Dr. Anna Lembke, director of the Stanford Addiction Medicine Dual Diagnosis Clinic, discusses the role of dopamine in the brain and the addictive world we live in. She highlights the impact of the internet, explores the connection between addiction and mental health, and explores physical movement and dopamine neurotransmitters. She also emphasizes the power of radical truth-telling in recovery and decision-making, the effectiveness of support groups, and delves into the dangers of fentanyl in the drug epidemic.
The excessive pursuit of pleasure and the easy accessibility of addictive substances and behaviors in today's society have led to a rise in addiction rates across various demographic groups.
The relationship between addiction and mental illness is complex, with each having its own complexities and pathways, indicating that treating mental illness may not necessarily address addiction fully.
Deep dives
The Role of Dopamine in Addiction
Dopamine is a neurotransmitter that is released in the brain's reward pathway, and it is involved in experiencing pleasure, reward, and motivation. Addictive substances and behaviors release more dopamine in this pathway, leading to feelings of pleasure and reinforcing the behavior. With repeated exposure to addictive substances, the initial dopamine spike weakens, but the brain experiences a stronger and longer-lasting dopamine deficit state. This chronic dopamine deficit state leads to addiction, as individuals need to use the drug or engage in the behavior to bring dopamine levels back to baseline.
The Relationship Between Addiction and Mental Illness
The traditional view of addiction suggests that people use substances or engage in addictive behaviors to self-medicate underlying mental illnesses. However, this perspective is not entirely accurate. Treating mental illness may not necessarily address addiction, as an individual may still be addicted even after resolving their mental illness symptoms. Research indicates that addiction and mental illness are two related pathways, each with its own complexities. Many individuals who recover from addiction also experience improvements in co-occurring symptoms of depression, anxiety, and other mental health conditions.
Genetic Factors and Addiction
Research suggests that approximately 50-60% of the risk of addiction is inherited through genetics. Individuals may have different levels of risk for addiction based on their genetic makeup. Having a biological parent or grandparent with addiction increases the likelihood of developing addiction, even when raised in a non-addicted environment. Genetic factors, such as impulsivity, emotion dysregulation, and the ability to delay gratification, contribute to an individual's risk of addiction.
The Impact of the Addictogenic World
We are living in an addictogenic world, where many substances and behaviors have become readily accessible and increasingly addictive. This includes not only traditional drugs but also the excessive use of digital devices, social media, video games, and other activities. The constant pursuit of pleasure has led to a rise in addiction rates across various demographic groups. Addiction can infiltrate even in people with stable lives, loving families, and fulfilling work. The addictive potential of substances and behaviors, combined with easy access, makes everyone vulnerable to addiction.
“We're living in an adicto-genic world,” says Lembke. “In which almost all substances and human behaviors, even behaviors that we typically think of as healthy and adaptive, like reading, have become addicted, have become drug refined, in some way made more potent, more accessible, [and] the internet has absolutely exploded this phenomenon.”