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Welcome to Dopamine Nation

Despite a proliferation of treatment options in America, addictive behavior and unhealthy coping strategies are more common than ever. Here's why.

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By Dr. Richard Juman

07/30/12

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We’re a nation of addicts. Would you care to dispute it?

Recent studies confirm an alarming reality: As a country, when it comes to dealing with personal problems, we use an external fix. Whether it's routine disruptions we face at work, the common crises at home, or our children trying to parse the maelstrom of media overload—the fact is that it's increasingly rare that Americans turn to internal or interpersonal resources to establish equilibrium. Instead, our first impulse is to seek out a quick and external source, which becomes both the cause of our problems, and the solution.

The first place people look is the simple dopamine spike. Most people have reliable techniques to make themselves feel better—or, as I like to say, to give themselves a little “dopamine spike.” Dopamine, as you probably know, is the neurotransmitter triggered by “rewarding events.” These pleasurable moments may occur naturally, but they are also the direct result of specific drugs, such as cocaine, methamphetamine or nicotine. 

How is it that we’ve wrapped ourselves in the fuzzy dopamine blanket of substance misuse, prescription medication, compulsive eating, celebrity worship, compulsive shopping, internet addiction, video gaming, and compulsive sexual behavior?

While we may admire the American impulse to applaud hard work, innovation, and daring, the rewards of these labors aren't immediate. We’re an impatient nation; we seek more immediate gratification. We’ve come to accept an approach of “why wait?”, so we grab ahold of whatever it takes to feel better, to keep feeling better, to make it through the day.

In our addicted culture, we go for the artificially-induced dopamine spike—and not just one, but one right after the next. Consider the following: Roughly one in ten Americans is currently an illicit drug user; nearly one quarter of American adults engage in binge drinking, many on a regular basis; and the majority of those with problem drug or alcohol use do not seek treatment for their problems. 

Now, if we broaden the criteria that we use in thinking about addiction to include unhealthy coping mechanisms and other “ways-to-get-through-the-day”—we face staggering results. For one, most Americans have lost their ability to eat normally, with two-thirds of the nation’s adults meeting the definition of obese. As another example, approximately one out of every five American women is on an anti-depressant. I recently signed up with a new primary care physician. When she found out that I’m a psychologist, she asked me “Why is every kid in New York on Ritalin, and every adult taking Ambien?”

It’s an excellent question.

How is it that we’ve wrapped ourselves in the fuzzy dopamine blanket of substance misuse, prescription medication, compulsive eating, celebrity worship, compulsive shopping, internet addiction, video gaming, and compulsive sexual behavior?

Here’s one reason: these external fixes are readily available, and every addiction fuels somebody else's craving—for cash. The alcohol industry takes in over $100 billion a year; Big Tobacco earns $35 billion. Gambling, pornography, prostitution, and texting all add fuel to our country's dopamine fire. 

The root issue is that direct, undiluted, authentic engagement with the world and others is a challenge, and the strategy of occasional mood alteration that many employ to "take the edge off" can slide into something more dangerous. Others end up in another kind of distorted dependence, finding that it's easier to move your onscreen avatar through the world than to actually navigate it on your own. What about thetragic case of the Korean couple who found it easier to raise a “virtual” baby in a popular internet cafe than to take care of their child who died while they were busy online?

The couple’s three-month old starved to death. She was only fed between sessions of the game. According to police, these parents “indulged themselves in the online game raising a virtual character so as to escape from reality, which led to the death of their real baby. Here in Dopamine Nation, internet and video game addiction are real concerns.

Those of us who work in the addiction treatment community find our most critical task—helping clients find an authentic path to recovery—more challenging than ever. In part, this is due to a culture that seems engineered to foster dependence on artificially induced means to “feel OK.”

Turn on the TV, and the prevailing wisdom says there’s no reason to suffer discomfort. Moreover, we’re being instructed that continuous synthetic  “adjustment” is the norm - in other words, there’s a pill for whatever ails you: ADHD, shyness, erectile dysfunction, fibromyalgia—you name it. Of course, abuse of these drugs is soaring, from anxiety medications to pain pills. But the problem is more insidious. 

We’re so addicted to food that we literally have to seek surgical intervention to staple our stomachs in order to control our weight. Technologies allow us to seemingly be everywhere at once, but we’re never quite “right here now.”

These same devices create a state of continuous partial attention. We’re so busy attending to our screens and keys, so dependent on the next little dopamine surge that comes in the form of a text, that we turn our eyes from the road and accidents are increasing in record numbers.

Speaking of cars, picture this. Your vehicle is acting up, so you take it to the service station. You know there’s something wrong because it just doesn’t run the way it used to. You explain the problem to the mechanic, and he lays out your options.

“OK,” he says. “You have a choice. You can put some goop in the engine every day. It’s expensive, you’ll have to do it forever, and it may make the problem worse. Plus, we’ll never know what’s wrong. Or, I can lift the hood and see what’s going on.”

Which option would you choose?

We’re all human, and we like to feel good. Dopamine is naturally generated from any number of physical and emotional sources. The accumulation of externally generated dopamine, however, creates a vicious cycle of relief- seeking that ultimately spirals out of control. For those who are lucky – or smart – it lands patients in our offices where we can finally begin to “lift up the hood”—and actively address the real problems.

Richard Juman is a licensed clinical psychologist who has worked in the field of addiction for over 25 years, providing direct clinical care, supervision, program development and administration across multiple settings. A specialist in geriatric care and organizational change, he is also the president of the New York State Psychological Association. Email him here, and follow his tweets at @richardjuman.

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