kortina.nyc / notes
15 Dec 2022

Lembke // Dopamine Nation

Anna Lembke’s Dopamine Nation discusses how addiction in various forms – drugs, alcohol, porn, trashy romance novels, social media, food, exercise, pain – tends to have a similar behavior pattern independent of what the addiction is to.

Lembke talks about the neurochemistry of addiction and some of the behaviors and forms of social engagement that have helped some of her patients successfully recover.

Some of my favorite bits…

Boredom is the space for creativity and imagination:

660 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 allowing ourselves to be within our lived experience.

Here’s an interesting anecdote about ice water as therapy that might help you recover from addiction:

2098 “Over the next couple of weeks, I started to notice that my mood after a cold shower was better. I researched cold-water therapy online and found a community of people taking ice baths. It seemed kind of crazy, but I was desperate. Following their lead, I progressed from cold showers to filling my bathtub with cold water and immersing myself in it. That worked even better, so I upped the ante and added ice to the tub water to get the temperature even lower. By doing that, I could get the temp to the mid-fifties.

“I got into a routine where I immersed myself in ice water for five to ten minutes every morning and again just before bed. I did that every day for the next three years. It was key to my recovery.”

“What does it feel like,” I asked, “immersing yourself in cold water?” I have an aversion to cold water myself, and couldn’t tolerate those temperatures for even a few seconds.

“For the first five to ten seconds, my body is screaming: Stop, you’re killing yourself. It’s that painful.”

“I can imagine.”

“But I tell myself it’s time limited, and it’s worth it. After the initial shock, my skin goes numb. Right after I get out, I feel high. It’s exactly like a drug . . . like how I remember ecstasy or recreational Vicodin. Incredible. I feel great for hours.”

The Scottish shower and some data on how ice baths affect the body:

2124 Endurance athletes claim it speeds muscle recovery. The “Scottish shower,” also called the “James Bond shower” as practiced by James Bond in Ian Fleming’s 007 novels, is newly popular and consists of ending a hot shower with at least a minute of cold shower….

Scientists at Charles University in Prague, writing in the European Journal of Applied Physiology, conducted an experiment 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.

Dopamine rose gradually and steadily over the course of the cold bath and remained elevated for an hour afterward. Norepinephrine rose precipitously in the first thirty minutes, plateaued in the latter thirty minutes, and dropped by about a third in the hour afterward, but it remained elevated well above baseline even into the second hour after the bath. Dopamine and norepinephrine levels endured well beyond the painful stimulus itself, which explains Michael’s statement, “Right after I get out . . . I feel great for hours.”

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.

Exercise as better than drugs:

2242 Exercise has a more profound and sustained positive effect on mood, anxiety, cognition, energy, and sleep than any pill I can prescribe.

You can also become addicted to exercise (or pain):

2401 Thanks for sharing. One issue I notice that you did not discuss is the question of whether wheel-running in mice and rats is a model for voluntary exercise or for pathological exercise (exercise addiction). Some animals housed in wheels exhibit what might be considered excessive levels of running, and one study has shown that wild rodents will use a running wheel that has been left outside in the environment.

I was fascinated and wrote him back immediately. What followed was a series of conversations in which Dr. Rosenwasser, who has spent the last forty years studying circadian rhythms, also known as the “clocks field,” schooled me in running wheels.

“When people first started doing this work,” Rosenwasser told me, “it was assumed, mistakenly, that running wheels were a way to keep track of the animals’ spontaneous activity: rest versus movement. Somewhere along the way, people became sensitive to the fact that running wheels are not inert. They’re interesting in themselves. One of the kickstarters was adult hippocampal neurogenesis.”

This refers to the discovery some decades ago that contrary to previous teaching, humans can generate new neurons in the brain into middle and late adulthood.

“Once people accepted that new neurons are born and integrated into neural circuitry,” Rosenwasser continued, “one of the easiest ways to stimulate neurogenesis was with a running wheel, even more potent than enriched environments [complex mazes, for example]. This led to a whole era of running wheel research.

“It turns out,” Rosenwasser said, “that running wheels are governed by the same endo-opioid, dopamine, endo-cannabinoid pathways that drive compulsive drug use. It’s important to know that running wheels are not necessarily a model for a healthy lifestyle.”

In short, running wheels are a drug.

This idea of “disclosure porn” is kind of a mind-fuck – because disclosure and vulnerability can be such a powerful way to connect with other people.

2767 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” that has become prevalent in modern culture, where revealing intimate aspects of our lives becomes a way to manipulate others for a certain type of selfish gratification rather than to foster intimacy through a moment of shared humanity.

At a medical conference on addiction in 2018, I sat next to a man who said he was in long-term recovery from addiction. He was there to tell his recovery story to the audience. Just before he went up on stage, he turned to me and said, “Get ready to cry.” I was put off by the comment. It bothered me that he anticipated how I would react to his story.

He indeed told a harrowing story of addiction and recovery, but I was not moved to tears, which surprised me because I am usually deeply affected by stories of suffering and redemption. In this case, his story seemed untrue for all that it may have been factually correct. The words he spoke didn’t match the emotions behind them. Instead of feeling that he was granting us privileged access to a painful time in his life, it felt like he was grandstanding and manipulating. Maybe it was just a matter of his having told it so many times before. In repetition, it may have grown stale. Whatever the reason, it didn’t lift me.

There is a well-known phenomenon in AA called “drunkalogues,” referring to tales of intoxicated exploits that are shared to entertain and show off rather than teach and learn. Drunkalogues tend to trigger craving rather than promote recovery. The line between honest self-disclosure and a manipulative drunkalogue is a fine one, including subtle differences in content, tone, cadence, and affect, but you know it when you see it.

I hope my disclosures here, my own and those my patients have given me permission to share, never stray to the wrong side of that line.

Plenty vs scarcity mindset:

2891 When the people around us are reliable and tell us the truth, including keeping promises they’ve made to us, we feel more confident about the world and our own future in it. We feel we can rely not just on them but also on the world to be an orderly, predictable, safe kind of a place. Even in the midst of scarcity, we feel confident that things will turn out okay. This is a plenty mindset.

When the people around us lie and don’t keep their promises, we feel less confident about the future. The world becomes a dangerous place that can’t be relied upon to be orderly, predictable, or safe. We go into competitive survival mode and favor short-term gains over long-term ones, independent of actual material wealth. This is a scarcity mindset.

An experiment by the neuroscientist Warren Bickel and his colleagues looked at the impact on study participants’ tendency to delay gratification for a monetary reward after having read a narrative passage that projected a state of plenty versus a state of scarcity.

The plenty narrative read like this: “At your job you have just been promoted. You will have the opportunity to move to a part of the country you always wanted to live in OR you may choose to stay where you are. Either way, the company gives you a large amount of money to cover moving expenses and tells you to keep what you don’t spend. You will be making 100 percent more than you previously were.”

The scarcity narrative read like this: “You have just been fired from your job. You will now have to move in with a relative who lives in a part of the country you dislike, and you will have to spend all of your savings to move there. You do not qualify for unemployment, so you will not be making any income until you find another job.”

The researchers found, not surprisingly, that participants who read the scarcity narrative were less willing to wait for a distant future payoff and more likely to want a reward now. Those who read the plenty narrative were more willing to wait for their reward.

It makes intuitive sense that when resources are scarce, people are more invested in immediate gains, and are less confident that those rewards will still be forthcoming in some distant future.

The question is, why do so many of us living in rich nations with abundant material resources nonetheless operate in our daily lives with a scarcity mindset?

As we have seen, having too much material wealth can be as bad as having too little. Dopamine overload impairs our ability to delay gratification. Social media exaggeration and “post-truth” politics (let’s call it what it is, lying) amplify our sense of scarcity. The result is that even amidst plenty, we feel impoverished.

Just as it is possible to have a scarcity mindset amidst plenty, it is also possible to have a plenty mindset amidst scarcity. The feeling of plenty comes from a source beyond the material world. Believing in or working toward something outside ourselves, and fostering a life rich in human connectedness and meaning, can function as social glue by giving us a plenty mindset even in the midst of abject poverty. Finding connectedness and meaning requires radical honesty.

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