A “Drive”, Not A Choice

https://www.hbo.com/addiction/understanding_addiction/112_stop_go_mechanisms.htmlPavlov’s Classical Conditioning and Addiction

Pavlov’s well-known experiment explains a lot about addiction. Pavlov rang a bell and fed a dog. Rang a bell. Fed the dog. Rang a bell. Fed the dog. Pavlov saw that the dog began to salivate upon hearing the bell. Salivation, this “psychic secretion” as he termed it, became an automatic response to the sound preceeding the pleasurable event. After all, you don’t have to tell yourself:”Self, it is time to start salivating so that we can eat this yummy pepperoni pizza.” It just happens. Pavlov also noticed that when he rang the bell, the dog would salivate even when food was not anywhere in the room. Eventually, the dog began to salivate anytime the dog saw a lab coat. The dog’s brain had been “trained” (Pavlov called it “conditioning”) to recognize: BELL=FOOD and LABCOAT=FOOD. A major player in this experiment was a chemical called dopamine. Coincidentally, dopamine and conditioning are also major players in the addiction cycle.

Dopamine is a neurotransmitter, or chemical messenger in the brain, that is responsible for the feeling of pleasure or reward. Any time we experience pleasure, dopamine is involved. Food releases dopamine. Sex releases dopamine. These things are pleasurable to us so that we will do them, remember them, and do them again. Food tastes yummy so that we’ll seek it out, eat it, and get the nutrients that we need to survive. Sex is pleasurable so that we’ll be more likely to remember to do it again and possibly procreate (for the survival of our species). So, dopamine is not only important for pleasure, it marks things for SURVIVAL.

The problem is, addictive substances also release dopamine, but in massive quantities (dopamine is where the “high” comes from). When a person uses an addictive substance for the first time (or participates in a highly stimulating, pleasurable activity, such as gambling) the brain is flooded with more dopamine than ever before. The immediate message to the brain is: “REMEMBER THIS!! It is extremely pleasurable and important…AND WE MUST REPEAT IT!”  And the brain is VERY good at remembering these experiences. The immense pleasure creates a heightened state of attention to the experience. The sights, sounds, smells, emotions, the people involved in the euphoric experience, the precise scene, all become recorded in the brain as part of the pleasurable experience. This is why, when a person is abstinent from using substances and they encounter a sight, sound, smell, or other “reminders” or “cues” that remind them of the high, their brain reacts instantly. The brain says again “This is important! This experience is about to happen again. Go for it!” This is what is called a “trigger” and is usually followed by mental, physical, or emotional “craving” – which then is more likely to drive the person back to use. This is also why most people with alcoholism report feeling better on their way to the liquor store or those who use IV drugs report feeling high before the needle even touches their arm. Their brain is already “salivating” by releasing a little dopamine in preparation for the use!

Addiction causes a problem with the “Stop/Go” System

Impulsivity is something that most people with addiction problems struggle with and the reason for that is due to this breakdown in the stop/go system. We have a system in the brain that tells us when to “go” for something (yummy food, that particular expensive item you want to buy, or that particular substance that is pleasurable). Luckily, we also have a “stop” system that tells us when NOT to act (for example, “you can’t afford that, you don’t get paid until next week.”). With addiction, when dopamine floods the brain, the brain is changed by the “high” experience and with repeated exposure to this flood of dopamine, the brain adapts (it decreases dopamine production because it has too much and with continued use, the brain eventually stops making dopamine on its own altogether) and begins to rely on the experience to supply it with what it needs. A “disconnect” occurs between the go and stop systems. Over time, the brain just says “go!” and the “stop!” messages are reduced to a whisper or are not able to get through at all. This is what fuels relapse – a complete break-down in the person’s ability to stop doing something that their brain believes they desperately must do to survive. This is how addiction “hijacks” the system and DRIVES behavior. Once a person reaches this state of addiction, they are no longer in control of themselves or their behavior and it is time for them to seek help.

It has been suggested that people with a genetic history of addiction have a higher number of dopamine receptors in their brain. Translation: they are likely to have a tendency to go overboard when it comes to pleasure – and, they are more likely to be impulsive when tempted by cues signaling pleasure (see recommended readings under the “Resources” page).

Euphoric Recall (also called “war stories” or “staying in the high”)

Oftentimes, people with addiction disorders report having vivid memories of their first using experiences, sometimes dating back to very young ages. For example: “When I was little, my mother gave me whiskey with honey and lemon to help my cough and I remember REALLY liking it and wanting more.” People with addiction disorders are also known to tell what are called “war stories” in which they reminisce about getting high – they relive the moment through talking about it in detail. This is called “euphoric recall” —  in other words they are recalling the euphoric experience. When a person with an addiction disorder talks in detail about using experiences, their brain actually releases a little bit of dopamine in preparation for the use, like salivating. This then leads to a craving or a stronger urge to use the substance and the person is more likely to go to greater efforts to ensure that they do indeed use. This is how the DRIVE of addiction is formed. The brain becomes trained with the first intense flood of dopamine and is driven to repeat the experience again and again because the brain associates the use of the substance with reward and survival.  It is no wonder that relapse rates amongst people with the disease of addiction are estimated to be at the very high level of about 80% – or 8 out of 10.

After this drive has kicked in, the only way to stop it (prevent relapse) is to 1. Abstain from using or engaging in the pleasurable experience (which is difficult because there is this pull back to doing it) 2. Allow time to pass for the brain to heal from this flood of chemicals (most studies report that the brain jump-starts the healing process at 90-days without use) 3. Learn how this disease works and get really good at recognizing when these types of situations are coming on.

Articles of interest about dopamine and impulsivity (see also recommended reading on the “Resources” page):

HBO: Addiction: Stop! Go! A Rogue System in the Brain

https://www.hbo.com/addiction/understanding_addiction/112_stop_go_mechanisms.html

Time Magazine article on dopamine and thrill-seeking behaviors:

http://www.time.com/time/health/article/0,8599,1869106,00.html

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Responses

  1. This is such great information, Michelle!

  2. Great blog site Michelle. Lots of good info. Can we maybe start an informative section for stupid/sad/funny situations active addicts put or found themselves in. Like the AA bigbook calls “pitiful and incomprehensible demoralization” and “beaten to a state or reasonableness”. I think back to realize now how insane active addiction was. For instance wanting pain pills so bad I would do almost anything and when I did finally get that paper prescription in my hand a calm euphoric high came over me yet all I had was the paper prescription but no drugs yet!!
    So many crazy days and nights. . It is so nice to be clean & sober today. AA’s 12 steps work and are “THE easier softer way”

    • Buddy, that calm euphoric high was exactly what I was talking about in this section:

      This is why, when a person is abstinent from using substances and they encounter a sight, sound, smell, or other “reminders” or “cues” that remind them of the high, their brain reacts instantly. The brain says again “This is important! This experience is about to happen again. Go for it!” This is what is called a “trigger” and is usually followed by mental, physical, or emotional ”craving” – which then is more likely to drive the person back to use. This is also why most people with alcoholism report feeling better on their way to the liquor store or those who use IV drugs report feeling high before the needle even touches their arm. Their brain is already “salivating” by releasing a little dopamine in preparation for the use!

      Great idea for the page for stories that people in recovery can share! I will consider adding that soon…only if you promise to post on it regularly! Yours would indeed be some of the funniest…but something tells me that they wouldn’t compare to hearing them in person.

      🙂 Michelle

  3. I look back and laugh but do know how lucky those of us who lived through it and then have been able to stay stopped, really are. You said 10% seek treatment and how many of those stay clean a year? I heard it’s realistically about one in thirty!! Consequences and pain motivated and guided me to do the work required for lasting sobriety. Maybe you could call the new page “Pain and Victory” For every Painful/funny war story told we have to tell a Victory/ spiritual “burning bush” experience to match. Oh do I have some funny stories with victories to match.

  4. Buddy, the statistic that I know of is that 8 in 10 relapse within 1-year of treatment. So…at least an 80% relapse rate. But, that’s the nature of the disease…it is hard to treat and most people don’t (can’t) get it the first time. I know very few who’ve been through treatment once and stayed clean/sober. It often takes numerous attempts. But, if you think about it, there is SO much to learn about this disease – and so much for the person to change – that it would be extremely difficult to get it all right the first time.

  5. Your right and my experience is it’s as much about “un-learning” old behaviors. Recovery is like attending The University of Unlearning. Dr. Doug Talbot teaches two (2) things make an addict: Genetic predisposition combined with Abuse.
    You can be genetically predisposed but not abuse -or- one can abuse but not be genetically predisposed. Neither become addicts. But if one is both genetically predisposed AND abuses we cross the wall into lifetime addiction. “Once a pickle we can never be a cucumber”. I also relate to AA Bigbook Dr.s opinion of a “manifestation of an allergy” We are allergic to alcohol and the symptom of the allergy is a craving beyond our control. Stop putting in and the symptom of the allergy (craving) goes away. Then we are left with the mental obsession believing we can use with impunity. Double edge sword Craving / Mental obsession. “Honey I’m gonna stop by the bar and just have two beers before I come home” then after 5 or 6 I’m drinking on the barstool trying to overcome a craving (symptom of allergy) beyond my control and my mind tells me “She a ____, I deserve a night out with the boys! There is a lot to learn and un-learn.


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