Anna LembkeReviews

Well written and engaging, but the overall argument is not entirely convincing. Kind of goes off track toward the end.½

An interesting book on addiction.

There is a pleasure pain balance. Pleasure is balanced by pain. More pleasure leads to more pain in order to maintain the balance.
Here is a trivial example: The pleasure of chocolate, the pain of longing for more.

Here is a quick summary of possible strategies.

Chapter 4 Dopamine Fasting
DOPAMINE
- D - Data
- O - Objectives
- P - Problems
- A - Abstinence
- M - Mindfulness
- I - Insight
- N - Next Steps
- E - Experiment

Chapter 5:
Self-Binding
- Physical
- Chronological
- Categorical

Chapter 6: A Broken Balance
- Meditation to restore a level balance

Part 3: The Pursuit of Pain

Chapter 7 Pressing on the Pain Side
- Cold water immersion
- Exercise - “Exercise is immediately toxic to cells,”
- Pain to treat pain (including Acupuncture)
- Doing something hard (like talking to strangers)
- Addicted to pain (rat running wheel, extreme sports)
- Addicted to work
“If we consume too much pain, or in too potent a form, we run the risk of compulsive, destructive overconsumption.”
“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.””

Chapter 8 Radical Honesty

“The average adult tells between 0.59 and 1.56 lies daily. Liar, liar, pants on fire.”

“Radical honesty—telling the truth about things large and small, especially when doing so exposes our foibles and entails consequences—is essential not just to recovery from addiction but for all of us trying to live a more balanced life in our reward-saturated ecosystem. It works on many levels.“

Section: Honesty Promotes Intimate Human Connections

“Intimacy is its own source of dopamine.”
“Any behavior that leads to an increase in dopamine has the potential to be exploited. What I’m referring to is a kind of “disclosure porn”…”

“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. “
“Patients who tell stories in which they are frequently the victim, seldom bearing responsibility for bad outcomes, are often unwell and remain unwell. They are too busy blaming others to get down to the business of their own recovery. By contrast, when my patients start telling stories that accurately portray their responsibility, I know they’re getting better.”

Section: Truth telling is contagious and so is lying

“Truth-telling engenders a plenty mindset. Lying engenders a scarcity mindset.”

Chapter 9 Prosocial Shame

“The thinking goes like this: Shame makes us feel bad about ourselves as people, whereas guilt makes us feel bad about our actions while preserving a positive sense of self. Shame is a maladaptive emotion.”
“Guilt is an adaptive emotion. My problem with the shame-guilt dichotomy is that experientially, shame and guilt are identical.”

“Yet the shame-guilt dichotomy is tapping into something real. I believe the difference is not how we experience the emotion, but how others respond to our transgression.”

I'm not a neurologist or psychiatrist and cannot comment on the science behind Dr. Anna Lembke's interpretation of the dopamine-fueled pleasure/pain balance, but I can make a few points regarding her book, Dopamine Nation. For one thing, it is a quick read and gives an interesting overview about how the actions of a particular neurotransmitter play a crucial role in our mental states. I agree with her that our modern world is a place of "overwhelming abundance" that is at odds with our brains' innate "scarcity" paradigm.

But on the other hand, there are some off-putting things about this book as well. It relies heavily on anecdotes from Dr. Lembke's practice as well as old studies with lab rats and mice. Her attitude towards sexuality combines prudery with fascination. For example, in the opening chapter, she describes in more detail than necessary a certain patient's homemade devices for self-pleasuring. I think Dr. L's fixation on "Jacob's" machines reveals more about her than it does her patient. In a scene that made me highly uncomfortable, she commands "Jacob" to get down on his knees and pray for forgiveness for his "sins."

Even though Lembke is a trained psychiatrist, she exhibits a disdainful attitude toward psychiatric drugs, despite their life-saving track record. She strongly supports an Alcoholics Anonymous-style approach to treating addictions of all kinds, even though that approach has been shown to be flawed. She advocates "dopamine fasts," although such "fasts" have not been shown to be effective.

I was unable to find a scientific review (i.e. above and beyond those that appear in library selection journals) of this book.

In short, I'm sure there are better books out there on the topic of dopamine.

I recently discovered Anna when she appeared on the two podcasts below.   So i immediately got hold of this book and decided to put all my other reading on hold and dive straight in: some times i feel some things are just that important.

So having listened to the two podcasts was there anything more to be learned from the book?

Yes.

Without a doubt, both podcasts were great in their own unique ways, Rich and Michael approach this topic from two very different angles and flavour their podcasts accordingly, and when it comes to the book i think that the reader will find their own bag within it.

One thing Anna isn't within this book is judging and preachy: she's not telling anyone what to do or what not to do.   Anna simply lays out a bunch of case histories and how the human propensity to seek pleasure and minimise pain within this age of abundance is what is ultimately causing so many problems.   The reader can make their own mind up as to where they are on this wild and crazy spectrum of addiction that is plaguing our age and species, and also what they may wish to do about it.

Super good and definitely a book to put on the shelf next to The Pleasure Trap: if you haven't read that then seriously, get reading that too.

But, whether you wish to take the time to read Dopamine Nation or not, i do hope you'll take the time to listen to the podcasts: both are different, so please don't just listen to one.

Rich Roll Podcast

Finding Mastery

Focuses on neuroscience behind addiction and how to resolve it. Zooms in on the role of dopamine and the brain's pleasure-pain balance. You'll learn:
• How the brain’s reward system works, and what is the “pleasure-pain balance.” Uncover why extreme pleasure can lead to after-effects of extreme pain.
• Facts and figures about the current crisis of addiction in many countries, and find out why an abundance of pleasure and the desire to avoid pain can lead us down the slippery path of addiction.
• Specific strategies and tips to overcome and prevent addictive behaviors, restore a healthy balance, build resilience to pain, and increase your capacity for pleasure.
Book summary at: https://readingraphics.com/book-summary-dopamine-nation/

Interesting book but not as unique as I thought it would be. I picked it up as I had seen that the author talks about her “addiction” to romance novels. This is an “addiction” I share so was intrigued to see what she had to say. Overall I felt the book was more about long term “hard” addictions like drugs and alcohol rather than the day to day addictions we all find ourselves with like phone use etc. The book seemed kinda dated with very little new information about addiction. Also addiction to romance novels is not a real thing.

The book is told through anecdotes and doesn't heavily emphasize the science or current research. Although some of the concept names were new to me, like self-binding, I didn't feel like I learned much from this book.

“Drug Dealer, MD” is an unfortunate title for this serious, compelling, well-documented book published by Johns Hopkins. Author Anna Lembke is well qualified to write about the prescription drug addiction crisis. She received her undergraduate degree in Humanities from Yale University and her medical degree from Stanford University. She is on the faculty of the Stanford University School of Medicine, a diplomate of the American Board of Psychiatry and Neurology, and a diplomate of the American Board of Addiction Medicine.

“Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop” appears to be a more accessible version of articles Lembke has published in medical journals: “Why Doctors Prescribe Opioids to Known Opioid Abusers.” “Drug Dealer, MD” is an easy and compelling read of only156 pages, yet contains 9 pages of references. Lembke uses case histories to drive home the severity and urgency of this appalling situation in our health care system where the profits of drug companies, the economics of medical practice and insurance create situations where the true medical need of the patient come last, if ever.

A “normal” patient can become a “professional patient” (one who trolls doctors’ offices to obtain scripts for addictive prescription meds) due to the efficacy of prescribing pain relievers, tranquilizers and sedatives, and stimulants rather than actually talking to the patient about his or her condition and needs. Worse yet, after a patient becomes a drug addict due to failure of physicians to properly treat medical needs, addiction treatment and rehab is often unavailable or prohibitively expensive. In short, these practices are appalling and tragic. “Drug Dealer, MD” is essential reading for anyone interested in the current state of medical practice.