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Desire, Reward, Craving, and Addiction

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Pamela Barnett

on 19 March 2017

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Transcript of Desire, Reward, Craving, and Addiction

Desire, Reward, Craving, and Addiction
Descent into Porn Addiction
Unlearning
learning something new triggers a chemical process called long term potentiation
Cravings and the Brain
Pleasure and Reward
Addiction, Context, and Behaviour Principles
Most addictive behaviour is not related to physical tolerance nor exposure to cues
People compulsively use drugs, gamble, or shop nearly always in reaction to being emotionally stressed - whether or not they have a physical addiction
Addiction is not simply a search for pleasure
Addiction has nothing to do with one's morality or strength of character
Ongoing debate - What is addiction?
Do drug dependence and addiction mean the same thing?
A disease?
Four Generally Accepted Views About Addiction
from Psychology Today
Two
Pleasure
Systems
from Doidge, Ch. 4
Appetitive - dopamine system
Consummative - opioid endorphin system
excites pleasure
relates to anticipating or imagining something we desire
satisfies pleasure
relates to feeling pleasure when we have fulfilled our desire
releases dopamine and we experience pleasure
releases endorphins and we feel euphoric
Cravings and the Brain
Addiction and the Brain
Learning / Unlearning
Memory and anticipation create an intense desire for more of the pleasure-giving, euphoric experience
Cravings occur when the brain becomes tolerant or sensitized to a drug or experience
Cravings are strong memories that are linked to feelings of pleasure and euphoria
Cravings
Sensitization vs Tolerance
Sensitization is different from tolerance
As sensitization develops, less and less of the substance or experience is required for the person with an addiction to want it intensely
As tolerance develops, more and more of the substance or experience is required for the pleasant effect to occur
Sensitization may to increased wanting
Wanting vs. liking
Addiction is complex - it's more than a medical issue
Craving the next fix is not simply a matter of anticipating the pleasure it gives or avoiding the pain of withdrawal
People who are addicted want and take drugs when there is no prospect of pleasure
Cravings
Sensitization
Tolerance
Wanting
Liking
from Doidge, Ch. 4
Even when they know they don't have enough of the substance for a high
They may crave more even before they begin to withdraw
High Price
by Dr. Carl Hart
from
Dr. Carl Hart's
High Price - A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society
(HarperCollins 2013) is an influential and informative exploration of this topic.
Dr. Hart combines autobiography, science and behavioural psychology to challenge prevailing views of addiction and the people we tend to refer to as "addicts."
In Hart's words, "the emotional hysteria that stems from misinformation related to illegal drugs obfuscates the real problems faced by marginalized people. This also contributes to gross misuses of limited public resources."
Politics and Propaganda
There is a tendency to reduce "complex human behaviour to simplistic terms like addiction and with trying to blame specific brain chemicals for people's actions" (Hart)
Brain Chemistry and Behaviour
The recent decades have been an age of new discoveries in neuroscience
Much emphasis has been placed on neuroplasticity and brain chemistry
Hart shifts the emphasis from brain chemistry to behavioural principles
Factors Affecting Drug Abuse
Mindset
Social Context
Negative outlook
marginalization
lack of prospects
absence of alternative reinforcers
Substantial Evidence
research and studies
with human subjects
on animal models
e.g. "rat park"
The Story of Sean Thomas
from Doidge, Ch. 4
Changes to Sean's brain maps
Changes in his sexual taste
Plasticity-based
focused attention
repetition and practice, over time
incremental process
LTP
LTP strengthens connections between synapses to create neuronal networks
LTD
unlearning requires a chemical process called long term depression
LTD weakens or loses connections between neurons
Plasticity-based processes
"Neurons that fire together wire together"
"Neurons that fire apart wire apart"
Roadblocks
a device or strategy that blocks or constrains an established neuronal pathway
in order to develop an alternative network of connections
e.g. Pascual Leone's blindfold experiment
the brain reorganizes quickly
however, change is temporary when the roadblock is removed after a short duration
It's a difficult path from drug addiction to recovery
Wikipedia Commons
ventral tegmental area VTA
nucleus accumbens
a small group of neurons located in the midbrain
uses dopamine as a neurotransmitter
a group of neurons located in the forebrain
receives input from the VTA

Here a link to my review of Carl Hart's book:
https://www.academia.edu/4190770/Review_of_Dr._Carl_Harts_High_Price
focused attention
motivation
repetition and practice over time
https://sites.google.com/site/prebarnett/neuroplasticity/pleasure-and-reward
How do drug use, drug abuse, and drug addiction differ?
Drs. Gabor Mate (
In the Realm of Hungry Ghosts
, Vintage Canada 2008) and Marc Lewis (
Memoirs of an Addicted Brain
, Doubleday Canada 2011) are among neuroscientists who have applied biology, sociology, humanism, and behaviour principles to inform and change our understanding of addiction.
http://www.spectator.co.uk/features/11260/self-abuse/
Spectator,, London UK, 2003
Craving is one of the characteristics of addiction
Cravings persist in spite of the person's awareness of the harm and ill effects cause by the object being craved
Do drugs cause addiction?
Addiction involves:

1. compulsive engagement and preoccupation with the behaviour

2. impaired control over the behaviour

3. persistence or relapse, despite evidence of harm

4. dissatisfaction, irritability or intense craving when the object is not immediately available

Dr. Gabor Maté
In the Realm of Hungry Ghosts
, 2008
Dependence
In medicine, dependence is evidenced by physical withdrawal symptoms
Dependence is one of the characteristics of drug addiction
However, physical dependence does not necessarily imply addiction
You don't have to be addicted to experience withdrawal
You just have to have been taking a medication for an extended period of time
For addiction, there also needs to be craving and relapse
Dr. Gabor Maté
In the Realm of Hungry Ghosts
, 2008
A mental illness?
A biological response to environmental, circumstances - political, social, economic...?
Here's the URL for this captioned TED Talk:
https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong?language=en
Everything You Think You Know About Addiction Is Wrong - TED Talk by Johann Hari
There is no addiction centre in the brain
Brain systems involved in addiction are among the key organizers and motivators of human emotional life and behaviour
soothes pain, both physical and emotional
responds to reinforcement, reinforcers
associated with self-regulation
plays an essential role in learning
Addiction hijacks the brain systems we rely on for pain relief and survival
A crime?
Pursuing pleasure or seeking relief from physical or emotional pain?
Food for thought:
"We need to avoid the trap of believing that addiction can be reduced to the actions of brain chemicals or nerve circuits or any other kind of neurobiological, pyschological or sociological data" Gabor Maté, In the Realm of Hungry Ghosts (2008)
"It is impossible to understand addiction from any one perspective" Dr. Gabor Maté
Hopelessness
Despair
absence of social, interpersonal connections

Note - "drugs of abuse" is not neutral language.
Remember - dopamine is also the neurotransmitter that consolidates learning by strengthening the synapses and pathways associated with learning a new concept, skill, procedure, etc.
Food for thought:
One person's pleasure and euphoria may be another's relief from physical or emotional pain
A person does not need to have developed a tolerance to be addicted
Learning/Unlearning
e.g. Jeffrey Schwartz's 4 Step therapy for OCD
All three have direct or indirect experience with addiction.
Full transcript