TL;DR Summary:

What is addiction?
What brain regions are affected by addiction?
The Pleasure-Pain Scale
The DOPAMINE Detox Tool
Supporting Research

Addiction is a complex disorder that affects millions of people around the world.

Despite its devastating effects on individuals and society, there is still much we don't understand about addiction, particularly in terms of how it affects the brain.

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That being said, some recent research has shed new light on the neuroscience of addiction and the role of the brain's reward system in this disorder.

So, I thought this would be the perfect topic to cover in today’s blog, let’s dive in!

The Brain & Addiction

At the center of addiction is the brain's reward system which is a complex network of neural circuits that are involved in the experience of pleasure and motivation.

When we engage in activities that we find pleasurable, such as eating, having sex, or using drugs, this system is activated, leading to the release of dopamine, a neurotransmitter that is associated with pleasure and reward.

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In addiction, the brain's reward system becomes dysregulated, leading to compulsive drug-seeking behaviors.

This dysregulation is thought to be due, in part, to changes in the brain's dopamine system which we will cover in-depth shortly.

Before we get into the pleasure-pain system, let’s talk neuroscience!

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Key Brain Regions Effected in Addiction

Nucleus Accumbens (NAc)

One of the key brain regions involved in the reward system is the nucleus accumbens, which is located in the basal ganglia.

The nucleus accumbens is responsible for integrating information from different brain regions and producing the experience of pleasure and reward.

In addiction, this region can become hyperactive, leading to an exaggerated response to drug-related cues and a reduced response to natural rewards.

This can result in increased drug-seeking and compulsive behavior.

Prefrontal Cortex (PFC)

Another brain region that is involved in addiction is the prefrontal cortex, which is responsible for decision-making and impulse control.

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Research has shown that addiction can lead to changes in the prefrontal cortex, which can impair decision-making and lead to poor impulse control.

This can make it difficult for individuals with addiction to resist drug-related cues and to make decisions that are in their best interest.

Amygdala

If you’ve been reading this for long, you know that the amygdala is involved in emotional processing, including fear and anxiety.

Addiction can lead to changes in the amygdala, resulting in increased sensitivity to drug cues and increased anxiety (more on this later).

Hippocampus

The hippocampus is involved in memory and learning.

Hippocampus Function and Location - Simply Psychology

Addiction can lead to changes in the hippocampus, resulting in a heightened sensitivity to drug cues and an increased risk of relapse… Yikes.

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Ventral Tegmental Area (VTA)

The VTA is a key brain region that is involved in the release of dopamine, which is associated with pleasure and reward.

Repeated drug use can lead to changes in the VTA, resulting in increased dopamine release and increased drug seeking.

File:Ventral tegmental area.svg - Wikimedia Commons

These brain regions are interconnected and form a complex network that is involved in addiction.

The changes that occur in these regions as a result of addiction can lead to a cycle of craving and compulsive behavior that is difficult to break.

If you’ve ever tried to quit anything addicting, you no doubt understand this cycle!

The Pleasure-Pain Balance

In the book "Dopamine Nation," Dr. Anna Lembke discusses the concept of the pleasure-pain balance, which refers to the idea that pleasure and pain are interconnected and that one cannot exist without the other.

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In fact, pleasure & pain are processed in the same area of the brain together!

You can think of this Pleasure-Pain balance like a scale with pleasure on one side and pain on the other.

Our brain & body want to maintain homeostasis at all times, which means they want to keep this pleasure-pain scale balanced.

To do this, our brain serves up an equal & opposite dose of what we give it, meaning if we tilt the scale towards pleasure, our brain will deliver us some pain to even us out.

Pain and Pleasure in Balance - Pictured As Balanced Balls on Scale that Symbolize Harmony and Equity between Pain and Pleasure Stock Illustration - Illustration of render, happy: 164600911

For example, when you eat a bite of something sweet or salty you get a dose of dopamine & pleasure.

Shortly after this, there’s that moment where you want more, this is the equal dose of pain that your brain is serving you.

If you let this moment of pain pass, you restore homeostasis & move on.

However, if you reach for another piece of candy, you push down on the pleasure side of the scale more, meaning an equal dose of pain is needed to restore balance.

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This is the underlying neurobiological mechanism of addiction! When you keep going back for more and more doses of pleasure, you get less and less of the reward.

Over time, this means you get a shorter & weaker pleasure response, and a stronger and longer pain response.

When I say “pain,” I’m talking about things like withdrawals, cravings, dysphoria, irritability, insomnia, anxiety, etc.

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Over prolonged periods of time, you start to shift your hedonic set point completely.

This makes it hard to find any pleasure at all because your scale is far tipped towards the pleasure side of the equation…

So, what can you do about this?! I’m glad you asked, below is a tool that Dr. Anna Lembke suggests to her addiction clients and it’s called DOPAMINE.

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DOPAMINE Tool

This tool has 8 steps, I’ll break them down below!

Step 1: Data

The first step is to become more aware of the activities, substances, or situations that trigger dopamine release in your brain.

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This may involve keeping a journal or diary to track your daily habits and identify patterns in your behavior.

Some key questions to keep in mind:

How much is being used?
When is it being used?
How often?
How is it used specifically?

Step 2: Objectives

The next step is to observe these behaviors with curiosity, without judgment or self-criticism.

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As you do this, it’s important to start to understand what these behaviors do for you? How do they help you?

Do they allow you to cope with stress? Or keep your anxiety at bay? Or do they help you push away painful memories?

Remember, these are “Firefighter Parts”, and they are a type of Protector inside of the IFS model we covered in some of our previous blogs.

Internal Family Systems therapy in virtual or skype online psychotherapy sessions — Soul Centre Therapy

Asking these Parts what they’re there for and what they’re scared would happen if you didn’t do this behavior can be super helpful as you try to understand these behaviors.

Step 3: Problems

Now that you understand some of the positives, or ways that these behaviors help you, what are the problem they cause?

What are the downsides of this behavior? What about the side effects? Are there any unintended consequences? How do they affect your health, relationship, or morality?

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This step can be hard because dopamine behaviors cloud our ability to see cause-and-effect relationships.

Meaning, we know we like the donut, but we don’t always understand that eating one every day will add 5-10lbs on us in 6 months.

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Step 4: Abstinence

You had to know this was coming… This is a dopamine detox process after all!

Dr. Lembke suggests a 30-day detox. This is generally enough time for our body & brain to reset our pleasure-pain scale back to a healthy level!

Numerous research studies support this 30-day windowing being the ideal amount of time as well.

4,944 30 Days Illustrations & Clip Art - iStock | Calendar 30 days, 30 days icon, 30 days notice

This is an average though, generally, younger people reset faster, and the older you get the longer it could take to fully reset yourself.

This brings us to a very large disclaimer!

Dr. Lembke never suggests a dopamine fast to individuals who might be at risk to suffer life-threatening withdrawal if they were to quit all of a sudden, as in cases of severe alcohol, benzodiazepine (Xanax, Valium, or Klonopin), or opioid dependence and withdrawal.

For these kinds of addictions, medically monitored tapering is necessary.

Step 5: Mindfulness

This is a very important part of the DOPAMINE process because as you start your detox, you will undoubtedly feel the withdrawal effects we talked about earlier.

The most common are cravings, dysphoria, irritability, insomnia, anxiety, etc.

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Withdrawl-mediated anxiety is one of the toughest ones for clients that I work with to handle.

This is oftentimes because the tool they’re detoxing from was the way they “treated” their anxiety.

I see this a ton with weed especially, little do they know that there is no real evidence that cannabis with this.

This is why Mindfulness is so important during a detox. By taking time to mindfully observe the feelings & thoughts that come up while you’re detoxing, you can release their grip on you.

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Something I suggest to my clients is to name the feeling or ANT (Automatic Negative Thought) they are struggling the most with.

For example, my anxiety’s name is Mamba, as you may know, if you’re a long-time reader!

By mindfully building awareness and a relationship with these kinds of emotions, you will start to notice them come up less and less over time.

After about 2 weeks, this withdrawal-meditated anxiety often stops.

Step 6: Insight

After the 30 days is us, pause and take a moment to reflect back on the 30 days.

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What insights can you glean from the experience? What effect did this behavior have on your life? What have you learned about the behavior and yourself?

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Step 7: Next Steps

Once you collect these new insights decide what you’re going to do about the information you’ve collected.

Take a moment to decide if this is something that you would like to continue to abstain from.

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Often times people decide to return to some level of controlled use still, which is perfectly OK, just remember, your pleasure-pain scale is very sensitive still.

Meaning it will tilt to the pain side faster in the future, so be careful!

Step 8: Experiment

Now it’s time to return back to the world with a new dopamine set point, and a plan for the behavior in the future!

As always, I suggest experimenting with this behavior as you return to the world. Use the Act, Access, Adjust Wheel to help you in this experimentation.

Try out different amounts, types, etc, but do some mindfully as a CHOICE, not a reaction.

You’ve Got This

I hope this tool helps you in your own life, I recently used this for sugar.

I’m not a drinker, but boy do I love me some ice cream!

So, you can rest assured that this tool is battle-tested by yours truly.

Detoxes are more fun with friends, so I challenge you to share this post with a couple of friends and then hold each other accountable for a 30 Dopamine Detox!

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Good luck, and until next time… Live Heroically 🧠

Supporting Research

Belin, D., Jonkman, S., Dickinson, A., Robbins, T. W., & Everitt, B. J. (2009). Parallel and interactive learning processes within the basal ganglia: relevance for the understanding of addiction. Behavioral brain research, 199(1), 89-102.
Deroche-Gamonet, V., Belin, D., & Piazza, P. V. (2009). Evidence for addiction-like behavior in the rat. Science, 305(5686), 1014-1017.
Everitt, B. J., & Robbins, T. W. (2016). Drug addiction: updating actions to habits to compulsions ten years on. Annual review of psychology, 67, 23-50.
Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nature Reviews Neuroscience, 12(11), 652-669.
Kauer, J. A., & Malenka, R. C. (2007). Synaptic plasticity and addiction. Nature Reviews Neuroscience, 8(11), 844-858.
Kalivas, P. W., & Volkow, N. D. (2011). The neural basis of addiction: a pathology of motivation and choice. American Journal of Psychiatry, 162(8), 1403-1413.
Koob, G. F., & Le Moal, M. (2001). Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology, 24(2), 97-129.
Koob, G. F., & Le Moal, M. (2008). Neurobiological mechanisms for opponent motivational processes in addiction. Philosophical Transactions of the Royal Society B: Biological Sciences, 363(1507), 3113-3123.
Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773.
Lembke, A. (2020). Dopamine Nation: Finding Balance in the Age of Indulgence. Dutton.
Sinha, R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141(1), 105-130.
Tice, D. M., & Bratslavsky, E. (2000). Giving in to feel good: The place of emotion regulation in the context of general self-control. Psychological Inquiry, 11(3), 149-159.
Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371.
Wise, R. A. (2009). Roles for nigrostriatal—not just mesocorticolimbic—dopamine in reward and addiction. Trends in Neurosciences, 32(10), 517-524.

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