I’ve started reading a fascinating book called Dopamine Nation: Finding Balance in the Age of Indulgence by Dr Anna Lembke. She is a professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic.1Anna Lembke Official Website
I’ve been learning about Dopamine lately, primarily via Andrew Huberman’s lengthy podcast. I really enjoy how he can explain relatively complex neurochemistry and then relate this understanding to practical, real-world actions one can follow. 2Huberman Lab Podcast #39: Controlling Your Dopamine For Motivation, Focus & Satisfaction.
In her book, Dr Lembke discusses Dopamine Fasting, either the sudden stopping of indulging in an addictive substance or behaviour.
She has created a rather useful framework for dealing with patients on this topic, with the acronym DOPAMINE.
In the same way she analyses her patients, we can look inwards and analyse ourselves.
D is for Data.
The first thing to do is to gather the simple facts of consumption. What is the pattern of addictive behaviour? If it is substance abuse, how many grams, millilitres, or doses is one taking? How often?
And get specific.
If it’s alcohol, is it red wine, whiskey, or something else? Is it a combination? Do you take different types of drinks at different times of the day?
If it’s food, is it sweet, salty, or fried? When are you overindulging? Are there specific triggers?
O is for Objectives.
What does this particular addictive behavior do for you? Why are we doing it? It is purely for pleasure itself, or are there are other motivations such as anxiety, escapism from our problems, or to attempt to enhance social relationships? Perhaps it is just be able to focus, or overcoming boredom, or simply to have fun.
What’s interesting is that everyone has an objective for their abusive behaviors, regardless of how bad it is. Even the person completely trapped in a fentanyl addiction will have some type of internal logic that justifies what they are doing.
P is for Problems.
What’s the downside?
What could you life look like if you stopped this addiction? What would the upsides of stopping? Do you want to continue this addition in ten year’s time? What about five years from now? What about next year?
You can categorize these problems into physical, mental, and social problems.
Sometimes, the problems are not going to be apparent right away, and it may the a case of positive first-order consequences, while the negative consequences and second and third order — thus far into the future.
Smoking may not feel damaging in the present moment, but the statistics are clear: 67% of smokers die from smoking related diseases. 3The terrifying rate at which smokers die from smoking
A is for Abstinence.
The thing that all addictive behaviours have in common is that they use Dopamine as the reward currency. Scientists can use the amount of Dopamine above baseline to measure how pleasurable different behaviours can be.
For instance, eating a bar of chocolate will temporarily increase Dopamine above baseline by as much as 55%.
Here is a table of some of the substances reviewed in the book:
|Activity||% Increase in Dopamine|
For minor addictions, you can overcome them and reset the brain’s reward pathway in approximately one month of absence. You’ll typically feel shitty for about two weeks, and then you’ll start to feel better. This is enough time to restore homeostasis, and it will allow us to gain pleasure from less potent rewards.
M is for Mindfulness.
This is an interesting one, and it actually surprised me when it came up in the book. I write a fair amount about mindfulness, and I think it is almost like a superpower once you really get into it. By stepping outside of the typical routine of thinking and identifying with your thoughts, you can train attention on attention itself.
This can lead to fascinating results. This is especially useful when dealing with the negative consequences of withdrawal symptoms. You can look at this from an almost inquisitorial mindset. You knew there would be withdrawal symptoms, and now they are happening. The silver lining here is that you know you are in a withdrawal — so things are working as they should!
You can then set yourself a challenge, taken right out of the Stoic handbook, of deciding how to react to negative stimuli.
Do you have to suffer?
I is for Insight.
Once you get through to that thirty days of abstinence, or even during the journey, you will have insights about the nature of your life both with and without this addicitve pattern.
Understand, deeply, how you feel better without doing what you’ve previously been doing. Why did it happen in the first place, and how do you stop from relapsing?
N is for Next Steps.
Once you’ve completed the thirty days, there is a choice you have to make. Will you continue with abstinence, or will you try and manage moderation?
The advantages of abstinence are clear, but there are downsides to living in a society with plenty of other human beings. Will you never have a social drink again, eat chocolate, or watch pornography? Or can you have a healthy relationship towards alcohol, food, and sex?
E stands for Experiment.
This is going back out into the world, with your new settings in your brain. You have a new pleasure-pain balance in your brain, and then you can use trial and error to figure out what will work and what doesn’t.
Moderation, as discussed above, can be an option. However, there’s something called the abstinence violation effect, which can affect people with severe addictions. If you had a severe alcohol problem and then completely stop, when you start again, even years after your last drink, you may find yourself right back to the same addiction level.
Living a life well lived comes down to designing the right set of habits.
We are what we repeatedly do. Excellence, then, is not an act, but a habit.”Aristotle