Dopamine Nation: Finding Balance in the Age of Indulgence

In keeping with the theme of Part 2, Lembke explores how medicine is used to treat addiction. She first introduces Chris, a patient of hers who was treated with buprenorphine, a “semisynthetic opioid” used to help reduce cravings for those with opioid addiction. Following a similar pattern as in the rest of the book, Lembke diverts away from a fully involved discussion of buprenorphine and the merits or shortcomings of treating a substance use disorder with a derivative of that very substance. Instead, she turns her attention to Chris’s story. This story is similar to that of David (earlier in the book), the patient who unwittingly developed a substance use disorder for Adderall. Chris’s story doesn’t suggest stunning emotional trauma; instead, he was a college student at Stanford studying to earn a PhD who had trouble acclimating to his new environment. Chris eventually developed a heroin use disorder because of opioid pill use. Lembke chronicles his story, one that shows a lost young man who at one time attempted death by suicide. Her point isn’t to garner sympathy for Chris. Instead, she uses the anecdote to further demonstrate the idea that addiction comes in as many different forms as one can imagine. Chris’s story indicates the need for people to reconsider stereotypes of what “drug addicts” really look like.

Lembke returns to the idea of treating addiction with medicine. She discusses the early days of her career when she was just starting out in residency. She notes that the prevailing views at the time indicated that prolonged substance misuse created a permanent imbalance in the brain weighted to the pain side. She reflects that her job was viewed as a means of supplying a person who had anxiety, or depression, with the appropriate missing chemical. In other words, it was expected that she’d diagnose and prescribe without wading too far into the kinds of cognitive behavioral therapy that would also help the patient. She says, “This messaging was widely disseminated and aggressively promoted by the pharmaceutical industry and found a receptive audience in doctors and patient consumers alike” (127). This is one of her more overt—if moderate—criticisms of the pharmaceutical industry. She uses this to launch into a fuller explanation of the tendency in modern medicine to overprescribe medication, even in light of evidence that suggests such medication doesn’t work as effectively as once thought. In light of the US’s battle with the opioid epidemic, Lembke’s assertion that “patients with pain who take opioids daily for more than a month are at an increased risk not only for addiction but also for worsened pain” (129) is impactful and highlights the theme of The Opioid Epidemic. She mentions similar evidence as it relates to Adderall and other psychotropic medications like Prozac and other antidepressants. Lembke closes the chapter by insisting, “These medications can be life-saving tools and I’m grateful to have them in clinical practice” (135), yet when one learns of the way these drugs are prescribed, the caveat she offers doesn’t soften the implied indictment of modern medicine’s willingness to chemically medicate patients.