Dopamine Nation: Finding Balance in the Age of Indulgence

This chapter begins similarly to the first chapter and reveals Lembke’s narrative strategy for most of the book. She begins with a story from one of her patients and then uses the details of the story to explore a larger point. In this case, she discusses David, a young man who developed an addiction to Adderall, which was prescribed to treat social anxiety associated with ADHD. David was a college student challenged by anxiety and a fear of failure, and he struggled to stay focused. He innocently sought help for these conditions, not fully realizing at the time that the initial prescription would lead him into a cycle of drug misuse that included sleep medication and the selective serotonin reuptake inhibitor (SSRI) antidepressant Paxil. David’s story re-emphasizes that drug addictions always have a backstory, and for many, the beginnings of substance use disorder are innocuous. They’re unsuspecting and don’t see the immediate dangers that prescription medicines pose, especially when misused. Even after recognizing his substance use disorder, David continued to take the drugs, though the drugs weren’t really helping him. Lembke pointed this out to David, and his response was, “‘It was easier to take a pill than to feel the pain’” (33). Lembke uses this comment to probe into whether avoidance of pain at all costs is a good idea in the long run.

Continuing her discussion of pain avoidance, Lembke notes, “The practice of medicine has likewise been transformed by our striving for a pain-free world” (37). While she doesn’t delve too deeply into the reasons why this is true—for example, the economic explanations for the change—she sees it as a negative turn: “The paradigm shift around pain has translated into massive prescribing of feel-good pills. Today, more than one in four American adults—and more than one in twenty American children—takes a psychiatric drug on a daily basis” (37). She follows this by citing a litany of data that highlights just how much medicine is prescribed to Americans to treat emotional and physical pain. As if these numbers aren’t startling enough, Lembke notes, “We’re constantly seeking to distract ourselves from the present moment, to be entertained” (39). In other words, even when people aren’t medicating themselves, they’re nonetheless distracting themselves, which has a similar kind of avoidance effect—and which can actually worsen anxiety or pain. Touching on the theme of The Danger of Digital Drugs, she recounts how she said to her patient Sophie, “All that distracting with devices may be contributing to your depression and anxiety” (40). Again, the ways that people treat pain are possibly making their pain worse. Lembke’s purpose in this chapter isn’t to criticize average people who try whatever they can to avoid pain. However, she sees a growing societal trend—bolstered largely by the tech and pharmaceutical industries—that prioritizes the complete elimination of experiencing pain. She considers this trend problematic and questions whether the remediation of all pain actually has the reverse effect.