When Virtues Become Vices

When addictive behaviors override our desires, it may be a sign to investigate the gap between what we crave and what’s really good for us.

Silhouette of man working on laptop
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When the behaviors we thought would make us happy don’t, we’re forced to bridge the gap between where we are and where we want to be. But our happiness goals are often stifled by the disease of addiction—and its complex neurochemical influence on our desires.

A conversation with psychiatrist Anna Lembke helps us understand the gap between the cravings that drive us and the happiness we seek.

This episode was produced by Rebecca Rashid and is hosted by Arthur Brooks. Editing by A.C. Valdez and Claudine Ebeid. Fact-check by Ena Alvarado. Engineering by Matthew Simonson.

Be a part of How to Build a Happy Life. Write to us at howtopodcast@theatlantic.com. To support this podcast, and get unlimited access to all of The Atlantic’s journalism, become a subscriber.

Music by the Flix (“Saturdays”), Mindme (“Anxiety”), Dylan Stills (“Queens”), and Yomoti (“Nebula”).

This transcript has been lightly edited for length and clarity.

Rebecca Rashid: I’m curious about how these things that we’re taught are good habits: How do those things become as harmful as a debilitating addiction or threaten to become that harmful? I’m curious for someone like you—how has workaholism played out in your life?

Arthur Brooks: I’m not immune from anything. And I guess the irony is that I specialize in the science of happiness, and I fall prey to a lot of these things myself.

There’s a lot of vice that we can engage in. Almost everything that we do that’s really good when we push it to the limit, when we pat ourselves on the back, when it becomes a source of pride, when it crowds out love relationships. Virtues can become vices.

Brooks: Today, we want to understand how our expectations of a happy life are complicated by the disease of addiction.

The complexities of addiction and addiction treatment can't be covered in one episode, but we do want to identify our tendencies towards addictive behaviors and how it affects our well-being.

The realities for those impacted by addiction are wide-ranging, but defining addictions’ effects on our identities, behaviors, and desires, may help us parse out the divide between where we are and where we want to be.

Brooks: Anna Lembke sat down with us to talk about her work treating patients with addiction. Dr. Lembke specializes in dopamine—a chemical in the brain that lies behind desire and plays an important role in our addictive behaviors.

In 2021, Dr. Lembke published the book Dopamine Nation: Finding Balance in the Age of Indulgence. She argues that many of our addictions today are not from things we would consider immediately addictive—like drugs and alcohol—but from behaviors that are even thought of as healthy or beneficial: things like exercise and work. Things we thought were virtues. But what you crave and what you want are usually not the same things.

Lembke: I realized that I was actually a bad psychiatrist early on in my career because I was not asking patients about drug and alcohol use. And the reason I wasn’t asking them is because I would have had no idea how to address those problems if they had happened to say, “Yes, I have a problem with that.”

So it was a kind of a “don’t ask, don’t tell” policy, which, by the way, was completely normative for psychiatrists at the time and is still quite a prevalent practice. Why? Because we don’t learn a lot in medical school or even psych residency about how to screen or intervene for substance-use disorders or other addictions.

Brooks: Our audience should understand that you’re not confessing to having some unusual deficit in your training. Psychiatrists are usually trained to treat people with mood disorders and behavioral problems.

Obviously when people think about addiction, they’re thinking about heroin or alcohol or gambling or pornography. But there are a lot of things that we do, notwithstanding the fact that they’re not entirely good for us.

Let me ask you the most basic question of all. What’s an addiction?

Lembke: So addiction is broadly defined as the continued compulsive use of a substance or a behavior, despite harm to self and/or others. The key piece is really the behaviors and whether or not they cross this threshold of impairing function.

And that is really the key piece for diagnosing any psychiatric disorder. We diagnose it based on what we call phenomenology, or patterns of behavior over time that are very similar across different demographic groups [and] points in history.

And what we see is that despite those differences in individuals, there are very classic patterns or manifestations of maladaptive patterns that ultimately we group in these different buckets: schizophrenia, major depression, OCD, addiction. I always like to emphasize that there’s no brain scan or blood test to date to diagnose any mental illness, including addiction.

Brooks: Tell me about the patients who come see Dr. Anna Lembke. What are they suffering from?

Lembke: So the types of patients that I have are patients struggling with all different forms of addiction. Not just addiction to drugs and alcohol, but also to all kinds of behaviors: pornography, gambling, shopping, digital products. So online pornography, compulsive masturbation is a huge and growing problem. Gaming disorder is something that we’re seeing more and more of, especially among young men. And they often also have co-occurring conditions like depression, anxiety, psychotic disorders.

Even previously healthy and adaptive behaviors—behaviors that I think we broadly as culture would think of as healthy, advantageous behaviors—now have become drugified such that they are made more potent, more accessible, more novel, more ubiquitous. And therefore, they have the potential for addiction where they didn’t have that before. And I use myself as an example in reading.

I think we all grew up with this idea that reading is healthy. And yet, in my early 40s, I actually got addicted to romance novels. And The Twilight Saga was my gateway drug, which is in and of itself embarrassing because it’s a vampire romance series written for teenagers. And obviously, I was a middle-aged woman.

This is very embarrassing, but it was impacting my ability to function. I was staying up later and later at night. I was not fully present for my kids and my husband the way I really wanted to be. And that was really the crazy thing about it—the things I really care about kind of started to be compromised in a way that I wasn’t fully in control of.

Essentially what was happening was that it was a fantasy escape world. And the more I read, the more I wanted to be in that world and the less I wanted to be in the real world. Also, the less interesting the real world became to me. So the salience and the positive and reinforcing qualities of the real world slowly began to diminish.

Brooks: Tell me a more typical story of perhaps one of your patients that comes in. And my guess is they’re not coming in when the elevator is now in the first basement. They’ve gone down 32 floors at this point. And when they’re coming to see you, it’s pretty bad.

Lembke: So for example, a middle-aged man who has used pornography through most of his young adult life. And then in the early ’90s, there’s the internet—and then all of a sudden it’s more available, it’s more graphic. And then the early 2000s comes around, and he gets his smartphone. And now we’re talking 24/7 access to highly potent images, and things start to fall apart.

Now this person is experiencing tolerance, finding that online pornography alone is not sufficient. Starting to, for example, engage prostitutes, lie to his partner—spending more and more time and resources chasing down this particular feeling, threatening his employment by using at work [and] knowing that he’s doing that. And yet feeling such an enormous compulsion that he can’t help himself, feeling horrible about himself. Enormous stigma. Unable to stop, although he tries repeatedly to do that.

And eventually comes to see me essentially feeling suicidal, feeling like, I don’t want to live anymore; I can’t stop this behavior. I have so much shame. I’m so depressed. I don’t even enjoy it. And yet I cannot stop. Will you help me?

And it’s the exact same narrative that we see with people who are severely addicted to drugs, severely addicted to alcohol, which is a drug. People start out using it for fun or to solve a problem. The drug works for them initially, so they return to using it over time. They escalate their use; they build up tolerance. They need more and more. Eventually it stops working, but they can’t stop. And then it even potentially turns on them and causes the very problem that they’re trying to solve, but they still can’t stop.

Brooks: There are a whole bunch of areas of behavior that we’ve been told since we were little kids that are really wonderful, you know—and that if you work hard, that’s always and everywhere, great. Do you see workaholics in your clinic?

Lembke: So typically we will not see patients who come in for workaholism as a chief complaint, because they won’t identify that as their problem. But what we do see is people who come in with serious drug and alcohol problems or pornography addiction, and they also are addicted to work.

And the way that comes out is this kind of “work hard, play hard” mentality where people push themselves so hard at work and exhaust themselves beyond the limits of what their minds and bodies can do, and then reward themselves at the end of a very hard work day or a very hard work week or a hard work month with the kind of a binge or overuse pattern.

One of the most fascinating and enduring themes in the disease of addiction is the role of control—and wanting to have this illusion of control over our lives. Drugs become a way to do that. And even when we get to a point where we know the drug isn’t working, we’re so terrified to let go.

And so this becomes really key to addiction recovery; really it’s an enormous leap of faith. It’s asking people to give up this thing that they have used their entire lives to self-soothe, to get that feeling that they need in order to feel kind of whole. And even when it stops working, just the fear associated with having to let that go. And then not knowing: Well, what will that be like? What will that existence be like for me? I mean, the terror of the unknown is so strong.

Brooks: So what do they do? No. What do we do? Look, I missed a lot of my kids’ childhood because I was on the wheel. I was on this treadmill. I was doing it too.

Lembke: Thank you for your openness and for sharing some of that regret. That’s really powerful—that someone like you is willing to be open in that way.

It’s amazing to me that we have an opportunity to change our lives at any point in our lives. I have seen people with severe, lifelong addictions in their 60s, 70s, and 80s get into recovery and absolutely transform their lives for the better—transform their family and friends’ lives for the better.

So I just want to say that because I think it’s never too late. And we all make mistakes. We all make mistakes, and we all have regrets. But you can change your life at any point in your life. And you can decide to live in a different way and to let go of that thing that you’ve been hanging on to, which you thought was your life raft—but which was really, you know, your anchor.

Brooks: Would you say there are probably a lot more people who are suffering from addiction than those who are diagnosed, or those who even know that that’s the case?

Lembke: I would say that that’s true in the modern age; there’s so much more access to highly potent and reinforcing drugs and behaviors. But also just in general, it’s underdiagnosed because there’s no infrastructure inside of medicine, or there’s a limited infrastructure inside of medicine to treat addiction. We have pretty good treatments that we’ve known about for decades. So it’s not that we don’t know what works. It’s that we’ve not built the infrastructure inside of medicine to deliver that care.

Brooks: We could get into a whole show in and of itself about what recovery looks like, but that’s traditionally about more conventional addictions. But it sounds to me like—given the fact that the primary damage that workaholism and success addiction do is to our relationships—and these are very fear-based addictions itself.

Lembke: Many people have the experience of trying harder at relationships and not having it work out. And so the drug is so much more reliable. Right. And what am I going to give up? This at least gives me some transitory relief or escape for what feels like a big gamble, and kind of not even having the basic tools for knowing how to go about renewing and strengthening those relationships with people in our lives.

This is what we get when we are willing to give up our drug. What we get is these wonderful, quite intangible things that you can’t buy and you can work for—but not in the same way. And chief among them is certainly meaningful and intimate relationships with other people.

How do we make more intimate relationships? We tell the truth to the people that we care about, and we stop lying to them. And that becomes a huge part of recovery. So when people stop using their drug, they’re so terrified to be honest toward their loved one about what they’ve been doing. Especially, let’s say, they told their loved one that they stopped and they really didn’t.

It would be nice to be able to skirt around that and not have to tell the truth. But if you don’t go back and tell the truth and apologize and make amends, then you’re not going to be able to ultimately get to that place where you have those relationships that are so incredibly sustaining and renewing and powerful—and make the need for these drugs so much less.

Rashid: Now that you’ve spent the bulk of your professional career studying how some of your early behaviors and your passion for what you did may have been a certain type of workaholism, what do you think you would have done differently if you knew what you know now?

Brooks: It’s a good question. In the first year of my marriage, I remember being on vacation. We were camping, and I just couldn’t handle it and I had to go home. Because I needed to get back to work.

And the result is, I published a lot of articles and taught a lot of classes. My career went really well, and my family life continued to suffer, quite frankly.

Here’s the key thing to ask yourself. Whether it’s workaholism, or maybe you’re just wondering if you’re drinking a little bit too much, is to interrogate that. A life that’s unexamined is one in which you’re helpless against these ravages that come from addictive behavior.

Here’s the most encouraging thing of all—when people understand what they’re doing and are honest with themselves, they’re willing to own up to the fact that they’re being managed by their desires. That process is the beginning of getting freedom.