Addiction

When you think of an addict, do you imagine a frail person trading money for drugs? Or maybe a suburban mom urgently opening a bottle of wine? Perhaps a man watching pornography all night? Or a college student glued to her smartphone instead of studying? Addiction is the repeated, uncontrollable use of a substance or behavior - like gambling, sex, or video games - even when it causes harm. All the examples above represent addicts.

Addiction risk increases with easy access, whether it's video games, books, or drugs. The U.S. opioid crisis was largely due to excessive painkiller prescriptions in the early 2000s. Today, drugs are more potent. Opioids are pharmaceutical-grade, and marijuana is much stronger than in the 1960s. However, drugs are only part of the problem. Our foods are now more addictive, loaded with sugar and fat. Technology also hooks us with endless clicks and scrolling.

Addiction rates are increasing globally, with 70% of deaths caused by smoking, obesity, and lack of exercise. The poor face a shortage of meaningful work and healthy opportunities but have easy access to dopamine-inducing escapes. For undereducated middle-aged white Americans, the top three causes of death are overdose, suicide, and alcohol-related liver disease.

To avoid misery leads to misery

In the 1800s, surgeons operated without general anesthesia, believing pain boosted the immune response and sped up healing. Today, doctors focus on healing and compassion, aiming to eliminate pain. This shift has led doctors to prescribe medications more frequently. Currently, one in four Americans takes a psychiatric medication daily, and one in ten uses antidepressants, with global use also increasing.

From 2006 to 2016, the use of stimulants like Ritalin and Adderall doubled in the U.S., while sedative use, including Valium and Xanax, rose by 67%. In 2012, the number of opioid prescriptions matched the U.S. population, with one bottle per citizen.

Deal with Discomfort and Find Purpose

We often avoid minor discomforts, like boredom, by distracting ourselves with entertainment. This avoidance prevents us from living in the present moment. Sophie, a Stanford undergrad, struggled with depression and anxiety. She spent most of her time on her phone. Lembke, her doctor, believed that Sophie's constant distraction was worsening her symptoms. She suggested Sophie walk to class without listening to her usual podcast. Though it sounds dull, boredom can help us explore our life's purpose. Allowing some space without distractions lets our thoughts grow.

Despite efforts to avoid pain through drugs or romance novels, it's worsening. The World Happiness Report revealed Americans were less happy in 2018 than in 2008, with similar declines in Belgium, Canada, Denmark, France, and Japan. Studies also found wealthier nations had higher rates of anxiety and depression compared to poorer countries.

Pleasure leads to pain: Pleasure and Pain Balance in the Brain

Anna Lemke got so hooked on the Twilight Saga that she read it four times. The second time wasn't as enjoyable as the first, and by the fourth time, the fun was gone. She started looking for stronger vampire-based stories to get the same thrill. This shows how the pleasure-pain balance works in our brains. When we experience pleasure, like the dopamine hit from something we enjoy, the brain also activates areas that feel pain. This creates a balance: the more pleasure we feel, the more pain our brain tries to counteract. After a while, the brain starts tipping more toward pain. This means that pleasure always comes with a dose of pain.

This pain usually shows up as cravings: wanting more of something that felt good before. We think, "One more will make me feel even better," but there's a problem: tolerance. Over time, our brains get used to the pleasure, and we need more to feel the same way. The more we indulge in something, the less pleasure we get, and the more pain we feel. This explains why addicts keep increasing their drug use and why Lemke searched for more intense romance novels. Eventually, the brain settles into a state where pain is more common than pleasure. When this happens, it's hard to enjoy things we once loved. For Lemke, reading was always her greatest joy, but it stopped working when she kept chasing the same thrill.

Yet, just like drug addicts who take more drugs to avoid withdrawal, people sometimes keep going back to the thing that caused the pain. This cycle makes it harder to break free. But the good news is, with time, the brain can restore balance. If we give ourselves a break, we can start enjoying life again without needing that "fix." However, for those who have used a substance or behavior for a long time, it can take much longer, and sometimes the damage is permanent. Although addiction can change our brains, over time, new pathways form to help us make better choices and avoid the pain of addiction.

Abstinence brings clarity

Our brains evolved in times of scarcity, but today's abundance leaves us constantly craving more, never fully satisfied. This mindset, often linked with productivity, ironically increases our vulnerability to pain while reducing our ability to experience pleasure. People battling addiction offer valuable lessons. Philosopher Kent Dunnington suggests addicts can be seen as modern-day prophets. Recovering addicts have gained wisdom uniquely suited to our culture of excess. Like them, we must first break our habits to gain clarity and perspective.

Delilah used weed daily to manage anxiety, similar to Sophie's constant phone use, which might worsen their symptoms. Dr. Lembke advised Delilah to try a dopamine fast - quitting weed for a month to reset her brain's reward system. Neuroscientist Nora Volko's brain imaging study found that even after two weeks of abstinence, drug addicts still showed lower dopamine activity compared to non-users. In contrast, a four-week study by psychology professor Marc Schuckit revealed that 80% of daily drinkers no longer met clinical depression criteria simply by abstaining from alcohol.

Understand the Impact of Abstinence on Health

Abstinence can reveal underlying health issues, as about 20% of patients may not show improvement after a dopamine fast, indicating possible psychiatric disorders. For individuals with prolonged use of hard drugs, a longer dopamine fast may be necessary. Withdrawal symptoms are generally mild for addictions like video games or pornography but can be severe and life-threatening for substances such as alcohol, benzodiazepines, and opioids. In these cases, Dr. Lembke advises against dopamine fasting and recommends medical supervision during withdrawal instead.

After a month without using marijuana, Delilah found her anxiety vanished. She also gained valuable insights. Experiencing vomiting during withdrawal made her realize the depth of her addiction, strengthening her resolve. Throughout her abstinence, Delilah observed how her anxiety stemmed from her dependence on weed. With the drug gone, she rediscovered joy in her life.

Balance of Pain Brings Pleasure

Michael, a former patient of Lembke, found that cold showers greatly improved his well-being after quitting drugs. He began taking ten-minute ice baths twice daily, likening the experience to ecstasy. Research from Prague's Charles University supports this, showing that an hour of cold-water immersion can boost dopamine levels in the blood by 250%. Michael's daily ice baths deliver a painful experience that shifts his brain's focus to long-term pleasure, surpassing the fleeting dopamine rush from drugs in duration.

Gradually exposing ourselves to pain can increase our resilience. This idea traced back to Socrates, explores how experiencing pain can lead to pleasure afterward, much like the high runners feel or the thrill from scary movies. Studies confirm this concept. For example, worms exposed to higher temperatures became more likely to survive such conditions compared to those not exposed. Similarly, Japanese citizens exposed to low-dose radiation in 1945 showed increased lifespan and reduced cancer rates.

Leverage Pain for Health Benefits

Intermittent fasting, a milder approach, has been associated with a longer lifespan, lower blood pressure, and enhanced resistance to age-related illnesses. Similarly, exercise, despite its initial discomfort and short-term strain on the body, boosts dopamine levels and is one of the simplest ways to enhance our overall well-being. Using pain strategically as a pain reliever dates back to Hippocrates, who stated, "Of two pains occurring together... the stronger weakens the other." Acupuncture exemplifies this concept in action. A study in the medical journal Pain, supported by neuroimaging, demonstrated that one painful stimulus can diminish the effect of another. Michael's journey to happiness included enduring ice baths, highlighting how adopting discomfort can lead to healing and growth.

Truth liberates us

Maria, a recovering alcoholic and member of Alcoholics Anonymous, faced a challenging moment when she opened a package addressed to her brother but lied when confronted. The guilt kept her awake that night. The next morning, Maria chose honesty, seeking her brother's forgiveness. This decision lifted the weight of her past lies caused by her drinking days. This act of honesty not only brought them closer but also relieved Maria of her burdens. Radical honesty isn't just a tenet in major religions; it's also crucial in recovery programs. This is because truth-telling, even when it reveals our flaws, heightens our awareness of our actions, ensures accountability, and enhances closeness with others.

When we talk openly with our therapist, AA sponsor, priest, or close friend, and honestly share our life and problems, it helps us gain new perspectives. This is crucial because addictive behaviors often operate automatically. We become so focused on seeking rewards that we overlook the potential consequences. In reality, this behavior can stem from denial, where we don't fully acknowledge the impact of our actions.

Enhance Honesty through Brain Stimulation and Truth-Telling

A Swiss study explored how electrical stimulation to the prefrontal cortex, which manages decision-making and emotions, boosted participants' honesty. This research sparked Lembke's idea: could truth-telling similarly activate the prefrontal cortex and improve emotional regulation? Although lacking supporting data, recovery wisdom suggests that adopting radical honesty can heighten awareness of our compulsive overconsumption habits and prompt behavioral change.

Being honest about our flaws can be daunting because we fear rejection. However, when we bravely reveal our imperfections, it brings us closer to others. This shared vulnerability lets people see themselves in us, reducing their sense of isolation. This openness creates intimacy, promoting a sense of security. When we surround ourselves with trustworthy individuals, we feel more confident and assured of our place in the world. Ultimately, this reassurance helps us navigate life with greater peace of mind.

Prosocial shame humbles us

Our culture is now more aware of the effects of shame. Harmful forms like slut shaming, body shaming, and social media shaming are widely criticized. We recognize that these types of shame are damaging because they lead to painful isolation and often cause repeated negative behaviors. However, shame also plays a crucial role in community building and is a natural response to inappropriate behavior. Unfortunately, addicts and alcoholics often have many reasons to feel ashamed, whether it's lying, stealing, overindulging, or even bed-wetting.

Alcoholics Anonymous uses prosocial shame, where mistakes are met with support and chances for redemption. Instead of being rejected, people in recovery are accepted with the understanding that everyone is flawed but deserving of forgiveness.

Destructive vs. Prosocial Shame

Lori, a patient of Dr. Lembke, struggled with alcohol abuse and overeating. As a lifelong churchgoer, she sought help from her church elders. Instead of offering support, they said they would pray for her and asked her to keep her issues private. This response isolated Lori and made her feel ashamed. Eventually, Lori joined Alcoholics Anonymous (AA), where she found honesty and acceptance, helping her feel less alone. Prosocial shame, however, is a positive force. It encourages humility and helps us connect with our support groups.

Lembke's mentor, an AA member, described his recovery as a "de-shaming process." By attending meetings, sharing experiences, and listening to others, he learned he wasn't alone. During his drinking years, he told many lies and saw disappointment in his wife's eyes, motivating him to get sober. AA provided a way to make amends and improve his life. AA's model of honest self-inventory helps people understand their own mistakes and develop greater compassion for others, which is invaluable since everyone needs compassion. Prosocial shame, on the other hand, is positive because it encourages humility and connects us with our support groups.