In this transcript Dr. Anna Lembke explains how dopamine fasting is the idea that if you avoid dopamine stimulating activities for extended periods of time, you will be able to ‘reset your brain’ and let go of addictive behaviors that

Anna Lembke is an American psychiatrist who is Chief of the negatively impact your life. Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University. Lembke appeared in the 2020 Netflix documentary The Social Dilemma

One of the findings in neuroscience in the last hundred years is that pleasure and pain are co-located by which I mean that the same parts of the brain that process pleasure also process pain and they work like opposite sides of the balance. So when we do something that’s pleasurable or reinforcing or rewarding that balance tips to the side of pleasure. When we experience something painful like cutting our finger it tips to the side of pain, but one of the overarching rules governing this balance is that it wants to remain level, it doesn’t want to be tipped for very long either to pleasure or pain and the brain will work very hard to restore a level of balance or what neuroscientists call homeostasis.

it’s really a biological imperative not just in our own physiologic symptoms but in the universe to go to homeostasis and that any deviation from neutrality is actually a form of stress; in fact biologists define stress as a deviation in either direction and that’s really the key the problem with modern life. One of the main problems with modern life is that we have too many pleasurable substances and behaviors that are actually stressing us out, it’s literally stressful. So when we do something just obviously pleasurable like I don’t know having a beer or playing a video game or eating a piece of chocolate it depends who you are because people are different; but in general those things are pleasurable to many people what we do is we get a little tilt to the pleasure side and we get the release of dopamine.

In our brain’s reward pathway which is this evolutionarily phylogenetically conserved is a very, very old part of the brain that’s been unchanged in our brains for just millennia and is also identical in other species all the way down to the lizard which is why it’s sometimes called the lizard brain. You know our evolution meant that we’ve piled a whole bunch of other layers on top, but that part is exactly the same as it’s always been and it’s the part that gets us again to approach pleasure and avoid pain. But here’s really the key, the way that the brain restores a level balance or homeostasis after this deviation to the pleasure side is to not just bring it level again but tilt it in equal and opposite amount to the side of pain and that’s called the opponent process reaction. I sort of think that is these little gremlins that represent neuro adaptation hopping on the pain side of the balance but they like it on the balance so they stay on until it’s tipped and equal and opposite amount that’s that moment of wanting, just one more video game, another beer, another piece of chocolate.

Now if we wait a little bit because it’s a powerful physiological drive to reach for more. If we wait the gremlins hop off, that feeling passes and homeostasis is restored. We want homeostasis to be restored. It’s really important because it’s fundamental to the resilience of this system. Because when the system is at baseline homeostasis it’s sensitive, it senses new pleasures, it’s aware of potential dangers and painful things so we know to avoid them.

But let’s look at what happens if we instead of waiting for those gremlins to hop off instead immediately reach for another beer, another piece of chocolate, another video game. Another major rule of this balance is that with repeated exposure to the same or similar stimuli that initial response gets weaker and shorter in duration and the after response gets stronger and longer so I think of that as sort of an Arnold Schwarzenegger type gremlin hopping on the pain side to bring it balance again. So we need stronger gremlins and essentially what’s happening in the brain by the way with those neuro-adaptation gremlins is that we’re down regulating our own dopamine transmission. We’re taking our dopamine receptors that are on the outside of our neurons and we’re resorbing them into the neuron all of which is a way to accommodate this huge increased bolus in dopamine; but again what ends up happening is now that, “opponent process reaction,” is stronger and longer so we go from shorter and weaker to stronger and longer on the pain side of the balance and that is the fundamental sort of paradox or vicious cycle that we get into.

Especially when we’re living in a world in which we have nearly universal ubiquitous access to highly potent, highly reinforcing drugs and behaviors which don’t just release a little bit of dopamine but a whole huge bolus and we’re all surrounded by them all the time,every day. Over time what that means is that we’re bombarding our dopamine reward pathway with way more dopamine than our primitive brains can handle. The result is that we end up with enough gremlins on the pain side of the balance to fill this whole room and they are now camped out there and that’s called, “allostasis,” so we’ve gone from homeostasis to allostasis and allostasis is where our body has to accommodate and work very, very hard to try to restore homeostasis and if it’s unable to do that using the normal mechanisms it essentially changes our set point.

The allostatic load is the “wear and tear” that accumulates in an individual as a result of continuous exposure to chronic stress. Based on these two types of allostasis, overload conditions are explained.

Type 1- It occurs when energy demand exceeds the supply. It activates emergency life history stage. And it serves driving the animals away from the normal life history stage to a survival mode. Until allostasis overload decreases and regains the energy balance.
Type 2- This begins when there is sufficient energy consumption accompanied by social dysfunction and conflict.This is the case in human society, and also in certain situations affecting animals in captivity. Type 2 allostasis overload does not create any escape response. It can only be counteracted by learning and changes in the social structure.

So now we’ve got those gremlins camped out there, they’re not leaving even when we wait a while they’re camped out there, our balance it’s easier to tip it to the side of pain and it’s really, really hard. Now to experience pleasure and when we’re not using we’re in a state of anxiety universal symptoms of withdrawal from any addictive substance anxiety, irritability, insomnia, dysphoria, and craving for our drug this is the fundamental problem.

If you look at rates of depression and anxiety all over the world today they are going up, skyrocketing suicide rates too, also physical pain.

The richest countries in the world are the countries that have the most suicide, anxiety, depression and physical pain and this is by many different measures, many different survey measures many different types of studies, so clearly we have something very strange going on here. Where the more we have of the kinds of ideal things that we think would make a good life right, lots of food, lots of fun stuff, lots of medicines to protect us from illness and pain. We’ve clearly reached some kind of tipping point, we’re now essentially more miserable than ever.

Therefore the question is;

Why?

I do think that the pleasure pain balance explains that because our primitive brains were not wired for an easy hyper convenient world. We are suffering as a result of all of this access to these feel good things, the first thing that we need to do is to cut out all of these feel-good substances and behaviors, at least for long enough for essentially dopamine fasting.

Whatever your source of dopamine is to cut it out for long enough. We are hardwired to approach pleasure and avoid pain and that’s really at the heart of our dopamine reward system. Dopamine is not just about the reward it’s also about the wanting and the motivation, it’s relative dopamine. So it’s whether our dopamine is above or below a well-being baseline that really is at the heart of this motivational cycle