Dopamine Nation: Finding Balance in the Age of Indulgence

This chapter highlights the theme The Necessity of Pain. In the anecdote that begins the chapter, Lembke says that for her patient Michael, quitting wasn’t as hard as staying that way. For him, cocaine use had occupied so much of his time that it left him uncertain as to how he could fill his time in productive ways. The point that Lembke emphasizes here is significant. Breaking the cycle of addiction, of course, involves abstaining from the drug one has been using. Addiction stories almost always involve some discussion of the struggles that a person experiences during initial abstinence. The way Lembke presents Michael’s story here, she omits many of the details surrounding his experience with initial abstinence and skips to the aftermath. The story points to a commonality shared by all who have experienced addictive behaviors: the question of what to do next. So much of the person’s identity is coupled with the substance use that once it’s gone, the person is left in a completely unfamiliar place in life. Lembke describes Michael’s state of mind: “After quitting, he was flooded with all the negative emotions he had been masking with drugs. When he wasn’t feeling sad, angry, and ashamed, he was feeling nothing at all, which was possibly worse” (140). One can see the difficulty here for Michael in charting out a new course—and the reasons that people experience a recurrence of symptoms become more apparent.

As Lembke moves through the chapter, she discusses how intentional infliction of pain can have a kind of inverse effect in that it leads to pleasure: “Pain leads to pleasure by triggering the body’s own regulating homeostatic mechanisms” (143). She adds that “the pleasure we feel is our body’s natural and physiological response to pain” (143). Naturally, the question arises as to whether, if one instinctively understands this, can one create scenarios in which one pays the price of pain first in order to get pleasure. Her position suggests that the answer is yes. Toward the end of the chapter, Lembke mentions that seeking pain, like pretty much anything else, can become a compulsive behavior. One can develop an addiction to the pursuit of pain. Another natural question arises here, one that may be outside Lembke’s area of expertise: whether the same mechanism applies to emotional pain—that is, whether self-destructive thoughts are actually attempts to intentionally inflict suffering for the purpose of experiencing the opposite? The narrative subtly suggests that this is at least a possibility. However, Lembke doesn’t advocate for self-infliction of pain; instead, she shows once again that keeping in line with the body’s natural balance is the wisest approach.