Dr. Robert Weiss LCSW, CSAT
To understand the addictive process, we must first understand certain brain basics, most notably how we experience pleasure, desire, and motivation.
In humans, a small portion of the brain known as the nucleus accumbens controls the experience of pleasure. For simplicity’s sake, this region is sometimes referred to as the pleasure center or the rewards center. This portion of the brain is activated (we feel pleasure) when we engage in naturally occurring, life-affirming stimuli such as eating, playing, learning, being sexual, helping others, etc.
This neurochemical pleasure response is two-pronged, involving the release and reception of certain neurochemicals—mostly dopamine but also adrenaline, serotonin, oxytocin, various endorphins, and a few others. For purposes of this discussion, however, we will focus primarily on dopamine. Some neurons release dopamine, other neurons receive it, and both actions must occur before we experience pleasure. It’s like a lamp. It doesn’t turn on until someone plugs it in and completes the circuit.
When pleasure is experienced, the reward center tells the mood, memory, and decision-making regions of the brain how much it enjoyed eating, playing, learning, being sexual, helping a friend, or whatever. This encourages us to engage in these life-sustaining activities again in the future. In short, the experience of pleasure creates desire and motivation that ensures our survival.
That’s awesome, right? Intelligent design at its finest.
Unfortunately, the rewards center can be manipulated. For instance, alcohol, addictive drugs, and intensely stimulating behaviors (like gambling and viewing pornography) can be used to artificially stimulate the system, flooding the brain with unusually high levels of dopamine. And then, as is the case with all pleasurable experiences, this pleasure-related information is conveyed to areas of the brain dealing with mood, memory, and decision-making, creating motivation to repeat the behavior.
Is it any wonder that addicts go back for more, more, and still more?
But still, everything seems OK. A little excess pleasure never hurt anyone, right? Except it can, and it does. In fact, at this point, the story of addiction and the brain starts to get ugly. For starters, the brain self-monitors and self-regulates, making internal adjustments as needed. For example, if a person goes blind, their brain will heighten their other senses to compensate. This is a good (and amazing) thing. Except…
When a portion of the brain is consistently overstimulated, as occurs with the heavy use of addictive substances and behaviors, it recognizes the ongoing neurochemical imbalance—too much dopamine, too much of the time—and it adjusts to that by reducing the number of neurons that release and receive dopamine. (Mostly it cuts down on the number of dopamine receptors.)
As the brain adjusts in this fashion, addictions have less of an impact, so users must use more of a substance/behavior or a more intense version of a substance/behavior to achieve the desired reward. Basically, the brain uses an internal dimmer switch to reduce the amount of pleasure the user experiences from a particular activity.
With this, addicts up the ante, so to speak, in an attempt to achieve the neurochemical pleasure response that they’re used to. Typically, they use more of an addictive substance or behavior or a more intense version of an addictive substance or behavior to get the desired high. Then, the brain adjusts yet again.
Despite this continual loss of the ability to experience pleasure from an addictive substance or behavior, the mood, memory, and decision-making regions of the brain remember the initial enjoyment and desire the same experience. Thus, the motivation to use remains despite the loss of in-the-moment pleasure. In this way, liking an addictive substance or behavior transforms into wanting/needing an addictive substance or behavior. Even though the stimulus no longer provides the pleasure it once did, the user wants and needs to continue. This is the start of addiction.
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