Dr. Robert Weiss LCSW, CSAT
In a previous post, I outlined the basic neurobiology of addiction, including the fact that when the nucleus accumbens (the dopamine rewards center of the brain) is consistently overstimulated, as occurs with the heavy use of addictive substances and behaviors, the brain will “heal” this imbalance by reducing the number of neurons that release and receive dopamine. In other words, the brain “turns down the volume” on the ability to experience pleasure from addictive stimuli.
With this, addicts experience two of the more common signs of addiction: tolerance and escalation. With tolerance and escalation, addicts must use more of an addictive substance or behavior or a more intense version of an addictive substance or behavior to get the desired high.
Consider heroin addiction. Heroin addicts almost never start out shooting heroin. Instead, they have a few beers at a party in middle school. By the time they’re in high school, they’re drinking a six-pack, or they’ve switched to hard liquor, or they’re smoking pot. Then they’re stealing grandma’s pain pills and crushing them into the pot they smoke. Before long, they’re snorting the pills for faster effect. Suddenly, with no real knowledge of how they got there, they find themselves in a back alley with a needle in their arm.
As addictions escalate, the neurobiological down-regulation of dopamine continues. The pleasure center of the brain continues to adjust. As this occurs, addicts find themselves “chasing the dragon,” meaning they’re constantly seeking ways to get the same high they got when they first used. Addicts escalate, the brain down-regulates, over and over and over.
The truly rotten part of this equation is that we only have one rewards center in our brains. This means that the down-regulation of dopamine rewards (our ability to experience pleasure) occurs not just with addiction but our entire system. All forms of pleasure, including natural rewards like eating a nice meal, being friendly, playing, learning, and feeling connected are dampened.
Over time, addicts typically find it difficult to experience pleasure through either normal or supernormal means. Sometimes, they are unable to experience natural rewards at all. Worse still, any time they are not actively using, they struggle with feelings of depression. And when they are using, they are simply “feeding the beast,” using their addiction not to get high but to get back to zero (to feeling normal rather than depressed).
This condition of constant mild depression in the absence of active addiction is known as anhedonia. Anhedonia occurs because, as stated above, when the brain turns the volume down on addiction, it turns down the volume on the entire rewards system; the volume is turned down on everything.
The good news for addicts is that the brain resets (heals itself) with sobriety. The rewards system eventually (usually after six months to one year of good sobriety) returns to baseline. Just as the brain recognizes that there is too much dopamine floating around, it will recognize that there is not enough dopamine floating around, and it will adjust the volume on pleasure in the other direction.
Until that happens, however, addicts may struggle to enjoy life, to connect, and to avoid slips and relapse. Often, it helps recovering addicts to know that their inability to feel pleasure from anything other than active addiction is a temporary phase of recovery. The brain is healing as fast as it can, and eventually they will be able to enjoy all aspects of life—even the small and simple pleasures.
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