Dopamine Nation: Finding Balance in the Age of Indulgence

by Anna Lembke

This book is about pleasure. It's also about pain. Most important, it's about how to find the delicate balance between the two, and why now more than ever finding balance is essential. We're living in a time of unprecedented access to high-reward, high-dopamine stimuli: drugs, food, news, gambling, shopping, gaming, texting, sexting, Facebooking, Instagramming, YouTubing, tweeting... The increased numbers, variety, and potency is staggering. The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation. As such we've all become vulnerable to compulsive overconsumption.

In Dopamine Nation, Dr. Anna Lembke, psychiatrist and author, explores the exciting new scientific discoveries that explain why the relentless pursuit of pleasure leads to pain...and what to do about it. Condensing complex neuroscience into easy-to-understand metaphors, Lembke illustrates how finding contentment and connectedness means keeping dopamine in check. The lived experiences of her patients are the gripping fabric of her narrative. Their riveting stories of suffering and redemption give us all hope for managing our consumption and transforming our lives. In essence, Dopamine Nation shows that the secret to finding balance is combining the science of desire with the wisdom of recovery.

"Brilliant... riveting, scary, cogent, and cleverly argued."--Beth Macy, author of Dopesick

Narrated by the author.

Genres: Nonfiction, Psychology, Self Help, Science, Health, Audiobook, Mental Health

304 pages, Audiobook

First published June 1, 2021

About the author

Anna Lembke is an American psychiatrist who is Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University. She is a specialist in the opioid epidemic in the United States, and the author of Drug Dealer, MD, How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.

Reviews

[Linda · Rating 1 out of 5]

This book is moralistic hogwash parading as science. Lembke repeatedly uses inappropriate data (Page 38: She quotes a "famous seventeenth century physician" who thinks pain and inflammation are part of the healing process. Guess what?: 21st century research has found the exact opposite to be true: Pain impedes healing, and inflammation IS disease); over generalizes anecdotes from her work with severely addicted individuals to the general population; and uses bogus statistics (She lists lots of increases in drug use as percentage rates without giving a baseline. An increase from zero to one is a 100% increase, but that doesn't make it a significant trend).
While Lembke has had her own brush with a behavioral addiction, she apparently has never suffered from chronic pain or she would not be so cavalier about the suffering and debilitation it causes nor would she make claims about it being good for anybody.
I'm done at page 66 where she states, "Science teaches us that every pleasure exacts a price, and the pain that follows is longer lasting and more intense than the pleasure that gave rise to it." Science teaches no such thing and that statement is hogwash. Even according to Lembke, this is only true of the long list of pleasures that have addicted her clients (or maybe just those pleasures she disapproves of), but it's not true of those that meet her approval, like watching a sunset or taking a walk. Yes, sunsets and walks are nice, healthy, life affirming activities, but so is a glass of wine over dinner with a friend and other moderate indulgences with potentially addictive pleasures by non addicts. Yet, according to Lembke, pleasure is dopamine is pleasure and it's all bad; it all leads to pain ... except maybe sometimes?

[Martin · Rating 1 out of 5]

Moral puritanism disguised as science. The author uses her credentials to make it seem like she is coming from a rational, scientific point of view, and then uses the kind of anecdotes you see in tabloids to cause scare/terrify you. For example, she tells the story of a four year old sodomizing his little brother as an example of the impact of widely available pornography on our society—as if such a bizarre, singular event had any statistical significance, and wasn't just meant to terrify you.

There is no other way for me to interpret her polemic on "availability" and touting the success of prohibition as tacit approval of the war on drugs.

This is what happens you spend your whole life wielding a hammer. Your love of romance novels and sexy vampires looks like a nail. Having a beer or surfing reddit every day looks like a nail. Everything that brings you any amount of joy that isn't "productive" is on the same spectrum as being an opiate addict or hooking yourself up to a masturbation machine for hours a day. Sorry, "the dark side of capitalism" is not the fact that you can now buy really good weed without fear of jail time—It's that if you do anything other than work your job and raise your kids, you should feel bad about it.

If you really enjoyed this book despite all that, I would highly encourage you to read Dr. Karl Hart's "Drug Use For Grownups" for a different perspective. I don't agree with everything in it either but I think it's a better bellwether for progress in the world of addiction medicine.

[Stephen · Rating 2 out of 5]

I have written nearly a thousand reviews on this site. The review that I wrote for this book has gotten hundreds more likes than any other, and it was the most negative one I ever wrote. Rather than continue to spread that negativity, I deleted the content of my original review and if you see this, I ask you to think on why that is.

And no need to tag this with a like. Spare my notifications.

[Cyndi Taylor · Rating 4 out of 5]

Oh this book could have been a 5, I so desperately wanted it to be a 5... But I just had a few complaints that I can't get over:

1. The opening shock-and-awe story of the man with the masturbation machine makes this book un-recommendable for lots in my conservative socal circle - which is super unfortunate because I want to recommend this book but now I have to put a big caveat on it. I felt the story was included for shock value and that disappointed me.

2. It needed more focus on less obviously destructive addictions. AKA - Why was there not a whole chapter on phones?!? Stephan, a reviewer on here, hit it right on the nail: "So for the low-dosing dopamine addict that is most of us inside our phones, it would be nice to discuss how to move the needle from a perceived bad habit to an acceptable escape, which is different from moving the needle from life-destroying addiction to abstinence."

3. I could have done without her personal romance novel addiction narrative - it felt somewhat contrived and did not add to the book.

I really liked this book. I love the idea of this book. We are a dopamine nation and it is destroying us each in different individual ways.

[Shane Whitaker · Rating 1 out of 5]

TL;DR skip it. There are better books about addiction and psychiatry.

A undercooked look at compulsive behavior and addiction, with lots of missing pieces. Seems like the author had a basic, mechanical understanding of homeostasis and tried to build out a global perspective on addiction that she wasn't prepared to give.

25% of this book was just lists of things people get addicted to. 25% was explaining homeostasis, which might be helpful to readers who have never heard of dopamine. The rest is anecdotes about patients and waxing poetic about the dangers of indulgence.

No mention of trauma or neurodiversity, not even a passing acknowledgement. Almost no mention of actual therapy(!?), and extremely stigmatizing discussion of antidepressants.

The author seems generally uninformed about the lives of people who don't come through her Stanford office. All mention of systemic and environmental factors that lend to risk of compulsive behavior, like race, poverty, disability, capitalism, etc are obligatory after-thoughts. It's no coincidence that basically all her patient anecdotes are about financially successful people addicted to food, sex, and prescription drugs.

Discussion of natural means to get dopamine and what healthy living can look like are shallow, and lack any real analysis of why people are so averse to feeling discomfort.

The author talks about some of her own mental health issues and doesn't seem to have a good grasp on herself either. She talks about how her childhood trauma (though she doesn't call it that) somehow made her better, and how she resolved her own compulsive behavior by leaning into...work.

Frankly, I'm shocked this person became chief of the addiction clinic at Stanford University. What the hell is going on at Stanford!?

The Body Keeps The Score isn't even about addiction, but offers much more for understanding why people resort to unhealthy behaviors to cope. Hell, Braiding Sweetgrass isn't even about psychology and has more to say about why people get lost in consumerism.

I only finished it because I was reading it in a book club. Wasn't worth the read.

[Riku Sayuj · Rating 3 out of 5]

Sorry, but I can't take seriously someone who can read the entire Twilight saga four times.

[Amir Tesla · Rating 4 out of 5]

Short Summary: From simple pleasure such as eating food to watching porn and using drugs, the desire we fill is fueled by a hormone called Dopamine.

Consider a scale in the brain. Whenever we indulge in a pleasure-seeking behavior such as scrolling through the Instagram feed to using drugs, it's like putting pleasure weights on this scale in the brain. The problem is that the brain always seeks to put this scale in equilibrium and balance. When you put pleasure on one side of the scale, the brain compensates by putting pain molecules on the other side of the scale.

The problem is that when the pleasure device is absent, you will have a lot of pain and craving. Why? Because the pleasure is absent on the scale, and the balance has tipped to the side of pain.

What's fascinating is that the other side of the story is also true. Namely, if you induce moderate pains onto yourself through activities such as a cold bath, or running in sprints, the brain tries to store the balance of the scale again. This time, by putting pleasure on the other side of the scale. What happens is that your biological set point for happiness is enhanced. In other words, you will generally have happier and more motivated in life.

Dopamine Fasting: The biggest takeaway for me is the concept of dopamine fasting. If we are addicted to destructive habits such as social media, alcohol, port, etc., since the balance is tipped to the side of pain, we will generally feel less motivated in life. We will have a hard time getting out of bed in the mornings. The way to restore this balance in the brain is by going on a Dopamine fasting. Namely, staying away from the addictive pleasure-seeking behavior that we have. It takes a maximum of one month for the brain to recover.

After that, we will feel much more lively and more importantly, we will derive more pleasure from more productive but maybe less pleasurable activities such as exercise or reading books.

[Samantha Shelley · Rating 3 out of 5]

This book did contain some valuable information (mostly for people who are pretty new to the topic) and I found it interesting most of the time, but I had some frustrations with it, namely:

- Complete vilification of cannabis. No mention of how people can use it medicinally or in a healthy way recreationally.
- Praising Islamic and Mormon dress codes, which in my experience as an ex-Mormon, are a dangerous part of toxic purity culture as well as rape culture. The author could have used them to make her point while also mentioning their potential harmfulness.
- Complete vilification of psychedelic drugs, with no mention of research showing that they’re an amazing tool for many with treatment-resistant depression, anxiety. etc.

[Crystal Canterbury · Rating 1 out of 5]

This entire book can be summed up with two words: Citation needed.

From beginning to end, the book drips with specious claims, not to mention moral puritanism. The author is repeatedly judgmental toward her clients (she is sickened by a client's masturbation machine, for example, and expresses overwhelming moral disdain for her temporary infatuation with romance novels). She alludes to ADHD patients abusing Adderall while ignoring the huge improvement these medicines have offered people with actual ADHD (and that these folks can take the prescribed stimulants and still end up taking a nap -- they aren't getting high). She seems to endorse at least one patient's disordered eating as a healthy lifestyle change! -- because hey, they lost weight, amirite? Another time, she -- a Stanford MD not in a religious therapy practice -- tells her patient to get down on his knees and pray. (Yet another reason why we should stop elevating professionals who attended/work at 'prestigious' schools, but I digress.)

Aside from these issues, the author still does a poor job of educating on the science of addiction/compulsion, and she barely invests any effort in laying out specific strategies readers can use to identify and change problematic, addictive behaviors.

Still considering reading the book? I'll leave you with this - her take on why strict religious/social groups attract more adherents than liberal ones, her quick pivot to "churches," and her rating of churches with larger followings as "generally more successful" (term undefined, religious studies credentials lacking, and citations throughout much needed).

Under Iannaccone's Theory of Sacrifice and Stigma, "behaviors that seem excessive, gratuitous, or even irrational in existing religious institutions, such as wearing certain hairstyles or certain clothing, abstaining from certain foods or forms of modern technology, or refusing certain medical treatments, are rational when understood as a cost to the individual to reduce free riding within an organization. ***You might think that religious organizations and other social groups that are more relaxed, with fewer rules and strictures, would attract a larger group of followers. Not so. Stricter churches achieve a larger following and are generally more successful than free-wheeling ones because they ferret out free riders and offer more robust club goods.***"

TL;DR Skip this unscientific, moralizing drivel.

[Morgan Blackledge · Rating 3 out of 5]

Dopamine Nation is Dr. Anna Lembki’s plain spoken exposition on the neuropharmacological substrates of addiction, with case study examples from her psychiatry practice, featuring clients who struggled and eventually successfully overcame a variety of substance and behavioral addictions.

The book does a very nice job of normalizing addiction and tying drug addiction together with behavioral issues like sex and porn addiction by elaborating on the way they all operate on the mesolimbic dopamine system, and as such, share a common etiology.

The book also does a fair to middling job of explaining the opponent process theory of addiction whereby elevating so-called “happy chemicals” (like dopamine) in your brain (via drugs, gaming and porn etc) make you feel great in the short term, but elicit escalated production of the opposite “crappy chemistry” (for example stress hormones like cortisol) that trash your mood and mental heath in the longterm.

I think this book will be useful for people who are brand new to the issue of addiction and who need a brief, reliable, scientifically grounded introduction to the subject.

But may not be interesting to professionals working in the field or sufficient for individuals and loved ones suffering from more severe addictions.

The author seems like a nice person and an excellent psychiatrist.

But in the end I was somewhat underwhelmed.

Hence the 3/5 stars ⭐️

[K.J. Charles]

In the opening chapter of this book the author goes on a rant about how she got addicted to "formulaic erotic genre novels." She is "ashamed to admit" she read at work between patients, and says

most of the time they were truly terrible...written according to a formula...designed to hook me...I am now sadly in possession of the knowledge that if you open any romance novel to approximately three-quarters of the way through you can get right to the point.

cool, cool, trash an entire genre and a lot of people's hard work and appropriate the language of drug addiction because you [checks notes] went on a reading binge. Seems balanced and appropriate.

Anyway, I gather Dr Lembke no longer reads romance novelists and I am happy to return the favour.

[Bill Weaver · Rating 1 out of 5]

What a terrible book. This book demonstrates how a buzzworthy title and good cover design can elevate mediocrity to the NY Bestsellers List. It joins the Sixth Extinction, Confederates in the Attic, and Wild as "books that fooled me" with marketing. 

So what was this book about? Not dopamine. Lembke waits 1/3 of her mercifully short book to even explain dopamine (in about two pages). This book was nothing but a loose collection of anecdotes of Lembke's patients struggling with their addictions to weed, porn, and prescription drugs. Plus Lembke's own 2-year addition to paranormal romance novels. Did you know it's easier to get high than ever before? Did you know porn and weed and opioids are readily available? Of course you did, because you can read. So I don't know who Lembke's book is for, because anyone who can read isn't going to learn anything from this book. Truly, you would learn more information from the Wikipedia article about dopamine. Throw in a little WebMD on breaking addictions and you're good to go, because this book offers nothing. Infinite Jest had better information on addiction, and that was a work of fiction. 

[Hannah · Rating 5 out of 5]

I had trouble putting this book down as the learning I was doing each page was supplying its own flow of dopamine to me. A fascinating read by Dr. Lembke which bubbles through a multitude of journeys her patients took through their own addictions to reach a more optimal balance of pleasure and pain in their lives.

Lembke highlights her own personal experiences with addiction which offer a grounded perspective to the reader and establish her admirable honesty as a pillar of the book. To not become too attached to pleasure or pain appears to be the key to maintaining a healthy relationship with dopamine. As someone who previously had not read about addictions or found the topic interesting, I loved this book and could certainly recognize my own self-defeating addictions to dopamine through the text. In the end, this makes for a great questioning of our own personal habits and what feelings or actions we gravitate towards in our lives.

[Lisa · Rating 1 out of 5]

I was looking for a refresher on "finding balance" (as promised on the book cover) in this pandemic time when binging Netflix or a glass of wine have become a bit too habitual. I was looking for a reminder about other ways to experience pleasure (laughter, yoga, joyful movement etc.) and tips on restoring that balance. However the book was focused on serious addictions but without serious help for the reader. The author is a doctor, has won lots of awards and runs an addiction program so I want to believe that her treatments consisted of more than "abstain for one month and then tell me how you feel" but that seemed to be what she was doing with clients. There were a couple of insightful aspects and I may have found this a tiny bit useful when I was a mental health practitioner but what moved my review from a possible 2 star to 1 star is that she lost all credibility when she talked about eating disorders. I'd be willing to bet she has no training in this field. She promotes fasting and doesn't really see any problem with weight loss surgeries/aka stomach amputations. Or rather she knows that it can lead to other significant problems such as alcohol addiction but still thinks that somehow these surgeries are a path to improved health. Overall, this book might have some helpful nuggets for folks with addictions but it could do damage as well especially for those with unaddressed trauma or with eating disorders.

[Kristen Christen · Rating 4 out of 5]

I picked up this book after watching Anna's interview on Diary of a CEO podcast. If you don't read the book please watch the podcast you won't regret it.

In the self help realm I honestly just want a book to inspire conversations with my closest people and force me to grab my journal to process. Dopamine nation did both. Immediately after processing and writing in my journal I was inspired to start making changes in my life where I am lacking radical honesty with myself. In general I feel more aware of the areas that I go for my quick dopamine highs. I am motivated to raise my children without a fear of pain and encouraging delayed dopamine when possible.

It is always special to hear the author reading their book as well.

[Madeline · Rating 2 out of 5]

While this book was intriguing and has a few good parts, there are numerous problems.

First: The author has some serious issues when it comes to her understanding of why people are fat. She claims that people are "obese" primarily due to food addiction, which is not supported by the science. But she just presents that as fact without supporting that claim with ANY scientific evidence, studies, etc. I feel like since she treats addictions for her job, she may just be seeing addiction as the root cause of this phenomenon. When your only tool is a hammer, everything looks like a nail and so-forth.

Secondly, she apparently has no awareness whatsoever regarding eating disorders. She praises one of her patients for losing a lot of weight, but then when she shares how this patient lost weight, we learn that this patient basically developed an eating disorder! She seems oblivious to this fact. Specifically, the patient has developed disordered eating strategies in order to ignore his hunger. We know that this level of weight loss is not sustainable in the long term (usually) and when eating disorders are sustained, they can be deadly! In general she thinks that being fat is an indication that a person has an addiction (false!) and that the best way to treat this addiction is with disordered eating! She is absolutely clueless.

Next, at one point she casually offers up the suggestion that people cover themselves up to prevent sex addiction! No evidence that this will work at all, no science. She pulls straight from purity-culture and rape-culture, which we know is so harmful, especially to women/girls who then view themselves as objects to be covered up rather than people with their own agency and inherent value. And again, I expected something scientific rather than the old purity-culture toxicity.

Finally: I listened to the audiobook, which the author herself reads, and it was SO CRINGEWORTHY when she tried to mispronounce words and mess up English grammar exactly the same way her patients do. She has a few patients who are from other countries, and when she tells their stories from their perspective, she mispronounces a lot of words, including the word penis, which is hugely distracting. I respect that people pronounce things differently and that's fine, but there was no value from her trying to recreate how they speak for her book. It was weird and distracting, and it added nothing of value to the stories she was telling.

Looking around here at the other review for Dopamine Nation on goodreads, it is clear that I'm not the only one who thinks this book is a mixed-bag! I've never encountered a book quite this strange.

Other than these MAJOR issues, the book was interesting to read, and it seems like this author is a good psychiatrist, but man, I was frankly shocked by the diet-culture/ disordered-eating / purity-culture / rape-culture BS contained in this book. I expected far better from a book that's supposed to be scientific. Hence my 2 star review.

[Ярослава]

Взагалі-то я не дуже задоволена своїми стосунками з інтернетом (ускладненими тим, що на інтернет зав'язана значна частина роботи і спілкування, тож просто відрубити соцмережі cold turkey я не зможу) і шукала книжку, яка допоможе виробити зручніший для мене спосіб співіснування з соцмережами й оцим усім. На жаль, це абсолютно не та книжка, хоча назва й анотації нібито обіцяють розповісти про пошук гармонії в нашу епоху, де дуже аддіктів практики завжди знаходяться на відстані одного кліка.

Натомість ця книжка - це олдскульне бурчання про те, що наше покоління так прагне задоволень і уникати болю, що стає якраз вразливішим до болю, а от раніше операції робили без наркозу і ніяких залежностей від вікодину не було (ай кід ю нот) (між іншим, я не певна навіть, чи в об'єктивно безпечнішому і сповненішому насолод західному світі справді більшає кейсів депресії і тривожності - можливо, у Східній Європі ХІХ століття це просто називалося не депресією, а "чули, що Микола в сараї повісився?") (при цьому я згодна, що є певна проблема в тому, що ми в середньому прагнемо задоволень, а не значущості, але книжку цю я читала не для того і вона не проте). І все це приправлено великою кількістю американського сексуального пуританства - може, це якраз ознака проблеми нашого покоління вседозволеності, але мене дуже смішило, коли авторка розписувала, яка в неї була Страшна Залежність Від Читання Вампірської Еротики, Вона Якось Зачиталася Твайлайтом До Ночі й Не Виспалася, А Потім Подумала, Чи Хоче Вона, О Жах, Серед Ночі Читати Про Баттплаги? Ні, Не Хоче!!! Чи там розказує про свого пацієнта, який компульсивно мастурбував і виготовив собі доморощений мастурбатор - і вона така "читач, напевно, вжахнеться" - а емпірична читачка я така "ого, як відсутність сексшопів спонукала людей до розвитку технологічних навиків" (цьому пацієнту авторка книжки каже ставати на коліна і молитися щоразу, як у нього виникнуть якісь не ті думки, я вірю, що релігійним людям це помагає, але мені як людині з-поза цього американського пуританського контексту це все дуже дивно звучить).

Загалом, якщо у вас дуже лайтові проблеми з інтернетом абощо, то ви не цільова аудиторія книжки. Авторка здебільшого працює з важчими залежностями й розповідає про них - і то зсередини дуже своєрідного культурного контексту, не завжди релевантного для нас.

[Inna · Rating 4 out of 5]

«Самостримування – це необхідна складова сучасного життя у світі, надмірно обтяженому дофаміном.»

🍓Анна Лембке починає свою книгу, наче професійна маркетологиня: з випадку пацієнта, якому потім вона поставить діагноз компульсивна статева поведінка (по-моєму, так це звучало, але це не точно). Хто ж після такого відкладе читання?))) Наступні майже 200 сторінок заглиблять вас в природу залежності та історії людей, які або покажуть вам, що ви ще не так погано живете, або що живете дуже нудно😅
«Ми всі тікаємо від болю. Дехто з нас приймає пігулки. Дехто лежить на дивані й переглядає Netflix. Хтось читає любовні романи. Ми робимо все можливе, аби відволіктися від самих себе. Проте всі ці спроби захистити себе від болю лише посилюють його.»

🎰Залежність. Акцент на палінні, алкоголізмі, наркотиках, азартних іграх, відеоіграх тощо, хоча хотілося б більше інших прикладів. Авторка побіжно згадувала залежність від соцмереж, що для багатьох людей нині справжні проблема, але сильно на цьому, на жаль, вирішила не зупинятися. Так само побіжно, наприклад, згадується покупки в Інтернеті як залежність. Хотілося б глибше туди, бо здається про це пишуть менше, ніж про цигарки і наркотики. Історія про хлопця, що через наркоту чотири рази вилітав зі Стенфорда, я так розумію, мала викликати у читача співчуття? А те, що авторка постійно повторювала про період у своєму житті, коли вона запійно читала еротичні любовні романи, скидалося на те, що вона усіма силами хоче довести: «Я така ж як ви! Я теж була залежна! Ну, не наркота, але ж!»😅

🍷 Задоволення і біль працюють як терези, що підпорядковані системі регулювання та мають лишатися в балансі. «Тривалий і повторюваний вплив стимулів задоволення призводить до того, що наша здатність терпіти біль слабне, а пороговий рівень, на якому ми можемо відчувати задоволення, підвищується.»
Саме тому люди збільшують дози, ставки, кількість книг😁

🎮«Нудьга – сприятлива атмосфера для відкриттів і винаходів. Вона створює простір, необхідний для того, щоб сформувалося нове мислення.» Пам’ятаєте, коли нам було нудно в дитинстві, ми вигадували цікаві, чудернацькі чи навіть трохи небезпечні розваги. Потім ми їх трансформовували, вигадували нові правила і залучали інших до наших ігор? В світі, де вас кожну хвилину розважає стрічка соцмереж і відосики в ютуб, про це можна забути.

☝️“Генетично модифіковані миші, не здатні виробляти дофамін, не шукають їжу й можуть померти з голоду навіть тоді, коли їжа лежить в кількох сантиметрах від них.”

📖 Книга класна, пізнавальна, не розмазана. Щоправда ближче до кінця можна вдосталь почитати про сором і чесність. А потім про чесність і сором. В той момент здалося, що авторці вже не було чого писати, бо пройшлася зовсім очевидною доріжкою. Але книгу перечитуватиму, це точно.

[Edward · Rating 2 out of 5]

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.

[Seyed Hashemi · Rating 4 out of 5]

از مواردی که واقعا همیشه آزارم می‌دهد، فریب و دروغ‌گویی است. دروغ‌گویی فضا را غبارآلود می‌کند، اعتماد را مخدوش می‌کند و زیست اجتماعی که مبتنی بر اعتماد است را تخریب! کتاب‌های روان‌شناسی زرد و بی‌اعتبار چنین کرده اند. فریب را گسترش داده اند و اعتماد را نابود کرده اند.

خواندن کتاب‌های خودیاری، روان‌شناسی عامیانه و معتبر بسیار مهم است و باید سعی کرد دانش عمومی و معتبر خودمون را در این زمینه‌های کاربردی روان‌شناسی افزایش بدیم. اما هجمهٔ محتوا و کتاب‌های بی‌اعتبار و زرد، به حدی فضا را غبارآلود کرده است که من یکی را از هرچه مطالعه در این زمینه‌ها بود زده کرد.
باری، خیلی تلاش کرده ام لااقل برای خودم این لوپ را بشکنم و سعی کنم با معیارهایی و جست‌وجوهای لازم، آثار خوب در این ژانر مطالعاتی را گلچین کرده و مطالعه کنم.

یکی از معیارها این است که چند آکادمیسین و آدم جدی که سراغ دارم لااقل از کتاب تعریف کرده باشند. در کنار این، نویسنده وابستگی/affiliation نهادی به یک ارگان رسمی و معتبر علمی داشته باشد و خودش پروندهٔ علمی قابل تاییدی داشته باشد که توسط جامعه آکادمیک تایید شده باشد.
معیار دیگر هم مشورت و گفت‌وگو با یکی از دوستانم که روان‌شناسی می‌خواند است که نوینسده، ادعاها و حرف‌هایش را به صورت کلی با او چک می‌کنم.

بیشتر از این از ما کاری ساخته نیست و سعی می‌کنم با این رویه به صورت شخصی در این فضای غبارآلود کمترین هزینهٔ ممکن را پرداخت کنم. همانا هزینهٔ هدر رفتن عمر در پس خواندن متون بی‌اعتبار و بدتر از آن شکل گرفتن ایده‌های مخرب و غلط به واسطهٔ خواندن آن نوع متون!

خلاصه، با معیارهای فوق این کتاب را انتخاب کردم. از خواندنش راضی هستم. ایدهٔ اصلی نویسنده که "میانه‌روی در عصر لذت‌جویی" است را متوجه شدم. هیچ توانایی و سوادی در بررسی نکات "علمی" اثر ندارم، اما به صورت کلی این ایده که لذت‌گرایی افراطی از قضی حالمان را بدتر می‌کند برایم قابل درک بود و نویسنده تلاش کرده بود با بیان داستان‌ مراجعین خودش، پژوهش‌های انجام شده و ایده‌های روان‌شناسی اعتیاد از این تز دفاع کند. به عنوان یک کتاب پاپ-ساینس موفق بود به نظر من. البته این ایدهٔ "لذت=دوپامین" خود محل نزاع علمی است و گفته شده است که نویسنده اندکی تقلیل‌گرایانه با موضوع مواجه شده است، اما خب، من را به علت عدم تخصص راهی در تشخیص مستقیم سره از ناسره در این فقره نیست.

نویسنده هم در جای جای کتاب بر روی منبر می‌رفت و پند اخلاقی و حکیمانه می‌داد. طبعا حرف‌هایش علمی نیست در آن شرایط و حرجی بر نویسنده و علم نیست. دیگر باید پذیرفت. نویسنده تلاش کرده است به اعتبار علم برای منبر خود مشروعیت بخرد. به مانند هر منبری و در لحظه بیان خطبه باید حساس باشیم که رتوریک و اقناع فریبمان ندهد و هم‌چنان با ذهن انتقادی بتوانیم حرف‌های درست از نادرست را تمیز بدهیم.

حال اگر بخواهم اندکی نقد کنم کتاب را، می‌گویم کتاب از "دایرهٔ میل" خارج نمی‌شود. این نقد را اولین بار از محمدمهدی اردبیلی شنیدم. نکات بسیار اساسی و بنیادینی در این بحث هست که همچنان برای خودم کاملا جانیافتاده است که بتوانم صورت‌بندی درستی از آن انجام بدهم اما به صورت کلی، نویسنده همچنان در زمین بازی میل توپ می‌زند و صرفا میانه‌روی در جهان میل را توصیه می‌کند. این حرف که باید از دایره میل خارج شد نسبتی با دنیاگریزی، زهد و مفاهیم شبیه آن‌ها ندارد و باید دقیق شد و موضع را فهمید. اگر با این عینک به کتاب نگاه کنیم قطعا ارزش کتاب برایم از بین خواهد رفت. اما چون به فهم همدلانه باور دارم سعی می‌کنم کتاب را در جایگاه خود و جهان معنایی خود درک کنم و از این مسیر کار و هدفی که دارد را درک کنم.



حتما این کتاب را به نزدیکان و اطرافیانم هدیه خواهم کرد. به خودم کمک کرد، احتمالا برای آنان نیز مفید باشد.


دست‌ودل‌بازانه به کتاب نمره دادم.



پی‌نوشت: از نکات جالب کتاب این است که قاطبهٔ خوانندگان به آن نمرهٔ بالایی داده اند و تنها 1% از خوانندگان یک‌ستاره داده اند اما پرلایک‌ترین مرورها برای کتاب، تعدادی از همان ریویوهای تک‌ستاره‌ای‌ست. تا جایی که همین‌جوری چشمی و بدون دقت مرورها را خواندم، متوجه شدم جریان‌های ضداقتدار و به نوعی لیبرتاریانیستی (همان ضدواکسن‌های آمریکایی) این چنین سفت به کتاب تاخته اند.
به باور این گروه از افراد، نگاه‌های آسیب‌شناسانهٔ اعتیادشناسان مانند لمبکی نویسندهٔ این کتاب و مشخصا تصویر منفی‌ای که لمبکی از اعتیاد نشان می‌دهد ضد آزادی است. پرلایک‌ترین مرور را که خواندم کتابی را معرفی کرده بود که در نگاه کلی (خواندن تعدادی مرور از آن کتاب) و اجمالی (خواندن مقدمهٔ کتاب و بخش‌های ابتدایی هر فصل) متوجه شدم گویی جریانی قوی در غرب و آمریکا هست که علیه مذموم‌انگاری نگاه آسیب‌شناسانهٔ اعتیادشناسانی مانند لمبکی نسبت به اعتیاد فعالیت جدی می‌کنند. در این دیدگاه، اصل آزادی و لذت انسان است و چیزی نباید جلوی آن را بگیرد. مخصوصا دولت. حتی اگر بخواهد توزیع فراگیر واکسن کرونا باشد.
آن کتاب ‌Drug Use for Grownups از Karl Hart است.

بیشتر از این در این مورد نمی‌نویسم، خود این فقره می‌تواند یک پژوهش کیفی خوب باشد که این دعوای موجود را مستقل از اعتبار و صحتِ علمی طرفین، مورد پژوهش قرار بدهیم. حداقل یک تحلیل تماتیک خوب شاید بتوان انجام داد.

[Saint Theo · Rating 1 out of 5]

I came into this book really wanting it to be good, to be an insightful analysis of the dynamics of pleasure and addiction in America, studying the causes and offering solutions. One of my friends had given it a glowing rating, and thus... I found myself disappointed with the uninformed, surface-level moralizing glazed over the text.

This book isn't for people who want to analyze, curb, or prevent addictions, this is a book that starts with the assumption that you're addicted to something and spends pages moralizing on your and other people's 'addictions', even if it has to define a short-term obsession or a minor bad habit as an addiction.

I honestly feel like this author doesn't have a working grasp on the full topic of addiction. She understands what it looks like on the surface or at its peak, when a person is so compelled to perform an action they come to her for help, but does not seem to understand any of the underlying causes of addiction, preferring to treat the surface-level actions without investigating the root causes and looking for ways to solve and/or cope with those, as well.

Additionally, she has no understanding of systemic or societal causes of misery or addiction outside of what a Buzzfeed article has been able to tell her.

I don't think she's ever met someone who lives in poverty, and if she has, I don't think she's ever seen any aspect of their life or listened to them without filtering it through a moralizing, puritan lens. Multiple times, she's able to cite studies of rats that state they'll rarely become addicted if given enriched, accessible environments fulled with large social groups, and rats isolated in bland environments will almost always become addicted, but fails to make the connection between this study and human environments.

She also doesn't seem aware of the existence of poverty in her own country, as multiple times she wonders why people are addicted to anything in the 'richest country in the world', making her seem deeply ignorant of the material conditions of the non-wealthy. Again, she can plainly state 'cheap entertainment is now more widely available than stable housing, meaningful work, affordable healthcare, meaningful community spaces or consistent community events', then turn around and, consciously or not, assume that the marginalized have all of the same resources her rich community and clientele do and merely choose to ignore them to become addicted to various substances.

When faced with solutions to concerning addiction, rather than proposing systematic changes to provide citizens with the missing resources she's cited before, she trots out the individual solutions her fellow silicone valley residents have used, leading to a large chunk of pages being used to praise how a man uses cold showers to cut down on his own drinking. Combined with a long tirade on how 'high-wage earners' are less likely to be addicted that puts the cart far before the horse (assuming that their high wages come as a result of avoiding addictions), it leads to the uncomfortable implication that the impoverished just haven't applied the right individual solution to conquer their own chemical dependencies.

The book operates under the assumption that everyone in America is drowning in artificial happiness all of the time, and pushes people to eschew pleasure and embrace pain as if most Americans outside her Stanford enclave aren't awash in low-grade malaise caused by structural isolation and increasingly unbearable economic inequality.

Speaking of her Stanford enclave, throughout the book, every single character is EXTREMELY privileged, and the author only acknowledges this in throwaway statements that feel like her editor or or brunch friends had to remind her to use. One character, a young doctor who got a DUI while earning his Ph.D offhandedly says 'if I was POC or poor, I would have lost everything' but thanks to his white wealth, he is given the privilege of showing off his flaws at every application without suffering any loss of status. I wish she'd actually spoken to someone who *had* lost everything to something like that.

Moreover, there is ZERO investigation into the root causes of either societal or individual addiction throughout the book, and, combining this with her well-off clientele, it begins to feel like addictions are oddly-shaped warts stuck onto otherwise perfect lives instead of flawed coping mechanisms for whatever actual struggles they may have, none of which she ever even seems to mention.

Further expounding upon her shallow analysis, throughout the book she keeps making the insulting equation of her short erotic literature obsession with full-blown chemical dependency. She continually causes her brief obsession 'an addiction', as if it could ever rival the drug or alcohol addictions of her clients. She presents many stories about her clients, but none of them ever seem to have the substance or critical analysis the topic deserves. Only ONE of her many anecdotes features someone with a life-long addiction, and his story feels like it's presented for shock value more than anything else.

The low-grade moralistic dog-whistling throughout the book ramps up in the final few pages, as she praises all forms of social restriction (pro-social shame and restrictive rulesets within groups) in the effort of weeding out 'freeloaders', a phrase loaded with connotations I *hope* she misunderstood, because the other implication is yet another instance of her looking down on 'lazy' people with 'no will power'.

Even before the book pulls the canine controlling device out of its' pocket, there's a distinct black-and-white mindset, where anything that isn't tightly and consciously controlled is an 'addiction'. To the point that the author states that people with mental issues or chronic pain shouldn't be using medications to improve their lives, claiming they're 'upsetting their dopamine balances' and further implying that because the drugs they're using could be abused in theory, the patients themselves are on the verge of abusing said drug at any time it becomes too pleasureful.

Referring back to the assumption of America as a nation drowning in artificial dopamine, the author assumes that everyone, at all times, is too joyful and the only way to 'reset their balance' is to pursue long-term asceticism. This dovetails nicely with her prescription of abstinence as the only cure for 'addictions', even to the point of uncritically promotes eating disorders in the form of extreme food restriction.

All of this, from the assumption of too much joy to the praise of restriction, all stems from a puritan mindset of 'pain will make you stronger' no matter what, and pleasure is just a loss of mental muscle mass that can only be regained by forcing yourself to abstain from what pleases you and lean into what hurts.

In summary, I feel like an alien wrote this book. Someone trapped in a misinformed, centuries-old mindset and a wealthy enclave who sincerely believes they have been given the answers when they still can't even comprehend the question.

[Krisette Spangler · Rating 5 out of 5]

This should be required reading for everyone. It really helped me to understand how the brain maintains homeostasis. Many people in our society are searching for pain free lives, but our brain knows we need equal amounts of pleasure and pain in order to maintain equilibrium. Miss Lembke states that we might need to face pain in our lives in order to find that equilibrium rather than overmedicating ourselves.

"The rewards of finding balance and maintaining balance are neither immediate nor permanent. They require patience and maintenance. We must be willing to move forward despite being uncertain of what lies ahead. We must have faith that actions today that seem to have no impact in the present moment are in fact accumulating in a positive direction, which will be revealed to us only at some unknown time in the future. Healthy practices happen day by day."

"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."

[James Tivendale · Rating 4 out of 5]

As someone who has an addictive personality and had a 10+ years drinking problem (nearly 4 years
sober) I found this audiobook extremely informative, with relevant case studies to hear about throughout. I have taken on a few of the tips that Lembke recommends and am already feeling the benefits. I am drinking less diet coke, using my phone less frequently, not taking pain killers, and not listening to music on my first walk in the morning. These have all made me feel fresher and have given me good awareness of dopamine and the pleasure and pain scales. I would like to thank my participant at work for recommending this to me and would also like to comment on how well the author does at delivering the audiobook version herself. The Dopamine Nation was an easy listen to follow, using a fine mix of real life examples, scientific studies and papers and Lembke’s professional experience. Recommended.

[Bre · Rating 1 out of 5]

I had high hopes for this book and was disappointed. There were several positions Lembke took that I just don’t agree with: 1) abstinence is gold standard for addiction (my opinion is that this is true for some, but not a universal truth) 2) “pro-social shame” is great for recovery 🤔 (no) and 3) absolute honesty is essential for a well balanced life (she gave the example of telling her daughter she was like the tone-deaf penguin on Happy Feet)… idk, the book felt very moralistic and judgmental. Didn’t love it.

[Kim · Rating 1 out of 5]

So absolutely horrible that I couldn't finish it. Moralistic high horse bullshit and not a real science book.

[Gabrielle Schwabauer · Rating 2 out of 5]

I would like to read a different version of this book.

I agree with the author that in contemporary US society, overconsumption as a way to numb emotional pain has become the norm for most people with the resources to do so. And addictions, from drugs to phones to Netflix to wine to exercise to dieting to Fortnite, have been normalized.

Unfortunately, this book lacks the kind of nuance that would allow most readers to really connect with her message. She keeps mentioning that even morally neutral behaviors, like alcohol consumption and video games, can become an addiction when you are unable to regulate your use. And then she uses only the most extreme anecdotes about behaviors that are actively destroying the lives of her patients. Her only "moderate" example is of her own addiction to steamy romance novels. This was a fine example of the concept, but having . . . yourself . . . be your only example of a less frightening addiction felt, uh, really tone deaf?

The author just kept making these wild claims, hyping the claims up for pages, and then giving a two-sentence aside about how "even this can also be bad, of course, but we won't go into any detail whatsoever on that."

There's a bizarre section where she explains that "throughout Western history" it has been acceptable to scream at, hit, scare, threaten, and otherwise abuse children to promote good behavior. Then she talks about how parents these days are "too scared of traumatizing their children" to let them face adversity. Uh, you can talk about how to help kids build healthy confidence through challenges without not-so-subtly suggesting that a movement away from child abuse is destroying our nation. And then she's like "child abuse is bad, of course, but we also can't coddle kids." So . . . no examples of what she considers real harmful abuse and what she considers coddling, just, if you worry TOO much about abuse your kids will become entitled whiny college babies who achieve nothing. Cool!

See also: "radical honesty is transformative and the only path to healing. This med student got a DUI and pleaded guilty instead of bribing the judge. It made his life harder but ultimately he believes it saved him from alcoholism to be honest about it and now he's a successful doctor. If he'd been poor, a woman, or a person of color, he probably would have rotted in prison, but I still think radical honestly is a blanket solution for all people everywhere." I'm not exaggerating, that is her actual take. She's constantly MENTIONING factors like racism, poverty, or trauma that might invalidate what she's saying, then totally failing to address those things in any way or provide helpful alternatives.

Perhaps most stunning is the part of the book where she talks about how strict in-group requirements increase group loyalty by reducing freeloading, then cites the devotion of people to extremist religious groups as proof that people "want" these strict rules and benefit from the sense of belonging they create, with absolutely NO examination of the threats, emotional conditioning, and need for safety that cause people to remain in abusive situations. This is supposed to teach us that we are most "human" and most "in control" when we choose to abstain from things. (????!!!!????) The problem is that there is a huge difference between a sex addict and serial cheater restricting himself of his own volition in order to heal his interpersonal relationships and stop living in misery and, say, a young woman raised in a fundamentalist cult feeling a strong sense of loyalty to the cult. I mean, you can't pretend that "rigid modesty dress codes increase personal investment" and just never acknowledge that these dress codes AREN'T an active personal choice, AREN'T connected to real morality, and AREN'T a form of self-binding chosen by the individual as a response to a harmful, cruel, or destructive personal behavior. Yikes, yikes, yikes.

She derails into this extremely strange section on a guy who curbed a "bad" addiction by taking cold baths, and now creates colder and colder and colder baths for himself because of the incredible rush he gets afterword. This is proof that pain creates pleasure. Should you uncritically suggest to people struggling with addiction that daily physical pain will lead to longer and truer pleasure than pleasant physical sensations? Seems like you should not? His story ends with him talking about how he gets a better high from cold water than he ever did from any substance and how he craves it each day and how he's building freezers for cold water immersion and then he laughs and says "I guess it's almost like an addiction." Like . . . is this funny? Should I be laughing too? She goes on to warn us that pain can become an unhealthy addiction as well, but doesn't offer meaningful solutions and clearly feels much better about this guy getting a high via physical pain than through substance abuse. At this point I was like . . . what is happening here.

By the end of the book, she has not once talked seriously about smartphones, TV, or any other tech addiction. She has not discussed how to tell if your behavior is healthy or addictive. She hasn't talked about how to set healthy boundaries around something that you're required to use in everyday life, or something you want to keep using in moderation. Plenty of people want to enjoy gaming with friends for a few hours on the weekend without neglecting responsibilities to grind out more digital XP, or want to reduce that twitchy check-my-phone impulse without refusing to answer emails from their boss. And we all have to eat, and should be eating without constant self-condemnation! She kind of hints at a 10-step process that was okay advice (taking an extended break, then reintroducing with boundaries, can be a helpful way to see if you're dependent on something optional) but everything is so anecdotal that she doesn't draw a clear path for the reader to address their own possible dependencies.

There were some interesting insights here about how too much sustained, repetitive pleasure can lose its effectiveness and recondition your brain to make it harder to feel any positive emotion. It was a thought-provoking book and did make me want to be more vigilant about making sure I'm in control of my own relationship to things like food or technology. But her confusing and often judgmental takes really muddled the whole thing.

[Dax]

Made it 30 minutes in and just couldn't handle how judgmental the author was. Just, wow.

[Lucy · Rating 5 out of 5]

I feel a little shocked getting on here to review this book to see that so many other readers found it objectionable. I did not. At all. It seemed like an unemotional, non-morally superior explanation of the endocrine system's homeostasis mechanism to balance pleasure and pain. I'd heard quite a bit of the same things from a few Huberman Lab podcasts but found Dr. Lembke's anecdotes and citations a bit more helpful, BECAUSE they felt less emotionally based.

The book starts uncomfortably. The very first chapter is about a masturbation machine and sex addiction and it feels disturbing and jarring at first. As Dr. Lembke continues sharing the notes and conversations from her therapy sessions with this client, it quickly becomes obvious that her intention is not to shock or be gratuitous, but to explain how something that many consider a common source of easy and harmless pleasure can be taken to an extreme level that does, in fact, become harmful.

Lembke weaves in the science of how we experience pleasure and pain when she shares other client experiences and even her own relatively mild anecdote of middle-aged-marital-stress-escapism for a few years reading repetitive vampire erotica on her kindle. I found her vulnerability and experience to be the most relatable compared to some of the other more chemically dangerous addictions, such as a reliance on opiates, cannibis and psychedelics, which are now a thousand times more potent and lethal with today's use of synthetics and the illegal and unregulated drug trade.

She gives some helpful suggestions of applied therapy she calls self-binding. Again, the vitriol against this book surprised me because this section of the book felt the least judgmental to me. Sometimes a certain way to overcome addiction works for some and a different way works for others and sometimes abstinence (like AA) works for some and for some other lucky people, moderation become possible. She brings up the difficulty of some modern addictions where total abstinence is impossible, such as with food and certain forms of technology. I found her tone to be hopeful and compassionate towards her clients and the pain so many find themselves trying to alleviate due to abuse, trauma and poverty.

She finishes her book addressing the use of pain in therapeutic ways. Think of the current popularity of ice baths or cold plunges and intense exercise, which she explains actually cause the body to experience pain, which forces the endocrine system to bring the body back to homeostasis by then releasing dopamine for an extended feeling of pleasure afterwards. There's that runner's high or good mood. This also explains the less palatable behavior of cutting or BDSM. I found that interesting.

I don't give this book five stars because I think it is the end all be all explanation of mental health, addiction or the only solution to any of our problems. I actually rarely give five stars because, for me, that fifth star is an emotional reaction to a book. I experienced that while reading this. I felt a light bulb turn on and felt grateful for access to the information and experiences of someone with her knowledge and credentials. I'd recommend it to anyone wanting to know more about how, why and when we experience pleasure and pain. It would be an excellent book to discuss with someone.

[Fateme · Rating 4 out of 5]

Dr.Lembke i ran 17 km while listening to the audiobook. And greatly enjoyed learning from you.
If you’re a person with a growth mindset this book is a must read; a part of bettering yourself is being able to see your flaws clearly and see validated when faced with them instead of rejected and i think finishing this book will give you some perspective on that.
In this day and age almost all of us are battling some type of addiction or i rather say “self soothing” mechanism in order to survive being anxious and stressed out about achieving more and more and then some more; and it makes sense. If you were born 100 years ago and did your chores and studied a little bit you’d be a respected person but now with the kind of access we have to resources and the expectations of our respective social classes it’s impossible to feel like a respected member or a successful one. Even if you’re your own person you might feel this way only by your own standards. The added pressure leads to us turning to methods to escape and therefore not being honest and true to ourselves. The chapter about radical honesty is something i intend to implement in my own life. I’m not one for re-reads but I’ll definitely check some parts of this book out again in the future.

[Alice · Rating 4 out of 5]

Neurodivergence and dopamine is a trending topic on TikTok right now and if you read the comments on popular videos, you will see a lot of people that struggle with ADHD, addiction, mood disorders, and other symptoms that leads to extreme and unproductive behavior in the pursuit of dopamine highs. I picked up this book to get a better understa nding of my own history with addiction and dopamine chasing and to find out more about the science behind it.

The blend of clinical and anecdotal storytelling makes this book an easy read. I also appreciated the humanization of shameful behaviors and looking at it from a neurological standpoint. Lembke keeps it simple by organizing the topic by extreme behaviors that lead to the pursuit of pleasure and pain. She does a really good job of identifying the problem without judging people's individual solutions. Interspersed between client stories, she also shares her own extreme behavior which I really appreciated and it gave me a better understanding overall of my own struggles.