Motivated by Dopamine

As we learn more about the neurobiological nature of addiction, dopamine has emerged as a central character, but its effects can be modulated.

I recently read Anna Lembke’s book Dopamine Nation: Finding Balance in an Age of Indulgence – a fascinating and engaging read. I highly recommend it. Dr. Lembke is a physician and the Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University. Needless to say, she’s got lots of experience working with people who had addictions that have adversely impacted their lives.

Right out of the gate, the book hooks the reader by introducing a middle-aged man who’s addicted to using a masturbation machine. I want you to read the book, so I won’t reveal too much about his story or the many other deeply personal stories that Dr. Lembke recounts (with gentleness and affection) — including her own compulsive habit of reading romance novels as a form of escape. In choosing that story to lead off her book and not a story about habitual substance use, Dr. Lembke makes clear that addiction is not (solely) about drug seeking and “getting high.” It can be any behavior that provides pleasure but, just as importantly, soothes pain. We all engage in pleasure-seeking behaviors. Heck, I’m writing this essay because I find it pleasurable, intellectually stimulating, and therapeutic. And when people provide me with positive feedback about my writings, I get a little rush of affirmation.

Technically speaking, dopamine is the “motivation” neurotransmitter. When we have a dopamine deficiency, we experience wanting and craving. Or, if it is prolonged, apathy and emotional numbness. When our brains receive hits of dopamine, it’s rewarding – reinforcing the desire to do it again. In educational psychology, behaviorists talk about how the desire for rewards (pleasure) and the avoidance of punishments (pain) motivate our behavior. And by repeatedly rewarding certain “desirable” behaviors (so-called “conditioning”), these behaviors become habituated and automatic.

We all have habits – things we do with regularity without much conscious thought. Morning routines. The route we take when driving to work. The particular ways we fold our laundry. Habituated behavior only becomes problematic when it negatively impacts relationships/social functioning, employment, or health. And it becomes even more psychologically challenging when we feel compelled to continue engaging in the habituated behavior despite knowing that it’s detrimental to our lives. But let’s face it. Once we’ve developed a habit, re-wiring our brains is hard, especially if we’ve engaged in the behaviors for many years.

Dr. Lembke describes why we are prone to addiction. Evolution has selected those who are adept at seeking pleasure and avoiding pain. During times of scarcity, our brains are sending us signals and motivating our behavior! Those who aren’t motivated to satisfy their basic needs (food, water, shelter, sex to ensure procreation) don’t live long enough to contribute to our gene pool. And we are hard-wired to avoid perceived dangers and potential sources of pain. So, we constantly strive to engage in things we perceive as pleasurable and avoid things that are painful. Works great when we don’t have enough to meet our essential biological needs and our lives are routinely threatened by eminent dangers. But this doesn’t work so well when we have perpetual abundance. We quickly adapt, our expectations change (hedonic adaption), and we continue to strive for more … and more.

Our expectations are a powerful driving force! When our expectations aren’t met, the experience feels like pain. I’m sure you’ve noticed.

Expectation is the root of all heartache.
-William Shakespeare

We might have otherwise been delighted or happy, but because our expectations weren’t met, the experience was unsatisfying. And our expectations get greater and greater with each experience. And the experiences become commonplace to us because the brain gets rewired. We hardly notice what a miracle it is to eat kiwi fruit from New Zealand … or live in perfectly climate-controlled homes! We are constantly striving to satisfy our increasing needs and desires (because we’ve grown to expect more and more), and when those expectations are not met, we actually feel displeasure (pain). What was a pleasurable experience BEFORE is no longer enough. Our set point has changed. When the new threshold is not achieved, we actually feel pain. The only way to reverse these neurobiological adaptations is to withhold or withdraw the experience for a prolonged period of time.

Dr. Lembke depicts this problem as a see-saw that she calls the “pleasure-pain” balance. When we indulge in our pleasures, we initially tip the balance toward pleasure (satiated state), but if we continue to indulge in our pleasures repeatedly, our brain begins to adapt to high levels of dopamine by down-regulating the dopamine receptors in our brain. Under these new conditions, even a “normal” (baseline) amount of dopamine is now perceived as unpleasant (aka pain) and leads to wanting and craving.

The Stoics of ancient Greece understood the problem quite well — that excessive pleasure leads to pain and hinders our ability to think clearly, preventing us from acting with reason. When we are ruled by our desire for pleasure, we become impulsive, seeking short-term gratification, and this pushes us away from a life of virtue and wisdom. Thus, temperance is among the four essential virtues that Stoics espoused. They would regularly withhold worldly pleasures to modulate their desires and expectations. To test themselves.

Here’s a lesson to test your mind’s mettle: take part of a week in which you have only the most meager and cheap food, dress in shabby clothes, and ask yourself if this is really the worst that you feared.
— Seneca, Moral Letters, 18.5-6

Dr. Lembke suggests that we are all prone to compulsive overindulgence. There are no easy ways to thwart this tendency. It’s not simply about “willpower.” Rather, it requires that we purposely create new habits (both thoughts and behaviors) intended to rebalance the pleasure and pain thresholds.

Here is a very accessible and entertaining video by Dr. Lembke about the key ideas from her book.

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