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How Dopamine Drives Addiction - Dr Anna Lembke 1 год назад


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How Dopamine Drives Addiction - Dr Anna Lembke

One of the most important findings in the neuroscience of addiction is that pleasure and pain are co-located in the brain and they work like opposite sides of a “balance”. A helpful metaphor for understanding this is used by Dr Anna Lembke in her book: Dopamine Nation (https://amzn.to/48wzHJp). Imagine “gremlins” on a seesaw. If you experience pleasure, gremlins hop on to the pleasure side, causing the balance to tip to that side. And if you experience pain, gremlins jump onto the pain side, causing it to tilt the other way. Your balance wants to remain level (i.e., in homeostasis). If you deviate from neutral—to the side of pain, or to the side of pleasure, your brain works very hard to restore homeostasis. It does this by tilting an equal amount in the opposite direction to the side of the initial stimulus. For example, if the initial stimulus was pleasure, it will respond by tilting to the side of pain. Or, if the initial stimulus was pain, it tilts to the side of pleasure. This partly explains why people feel good after cold water exposure or vigorous exercise. Now imagine that you eat a chocolate truffle. In response, your brain releases a small amount of dopamine in your reward pathway, causing you to feel good. At this point, a small number of gremlins hop on to the pleasure side of the balance. In response, an equal number of gremlins now jump onto the pain side to bring it level again, staying on until the balance has tilted an equal amount in the opposite direction. This is typically the moment when you experience a mild craving to have another truffle. As we all know, if we can sit with this long enough, the craving passes and the balance is restored. However, if you’re sitting with hundreds of truffles in front of you, a different scenario could very easily play out—and this can be helpful for understanding how the addictive process take hold. Imagine that you lose self control and just keep eating chocolate, after chocolate, after chocolate. If you continue for long enough, you’ll eventually accumulate an army of gremlins on the pain side of the balance. So much so, that they sort of “camp out” there, meaning your balance gets stuck on the pain side. This is the beginning of the addicted brain. You’ve now essentially reset your hedonic set point (the amount of joy you’re able to experience in daily life). Now, the only way you can temporarily restore the balance (and not feel pain) is to eat another chocolate. However, anytime you are not eating a truffle, your pleasure/pain balance is tilted to the side of pain. In essence, you are in a chronic state of dopamine deficiency. And the only way you can get out of it, is to have more of the very thing that caused it in the first place. So your whole life starts to revolve around getting your next chocolate truffle hit. You experience withdrawal symptoms like anxiety, craving, and irritability. This also explains why the effects of addiction can often look similar to things like major depressive disorder, generalised anxiety disorder, and insomnia. Book recommendation: https://amzn.to/48wzHJp

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