With a world that has become increasingly abundant in ways that people can become addicted to mild to extremely potent forms of pleasure, Dr. Anna Lembke in her 2021 New York Times Bestseller Dopamine Nation: Finding Balance in the Age of Indulgence aims to describe the neuroscience of addiction and practical tools that can enable us to ultimately live a more freeing life. The pursuit of pleasure is often associated with the idea of freedom, which sounds like slogans commissioning you to do whatever you want and live your life to the fullest. Lembke dispels this myth by revealing how people become slaves to their passions and introduces the following concept that’s largely unheard of in the modern world: freedom is balance.

Dr. Anna Lembke is a professor of Psychiatry and Addiction Medicine at Stanford University of Medicine, and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She uses her wealth of knowledge and experience to deliver her message in a way that’s captivating and easy to digest for the average consumer. She unpacks the science of addiction by describing the role of the neurotransmitter called dopamine, which is what scientists use as the measuring stick for how addictive an experience is. She explains that the brain processes pleasure and pain in the same place and uses an extended metaphor of a teeter totter in order to paint a picture detailing how our brain desires balance. When we experience any kind of dopaminergic response from eating a piece of chocolate, playing a video game, or doing meth, there is a moment immediately after where our brain tips to the pain side and we begin craving more of whatever we are consuming in order to relieve this discomfort. Drugs will trigger significantly more dopamine, which explains why their withdrawal symptoms cause greater suffering to the user.

Lembke has gotten permission from her patients to tell their true stories of becoming addicted and undergoing recovery and she interweaves these narratives beautifully throughout the book. This work has been expertly crafted, but stands out because of Lembke’s obvious passion and heart for the work she does. Lembke organizes her book into the following three parts: “The Pursuit of Pleasure,” “Self Binding,” and “The Pursuit of Pain.” She interweaves these narratives throughout, which allows the science she explains to be understood in practical application. Her first chapter dives into her real patient Jacob’s journey into sex addiction by the way of building his own masturbation machine, which is literally electrifying and sure to grip any reader. She explains that extreme examples like this are not being used for their shock factor, but because they have the power to show how someone can become stronger through the process of recovery even in the most severe cases of addiction.

I have seen several negative reviews that had a problem with how Dr. Lembke included her dependence on romantic and erotic novels alongside the stories of her patients. She clearly argues that her dependence was not as severe, yet still demonstrates the pleasure-pain principle she laid out with the explanation of dopamine. The people writing these negative reviews are missing the point of how commonplace overconsumption is. Lembke’s storytelling is a testament to not only her skilled abilities as a writer, but the years she’s spent as a clinician listening and responding with compassion to her patients’ pain. She is not afraid to see where addiction is showing up in her own life, which should challenge us to see ourselves in her patients and consider how we are managing our consumption in the dopamine-potent world we live in.

Lembke gives several practical tools that readers can use to combat their addictions and consumption to achieve homeostasis, which is the state our brain is in when it is balanced and stable. In this state our baseline for pleasure will be lower and we will begin to find joy in everyday life without needing to exhaust dopamine sources to feel anything at all. An example of some self-binding strategies Lembke gives are to abstain from the source of dopamine we are overindulging in to reset our brain’s reward pathway and several ways we can remove triggers to lower the degree of temptation of using since addiction makes it hard to exist by going off of willpower alone. She also offers suggestions and research for how pressing on the pain side through engaging in strenuous exercise or ice baths for example could help our brain reset.

This is the last book I read last year and one that I consider the most important for me personally going into 2024. With depression and anxiety rates at an all time high and a culture constantly offering ways for us to escape reality, it’s easy to get caught in a loop of avoiding pain and thus creating more pain for ourselves in the process. I personally am realizing that I get caught in a loop of wanting more and have discovered that finding tools like gratitude and exercise enable me to want less. I feel like I am at least starting to learn how to live a good life because I am choosing to not run away but immerse myself into it. Dr. Anna Lembke finishes the book with a line that reads like it could be an excerpt from a classic novel or poem. I want to give her following quote the space it deserves without paraphrasing it because I believe it holds essential truths that we all need to make space in our lives to receive and practice:

“I urge you to find a way to immerse yourself fully in the life that you’ve been given. To stop running from whatever you’re trying to escape, and instead to stop, and turn, and face whatever it is. Then I dare you to walk toward it. In this way, the world may reveal itself to you as something magical and awe-inspiring that does not require escape. Instead, the world may become something worth paying attention to. The rewards of finding and maintaining balance are neither immediate nor permanent. They require patience and maintenance. We must be willing to move forward despite being uncertain of what lies ahead. We must have faith that actions today that seem to have no impact in the present moment are in fact accumulating in a positive direction, which will be revealed to us only at some unknown time in the future. Healthy practices happen day by day. My patient Maria said to me, “Recovery is like that scene in Harry Potter when Dumbledore walks down a darkened alley lighting lamp posts along the way. Only when he gets to the end of the alley and stops to look back does he see the whole alley illuminated, the light of his progress.”