading the life stories of severe addicts in this book absolutely unimaginable, as they are such the polar opposite of how I have been living. On reflection, this would seem to make perfect sense as my lifestyle makes any form of addictive behaviour almost impossible to maintain in the long-term (which may be a key insight).
The world now has digital drugs along with the rise of it specialised drug dealers (content creators). This state of affairs makes it even more essential that content creators (drug-dealers) are careful about what drugs they are feeding their audiences. Significantly, what addictive behaviours are the content creators creating and inspiring? As the rates of addiction are increasing the world over.
Significantly, “the poor and undereducated, especially those living in rich nations, are most susceptible to the problem of compulsive overconsumption.” Counter intuitively, however, the poor and undereducated in rich nations are also the most suitable candidates to become genius Involgizers. It is a classic example of the worse things become, then the more chance that we can come up with something radically innovative to change the status quo. That said, in the foreseeable future, it is highly likely that they will continue to suffer in a spiral that will continue to get worse and worse. In support, middle-aged white Americans without a college degree are now dying younger than their great-grandparents, grandparents, and parents.
Things have become so bad (2021) that people are running from any form of discomfort. They are deliberately distracted themselves with entertainment as they have lost the ability to tolerate even minor forms of pain. This would suggest that something like an Involgize community is needed now more than ever. In fact, not only is it needed. But it is likely to become one of the only things left that contains people who have not lost their judgement and critical thinking faculty to addictive behaviour. Those outside of its protective circle will eventually start to feed upon the ignorance and addictive behaviour of each other. In this respect, it is going to become more and more essential for groups to move in silence behind closed doors – admitting only those who have been deliberately transitioned into a higher state of consciousness. The majority of us simply have no idea what is coming. And for those of us who do, it is now time to establish the frameworks and continue with our preparations.
“For a rat in a box, chocolate increases the basal output of dopamine in the brain by 55 percent, sex by 100 percent, nicotine by 150 percent, and cocaine by 225 percent.” Wow… so, in theory, nicotine creates a high that is 50 percent stronger than having sex. Hmm? Very interesting. So, this would suggests that, those who smoke get more from smoking everyday than they would from having a sexual relationship. And does this make it more likely that they will tend to undervalue sexual intimacy, and be more likely to jump from sexual partner to sexual partner? Is the reverse also true: those who do not smoke are more likely to value (be affected by) being intimate with someone; so, are less likely to seek numerous sexual partners?
ADHD medication increasing the release of dopamine by 1000%. Hmm? I am wondering now what are the similar character traits of those I know that are on this type of prescription?
Every time we experience pleasure, we have a self-regulating mechanism (like a seesaw) that induces pain automatically in order to re-balance the pendulum or return us back to equilibrium. Therefore, the greater the pleasure we feel, the stronger the pain needed to balance us out. For me, this means that I have got to be very careful and sensitive to the feelings that I may cause others to feel.
Insert the seesaw pictures with the gremlins into your book review.
With repeat exposure to the same or similar pleasure stimulus our actual feelings of pleasure become weaker and shorter, as our gremlins of pain become bigger, faster, stronger, and last longer. This means that it is important to ration our exposure to pleasure so that we can sufficiently re-balance the seesaw. This will reset our pleasure and pain mechanism, allowing us to again feel the same high levels of pleasure from the same stimulus.
To reduce the amount of pain felt after experiencing great pleasure, it is important to ensure that we reduce or regulate the dose of pleasure that we expose ourselves to the next time round.
The pursuit of pleasure (Hedonism) for its own sake, will inevitably lead to the inability to enjoy pleasure of any kind (anhedonia).
“A pleasure-pain balance tilted to the side of pain is what drives people to relapse even after sustained periods of abstinence. When our balance is tilted to the pain side, we crave our drug just to feel normal (a level balance).” This is an extremely important point. If we are now experiencing greater pain than the pleasure that we previously enjoyed, then returning to the pleasurable stimulus will now make us just feel normal, rather than provide us with the initial heightened feeling. When we need the stimuli to now feel normal (balance out) that is a clear sign that we have become addicted. Therefore, in response, we should continue to regulate or reduce the dose of the pleasurable stimulus (return to our baseline homeostasis) until we no longer need it to balance out.
This text reveals that the addictive nature of social media relates to the uncertainty of whether the user will or will not get a like. Just like when gambling, a gambler is uncertain whether they will win or lose. If you get a like (you win), then you get a spike in dopamine. But if you get no or little likes, then you experience pain, and the cycle continues again. This is precisely the reason why I, deliberately, ignore the likes on Instagram for many days and weeks, blurring my vision every time I open the app, because it forces me to become psychologically detached from this pleasure and pain producing mechanism.
The brain changes (neuron pathways) from addiction are permanent, but the plasticity of brain means that we can create new neuron pathways that by-pass the previously changed areas with these new pathways becoming permanent also.
The downside of being an external pleasure seeker is that we will never be satisfied. Therefore, it is extremely important that we practice detachment if we want to experience true internal peace, and pleasurable experiences from carrying out very simple activities.
DOPAMINE stands for…

D = Data: how many days or hours is the activity taking up
O = Objective: what is the reason for the activity is it boredom, to have fun, to manage pain, etc.
P = Problems: high-dopamine drugs always lead to health, relationship, or moral problems.
A = Abstinence: abstinence is needed to restore the pleasure and pain baseline homeostasis (rebalance the seesaw), which typically takes about 4 weeks for the majority of the writer’s patients.
M = Mindfulness: mindfulness is simply the ability to observe what our brain is doing while it’s doing it, without judgment.
I = Insight: “… abstaining from our drug of choice for at least four weeks gives clarifying insight into our behaviours. Insight that simply is not possible while we continue to use.”
N = Next Step:This is where I ask my patients what they want to do after their month of abstinence.”
E = “This is where patients go back out into the world armed with a new dopamine set point (a level pleasure-pain balance) and a plan for how to maintain it.”
It has been the writer’s clinical experience that some people, especially those with a less severe form of addiction, can return to using the drug of their choice in a controlled way without adverse consequences.
It seems that I have successfully eradicated or removed many of the weaknesses, contained within the following statement, that still affect the average person … “Are we losing the knack of puzzling things out, or being frustrated while we search for the answer, or having to wait for the things we want?”
As a result of doing deep work, Involgizers will be developing the prefrontal cortex of their brains — the part of the brain involved in planning and abstract thinking. In the meantime, the majority of society appear to be in the process of damaging their prefrontal cortex in favour of strengthening their emotion and reward part of their brains. Consequently, it looks like the future for most people is going to become increasingly difficult.
When it comes to combating temptation or addictive behaviour, the cleverer we are at fooling or negotiating with ourselves (our emotions), and the greater self-awareness we possess (self-binding), then the more likely we will pass things like the marshmallow test.
Throughout my life, I have made the same observation that the writer has seen all through clinical practice: when a person is extremely well its shows by the way their skin and clothes seems to fit them. The reverse also being true. When a person’s skin and clothes are not well suited that is usually a clear indications that that individual is not in balance or harmony.
Self-binding is another way of saying ‘choosing to be spiritual in orientation’ in order to keep in check any potential addictive behaviours.
With ADHD drugs increasing dopamine production by 1000% form the baseline it is no wonder that it impairs the academic performance and social-emotional capacity of students in the long run.
Now it all makes more sense: cold showers or ice therapy treatment will cause the dopamine levels in the body to increase by hundreds of percent because it pushes down the on the pain side of the baseline seesaw. This, inevitably, causes the body to produce dopamine as a reflex in order to return the baseline to neutral. Therefore, the more pain, the more dopamine production (in theory).
Copy and insert into this book review the seesaw picture on page 145.
Dopamine that comes indirectly from the pain side reflex is potentially more enduring. Therefore, it may make strategic sense to always produce dopamine by self-binding spiritual practices. This is why we feel high after running, or feeling of gratitude after the pain of being sick. That said, the universe knows what it is doing, as pursuing pain is naturally harder than pursuing pleasure.
This book confirms that exercise is key to being able to curb addictive drug use: “In humans, high levels of physical activity in junior high, high school, and early adulthood predict lower levels of drug use. Exercise has also been shown to help those already addicted to stop or cut back.” In support, having a body is such an important part of the human experience that most avatars in video games always run, jump, fly, climb, and shoot.
Reminded that we can train our brains, over time, to develop a tolerance for any type of fear.
It was fascinating to learn that a running wheel is actually a drug (dopamine) inducing device as oppose to an instrument for a healthy lifestyle.
Essentially, when it comes to people, the things we do indicate that there is a drug in play, it just whether we realise this or not. Hence, apps are now a new form of (digital) narcotics.
“A study of skydivers compared to a control group (rowers) found that repeat skydivers were more likely to experience anhedonia, a lack of joy, in the rest of their lives.” This is a really important point. It seems that walking the spiritual path is totally the most superior way to live.
The writer makes the point that a clear sign that many people are addicted to extreme sports is that some require an incomprehensible amount of technological equipment to make it possible to perform. Again, this further makes the point that the spiritual way of life is probably the most sensical.
This book has enable me to acknowledge a very important fact about overtraining. When we overtrain, we will no longer enjoy the endorphin benefits of training because our bodies will stop producing them. So creating pain is one thing, but it crucial to gauge when we may be doing too much.
Doctors are incentivized to prescribe more medicines because their performance is measured by how much they have billed each month, hence the extent of the healthcare drug problem.
It is true, radical honesty with ourselves allows (leads) us to produce a powerful and truthful autobiography. It is such an unrecognised, but truly important, component.
I did not know that the prefrontal cortex is such an important area for storytelling. However, this would make perfect sense as we would not be expected to use the amygdala (part of the brain that perceives fear) to tell great stories. Does this suggest that all great storytellers have highly developed prefrontal cortexes I wonder?
Oxytocin (dopamine) is a hormone much involved with intimacy, falling in love, mother-child bonding, and lifetime pair bonding of sexual mates. You see, everything human do involves some sort of drug. It is just whether we realise this or not.
“Experiments show that a free rat will instinctively work to free another rat trapped inside a plastic bottle. But once that free rat has been allowed to self-administer heroin, it is no longer interested in helping out the caged rat, presumably too caught up in an opioid haze to care about a fellow member of its species.” I believed that this may be exactly what is going on with us on many levels. Those of us that are able to stand-by and acknowledge that others are suffering are, clearly, under the influence of some sort of drug that is numbing our natural responses (putting us out of our right minds).
“What I’m referring to is a kind of “disclosure porn” that has become prevalent in modern culture, where revealing intimate aspects of our lives becomes a way to manipulate others for a certain type of selfish gratification, rather than to foster intimacy through a moment of shared humanity.” This immediately makes me think of a few people that I know who have done, or do, this on instagram. How you can tell that it is off is because they, either, always appear to not fully acknowledge that they are actually true architects of their own stories, or they over share unnecessary graphic details of their bad experiences. Surely our future husband, wife, or partner to be, will not benefit from us laying out all of our dirty lining in public? In fact, it also puts those people on notice that anything that happens within their private relationship is also highly likely to be served up at some point for public consumption. So, surely, “no thank you” is the answer that such a person is likely to get to the request for a committed relationship.
“The antidote to a false self is an authentic self.” I do my best everyday to stay as true as I can to my authentic self. I guess this means staying out of public view as much as possible in order to give myself room to not fall into the trap of first becoming what others hope for or expect. Then having to maintain, falsely, what others thinks we should be because we did not cultivate space in their perception to actually be something or someone completely different. I like to think that I do not engage in social media exaggeration of any shape or form, but I suspect that I must do at least a little (hmm?).”
I like to think that I do not engage in any group activity that creates fear in others of being punished or abandoned or cast out as a form of punishment. Exploiting the terror of being cast out, shunned, no longer part of the herd. That said, it could be argued that Involgize has and does still produce this type of feeling in others. This is because the more that we create the sense of a unified community, then this reveals that there exists some sort of us and them divide. Which then naturally causes a person to wonder or question… (1) why they have been excluded, or have not been invited to be a part of it… and (2) whether there is something wrong with them. So, the question is how can I mitigate this with the truth? (1) Stop making specific reference to Involgizers directly within posts or videos. (2) Continuously make it clear that, at present, that Involgize is truthfully experimenting on a small sample of people with the intention of producing something for others later that contains the right quality.
This book suggests the utilisation of Prosocial Shame to pressure others to give up their addictions. I don’t know how I feel about that. I guess if the group consist of people who are naturally support and empathic whilst at the same time driven and focused, then the right balance or mix will be achieved between providing pressure and support. I further guess this is where I come in. I have to make sure that the learning environment (training ground, facilities, and management and coaching team) remains suitable and right for the continued growth of the star players (all those involved).
This book, overall, has revealed to me that telling Involgize stories about what happen to each Involgizer is definitely what any book about the intelligence movement should be about for sure. Especially as this is likely to keep most readers easily gripped and curious about what would happen to them if they were on the programme also.
On further reflection, Involgize already has a Prosocial Shame community, as we expect Involgizers to be focused and consistent with their reading, training, and planning every week. And it is truly predicated on the idea that we are all flawed, capable of making mistakes, and in need of forgiveness. In addition, we encourage adherence to group norms, without casting out every person who strays, with a post-shame “to-do” list that provides specific steps for making amends (just start reading and planning consistently again). Involgizers are allowed to fall off as a natural part of the intelligence process, as falling off strengthen their understanding of the power and difference that Involgizing makes to their lives.
Because Involgize has a requirement for members to be consistently reading to solve their problems, training to maintain their health, and planning to keep their lives under control, it is likely to be more successful than alternative groups that do not have any requirements or high expectations of members. In other words, similar to the criticism lobbed at AA, Involgize’s cultishness is the source of its effectiveness.
The knowledge in this book seems to confirm that we are taking the right approach when grouping Involgizers. First, we must assess if the person is truly open to learning and living via truth. Second, the person must be observed over a good period (without their knowledge) to determine exactly how they have been co-opted behind closed doors. Third, the person’s level of spiritual consciousness must be assessed to determine if or when they are likely to be ready for group integration. Fourth, if the person has any trapping of the mainstream system, then there has to be clear evidence of their transition (i.e. critical thinking books) before being integrated into the group to prevent any possible cross-contamination.
Straight from the psychiatrist’s mouth herself, who has been treating patients for more than 20 years, it all comes down to how well we “… immerse yourself fully in the life that you’ve been given.” It is as simply as that!
Any Involgizer who reads this book will be really thankful, as they will see how fortunate we all are to be Involgizing (getting stronger) in this “hypermedicated, overstimulated, pleasure-saturated world of today.”

Key Strategic Sentences and Paragraphs from ‘Dopamine Nation‘

“The New York Times bestselling psychology book on how to find contentment by keeping dopamine in check (Loc 76).”

“All around us people are looking at their phones too much, eating too much, drinking too much. Our world is addicted to fleeting distracting pleasures that get us nowhere. Dr Anna Lembke provides a clear way back to a balanced life (Loc 77).”

“Most importantly, it’s about how to find the delicate balance between the two, and why now more than ever finding balance is essential (Loc 80).”

“Dopamine Nation shows that the secret to finding balance is combining the science of desire with the wisdom of recovery (Loc 88).”

Introduction The Problem

“Scientists rely on dopamine as a kind of universal currency for measuring the addictive potential of any experience. The more dopamine in the brain’s reward pathway, the more addictive the experience (p 2).”

“Persons with severe addictions are among those contemporary prophets that we ignore to our own demise, for they show us who we truly are (p 2).”

PART I: The Pursuit of Pleasure

CHAPTER ONE: Our Masturbation Machines

“Through this method of micro-adjustments, Jacob was able to maintain a pre-orgasm state for hours. “This,” he said, nodding, “very addictive” (p 13).”

“Perhaps you are repulsed by Jacob’s masturbation machine, as I was when I first heard about it (p 13).”

“When I finished Twilight, I ripped through every vampire romance I could get my hands on, and then moved on to werewolves, fairies, witches, necromancers, time travelers, soothsayers, mind readers, fire wielders, fortune-tellers, gem workers . . . you get the idea. At some point, tame love stories no longer satisfied, so I searched out increasingly graphic and erotic renditions of the classic boy-meets-girl fantasy (p 14).”

“In short, I became a chain reader of formulaic erotic genre novels (p 15).”

“About a year into my new obsession with romance, I found myself up at 2:00 a.m. on a weeknight reading Fifty Shades of Grey. I rationalized it was a modern-day telling of Pride and Prejudice—right up until I got to the page on “butt plugs” and had a flash of insight that reading about sadomasochistic sex toys in the wee hours of the morning was not how I wanted to be spending my time (p 16).”

“Addiction broadly defined is the continued and compulsive consumption of a substance or behavior (gambling, gaming, sex) despite its harm to self and/or others (p 16).”

“What happened to me is trivial compared to the lives of those with overpowering addiction, but it speaks to the growing problem of compulsive overconsumption that we all face today, even when our lives are good (p 16).”

“Likewise, decreasing the supply of addictive substances decreases exposure and risk of addiction and related harms. A natural experiment in the last century to test and prove this hypothesis was Prohibition, a nationwide constitutional ban on the production, importation, transportation, and sale of alcoholic beverages in the United States from 1920 to 1933. Prohibition led to a sharp decrease in the number of Americans consuming and becoming addicted to alcohol. Rates of public drunkenness and alcohol-related liver disease decreased by half during this period in the absence of new remedies to treat addiction (p 19).”

“In 1805, the German Friedrich Sertürner, while working as a pharmacist’s apprentice, discovered the painkiller morphine—an opioid alkaloid ten times more potent than its precursor opium (p 21).”

“In an attempt to find a less addictive opioid painkiller to replace morphine, chemists came up with a brand-new compound, which they named “heroin” for heroisch, the German word for “courageous.” Heroin turned out to be two to five times more potent than morphine and gave way to the narcomania of the early 1900s (p 21).”

“Fentanyl, a synthetic opioid, is fifty to one hundred times more potent than morphine (p 21).”

“Today’s cannabis is five to ten times more potent than the cannabis of the 1960s and is available in cookies, cakes, brownies, gummy bears, blueberries, “pot tarts,” lozenges, oils, aromatics, tinctures, teas . . . the list is endless (p 22).”

“As you can see in his illustration, he started at age seventeen with alcohol, cigarettes, and cannabis (“Mary Jane”). By age eighteen, he was snorting cocaine. At age nineteen, he switched to OxyContin and Xanax. Through his twenties, he used Percocet, fentanyl, ketamine, LSD, PCP, DXM, and MXE, eventually landing on Opana, a pharmaceutical-grade opioid that led him to heroin, where he stayed until he came to see me at age thirty. In total, he went through fourteen different drugs in a little over a decade (p 22).”

“The world now offers a full complement of digital drugs that didn’t exist before, or if they did exist, they now exist on digital platforms that have exponentially increased their potency and availability. These include online pornography, gambling, and video games, to name a few (p 23).”

“At low volume, I feel nothing. At higher volume, it is painful. In between, I can orgasm from the sensation” (p 25).”

“The Internet promotes compulsive overconsumption not merely by providing increased access to drugs old and new, but also by suggesting behaviors that otherwise may never have occurred to us (p 27).”

“Rates of addiction are rising the world over. The disease burden attributed to alcohol and illicit drug addiction is 1.5 percent globally, and more than 5 percent in the United States (p 29).”

“The poor and undereducated, especially those living in rich nations, are most susceptible to the problem of compulsive overconsumption (p 29).”

“They have easy access to high-reward, high-potency, high-novelty drugs at the same time that they lack access to meaningful work, safe housing, quality education, affordable health care, and race and class equality before the law. This creates a dangerous nexus of addiction risk (p 29).”

“… middle-aged white Americans without a college degree are dying younger than their parents, grandparents, and great-grandparents (p 30).”

CHAPTER TWO: Running from Pain

“In 2012, enough opioids were prescribed for every American to have a bottle of pills, and opioid overdoses killed more Americans than guns or car accidents (p 39).”

“Beyond extreme examples of running from pain, we’ve lost the ability to tolerate even minor forms of discomfort. We’re constantly seeking to distract ourselves from the present moment, to be entertained (p 40).”

“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” (p 40).”

“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” (p 40).”

“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” (p 41).”

“used to justify continued use of pills. I’ve seen a similar paradox in many of my patients over the years: They use drugs, prescribed or otherwise, to compensate for a basic lack of self-care, then attribute the costs to a mental illness, thus necessitating the need for more drugs. Hence poisons become vitamins (p 43).”

“David was admitted to the inpatient psychiatric ward and diagnosed with stimulant and sedative addiction. He stayed in the hospital until he finished withdrawing from Adderall, Ambien, and Ativan, and until he was no longer suicidal. It took two weeks. He was discharged home to his pregnant wife (p 44).”

“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 (p 44).”

“The reason we’re all so miserable may be because we’re working so hard to avoid being miserable (p 46).”

CHAPTER THREE: The Pleasure-Pain Balance

“Neurotransmitters are like baseballs. The pitcher is the presynaptic neuron. The catcher is the postsynaptic neuron. The space between pitcher and catcher is the synaptic cleft. Just as the ball is thrown between pitcher and catcher, neurotransmitters bridge the distance between neurons: chemical messengers regulating electrical signals in the brain. There are many important neurotransmitters, but let’s focus on dopamine (p 47).”

“For a rat in a box, chocolate increases the basal output of dopamine in the brain by 55 percent, sex by 100 percent, nicotine by 150 percent, and cocaine by 225 percent (p 50).”

“Amphetamine, the active ingredient in the street drugs “speed,”“ice,” and “shabu” as well as in medications like Adderall that are used to treat attention deficit disorder, increases the release of dopamine by 1,000 percent (p 50).”

“Hence, every time the balance tips toward pleasure, powerful self-regulating mechanisms kick into action to bring it level again. These self-regulating mechanisms do not require conscious thought or an act of will. They just happen, like a reflex (p 51).”

“Any prolonged or repeated departures from hedonic or affective neutrality . . . have a cost.” That cost is an “after-reaction” that is opposite in value to the stimulus. Or as the old saying goes, What goes up must come down (p 52).”

“With repeated exposure to the same or similar pleasure stimulus, the initial deviation to the side of pleasure gets weaker and shorter and the after-response to the side of pain gets stronger and longer, a process scientists call neuroadaptation. That is, with repetition, our gremlins get bigger, faster, and more numerous, and we need more of our drug of choice to get the same effect (p 53).”

“Needing more of a substance to feel pleasure, or experiencing less pleasure at a given dose, is called tolerance. Tolerance is an important factor in the development of addiction (p 53).”

“What’s more, when these patients tapered off opioids, many of them experienced improvements in pain (p 55).”

“The paradox is that hedonism, the pursuit of pleasure for its own sake, leads to anhedonia, which is the inability to enjoy pleasure of any kind (p 57).”

“A pleasure-pain balance tilted to the side of pain is what drives people to relapse even after sustained periods of abstinence. When our balance is tilted to the pain side, we crave our drug just to feel normal (a level balance) (p 57).”

“The neuroscientist George Koob calls this phenomenon “dysphoria driven relapse,” wherein a return to using is driven not by the search for pleasure but by the desire to alleviate physical and psychological suffering of protracted withdrawal (p 57).”

“Here’s the good news. If we wait long enough, our brains (usually) readapt to the absence of the drug and we reestablish our baseline homeostasis: a level balance. Once our balance is level, we are again able to take pleasure in everyday, simple rewards. Going for a walk. Watching the sun rise. Enjoying a meal with friends (p 57).”

“Which is to say, if we get the expected reward, we get an even bigger spike. If we don’t get the expected reward, we experience an even bigger plunge (p 60).”

“My patients with gambling addiction have told me that while playing, a part of them wants to lose. The more they lose, the stronger the urge to continue gambling, and the stronger the rush when they win— a phenomenon described as “loss chasing” (p 62).”

“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 (p 62).

“The brain encodes long-term memories of reward and their associated cues by changing the shape and size of dopamine-producing neurons. For example, the dendrites, the branches off the neuron, become longer and more numerous in response to high-dopamine rewards. This process is called experience-dependent plasticity. These brain changes can last a lifetime and persist long after the drug is no longer available (p 62).”

“Here’s some good news. My colleague Edie Sullivan, a world expert on alcohol’s effects on the brain, has studied the process of recovery from addiction and discovered that although some brain changes due to addiction are irreversible, it is possible to detour around these damaged areas by creating new neural networks. This means that although the brain changes are permanent, we can find new synaptic pathways to create healthy behaviors (p 64).”

“… then used optogenetics— a biological technique that involves the use of light to control neurons—to reverse the synaptic brain changes caused by cocaine. Maybe someday optogenetics will be possible on human brains (p 64).”

“With prolonged and repeated exposure to pleasurable stimuli, our capacity to tolerate pain decreases, and our threshold for experiencing pleasure increases (p 66).”

“By raising our neural set point with repeated pleasures, we become endless strivers, never satisfied with what we have, always looking for more (p 67).”

“The net effect is that we now need more reward to feel pleasure, and less injury to feel pain. This recalibration is occurring not just at the level of the individual but also at the level of nations. Which invites the question: How do we survive and thrive in this new ecosystem? (p 67).”

PART II: Self-Binding

CHAPTER FOUR: Dopamine Fasting

“This is concerning on many levels, not the least of which is that daily use has been linked to addiction. For myself, I began to suspect I was teetering into the danger zone when reading romance novels started to take up hours a day and days at a time (p 73).”

“The o in DOPAMINE stands for objectives for using. Even seemingly irrational behavior is rooted in some personal logic. People use high-dopamine substances and behaviors for all kinds of reasons: to have fun, to fit in, to relieve boredom, to manage fear, anger, anxiety, insomnia, depression, inattention, pain, social phobia . . . the list goes on (p 73).”

“High-dopamine drugs always lead to problems. Health problems. Relationship problems. Moral problems. If not right away, then eventually (p 74).”

“Can I stop for a week?” she asked. “I’ve done that before.”“A week would be good, but in my experience, a month is usually the minimum amount of time it takes to reset the brain’s reward pathway (p 76).”

“Abstinence is necessary to restore homeostasis, and with it our ability to get pleasure from less potent rewards, as well as see the true cause and effect between our substance use and the way we’re feeling. To put it in terms of the pleasure-pain balance, fasting from dopamine allows sufficient time for the gremlins to hop off the balance and for the balance to go back to the level position (p 77).”

“Think back to the imaging study by neuroscientist Nora Volkow, showing that dopamine transmission is still below normal two weeks after quitting drugs. Her study is consistent with my clinical experience that two weeks of abstinence is not enough. At two weeks, patients are usually still experiencing withdrawal. They are still in a dopamine deficit state. On the other hand, four weeks is often sufficient (p 78).”

“Naturally I’ve seen patients who need less than four weeks to reset their reward pathway, and others who need far longer. Those who have been using more potent drugs in larger quantities for longer duration will typically need more time. Younger people recalibrate faster than older people, their brains being more plastic (p 79).”

“An ongoing controversy in the field of addiction medicine is whether people who have been using drugs in an addictive way can return to moderate, nonrisky use. For decades the wisdom of Alcoholics Anonymous dictated that abstinence is the only option for people with addiction (p 86).”

“But emerging evidence suggests that some people who have met criteria for addiction in the past, especially those with less severe forms of addiction, can return to using their drug of choice in a controlled way. In my clinical experience, this has been true (p 86).”

“Further, 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 (p 88).”

CHAPTER FIVE: Space, Time, and Meaning

“As this famous Greek myth illustrates, one form of self-binding is to create literal physical barriers and/or geographical distance between ourselves and our drug of choice (p 93).”

“One in four gastric bypass surgery recipients develops a new problem with alcohol addiction (p 99).”

“This study suggests that by restricting drug consumption to a narrow window of time, we may be able to moderate our use and avoid the compulsive and escalating consumption that comes with unlimited access (102).”

“Opioid-addicted study participants referred to a future that was on average nine days long. Healthy controls referred to a future that was on average 4.7 years long (p 103).”

“This striking difference illustrates how “temporal horizons” shrink when we’re under the sway of an addictive drug (p 104).”

“Are we losing the knack of puzzling things out, or being frustrated while we search for the answer, or having to wait for the things we want? (p 104),”

“They found that when participants chose immediate rewards, emotion-and reward-processing parts of the brain lit up. When participants delayed their reward, the prefrontal cortex— the part of the brain involved in planning and abstract thinking—became active (p 104).”

“The implication here is that we are all now vulnerable to prefrontal cortical atrophy as our reward pathway has become the dominant driver of our lives (p 105).”

“Ingestion of high-dopamine goods is not the only variable that influences delay discounting (p 105).”

“For example, those who grow up in resource-poor environments and are primed with mortality cues are more likely to value immediate rewards over delayed rewards compared to those who are similarly primed and grow up in resource-rich environments. Young Brazilians living in favelas (slums) discount future rewards more than age-matched university students (p 105).”

“The evolution of the gluten-free diet illustrates how attempts to control consumption are swiftly countered by modern market forces, just one more example of the challenges inherent in our dopamine economy (p 113).”

“The researchers discovered that of approximately one hundred children, one-third made it long enough to get the second marshmallow. Age was a major determinant: the older the child, the more able to delay (p 116).”

“The children “cover their eyes with their hands or turn around so that they can’t see the tray . . . start kicking the desk, or tug on their pigtails, or stroke the marshmallow as if it were a tiny stuffed animal” (p 116).”

“This metacognitive sleight of hand, transforming an object of temptation into a symbol of restraint, helped Jasmine abstain (p 116).”

“As soon as I laid eyes on him, I knew he was doing well. It was the way his clothes fit him, the way they hugged his body (p 117).”

“But it wasn’t just his clothes. His skin fit him too, the way it does when a person feels connected to themselves and the world (p 117).”

“As Immanuel Kant wrote in The Metaphysics of Morals, “When we realize that we are capable of this inner legislation, the (natural) man feels himself compelled to reverence for the moral man in his own person.” Binding ourselves is a way to be free (p 118).”

CHAPTER SIX: A Broken Balance?

“Perhaps it had something to do with being that poor kid from Arkansas (p 121).”

“As public health psychologist Gretchen LeFever Watson and her co-authors wrote in The ADHD Drug Abuse Crisis on American College Campuses, “Compelling new evidence indicates that ADHD drug treatment is associated with deterioration in academic and social-emotional functioning” (p 130).”

“But what if Kramer got it wrong? What if instead of making us better than well, psychotropic drugs make us other than well? (p 131).”

“Today, I’m finally okay with being a somewhat anxious, slightly depressed skeptic. I’m a person who needs friction, a challenge, something to work for or fight against. I won’t whittle myself down to fit the world. Should any of us? (p 132).”

“In medicating ourselves to adapt to the world, what kind of world are we settling for? Under the guise of treating pain and mental illness, are we rendering large segments of the population biochemically indifferent to intolerable circumstance? Worse yet, have psychotropic medications become a means of social control, especially of the poor, unemployed, and disenfranchised? (p 132).”

“The sci-fi movie Serenity (2005), directed by Joss Whedon, imagines a future world in which national leaders conduct a grand experiment: They inoculate an entire planet’s population against greed, sadness, anxiety, anger, despair in hopes of achieving a civilization of peace and harmony (p 136).”

PART III: The Pursuit of Pain

CHAPTER SEVEN: Pressing on the Pain Side

“Using blood samples, the researchers showed that plasma (blood) dopamine concentrations increased 250 percent, and plasma norepinephrine concentrations increased 530 percent as a result of cold-water immersion (p 142).”

“Michael’s accidental discovery of the benefits of ice-cold water immersion is an example of how pressing on the pain side of the balance can lead to its opposite— pleasure. Unlike pressing on the pleasure side, the dopamine that comes from pain is indirect and potentially more enduring. So how does it work? (p 144).”

“It’s not possible to read this experiment without feeling pity for the animals subjected to this torture. Yet the so-called “fit of joy” suggests a tantalizing possibility: By pressing on the pain side of the balance, might we achieve a more enduring source of pleasure? (p 147).”

“Perhaps like Socrates, you’ve noticed an improved mood after a period of being ill, or felt a runner’s high after exercise, or took inexplicable pleasure in a scary movie (p 148).”

“Just as pain is the price we pay for pleasure, so too is pleasure our reward for pain (p 148).”

“In humans, high levels of physical activity in junior high, high school, and early adulthood predict lower levels of drug use. Exercise has also been shown to help those already addicted to stop or cut back (p 151).”

“I sometimes wonder if our modern predilection for becoming addicted is fueled in part by the way drugs remind us that we still have bodies (p 151).”

“The most popular video games feature avatars that run, jump, climb, shoot, and fly (p 151).”

“A key to well-being is for us to get off the couch and move our real bodies, not our virtual ones (p 152).”

“But pursuing pain is harder than pursuing pleasure. It goes against our innate reflex to avoid pain and pursue pleasure. It adds to our cognitive load (p 152).”

“Pursuing pain instead of pleasure is also countercultural, going against all the feel-good messages that pervade so many aspects of modern life (p 152).”

“Once the “patient” had recovered from the second shock, Cerletti and Bini observed he “sat up of his own accord, looked about him calmly with a vague smile, as though asking what was expected of him. I asked him ‘what has been happening to you?’ He answered, with no more gibberish: ‘I don’t know, perhaps I have been asleep.’ The initial patient received thirteen more ECT treatments over two months and was, per report, discharged in complete recovery” (p 156).”

“The most likely explanation for Honnold’s brain differences is the development of tolerance to fear through neuroadaptation. My guess is that Honnold’s brain started out no different from the average brain in terms of fear sensitivity. What’s different now is that he has trained his brain through years of climbing not to react to fearful stimuli (p 159).”

“Of note, Honnold nearly had a panic attack when he went inside the fMRI machine to get pictures taken of his “fearless brain,” which also tells us that fear tolerance doesn’t necessarily translate across all experiences (p 160).”

“It turns out,” Rosenwasser said, “that running wheels are governed by the same endo-opioid, dopamine, endo-cannabinoid pathways that drive compulsive drug use. It’s important to know that running wheels are not necessarily a model for a healthy lifestyle” (p 162).”

“In short, running wheels are a drug (p 162).”

“In some cases, rats run until they die (p 163).”

“A study of skydivers compared to a control group (rowers) found that repeat skydivers were more likely to experience anhedonia, a lack of joy, in the rest of their lives (p 165).”

“Skydiving can be addictive and can lead to persistent dysphoria if engaged in repeatedly (p 165).”

“To accomplish this feat, he relied on the following technology and devices: lightweight, waterproof, heatproof clothing, “air-mesh” running shoes, a GPS satellite tracker, a GPS watch, an iPhone, hydration systems, electrolyte tablets, aluminum foldable trekking poles, “industrial water sprayers to simulate misting” (p 166).”

“In November 2017, Lewis Pugh swam a kilometer in – 3˚C (26˚F) water near Antarctica in nothing but his swimsuit. Getting there required travel by air and sea from Pugh’s native South Africa to South Georgia, a remote British island. As soon as Pugh was done swimming, his crew whisked him to a nearby ship, where he was immersed in hot water and where he remained for the next fifty minutes, to bring his core body temperature back to normal. Without this intervention, he surely would have died (p 166).”

“Overtraining syndrome” is a well-described but poorly understood condition among endurance athletes who train so much that they reach a point where exercise no longer produces the endorphins that were once so plentiful. Instead, exercise leaves them feeling depleted and dysphoric, as if their reward balance has maxed out and stopped working, similar to what we saw with my patient Chris and opioids (p 167).”

“Even in fields like medicine, health care providers see more patients, write more prescriptions, and perform more procedures, because they’re incentivized to do so. I get a monthly report on my productivity, as measured by how much I’ve billed on behalf of my institution (p 168).”

“If we consume too much pain, or in too potent a form, we run the risk of compulsive, destructive overconsumption (p 170).”

“But if we consume just the right amount, “inhibiting great pain with little pain,” we discover the path to hormetic healing, and maybe even the occasional “fit of joy” (p 170).”

CHAPTER EIGHT: Radical Honesty

“First, radical honesty promotes awareness of our actions. Second, it fosters intimate human connections. Third, it leads to a truthful autobiography, which holds us accountable not just to our present but also to our future selves. Further, telling the truth is contagious, and might even prevent the development of future addiction (p 176).”

“The prefrontal cortex is the frontmost part of our brain, just behind the forehead, and is involved in decision-making, emotion regulation, and future planning, among many other complex processes. It’s also a key area involved in storytelling (p 178).”

“In fact, the opposite happens. People come closer. They see in our brokenness their own vulnerability and humanity. They are reassured that they are not alone in their doubts, fears, and weaknesses (p 182).”

“Intimacy is its own source of dopamine. Oxytocin, a hormone much involved with falling in love, mother-child bonding, and lifetime pair bonding of sexual mates, binds to receptors on the dopamine-secreting neurons in the brain’s reward pathway and enhances the firing of the reward-circuit tract. In other words, oxytocin leads to an increase in brain dopamine, a recent finding by Stanford neuroscientists Lin Hung, Rob Malenka, and their colleagues (p 183).”

“After his honest disclosure to his wife, followed by her expression of warmth and empathy, Jacob probably experienced a spike in oxytocin and dopamine in his reward pathway, encouraging him to do it again (p 184).”

“Experiments show that a free rat will instinctively work to free another rat trapped inside a plastic bottle. But once that free rat has been allowed to self-administer heroin, it is no longer interested in helping out the caged rat, presumably too caught up in an opioid haze to care about a fellow member of its species (p 184).”

“What I’m referring to is a kind of “disclosure porn” that has become prevalent in modern culture, where revealing intimate aspects of our lives becomes a way to manipulate others for a certain type of selfish gratification rather than to foster intimacy through a moment of shared humanity (p 184).”

“I hope my disclosures here, my own and those my patients have given me permission to share, never stray to the wrong side of that line (p 186).”

“In more than twenty years as a psychiatrist listening to tens of thousands of patient stories, I have become convinced that the way we tell our personal stories is a marker and predictor of mental health (p 186).”

“In his online life, my patient Tony, a young man in his twenties, ran every morning to take in the sunrise, spent the day engaged in constructive and ambitious artistic endeavors, and was the recipient of numerous awards. In his real life, he could barely get out of bed, compulsively looked at pornography online, struggled to find gainful employment, and was isolated, depressed, and suicidal (p 191).”

“The antidote to the false self is the authentic self (p 192).”

“I’ve seen husbands who stop drinking followed by wives who stop having affairs (p 193).”

“Social media exaggeration and “post-truth” politics (let’s call it what it is, lying) amplify our sense of scarcity. The result is that even amidst plenty, we feel impoverished (p 196).”

CHAPTER NINE: Prosocial Shame

“The terror of abandonment, its own form of punishment, is especially potent. It is the terror of being cast out, shunned, no longer part of the herd (p 208).”

“If others respond by holding us closer and providing clear guidance for redemption/recovery, we enter the cycle of prosocial shame. Prosocial shame mitigates the emotional experience of shame and helps us stop or reduce the shameful behavior (p 208).”

“During this time, she used food, pills, alcohol, cannabis, whatever she could get to escape from herself. In a typical day, she would eat a bowl of ice cream for breakfast, snack through work, and take an Ambien as soon as she got home (p 212).”

“Prosocial shame is further predicated on the idea that we are all flawed, capable of making mistakes, and in need of forgiveness. The key to encouraging adherence to group norms, without casting out every person who strays, is to have a post-shame “to-do” list that provides specific steps for making amends. This is what AA does with its 12 Steps (p 216).”

“The prosocial shame cycle goes like this: Overconsumption leads to shame, which demands radical honesty and leads not to shunning, as we saw with destructive shame, but to acceptance and empathy, coupled with a set of required actions to make amends. The result is increased belonging and decreased consumption (p 217).”

“You might think that religious organizations and other social groups that are more relaxed, with fewer rules and strictures, would attract a larger group of followers. Not so. “Stricter churches” achieve a larger following and are generally more successful than freewheeling ones because they ferret out free riders and offer more robust club goods (p 221).”

“AA and other 12 Step groups have been maligned as “cults” or organizations in which people trade their addiction to alcohol and/or drugs to an addiction to the group. These criticisms fail to appreciate that the strictness of the organization, its cultishness, may be the very source of its effectiveness (p 221).”

“Similarly, there are situations in which members of a group benefit, but they harm those outside the group, such as various entities today who use social media to spread falsehoods (p 223).”

“Many of these rules seem excessive and gratuitous, but when viewed through the lens of utility-maximizing principles to strengthen participation, reduce free riding, and augment club goods, they make sense. And kids flock to this team in particular, seeming to love the strictness, even as they complain about it (p 228).”

Conclusion Lessons of the Balance

“I urge you to find a way to immerse yourself fully in the life that you’ve been given (p 233).”

“Here we are at the end, but it could be just the beginning of a new way of approaching the hypermedicated, overstimulated, pleasure-saturated world of today (p 234).”