Introduction
The world has transformed from a place of scarcity to a place of abundance -- food, shopping, information, connectivity.
Dopamine is the universal currency of measuring addictive potential of any experience.
The book is about how to manage compulsive overconsumption in a world where consumption has become the all-encompassing motive of our lives.
Chapter 1 : Our Masturbation Machines
We are all engaged in our own masturbation machines.
For some the addiction may be an evident one -- addiction with drugs, drinking, sex, gambling etc but it can also be something insiduous such as addiction with books, movies etc. Something which is not evidently harmful as itself but the addiction is way of escaping from other pain or uncomfortable emotion in your life.
One of the easiest risk of getting addicted to a drug is easy access to that drug
Trauma, social upheaval and poverty contribute to addiction risk
The potency of addictive substance is much higher than before
Digital drugs -- pornography, gambling, video games.
The technology is addictive due to multiple reasons -- flashing lights, musical fanfare, ongoing engagement and rewards.
The act of consumption itself has become a drug, searching for products online, comparing prices, reading reviews, anticipating delivery.
The internet promotes compulsive overconsumption not merely by providing increased access but also suggestive behaviour that wouldn't have occured to you in the first place.
Videos that go "viral" are contagious. We see other people doing it and think it is normal.
70% of the world's global death are attributable to modifiable behavioural risk factors such as smoking, physical inactivity and diet. The leading risk for mortality are high blood pressure, tobacco, high blood sugar, physical inactivity and obesity.
In 2013 there are an estimated 2.1 billion people who are overweight compared to 857 million in 1980.
The poor, uneducated people especially in rich regions are more susceptible to the problem of compulsive overconsumption. They have access to high potency, high risk drugs at the same time lacking affordable healthcare, quality education, safe housing and meaningful work.
Chapter 2 : Running from Pain
The authors talks about how nowadays children are treated as psychologically fragile. Parents are terrified of saying something lest it leave an emotional scar in the adulthood.
Based on Freud research that early childhood experiences, even those forgotten, can have a lasting psychological damage. The parenting and education now-a-days is inspired by this developmental psychology. While this in itself is a positive change the author argues whether it has a negative effect on children. By increasing self esteem using false praise and lack of real world consequence, have the children become more self absorbed, less tolerant and ignorant of their own defects.
Beyond extreme examples of running from pain, we have lost the ability to even tolerate minor discomforts. We constantly seek to distract ourselves from the present moment, to be entertained.
All this serves one purpose -- avoid ourselves. But it becomes exhausting to avoid yourself (looking for more and more forms of entertainment and distractions). Boredom is terrifying because it confronts us with questions of meaning and purpose but it is also an opportunity for discovery and invention. It creates the space necessary for new thoughts to form. Brain likes reacting to stimuli.
The author tells the story of another patient who got addicted to taking adderall and other drugs, often ignoring things until the last moment and then taking these meds to push through the work. This continued for years and become a daily thing, taking it before and after office. Abundance become the new normal
Chapter 3 : The Pleasure - Pain Balance
Dopamine plays a bigger role in the motivation to get a reward rather than the pleasure of the reward itself. Wanting more than liking. The text mentions the examples of genetically engineered mice who would not seek food even when hungry and food is in their reach. They would however chew it once the food is placed in their mouth.
Dopamine is used to measure the addictiveness of any drug. The amount and rapidity with which they release dopamine in brain's reward pathway is their addictiveness.
Chocolate increases the basal output of dopamine by 55%, sex by 100%, nicotine by 150% and cocaine by 225%. Amphetamine, which is active ingredient in the street drugs and medications such as Adderall increase the release of dopamine by 1000%.
As much as I understand here, we creave dopamine which is released in motivation of doing or wanting something. That means that the process of achieving something provides the pleasure rather than the end reward.
Pain and pleasure are like a balance. When we feel pleasure, the balance tips over to the pleasure side and dopamine is released in the reward pathway. But every time the balance tips over powerful self regulating mechanisms kick in to restore the balance.
This reciprocal relationship is called opponent-process theory. "Any prolonged or repeated departure from hedonic or affected neutrality has it's cost"
We feel a craving after any pleasure, to want to recreate the same feeling. However with repeated exposure to the same or similar stimulus, the initial deviation towards the side of pleasure gets weaker and shorted and the after response to the side of pain gets stronger and longer, this phenomenon is called neuroadaptation.
Needing more of a substance or experiencing less pleasure given the same dose is called tolerance.
Prolonged consumption of high-dopamine inducing substances result in dopamine deficit state.
The pursuit of pleasure for itself leads to the state of anhedonia, which is inability to enjoy pleasure of any kind.
The universal symptom of withdrawl from any addictive substance is anxiety, irritability, insomnia and dysphoria.
The pleasure pain balance tilted to the pain side is what drives people to relapse even after a sustained period of abstinence. We crave the drug to feel normal (balanced). This is called "dysphoria driven relapse". The motivation here is not the search of pleasure but to alleviate physical and psychological suffering of withdrawl.
The good news is : If we wait long enough then our brains readapt to the balance of the drug and restablish baseline homeostasis.
Cue-dependent learning - The is a pre-reward dopamine spike in the brain incase of a conditioned cue. The anticipatory pleasure than good things are coming. Right after the conditioned cue there is a temporary dopamine deficit which creates the craving for the reward. If we get the reward, we get a even bigger spike and if we don't get a reward we experience an even bigger plunge.
Notifications on our phone are a cue conditioning. We anticipate that our friend or loved one will be texting us. This causes us to check our phone in anticipation. If the notification is not a message from someone then we feel even worse. One way to avoid this could be to have different sounds for difference applications. This way you are not building up the anticipation. Or maybe wait 5 mins before checking the notification.
Dopamine release as a result of gambling links to unpredictability of reward delivery. The motivation to gamble is mostly based on inability to predict the reward itself rather than financial gain. Gambling disorders highlights the difference between reward anticipation and reward response. Gamblers mention that a part of them want to lose which increases their urge to continue gambling and heightens the rush when they win, called "loss chasing"
The author mentions that something similar happens on social media where the anticipation of getting a like is equivalent to getting the like itself because of how capricious and unpredictable other people are.
The brain encodes long-term memories of reward and their associated cues by changing shape and size of dopamine producing neurons. This is called experience-dependent plasticity.
Not everyone starts with a level balance. People with depression, anxiety and chronic pains start with a balance tipped over to the side of pain, making them more susceptible to addiction.
With prolonged and repeated exposure to pleasurable stimuli, our capacity to tolerate pain decreases and our threshold for experiencing pain increases. These changes get imprinted in the brain for permanent. Now we need more reward to feel pleasure and less injury to feel pain.
Chapter 4 : Dopamine Fasting
The author described the method she has developed for her practice -- DOPAMINE
Data - gaining knowledge about consumption -- what, how much, how often.
Objective - what does consumption do for you? Each addiction does something positive for that person -- to have fun, to avoid boredom, to manage fear, anger, anxiety, depression, social phobie etc.
Problems - What are the unintended consequence of that addiction? Health problems, relationship problems, moral problems. Sometimes the effets are clouded when we are still consuming the high-dopamine substance. In short term we don't see the effect but in longer term the effects of unintended consequence amplify.
Abstinence - Abstinence is necessary to achieve homeostasis and our ability to get less potent rewards. 4 weeks of abstinence usually works. Many times we are taking the substance only to relieve ourselves of the withdrawl from last time. Don't replace one reward with another that is potent enough to become addictive itself (cross addiction).
Mindfulness - observe what our brain is doing while it's doing it, without judgement. Before it starts feeling better it will feel much worse (induced due to withdrawl). It is very important to be non judgemental here because the moment you start condemning the brain for the thoughts we cease to be an observer. Need to stop running away from negative emotions and learn to tolerate them.
Insight - After a decent amount of time of abstinence will you start getting insights into your behaviour.
Next steps - Can you go back to using it again in a controlled way?
Experiment -
Chapter 5 : Space, Time and Meaning
Chapter 7 : Pressing on the Pain Side
Cold-water immersion - Dopamine rises gradually and steadily over the course of the bath and remained elevated for an hour afterwards. More studies show that cold water immersion shows elevation in monoamine neurotransmitters (dopamine, norepinephrine, serotonin). Beyond this extreme cold in animals has been shown to promote neuronal growth.
Pressing on the side of pain can lead to pleasure. The dopamine that comes from pain is more enduring.
With intermittent exposure to pain, our natural hedonic set point gets weighted towards to the side of pleasure, such that we become less vulnerable to pain and more able to feel pleasure over time.
Intermittent fasting and calorie restricted eating has shown to increase lifespan and age related diseases.
Overwhelming amount of evidence supporting the benefits of exercising. Exercise has a more profound and sustained positive effect on mood, anxiety, energy and sleep than any pill I can describe.
Persuing pain can be difficult but we must remember that we will feel pleasure afterwards.
Extreme sports can tilt the pleasure-pain balance towards pain intensely. This instense fear/pain along with release of adrenaline can create a potent drug. Too much pain or in too potent form can increase the risk of being addicted to pain.
Stress also can release dopamine leading to similar brain changes as seen with addictive drugs.
Addiction with work - Invisible incentives are now woven into the fabric of work -- bonuses, stock options. Higher reward for those at the top of economic food chain.
The "flow" of deep concentration while being highly rewarded could be a drug in itself if it keeps us from intimate connections with friends and family.
Chapter 8 : Radical Honesty
Being honest with yourself is an important part of recovery from any addiction.
Radical honesty promotes awareness of our actions. Second, it fosters intimate connections.
Awareness - Recounting our experience gives us mastery over them. A well recognised phenomenon in addiction is denial -- a half conscious state akin to a waking dream. Denial is mediated by disconnect between the reward pathway part of the brain and higher cortical brain region that allows us to appreciate consequence, plan for the future.
Practicing radical honestly can be really helpful. Articulating your wishes and desires strengthens your resolve. People see in our brokenness their own vulnerability and humanity. They are reassured that they are not alone.
Intimacy is it's own source of dopamine.
Any behaviour that leads to increase in dopamine can be exploited. A particular example of this is "Disclosure porn" where revealing an intimate part of our lives becomes a way to manipulate others for certain kind of selfish gratification.
The way we tell our personal stories is a marker of mental health.
In the practice of empathy we should not forget accountability. If a therapist and patient re-create a story in which the patient is the victim of forces beyond their control, chances are good that the patient would continue to be victimised.
"the false self" is a self constructed persona in response to external demands and stressors. The creation of false self can lead to profound emptiness. When our lived experience diverges from our projected image, we are prone to feel detached and unreal. ==> derealisation and depersonalisation.
The antidote to false self is the authentic self, honesty being the path towards it. It makes us feel real in the world. It also reduces the cognitive load required to maintain all those lies, freeing up mental energy to live more spontaneously in the moment. Truth-telling is contagious.