The Dope on Dopamine — My Response to Joe Rogan and Anna Lembke

Zach was very hopeful that the tides of addiction theory and treatment were turning when super podcaster Joe Rogan had Carl Hart on his show. Carl, author of “Drug-Use for Grown Ups,” despite being a neuroscientist, doesn’t believe that biology explains addiction.

Actually, Carl doesn’t deal with addiction per se. He combines SUDs and addiction when considering drug harms. And he doesn’t think that they are explicable biologically.

Joe Rogan likes Carl. Carl’s up-from-the-ghetto to become the first tenured Black science faculty member at Columbia University appeals to Joe — as it does to many, including Zach and Stanton.

But when it comes to substance use (despite his own regular drinking and cannabis use, whose acceptance by the privileged Carl calls “drug exceptionalism”), Joe’s head is in a different place.

Thus Joe lavished attention on a subsequent guest, psychiatrist Anna Lembke. In a nutshell, as Lembke describes in “Dopamine Nation,” humans’ search for dopamine — which is claimed to chemically mediate human pleasure — and need to sustain dopamine levels in their brains is the root of all forms of addiction.

Ironically, that ship has sunk in a maelstrom in recent decades. National Institute on Drug Abuse director Nora Volkow, who could once be heard muttering numerous times a day “it’s all about the dopamine,” has since learned to stifle that verbal tic.

For one thing, based on that model, during her stewardship drug deaths have skyrocketed to four times the annual level they were at the start of her tenure. Secondly, dopamine has always worked better for stimulants like cocaine than for depressants like opioids. And while cocaine was her main research thrust, opioids have been Volkow’s main policy concern.

In fact, although Volkow and others have shown brain activation patterns with cocaine use, no research can identify which of those activated brains — and the people attached to them — will become “addicted” (or, more accurately, harmful users).  And the latter, as Volkow now concedes, are the overwhelming majority of cocaine and other drug users.

So how, then, will dopamine hope to explain the range and the reach  of addiction farther afield than drugs, as Lembke seeks to do, where the dopamine connection to is even more attenuated than it is with cocaine?

Most crushingly of all for the dopamine mafia — and again as Volkow concedes — most of those considered addicted to cocaine and other drugs outgrow their addictions in the course of time (in fact the modal length of cocaine dependence is five years).

But all of this isn’t Rogan’s bailiwick. He just likes the idea of “Dopamine Nation.” And, so, to Zach’s chagrin, there were no moments of — “But as Carl Hart points out most drug users aren’t addicted, and even those who might be considered so will give up their habit for the right amount of money, or simply as their lives move on.”

Finally, those who don’t quit or cut back — and who sometimes die — are mostly classifiable as “deaths of despair.” They are people who have lost hope in life. These are the underprivileged— not the privileged.

Also ironic, the subtitle of Lembke’s book is: “Finding Balance in the Age of Indulgence.” Taking the idea behind the title seriously indicates that those dying deaths of despair are indulging themselves in too much pleasure!

One might even say that those who believe in “dopamine nation” are more likely to become disenchanted with life and be less likely to quit and more likely to die!

None of this was the faintest bit on Rogan’s mind as he interviewed Lembke. And, so, Zach’s hopes for some kind of sensible discussion of drugs and addiction were dashed once again.

____________________________

Please let us know your thoughts in the comments below – we would love to hear from you.  Have you used psychedelics to improve your life? To get over an addiction?