The Resilient Mind - Why You’re Never Satisfied: Your Dopamine System Is Overwhelmed - Dr Anna Lembke

Episode Date: November 24, 2025

Dr Anna Lembke is Professor of Psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She is the author of bestselling books such as, ‘Dopamine Nation: Finding Balance in the Age of Indulgence’.Take action and strengthen your mind with The Resilient Mind Journal. Get your free digital copy today: ⁠⁠⁠⁠Download Now⁠⁠This episode is brought to you in partnership with Steven Bartlett for more inspiring videos: https://www.youtube.com/c/TheDiaryOfACEO🌍 The Resilient Mind Podcast is a proud member of 1% for the Planet — building resilient minds and a resilient planet. Hosted on Acast. See acast.com/privacy for more information.

Welcome to the Resilient Mind podcast. In this episode, you will be listening to why you're never satisfied. Your dopamine system is overwhelmed with Dr. Anna Lemke. Get access to the Resilient Mind Journal by clicking the link in the show notes. Enjoy. Why does dopamine matter? Ah, good question. Good place to start.

I mean, dopamine matters because it's fundamental to our survival, right? So it's the chemical that we make in our brain that tells us this is something we should approach, explore, investigate. So it's really almost the survival chemical. So what is dopamine? If you had to explain it to a 10-year-old, how would you go about explaining it? So dopamine is a chemical that we make in our brain. It has many different functions, but one of its most important functions is that it helps us experience pleasure, reward and motivation. It may be even more important for the motivation to do things than it is

for the pleasure itself. So for example, there's a very famous experiment in which rats were engineered to have no dopamine in the brain's reward pathway. And the scientists discovered that if they put food in the rat's mouth, the rat would eat the food, would seem to get some pleasure from the food, if you can determine that from watching a rat eat, which I think they felt like they could. But if you put the food even a body length away, the rat will starve to death. The idea being that without dopamine, we're not motivated to seek out the things that we need for our basic survival. That's crazy. So you get a rat, you put the food an inch from its mouth and it will starve to death because it doesn't have dopamine, the dopamine required to just

reach out and eat. Yeah, essentially. Maybe it's not an inch. Maybe it's a little more than an inch, But the idea being that dopamine is necessary to be motivated to do the work to get the thing that we need. And having an understanding of dopamine, how might that improve in my life? Having a basic understanding of how dopamine works, how we process pleasure and pain, and also what happens with dopamine as we go from adaptive recreational use to maladaptive addictive use is something that is really useful, especially for those of us living in the modern world, where now we're exposed to so many reinforcing substances and behaviors that we've all become vulnerable to the problem of addiction.

And what are the biggest misconceptions on the subject of dopamine? Because it's kind of thrown around in society. I see it in my group chats, people saying, I need more dopamine or whatever, or, you know, that person just craves dopamine. What are the biggest misconceptions you've come across? The main misconception is that somehow we can get addicted. to dopamine. We're not getting addicted to dopamine itself. Dopamine is neither good nor bad. It's a signal to tell us whether or not something that we're doing is potentially useful for our survival. And also,

it's related to what we predicted about how rewarding or pleasurable something would be. And so it's really, you know, I sort of, sometimes I joke, it's like the reward theory of relativity. dopamine is in the sense that pleasure and pain really are truly relative to one another. And so dopamine gives us information about where we are in that relativity scale between pleasure and pain. And when you say relative, you mean, I mean, it's quite fitting. For anyone that can't see, we have a set of scales on the table. And scales are relative to each other because if you pour in one end, the other end goes up. And if you pour in the other end, the other end goes up and this end goes down.

And when you say relative, that's what you're describing, right? Yes, that's what I'm describing, yes. Okay. And what activities that I do every day have an impact on my dopamine? Well, probably almost everything, you know, in some ways. I mean, every time we are doing something that's pleasurable, reinforcing, rewarding, that will affect dopamine. It's really the primary signal that lets us know that this thing is potentially important for our survival, as I mentioned. But, you know, even aversive stimuli can trigger dopamine.

Something that's painful or not pleasurable, dopamine gets involved in that equation. Anything that's novel or new is something that triggers our dopamine in our reward pathway. Dopamine is fundamental for movement, so not just pleasure and reward, but also movement. So, for example, Parkinson's disease, which is a disease related to stiffness and tremor, is caused by a depletion of dopamine in a part of the brain called the substantia nigra. And as dopamine gets depleted in that part of the brain, people lose the ability to move their bodies. And it's probably no coincidence that the same neurotransmitter that is so important for pleasure,

reward, motivation is also really important for movement because most organisms have to locomote toward the object of their desire. We want that thing. We have to exert effort, right? We have to put in the work to go get it. But in the world today, we really don't have to do that, right. We can swipe right. We can swipe right. We can swipe left. And all of a sudden, it magically appears at the touch of a finger. And that's very confusing for our brains, because that's not how we evolved. We really evolved for having to do quite a bit of upfront work for a time. little bit of reward. One of the most exciting findings in neuroscience in the past 75 years is that pleasure and pain are co-located in the brain. So the same parts of the brain that process pleasure

also process pain. And in a very simple reductionist kind of way, they work like opposite sides of a balance. So imagine that deep in your brain's reward pathway, which is another exciting discovery, right, that there's this dedicated reward pathway of the brain that consists, broadly speaking, of the prefrontal cortex, which is this large gray matter area right behind our foreheads. It's so important for future planning, for delayed gratification, for appreciating future consequences. You might think of it as like the brakes on the car if we're going to analogize to an engine. And then deep, you know, in the brain, we've got what we call the limbic areas or the emotion brain. And there you have.

the nucleus accumbens and the ventral tegmental area that are rich in dopamine releasing neurons, right? And they act like the accelerator on the car. So when you've got a healthy functioning brain, you've got enough accelerator but not too much, right? So enough dopamine being released, but not too much. And you've got a healthy prefrontal cortex putting the brakes on that dopamine release. When people become addicted, there's either a problem, with the brakes, the prefrontal cortex, or the accelerator, the nucleus accumbens and ventral tegmental area, or both, right? What we're finding is that there's actually a disconnect. So there are large neuronal circuits and pathways between those deep limbic structures and the prefrontal cortex that literally get severed or disconnected when people become addicted.

As we think about pleasure and pain being co-located in the same parts of the brain, working like opposite sides of the balance, in order to understand what happens in the addicted brain is to appreciate that there are fundamental rules governing this balance. And one of the most important rules is that the balance wants to remain level. It does not want to be tilted very long to the side of either pleasure or pain. And in fact, what our brain does is first tilt an equal and opposite amount to whatever the initial stimulus is. So I'm going to try to illustrate that here. So let's say our initial stimulus is alcohol. Now, alcohol works through its own chemical pathway. It works on our endogenous opioid system, the opioids that we make. We have receptors for opioids in our brains. It works on our endogenous GABA system, which is our calming neurotransmitter. And at the end of the day, it releases dopamine in the reward pathway. So any potentially addictive substance will release dopamine in the reward pathway. The more that's released and the faster that's released in a given individual, the more likely that substance is to be addictive. Now, another important concept here is what we call drug of choice, which is to say what

releases a lot of dopamine in your brain may not release a lot of dopamine in my brain and vice versa, right, which is this idea that people have predilections to different kinds of drugs. And by the way, people can get addicted to behaviors too. I should emphasize that. When you say drug of choice, you mean the brain has a particular sensitivity to that drug in terms of dopamine? Yes. Okay. The more dopamine that's released, the faster that it's released, the more likely that drug is to be addictive for a given individual.

So you're holding some whiskey there? I'm holding some whiskey. There could be a brain that is very sensitive to whiskey, and there could be a different brain that you could pull all the whiskey and you like in. the dopamine response is sort of limited. Exactly. Okay. And for many of my patients who become addicted to alcohol, they will tell you that from the first moment they had alcohol, they knew they were either in trouble or had met their best friend

or some combination. It was a very potent experience for that. All right. So let's go ahead and put this on the pleasure side of the balance. Dopamine is being released, but no sooner has that happened than my brain, will work very hard to restore a level balance. And by the way, a level balance is what neuroscientists call homeostasis. And one of the overarching physiologic drives for all living organisms is to homeostasis. Homeostasis is that parameter of what's often called affordances or states of being

that are adaptive and healthy for the organism. For example, like we have a certain homeostasis of body temperature. And if we go much too, much beyond that, either too high or too low, we will disintegrate and die, right? So homeostasis is that states of being that are compatible with existence and potentially advantageous too. Sort of baseline level. That's right. Yeah, baseline level. And by the way, we're always releasing dopamine at a kind of tonic baseline level in our brains. I sometimes think of it as the heartbeat of the brain. So what's happened here for people that can't see is you put a little bit of whiskey into one end of the scale, the pleasure side of the scale.

and the other side of the scale has risen, because now there's whiskey in the pleasure side, which I guess has released dopamine. Exactly. So now we've released dopamine in the reward pathway. Okay. Because the pain side went up, does that mean there's now less pain in the brain? Well, I think, you know, again, this is a metaphor. It's an oversimplification.

The idea here is just when we press on the pleasure side, we're releasing dopamine in the reward pathway and experiencing pleasure. Okay. Okay. But no sooner has that happened, then our brain will try to compensate or adapt to increase dopamine firing by downregulating dopamine transmission, for example, by invaluting post-synaptic dopamine receptors. What does that mean? Okay. Okay.

Okay. So our brain is a bunch of wires, you know, that conduct these electrical signals. And these long spindly cells are called neurons. And the thing about neurons is that they don't actually touch end to end. there's a little gap or space between them, and that gap is called the synapse. And that gap or synapse is bridged by what we call neurotransmitters, and dopamine is one of those neurotransmitters, okay?

And when the presynaptic neuron pulses and releases dopamine, it crosses the synapse and binds to a receptor on the post-snaptic neuron, which either continues or aborts that electrical signal. Does that make sense? Yes. Okay. So one of the ways that our brain can, decrease the effects of dopamine, decreased dopamine transmission, is by invaluting or taking inside

the neuron the post-synaptic receptor. That way when dopamine is released, it has nowhere to bind. Oh, okay. So it's like removing the docking station? Exactly. Very good. It's removing the docking station. So essentially, getting back to our scale, we've, you know, ingested alcohol, we've increased dopamine firing in the reward pathway. But remember, our pleasure paid balance wants to return to a level position, level with the ground, homeostasis. So it's going to decrease dopamine transmission by, for example, invaluting those post-synaptic dopamine receptors. But one thing about the brain in its process of trying to get back to homeostasis, and again, I like to think of this neuroadaptation process as these gremlins hopping on the pain side of the balance to bring it level

again. You don't have gremlins here. You have these little rocks, but let's go ahead and put a rock on the pain side of the balance. And these rocks are our friends, right? Their job is to level the balance because remember we got to go back to homeostasis. So I'm going to put a rock on and you're going to see, oh my gosh, it overshot, right? Now I've got it pressed down on the pain side of the balance. But that's exactly what happens in our brains. In this process of neuroadaptation, those gremlins hopping on the pain side of the balance don't get off as soon as the balance's level. They stay on until we're tilted and equal and opposite amount. So is that what a hangover is or a come down, as they would say, when people take drugs, they say, I have a come down.

Exactly. That's exactly what it is. That's the hangover, the come down, the blue Monday, or on a much smaller scale, just that moment of craving, right? That moment of wanting to have one more shot, right? Why does it overshoot? Why can't it just perfectly hit homeostasis? Such a great question. Because then we'd feel fine. Yeah. Why did Mother Nature do that to us? So cruel. Right? Yeah. Okay.

I'm going to tell you an evolutionary just-so story. What we mean by that is we don't really know why, you know, this mechanism exists. But from an evolutionary perspective, if you're living in a world of scarcity and ever-present danger, this is the perfect mechanism to make sure that we're never satisfied with what we have, that we're always wanting more. It's made us the ultimate seekers. alcohol is a product of human engineering that releases so much dopamine all at once in the reward pathway that our brains are reeling to compensate, right? We really weren't evolved for this much pleasure with this much easy access. As you said yourself, we were really evolved to have to do quite a lot of work up front

and to be hungry and to be lonely and to be tired and then get a little bit of reward that would then bring us back up to homeostasis. So really, we were evolved to be pressing on the pain side of the balance in our effort to find pleasure. And then when we find it, that little bit of food or clothing or shelter or a mate would bring us back to the level position.

We are all wired to be addicted. And if you're not addicted yet, it's right around the corner. Right. Coming to a website near you. Yes. I guess I would qualify that a little bit by saying we're wired for survival in a world of scarcity. That's not the world we live in now. We live in a world of overwhelming overabundance.

And so there is a mismatch between this ancient wiring that has us relentlessly pursuing pleasure in order to survive and a world that's so infused with pleasure and so many rewarding stimuli that now we're overwhelming our reward system. and our brains are reeling in response to try to compensate. So what happens to this scale then in such a world where I can get a big hit of dopamine all the time using some of these synthetic things or the internet or pornography or whatever else? What's going on with this scale over and over again? Okay, great. So let me get there. Let me first say, though, that remember, after we do something that's highly pleasurable,

our brain compensates with neuroadaptation, tilting an equal and opposite amount to the side of pain, and then restoring our balance back to the level position, right, or what we call homeostasis. So this doesn't last forever, right? It's to pleasure, then it's to pain, then it's back to the level position. But if we continue to consume our drug of choice over days to weeks to months to years, and we add in a whole bunch of other drugs, and now we're consuming, you know, pornography and smoking pot and eating donuts, And, you know, you name it all at the same time, then essentially what happens is those gremlins on the pain side of the balance end up camped out there.

For anyone that can't see, she put all of the rocks into the pain side to represent all of the addictive behaviors that this individual has now taken on. Right. And now we've entered addicted brain, by which I mean that we've changed our hedonic or joy set point. to the side of pain. Now we need more and more of our drug in more potent forms, not to get high and feel good, but just to level the balance and feel normal. And this is not going to be enough. To level the balance,

I would have to keep filling this much more than this container can hold. And that would be in pursuit really of just trying to level that balance so that we can feel normal. And when we're not using, we're walking around with a balance tilted toward the side of pain, experiencing the universal symptoms of withdrawal from any addictive

substance or behavior, which are anxiety, irritability, insomnia, depression, and craving. So if I manage to get enough vodka, whiskey, rum, and pour it into the pleasure side of the scale, now that all the rocks are in the pain side of the scale, I managed to outweigh it, what would then happen? More rocks. More red, the badded. Yes. Okay. So momentarily, I would maybe be in a little bit of pleasure.

Yes. But then my brain would remove those docking stations again, remove more of them, and more rocks would go in and I'd slam down on the pain side again, which means I need more alcohol to try and get up to pleasure. Okay. So really you want to, like, dopamine fast. You need to just balance this. And this is so difficult because of the world we live in. It's almost, it's funnily enough because this little scales experiment,

analogy here has given me a huge amount of empathy for people that are addicts. Oh, gosh, I'm so glad you said that because I think that is the key to empathy for the disease of addiction, as well as for people with the disease having empathy for themselves, is recognizing that on some level it's out of their control, right? Because when we are tilted to the side of pain, the overwhelming drive to restore a level balance or restore homeostasis as quickly as possible overwhelms any other rational thought about the consequences of my drug use, right? It's just like get back to the level position because if I do that, I'll at least feel temporarily better.

One of the things this analogy also highlights for me is that people who are addicted aren't trying to self-harm. Right. And this is kind of the prevailing narrative that if you're like, why would you do that to yourself? Right. Whereas when I look at this analogy, I go, actually, what they're trying to do is to deal with pain. And we're all trying to find ways to deal with our pain. And but in this analogy, what ultimately happens, and I guess what's happening with addicts is the way they're choosing to deal with their pain is becoming self-destructive, and that's creating more pain.

Right. And it's this vicious downward cycle. And I think that sort of reframing of what's going on there is really critical because, again, it begets more empathy. Absolutely. I agree with you. And I think, you know, we, this metaphor, it makes an assumption that we all start with a pleasure pain balance that's level with the ground, but actually that's probably not true, right? Some people at baseline may actually be more depressed or more anxious or may have had

life experiences that sets them up for a kind of chronic stress reaction. And we know that people with co-occurring psychiatric disorders, for example, are at increased risk of developing addiction, probably because they're reaching for that substance to self-medicate their psychiatric problem. The issue with that is that it's not medicinal, right? It's not healing. Although in the short term, substances can help with those kinds of feelings of psychological and physical pain.

Over time, because of the way the brain adapts, as we've discussed, substances and other addictive behaviors just make psychiatric problems worse, right, as we drive ourselves further into the kind of, you know, the pain side of the balance. So is this why trauma often leads to addictive behaviors? Because the trauma has caused a pain, a stress, and we're searching for ways to medicate that pain or stress. Yeah, to numb ourselves, to not be present in our reality and have to deal with what's going on there. It's dope. It's... It's a lot of... It's all the same. Dopamine originally was to help us find those things that we need to survive. Food, clothing, shelter, a mate. We call those natural rewards. But today, that same reward pathway that relies on dopamine has been hijacked by all of these artificial rewards that our brain confuses as necessary for survival, which is why people with severe addiction will be willing to.

to lose, you know, not consciously but unconsciously, their loved ones, their homes, their jobs, everything they have in pursuit of their drug of choice. It's because their brain has been hijacked and they now confuse the drug as necessary for survival. The other thing about drugs is that they're incredibly potent. They release a lot of dopamine all at once, which again is confusing for our brain. Natural rewards require upfront effort where we do a lot of dopamine. We do a lot of, of work, and then we get a little bit of dopamine. And that's what our brains evolved for. There's a very interesting series of experiments in rodents, mice and rats, where they, first of all, rodents very easily get addicted to cocaine. They will press a lever for cocaine

until exhaustion or death. But if that cocaine is then taken away, that behavior will extinguish, which means that the mice will eventually just stop pressing the lever, right? Because they're not getting any cocaine. Totally makes sense. And then they'll go off and do something else in the cage. But if they're then exposed to a very painful foot shock, right? So a very extreme physical pain, which you could equate to a serious life stressor, the first thing the rat will do is run over to the lever and start pressing for cocaine, which tells us that once our brain, has discovered a drug that releases a lot of dopamine in our reward pathway, even after we stop using that drug, if we are exposed to an extreme stressor, our brain will tell us immediately,

go and do that thing that gives us a lot of dopamine because you are under stress and I need to be relieved of stress. Does that make sense? Makes perfect sense. Yeah. So if you, especially, so if you discover your drug of choice when you're younger and it's food or it's pornography or if it's, I don't know, anything that really made you feel good for a moment, a moment of pleasure that will always become, in the case of these rodent experiments, the thing you run back to when life gets hard. Right. And we see that again and again in people in sustained recovery from addiction, that when they are under stress, that is a trigger potentially for them to realize.

So they have to be really thoughtful in their lives for, number one, trying to avoid stressful situations. And by the way, stress can come in many different forms. There's a great acronym in Alcoholics Anonymous called Halt, Hungry, Angry, Lonely, Tired. Those kinds of stressors, everyday stressors, which we all experience, hungry, angry, lonely, tired, can trigger us to want to use. So people in recovery have to be really thoughtful about not getting too hungry, not getting too angry, not getting too lonely, and not getting too tired. Thank you for tuning in. Continue strengthening your mind by listening to our other episodes.