One strange feature of addiction is that someone can hate the addiction and derive little pleasure from using, but continue to use even as her life falls apart. There are several threads in this web including habit and fear of withdrawal. Another thread is that you can actually want something, even if you don’t like it, and it’s the wanting that keeps you stuck.
Most people know that dopamine plays an important role in addiction. Actually, dopamine is related to any sort of pleasurable experience–food, socializing, sex, etc. While the dopamine produced by, say, chocolate cake is about double normal levels, the dopamine produced by heroin is closer to ten times normal levels.
However, the relationship between pleasure and dopamine is more complex than most people realize. It seems dopamine is not responsible for pleasure but for motivation. It makes sense that the two processes should be related. Obviously, if an experience is pleasurable, we will want to repeat it, but experiencing pleasure and wanting to repeat it are two different mental processes. Researchers have been able to completely disable the effect of dopamine in rats. It makes them indifferent to food, but they still enjoy food when they are fed.
With addiction, essentially the opposite happens. Drugs are extremely enjoyable at first. You get this elevation in dopamine, which teaches the brain that drugs are definitely something it wants more of. Gradually, drugs get less and less pleasurable as your tolerance builds, but your brain still has adamant instructions to seek the drugs associated with that huge dopamine response. Whereas the rats experienced pleasure without desire, addicted people experience desire without pleasure. This is one reason addiction is described as a hole you can never fill. The reward-seeking behavior remains very powerful but the reward is always inadequate.
Triggers are associated with this dopamine response. Dopamine actually rises in anticipation of using, which is what drives the wanting behavior. Once you are exposed to a trigger, whether it’s stress, a place, people, or paraphernalia, dopamine takes the wheel. You suddenly get those strong cravings that are totally divorced from reasonable expectations.
One reason it’s good to know how is this works is that you can recognize a craving for what it is. It’s an isolated process that normally provides a useful function–wanting to repeat a positive experience–only it’s been turned up to 11. When you experience a craving, you can look at it and say, ‘Oh, that’s just wanting’. You don’t need to use; you just really want to. It doesn’t even correspond to the reward. Just because you really want something, doesn’t mean it will be that great when you get it. In fact, you’ll probably feel even worse for perpetuating your addiction. Knowing what’s really going on takes some of the fear and mystery out of recovery.
