Dopamine Nation: Finding Balance in the Age of Indulgence

Lembke begins the chapter with another anecdote from her clinical practice, this one about a teenager named Delilah. Delilah’s parents requested that she seek help for her cannabis use. Delilah saw her use of cannabis as a way of treating her anxiety and stress and saw no reason to quit using cannabis. Lembke then transitions into discussing an acronym she uses, DOPAMINE, and then identifies what each letter represents, describing each in varying detail. She refers to this as a framework she has developed to work through patients’ compulsive tendencies.

The D stands for Data. Lembke says that the first thing she does is gather as much initial data as she can about the patient and their level of substance use. The O stands for Objective, which Lembke uses to identify how a person with an addiction perceives the reasons and expectations for their usage. The P stands for Problems, which Lembke claims almost always occur with high-dopamine drugs. She then discusses why Delilah was unable to see the problems that cannabis may have been causing. She attributes some of this to Delilah’s young age and says that the immediate consequences of using drugs become more apparent as people age. Lembke returns to the acronym, noting that the A stands for Abstinence. She notes that the only way for a person with an addiction to achieve homeostasis is to abstain completely. She then asserts that just how long a person must abstain to achieve this is uncertain and discusses the differing opinions on this question, including evidence from her own clinical practice. Lembke continues to dissect the acronym, stating that M stands for Mindfulness. This involves guiding patients to listen to what their bodies are saying. She asserts that mastering this technique allows people to feel less afraid of negative thoughts and behaviors. I stands for Insight, which she maintains often comes as a result of abstinence and happens when one has a light-bulb moment in relation to one’s compulsive behavior. N is for Next steps, a stage that usually comes later, in which she discusses with the patient plans for moving forward. The last letter in the acronym, E, stands for Experiment. Lembke discusses whether complete abstinence is a necessary component of every recovery strategy, noting that moderation is achievable for some people who present as experiencing addiction less severely than others.