[[Dr. Anna Lembke]] [[lit/kindle/Dopamine Nation|Highlights]] Lembke shares a collection of patient stories from her psychology practice for patients struggling with various forms of addiction. As Lembke points out, the human brain evolved in an environment of scarcity and has only recently been plunged into an environment of abundance. The abundance of available rewards--from high-calorie foods to online gambling to pornography--has hijacked our reward pathways ("a brain circuit that links the ventral tegmental area, the nucleus accumbens, and the prefrontal cortex") and unbalanced dopamine function in the brain. > Why, in a time of unprecedented wealth, freedom, technological progress, and medical advancement, do we appear to be unhappier and in more pain than ever? The reason we’re all so miserable may be because we’re working so hard to avoid being miserable. Lembke herself was addicted to fantasy erotica, having been introduced to it by the *Twilight* saga. The compulsion to read low-quality erotica affected her work and family life. Eventually she had to admit her problem and get rid of her e-reader to avoid the temptation. Processing of pain and pleasure are co-located in our brains. Our brains seek to maintain homeostasis by balancing pleasure and pain. Lembke likens this to a teeter-totter where "gremlins" hop on the pain side in response to our choices to press the pleasure side. The more pleasure we experience, the more gremlins hop on and thus the more pain when the pleasurable stimulus is removed. However, abstinence--Lembke recommends at least one month--can return the brain to homeostasis. > Here’s the good news. If we wait long enough, our brains (usually) readapt to the absence of the drug and we reestablish our baseline homeostasis: a level balance. Once our balance is level, we are again able to take pleasure in everyday, simple rewards. Going for a walk. Watching the sun rise. Enjoying a meal with friends. On the flip side, we can press on the pain side to create pleasure. Cold showers and cold plunges create a rush of pain that is followed by a euphoria and often hours of sustained positive mood. However, people can become addicted to pain as well as pleasure for the same reasons. > If we consume too much pain, or in too potent a form, we run the risk of compulsive, destructive overconsumption. But if we consume just the right amount, “inhibiting great pain with little pain,” we discover the path to hormetic healing, and maybe even the occasional “fit of joy.” Lembke promotes radical honesty and what she calls "prosocial shame" to help addicts escape the cycle of addiction. She ends the book with ten "Lessons of the Balance." 1. The relentless pursuit of pleasure (and avoidance of pain) leads to pain. 2. Recovery begins with abstinence. 3. Abstinence resets the brain’s reward pathway and with it our capacity to take joy in simpler pleasures. 4. Self-binding creates literal and metacognitive space between desire and consumption, a modern necessity in our dopamine-overloaded world. 5. Medications can restore homeostasis, but consider what we lose by medicating away our pain. 6. Pressing on the pain side resets our balance to the side of pleasure. 7. Beware of getting addicted to pain. 8. Radical honesty promotes awareness, enhances intimacy, and fosters a plenty mindset. 9. Prosocial shame affirms that we belong to the human tribe. 10. Instead of running away from the world, we can find escape by immersing ourselves in it. I was slightly disappointed with the book for not providing more actionable insights into how to balance dopamine better in daily life or more of a neuroscientific basis for her arguments. Instead the book was more a collection of patient stories and personal anecdotes interspersed with her ideas on dopamine.