Welcome to the end-o-the-week roundup of things I found interesting, which usually goes out on Fridays but sometimes does not because time is an illusion and clocks are a curse. This week I have some dopamine discourse analysis for you, some updates on the whole Cerebral debacle I’ve been following for a bit now, and a handful of loose links re: antidepressant studies. If you like it, pls share it with your friends.

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Chasing the Dopamine: A Case Study in Neurowashing Anti-Drug Propaganda

Dopamine, a neurotransmitter falsely synonymous with pleasure, actually has a lot more to do with anticipation, and it also regulates things like motor function and lactation. But the way people talk about it online, you would think it’s a kind of heroin that your brain makes when you enjoy things.

Take the videos of ADHD influencer Matt Raekelboom, who describes himself as a “Life Changing Expert & Thought Leader”. In this Reel, he tells us that the reason we enjoy music is because it increases our dopamine by 9%, and that’s why good music gives us the chills.

You don’t just listen to music, though — you experience it, and that experience is affected by all kinds of factors like setting, emotion, memory, spirituality, and community. It’s super reductive to say we are moved by a piece of art because of one brain chemical, but trying to explain the phenomenon of aesthetic experience with neuroscience has actually become quite a trend in the humanities.

Matt references a “small study” for his 9% number, but doesn’t provide a citation, so I did a little Googling to try to figure out which one he was referring to. The second result for “9% increase dopamine music study” was this BBC article from 2011, about a brain scan study on 8 people.

Researchers selectively chose 8 people who already experienced chills when listening to specific songs in order to scan their brains and see what their dopamine was doing.

So, Matt is generalizing this stat to the entire population of people diagnosed with ADHD, based off a study on an extremely small group of people not diagnosed with ADHD who were already predisposed to experience the chills he’s talking about, because those chills are (presumably) caused by dopamine, which is (presumably) a feel-good drug your brain makes that ADHDers are (presumably) addicted to because ADHD is (presumably) a dopamine deficiency.

Oh Matt, you presume too much!

There are some obvious parallels to the whole addiction-is-a-brain-disease discourse going on here, too. Matt has made several videos about “chasing the dopamine” where he claims that dopamine controls us, which has actually been a core message in anti-drug propaganda for most of the last century.

Starting in the early 1900’s, the US government told everyone that drugs had the power to take over your mind and “enslave” you, and they used this rhetoric to justify everything from anti-immigration laws, to racism, to policing women’s sexuality, to calling gay men pedophiles.

If you’ve ever seen Reefer Madness, the infamous propaganda film that became fantastic musical satire, you will recognize the argument that people are powerless to the chemical effects of drugs, neglecting everything in their life in pursuit of the next high. (“Chasing the dragon”, anyone?)

Matt says something similar about “chasing the dopamine” — that it can cause us to ignore our friends, our job, our hygiene, and that it also controls our morality.

He claims that dopamine rules over “our motivation, our concentration, and our pleasure”, that it can “control what we’re thinking about”, and that “people with ADHD blackout and overdose more than any other type of person in the world” because we have a “dopamine-deficient brain”.

At the end of his video on “The Abusive Tendencies of the ADHD Brain”, Matt gives us this example: when he’s drunk at a party and someone offers him another shot, he says yes, even though he doesn’t need it, because dopamine is making him think that it is morally right.

But your neurotransmitters don’t know shit about human morality, and there’s nothing about a substance that makes it inherently right or wrong — we assign moral value to certain substances based on our culture and context.

While he’s moralizing drug use, Matt completely misses a much simpler explanation for this behavior: alcohol lowers your inhibitions. You do another shot you don’t need when you’re already drunk because of the direct effect of alcohol, not because your dopamine is a devil on your shoulder telling you it’s the right thing to do.

Matt’s arguments essentially reduce us all down to one neurotransmitter and assign it the power to control almost everything about us. This strange rehashing of old War on Drugs narratives can be convincing for viewers who don’t have the background knowledge necessary to see that it’s more ideology than science, and it perpetuates false, disempowering brain disease discourse about both addiction and ADHD.

I don’t deny that neurodivergent people often struggle with substance abuse (I did for 15 years) but I do reject the idea that it’s simply neurochemical. I was doing drugs because I was trying to cope with an overwhelming world — drugs were serving a purpose in my life, albeit an unhealthy one, and developing a less destructive relationship with them required that I dig into why I was using them, not chalk it all up to my dopamine.

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All That Bad Press Finally Caught Up to Cerebral

Last week, a former executive filed a labor lawsuit against the telehealth company, claiming that they fired him after he brought up his concerns about putting profit over patient safety:

For instance, he told higher-ups that he had found more than 2,000 duplicate shipping addresses in the patient database, suggesting customers were setting up multiple accounts to obtain additional medication. Truebe said he reported the findings to Cerebral CEO Kyle Robertson and other executives but they took no action, and Robertson said the issue was his "lowest priority."
Robertson also allegedly asked employees to track customer retention rates for ADHD patients who were prescribed stimulants versus those who were not. Later, Robertson “directed Cerebral employees [to] find ways to prescribe stimulants to more ADHD patients to increase retention,” according to the complaint.
Chief Medical Officer David Mou said in a later meeting that the “goal was to prescribe stimulants to 100% of Cerebral’s ADHD patients," the lawsuit alleges.

He also alleges that the company neglected reports of overdose and suicidal ideation, and did nothing about a security breach of patient data.

Former employees spilled similar stories to Bloomberg in March, and it’s not surprising, considering how shitty the company has been to them:

…Cerebral’s messaging doesn’t square with how it treated certain employees, including many of the therapists integral to delivering care to its patients. In fact, the San Francisco, California-based company, which raised $300 million at a $4.8 billion valuation led by SoftBank Vision Fund 2 just last week, changed the contract status of more than 200 of its employees from salaried to hourly workers over the summer and switched eligibility for medical, vision and dental benefits to be contingent on hitting certain quotas.

In the shitstorm of all this press (remember that one about their shady TikTok Ads, too?) the company has decided to pause stimulant prescriptions and put more stringent prescribing measures into place.

A similar company, Ahead, just announced that it will be shutting its doors, which raises questions about the future of all these teleprescription companies that popped up in the wake of the Ryan Haight Act waiver. (It’s a law that blocks prescribing of controlled substances over the internet, but it was waived during the pandemic.)

Companies like Cerebral, Talkspace, Him & Hers, plus organizations like The American Psychiatric Association and The American Telemedicine Association wrote a letter to the DEA in March requesting that the waiver become permanent. It looks like both the DEA and the DOJ are now investigating Cerebral, though, so we’ll see what happens.

The Antidepressant Study Corner:

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The Little Sea Bugs In My Dirt

I’ve gotten a bit obsessed with learning how to garden since I moved into a house a couple weeks ago. This is not new — it’s happened to me every spring for the last few years, but I’ve never had any space to actually plant outside before (all my sad little apartment herbs died, RIP) so now the special interest is really flourishing.

Maybe it’s because I’ve been living in the city for so long and never really got to dig in dirt, but I was shocked at how many bugs there are in soil. SO many bugs! Mostly, these little guys we call pill bugs, which are actually CRUSTACEANS (!!) who adapted to live on land and help us out with decomposition by eating dead stuff.

Naturally, I tripped down a pill bug rabbit hole and discovered that there are giant versions of them in the deep sea — they’re called giant isopods. At first I thought the little pill bugs in my dirt were creepy and gross, but now I’m sort of fascinated by them, in the same way I came around to loving slugs. These little dudes are actually ancient creatures! And we wouldn’t have plant life or flowers or vegetables without them!

This is relevant to the newsletter, I promise — honestly, it’s the heart of this newsletter. Embracing the gross, the weird, the deviant; becoming curious about it, turning towards it with care, instead of trying to fix it, cure it, change it, or force it to fit in.

I will leave you with a truly random sort-of-eerie-but-also-awe-inspiring moment of the week, this video I found of giant isopods eating an alligator at the bottom of the ocean:

I appreciate you slugging along with me this week —> pls send your tips, questions, and suggestions to sluggish@substack.com <3

Sluggish

Dopamine Doesn't Control You