Dopamine Nation

Dopamine Nation Plot Summary

Introduction

Have you ever found yourself mindlessly scrolling through social media at 2 AM, knowing you should sleep but somehow unable to put your phone down? Or perhaps you've promised yourself "just one more episode" of a show, only to emerge hours later wondering where the time went. In our modern world of unlimited pleasures and constant stimulation, many of us find ourselves caught in cycles of compulsive consumption we can't seem to break. We live in an age of unprecedented abundance, where virtually any desire can be satisfied with the tap of a screen. Yet paradoxically, rates of depression, anxiety, and addiction continue to rise. This book explores the neuroscience behind this troubling phenomenon, revealing how our brains process pleasure and pain, and why too much of a good thing leads to suffering. Through compelling case studies of individuals struggling with various forms of addiction, we'll discover practical strategies for finding balance in our dopamine-flooded world. You'll learn how our pursuit of pleasure can become a prison, how strategic discomfort might be the key to greater happiness, and how honest self-reflection creates the foundation for a more balanced life.

Chapter 1: The Masturbation Machine: Our Pursuit of Pleasure

Jacob was a soft-spoken man in his sixties with a kind face and the unremarkable appearance of a Silicon Valley professional in khakis and a button-down shirt. Nothing about his demeanor suggested the extraordinary nature of his addiction. As he settled into the therapist's office, he began sharing his story with remarkable candor. "I masturbated first time when I was two or three years old," Jacob explained in his thick Eastern European accent. Growing up in a strict Catholic household, he learned early that his natural urges were considered sinful. Every Friday, he would visit his local priest to confess his "mortal sin" of masturbation. The priest would ask how many times, and Jacob would answer truthfully: "Every day." The priest would simply respond, "Don't do it again." This cycle of pleasure, shame, and failed abstinence continued throughout his adolescence. By age twenty-three, Jacob had married and hoped to leave his compulsions behind. But after moving to Germany for work, he discovered pornography and adult entertainment venues. He managed his urges for years until 1995, when everything changed. "The Internet," Jacob explained. "I am forty-two years old, and doing okay, but with the Internet, my life start to fall apart." His compulsive behavior escalated dramatically. During one business trip, he stayed up all night watching pornography instead of preparing for an important presentation the next day. Jacob's story took an even more troubling turn when he began experimenting with electrical stimulation devices. "I attach electrodes and wires to my stereo system," he explained. Eventually, he built increasingly sophisticated devices, programmed them with customized routines, and even connected with an online community where people shared their creations. "The pleasure comes from the sensation, but also from building the machine, anticipating what it will do, experimenting with ways to improve it, and sharing with others." Jacob's case illustrates a fundamental truth about our relationship with pleasure in the modern world: technology has transformed not just what we consume but how we consume it. The Internet didn't create Jacob's addiction, but it amplified it exponentially by providing unlimited access, increased novelty, and even community validation. His homemade devices represent a metaphor for how we've engineered our entire society around maximizing pleasure, creating increasingly potent delivery systems for dopamine. The human brain evolved in an environment of scarcity, where strong desires motivated us to secure resources essential for survival. But in today's world of abundance, those same neural pathways can lead us into destructive patterns of overconsumption. Whether it's pornography, social media, video games, or food, we're surrounded by supernormal stimuli that hijack our reward systems and leave us wanting more, even as our satisfaction diminishes.

Chapter 2: Running from Pain: The Modern Escape

David arrived at the clinic seeking help for what had become a dangerous dependency on prescription medications. A shy computer enthusiast in his thirties, he explained how his problems began in college when he visited student mental health services for anxiety and poor academic performance. "I was afraid to fail. I was afraid to be exposed as not knowing. I was afraid to ask for help," David explained. After a brief evaluation, he was diagnosed with attention deficit disorder and generalized anxiety disorder. He was prescribed Paxil for anxiety and Adderall for ADD, but received no psychotherapy or behavioral modification strategies. The medications helped initially, but David soon found himself using Adderall in increasingly problematic ways. "I'd take ten milligrams first thing every morning before class. It helped me get that deep focus. But looking back, I think I just had bad study habits. Adderall helped me make up for that, but it also helped me procrastinate." Soon he was taking stimulants around the clock to cram for exams he hadn't properly prepared for. When asked if it was difficult to get more pills, David explained how he manipulated the system: "I'd call the psychiatrist a few days before. Not a lot of days before, just one or two, so they wouldn't get suspicious." After college, David moved back with his parents, feeling resentful and directionless. Eventually, he followed his girlfriend to Palo Alto, got married, and landed a job at a tech startup. On the surface, things were improving, but his medication use was spiraling out of control. "I was taking up to thirty milligrams of Adderall a day, fifty milligrams of Ambien a day, and three to six milligrams of Ativan a day. I thought, I have anxiety and ADHD and I need this to function." The truth was that David was using these medications to compensate for basic lack of self-care, creating a vicious cycle. He attributed his fatigue and inattentiveness to mental illness rather than to sleep deprivation and overstimulation, which he then used to justify more medication. "You were getting your A vitamins: Adderall, Ambien, and Ativan," his doctor later joked. David managed to hide his addiction from everyone, including his wife, until he reached a breaking point. Contemplating suicide but aware his wife was pregnant, he asked her to take him to the hospital, where the full extent of his dependency was finally revealed. David's story reflects a troubling shift in how we approach discomfort in modern society. Rather than developing resilience or addressing root causes, we increasingly seek chemical shortcuts to eliminate pain and unpleasant emotions. This medicalization of normal human struggles has coincided with massive increases in prescribing of psychiatric medications. Today, more than one in four American adults takes a psychiatric drug daily. The paradox is that our efforts to eliminate pain may actually be making us more miserable. Despite unprecedented wealth, technological progress, and medical advancement, people in developed nations report higher rates of anxiety, depression, and physical pain than ever before. Studies show that Americans report more bodily pain than residents of any other country, with 34% saying they experience pain "often" or "very often," compared to just 11% in South Africa. Our cultural aversion to discomfort extends beyond medicine. Modern parenting and education increasingly shield children from failure and frustration. Social media encourages constant distraction rather than presence. Even religion has shifted toward what one scholar calls a "God Within" theology focused on personal happiness rather than moral exhortation. We've created a society where running from pain has become not just acceptable but expected.

Chapter 3: The Pleasure-Pain Balance: Understanding Our Brain's Reward System

Neuroscientists have made remarkable discoveries about how our brains process pleasure and pain, providing crucial insights into why excessive pleasure-seeking ultimately leads to suffering. At the center of this understanding is dopamine, a neurotransmitter first identified in the human brain in 1957. When neurons in our brain communicate, they release chemical messengers called neurotransmitters across synapses. Dopamine is perhaps the most important neurotransmitter involved in reward processing. Scientists use dopamine as a universal currency for measuring how addictive an experience is. The more dopamine released in the brain's reward pathway, and the faster it's released, the more addictive the substance or behavior. Different experiences trigger different levels of dopamine release. For a laboratory rat, chocolate increases dopamine output by about 55%, sex by 100%, nicotine by 150%, and cocaine by 225%. Most striking is amphetamine (the active ingredient in Adderall), which increases dopamine release by an astounding 1,000%. By this accounting, one hit of methamphetamine is equivalent to approximately ten orgasms. Perhaps the most profound neuroscientific discovery is that pleasure and pain are processed in overlapping brain regions and work via an opponent-process mechanism. Imagine your brain contains a balance scale with a fulcrum in the center. When nothing is on the balance, it's level with the ground. When we experience pleasure, dopamine is released and the balance tips to the side of pleasure. The more it tips, and the faster it tips, the more pleasure we feel. However, the balance naturally wants to remain level. Whenever it tips toward pleasure, self-regulating mechanisms automatically kick in to bring it back to equilibrium. These mechanisms don't require conscious thought - they just happen, like a reflex. Once the balance returns to level, it keeps going, tipping an equal and opposite amount to the side of pain. This is why what goes up must come down. With repeated exposure to the same pleasure stimulus, something troubling happens: the initial deviation to the side of pleasure gets weaker and shorter, while the after-response to the side of pain gets stronger and longer. Scientists call this neuroadaptation, but we experience it as tolerance - needing more of a substance to feel the same effect, or feeling less pleasure at the same dose. One woman described how this played out with her romance novel habit: "Reading the Twilight saga for a second time was pleasurable but not as pleasurable as the first time. By the fourth time I read it, my pleasure was significantly diminished. Furthermore, each time I read it, I was left with a deeper sense of dissatisfaction in its aftermath and a stronger desire to regain the feeling I had while reading it the first time." With prolonged, heavy use of high-dopamine substances or behaviors, our pleasure-pain balance eventually gets weighted to the side of pain. Our hedonic set point changes as our capacity to experience pleasure decreases and our vulnerability to pain increases. This explains why people addicted to opioids for chronic pain often find their pain getting worse over time despite increasing doses - a phenomenon called opioid-induced hyperalgesia. Brain imaging studies confirm these changes. When researchers compared dopamine transmission in healthy controls versus people addicted to various drugs, they found striking differences. In healthy brains, reward regions lit up bright red, indicating high dopamine activity. In the brains of addicted individuals, even after two weeks of abstinence, these same regions showed little or no red, indicating minimal dopamine transmission. The paradox of addiction is that hedonism - the pursuit of pleasure for its own sake - ultimately leads to anhedonia, the inability to enjoy pleasure of any kind.

Chapter 4: Self-Binding: Creating Barriers to Compulsive Overconsumption

After a year of abstaining from compulsive sexual behaviors, Jacob relapsed. The trigger was a trip to Eastern Europe to see his family, complicated by tensions over money between his current wife and children from his first marriage. Two weeks into his three-week trip, feeling depressed and conflicted, he found himself in a hotel room flipping through television channels. "It is the TV in the hotel room that get me started craving again," Jacob explained. "I lie there flipping through the channels, feeling depressed, thinking about my family, and my wife, and how everyone is angry at me. I see a naked woman on TV." This exposure triggered an overwhelming urge that led to a rapid downward spiral. Within days of returning home, Jacob had rebuilt his electrical stimulation device and fallen back into his addictive patterns. "I don't think about anything else. I go twenty hours without stopping," Jacob said. "On Thursday morning, I throw the machine parts away in my garbage and go back to work. On Friday morning, I take them out of the garbage again and repair them and use all day." This cycle of using, disposing of his device in shame, and then retrieving it continued until he finally reached out for help. His therapist gave him clear instructions: "Pack up the machine and any spare parts and put it all in the garbage. Then take the garbage to the dump or somewhere else where it is impossible for you to retrieve it." She also advised him that whenever he felt the urge to use, he should drop to his knees and pray, then call his sponsor from Sexaholics Anonymous. This strategy Jacob employed is called self-binding - the intentional creation of barriers between ourselves and our drug of choice to prevent compulsive overconsumption. Self-binding isn't primarily about willpower. Rather, it openly recognizes willpower's limitations. The key is acknowledging the loss of voluntariness we experience when under the spell of powerful compulsions, and binding ourselves while we still possess the capacity for voluntary choice. Self-binding strategies fall into three broad categories: physical strategies (space), chronological strategies (time), and categorical strategies (meaning). Physical self-binding creates literal barriers or geographical distance between ourselves and temptation. The ancient Greek tale of Odysseus illustrates this perfectly - he had his crew tie him to the mast of his ship so he couldn't succumb to the Sirens' song. Modern examples of physical self-binding include removing televisions from bedrooms, putting devices in safety deposit boxes, or calling hotels in advance to remove minibars. Some people use medications like naltrexone, which blocks opioid receptors and diminishes the reinforcing effects of alcohol and other substances. Others resort to more extreme measures like weight-loss surgeries that physically restrict food intake. Chronological self-binding involves setting time limits - consuming only on weekends, never before 5 PM, or only after completing important tasks. Studies with laboratory rats show that those given unlimited access to cocaine for six hours per day gradually increase their consumption to the point of exhaustion, while rats restricted to one hour per day maintain steady, controlled use. Categorical self-binding limits consumption by sorting rewards into different categories - those we allow ourselves to consume and those we don't. For someone recovering from gambling addiction, this might mean avoiding not just betting but also watching sports on TV, reading the sports page, or listening to sports radio. For Jacob, it meant avoiding not just pornography but anything that might trigger sexual thoughts. "I must avoid anything that might entertain my addict mind," Jacob explained. Through these various forms of self-binding, he was eventually able to maintain his recovery. Far from feeling constrained by these limitations, he experienced them as liberating. "I am free of my obsession. I am not compelled to behave in a certain way. I am free to make decisions again about what I will do." In our hyperconnected world of endless temptations, self-binding has become a modern necessity. By creating space between desire and consumption, we press the pause button long enough to make conscious choices rather than succumbing to reflexive impulses. As philosopher Immanuel Kant suggested, binding ourselves can be a path to true freedom.

Chapter 5: Pressing on the Pain Side: Hormetic Healing Through Discomfort

Michael, a successful real estate entrepreneur, had once lived what seemed like a Silicon Valley fairy tale. By thirty-five, he was wealthy, handsome, and happily married. But he had a secret life of cocaine and alcohol addiction that eventually threatened everything he had built. When his wife told him tackling his addiction was the only way to save their marriage, he committed to recovery. Quitting wasn't the hard part for Michael; it was figuring out what to do next. After quitting, he was flooded with all the negative emotions he'd been masking with drugs. Then he stumbled upon something unexpected that gave him hope. "The first time it happened, it was an accident," Michael explained. He had been taking morning tennis lessons as a way to distract himself in early recovery. When he mentioned to his coach that he was still sweating an hour after showering, the coach suggested trying a cold shower instead. "The cold shower was a little painful, but only for seconds until my body got used to it. When I got out, I felt surprisingly good, like I'd had a really good cup of coffee." Intrigued by this effect, Michael began researching cold-water therapy and found a community of people taking ice baths. He progressed from cold showers to filling his bathtub with cold water, then adding ice to lower the temperature even further. "I got into a routine where I immersed myself in ice water for five to ten minutes every morning and again just before bed. I did that every day for the next three years. It was key to my recovery." When asked what it felt like, Michael described: "For the first five to ten seconds, my body is screaming: Stop, you're killing yourself. It's that painful. But I tell myself it's time limited, and it's worth it. After the initial shock, my skin goes numb. Right after I get out, I feel high. It's exactly like a drug... like how I remember ecstasy or recreational Vicodin. Incredible. I feel great for hours." Michael had accidentally discovered the principle of hormesis - the beneficial effects of administering small to moderate doses of otherwise harmful stimuli. Scientists at Charles University in Prague found that when men submerged themselves in cold water (57°F) for one hour, their plasma dopamine concentrations increased by 250%, and plasma norepinephrine increased by 530%. These elevations persisted well after the exposure ended, explaining the prolonged mood boost Michael experienced. This counterintuitive approach - pressing on the pain side of the balance to experience pleasure - works by triggering the body's natural homeostatic mechanisms. When we voluntarily expose ourselves to manageable amounts of discomfort, our body responds with a compensatory reaction that often overshoots the mark, leaving us feeling better than before. A famous experiment from the 1960s demonstrated this principle with dogs exposed to mild electric shocks. Initially, the dogs showed terror and extreme physiological responses. But with repeated exposure, their reactions changed dramatically. Instead of terror, they showed only mild annoyance during the shocks. And afterward, instead of distress, they displayed what researchers called "a fit of joy," rushing about and wagging their tails. Their heart rates, which initially spiked during shocks, began showing prolonged periods of below-baseline rates after the shocks ended - a sign of deep relaxation. This principle extends beyond cold exposure. Exercise, which is immediately stressful to cells, promotes long-term health benefits and increases many of the neurotransmitters involved in positive mood regulation. Intermittent fasting and calorie restriction have been shown to extend lifespan and increase resistance to age-related diseases in laboratory animals. Even certain forms of radiation exposure at very low doses may trigger beneficial adaptive responses. The therapeutic application of controlled discomfort isn't new. Hippocrates wrote in 400 BC: "Of two pains occurring together, not in the same part of the body, the stronger weakens the other." Modern research confirms this ancient wisdom, showing that the application of one painful stimulus can lessen the subjective experience of another pain by triggering the body's endogenous opioid system. For Michael, cold-water immersion provided not just a natural high but a sustainable path to recovery. "Cold water reminds me that being alive can feel good," he explained. Unlike his former drug use, which led to escalating tolerance and diminishing returns, his controlled exposure to discomfort offered a reliable source of well-being that didn't require constant escalation. The lesson is clear: strategic discomfort may be one of our most powerful tools for resetting our dopamine balance in a world of excessive pleasure. By voluntarily embracing manageable pain, we can experience more sustainable joy.

Chapter 6: Radical Honesty: The Path to Awareness and Connection

Maria sat across from her therapist, looking composed and put-together as she had for the five years they'd been working together. She had been in sustained remission from alcohol addiction throughout that time, achieved through her participation in Alcoholics Anonymous. When asked about the role of honesty in her recovery, she shared a revealing story. "I came home from work to find an Amazon package waiting for Mario," Maria explained, referring to her younger brother who lived with her and her husband. "I decided to open it even though it wasn't addressed to me. A part of me knew I shouldn't." After opening the package, she resealed it and left it with the rest of the mail, promptly forgetting about it. When her brother came home and accused her of opening his package, Maria lied twice, denying any involvement. That night, she slept poorly, and by morning, she knew what she needed to do. "I walked into the kitchen where Mario and Diego were eating breakfast and said, 'Mario, I did open your package. I knew it was yours, but I opened it anyway. Then I tried to cover it up. Then I lied about it. I am so sorry. Please forgive me.'" This small act of radical honesty represented a profound shift for Maria. "I would never have admitted the truth back when I was drinking," she explained. "Back then, I lied about everything and never took responsibility for the things I did. There were so many lies, and half of them didn't even make sense." Her husband confirmed this, describing how she used to hide in the bathroom to drink, turning on the shower to mask the sound of beer bottles opening, and even replacing consumed beer with water before gluing the caps back on. Maria's story illustrates how radical honesty - telling the truth about things large and small, especially when doing so exposes our flaws and entails consequences - is essential not just for recovery from addiction but for anyone seeking balance in our reward-saturated world. It works on multiple levels. First, radical honesty promotes awareness of our actions. When we recount our experiences truthfully, we bring our behavior into relief, allowing us to see it clearly, sometimes for the first time. This is especially important for behaviors that involve a level of automaticity outside conscious awareness. Neuroscientist Christian Ruff and colleagues have demonstrated that increasing neural excitability in the prefrontal cortex - the brain region involved in decision-making and future planning - significantly reduces dishonest behavior. Practicing honesty may strengthen these neural circuits, enhancing our awareness of our pleasure-pain balance. Second, honesty fosters intimate human connections. Jacob, the man struggling with sexual addiction, discovered this when he forced himself to tell his wife the truth about using a shower-curtain ring to build one of his devices. Instead of the anger and rejection he expected, his wife responded with gratitude for his honesty and a hug. This intimate moment likely triggered the release of oxytocin, a hormone that enhances dopamine firing in the brain's reward pathway. While high-dopamine substances and behaviors lead to isolation, honest vulnerability draws people closer. Third, truth-telling creates a truthful autobiography that holds us accountable. The stories we tell about our lives not only measure our past but shape our future behavior. In more than twenty years as a psychiatrist, one therapist observed that patients who tell stories in which they are frequently the victim, seldom bearing responsibility for bad outcomes, often remain unwell. By contrast, those who accurately portray their own responsibility tend to improve. Finally, honesty appears to be contagious and might even prevent the development of addiction. When one family member gets into recovery, others often follow. Studies show that when adults keep their promises to children, those children become better able to delay gratification. This suggests that truth-telling fosters what might be called a "plenty mindset" - a confidence that the world is orderly, predictable, and safe, which reduces the impulse for immediate rewards. For Maria, the simple act of admitting she opened her brother's package represented a fundamental shift in how she approached life. "When I told my brother the truth that day, even though I knew he'd be pissed, I knew something had really changed in me. I was done with all those little lies filling up in the back of my mind and making me feel guilty and afraid. I realized that as long as I'm telling the truth, I don't have to worry about any of that. I'm free."

Chapter 7: Prosocial Shame: Building Community Through Vulnerability

Lori arrived at her therapist's office with a defensive attitude, insisting she was only there because her primary care doctor had sent her. She spoke condescendingly, explaining that she needed unusually high doses of multiple medications due to her gastric bypass surgery causing "malabsorption syndrome." Her daily regimen included 120 milligrams of Lexapro (six times the normal dose), gabapentin, medical marijuana, and Ambien. When gently questioned about possible substance misuse, Lori became rigid. "I told you, Doctor, I don't have that problem," she said tersely. Only when invited to share her life story did her defenses begin to soften. Lori grew up on a farm in Wyoming in the 1970s, the youngest of three siblings. From an early age, she felt different and out of place. Her family attended a strict church where she learned about "a damning God" who would send imperfect people to hell. In high school, she excelled at track until an injury ended her athletic career. "The only thing I was good at got taken away. That's when I started eating," she explained. For the next fifteen years, Lori moved from town to town, job to job, using food, pills, alcohol, and cannabis to escape her feelings. She would eat ice cream for breakfast, snack throughout the day, take Ambien as soon as she got home, then consume more food and pills in the evening. Despite this destructive pattern, she attended church every Sunday, maintaining the appearance of the "perfect Christian." When her therapist suggested she might have a problem with compulsive overconsumption, Lori initially resisted but eventually acknowledged the truth. She decided to speak with the elders at her church. "I was open in a way I'd never been before," she said. "I just put it all out there." Their response was disappointing. "They seemed confused, anxious, like they didn't really know what to do with me. They told me to pray. They also encouraged me not to discuss my problems with other members of the church." Lori stopped attending church after this interaction, and no one reached out to check on her. "At that moment I felt that damning, shaming God. I can't live up to that expectation. I'm not that good," she explained. Lori was caught in what might be called a destructive shame cycle, where her attempts at honesty were met with implicit rejection, driving her further into isolation and continued substance use. Shame is a complex emotion that can either perpetuate addictive behaviors or help overcome them. Destructive shame makes people feel bad about themselves as people rather than about their specific actions. When communities respond to honest disclosures with rejection or encouragement to keep problems hidden, they contribute to this harmful cycle. By contrast, prosocial shame acknowledges that feeling shame for transgressive behaviors is appropriate while recognizing that we are all flawed and in need of forgiveness. The key is having a clear path to making amends and rejoining the community. Alcoholics Anonymous exemplifies this approach. When Lori eventually attended AA, she found the supportive fellowship she had been seeking. "Hearing people's stories. The relief I felt letting go of my deepest, darkest secrets. Seeing the hope in newcomers' eyes. I was so isolated before. I remember just wanting to die. In AA, I learned to accept myself and other people for who they are. Now I have real relationships with people. I belong. They know the real me." AA leverages prosocial shame in several ways. There is no shame about being an "alcoholic," but there is appropriate shame about half-hearted pursuit of sobriety. The anticipated shame of having to admit to the group that one has relapsed works as a deterrent against relapse. When members do relapse, the group responds not with rejection but with acceptance coupled with a clear set of steps to make amends. This approach creates what economists call "club goods" - the rewards of belonging to a group. The more robust these club goods, the more likely the group will maintain current members and attract new ones. Paradoxically, groups with stricter rules and higher expectations often create stronger bonds and more successful outcomes than more permissive ones. The principles of prosocial shame can be applied to families as well. Parents who are open about their own mistakes and willing to make amends create space for children to be honest about their struggles. One mother described how she admitted to her children that she had eaten parts of their Easter chocolate bunnies and then lied about it. Her children forgave her, and the incident became a family story that reinforced their values: people make mistakes, but they aren't permanently condemned for them. In our increasingly digital world where social media shaming and "cancel culture" have become new forms of destructive shunning, understanding the difference between harmful and helpful forms of shame is crucial. Prosocial shame affirms that we belong to the human tribe despite our flaws. It creates accountability without rejection, fostering the intimate connections we all crave.

Summary

The key insight from this exploration of our dopamine-driven world is deceptively simple: the relentless pursuit of pleasure ultimately leads to pain. Our brains process pleasure and pain like a balance scale - when we experience intense pleasure, our neural systems automatically compensate by tipping toward pain afterward. With repeated exposure to high-dopamine experiences, whether substances or behaviors, this balance gradually weights toward the pain side, requiring more stimulation to feel normal and making us increasingly vulnerable to suffering. To recalibrate your pleasure-pain balance, start with a dopamine fast - abstain completely from your problematic substance or behavior for at least four weeks to reset your reward pathways. Create barriers between yourself and temptation through self-binding strategies: physical barriers like removing devices, time limits like weekends-only rules, or categorical boundaries like avoiding triggers. Consider embracing strategic discomfort through exercise, cold exposure, or fasting to experience more sustainable pleasure. Practice radical honesty about your struggles, which builds awareness and fosters genuine connection. Finally, seek communities that hold you accountable with compassion rather than judgment. The path to freedom isn't found in escaping the world through endless pleasures, but in fully immersing yourself in it, embracing both its joys and challenges with clear-eyed awareness.

About Author

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Anna Lembke

Anna Lembke is an American psychiatrist who is Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University. She is a specialist in the opioid epidemic in the United States, and the author of Drug Dealer, MD, How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.

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