We live at a time when everything is available at every moment. Just on your phone, you can order lunch, bet on sports, read this story, watch porn, chat with a friend, chat with a stranger, chat with a large language model or buy a car. Dr. Anna Lembke says that all that convenience and abundance is making us less happy, and there is plenty of research to back her up: In the developed world, we are lonelier, more anxious and more depressed than ever.

Lembke is a psychiatrist who works at Stanford University’s Addiction Medicine Dual Diagnosis Clinic, where she sees patients dealing with all sorts of addictions, from opioids and alcohol to what she calls “digital drugs” that, she says, put us in a “trancelike state where we lose track of time.” In her best-selling book, “Dopamine Nation,” about the science behind addiction, Lembke argues that our brains are wired to constantly seek stimulation, and that modern life, with its never-ending stream of content and stuff, makes it nearly impossible to fight that urge.

At the same time, scientific breakthroughs in medical interventions and new cultural habits, like the decrease in alcohol consumption, hold some promise. My own experience reflects those recent changes. Addiction runs in my family. In 2020, my sister, who struggled with alcoholism for years, died of liver failure — something I shared with Lembke before our interview began. Her “death of despair” made me change my own behavior. After a lifetime of obesity, I started taking Ozempic, which curtailed my obsessive relationship with food. And two years ago, I stopped drinking alcohol. But while I feel physically great, losing weight and getting sober hasn’t stopped some other destructive behaviors, like online shopping, from creeping in. This is a dynamic Lembke is familiar with — both in her work and in her personal life. How to find balance in a world feeding us temptation, she says, is a struggle for us all.

You published “Dopamine Nation” in 2021 with the thesis that the overabundance of modern culture has us constantly stimulated by dopamine. And that has only accelerated since, I think. Generally speaking, have you seen things in your practice that weren’t there before?

So, to put it in perspective from my clinical front-row seat: In the early 2000s, we were seeing a sudden increase in people addicted to the very same pills their doctors were prescribing to them for chronic and minor pain conditions, leading to our current-day opioid epidemic. But also, middle-aged men were coming in with severe internet-pornography addiction and compulsive masturbation. Primarily men who had been able to consume pornography in reasonable moderation without a lot of harm to their lives until the advent of the internet — and then especially, in the first decade of the 2000s, the smartphone. And that was probably our earliest signal for behavioral addictions. And then around 2012, 2013, we were seeing a bunch of teenage boys brought in by their parents primarily for internet-gaming disorders. Then roughly 2015, 2016, we started to see the earliest signal of social-media addiction, online shopping, a huge increase in online gambling addiction. And then what I would say I’ve seen primarily in the past five years is a sort of diffuse addiction to the internet. People will have their drug of choice, whether it’s shopping or social media or video games or pornography. But if that’s not available, they’ll switch to something else.

That timeline is — and I’m going to use the word — very sobering. Yeah.

How do you define addiction? Addiction is the continued compulsive use of a substance or a behavior despite harm to self and/or others. Importantly, there is no brain scan or blood test to diagnose addiction, and there won’t be for a very long time, if ever. We still base our diagnosis on what we call phenomenology, which is patterns of behavior that repeat themselves across individuals, temperaments, cultures, time periods, etc.