As a gynecologist board certified in all the biological issues women face over their lifetime, I’ve thought a lot about what we women are up against when it comes to work and life—nearly always in battle with the competing priorities of friendships, dating, family, raising children, being a partner to spouses, supporting aging parents, making money, and, last on the list, finding time for self-care. It’s no wonder that we are commonly in a state of hyperarousal, and that a little something to take the edge off, like a glass of wine or a cupcake or a dose of cannabis or even online shopping, seems like the best option.

We’re expected to be perfect at work and perfect at home, and few of us are wise enough to see the conundrum or refuse to buy into it. We go about our way with limited guidance, biding our time until retirement, armed with few good or realistic models for how to integrate it all into a sacred, cohesive whole.

Not only do we lack a model of wholeness, but most of us end up on the path of developing cravings and addictions: shopping, social media, alcohol, posh vacations, caffeine, affirmation from excessive work, exercise, or opioids. The overwhelm of daily life and cycles of exhaustion—physical, emotional, spiritual—make it nearly impossible to find the homeostasis we need.

The overwhelm of daily life and cycles of exhaustion—physical, emotional, spiritual—make it nearly impossible to find the homeostasis we need.

But the ups and downs of a busy life and the struggle to find balance don’t need to be a life sentence—the cravings, addictions, and manic states aren’t simply “a fact of life.” We have the science and the tools to reclaim the lost balance in our lives, and there’s even a specific personalized lifestyle medicine protocol to help eliminate these behaviors that rob you of equilibrium. You can get your life back.

The Pleasure Trap

Living in an insane and demanding world creates “the pleasure trap,” also known in scientific terms as reward deficiency syndrome. We crave the chemical reward of pleasure, that dopamine hit. Call reward what you will: freedom, escape, comfort, peace, release, bliss, relief from pain. For most of us, the pleasure trap begins when we seek relief in a harmful way when we are young and no wise adult is around to offer an alternative. Then we get older, and the stressors and toxins of modern life turn us into the unaware and unsuspecting saboteurs of our own health. We get stuck in a self-destructive rut, but go along with it because denial seems easier than change.

We all need better options to restore homeostasis, which knits together brain and body into a nourishing whole. If you crave homeostasis but feel stuck in destructive patterns, it’s not because you are lazy or undisciplined or inherited bad genes, but rather because we are anciently wired for the primitive drives that today create self-sabotage. The key to escape the pleasure trap is to reclaim your power by outsmarting your inner saboteur and base drives.

The key to escape the pleasure trap is to reclaim your power by outsmarting your inner saboteur and base drives.

Most women are not aware of being stuck in the pleasure trap. They believe addiction affects other unfortunate people, but not them. They think addiction is a lack of willpower, or, like I was taught in medical school, “purely” a mental health problem. They have no idea that people just like you and me pass through a specific physiological condition prior to addiction called hyperarousal, which is a state of heightened physical and emotional tension marked by anxiety, stress, exaggerated startle response, insomnia, fatigue, and accentuated personality traits (hint: not the good ones!).

Not only are many people convinced that addiction is all in the mind, they aren’t aware of the latest discovery that addiction is a brain and gut problem. Once again, gut/brain imbalance—specifically, gut dysbiosis—is linked with addictive behavior in addition to other brain/body disconnections. When you finally understand exactly the brain/body states that lead to addiction, you can switch gears and heal the drivers of addictive behavior before it’s too late.

Furthermore, I find that my patients don’t realize that their brain dopamine activity may be abnormal—either too low or too high, but certainly in a state of altered balance—putting them at risk for addictive behavior as their brain bodies seek homeostasis from external sources. Think of dopamine as the that-feels-good, do-it-again-please neurotransmitter. It’s the star of the pleasure-reward system in your brain and the brain chemical involved in motivation, sex, satisfaction, and habit formation.

Dopamine is central to your reactions to behaviors that naturally produce dopamine (such as exercise and meditation) and substances that stimulate dopamine production but may cause harm (alcohol, caffeine, cigarettes, opioids, etc.). When you are in hyperarousal, there’s an internal pattern of your brain body driving you to seek outside substances to satisfy the feel-good brain receptors that aren’t, well, feeling good.

On a more somber note, when you have a genetic tendency toward altered dopamine activity in the brain, it can lead to impulse control problems, low motivation, addiction, and—when dopamine-based neurons degenerate—Parkinson’s disease. On the other hand, inheriting a gene isn’t required to have a problem with addictive behavior, and moreover, according to the relatively new study of epigenetics, you’re not stuck with the genes you have.

That’s what I have: I carry a gene that makes me chronically low in dopamine. It makes me vulnerable to addiction. On the more positive side, it’s called the “Explorer Gene,” meaning that I’m exploratory and eager to try the next shiny object. But I have to temper that exploration with common sense that I don’t binge on food, fine wine, Seal Team, or Tamara Mellons. And I have to make sure that I cover my bases—biological bases, like calming myself down when I get overactivated by a jerk at work, or pushy television producer, or one of my teenagers. I have to start each morning with a 10-minute “get present” breathing exercise so I am fit for human company. And drinking green tea is part of that morning ritual, which happens to raise dopamine in my dopamine-starved brain.

My primary addiction was food, followed closely by a love of the drink, as my Irish relatives like to call it. I had what is now considered spread addiction—my addictive patterns were spread among many outlets, from chocolate chip cookie dough to overexercising to overworking to over-Amazoning.

One way I recognized my food addiction is that I experienced a powerful sort of craving when I ate just one bite of certain foods (items containing flour, sugar—even paleo cheesecake), and the result was that I ate more than I intended. My old relationship to food was similar to that of someone who is addicted to alcohol. When I wasn’t bingeing, I thought about food all the time. After I binged, I was full of remorse and helplessness. This cycle repeated itself thousands of times: binge, remorse, preoccupation, despair. Sadly, the despair arose from shame and guilt, so I’d start the cycle all over again, each time convinced that I simply needed to try harder or learn a new strategy to navigate food in a different way. That would help me manage it better next time and, of course, with different results.

Reclaiming your power

In my new book, Brain Body Diet, I focus on how problems with the brain body lead to the pleasure trap, hyperarousal, gut microbes that are out of balance (dysbiosis), and issues with dopamine. For the scientifically inclined, I review how altered dopamine balance interacts with the brain’s pleasure centers to create impulsive, obsessive, compulsive, and addictive behaviors.

Here are a few proven biological strategies:

• Take your supplements, including vitamin D, magnesium, omega-3s, zinc, multivitamin (featuring methylated B vitamins), minerals. People with addictive behavior tend to be depleted in the nutrients.
• If I had to pick one important supplement to add for those of us with addictive tendencies, it would be N-acetyl cysteine (NAC). NAC reverse oxidative stress in the body, which is like the rust on a car left in the rain with no protection. NAC reduces cravings, desire to use, and relapse. It works by lowering excitability in the brain, presumably by improving glutamate balance. The details are in my book.
• My favorite adaptogen for people with the pleasure trap is ashwagandha.

Is that a long list? Yes. Do those of us with addictive tendencies need to fill in more micronutrient gaps compared to “normal” (i.e., without addiction)? Yes. Do they help with hyperarousal? Yes, yes, oh yes.

Our goal is to mitigate the biochemical discomfort that leads to problematic behaviors. This is a missing part of the addiction and recovery model. A holistic model includes all of it—nutritional, biological, physical, emotional, and spiritual health. Psychiatrist Carl Jung believed that addiction represents a spiritual hunger for wholeness. I would add that biology set us up for that spiritual hunger and can keep us trapped.

So why not address the biological along with the spiritual? Why not integrate it all, instead of focusing myopically on just one piece of the puzzle?  I believe in addressing the root cause of the pleasure trap by getting your brain body back in balance, so that you can finally end the cycle of suffering, repair the damage and replenish the brain body, feel whole again, and ultimately live the life meant for you, full of purpose and meaning.