Anna Lembke

What does it feel like,” I asked, “immersing yourself in cold water?” I have an aversion to cold water myself, and couldn’t tolerate those temperatures for even a few seconds.
“For the first five to ten seconds, my body is screaming: Stop, you’re killing yourself. It’s that painful.”
“I can imagine.”
“But I tell myself it’s time limited, and it’s worth it. After the initial shock, my skin goes numb. Right after I get out, I feel high. It’s exactly like a drug . . . like how I remember ecstasy or recreational Vicodin. Incredible. I feel great for hours.”

Exercise increases many of the neurotransmitters involved in positive mood regulation: dopamine, serotonin, norepinephrine, epinephrine, endocannabinoids, and endogenous opioid peptides (endorphins). Exercise contributes to the birth of new neurons and supporting glial cells. Exercise even reduces the likelihood of using and getting addicted to drugs.

Exercise has a more profound and sustained positive effect on mood, anxiety, cognition, energy, and sleep than any pill I can prescribe.

contrast, blue-collar jobs are increasingly mechanized and divorced from the meaning of the work itself. Working under the employ of distant beneficiaries, there’s limited autonomy, modest financial gain, and little sense of common mission. Piecemeal assembly-line work fragments the sense of accomplishment and minimizes contact with the end-product consumer, both of which are central to internal motivation. The result is a “work-hard/play-hard” mentality in which compulsive overconsumption becomes the reward at the end of a day of drudgery.

This kind of single-minded focus, although heavily rewarded in modern rich nations, can be a trap when it keeps us from the intimate connections with friends and family in the rest of our lives.

Oxytocin, a hormone much involved with falling in love, mother-child bonding, and lifetime pair bonding of sexual mates, binds to receptors on the dopamine-secreting neurons in the brain’s reward pathway and enhances the firing of the reward-circuit tract. In other words, oxytocin leads to an increase in brain dopamine, a recent finding by Stanford neuroscientists Lin Hung, Rob Malenka, and their colleagues.
After his honest disclosure to his wife, followed by her expression of warmth and empathy, Jacob probably experienced a spike in oxytocin and dopamine in his reward pathway, encouraging him to do it again.

any high-dopamine substance or behavior we ingest too much of for too long

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.

High-dopamine drugs always lead to problems. Health problems. Relationship problems. Moral problems. If not right away, then eventually

hink back to the imaging study by neuroscientist Nora Volkow, showing that dopamine transmission is still below normal two weeks after quitting drugs. Her study is consistent with my clinical experience that two weeks of abstinence is not enough. At two weeks, patients are usually still experiencing withdrawal. They are still in a dopamine deficit state.

On the other hand, four weeks is often sufficient