Book Review – Dopamine Nation
Image: Dopamine Nation by Len Lantz (CC BY-NC-ND)
Synopsis: Len's Star Rating: 10 out of 10. An excellent book on the reasons behind and how to escape addiction.
BY LEN LANTZ, MD / 3.28.2025; No. 128
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Star Rating – 10 out of 10
Rating guide: 1 = horrible, 5 = average and 10 = wow
Author
Anna Lembke
About the author
Anna Lembke, MD, is a clinical psychiatrist in addiction medicine, speaker, researcher, professor of psychiatry at Stanford University School of Medicine, and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She achieved her BA in humanities at Yale and her medical doctorate at Stanford, and she completed her specialization in psychiatry at Stanford. She has received numerous awards for her teaching, research, and clinical innovations. Her 2016 debut book Drug Dealer, MD was chosen as one of the best books for understanding the US opioid epidemic by The New York Times, which also listed her second book, Dopamine Nation, as a bestseller.
General description
In Dopamine Nation, author Dr. Anna Lembke explains how we can feel miserable despite having abundance and experience pain in reaction to excessive pleasure. She writes convincingly about how “our brains are not evolved for this world of plenty” and provides steps the reader can take to escape the numerous addictive traps in the modern world. Any substance or activity places us at risk of compulsive overconsumption, from drugs to gambling to smartphones. The dopamine reward system is at the heart of addiction, because once that system gets out of balance, the results range from pain, anxiety, and depression to catastrophe.
Most importantly, Anna Lembke provides realistic hope for any reader struggling with addictive behaviors by highlighting stories of her patients, sharing her personal struggles with overconsumption, and explaining research in a way that any reader can understand. Recovery is not only possible; it’s transformative. Topics covered in this book include:
The reason why too much pleasure leads to pain
The way dopamine controls the brain’s balance between pleasure and pain
The variety of strategies for recovery
The role of abstinence in achieving and maintaining sobriety from addictive substances and behaviors
The power of connection to others and radical honesty in recovery
Unique and most important aspects
Anna Lembke’s highly engaging writing in Dopamine Nation draws you in immediately, starting with a story about sexual addiction followed by her own compulsive overconsumption. Dr. Lembke goes on to reveal the why behind addiction and how overabundance can actually be a big problem. She asserts at the heart of it, “The reason we’re all so miserable may be because we’re working so hard to avoid being miserable.”
The dopamine reward system is both the problem and the solution when it comes to addictions, and I found her chapter, “The Pleasure-Pain Balance,” to be one of the best in Dopamine Nation. Throughout the book, Anna Lembke shares personal experiences, clinical observations, societal difficulties, philosophy, and research to bring understanding and hope to the reader.
While I did not agree with some of the sweeping statements the author made about psychiatric medications and the treatment of childhood mental illness, I didn’t find that those perspectives detracted from my enjoyment of the text. At the end of the book, the author provides her ten “Lessons of the Balance,” which wonderfully sum up her main points. Important features of this book include:
The influence of “limbic capitalism” (the dopamine economy)
The opponent process theory, which explains the reciprocal relationship between pleasure and pain
The process of neuroadaptation in addiction that shows up as tolerance
The risks of opioid-induced hyperalgesia
The “dopamine deficient state,” which occurs due to prolonged exposure to high-dopamine substances
The risks of “dysphoria driven relapse” and “abstinence violation effect”
The biology of “loss chasing” in pathological gambling and how that relates to social media use
The negative impact that addiction can have on delayed gratification (referred to as “delay discounting”)
The concept of self-binding to promote success in abstinence from an addictive substance or behavior
The example of Alcoholics Anonymous (AA) as a model for prosocial shame
Best quotes
“In addition to the discovery of dopamine, one of the most remarkable neuroscientific findings in the past century is that the brain processes pleasure and pain in the same place. Further, pleasure and pain work like opposite sides of a balance.”
“I was struck by how much hotel rooms are like latter-day Skinner boxes: a bed, a TV, and a minibar. Nothing to do but press the lever for drug.”
“These risk factors notwithstanding, increased access to addictive substances may be the most important risk factor facing modern people. Supply has created demand as we all fall prey to the vortex of compulsive overuse.”
“Dopamine may play a bigger role in the motivation to get a reward than the pleasure of the reward itself. Wanting more than liking.”
“The paradox is that hedonism, the pursuit of pleasure for its own sake, leads to anhedonia, which is the inability to enjoy pleasure of any kind.”
“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.”
“The depressed men in Schuckit’s study went into the hospital for four weeks, during which time they received no treatment for depression, other than stopping alcohol. After one month of not drinking, 80 percent no longer met criteria for clinical depression.”
“Opioid-addicted study participants referred to a future that was on average nine days long. Healthy controls referred to a future that was on average 4.7 years long. This striking difference illustrates how ‘temporal horizons’ shrink when we’re under the sway of an addictive drug.”
“Dopamine consumption is not just a way to fill the hours not spent working. It has also become a reason why people are not participating in the workforce.”
“This type of radical honesty without shaming is also important to teach children their strengths and weaknesses.”
Who would enjoy this book?
Readers who want to learn more about addiction and what to do about compulsive overconsumption will likely enjoy Dopamine Nation.
Who would not enjoy this book?
Readers who are looking for a scientific text or who would be turned off by positive references to Alcoholics Anonymous (AA), radical honesty, or “prosocial shaming” are unlikely to enjoy Dopamine Nation.
Conclusion
Dopamine Nation is an excellent book on the reasons behind and how to escape addiction.
