Anna Lembke, M.D., is the head of the Addiction Medicine Dual Diagnosis Clinic at Stanford Health Care. A graduate of the Stanford University School of Medicine, Dr. Lembke is a psychiatrist and a professor of Psychiatry and Behavioral Sciences at Stanford who has recently been board-certified in Addiction Medicine.

Dr. Lembke is also the author of The New York Times bestseller, Dopamine Nation, published by Dutton in 2021. Dopamine Nation examines a world awash in opiates, and describes what that is doing to us individually and collectively. But the dopamine hit is delivered by a variety of compulsive behaviors, as outlined by Dr. Lembke:

Drugs, food, news, gambling, shopping, gaming, texting, sexting, Facebooking, Instagramming, YouTubing, tweeting… the increased numbers, variety, and potency of highly rewarding stimuli today is staggering. The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation.

Dr. Lembke is one of the co-authors of the mammoth Recommendations of the Stanford-Lancet Commission on the North American Opioid Crisis, published by The Lancet in February 2022. Among the courageous recommendations made in the report: “The USA should restore limits on the political campaign donations of pharmaceutical companies.” It isn’t just the medical community’s job to solve the opioid epidemic in America.

The report demonstrates some very clever thinking about reducing opioid dependency without reducing the quality of pain care. For example, the authors note that “30% of ‘opioid’ overdoses involve concomitant use of a benzodiazepine.” Proper training and monitoring of over 300 pharmacists at the Veteran’s Administration led to “the number of patients receiving the risky combination of opioids and benzodiazepines [to decline] by 47%.” Simply changing the default pain prescription size from 30 pills to 12 pills resulted in 15% fewer opioids being prescribed without any indication of harm to patients.

The authors cite stigma as a major impediment to recovery and recommend better integration of substance abuse treatment into the healthcare system. The authors go a long way toward easing the stigma with this elegant description of the problem:

[…] our species has a brain which evolved to be highly drawn to and influenced by particular molecules that are available in the modern world at a level beyond anything for which evolution prepared us.

In a New Year’s Day interview for the South Korean newspaper, DONG-A ILBO, Dr. Lembke talked about the need for people to face their problems rather than hide from them with substance abuse and other compulsive behaviors. “Facing your pain is the key to happiness,” Dr. Lembke said.

The language is quite similar to the motto of BrainWeighve, the self-driven behavior modification app currently in trials at UCLA, which asks users to “Face It… Don’t Displace It.” Learning non-harmful ways of dealing with stress and pain is key to successfully overcoming any addiction.

Written by Steve O’Keefe. First published January 4, 2024.

Sources:

Dopamine Nation: Finding Balance in the Age of Indulgence, by Anna Lembke, M.D., published by Dutton in 2021.

“Responding to the Opioid Crisis in North America and Beyond: Recommendations of the Stanford-Lancet Commission,” The Lancet, February 2022.

“Facing your pain is the key to happiness,” DONG-A ILBO, January 2024.

Image Copyright: anima21.