The drugification of everything

There’s a weird molecule in your brain. It makes you feel good, makes you look smart whenever you utter its name, and is also responsible for ripping apart families and the fabric of society. It’s gotta be the most destructive molecule known to mankind—more destructive than uranium and plutonium.

Any guesses?

I am talking about dopamine.

It’s the most famous and sexiest molecule ever. Neuropsychologist Vaughan Bell called it the “Kardashian of neurotransmitters.” If you’ve been reading this blog, you may have noticed that it’s filled with regrets about not reading all the books I want to. Another book that I’ve been wanting to read for a long time but is cursed by my tsundoku is Dopamine Nation by psychiatrist Dr. Anna Lembke. One of her videos popped up in my YouTube feed—see, algorithms are not all bad—and I’ve been bingeing on her videos and podcasts all week.

Dopamine is a term that gets thrown around a lot, but very few people understand what it is. It’s the Stephen Hawking book of words—everybody buys his books, but nobody reads them.

Since I’ve heard Anna Lembke’s podcasts, I’m obviously an expert on dopamine. I’m just two PDFs away from being a neuroscientist on the internet. Like, apart from the fact that actual neuroscientists study for a decade, do research, and cut open actual brains, there’s no difference between what I know from listening to podcasts and them. Ok, coming back to dopamine. To understand this mysterious chemical, you need to learn a little bit about the brain. Lucky for you, I’m a neuroscientist.

Neurons, or nerve cells, are the fundamental building blocks of our brains. They are like messengers that are responsible for processing and transmitting information through the body. The way they send biological WhatsApp messages is through electrical and chemical signals. They constantly text various parts of the body to ensure all bodily actions happen on time so that we don’t die. If you are on the LinkedIn website building your professional network and you suddenly and involuntarily pee in your pants, as has happened to many of us, it wasn’t you—it was your incompetent neurons.

Neurons have a gap between them called a synapse. As you can imagine, two neurons can’t communicate with each other if there’s a gap. As far as we know, we don’t have an endogenous neural WiFi network. This is where neurotransmitters come in. They are chemicals that our brain produces to help neurons talk to each other—think of them as ChemFi. Dopamine is one such neurotransmitter. Groovy stuff, right?

As soon as I heard one video of Dr. Lembke, I was hooked. Over the course of the week, I listened to several of her conversations, and she’s brilliant. I figured I might as well share a few ideas I picked up from listening to Dr. Lembke:”

Dopamine isn’t just about pleasure; it keeps us alive

Most people assume that dopamine is only pleasure, but that’s like saying the sun is just a dumb, giant ball of fire. You’re not entirely wrong, but you’re not entirely right either. Dopamine is much more complex than just pleasure and reward.

If you think about it, as humans evolved over thousands of years, the primary imperative was survival. That means we are hardwired to avoid pain and seek pleasure. Dopamine is the chemical that modulates this behavior.

Dr. Lembke cited a famous study in this talk that illustrates my point:

There’s a very famous experiment where scientists engineered a rat to have no dopamine, and what they discovered was that when they put food into the rat’s mouth, it ate the food and seemed to get pleasure from eating and swallowed the food. But if they put that food even a single body length away, the rat would starve to death, so it wasn’t motivated to get up and go get the food, suggesting indeed that dopamine has this fairly fundamental role not just in the experience of pleasure.

Perhaps dopamine’s most important function is motivation. To get a reward or to feel pleasure, we need to perform certain actions, and dopamine is the catalyst. Dopamine is also linked to movement because rewards require people to move and do things. The abominable Parkinson’s disease is caused by the degeneration of dopamine-producing neurons in a brain region called the substantia nigra. As dopamine production reduces, people with Parkinson’s experience tremors, rigidity, and mobility issues.

You can’t get addicted to dopamine

If you had a rupee for every time you used the phrase “addicted to dopamine hit” or heard other people use it, you’d be rich enough to buy a penthouse suite in Bandra, Mumbai. Dopamine is a chemical naturally produced in the brain, and in a way, it keeps us alive. Our brains naturally produce dopamine at a baseline level:

We’re always releasing dopamine at baseline tonic levels in the brain. It’s kind of like the heartbeat of the brain, and it’s the fluctuations in dopamine firing, either above baseline or below baseline, which influence how we feel, whether or not we’re motivated to do that thing again.

Pleasure and pain are joined at the hip

The same parts of the brain that process pleasure also process pain, and our brains like balance. The brain prefers this balanced state called homeostasis—neither too much pain nor too much pleasure. So whenever you experience pleasure, there’s a price to be paid, and you experience an equal and opposite amount of pain. This is why you feel hungover after getting drunk. Think of pain and pleasure as a see-saw.

The fascinating thing I learned is that whenever we do something pleasurable, such as eating a piece of chocolate, the dopamine levels in our brains spike above baseline. However, what’s interesting is that these dopamine levels don’t return to baseline levels after we finish eating the chocolate. Instead, our brain attempts to restore homeostasis by reducing dopamine production, resulting in a state of dopamine deficit.

Remember, there’s an equal and opposite reaction to pleasure, and this is how pain manifests—in the form of craving. If you don’t feed your cravings, they eventually subside, and dopamine is restored to baseline levels.

But if you give in to your craving and continue eating chocolate, you are increasing the amount of pain you will experience in the future. This is because as long as you continue eating chocolates, dopamine levels will remain high, which your brain dislikes. If you stop eating, you enter a dopamine deficit state because the brain has to reduce dopamine production and bring it back to normal levels. This is why people experience addiction in a dopamine-deficient state. If you don’t continue eating chocolates, you will feel terrible.

The scary part is that once you are in a dopamine deficit state, even if you eat chocolate, you don’t feel pleasure; you just stop feeling pain. In other words, you have to increase the amount of chocolate you eat to experience pleasure. Replace chocolate with cocaine, and this example immediately becomes clear. A drug addict would need to continue increasing the dose just to get the same high because the pain side of the equation keeps increasing in the opposite direction.

Anna Lembke: With repeated use of the same or similar reinforcing substances and behaviors, we eventually end up in this kind of dopamine deficit state. Now we need more of our drug and more frequent doses over time, not to get high, but just to feel normal and stop the craving. This is exactly why people with severe addiction will relapse even weeks after they’ve stopped using, even though they can objectively tell you, “Yes, my life is much better because I’m not using, and my spouse is back, and my job is back, and from a physical health point of view, I’m doing better.” But mentally, many of them are still struggling with those universal symptoms of that dopamine deficit state, which are anxiety, irritability, insomnia, depression, and craving..

Anything can be addictive and anyone can get addicted

Addiction doesn’t discriminate against anyone. Dr. Lembke herself, a renowned psychiatrist who treats people struggling with addiction, was addicted to romance novels. It started with Twilight novels, and then she lost control:

Anna Lembke: Well, it’s always a little embarrassing as these things are. But in my early 40s, I did develop a kind of compulsive attachment, which I think you could fairly call a mild addiction to romance novels. So it started with the Twilight Saga, you might think of The Twilight Saga as my gateway drug. And then I got a Kindle, which was akin to my hypodermic syringe. And it escalated from there over the course of about two years, to what I consider to be a kind of socially sanctioned addiction to erotica, or, you know, pornography for women, if I could phrase it like that. To the point where I was habitually staying up very late at night, reading romance novels.
As soon as I would finish one book, in fact, before I would actually finish it, once I got three quarters of the way through to the climax, I wouldn’t even finish it, I would already be on Amazon looking for the next book. To the point where I was often groggy in the morning, exhausted on my way to work, not fully able to be present for my patients, or my children or my husband.
Several nadir’s in the course of my compulsive behaviours, were, at one point, I did bring a book to work and found myself in the 10 minutes between patients, just wanting to escape and read that book. Once I went to a social event with another family, and found a room where I could read in the middle of the social event.

Addiction isn’t just about substances; behaviors can be addictive as well. Anything from eating, Instagram, shopping, pornography, seeking attention, exercising, and even drinking water:

So I’ve seen one case of that in my career. It was actually very sad. It was a woman with a very severe alcohol addiction who got into recovery from her alcohol addiction. That is to say, she was no longer consuming alcohol, she was actively working on her health. But somehow or another, she discovered that if she drank water in copious amounts, she could feel altered, and she got addicted to that process. She had several very severe episodes of hyponatremia and almost died from those episodes. — Rewiring Your Dopamine Systems with Neil deGrasse Tyson and Anna Lembke

Addiction is a biopsychosocial disease. Biological, psychological, and social factors all play significant roles in influencing addiction. It’s not just an individual thing; factors such as genetics, personality, social situation, and environment can all influence one’s propensity for addiction.

Like, I think we’re all gonna get addicted to something because now that special key that works for each of our individual locks, it’s out there somewhere and the worldwide web will allow us to find it. Having said that, it is true that people bring different degrees of vulnerability to the process of addiction.
We do know that about 50-60% of the risk of becoming addicted is genetic. That’s based on family studies, showing that if you have a biological parent or grandparent addicted to alcohol, you are at increased risk of becoming an alcoholic yourself, even if you’re raised outside of the alcoholic home, in a non-using home. So, that’s powerful genetics.
It’s polygenic, it’s complex, we don’t fully understand it. It’s thought to be related to things like impulse control, ability to delay gratification, emotional dysregulation. But, you know, we don’t really know what it is.
Other risk factors include co-occurring psychiatric disorders. People with psychiatric disorders are more likely to develop an addiction, and also how you were raised. If you had a traumatic experience, as we’ve talked about, that puts you at risk. If you have parents who have explicitly or implicitly condoned substance use, either for recreation or as a coping strategy, that puts you at risk. Things like poverty, unemployment, that puts you at risk.
So there are lots and lots of risk factors, but I think that the major risk factor in the modern world and one which is generally ignored, is simple access. If you have access to a drug, you are more likely to try it and more likely to get addicted to it. And now, as we’ve talked about, we live in a world of virtually infinite access.

I’m still learning the nuances of addiction, and I will write about it in future posts.

One of my favorite metaphors that Dr. Anna used was the “drugification” of everything, and that’s so apt. We live in a society where the potency of everything, from food and drugs to content, entertainment, and even leisure, has been amplified. The goal of every corporation is to stimulate our brains to ejaculate the maximum amount of dopamine and keep us coming back for more. The incentive of late-stage capitalism is to turn us into compulsive consumers

Everything is just so readily available now, and it’s never been harder not to get hooked on something. It’s a weird paradox that abundance has become a curse.

Adel: The fact that evolutionarily we’ve had a system that’s got us to the point that we are at now because of our adaptability to avoid pain.
Anna Lembke: That’s exactly right.
Adel: But now we’re in a completely different context.
Anna Lembke: That’s right.
Anna Lembke: And so it is this mismatch between the ancient wiring, which was really intended for a world of scarcity, and the world that we live in now, which is a world of dopamine overload or overwhelming overabundance, in which almost every aspect of our lives, from the food we eat to the games we play, has been drugified in some way. And when I say drugified, I mean it’s been made more potent, so it releases more dopamine hypothetically than other types of reinforcers. It’s more abundant, meaning that there’s kind of no natural stopping point because it doesn’t run out.
It’s more accessible, and one of the biggest risk factors for addiction is simple access to that drug. And finally, it’s more novel, right? So what we figured out how to do is overcome tolerance to these drugs. Once we acquire tolerance, by, for example, combining two drugs together to make a more potent form of the original drug.
Adel: Yeah, everything you talk about, I can’t help but think about social media on the iPhone, yeah? And in regards to accessibility, right? If that’s a rule of thumb, can you imagine how accessible, and we’re thinking about social media as a drug, right? How accessible is social media? It’s like the most accessible drug, right?
Anna Lembke: Exactly. And I know, you know, in clinical practice, it really was starting in 2001 when the smartphone was invented that we started to see more and more patients coming in with life-threatening pornography addictions, gambling addictions, and then later, video game addiction, social media addiction, shopping addiction, all of these things that were really made possible by the 24/7 mobile access to the internet afforded by the smartphone.

Say no!

There are debilitating addictions to drugs and alcohol that require medical interventions, but for the vast majority of us, our addictions aren’t that serious. The most common addictions outside of drugs, tobacco, and alcohol are probably our dependence on digital devices, social media, shopping, gambling, and work. Social media is particularly pernicious because using platforms like Instagram, Twitter, and Facebook activates the same parts of the brain as drugs and alcohol. Being on social media is akin to snorting cocaine.

Before you can fix a problem, you must first acknowledge that there’s a problem. If you are oblivious to your addictions, then you don’t have a problem. Then comes acceptance. This is the hard part because we, as humans, possess the dangerous ability to rationalize anything, from bingeing on burgers to committing genocides.

“Man is not a rational animal; he is a rationalizing animal.”
―Robert A. Heinlein

While accepting a problem sounds nice in theory, it’s complicated in practice. There’s no bright line that separates addictive and non-addictive behavior, and the intensity of addictive behavior differs between individuals. According to Dr. Lembke, often the only way to determine if we have a problem is to abstain from the activity for a period of time, such as a month.

If you’re smart enough to figure out and accept that you have a problem, Dr. Lembke recommends the deceptively simple practice of dopamine fasting. This is all the rage these days, thanks to Silicon Valley bros and health podcasters, but the idea is simple: stop taking the drug that you like for 30 days.

Why 30 days?

According to Dr. Lembke, a month is the average time it takes for the brain to reset the dopamine pathways back to normal. In other words, your brain goes from a state of dopamine deficit to baseline. Dr. Lembke notes that, apart from people with serious addictions requiring medical interventions, most of her patients start feeling better after 30 days.

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