“Telling an addict to just stop is useless. It is like telling someone driving a car with no brakes to just stop. They want to but they don’t have what they need.” – Dr. Nora Volkow, NIDA
Welcome to installment 2 of the of the science of addiction, The Dopamine Response – Addiction Stole My Brain. Installment 1 discussed the adolescent brain, so now we are getting to the meat of how addiction alters the brain. When we understand how the addict’s brain has changed, we have a better chance of finding workable solutions that use our limited resources wisely. Afterall, there are many worthwhile causes, so we must be wise in our approach (that is where you come in). So, let’s discuss what we know about dopamine and some theories that may help round out our understanding.
I Get What Dopamine Is But Why Is It There?
You are probably somewhat familiar with dopamine from discussions about cellphone behavior/addiction but let’s go over the basics so that we are all on the same page. Dopamine is a substance that your brain makes and when it hits a dopamine receptor in your brain, it makes you feel good. This part of the brain is sometimes referred to as the pleasure center of the brain. Generally speaking, you have some baseline level of dopamine floating around your brain that is your general feeling of well-being and certain things cause a release of more dopamine that make you feel even better.
Whether you believe in God, evolution, some combination or nothing at all, I think that we can all agree that humans, and the whole universe, are amazing systems. Nothing is without purpose, so why is this dopamine system even there in our brains? I believe that it is a conditioning system that exists to make us do what is important and since ancient peoples existed much longer than modern “civilized people” it focuses on the needs of our ancestors. The most well-known example of conditioning is “Pavlov’s dog”. Pavlov rang a bell whenever he fed his dog and soon all he had to do was ring the bell and the dog acted like he was fed, he salivated. This was not a conscious choice for the dog, it was an automatic response to the stimulus, the bell. I believe that dopamine is the stimulus that is there in our brain to make us respond automatically, probably somewhat consciously but more so subconsciously, to pursue the thing that caused the release of dopamine.
Let me give you two common examples to illustrate this belief. What kind of food do you like? Cookies, cakes, steak, chips, bacon, chocolate. All of these foods are high calorie, high fat, high salt foods that cause a little dopamine bump that makes us feel good. That is why we like them. Consider the classic image of a teenage girl who’s first boyfriend broke up with her and she is drowning her sorrows in a ½-gallon of ice cream, which by the way isn’t a ½-gallon anymore. She is getting a dopamine bump (this is a fact, not theory), it is making her feel a little better. Now for us, this is not an advantage, it makes us eat poorly and get fat but food was hard to come by for our ancestors. High fat, high calorie foods got them the most bang for the buck. It helped them survive. Do you have a hard time resisting one of these foods? Of course you do, you like the bump in dopamine. For some people this can rise to the level of addiction.
The second example I would offer to support this belief is sex. Sorry to disappoint all you romantics but one of the main reasons that you like sex is because it causes a bump in the amount of dopamine in your brain. Now consider ancient peoples again. They were busy trying to get their high fat, high calorie foods and trying not to be some other species high fat, high calorie food. They were dirty, they were hairy, they were stinky. Do you think that they would want to be intimate? Well, sex gives you a dopamine bump, probably bigger than chocolate. Ancient peoples got this good feeling and said, “I like this. I’m going to do this again when I get a chance.” And so, they made little ancient people and their offspring made little ancient people and so on, and here we are. The species survived because conditioning, through dopamine, programmed them to do what they needed to survive and reproduce.
I Thought This Was Mostly About Drug Addiction
It turns out that dopamine is the main player driving addiction and in particular driving drug addiction. It makes sense (although I do not know if it is well documented) that the stronger the dopamine response, the stronger and more rapid the conditioning. When someone uses an addictive substance, the brain is flooded with dopamine, something on the order of 10 times the response one gets from sex. This flood of dopamine is what causes the feeling of being high. The conditioning immediately begins, causing the user to fixate on this substance. Furthermore, dopamine is a sign to your brain that this is something important. The biggest, brightest sign that your brain will ever see.
Your brain recognizes, however, that this is an unnaturally good feeling. Something is wrong. Since the brain can’t stop the flood of dopamine it responds by turning off dopamine receptors. This is what causes drug tolerance, the need for an addict to use more and more to get the same high. In fact, you will never again reach that first good high. You will spend your life chasing it but you will have fewer and fewer receptors to respond to the dopamine. Abuse a substance long enough and hard enough and you will turn off so many dopamine receptors that you will no longer have that basic feeling of well-being. You will feel like horrible all the time and when you use, you will no longer get high. You will just get back to normal.
Different drugs cause different kinds of high and it appears that we have a predisposition for a particular type of high. This is known as your drug of choice and this is what really rings your bell.
Addiction Takes Control of Your Brain
As I said in Part 1, it seems like the drug is a living being attempting to preserve itself. It hijacks your dopamine system and uses it to control your behavior. It uses conditioning to turn your subconscious against you so that you are driven to seek the object of your addiction, be it a drug, gambling, alcohol, over-eating or checking your Facebook page. The bell rings and you salivate, not by choice. But wait, the drug is just a chemical, it is not a living thing. Your brain is the living thing and addiction is a part of it. Therefore, if you try to use just will-power, strong character, etc. to overcome addiction, you will fail. All of the will-power at your disposal is also working to preserve the addiction. Remember, the flood of dopamine has told your brain that this (the addiction) is very important.
A study was done in which an electrode was inserted into a rat’s brain so that the dopamine response could be stimulated. The rat was placed in a cage with two levers. One provided a food pellet when pushed, the other stimulated the dopamine response. Without fail, the rats starved to death because they stimulated the dopamine response to the exclusion of the food. I think that we are smarter than rats but this is a very telling result.
I once heard a drug counsellor relate what an addict who was in rehab once again had to say. He said, “It is like the drug knows exactly what I am going to do or trying to do and it is just a little smarter than me.” He hit the nail on the head except it is not the drug. It is his own brain, so of course it knows what he is trying to do. Also, since the addictive part of the brain is functioning in both the conscious and subconscious part of the brain and he is only using the conscious part, it is smarter than him. This does not mean that an addict has completely lost their free will but it does mean that they are attempting to fight the addiction with one-hand tied behind their back.
I read an article about a woman in recovery and she was discussing her attempts to break free from addiction. She said that when she had just gotten loaded, she was certain that she could stop but when she sobered up she was certain that she could not live without the drug. When loaded, the conditioned drive to use is satisfied but as one becomes sober, the addicted part of the brain comes roaring back to protect what is important, using. Free will is not gone, just completely overwhelmed. Worst of all, this is not the end of the discussion of changes to the brain. The next installment will discuss the physical alteration to the brain.
An addict is someone who repeatedly does something that is detrimental to their well-being, even when they don’t want to. “Even when they don’t want to”, this is key to understanding addictive behavior. No one ever truly thinks, “I want to be a junkie”, “I want to be ruled by a chemical or food or gambling”.
Is Addiction Really a Disease?
The individual made a poor choice and used, then dopamine caused conditioning that drove the individual into addictive use. The conditioning operates in both the subconscious and conscious mind and therefore, has tremendous control over our behavior. Free will is not gone but mightily overwhelmed. Understanding this is what caused me to see addiction as a disease, but more on this in posts after we get through the basic science. Do you have ideas or experiences to share? Please comment, let’s work together and help each other to understand this problem.
I hope that you will join me next week for “The Dopamine Response and Neuroplasticity”.