Clicks! Likes! Sugar! Gambling! In a world of quick pleasures, an addiction expert says it might be time for a ‘dopamine fast'

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21 hours ago

A couple are silhouetted against the smoke filled sky as they both look on their smart phones in Britannia Beach, B.C., Friday, October 2, 2020. THE CANADIAN PRESS/Jonathan Hayward
Maybe you'd like to spend time on hobbies or hang out with friends, but nothing feels as exciting and engaging as it used to –– so you just squander another hour on social media.
Your problem may have to do with your dopamine levels.
In many parts of the world, people are fed media, activities and foods that can cause dopamine to surge and throw the balance off, and that could affect your mental health, according to Dr. Anna Lembke, professor of psychiatry and behavioral sciences at Stanford University School of Medicine, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic and author of 'Dopamine Nation: Finding Balance in the Age of Indulgence.'
Lembke spoke with CNN about what dopamine is, what it does and how you can find better balance.
This conversation has been lightly edited and condensed for clarity.
CNN: What is dopamine exactly?
Dr. Anna Lembke: Dopamine is a chemical we make in our brain. Specifically, it's a neurotransmitter. Neurotransmitters allow for fine-tuned regulation of electrical circuits. Basically, our brain is a bunch of electrical circuits, a bunch of wires in the form of neurons that conduct electrical signals that allow for information processing — the job of our brains.
Dopamine has many functions, but in the last 75 years or so, it's been identified as a key player in pleasure, reward and motivation. It's not the only neurotransmitter involved in that process, but it has become a kind of common currency for neuroscientists to measure the reinforcing potential of different substances and behaviors.
CNN: How does dopamine impact our mental health?
Lembke: It plays a central role in the phenomenology of addiction. Addiction is a brain disease where there's dysregulation in a specific reward pathway, a specific circuit in the brain, and dopamine plays a critical role in the brain's reward pathway.
When we do something that's reinforcing, that releases dopamine in the reward pathway and tells our brain, 'Oh, that's something you need to do more of. That's important for survival.'
The highly reinforcing substances and behaviors that we have engineered and have access to now are overwhelming the system. (They) release so much dopamine all at once in the reward pathway that the brain has to adapt or compensate by downregulating dopamine transmission.
The result is that, over time, we can enter into a chronic dopamine-deficit state, where we have essentially changed our hedonic or joy set point. Now we need more of our reward — and more potent forms –– not to feel good, but just to stop feeling bad. And when we're not 'using,' we're experiencing the universal symptoms of withdrawal from any addictive substance or behavior like anxiety, irritability, insomnia, dysphoria and craving.
CNN: Does this just affect people who have an addiction to drugs or alcohol?
Lembke: We're all now kind of on the spectrum of compulsive overconsumption, moving toward addiction, which is resetting our hedonic threshold –– or joy set point. We need more and more of these reinforcers to feel any pleasure at all, and when we're not using, we're dysphoric, we're irritable, we can't sleep.
CNN: What kinds of things risk putting us into dopamine deficit?
Lembke: A lot of different things release dopamine in the reward pathway, including things that are good for us, like learning or spending time with friends.
It's not that dopamine is the villain here, that dopamine release is bad –– not at all. The problem is that we've now engineered old-fashioned drugs to be more potent than ever before, and we've also created drugs that never existed before, like digital media, like 'drugified' foods. We've even taken healthy behaviors like exercise and drugified them by (tracking) ourselves and ranking ourselves and adding in social media and social comparisons.
We're now seeing more and more and more people addicted to social media, online pornography, online gambling, video games and all manner of addictive digital media. There's emerging evidence that these digital media activate the same reward pathways as drugs and alcohol and cause the same kinds of dysregulations as we see in other addictions.
It's the same thing with sugar. Ultraprocessed foods cause dopamine release, and the reward pathway leads to the same kinds of behaviors as when people get addicted to drugs and alcohol. There's a growing consensus that it's basically the same disease process, just with a different object of desire or reward.
CNN: How can we find out if a substance or behavior is problematic?
Lembke: When we look at what makes something addictive, there are several factors. One is potency, which refers to how much dopamine is released in the reward pathway and how quickly it's released. But other factors are simple things like access.
We know that the easier it is to access a reinforcing substance or behavior, the more likely people are to use it and hence get addicted to it. We now live in this world of very easy, frictionless access to a lot of rewarding substances and behaviors.
Digital media in particular is a 24/7 mobile access — anytime, anywhere, to an almost infinite source.
The other thing that makes something addictive is the quantity and frequency of exposure. The more dopamine hits the brain gets, the more likely it is to change and adapt in a way that can create a disease of addiction. (Social media algorithms are) actually engineered to overcome tolerance and create novelty, to encourage people to keep searching for the same or similar rewards as what they've already viewed but hopefully a little bit better.
The criteria for diagnosing addiction are pretty much the same across different definitions. You're looking for the four C's: out-of-control use, compulsive use, craving and consequences — especially continued use despite consequences — as well as the physiologic criteria that indicate biological dependence. Those would be tolerance, needing more (or more potent forms) over time to get the same effect, and withdrawal when you try to stop using.
CNN: What can we do to address dopamine deficit?
Lembke: What I recommend is a 30-day abstinence trial, colloquially called a 'dopamine fast,' from the drug of choice. Not from all rewards but just from the problematic substance or behavior to see how difficult it is to stop — and also to see if you feel better after four weeks.
Why four weeks? Because that's, on average, the amount of time it takes to reset reward pathways, at least phenomenologically. I always warn people, they're going to feel worse before they feel better. But if they get through the first 10 to 14 days, often they will feel much better.
After the abstinence trial, when people want to go back to using, they just need to be very specific about what they're going to use, how much, how often, in what circumstances, how they're going to track it, and what their red flags will be for slipping back into old habits.
Then they can reevaluate whether they can really use in moderation. When it comes to food, obviously, people can't abstain, and nor should they try. But they can abstain from sugar. They can abstain from ultraprocessed foods.
How do we engage in pleasurable things but stop before we get to dopamine deficit?
Lembke: It's not about not having pleasure in life; it is about resetting the balance so that simple pleasures are rewarding again. That is not going to happen if people are constantly indulging in these frictionless, high-potency rewards.
I talk a lot about 'self-binding' and making sure we don't constantly surround ourselves with easy access to these high-potency, cheap pleasures so we don't get into that problem in the first place.
But it takes intentionality because we live in a world where we're constantly being invited to consume, and we're told that the more we consume, the happier we'll be. So, it does take planning and intentionality to create barriers between ourselves and the many drugs out there.
Self-binding can mean physical barriers. If the issue is food, not having ultraprocessed food or sugary food in the house. If it's cannabis, not having pot in the house, not having alcohol. Now, if it's some form of digital media, you can use time as a self-binding strategy: 'I'm only going to use on these days for this amount of time with these people.'
Other people are a very important form of self-binding. We tend to do what those around us are doing, so try to hang out with people who are using substances and behaviors in a way that you want to use them.
Madeline Holcombe, CNN