What We Know is Driving Addiction: Dopamine

Addiction is often thought of as a decision or selfish behavior. What if I told you that the process of addiction is an automatic unconscious process of the brain that acts like a reflex? Dopamine is a big player in how the brain works and continues cycles of addiction. Dopamine is released in abundant amounts while using drugs or engaging in compulsive behaviors (e.g. gambling, sex, and compulsive eating.) But dopamine is also released as a reaction to stress, which creates the cycle of addiction.

When an individual experiences stress, they release Corticotropin-releasing factor (CFR) which activates a stress reaction in the body. To counter this reaction and create homeostasis, the body activates dopamine to oppose CFR and drop the CRF response. Once dopamine is released, individuals will want to seek whatever their body associated with dopamine. Individuals suffering from addiction, this would most likely be their substance/s of choice. Because these substances have such a high association with dopamine, the individual will have a "reflex" to automatically desire the substance. This would be a trigger to the reward effects of the compulsive behaviors. This state is unconscious and automatic and is not controlled by the individual.

Four Major Effects on the Brain

When an individual uses a substance, high unnatural levels of dopamine flood the brain and four major effects occur.

1. The substance that breaks down the substance called an enzyme begins to increase; therefore depletes the natural substance available.
2. The brain down-regulates the system by closing off receptor sites on nerve cells that the substance attaches to neurons.
3. The brain begins to produce less of the natural occurring substance that naturally binds to those receptor sites.
4. The genes which are turned on and off based on the environmental factors is referred to as the epigenome system. Epigenetics of individuals suffering from addiction can be altered by changing which genes are expressed based on chemical compounds that impact their activity.

Stress and boredom are often the sources which release CRF but also deeper-rooted problems like unresolved loss, history of untreated trauma or attachment and abandonment issues within relationships. After examining the process of CRF, it is easier to understand why individuals would avoid sources which activate CRF. This can be avoiding therapy, avoiding triggers of stress, or through activating reward systems by using substances that activate dopamine to deplete CRF.

The presence of CRF and spikes of dopamine decreases frontal lobe functioning. We refer to this low functionality of the frontal lobe as, Hypofrontality. Hypofrontality would result in reduced abilities to reason, logically plan and categorize, problem solve, maintain attention, proper judgement and reasonably reduce or avoid habitual responses or tempting behaviors.

Treatment and Recovery

What does this mean for treatment and recovery?

1. The development of a relapse and recovery plan to help client's reduce and manage stress is key to recovery.
2. Utilization of psychotherapy to learn and cope with trauma or deep rooted issues that the client might be avoiding through the use of substances.
3. Start rewiring the client's brain reward system with healthy adaptive behaviors, like exercise or hobbies. This will allow the stress and dopamine response to push the client towards healthy behaviors and decreases the desire to go back towards the substance.
4. It is recommended that individuals stop all substances. If clients continue to activate the dopamine response in the brain, it will be more difficult to detour to healthy coping skills. We know through a meta-analysis that individuals that continue to smoke tobacco in rehabilitation are 30% more likely to go back to their drug of choice.

The good news is the brain can recover. We know it can take 18 months for the brain to have reached maximum recovery. The majority of recovery happens quickly within the first few months. The brain recovery then slows down but continues to improve over the following months. Clients and family members must understand the neurophysiology of addiction. Understanding neurophysiology of addiction will not only help reach recovery and remission, but help maintain empathy and compassion throughout the treatment process.

Ann-Marie Sands, LCSW, CADC