Dopamine Nation

participants (145 total) to play a game in which they rolled dice for money
using a computer interface. Before each roll, a computer screen indicated

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which outcomes would yield the monetary payoff, up to 90 Swiss francs
(about 100 US dollars).
Unlike gambling in a casino, participants could lie about the results of the
die roll to increase their winnings. The researchers were able to determine
the degree of cheating by comparing the mean percentage of reported
successful die rolls against the 50 percent benchmark implied by fully honest
reporting. Not surprisingly, participants lied frequently. Compared with the
50 percent honesty benchmark, participants reported that 68 percent of their
die rolls had the desired outcome.
Then the researchers used electricity to enhance neuronal excitability in the
participants’ prefrontal brain cortices, using a tool called transcranial direct
current stimulation (tDCS). The prefrontal cortex is the frontmost part of our
brain, just behind the forehead, and is involved in decision-making, emotion
regulation, and future planning, among many other complex processes. It’s
also a key area involved in storytelling.
The researchers found that lying went down by half when neural
excitability in the prefrontal cortex went up. In addition, the increase in
honesty “could not be explained by changes in material self-interest or moral
beliefs and was dissociated from participants’ impulsivity, willingness to
take risks, and mood.”
They concluded that honesty can be strengthened by stimulating the
prefrontal cortex, consistent with the idea that the “human brain has evolved
mechanisms dedicated to control complex social behaviors.”
This experiment led me to wonder if practicing honesty can stimulate
prefrontal cortical activation. I e-mailed Christian Ruff in Switzerland to ask
what he thought of this idea.
“If stimulating the prefrontal cortex causes people to be more honest, is it
also possible that being more honest stimulates the prefrontal cortex? Might
the practice of telling the truth strengthen activity and excitability in the parts
of the brain we use for future planning, emotion regulation, and delayed
gratification?” I asked.
He responded, “Your question makes sense. I have no definitive answer to
it, but I share your intuition that a dedicated neural process (like the

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prefrontal process involved in honesty) should be strengthened by repeated
use. This is what happens during most types of learning, according to Donald
Hebb’s old mantra, ‘what fires together wires together.’ ”
I liked his answer because it implied that practicing radical honesty might
strengthen dedicated neural circuits the same way that learning a second
language, playing the piano, or mastering sudoku strengthens other circuits.
Consistent with the lived experience of people in recovery, truth-telling
may change the brain, allowing us to be more aware of our pleasure-pain
balance and the mental processes driving compulsive overconsumption, and
thereby change our behavior.
—
My own dawning awareness of my problem with romance novels occurred in
2011 when I was teaching a group of San Mateo psychiatry residents how to
talk to patients about addictive behaviors. The irony is not lost on me.
I was in a first-floor classroom of San Mateo Medical Center, giving a talk
to nine psychiatry residents about how to have the often difficult
conversations with patients about drug and alcohol use. I stopped partway
through the lecture to invite the students to engage in a learning exercise:
“Pair off with a partner to discuss a habit you want to change, and discuss
some steps you might take to make that change.”
Common examples of what students talk about in this exercise include “I
want to exercise more” or “I want to eat less sugar.” In other words, safer
topics. Serious addictions, if they have them, don’t usually get mentioned.
Nonetheless, by talking about any behavior they’re not happy with and want
to change, students gain insight into what it might be like for patients to have
these conversations with them as health care providers. There’s also always
the chance they’ll discover something about themselves in the process.
I realized that with an odd number of students, I would have to partner with
one student. I paired up with a soft-spoken, thoughtful young man who had
been listening attentively throughout the lecture. I took the role of the patient
so he could practice his skills. Then we would switch.

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He asked me about a behavior I wanted to change. His gentle manner
invited disclosure. To my surprise, I began to tell him an anodyne version of
my late-night novel reading. I did not specify what I was reading or the extent
of the problem.
I said, “I stay up too late at night reading, and it’s interfering with my sleep.
I’d like to change that.”
As soon as I said it, I knew it was true, both that I was staying up too late
reading and that I wanted to change the behavior. Until that moment, though, I
wasn’t really aware of either of those things.
“Why do you want to make that change?” he asked, using a standard
question from motivational interviewing, a counseling approach developed
by clinical psychologists William R. Miller and Stephen Rollnick to explore
internal motivations and resolve ambivalence.
“It’s interfering with my ability to be as effective as I’d like to be at work
and with my kids,” I said.
He nodded. “Those sound like good reasons.”
He was right. Those were good reasons. In saying them aloud, I realized
for the first time how much my behavior was negatively impacting my life
and the people I care about.
He then asked, “What would you be giving up if you stopped that
behavior?”
“I’d be giving up the pleasure I get from reading. I love the escape,” I
answered right away. “But that feeling is not as important to me as my family
and my work.”
Again, by saying it out loud, I realized it was true: I value my family and
my work above my own pleasure, and in order to live according to my
values, I needed to stop the compulsive, escapist reading.
“What is one step you can take to change that behavior?”
“I can get rid of my electronic reader. Easy access to cheap reads fuels my
late-night reading.”
“Sounds like a good idea,” he said, and smiled. We were done with me
being the patient.

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The next day, I kept thinking about our conversation. I decided to take a
break from romance novels for the next month. The first thing I did was get
rid of my e-reader. For the first two weeks, I experienced low-threshold
withdrawal, including anxiety and insomnia, especially at night just before
going to bed, a time when I would usually read stories. I had lost the art of
falling asleep on my own.
At the end of the month, I was feeling better and gave myself permission to
read romance again, planning to read in more moderation.
Instead, I binged on erotica, staying up late two nights in a row and feeling
exhausted as a result. But now I saw my behavior for what it was—a
compulsive, self-destructive pattern—which took the fun out of it. I felt a
growing resolve to stop the behavior for good. My waking dream was
coming to an end.