Dopamine Nation

PART II
Self-Binding

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I’
CHAPTER 4
Dopamine Fasting
m here because my parents made me come,” Delilah said in that sullen
voice that is the hallmark of the American teenager.
“Okay,” I said. “Why do your parents want you to see me?”
“They think I’m smoking too much pot, but my problem is anxiety. I smoke
because I’m anxious, and if you could do something about that, then I
wouldn’t need the weed.”
I was gripped by a moment of overwhelming sadness. Not because I didn’t
know what to recommend, but because I was afraid she wouldn’t take my
advice.
“Okay, then let’s start there,” I said. “Tell me about your anxiety.”
Long-limbed and graceful, she folded her legs underneath her.
“It started in junior high,” she said, “and it’s just gotten worse over the
years. Anxiety is like the first thing I feel when I wake up in the morning.
Hitting my wax pen is the only thing that gets me out of bed.”
“Your wax pen?”
“Yeah, I vape now. I used to do blunts and bongs, Sativa in the daytime and
Indica before bed. But now I’m into concentrates . . . wax, oil, budder,
shatter, scissor, dust, QWISO. I mostly use a vape pen, but sometimes a
Volcano. . . . I don’t love edibles, but I’ll use them in between or in an
emergency when I can’t smoke.”
D Stands for Data

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By prompting her to say more about her “wax pen,” I was inviting Delilah to
delve into the nitty-gritty details of her everyday use. My conversation with
her was guided by a framework I’ve developed over the years for talking
with patients about the problem of compulsive overconsumption.
This framework is easily remembered by the acronym DOPAMINE, which
applies not just to conventional drugs like alcohol and nicotine but also to
any high-dopamine substance or behavior we ingest too much of for too long,
or simply wish we had a slightly less tortured relationship with. Although
originally developed for my professional practice, I’ve also applied it to
myself and my own maladaptive habits of consumption.
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The d in DOPAMINE stands for data. I begin by gathering the simple facts of
consumption. In Delilah’s case, I explored what she was using, how much,
and how often.
When it comes to cannabis, the dizzying list of products and delivery
mechanisms that Delilah described is standard fare for my patients
nowadays. Many of them have the equivalent of a PhD in Pot by the time they
come to see me. In contrast to the 1960s, when recreational weekends-only
use was normative, my patients start smoking the moment they wake up in the
morning and keep going all day long until they go to bed again. This is
concerning on many levels, not the least of which is that daily use has been
linked to addiction.
For myself, I began to suspect I was teetering into the danger zone when
reading romance novels started to take up hours a day and days at a time.
O Stands for Objectives
“What does smoking do for you?” I asked Delilah. “How does it help?”
“It’s the only thing that works for my anxiety,” she said. “Without it I’d be
nonfunctional . . . I mean even more nonfunctional than I am now.”
—

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In asking Delilah to tell me how cannabis helped her, I was validating that it
was doing something positive or she wouldn’t be using it.
The o in DOPAMINE stands for objectives for using. Even seemingly
irrational behavior is rooted in some personal logic. People use high-
dopamine substances and behaviors for all kinds of reasons: to have fun, to
fit in, to relieve boredom, to manage fear, anger, anxiety, insomnia,
depression, inattention, pain, social phobia . . . the list goes on.
I used romance to escape what for me was a painful transition away from
parenting young children to parenting teenagers, a job at which I felt much
less skilled. I was also assuaging my grief at never having another baby,
something I wanted and my husband did not, creating a tension in our
marriage and in our sex life that hadn’t existed before.
P