Book Review: Dopamine Nation: Finding Balance in the Age of Indulgence by Anna Lembke, MD

Anna Lembke, MD, is the medical director of Stanford [University] Addiction Medicine, program director for the Stanford Addiction Medicine Fellowship, and chief of the Dual Diagnosis Clinic. Her previous book, Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, And Why It's So Hard To Stop, is widely considered one of the best and most comprehensive books regarding the opioid crisis. She has won many awards as well as published several papers in prestigious journals. Her newest book, Dopamine Nation: Finding Balance in the Age of Indulgence, is about how our current world has set us up to all be addicts, which in turn is destroying our planet and our ability to experience joy. "Our compulsive overconsumption risks not just our demise but also that of our planet. The world's natural resources are rapidly diminishing. Economists estimate that in 2040 the world's natural capital (land, forests, fisheries, fuels) will be 21 percent less in high-income countries and 17 percent less in poorer countries than today. Meanwhile, carbon emissions will grow by 7 percent in high-income countries and 44 percent in the rest of the world. We are devouring ourselves." (p.30, Dopamine Nation, Lembke, 2021)

The book is divided into three sections. Section one tackles addiction's societal, personal, and neurological factors, ranging from a driving need to be entertained, easy access to anything we desire, and intolerance for being uncomfortable. Her observations on our current world and how our prehistoric brains are struggling with this age of ultra-plenty are convincing and insightful. She is compassionate and nonjudgmental when writing about her patients' personal stories of addiction. However, what makes section one a gripping powerhouse is her neurological explanation of addiction and how we can get just as addicted to video games as alcohol. The root of addiction is not the behavior or chemical substance rather the dopamine reward system in our brains. She breaks down the science in startling clarity. Part One of Dopamine Nation is so good that alone is worth buying the book. It's also a section well worth returning to for a second read.

Section Two of Dopamine Nation covers what Dr. Lembke refers to as Self-Binding. Self-binding is all about either quitting an addiction we have or at least cutting down on our usage. Self-binding is essentially various strategies we can use to stop using or only use in moderation. The point Dr. Lembke makes very clear throughout the book is that A. our society has turned us all into addicts (though in varying degrees and ways) and that B. all addictions are the same as far as our brains are concerned. It is a crucial point, as it instantly removes us from othering traditional addicts (alcohol, drugs, sex, gambling). Her self-binding tips were helpful, though at times were a little obvious. The best was the 30-day dopamine cleanse, where you quit a behavior, food, or anything you are addicted to for 30 days. After the cleanse, you can then decide whether or not to quit or use in moderation. She assures us that we can return our brains to balance most of the time after 30 days of abstinence. The science and her writing are encouraging and convincing.

Part Three, The Pursuit of Pain, is by far the weakest section in the book. It almost read like a rough draft—it was as if her editor took a job elsewhere, and there wasn't time to assign a new editor. I often would read a paragraph and feel like it should have been placed in a section a few pages back. The third section deals with three key elements: the pros and cons of using pain as a path to dopamine balance, the importance of radical honesty (her term), and prosocial shame (her term) versus toxic shame. While the third section lacks some of the incredible storytelling and cohesion found in the other two sections, it is still filled with moving patient stories, interesting science, and an overall feeling that quitting an addiction is worth doing, not as impossible as you would think, and that the brain can with effort heal and return to balance.

"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 distance ourselves from ourselves. Yet all of this trying to insulate ourselves from pain seems only to have made our pain worse." (p.44, Dopamine Nation, Lembke, 2021)

Dopamine Nation: Finding Balance in the Age of Indulgence by Dr. Anna Lembke is a book, I believe, that is desperately needed in our current world. It is unique in its readability (it was a page-turner and very difficult to put down), accessible science, and nonjudgmental treatment of addiction. It was also unique because she cast addiction as a broader societal problem that affects all of us.

From a dialogue between Dr. Lembke and a patient: "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 allow ourselves to be within our lived experience." (p.41, Dopamine Nation, Lembke, 2021)

Dopamine Nation: Finding Balance in the Age of Indulgence

Author: Anna Lembke, MD

Publisher: Dutton

304 Pages

August 24, 2021

U.S. $28.00 CAN $37.00

If you are interested in checking out Dopamine Nation for yourself, you can find it on Amazon here.

Jennifer Barnick is a painter and writer. She studied painting at the San Francisco Art Institute. She founded Twenty-two Twenty-eight. “One of the most exciting aspects of Twenty-two Twenty-eight is building a channel for artists and writers to share their work with the world.” You can follow Jennifer on her Instagram here.

Check out Jennifer’s book. You can read the first short story for free on Amazon here.