I know a lot of people — in my personal life as well as in my practice — who talk about being “addicted” to their phones. Is phone addiction an actual thing? Does it fall into the same category as addiction to nicotine, alcohol, or heroin? The answer, in a word, is yes.
I have come to think of all addictions as dopamine addictions. In “Dopamine Nation: Finding Balance in the Age of Indulgence,” Stanford psychiatrist Anna Lembke explains that all pleasurable behaviors — from doing a puzzle or spending time with a good friend to eating an entire bag of potato chips or spending hours at the gambling table — release dopamine in the brain. And dopamine feels good.
“What’s tricky is that when there’s been a high level of dopamine release, the end of that release triggers feelings of withdrawal,” she writes. Dopamine withdrawal leaves people with low energy and motivation, feelings of depression and anxiety, and most significantly, craving for increasingly extreme hits of dopamine. Unfortunately, extreme dopamine release desensitizes the brain to dopamine’s pleasures, meaning that people need more and more of it to induce the same level of gratification, and before they know it, they’re on the “dopamine seesaw”: extreme hit, extreme withdrawal, extreme hit, extreme withdrawal.
There is an idea circulating in psychiatry that much of what drives psychiatric illness is a result of “dysfunctional reward processing.” Bipolar disorder, for instance, is basically a seesaw between periods of high and low brain excitation, otherwise known as mania and depression. The excitable state we call mania is often characterized by racing thoughts, grandiosity, intense creativity, euphoria and/or irritability, and impulsivity (buying everything on your social media feed, for example). When manic, people are overusing the dopamine reward system, losing their ability to put their foot on the brakes. Periods of mania are generally followed by extreme withdrawal, characterized by low energy, excessive sleep, depression, and often feelings of worthlessness, hopelessness, and helplessness. Cycles between highs and lows often become shorter and shorter with time, because the nervous system of the person experiencing them is desperate to get back the relief induced by overuse of the reward system.
People who suffer from extreme anxiety are on a similar seesaw, experiencing an addicting cycle of worry, distress, and fear, followed by a rewarding sense of relief when situations that trigger anxiety are resolved. In other words, anxiety can become addictive. People who procrastinate (getting more and more anxious as deadlines approach) get huge relief when they complete the things that they’ve been avoiding — so why would they want to do things early if the post-anguish pleasure feels so good?
While medication is often essential to recovery from bipolar disorder and extreme anxiety, I’ve found that people need less of it when they find their way to a gentler up-and-down on the dopamine seesaw. Lembke suggests starting by fasting from the addictive rush for a month, during which a person’s system can reset and learn to function with gentle, ordinary dopamine release.
In the setting of the blizzard of 2026, a friend of mine lost all power for most of the week. His life was consumed with finding and storing food and water, cooking outside with propane, and finding fuel for the fireplace to keep his family and houseguests warm. All of the things that had made him anxious for months disappeared. There was no time for anxiety when his focus was grounded in the here and now.
Another strategy for coping with extreme dopamine cravings is based on a biological principle called hormesis, which asserts that a stressor or toxin that causes harm at high doses can actually cause a beneficial adaptive response at lower doses. (Think: “What doesn’t kill you makes you stronger.”) Hence, when you engage in limited amounts of mildly uncomfortable activities, such as cold plunges, cardiovascular exercise, or anxiety-provoking situations such as public speaking, you briefly stress your system; when the stress ends, you experience a healthy dopamine release, which encourages further engagement in healthy behaviors.
Never before in human history have we had such easy access to extreme reward, be it through our phones, pornography, junk food, drugs, or shopping. With such readily available opportunities for comfort, it should come as no surprise that so many young people have such high rates of anxiety and depression.
A recent column by the journalist David Brooks made me see the dopamine seesaw through a different lens. In his essay “We’re Living Through the Great Detachment,” Brooks suggests that with decreasing attendance at places of worship and community groups, fewer marriages, and fewer romantic relationships — particularly among youth — there is a loss of love. He goes on to say, “Love is the most powerful energy source known to humans.” Love is so powerful and motivating, Brooks writes, that it makes you “want to care for and serve the thing you love. Your love is propelling you this way or that. You want communion with the thing you love.” In other words, love creates a powerful and stable reward system in the brain. Dramatic highs and lows are seductive stuff, but gentle and enduring love — for people, for work, for hobbies, for a higher power — is a happier and ultimately more sustaining approach.
I am reminded of a limerick that my friend, neurologist and psychiatrist Barry Fogel, wrote about dopamine and oxytocin (a neurotransmitter that modulates attachment, empathy, and the feeling of safety in relationships):
A captain remarked to his bosun,
He’d had ladies all over the ocean.
Now for babies and wife,
He’d reordered his life.
Then dopamine, now oxytocin.
Intense dopamine hits sure do feel good. But perhaps the enduring love and human connection that people experience in healthy relationships, family, the 12-step fellowship, and a supportive community feel even better.