Have you ever experienced the need to engage in a certain activity or behavior? Sometimes this can be really positive such as going to the gym or cleaning your house. However for some people this can look like something they might want to change or modify such as drinking too many beers or online shopping. Regardless of the activity or behavior they all have something in common – and that is the chemical reward you receive from participating in whatever activity you are doing. This is the response we get from dopamine. In most addiction work people learn how dopamine is the driving force behind addictive behaviors. These become something of concern when our body needs and depends on the dopamine it receives from doing these activities.

This is the topic of our blog this week with a review of the fantastic book, Dopamine Nation, by Anna Lembke, MD. In this book she shares detailed accounts of clients of whom she worked with who were being treated for various addictive behaviors. She shares how the need for dopamine is a response from the abundance of pleasures and a repulsion to pain many people experience. Regardless of the behavior she finds when people can understand how this activity triggers dopamine and how this can be managed in different ways – people can find healing through relationships and balance. Lembke believes in honoring all parts of the self and finding ways to cope with these negative experiences while gaining dignity, integrity, and self-agency.

This book is very captivating throughout. Lembke shares when she works with her patients it is important for her to first hear their story. She takes us through the journey she has with clients to learn when the behavior started happening and when it began to be considered “out of the client’s control.” The shared experience of the clients in the book are that they all have the desire to not engage in the “destructive behavior.” They said the most troubling aspect of engaging in addictive behaviors was the secrecy, depression, and anxiety that often followed. People wanted to feel a sense of normalcy and control. Lembke shares that her patients have the belief their addictions are a way to cope with depression, anxiety or insomnia. However, counterintuitively the addictions often times becomes the cause of further pain rather than to provide relief from it. This is due to the behavioral triggers leading to an initial flood of dopamine which takes the person down the path to experience the chemical of pleasure. However, when the dopamine wears off the person often feels worse than before, leading them to continue to seek the stimulus which provides the relief they need. This cycle becomes very difficult to overcome on one’s own. This is where the help of a counselor can be vital for learning new ways to cope while withdrawing or changing the addictive behavior.

I found the most helpful aspect of the book was Lembke’s suggestions on how people have used effective strategies to cope with their addictions. The first suggestion she often gives her patients is withdrawl or fast from the addictive behavior for one month. This allows enough time to determine if the anxiety or depression was caused by the addiction rather than a treatment for it. This also helps the person reset their body and find more balance. After this time she often reflects with her patient about how they feel and what the experience was like. It is no surprise how difficult the first few weeks are for someone withdrawing from any addictive behavior. However, when a person is able to move past the first couple weeks a new sense of relief emerges. Many of her patients report feeling much better and many of their other symptoms disappear. The most challenging aspect of what happens next is finding ways of not relapsing back into the old patterns. This leads her to report on how pain can sometimes be an effective way to cope with needing more dopamine.

One popular pain remedy Lembke describes is “cold therapy.” This is used by some people as an effective way to cope with addiction and find greater homeostasis. Many people report feeling a “natural high” and a great release of dopamine as an effect. We also often hear about a “runner’s high” when a person pushes their body to a certain limit and feels a flood of feel good chemicals. These solutions can help a person experiencing addiction to replace their negative behaviors with a way to receive dopamine in an alternative way.

One popular pain remedy Lembke describes is “cold therapy.”


The biggest takeaway I received from this book was the normalcy of addiction. While some people have experienced addictive behaviors that are very damaging to their health and relationships, there are other socially acceptable behaviors which also can cause distress such as social media intake or excessive caffeine. Our current society is overly stimulating and overly triggering in many ways. It is so easy for a person to struggle to navigate the world without become vulnerable to addictive behaviors. Lembke is a supporter of honoring the whole self and finding ways to cope while learning how to move through the uncomfortable feeling of needing a dopamine release. She shares a thought provoking example of a patient whom was taking medication to help with depression. This patient found herself unable to have the wide range of emotions such as “awe and grief” which make us human. She realized this was a problem when she was unable to cry at her mother’s funeral. She accepted that while the feeling of being numb and feeling pain on a daily basis is uncomfortable, it’s also a part of living.