"dopamine fasting:" the smoking gun (cigarette) in everyone's mouth

an exploration of addiction, wellness fads, and the moral roots of steadfast sobriety

CW: This post discusses addiction, diet culture, fatphobia, and sexual behavior as referenced in the book Dopamine Nation.

Okay, y’all. When I started writing this, I planned on it being primarily a “book review” style piece about Dopamine Nation. But, as I read the book, and as I began to do my own research to understand the social and political stances behind this book, the piece morphed.

So, what we’ve got is part personal-essay about my life, part social and cultural recap of recent addiction science conversations in the public eye, and, yes, part book review.

I’d love to know what you all think, if you’ve read Dopamine Nation, and anything you’d like to share. I’ve been working on this on and off for a while, so thank you for reading!

Also, hat tip to

Jesse Meadows

, whose incredible work is worth checking out, and who writes about dopamine “culture” and who has written about this book as well— I really recommend reading Jesse’s take. When I was researching the book further, Jesse’s work was some of the only critical work I could find, which helped me feel not insane.

giving up on quitting

In the middle of last year, I was listening to the podcast This American Life while walking my dog. One episode was called “I Can’t Quit You, Baby” and it featured one of the show’s producers, Jamie Flowers, trying to quit smoking.

I found Jamie’s predicament fascinating and relatable. While I have not been a smoker, both of my parents smoked until I was about 10-14.

Now, my parents did not glamorize smoking to me. In fact, it was compartmentalized in our home: my parents smoked only in the garage, with the door to our house shut, and the garage fully open to the outside air. They didn’t smoke in the car; our clothes never smelled like cigarettes; they didn’t really talk about smoking. Probably the biggest giveaway, besides cartons in our recycling, was the handful of Marlboro branded items around our house.

At the time, Marlboro had a rewards program. You could cut a piece of each carton off and mail them in for points, so we had: a Marlboro leather backpack; three Marlboro sleeping bags (which I had until 2018 and did use for camping); two red duffel bags; and a big, round, metal canteen one might use in a desert that had the red and white Marlboro insignia branded on the front. When I think of these items, a fuzzy, warm feeling (maybe like emphysema) warms my chest with the nostalgia of the 1980s and 1990s American culture of smoking and the legacy of Philip Morris.

My dad, Peter, quit smoking first. He thought he had an ulcer, went to the doctor, and they found that he had 99% of his main artery from his heart clogged. He was scheduled for a quadruple bypass surgery. Quitting smoking, for my dad, was easier than for most people, I think. My dad has this ability where if he decides to do something, he will just do it. He quit smoking cold turkey. He went vegan for about two years, and the man just “decided to do it” and never found himself craving steak or animal products while he was vegan. It’s honestly kind of hard, sometimes, discussing things that might be considered acts of willpower with my dad, because for him there’s this steel undergirding his will that feels unlike anyone I’ve ever known. (It also makes my dad very stubborn when he wants to be.)

My mom, Helena, in the wake of my dad quitting, decided to quit, too. It was much harder for her. I remember nicotine gum. There were multiple attempts to stop smoking.

On one trip to Europe to visit our family—my mom and dad were both European and emigrated from the Czech Republic and the Netherlands to the United States—my mom had been able to quit for perhaps a month or two. As a coping tool, she had these fake cigarettes. They looked just like cigarettes except they were fully paper.

In a moment of muscle memory, my mom lit one. I watched as it proceeded to burn in her mouth like a minuscule stick of dynamite.

So, I come back to the podcast episode: I was fascinated at the discussion around addiction to nicotine and smoking. I have smoked tobacco a few times in my youth, but I never gave cigarettes a try, and likely never will, because of how hard it was to see my parents go through quitting. (And being traumatized as a child with videos about how smoking will kill you, as a 1990s D.A.R.E. indoctrinated youth.)

At one point, Jamie has been able to quit but finds himself thinking about cigarettes so often, it’s difficult for him. He also started smoking as a young adult, so he’s been smoking for several decades.

Anna Lembke comes onto the show, and she says, very plainly, something along the lines of (I’m paraphrasing) “You might have to use nicotine gum forever, and in higher amounts than you might think. Basically, you’ve smoked for so long, your brain might need a small amount of nicotine, maybe forever.”

In American culture, where quitting a “bad for you” item or dieting are treated with utmost moral superiority, and mainstream culture strongly pushes a “full sober” approach to quitting something (like, if you have alcoholism, you can never, ever have a beer or wine again without it being considered a relapse), I found Lembke’s advice fascinating. Here was someone acknowledging the science of how nicotine was impacting the brain and honestly saying, “You can use nicotine gum forever, and that’s your version of quitting, and that’s okay.”

Her book, which I’d seen around, instantly moved to the top of my “to read” list.

some background on Anna Lembke

Dr. Anna Lembke is the chief of Stanford University’s Addiction Medicine Dual Diagnosis Clinic. She also offers three online Stanford EdX courses on addiction and maintains a private practice. She’s testified before the United States Senate on the topic of the opioid crisis, as well. She wrote a book in 2016 all about the opioid epidemic.

Lesser known about Dr. Lembke is that, in an 2021 case against Walgreens, the Sacklers and Purdue, she made the case that they downplayed how addictive OxyContin is. In Dr. Lembke’s eyes, addiction lies in the over-prescription of opioids, based on testimony she gave in 2015 to the U.S. House of Representatives.¹ She also argues that doctors are incentivized to prescribe opioids: they’re afraid patients will be angry or sue them if they don’t prescribe them, and they’re incentivized by insurance companies, who will typically approve a Vicodin prescription much more easily than a different, non-opioid medication, in her words.

how theories of addiction impact the cultural context this book lives in

Given all of Dr. Lembke’s expertise and her high profile, she was selected as an expert to offer testimony in this 2021 case in California. Dr. Lembke is arguing for what, in addiction spaces, is called the “disease theory” of opioid addiction. Lembke’s stance is that opioid are highly addictive, and people prescribed opioids are all at great and equal risk of addiction.

Proponents against this theory agree that opioids can be addictive, but their main skepticism is around the idea that it’s equally addictive to everyone—they basically want more proof around how addictive opioids are, since there are people who take opioids without addiction becoming a part of their experience.

According to an article from Filter Mag in November 2021², the judge ruled against the plaintiffs citing that Lembke’s testimony was false in a few main areas. They failed to prove that it was the prescribing itself that caused the increase in addictions, they generalized about geographic areas impacted by addiction, they overstated the amount of opioid addiction, and they failed to acknowledge how opioids provide a very real kind of pain relief. Author Stanton Peele writes:

The judge, who regularly stopped the trial to hold detailed discussions about evidence, noted in his ruling that Lembke “testified that one in four patients prescribed opioids would become addicted.”

But, he continued, “as Defendants point out, the studies relied upon by Dr. Lembke for that conclusion are inadequate to support it … the more reliable data would suggest less than 5 percent, rather than 25 percent.” And even with that much lower figure, “addiction based solely on the patient having been prescribed opioids does not occur in ‘most of these patients.’”

I didn’t know any of this before I read Dr. Lembke’s book, and, in fact, had to do a bit of digging to find any information around this—all of this is not present in her Wikipedia page, for example, or in any interviews (of which she’s done many) on podcasts or public radio that I’ve listened to.

While her 2016 book is referenced at times, the more scientific ideas behind her work and these complex ideas around addiction are not present, probably because her most recent book fits neatly in the “pop psychology” or “pop science-based self-help/development” categories of nonfiction.

Now, a quick note on the context of the very title of Dr. Lembke’s book, and then we’ll get into it.

what is “dopamine fasting?”

Dopamine fasting is a very current, trendy term, but it’s been around in some form since 2008.

Here are some recent headlines around dopamine fasting:

NPR: “Too much pleasure can lead to addiction. How to break the cycle and find balance.”

New York Times: “How to feel nothing, in order to feel more later”

When I even typed in the phrase, these were what my search results looked like:

So, the term “dopamine fasting” was coined by psychiatrist Dr. Cameron Sepah. Sepah himself told the New York Times in 2019 that term is “not to be taken literally,” but is, in fact, a catchy name. ³

Essentially, Dr. Sepah was arguing for ways to separate oneself from the constant-notifications, always-online, anything-at-your-fingertips “addictiveness” of modern life. He suggests things like spending time outside, doing things offline, and enjoying simple pleasures. It’s not unlike general mindfulness and trying to give some balance to life that’s largely instant and always blue light backlit.

Dopamine is often called the “pleasure chemical,” and it’s a neurotransmitter and hormone our bodies release in relationship to many things, but, in part, pleasure. Very low levels of dopamine can be related to mental health or physical illnesses, and dopamine is related to movement, memory, and mood. The idea of “fasting” (more diet culture) from dopamine is the idea that one can wean oneself off of “high dopamine-generating” activities, like Instagram scrolling, in favor of lessening their impact on our brans. Scientifically, this isn’t actually true, and the founder of “dopamine fasting” admits this to a degree.⁴

With all of this in mind, let’s get into the book itself, and the very idea at the core: “dopamine fasting.”

Part 1

In the introduction, Lembke writes that “understanding [the relationship between pleasure and pain] has become essential for a life well lived. Why? Because we’ve transformed the world from a place of scarcity to a place of overwhelming abundance: Drugs, food, news, gambling, shopping, gaming, texting, sexting, Facebooking, Instagramming, YouTubing, tweeting. . .”

Now, I’ll admit, this was my first pause because one of these items is actually necessary for human survival. And, while this might be controversial, I don’t actually think that food, sex, or other things that are hard-wired into us are addictive. Can you eat or have sex compulsively in a way that creates other issues or might be psychologically motivated? Sure. But we live in a culture that demonizes sex and eating, and you know what makes something seem a lot more tempting. . . ? Constantly saying it’s bad, it’ll ruin our lives, it’ll kill us, and waving it around in our faces in media and advertising, while also not teaching healthy approaches to the thing. In the U.S., this is pretty much true of both sex and food.

Okay. But I was determined to give this author the benefit of the doubt. So let’s continue. . . At the end of the introduction, Lembke says something that sounds perfectly reasonable: “[W]e all engage in behaviors we wish we didn’t, or to an extent we regret.” Yes! Sure. That’s why I’m here!

The first patient that Lembke introduces readers to is Jacob. Moderately attractive, White, Eastern European. But, brace yourselves: “Jacob’s story shocked me. What disturbed me most was what it implied about the world we live in now, the world we’re leaving to our children.” What’s that world? Well, of masturbating.

Lembke goes on to tell Jacob’s sad circumstances. He masturbated as a kid. Then, he learned it was a sin at his First Communion. Fast forward: he’s an adult, and he continues masturbating. In fact, he builds “a machine” to do so. Upon hearing this, Lembke reflects:

“Perhaps you are repulsed by Jacob’s masturbation machine, as I was when I first heard about it. Perhaps you regard it as a kind of extreme perversion that is beyond everyday experience, with little or no relevance to you and your everyday life. [. . . ] We are all, of a sort, engaged with our own masturbation machines.

Circa age forty, I developed an unhealthy attachment to romance novels.”

Okay. Now, I’ll grant Lembke that Jacob is hanging out with his machine for “several hours each day” and is it reasonable that he wants to scale back? If he wants to, I guess, sure. But to think of the idea of a masturbation machine as something sick and perverse. . . well, I want to ask Dr. Lembke if she knows that there are ancient dildos carved by hand, made of rock. These “machines” have been around for a long time.

On second note, the romance novel thing. Lembke goes on to say how she “ripped through every vampire romance I could get my hands on” and she “searched out increasingly graphic and erotic renditions.” Then, precious, innocent reader, she got a Kindle, and she “became a chain reader of formulaic erotic genre novels.” She says it came to a head when she was “reading instead of socializing, reading instead of cooking, reading instead of sleeping, reading instead of paying attention to my husband and my kids.”

I want to take the author aside and say, “Hey. I get that you have to tell us some narrative about your own ‘experience’ with ‘addiction’ to be relatable. But, also, perhaps, if I were to be acting like your therapist (which I’m not and I wouldn’t be), I’d be like, ‘Maybe you just need a break. Maybe you need to relax, and this feels like a socially acceptable way to do so. Maybe you’re a little bit of a workaholic but reading feels like ‘work’ enough that you can chill, but now you’re reading things you actually don’t even like that much because there’s something mindless about it. What if you just took, I don’t know, a vacation or a couple days off of work.”

Okay—we’ll come back to Jacob, but jumping a head a little bit. . .

Around 12% into the book (because, *gasp* I was reading on an eReader) we get a few interesting quotes. Lembke quotes Philip Reiff, a 20th century philosopher/psychologist who said “religious man was born to be saved; psychological man is born to be pleased.”

We also get a quote from Ross Douthat, author and religious scholar, who describes the “New Age” idea of the “God Within” (that god is in us, I guess, Lembke doesn’t elaborate) as having “little moral exhortation” and the guidance it features is basically just “do what feels good”.

Moving on from this idea, Lembke connects it to child-rearing and a specific patient of hers whose parents are afraid to be too hard on him. “[E]very child is taught to be on the lookout for bullies” and “at the university level, faculty and students talk about triggers and safe spaces.”

This is interesting. It’s almost as if Lembke is subtly signaling a kind of right-wing interest against snowflakes and people who don’t understand discipline and conflating that with over-protection. “I worry that we have both over sanitized and overpathologized childhood, raising our children in the equivalent of a padded cell,” Lembke writes.

One thing I find curious about Lembke is when she decides someone’s pain is worth treating, and to what degree. Jacob (the masturbator) discusses thinking about killing himself. Lembke wants to help him, but she also admits to being horrified of his struggle. In the second chapter, Lembke conflates the desire to “numb” oneself with the increasing rise of antidepressant use. She cites tons of statistics about how many people are using them in various countries, comparing years like 1996 to 2013 and implying that the increase in use is an increase in coddling teenagers, or people simply “running from pain.”

The part about dopamine

In chapter three, we get into dopamine analogies and little diagrams of baseball players. “Dopamine may play a bigger role in the motivation to get a reward than the pleasure of reward itself. Wanting more than liking.”

Lembke moves between describing lab rats addicted to amphetamines to her fling with the romance novel genre, and says “here’s the good news. If we wait long enough, our brains (usually) readapt to the absence of the drug and we establish our baseline homeostasis.” But she also says pain and pleasure experiences aren’t perfectly balanced in the brain, and that we live in a world of “compulsive overconsumption.” So what do we do? Here’s what she proposes.

Part 2 of the book - weight-shaming, pro-strict church rules, and pneumonic devices

Lembke says she has a pneumonic, “DOPAMINE” to help her explore addictive behaviors.

D = data (usage amount, frequency, etc.)

O = objectives

P = problems related to use

A = abstinence

M = mindfulness

I = insight

N = next steps

E = experiment

Basically, Lembke encourages a person who’s curious about their behavior to look at how and why they’re doing said behavior, take a period of abstinence, and then use mindfulness and self-reflection to consider if they’d like to re-engage with that behavior (and how) in the future. This seems, genuinely, like a great idea for things like social media, but a much more complex thing for issues of actual addiction or behavior that is triggered by things we cannot stop doing (either because of society or physical needs).

“Self-binding” is the term that Lembke uses to handle a “relapse.” For example, Jacob ends up relapsing and using his sex machine (or a new one he built, hard to say). Lembke instructs him to take the machine and its parts to a garbage dump or somewhere else he cannot retrieve the item from, and then to pray.

“Doctors don’t talk about God. But I believe in believing, and my instincts told me this would resonate for Jacob, raised Roman Catholic.”

She says that Jacob throwing his machine away and then praying (and then calling his S.A.A. sponsor) is a way of binding. You “creat[e] tangible barriers between ourselves and our drug of choice.” There can be physical, time-based, or meaning-based strategies for limiting unwanted behavior.

This can be something like putting your TV in your closet, getting rid of all of the alcohol in your house, or. . . “anatomical changes to our bodies; for example, weight-loss surgeries such as gastric banding, sleeve gastrectomy, and gastric bypass.”

Here, dear reader, Lembke even admits that 1 in 4 people who undergo a surgery like this develop an alcohol addiction. But she still acts like it’s a way to “solve” a body size.

a brief tangent into weight as moralistic failure

As I’ll elaborate on later, there are obvious ties to moralism and constraint/self-control/“non-addiction” behaviors (that’s a term I’m making up for the purposes of this piece).

We already live in a climate where weight is seen as a moral issue—how much you can restrict, fast, diet, etc. is viewed a sign of willpower. (It’s not, though.) A sign of personal strength because to be larger bodied is to be seen as stupid, gluttonous, selfish, indulgent, lacking in moral fortitude. None of this is actually true, except we’re culturally indoctrinated with it. So it doesn’t surprise me that Lembke is building off of this idea here.

But I’d like to look at something Lembke doesn’t say, which is interesting to me, given that she’s a psychiatrist. Patients who undergo bariatric surgery as statistically more likely to self-harm and attempt suicide. This is true across studies in a meta-analysis, which is basically a scientific study that takes a bunch of other studies on the same topic and looks at all of the data and stats across them, to see if there is a consistent trend in the data from all these individual reports.

Here’s what the meta-analysis found:

The review showed that suicides, self-harm emergencies, or both were higher among patients who had undergone bariatric surgery than among persons in the general population, persons in control groups, and presurgical patients.

[…]On the basis of the results of the current study and of other reports of increased self-harm after bariatric surgery, there is an apparent pressing, unmet need to better predict and prevent this uncommon but very serious sequela of bariatric surgery.

So, we’re talking about encouraging a life-altering surgery that increases your risk of suicide, all in the name of not being “addicted” to food. (Again, I don’t believe this is possible.)

food =/= addictive

There’s a ton of information about how our society handles food, but in general, studies of rats and humans show that restricting access to food is a predictor for binge-eating behavior.

Let me say that again. THE MORE FOOD IS RESTRICTED, THE MORE LIKELY INCREASED CONSUMPTION IS. This has been shown in both rats and humans⁵.

This makes so much sense that to most people, in our diet culture, it doesn’t make sense at all. Animals need food to survive. If we believe that food will be scarce, out of a sense that we will not have proper access to sufficient nutrition, we will eat in order to store energy for a perceived or real starvation. This is why dieting leads to bingeing, which then leads to shame (this has been scientifically demonstrated⁶), which can lead to dieting, etc.

People who actually experience food insecurity are more likely to binge eat⁷. There’s nothing moral about this. In fact, it makes 100% sense when you stop thinking about “eating more food” as bad.

Furthermore, the more shame someone feels about weight, the more likely they are to exhibit eating disorder-related behaviors⁸. Not the other way around. We’ll come back to shame in a second, so remember this.

maybe we’re all just bored, though?

Lembke says “another variable” in compulsive overconsumption is “the growing amount of leisure time we have today, and with it the ensuing boredom.”

What astonishes me, here, is the idea that boredom is the fault of the individual or modernization of society. Yes, we have more time than a laborer pre-Civl War America, which is an actual statistic she cites. You know what that also featured? Actual human slaves. On top of this, Lembke says nowadays “adults living in the US without a high school diploma have 42 percent more leisure time than adults with a bachelor’s degree” and “dopamine consumption is not just a way to fill the hours not spent working. It has also become a reason why people are not participating in the workforce.”

Lembke, earlier in the book, explores the rise of antidepressants and the rise of chronic pain and illnesses, but then posits that we both a) have tons of free time and b) we’re unable to work, and that’s bad, because of the internet.

What happened to Jacob, anyway?

Jacob struggles, but he finds a way to “handle” his addiction. He doesn’t watch TV, movies, YouTube, or anything that could provide a sexually explicit image. He can’t be naked alone. He can’t read anything that might involve sex. To me, these limits seem pretty extreme, but Lembke sees Jacob “half a year into his second attempt at recovery” and as soon as she “laid eyes on him,” she knew he was doing great. “It was the way his clothes fit him, the way they hugged his body. But it wasn’t just his clothes. His skin fit him, too.”

Okay, so, Jacob is liberated and doing great. But also, Jacob’s physically hotter, maybe? A moral, non-addicted person is physically more attractive? You might say, Aviv, you’re reading way too much into this. And sure, Lembke’s trying to wrap up his story in a bow and saying he looks great is what every doctor in every self-help book does, but stay with me for a second.

Inside of Lembke’s writing, there’s an unspoken idea that attractiveness and thinness are moral. And, as we’ve seen from some of the references she makes in her book, moralism is presented as spiritually good. Healthier, you might say.

This is further interesting because we come back to drugs—drugs used, in this case, to help treat addiction, but which themselves may be addictive if not used carefully.

“Beyond the problem of addiction is the question of whether or not these drugs help,” Lembke says she’s plagued “by a deeper question: What if taking psychotropic drugs is causing us to lose some essential aspect of our humanity?”

I don’t want to totally rag on Lembke’s idea here. I know people who have taken antidepressants and been totally numbed out to the good and the bad of their feelings. But this idea, that medication is somehow a thing that makes us “less human,” strikes me, again, as moralistic and also as potentially ableist.

Lest we think Lembke is totally unaware of this idea, she calls up a statistic about how poor children are more likely to be prescribed medication. Don’t they have a right to be angry, and shouldn’t they not be medicated out of it? Here, I’d say, yes! But does Lembke write a book about how to change the medicalization of non-White youth? No. She, instead, talks about things like “self-binding” and even writes, “Worse yet, have psychotropic medications become a means of social control, especially of the poor, unemployed, and disenfranchised?”

I understand that Lembke is trying to say something nuanced, but it feels like she’s trying to cram a lot into a little, and she’s trying to have her cake and eat it, too. “Please don’t misunderstand me,” she writes. The medications can be “lifesaving tools” but “there is a cost to medicating away every type of human suffering” and she says a better idea may be to “embrac[e] pain”.

The last part — “Embrace the pain”

If you, like me, are like, “Well, where the fuck does this all go?” Let me tell you. I promise, we’re almost there.

Lembke talks about radical honesty–not lying, being open with one another–which all sounds great in practice. Then, we get to the point in a sub-section called “Truthful Autobiographies Create Accountability.”

Patients who tell stories in which they are frequently the victim, seldom bearing responsibility for bad outcomes, are often unwell and remain unwell […]] By contrast, when my patients start telling stories that accurately portray their responsibility, I know they’re getting better. The victim narrative reflects a wider societal trend in which we’re all prone to seeing ourselves as the victims of circumstance and deserving of compensation or reward for our suffering.

I don’t completely disagree that if you’re trying to be accountable for a behavior, especially an actual medical addiction or behavior which causes others great harm, you need to be open about ways in which you might be responsible. But this idea that not being responsible is linked to wider societal trends around victimhood smacks of an idea that people are only victims if they choose to be. Given that this book was written post-#MeToo, in an era of seeking accountability in topics like police violence, genocide, racism, and other actual, systemic, often-state-funded and state-sanctioned practices of oppression feels, well. . . a little “pull yourself up by your bootstraps, this is America” and points to the lack of racial (and other) intersectionality that Lembke, a White woman, seems to have negated to even consider in this book.

This idea, of “owning” responsibility, gets us to what I consider to be the most concerning part of the book: chapter nine.

Lembke says that shame (or guilt, which she deems identical) is useful to a degree. She paints a picture between two kinds of shame: “destructive shame,” which is basically when others disapprove of us for a behavior and it makes us emotionally spiral and “prosocial shame,” or shame that tells us we’ve done something wrong socially, but we’re given “clear guidance for redemption/recovery.”

Groups like AA are examples of prosocial shame, Lembke says.

“Prosocial shame in AA leverages adherence to group norms. […] Importantly, when AA members do relapse, the relapse itself is a club good. Behavioral economists refer to the rewards of belonging to a group as club goods. The more robust the club goods, the more likely a group will be able to maintain its current members and attract new members.”

She refers to a behavior economist, Laurence Iannaccone, who writes that active participation by others and a group commitment to the “club goods,” or rules of being in a club, are threatened for every member that does not adhere to these rules.

‘The pleasure I derive from Sunday service depends not just on my own inputs by also on the inputs of others: how many others attend, how warmly they greet me, how well they sing, how enthusiastically they read and pray,’ is a quote from Iannaccone that Lembke cites.

This continues—with emphasis below mine:

“In particular, those behaviors that seem excessive, gratuitous, or even irrational in existing religious institutions, such as […] certain clothing […] abstaining from various foods or forms of modern technology, or refusing certain medical treatments, are rational when understood as a most to the individual to reduce free riding within an organization.”

Lembke then concludes that balance is important, and she provides a list of ten points that encourage balance, which features ideas like self-binding.

the unspoken element of Christian moralism (an actual term, don’t be mad) in this book

What’s wild is that this book capitalizes upon a title that’s based on bunk science, but that doesn’t really stop the author from a vast oversimplification, which she then uses to slyly tie moralism in general, and, more specifically, Christian moralism.

Christian moralism is the idea that obedience is often required to lead one to grace— for Christians, forgiveness and being saved through the redemption of Jesus Christ or God. This means that being a “moral” person is both more important than identifying as Christian, but also the idea that being obedient to moral behavior is necessary for being a good person (and a stepping stone to Saving Oneself).

I think I would mind this book somewhat less—though it is relatively fatphobic and sex-negative, so I’m not saying I’d like it—if it was honest with what it was trying to say. In fact, this radical honesty Lembke talks about feels like it should include the idea of being honest about one’s intentions around behavior. And it feels, to me, like in a small way, Lembke is trying to “save” readers from their sins of addiction, when most of what she’s talking about is not addiction at all.

Furthermore, as Lembke knows very well, addiction is a medical illness. It is not a moral failing. This has been known for decades, despite how addicts are often portrayed in media (which is also tied to racism). While Lembke claims over and over not to judge her patients, for the most part, and I appreciate that she is in some ways honest about when she does judge them, she seems to be committing a few different authorial sins, in my opinion:

• Blending pop science with her personal opinion but couching it in “science” (like dopamine fasting)

• A primary focus on personal responsibility around addictive/negative behaviors or behaviors deemed societally negative

• A rationalization of religion or religious practices which, historically, have led people to not seek medical treatment

• A narrative that, despite on the surface seeming not to, still encourages a sense of shame if habits like “self-binding” don’t work, instead of an analysis of societal, moral, and, yes, religious messaging which might lead to these addictive behaviors (or sense of shame that fuels secretive behaviors) in the first place

I’m shocked, honestly, that more hasn’t been written about this book. I searched in a million search engines, in Reddit threads, and found very little that was critical of this book.

I credit that to the author’s strong PR and marketing teams, the intense, wide range of interviews she’s done about the book, and probably the whole pop self-help genre, which truly celebrates some horrible individuals in the name of some good “advice” they gave.

I also think people are perhaps embarrassed to say, “Oh I read this book and it didn’t work for me,” because, to the very point of Lembke’s implied moral argument, to fail is to be addicted. If you can’t use your phone less, that’s a bit the engineering, but it’s also your lack of properly Self-Binding, being Radically Honest, and caring about the Club Goods of whatever social group you find yourself in, right? Right. (That’s sarcasm.)

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Have you read this book? Despite my criticism of it, I’d love to know if you found the book helpful. Also, how was this for you? I know it’s different than what I’ve written before, and I’d love to know what you think!

1. https://docs.house.gov/meetings/IF/IF02/20150423/103367/HHRG-114-IF02-Wstate-LembkeA-20150423.pdf

2. https://filtermag.org/court-opioid-addiction-disease/

3. https://www.nytimes.com/2019/11/07/style/dopamine-fasting.html

4. https://www.health.harvard.edu/blog/dopamine-fasting-misunderstanding-science-spawns-a-maladaptive-fad-2020022618917

5. https://www.researchgate.net/publication/369979102_Unpredictability_of_access_to_a_high_fathigh_sugar_food_can_increase_rats'_intake

6. https://pubmed.ncbi.nlm.nih.gov/35973455/

7. https://twin-cities.umn.edu/news-events/individuals-experiencing-food-insecurity-likely-binge-eat-when-food-available

8. https://pubmed.ncbi.nlm.nih.gov/30903861/