The Science of Pleasure and Pain

Dr Anna Lembke, author of Dopamine Nation, shares insight into the pain-pleasure circuitry in the brain and how it affects our ability to become addicted to painful things and numb to pleasurable ones—and how we can do a ‘reset’ to get back a sensitivity for both.

Full show notes

What do you do when your teen suddenly seems to be in a rut? It might be that they barely eat, lock themselves in their room, or stop talking to their friends…whatever it is, they won’t clue you in to what’s wrong. The truth is, they may not even know! These days, more and more people are finding themselves feeling down without an obvious reason—and this week, we’re going to find out why.

In recent years, the number of prescriptions for antidepressants has gone up all across the globe…but so have rates of depression and anxiety. How could this be possible? It might just be that relying on medicine is actually making us feel worse in the long run–and the same goes for other substances, or even unexpected comforts like social media and video gaming. To help us understand further, we’re talking to a brilliant psychologist who knows a thing or two about addiction and the mind’s ability to process feel-good chemicals. 

Dr. Anna Lembke is the Medical Director of Stanford Addiction Medicine and has been a leading researcher on addiction for over 25 years! Her new book, Dopamine Nation: Finding Balance in the Age of Indulgence, highlights just how easy it is to partake into too much pleasure when we’re constantly oversaturated with media influence and convenient dopamine hits like fast food and vaping. Beyond just substance abuse, many teens are finding themselves addicted to digital stimulation, pornography or social media, but may not exactly why they’re feeling so blue all the time.

To help us understand this mental health crisis, Dr. Lembke and I are discussing the neurological and evolutionary reasons behind why teens get into depressive episodes from too much indulgent behavior. Plus, we’re talking about what we can do to make our teens less vulnerable to addictive forces, and how to get them to open up about their bad habits.

Why Your Teen Might Be in a Slump

There are a lot of reasons why teens can end up in a bad mood, but if they seem like they’re in a hole they just can’t get out of, an addictive behavior might be behind it. Anna explains that in our modern world, with access to endless entertainment and substances, we have a tendency to bombard ourselves with pleasure…but it has a price. When we experience a rush of happiness, our minds react by releasing dopamine, a feel-good chemical. Then, in order to restore our mind's balance, our brain brings in different chemicals that make us feel, well, not so good.

Usually, this system works efficiently and effectively to keep our moods stable. But when we’re constantly filling up our brain with dopamine by reaching for alcohol or even the TV remote, we set our brain’s balance off, says Anna. To try and restore the balance, our brain pumps out  chemicals to lower our moods…but it doesn’t really know when it’s reached the right threshold. This leads us to feel chronically depressed and anxious as a result of our addictive behavior, Anna explains.

This search for pleasure developed as humans tried to survive bleak conditions, and needed that dopamine to go on, she tells us in the episode. But as we became pleasure-seeking creatures, we started to get a little too good at it! Now, instead of wandering through the forest, scavenging for food with enough sugar and fat to keep us alive, we can drive through McDonalds and get burgers in sodas in less than ten minutes. Instead of waiting for the sparkle of the stars to stimulate our minds, we can flip on a screen at any moment and watch whatever we want. 

We are programmed to search for pleasure as though we are still in a place of scarcity, even though we live in abundance. Dr. Lembke describes us as cactuses in the rainforest! This leads our whole mental balance to fall out of place, especially for teenagers whose minds are still developing. So how can we fix it? Dr. Lembke and I discuss solutions in the episode.

Treating a Depressed Teen

Nowadays, when teens are feeling blue, we tend to prescribe them an antidepressant or anti-anxiety medication. But this may not be the answer, says Dr. Lembke. In the episode, she explains that while these medicines can be helpful and even life changing, they really only work in the short term. There is almost no reliable evidence to support the idea that these medications are helpful when taken for months or even years, she says. The problem is that users of these drugs begin to build a tolerance to them, making them ineffective, or even harmful if they set off the brian’s natural balance.

A lot of times, teens who are dependent on an addictive substance or behavior might not be open to letting that behavior go, Anna explains. They might believe that the behavior is helping them feel less depressed or anxious, when really it’s the cause of the problem! Anna explains how humans are born with brilliant storytelling abilities, and we often harness that ability to create elaborate and convincing rationales for our own destructive behavior. For teens who aren’t yet seeing the physical effects of their addictive behavior, it’s even harder to see a reason to stop indulging.

Anna usually advises most of her patients to do one single thing–lay off their destructive habit for 30 days. This allows their brain to restore its natural chemical balance, free from the dopamine overload caused by that addictive behavior. If your teen has been spending too much time playing Fortnite or scrolling through Instagram, it might help to suggest that they delete it for a month, and see if their mood improves! 

Obviously, it’s not super likely that your teen will be incredibly receptive to this suggestion. In the episode, Anna and I discuss how you can get teens to open up to the idea of dropping their addictive behavior.

Helping Teens Improve Their Habits

It’s not easy to talk to a teen out of a bad habit. Half the time, they just shut the door in your face, or throw some hurtful words at you to get you to go away. If we're going to figure out how to get through to them, we’ll have to talk to someone who’s an expert at talking to avoidant addicts and helping those who don’t want to help themselves! Luckily, Anna is here to give us some expert tips so we can have productive discussions with teens instead of scaring them off.

To get kids to think critically, Anna recommends invoking the idea of the future. Teenagers who are behaving impulsively might benefit from thinking about where they’re at and where they want to be. Young people are especially likely to search for immediate gratification without thinking about future consequences. Dr. Lembke suggests asking them questions like: do you want to keep vaping like that for the rest of your life? Or, do you want to play video games this much when you’re twenty five? This might prompt them to shift their perspective by causing them to think about their life’s direction.

Anna also emphasizes the importance of keeping your own parental emotions out of the discussion. This kind of serious conversation should happen when you’re feeling comfortable enough to have an open discussion and not react with panic or overwhelming urgency, she says. Instead of offeri...