Dopamine Nation: Finding Balance in the Age of Indulgence

Nonfiction | Book | Adult | Published in 2021

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Summary

Background

Chapter Summaries & Analyses

Part 1, Introduction-Chapter 1

Part 1, Chapter 2

Part 1, Chapter 3

Part 2, Chapter 4

Part 2, Chapter 5

Part 2, Chapter 6

Part 3, Chapter 7

Part 3, Chapter 8

Part 3, Chapter 9-Conclusion

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Part 1, Chapter 3Chapter Summaries & Analyses

Chapter 3 Summary: “The Pleasure-Pain Balance”

Lembke begins this chapter with a more technical and scientific discussion in which she describes, in lay terms, how dopamine is transmitted within the brain. She discusses the various beliefs surrounding the extent of dopamine’s role in human motivation. Lembke points out that dopamine is released in the brain and doesn’t come from an external source such as a drug. She includes graphics to provide visual interpretation for her technical discussion of how dopamine relates to the pleasure-pain balance in the brain. Lembke points out that the centers for pain and pleasure are in the same place. She discusses tolerance—what it is and how it forms in relation to excessive dopamine release in the brain. Essentially, tolerance is the need to consume increasing quantities of a substance to achieve the desired effect. Eventually, tolerance reaches such a degree that no amount of consumption of the substance can create the original effect.

Lembke then discusses opioid addiction. Interestingly, the longer someone takes opioids, the less likely it is that the medicine will fulfill its intended purpose, which is to mitigate pain. In fact, Lembke argues that the inverse happens; the longer someone takes opioid medication, the more likely they are to experience pain. She then cites studies that demonstrate how, often, when people stop using opioids, their pain actually decreases. In addition, Lembke notes how people with compulsive disorders, including addiction, tend to associate certain places, people, and things with their behavior, which leads the author into an exploration of anticipation and craving. External cues, particularly the anticipation of reward, trigger cravings. Over the long term, this dopamine-seeking behavior leads to actual physical changes in the neurotransmitters in the brain. In concluding this part of the book, Lembke sets up the transition to the next part. She reveals that the best people from whom to learn more about addiction and compulsive behavior are those who have the behaviors themselves.

Part 1, Chapter 3 Analysis

Lembke explains how dopamine works in the brain, specifically how it relates to the pleasure-pain balance. She uses analogies and graphics to help make the scientific concepts digestible for laypeople and those who don’t specialize in neuroscience. Essentially, dopamine is a “neurotransmitter involved in reward processing” (47). When a person receives pleasure, the brain releases dopamine. Lembke discusses how the artificially induced dopamine releases that come from drug use alter the pleasure-pain balance in the brain. Since the brain is always looking to maintain a state of homeostasis, dopamine releases are followed by reversions to discomfort or pain. Lembke uses pictures of a teeter-totter to illustrate this concept and visually augment her discussion.

An insightful and informative discussion of tolerance leads into an analysis of prolonged opioid use and introduces another of the book’s themes: The Opioid Epidemic. Lembke notes that prolonged use of these and other drugs changes the pleasure-pain balance so that it’s “weighted to the side of pain” (54). She then discusses her clinical experience of seeing “more patients coming into [her] clinic on high-dose, long term opioid therapy” (54). This began in the early 2000s, and she observed that “[d]espite prolonged and high-dose opioid medications, their pain had only gotten worse over time” (54). The prolonged use of opioid medication to treat physical pain eventually tilted the pleasure-pain balance to the point that the medication didn’t even perform as intended. Lembke then notes that the medication may have made the patients’ pain worse and more wide ranging. She cites neuroscientist Nora Volkow and colleagues, who discovered that “heavy, prolonged consumption of high-dopamine substances eventually leads to a dopamine deficit state” (55). Given all that Lembke has presented in the chapter, this makes complete sense. Lembke avoids wading into a discussion on the mechanisms that led to the opioid epidemic, and she doesn’t lash out at the pharmaceutical industry. Her tone remains objective. She’s not pedantic, and her purpose isn’t to scare people away from medication that might be useful under the appropriate circumstances. Instead, her discussion in this chapter provides much-needed context for a cultural reconsideration of pain management. She notes, “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” (66). Her informative style in this chapter helps drive home this significant and crucially important point, which perhaps isn’t well-known to the general population. In addition, this point alludes to another of the book’s themes, which she explores in greater detail later in the book: The Necessity of Pain.