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Dopamine, Addiction, and the Brain: Understanding the Science Can Help Us Change

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The research has taken three quarters of a century (and counting). But the findings are truly remarkable: pain and pleasure are naturally balanced in a healthy brain. Substances can drastically disrupt that balance, however. In the effort to restore it, our brains go into overdrive. Fortunately, we can help it along—and help ourselves at the same time.

Dr. Anna Lembke is a Stanford professor of psychiatry and behavioral science. She was also one of the first experts to sound the alarm about the opioid epidemic and the over-prescribing of opioid medications. These days, she dedicates her public events to explaining the neurochemistry of addiction.

Lembke is a gifted explainer. If you’re like me, you’ve probably heard the terms—stimulants, dopamine, neurotransmitters, pleasure centers—without being able to put the pieces together into a solid understanding of what’s going on up there when I eat that chocolate. Or take that pill, or even stare too long at my phone. In these 13 minutes, Lembke makes it clear and simple.

Also fascinating. Who knew that dopamine, a chemical produced in the brain, was “the final common pathway” for all pleasure and rewards? Who knew that pleasure and pain were handled by exactly the same part of the brain, or that the brain worked tirelessly to keep them in balance?

That effort is where addiction makes its entrance. In the modern world, we bombard our system with things that stimulate dopamine production—sugar, chocolate, sex, coke, opioids. Each and every time, our brain flies into action to counter that stimulus, or in Lembke’s terms, to add weight on the pain side of the see-saw. Our brain only stops when we do.

The problem? Our brains go too far, tipping the balance towards pain. The more we reach for pleasure stimulants, the more our brains generate, and cling to, a pain response. Worst of all, that pain is ultimately stronger and longer lasting than any pleasure inputs we can reach for. As this wild see-sawing goes on, we get stranded in a “dopamine deficient state.” We come to need drugs not to feel pleasure, but merely to dampen the debilitating pain produced within ourselves. That, says Lembke, is addiction.

Fortunately, when we abstain, our brains eventually do return to balance. The cravings of withdrawal (that state of low-dopamine misery) pass. The final part of this absorbing talk is all about what to do with this knowledge, and Lembke’s just as compelling on these points as she is in describing the biochemistry. Have a listen. I think you’ll find her points both satisfying and useful.

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