Summary to start/overview.
Dopamine Nation (2021) uses clinical stories and case studies as a segue to more empirical and meta-studies on our neurological pleasure-pain balance, which is physical/biochemical, and the ease of access to dopamine generating activities and substances that have thrown us into imbalance. We have more dopamine-inducing stimuli than ever – sex, drugs, smartphones, shopping… social media. The chapters build to explain how we are off balance and can achieve a healthy balance. Our compulsive over-consumption has not only led to increased psychological suffering; we are literally consuming ourselves to death. 70% of global deaths are attributable to modifiable behavioral risk factors (smoking, physical inactivity, diet, depression). And the pharmaceuticals that we try to use to fill those gaps only make it worse. Holistic approaches, allowing yourself some discomfort and knowing that is ok and part of the human experience, cold showers, outdoor walks, and other healthier hacks to get the pleasure-pain balanced are far healthier.
CH 1. Masturbation Machine Story of a guy's addiction so severe that he literally created his own masturbation machines, that case is a segue to the author's addiction to erotic fantasy.. on to... "Addiction broadly defined is the continued and compulsive consumption of a substance or behavior (gambling, gaming, social media, sex) despite its harm to self and/or others."
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." Under recognized benefit of prohibition..
In the 1990s, the percentage of Americans who drank alcohol increased by almost 50 percent, while high-risk drinking increased by 15 percent. Between 2002 and 2013, diagnosable alcohol addiction rose by 50 percent in older adults (over age sixty-five) and 84 percent in women, two demographic groups who had previously been relatively immune to this problem.
Dopamine economy is limbic capitalism.
CH 2 running from pain
"These brochures (numerous ones found in a waiting room at Stanford all focused on happiness) illustrate how the pursuit of personal happiness has become a modern maxim, crowding out other definitions of the "good life." Even acts of kindness toward others are framed as a strategy for personal happiness. Altruism, no longer merely a good in itself, has become a vehicle for our own "well-being.""
In his book Bad Religion, writer and religious scholar Ross Douthat describes our New Age "God Within" theology as "a faith that's at once cosmopolitan and comforting, promising all the pleasures of exoticism...without any of the pain... mystical pantheism, in which God is an experience rather than a person.... It's startling how little moral exhortation there is in the pages of the God Within literature. There are frequent calls to 'compassion' and 'kindness,' but little guidance for people facing actual dilemmas. And what guidance there is often amounts to 'if it feels good, do it.""
Before Freud, children were looked on more like mini-adults. They were not very pampered, had expectations, and were taught to live up to rules of discipline and behavior. Now, with such a focus on emotional wellbeing and lines of thought on how a childhood experience can "Scar" or otherwise lead to lifelong issues, the balance has tilted too far to the side of pleasing, praise, and autonomy for children, leading them to be overly focused on their own happiness and unprepared for the world. Thus, rise in depression, anxiety, etc... (along with other environmental factors like social media, etc. that feed into the Me Culture). This is exacerbated by the view that doctors should be able to help us gain a pain-free existence. Thus the big pharma explosion.
Per studies and surveys, the USA and nations like it are now reporting to be in more pain and more frequently than in years and decades past - yet, wealth, resources, tech, etc. are at all-time highs - why? Could it be that all this focus and work on not being miserable is making us miserable?
Ch. 3 Pleasure-Pain Balance
Dopamine is one of the most important neurotransmitters for reward circuitry.
See image on levels of dopamine increase per stimulant.
The body seeks Neuro-homeostasis so as you get big dopamine hits then the body reacts to level it out. This is called opponent-process theory, what goes up must come down... "Johann Wolfgang von Goethe, Ewald Hering, and others have demonstrated how color perception is governed by an opponent-process system. Looking closely at one color for a sustained period spontaneously produces an image of its "opposing" color in the viewer's eye. Stare at a green image against a white background for a period of time, and then look away at a blank white page, and you will see how your brain creates a red afterimage. The perception of green gives way in succession to the perception of red. When green is turned on, red can't be, and vice versa."
With dopamine the up is met with a swing equivalently down - see gremlin image and the metaphor of the balanced lever.
Neuroscientists demonstrate that dopamine is released in the brain in response to conditioned cues well before the reward itself is ingested. The pre-reward dopamine spike in response to the conditioned cue explains the anticipatory pleasure we experience when we know something good, or addictive, is coming. Right after the conditioned cue brain dopamine firing decreases not just to baseline levels but below baseline levels. This transient dopamine deficits State motivates us to seek out the reward, which is the hook in addiction and craving. The brain encodes long-term memories of a reward and their associated cues by changing the shape and size of neurons that produce dopamine. The dendrites, branches off the neuron, become longer and more numerous in response to high dopamine rewards, a process called experience dependent plasticity. Scientists injected rats with cocaine for 5 days in a row and observed their progressive behavior according to the stimulant. After a year of no cocaine, which is near a portion of the lifetime of a rat, they injected the rat with cocaine once and found the rat behavior regressed to the final day of the original experiment. Findings like the show that a drug like cocaine alters the brain forever. Similar findings have been shown for other addictive substances from alcohol to opiates to cannabis. Drugs rewire the brain. Learning increases dopamine firing in the brain. Brain changes that occur in response to a stimulating a novel environment are similar to those seen with high dopamine, which is to say addictive, drugs. An experiments those pre-treated with a stimulant such as a methamphetamine before entering an enriched in learning environment, fail to show the synaptic changes seem previously by those exposed to the environment without the stimulant. The suggests that stimulants like methamphetamines limit the ability to learn and irreversibly alter the brain. Scientists studying alcohol's effect on the brain have found the process of recovery from addiction shows that some brain changes are irreversible though it is possible to detour around damaged areas to create new neural networks. This means that although the brain changes are permanent we can find new synaptic pathways for healthy behaviors. Studies on pain include Henry Beecher, a medical doctor, that found that people who were severely injured with painful injuries during a particularly dangerous environment reported very little pain. The relief of no longer being in the war zone or the high potential for death superseded the sensation of pain. By contrast, a 29-year-old construction worker in the British medical journal arrived at the hospital with a nail that went completely through his boot from bottom to top. He reported immense pain as the crew tried to remove the nail from his foot. He was given fentanyl and midazolam, powerful opiates and sedatives, and when the nail was removed it was found that the nail had penetrated between his toes leaving him completely uninjured. His pain was only his perception. "Human beings, the ultimate pleasure seekers, have responded too well to the challenges of pursuing pleasure and avoiding pain. We've transformed the world from a place of scarcity to a place of overwhelming abundance. Our brains are not evolved for this world of plenty... The net effect is that we now need more reward to feel pleasure and less injury to fill pain." CH 4 dopamine fasting The author, doctor, approach to balance and addiction free existence. Dopamine: D - data.. gather data on why you use O - objective.. what's the objective.. benefit P - problem... What problems does it cause? A - abstinence... Try a break, studies show 4 weeks tends to work but first 2 weeks are tough M - mindfulness. Use practices to create a proper relationship with pain I - insight. Use the period after 4 weeks to look back on life and behaviors to gain insight N - next steps. Create a positive path forward, avoiding slips. Studies show tendency that a "first sip " after abstinence is often a full on binge and then repeated use E - experiment with new healthy behaviors CH 5 space time meaning This chapter is on self-binding, which is a method for creating barriers between you and whatever is your addiction. This could be physically placing barriers between you and the video game console, drug, whatever. It could be creating time windows in which you only allow yourself to use or participate or consume within a certain environment, window of time, or similar in order to try and moderate compulsive consumption. Various studies show varying effects and success with these types of approaches come out of the book states that high dopamine activities inhibit our ability to delay gratification, which is called delayed discounting. Behavioral economist running a study with active heroin and amphetamine users compared to X users and a control group. They ask people to imagine they had won the lottery of 100,000 and ask the participants if they would rather have less money right now or the full amount a week from now. Active drug users were the most likely to take the money right now, 20% of them, compared to only 4% of former users and only 2% in the control group. Cigarette users were found to have the same behavior, whether with regard to hypothetical or real money. Across various studies, opioid users referred to a future that was on average nine days long. This is compared to the control group which looked at the future as an average of 4.7 years long, this illustrates temporal horizon shrink when under the sway of an addiction. • In today's dopamine Rich ecosystem we've all become primed for immediate gratification. Want something get it the next day your doorstep, want to know something get the answer on our screen in a second. Are we losing The Knack to puzzle things out, to allow ourselves to be frustrated while we search for an answer or think, or allow ourselves to live with a craving? • neuroscientists found that when participants choose immediate rewards the emotion and reward processing parts of the brain light up. When participants delay rewards they use the prefrontal cortex, the part of the brain involved in planning an abstract thinking. • poor people show s tendency for delay discounting and they choose immediate returns The Stanford experiment on delayed gratification, where researchers put a marshmallow in front of children from 1 to 6 years old and then told them if they can wait 15 minutes then they will get two marshmallows to eat. Only 1/3 of them were able to wait long enough to get the second marshmallow. Age was a major determinant. Children who were able to wait for the second marshmallow tended to have better SAT scores and educational attainment, as well as socially adjusted adolescents in follow-up studies. CH. 6 broken balance Medications like Adderall and Ritalin prescribed for attention deficit disorder promote short-term memory and attention benefits, but there is little or no evidence for enhanced long-term complex cognition, improved scholarship, or higher grades. 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." Psychiatric and opioid prescriptions are more frequent as you move down in economic classes. Are we treating neighborhood issues and sentiments with drugs? And in the process dampening future behaviors and/or pushing toward future dependency? CH 7 pressing on the pain side Story of a rich guy addicted to coke that beat it with cold showers. "Scientists at Charles University in Prague, writing in the European Journal of Applied Physiology, conducted experiments in which ten men volunteered to submerge themselves (head out) in cold water (14 degrees Celsius) for one hour. This is 57 degrees Fahrenheit. 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." Other studies examining the brain effects of cold-water immersion in humans and animals show similar elevations in monoamine neurotransmitters (dopamine, norepinephrine, serotonin), the same neurotransmitters that regulate pleasure, motivation, mood, appetite, sleep, and alertness. Author stated this is an example of how you press on the pain side of the lever and the body will respond by pressing on the pleasure side (like spicy stuff?). "How strange would appear to be this thing that men call pleasure! And how curiously it is related to what is thought to be its opposite, pain! The two will never be found together in a man, and yet if you seek the one and obtain it, you are almost bound always to get the other as well, just as though they were both attached to one and the same head.... Wherever the one is found, the other follows up behind. So, in my case, since I had pain in my leg as a result of the fetters, pleasure seems to have come to follow it up." - Socrates, as recorded by Plato in "Socrates' Reasons for Not Fearing Death" James Bond showers: last full couple of minutes of a shower is cold. Reduces inflammation and helps the mind. Worms exposed to higher than ideal soil lived 25% longer and were more likely to survive high temp in the future (but only when exposure was two hours at a time vs 4). Fruit flies the same. Some Japanese in a band around the bomb lived longer and had lower cancer rates than population elsewhere - theoretically due to low dose exposure. Intermittent fasting can be good, as with intermittent pain. Just as we become tolerant to pleasure stimuli with repeated exposure, so too can we become tolerant to painful stimuli, resetting our brains to the side of pain. 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... Suggesting over stimulating the fear/pain balance can lead to system resets through addiction. "If we consume too much pain, or in too potent a form, the risk of compulsive, destructive overconsumption. we run But if we consume just the right amount, "inhibiting great pain with little pain," we discover the path to hermetic healing, and maybe even the occasional "fit of joy." CH 8 radical honesty "Consistent with the lived experience of people in recovery, truth-telling may change the brain, allowing us to be more aware of our pleasure-pain balance and the mental processes driving compulsive overconsumption, and thereby change our behavior." Honesty and vulnerability sharing can bring intimacy, which itself increases oxytocin. Oxytocin leads to an increase in Dopamine and reward pathways. Summary in sentences to Conclude Lessons of the Balance 1. The relentless pursuit of pleasure (and avoidance of pain) leads to pain. 2. Recovery begins with abstinence. 3. Abstinence resets the brain's reward pathway and with it our capacity to take joy in simpler pleasures. 4. Self-binding creates literal and metacognitive space between desire and consumption, a modern necessity in our dopamine-overloaded world. 5. Medications can restore homeostasis, but consider what we lose by medicating away our pain. 6. Pressing on the pain side resets our balance to the side of pleasure. 7. Beware of getting addicted to pain. 8. Radical honesty promotes awareness, enhances intimacy, and fosters a plenty mindset. 9. Prosocial shame affirms that we belong to the human tribe. 10. Instead of running away from the world, we can find escape by immersing ourselves in it.
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