If you have ever asked yourself “why I simply can’t stop” gambling, shopping, scrolling the feed, or repeating the same pattern, the answer is not in your willpower. It is in your brain.
Have you ever tried to stop using your phone, control online shopping, or decrease the time on sites and apps that give you a quick rush of pleasure, and felt it was much harder than it should be? It is not a lack of willpower. It is the predictable functioning of a brain system that, today, is under a type of pressure it was never designed for.
This is the central thesis of psychiatrist Anna Lembke, a professor of Psychiatry at Stanford University and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. In her book Dopamine Nation, a New York Times bestseller, she explains why we live surrounded by high-reward stimuli (gambling, social media, online shopping, pornography, ultra-processed food) and why this abundance, paradoxically, is making us more anxious, more dissatisfied, and more prone to compulsive behaviors.
In this article, I bring the fundamentals of her work and three practical strategies she proposes, adapted to common situations in the office: the urge to gamble, the sexual urge, the urge to shop, and an important focus that many people do not associate with this topic: adults with undiagnosed ADHD, who usually have an even more delicate relationship with the reward system.
The seesaw of pleasure and pain
Lembke uses a simple metaphor to explain the neuroscience behind this: imagine a seesaw inside the brain, with pleasure on one side and pain on the other. Our brain is programmed to keep this seesaw balanced, which is what we call homeostasis.
When we do something pleasurable (gambling, shopping, eating something very good, engaging sexually, scrolling the phone feed), the seesaw tips to the pleasure side. The problem is that the brain reacts immediately by trying to rebalance itself, and it does so by pushing the seesaw to the opposite side, slightly beyond the neutral point. This is why, after the peak of pleasure, we feel a slight sense of emptiness, irritation, or a desire to repeat the dose.
When this cycle repeats several times a day, with increasingly potent and easily accessible stimuli (a casino in your pocket, one-click shopping, dating apps available 24 hours), the pain side of the seesaw accumulates weight. We need larger and larger doses of the stimulus just to feel “normal,” no longer euphoric. This is, in essence, the biological mechanism behind tolerance and compulsion.
The three practical strategies
From this foundation, Lembke proposes some concrete tools to rebalance this seesaw. The three most cited, and most applicable to daily life, are known as self-binding strategies, combined with what she calls a dopamine fast.
1. Physical self-binding: remove easy access
The idea is simple: if the decision to resist an urge has to be made every time the stimulus is in front of you, you will eventually lose some of those battles. That is how the brain works under repeated temptation. Physical self-binding removes the object of desire from your reach, so the decision is made only once, with a calm mind, and not repeatedly, in the heat of the urge.
- Gambling: use voluntary self-exclusion tools on betting platforms and apps, remove saved card details, uninstall apps.
- Shopping: remove saved cards on e-commerce sites, unsubscribe from promotional email lists, let the cart “cool down” for 24h before completing the purchase.
- Sexual urge: use content blockers, screen time limits, reorganize the digital environment.
2. Chronological self-binding: create time windows
Here the logic is to limit when the behavior can happen, not eliminate it entirely. This is usually more sustainable than attempting total abstinence, because it reduces the feeling of deprivation while still breaking the automatic pattern of repetition.
- Define specific and restricted times to check betting apps or shop online, instead of unrestricted access.
- Scheduled periods of “fasting” from a certain stimulus (days without betting, without non-essential shopping, without using dating apps). Lembke usually suggests an initial period of about 30 days as a way for the brain to rediscover its pleasure baseline before reintroducing the stimulus more consciously.
3. Categorical self-binding: completely eliminate a category
For more severe behaviors or those that already cause significant harm (financial, relational, professional), Lembke recommends cutting the entire category, not just moderating it. This is especially true for pathological gambling and advanced compulsive shopping, situations where “a little” tends to reignite the whole cycle.
In these cases, support from a mental health professional is important to design this cut safely and sustainably, without the person simply displacing the compulsion onto another stimulus.
Why gambling, shopping, and sexual urges often appear together
It is no coincidence that these three behaviors appear side by side in scientific literature. Pathological gambling, compulsive shopping, and hypersexuality share a common neurobiological circuit: the mesocorticolimbic dopaminergic system, with a central role played by the nucleus accumbens, the same region involved in substance dependencies. Research even shows significant overlap between these conditions: people with compulsive buying disorder have higher rates of gambling disorder than the general population, and vice versa.
The point many people miss: ADHD in adults
Here comes a detail that I consider essential and that is rarely discussed along with this topic: adults with ADHD, especially those who were never diagnosed, have a particularly vulnerable relationship with this reward system.
ADHD is associated with differences in the functioning of the dopaminergic reward circuit: the search for intense and immediate stimuli tends to partially compensate for a difficulty in sustaining motivation in tasks with slower or deferred rewards. A recent study conducted in the UK, comparing adults with and without ADHD, found a higher propensity for addictive behaviors (including problems related to gambling, internet use, and compulsive shopping) in the group with ADHD, even among those already on medical treatment.
This helps explain a common pattern in the office: adults who have spent their entire lives being described as “impulsive,” “lacking willpower,” or “addicted to everything,” without ever being evaluated for ADHD. Often, what seemed like a lack of discipline was, in fact, a brain actively seeking the dose of dopamine that its own internal regulation has a harder time sustaining on its own.
For this population, Lembke’s strategies remain valid, but they usually work better when combined with:
- Proper diagnostic evaluation: many adults only discover ADHD when specifically investigating a repeated pattern of compulsions that does not yield to willpower.
- More explicit external structure: physical and chronological self-binding tends to help more than relying solely on internal discipline.
- Treating both fronts simultaneously: treating ADHD in isolation without addressing the established compulsive behavior, or vice versa, tends to have partial results.
An important reminder
Lembke’s work does not treat these behaviors as character flaws, but as the predictable response of a human brain exposed to an environment of stimuli much more potent and accessible than any previous generation faced. This does not remove the responsibility for one’s choices, but it removes the excessive shame that often paralyzes people before they even try to change.
If you recognized yourself in any of these patterns (whether regarding gambling, shopping, compulsive sexual behavior, or saw yourself in the section about uninvestigated ADHD), it is worth talking to a professional. Rebalancing this system is possible, and it doesn’t have to be done alone.
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Frequently Asked Questions
Does ADHD increase the risk of gambling, shopping, or internet addiction?
Yes. Studies with adults show a higher propensity for addictive behaviors, especially compulsive internet use and signs of dependence on activities like exercise, in those with ADHD, even among those already undergoing medical treatment. Impulsivity, a core symptom of ADHD, is directly linked to this risk.
What is a dopamine fast and does it really work?
It is a period (Lembke suggests about 30 days) of a complete break from a specific stimulus (gambling, non-essential shopping, social media) so that the brain’s reward system can return to its baseline. There is no evidence that it literally “zeroes out” dopamine, but the behavioral pause helps break the automatic cycle of seeking and rewarding.
Can compulsive sexual urges be treated?
Yes. It usually involves specialized therapy, and in many cases the same self-binding strategies (physical, chronological, categorical) described in this article, combined with professional monitoring, since the behavior is often linked to other emotional factors worth investigating together.
Do gambling, shopping, and sex addictions have the same cause?
They share the same brain reward circuit (the mesocorticolimbic dopaminergic system), which explains why it is common for a person to present more than one of these patterns at the same time. But each has its own triggers and treatments. It is not a single cause with interchangeable symptoms.
References
FINDON, James L. et al. Investigating behavioural addictions in adults with and without attention deficit hyperactivity disorder. PLOS ONE, [s. l.], v. 20, n. 2, p. e0317525, 2025. DOI: 10.1371/journal.pone.0317525.
GRANERO, Roser et al. Compulsive buying behavior: characteristics of comorbidity with gambling disorder. Frontiers in Psychology, [s. l.], v. 7, artigo 625, 2016. DOI: 10.3389/fpsyg.2016.00625.
LEMBKE, Anna. Dopamine nation: finding balance in the age of indulgence. New York: Dutton, 2021.
WOLFSCHLAG, Mirjam; HÅKANSSON, Anders. Drug-induced gambling disorder: epidemiology, neurobiology, and management. Pharmaceutical Medicine, [s. l.], v. 37, n. 1, p. 37-52, 2023. DOI: 10.1007/s40290-022-00453-9.
