The brain’s reward system is a complex collection of neurons, neurotransmitters and brain structures. It is a natural process. The brain uses it to maintain behavior. Associations between stimuli, events and behaviors are made and strengthened. Desirable outcomes are encouraged, and poor decisions are punished.
Our behavior is influenced by the rewards we receive. External rewards result in internal changes in neurotransmitter levels, neural firing patterns, and structural changes. When we eat something we like, we get a little surge of dopamine. When someone says you look nice today, you get another little surge. When you take cocaine or meth, you get an ocean of dopamine such as nothing else can ever match. The more drugs you take, the more waves of dopamine, and the less free will you have.
What is the brain’s reward system?
One of the most asked questions I receive is why people addicted to drugs or alcohol don’t stop. They know they are ruining their lives. They know they are losing their marriage, family, house and job. Why don’t they stop? It doesn’t make any sense.
The problem is we assume people are rational. For the most part we are, expect when we buy things on impulse, “diet” but still eat the last donut, or fall in love. Or when we are on drugs.
Caleb (not his real name) was a student of mine. During a lecture on drugs, he shyly sort-of-kinda raised his hand in a defense movement. He wasn’t looking at me or toward the projection screen, but he looked uncomfortable. I glanced at the slide and quickly changed it to a black screen. It had been a picture of a syringe, and it was triggering Caleb.
Addicts get easily triggered by stimuli even after years of being clean. A glass of dark looking liquid or a stein of beer can be unbearable for an alcoholic. Cigarettes or smoke can trigger smokers. Even the word heroin can trigger a former druggie.
We have a normal reward system that gets hijacked by drugs. Let’s take a common situation: the smell of coffee in the morning. I love the smell of coffee first thing in the morning. It’s comforting and reminds me of home. My parents brewed coffee every morning.
As you know, coffee contains caffeine, a weak stimulant that is GRAS (generally recognized as safe). Safety, of course, depends on dosage. A tablespoon of powdered caffeine (10 grams) will kill you. This is equivalent to 50-100 cups. Anything over 5 cups a day is probably unwise.
Caffeine is used worldwide but it is a psychoactive drug. It does impact your brain. It makes you feel more alert and less sleepy. The downside is that it doesn’t mean you don’t need your sleep, just that you’re not getting the normal signals telling you to slow down.
I ask my students to give up something for 20 days. Twenty days for 20 extra credit points. Many choose to give up caffeine. The results are predictable. They experience withdrawn symptoms, such as sleepiness, headaches, heart palpitations and general irritability. They get in fights with the significant others, have difficulty concentrating and do poorly on tests.
Maybe next time I should warn them. Naw, it’s a learning experience. I want them to understand how hard it is to give up a small stimulant like caffeine so they will empathize with the gigantic pull that super-stimulants like cocaine and meth have a person.
It’s the brain’s own reward system that is impacted by drugs. Most of the effects of caffeine are reversible. Many of the effects of other drugs are not.
What Does It Do?
The reward system tells when something is important. It can be important good or important bad. The system is a series of brain regions that work together to mark importance and indicate how important it is compared to other items.
When we eat a delicious meal, we raise the level of its importance. Our “yumminess” meter goes up. When we smell spoiled milk, our “yumminess” meter goes down. We have a hierarchy of rewards that continuously readjusts to the environment.
Rewards are internal states. We feel rewarded. We like it when people smile at us, say hello and tell us how much they like us. We use the reward system to maximize those positive feelings and minimize the negative ones that come from unpleasant experiences.
Some behaviors are intrinsically rewarding. Our desire for food helps keep us alive. Our desire for orgasm helps keep our species viable.
Other rewards are more extrinsic. We like to get a paycheck mostly for what it can buy us. The check itself is not as rewarding as the stuff we can get. This explains why we prefer to make purchases instead of put everything in savings.
Rewards do more than make us happy. They affect behavior.
If rewards are the inside feelings, the external factors are what B.F. Skinner called reinforcements. By nature, we move around and interact with our environment. The consequences of these behaviors increase or decrease our likelihood of doing them again. In other words, we use our internal reward system to track our external interactions.
When we gain something as a consequence of our behavior, Skinner calls it a positive, as in posit or deposit. It is something we get. Something added which we like (positive reinforcement) increases our likelihood of doing it again. Something added which we don’t like (positive punishment) decreases our likelihood of doing that same behavior again.
When we lose something as a consequence of behavior, it is a negative, as in negate. It is something taken away from us. When we like having it taken away (not having to do chores, for example), it is negative reinforcement. When we dislike having our car keys or privileges taken away, it is negative punishment.
The general nature of punishment is to stop behavior. The general tendency of reinforcement is to increase behavior. Naturally, what you and I like can be different. If someone gives you a chocolate chip cookie, it is a positive reinforcer or a positive punishment solely based on whether you like chocolate chip cookies.
That’s one of the problems with trying to reinforce someone else’s behavior. What the receiver likes can be vastly different from the giver’s point of view. Remember getting a Christmas present from someone else thought you’d like, rather than the present you really wanted?
Some people are motivated by money. But other workers might prefer a better job title, or a bit of respect for the hard work they do. Reinforcers are very personal.
Our brain adjusts its internal reward system to accommodate these environmental consequences. It does it directly by adjusting the priority hierarchy and indirectly by using environmental cues.
Let’s assume the reward system is like the symbols and notifications that appear on your car’s dashboard. It notifies you of important information, both good and bad.
You have one meter that shows how much good you feel. The more reward you receive, the more the meter signals pleasure. You have a separate meter that displays bad feelings (fear, anxiety, sadness, etc.). You can feel happy-anxious.
Your metaphorical car also keeps track of locations (environmental cues). It knows what you do in one neighborhood and what you don’t do in another. The brain makes associations between your reward level and all the environmental cues that surround you.
My brain stored the smell of coffee with cues about my family home, my age, and my family members. Your brain stores your favorite restaurant’s food, décor, smells, lighting levels, location, time of day and a thousand other details. It ties all of these associations together.
Your reward system tracks the amount of reward, its importance and salience (how much we notice it; brightness of dashboard lights). Salience is adjustable. Some days we notice details that have escaped us for months. Other days, we notice hardly anything.
We couple this combination of cues, salience, importance and reward level with an estimator. We predict both the size of future rewards and likelihood of them occurring. We play the lottery when the reward size is large, even when the likelihood of winning is low. Some suggest we also choose potential mates on the basis of attractiveness (reward size) and willingness to date us (likelihood). According to this theory, we might ask out someone less attractive because we predict they are likely to say yes.
All of this occurs automatically. The reward system of the brain tracks millions of cues, rewards, salience, importance levels and uses all of this data to predict future rewards, their likelihood and how to repeat those experiences.
Where is the brain’s reward system located?
If the reward system was a movie it would have three major locations and two leading roles. The locations are each complex entities in their own right but work together to make things even more confusing.
The locations are the prefrontal cortex, the basal ganglia and the thalamus. The leading roles are two neurotransmitters: dopamine and GABA.
Prefrontal Cortex
The first location is the prefrontal cortex. It is both easy and hard to find. Let’s start at the top and work our way down.
As you know, the brain has four major lobes (frontal, temporal, occipital and parietal). The frontal lobe has three major components: the motor cortex (to move your muscles), the premotor cortex (for planning movements) and the prefrontal cortex.
This prefrontal cortex has three parts too. The dorsolateral portion houses rules about rules. It is the last region of the brain to myelinate. It helps integrate information from all the other parts of the brain, and uses that data for high level motor planning. The dorsolateral cortex is involved in working memory, decision making and comparing inputs. You don’t blurt out what you’re thinking because your dorsolateral region helps inhibit your impulses. On the other hand, when you lie it’s because of your dorsolateral cortex. Our tendency is to tell the truth. When we want to lie, we have to use brain power to make up the lies. When you suffer from sleep deprivation, it is the dorsolateral region that is mad at you. Tumors in this region produce schizophrenia-like symptoms.
The dorsolateral cortex is directly bi-directionally connected to the orbitofrontal region, which houses rules about when you should switch what you are doing. When the orbitofrontal area is damaged, patients suffer from lack of control. They swear excessively, become hypersexual, have poor social interactions. They can’t judge social awkwardness, have poor emotional regulation and display compulsive behavior common in ADHD and OCD.
The orbitofrontal cortex is involved in three major issues related to reward: Alzheimer’s, gambling, and drug abuse. It is one of the brain regions where the neuro-tangles of Alzheimer’s occur. Something happens to the neurons and they get tangled up and die. The result is poor emotional regulation and a lack of intuitive judgement. Rewards seem to be overvalued and punishment (or loss) is underestimated.
The orbitofrontal region is involved in comparing expected and actual outcomes, and evaluating reward and punishment expectations. Damage to the orbitofrontal area results in compulsive behavior. For example, it shown a button labels DON’T PRESS, patients can’t stop themselves from pressing it. The inability of gamblers to effectively evaluate their losses is correlated with damage to the orbitofrontal cortex.
Similarly, the orbitofrontal portion of the prefrontal cortex allows you to switch rules when you need to. When the region is damaged, patients can’t switch away from an activity even though they can articulate that they should. They get stuck. They continue to pursue losing hands.
The orbitofrontal cortex is also involved in drug addiction. In addition to the compulsive use of drugs, cravings are associated with activity in this region. During cocaine withdrawal, the more you crave, the more activity there is in it.
As withdrawal continues, the orbitofrontal area activity drops to below normal levels. Three to four months after stopping cocaine use, the orbitofrontal region is not working as well as non-drug users. A similar pattern occurs in alcoholics.
Since the orbitofrontal cortex is involved in evaluating the emotional value of reinforcers, this might lead to an increased motivation to take a drug.
The three prefrontal cortex parts (dorsolateral, orbitofrontal and ventromedial) all work together. The orbitofrontal and dorsolateral are directly interconnected by neurofibers. The orbitofrontal and ventromedial portions are anatomically inseparable. All three do somewhat different functions but are so intertwined it is difficult to say when they aren’t working together.
Thalamus
“All roads lead to Rome” is a great metaphor for the thalamus. In the days of Caesar Augusus, all roads led to a monument (Milliarium Aureum) in the middle of Rome. Distance along any road was measured from this monument, so the saying should really be that “all roads lead away from Rome.” Both directions work for the thalamus. Everything directly or indirectly comes to or is sent from the thalamus complex.
The thalamus sends and receives input to most regions of the cortex. This thalamus-cortico-thalamus loop provides a complex feedback system. Specialized cells in the thalamus oscillate in response to the rhythmic patterns of neural input. The level of oscillation correlates with the level of cortical response.
In addition to being the processor of incoming stimuli and the filter for outgoing traffic, the thalamus is the center of pain perception. It regulates sleep, consciousness, alertness, and every sensory input but smell. One region (the LGN) accepts all the inputs of the eyes and transfers them to the occipital lobe. Another nucleus (the MGN), transfers all of the auditory inputs to the temporal lobe. Degeneration of the thalamus results in permanent insomnia and eventually death.
The hypothalamus is part of the thalamus complex. It runs much of your life. When the bark of a big dog scares you, it is the hypothalamus that triggers your fight-flight response. When you are hunger or thirsty, the hypothalamus is at work. If you have a menstrual period, it is caused by the cyclical properties of the hypothalamus. The hypothalamus is involved in sleep, circadian rhythms, and body temperature, among others. It is the major link between neurons and hormones.
The thalamus is in the center of the head and just above the midbrain (substantia nigra, inferior colliculi, superior colliculi, etc.). Neurons extend out in all directions. It is the Rome of your brain.
Basal Ganglia
In addition to the prefrontal cortex and the thalamus, the basal ganglia is a major component of the brain’s reward system. It’s basal (basement) because it is located under the cerebrum. It’s ganglia (neuron cluster or swelling) because it is not a single structure but several entities that work together as a single unit.
The basal ganglia is the brake of the brain. It works on the disinhibition principle. Basically, it says “No, No, No, No” until it receives an input that releases the brake. It balances the excitatory inputs of the cerebellum to make your dance movements smooth. It balances the cortical activity to calm you down. It balances the thalamus activity to help regulate your emotions.
Balance is important. Too little braking initiates multiple uncontrolled simultaneous activities. This is what happens in Huntington’s disease. In contrast, Parkinson’s disease is the result of too much braking. It makes it difficult to initiate movements.
The basal ganglia is composed of two major structures and two smaller ones. The striatum is the largest structure. It looks like two blobs of gray separated by large white stripe. It receives inputs from many brain areas but only outputs to other parts of the basal ganglia.
1. Striatum
The striatum coordinates multiple aspects of cognition, including action planning, decision making, motivation, reinforcement and reward. The striatum is activated by novel, intense or unexpected stimuli. Its activity is associated with reward and aversive stimuli. Huntington’s is a genetic disorder that causes damage to the striatum.
Its dorsal aspect of the striatum is composed of the caudate and putamen, which together look like a backward “at” sign (@). The putamen, the center circle or “a” of the at-sign, is the outermost portion of the basal ganglia. It interconnects with the thalamus and many brain regions. It is involved in the learning of skills and movements, and is one of the regions damaged by Parkinson’s disease.
The caudate (semicircular tail) is also damaged by Parkinson’s. In addition to regulating motor functions, the caudate is involved in procedural learning (do this before that) and making associations. It is plays a major role in the reward system (cortico-basal ganglia-thalamic loop).
The ventral (opposite of dorsal) striatum is composed the olfactory bulb and the nucleus accumbens. The olfactory bulb is the primary region for processing smell. The interaction of the olfactory bulb and the basal ganglia explains why smells can produce such strong emotions.
The nucleus accumbens is sometimes called the pleasure center of the brain. Remember those rat studies where they pressed a lever to get more brain stimulation? The probes were placed in the nucleus accumbens.
But pleasure and reward in humans is not that simple. The nucleus accumbens plays a major role in the cognitive processing of motivation, pleasure, reward, reinforcement, aversion and addiction. It plays a minor role in processing fear, impulsivity, encoding motor skills and the placebo effect. It is particularly good at encoding new motor programs that help us get future rewards.
The nuclei (one in each hemisphere) each has two parts: a shell and a core. The shell processes want (motivational salience) and influences the perception of rewards and reinforcements. It responds both to drugs and naturally rewarding stimuli.
Stimulating the nucleus accumbens strengthens associations between a drug and its environmental cues. Even after stopping its use, the look, smell, who you are with, lighting and environmental cues associated with taking cocaine and amphetamines continue to trigger an emotional response. These triggers can last for months or years. Alcohol use has similar effect.
In addicts, the nucleus accumbens appears to release seratonin, dopamine and perphas other neurotransmitters. This release correlates with drug cravings. The prefrontal cortex also seems to be activated by or causes cravings.
2. Pallidum
After the striatum, the pallidum is the second large component of the basal ganglia. It receives input from the striatum and sends inhibitory output (GABA) to a number of motor-related areas.
The pallidum is involved in planning and inhibiting movements. This includes movements that are voluntary and those well-practiced movements that are more subconscious. As a balance to the cerebellum, the pallidum allows smooth and controlled movement.
The dorsal portion of the pallidum (the globus pallidus) contains very large neurons that form a 3-D cluster of flat discs. It directly outputs to the substantia nigra.
3. Substantia nigra
Located in the midbrain (the region between the limbic system and spine), the substania nigra is closer to the pons than anywhere else. It receives input from the globus pallidus and outputs to many brain structures. It also supplies the striatum with dopamine.
The substantia nigra impacts both movement and emotion. It is probably best known for its connection with Parkinson’s disease. As we age, we lose a few of the dopamine neurons in the substatia nigra. We have plenty so it it’s really a problem until we have lost 70-80% of them. The premature and massive loss of dopamine neurons in the substantia nigra causes Parkinson’s symptoms.
GABA
The most prevalent neurotransmitters in the brain are glutamate and GABA. Glutamate is an excitatory neurotransmitter. It accounts for 90% of the neurons in the brain. It is the “GO, GO, GO” signaler of the brain. In contrast GABA, which is synthesized from glutamate, is the “STOP, STOP, STOP” signaler of the brain. It accounts for about 9% of the brain’s neurons. The basal ganaglia primarily outputs GABA.
Dopamine
When something happens that you want to remember, your brain releases several neurotransmitters to mark it as important. This is true of good things and bad things. Anything that seems important. One of those neurotransmitters is dopamine.
Dopamine is released from an area under the cortex and above the spine. It is either part of the substatia nigra or next to it. This VTA (ventral tegmental area) isn’t as much a nucleus (cluster of gray matter) as it is a borderless region or zone. You’ll find it next to hypothalamus, the red nucleus, the pons and the substantia nigra.
You probably know that the pons connects the cerebrum to the cerebellum, and back again. It and the red nucleus help you coordinate your movements and swing your arms when you walk.
From the VTA, dopamine neurons connect first to the nucleus accumbens, and then head for the prefrontal cortex, with branches leading to most portions of the brain.
How The Brain’s Reward System Works
The reward system is an integral part of our perceptual system. When you are awake, you are constantly moving around and doing things. You are both producing behaviors and receiving inputs.
As you engage the world, your brain does a preliminary assessment of importance. It works on the principle of triage. The most important things are dealt with first, things that can wait are put on hold, and things that stay the same are ignored.
If something is important, a small dose of dopamine, norepinephrine and other neurotransmitters are released. Dopamine is not so much a pleasure maker as an importance marker. Since we think pleasure is important, there is quite a bit of overlap between them. But dopamine is also released when you feel you are in danger.
If something really important happens, large doses of dopamine are released. Obviously, threats and novel stimuli are most important. Moving objects, strange noises, loud sounds and unusual smells are also very important to us.
Rewards can be classified as lures or reinforcements. Lures are attractive things you dangle just out of reach. This is the carrot of carrot-stick fame. You get the donkey to go by keeping the carrot dangled just in front of the donkey’s nose. In human terms, this is an inducement. It is simple to use, comes naturally do us, and effective in the short run.
Imagine you are trying to train a dog to jump through a hoop. One way is to take a treat and, keeping it just out of reach, move the treat and dog through the hoop. You can get a dog to walk beside you or sit by moving the food in your hand along the path you want the dog’s body to follow.
The downside is that the dog’s focus will be on the treat. The dog will not look at you during or after the exercise. Nor will they be focused on doing the task. So lures only work for simple tasks. Even proponents of its use recommend limiting it to 3-4 times, and they usually combine it with giving the dog the treat (reinforcement).
Reinforcements teach the dog the rule. It is a contract. You do this and I’ll give you that. On a grand scale, it’s not a very complicated rule but, unfortunately, dogs aren’t really good at rule acquisition. Animal trainers point out that dolphins, whales and elephants are superfast at learning rules. Dogs? Not so much.
The advantage of reinforcement is that it is long lasting, portable and fair. Reinforcement looks at patterns of behavior over time. It is inconvenient to carry fish food, apples and bones in your pocket just in case you have to lure your goldfish, horse or dog. Reinforcements maintain behavior patterns over long periods of time. You still do some things you were reinforced for as a child.
Reinforcement is portable. Luring tends to be environmentally specific. The dog learns to do it only under certain circumstances, the most obvious being that you have a treat in your hand.
Compared to luring, reinforcement is fair. It a contract that says it A happens then B will happen. If you never give the dog his bone, and only use it as a lure, you’re not being fair. If you give it to the dog after getting the dog to do what you want, it is called reinforcement. Skip the lure and start with reinforcement.
People like luring because they want to be in control. I know someone who wants their dog to “respect” them. What they mean is compliance. I’ve seen people do the same thing with their children. “When I walk into a room, my children should stop playing and immediately come and hug me. It’s a matter of respect.”
It is hard to forget that we are not in control of others’ lives. Being a tyrant is a bad thing. Working with others, humans or animals, is a cooperative process. Just because you can pick them up, doesn’t mean you have the right to force them.
I always recommend people begin animal training with chickens or whales. Neither animal will do what it doesn’t want to do. Whales, elephants and Great Danes are great because they are too big to bully. You must learn to interact with them. You must learn to negotiate.
Chickens, goldfish and hamsters can be physically bullied but they are so dumb that again you must learn to negotiate. They will only do what you and they agree to do.
Contract negotiation produces cooperative interaction. If you want instant compliance, buy a robot.
Another contrast between luring and reinforcement is the focus. In luring, the focus in on the food. In reinforcement, the focus is on performance. The perceptual centers of the brain are centered on different sources. It makes a difference in what the animal tracks.
Reinforcement also allows your dog to learn more complex patterns of behavior. Luring only works on simple tasks.
Which portion of the brain being activated is different too. Being lured into activity provides a little of spike of dopamine. This is anticipatory reward. It is marking it as something to look forward to. It is a simple reward and activates the general reward centers. This is what happens when you enjoy a snack. Your brain registers that it tastes good. You “good” meter spikes.
In reinforcement, more brain centers are activated. In humans, it means that the prefrontal cortex of the frontal lobe is involved, in addition to the amygdala’s emotional “good” response. Whenever we are involved in rule making, more processing is required. But the rule is more portable. It will work in more situations.
Reinforcement requires practice in other situations too. You must teach your dog that the rule applies here, and here, and here. This is similar to teaching your children that this rule applies here but not there. It is okay to yell at a baseball game but not in the library. Every rule needs generalization but reinforcement rules work better than luring.
Notice that dopamine works as a marker. Its release signifies that THIS is something to remember in the future.
In training, it helps to have a marker you can use to specific what THIS is. A marker can be a word, gesture or sound. You can say “Good” or “Hai.” Your dog isn’t a native speaker of English or Japanese. Any word you choose could work. But shorter is better.
Sound works even better as a marker. A toy clicker is a great marker. It is a bent piece of metal and clicks when you push is down. And clicks again when you release it. The click a clear cue, has a quick onset and is distinctive. The quick onset helps the animal know what is being rewarded. The distinctiveness lets it stand out against all the background noises. It can even be used from far away (something a lure can never do). A clicker is good. It would be even better if it didn’t have two sounds.
I should point out that the clicker is used only for training. You have to have it with you during training but not afterward. By the way, having training sessions is a good thing. It helps differentiate between school and home.
Clickers, like words, don’t mean anything to the dog until you pair it to a reward. Remember Pavlov’s dogs? They began to salivate to the sound of a bell because it had been repeatedly paired with their food.
Basically, it is a reflex being triggered by a previously neutral stimulus. This classical conditioning occurs with all of the stimuli around us. We learn to find peace at the ocean or excitement at Disneyland. We associate Christmas with snow, even if we live in Southern California.
These environment cues not only serve to reward us but to protect us. When we were children, our family went out for Chinese food for special occasions, including (as we got older) birthdays. My brother loves prawns. He could eat a million of them, he said. And what he really wanted for his birthday at age 14 or 15 was a whole platter for himself.
My parents complied. My brother ate them all (or close to it) and never wanted them again. For several years, just the word prawns disturbed him.
All the smells, lighting, decorations, and ambiance provide cues we use to store important information, such as don’t let me be that stupid again.
My story is as an adult. I took my family to a fancy burger joint, got sick and never wanted to go back to that place. When you get food poisoning, your brain keeps track. In fact, it makes a BIG mental note. Positive circumstances may take dozens of pairings for us to make associations. It took Pavlov’s dogs 50-75 trial to learn that the bell meant food was coming. But one dose of food poisoning is enough. Your reward system is very sensitive to adverse events.
One other thing before we talk about how the system can break. We not only learn single activities but chains of behaviors.
Think of your morning or evening routine. You get up, rub your eyes, go the bathroom, wash your face, go to the kitchen, take a shower, brush your teeth, get dressed and drink some coffee. Maybe not in that order but there is a chain of behavior you follow every day.
We learn forward chain but learning one item and then adding to it. This is how we typically learn a song. The good news is that works. The bad news is that we remember the first part well but less and less as we go. We remember “O Canada! Our home and native land!” Then we hum along until we get to “We stand on guard for thee.”
How The Reward System Breaks
There are two ways your reward system can breaks down. First, it can physically break from damage to the component parts. This is usually by disease (stroke, Parkinson’s, Huntington’s or Alzheimer’s) or by brain trauma (car crash, boxing or football).
Second, it can be hijacked by drugs. Any drug that is addictive impacts dopamine. If it’s addictive, it’s dopamine.
Drugs overwhelm your brain with dopamine. Think of your best orgasm (usually the highest natural high people have). One dose of cocaine feels 10x higher and more intense.
Cocaine leaves more dopamine in the synapses by disrupting its reuptake (recycling). Instead of going back into the cell for reuse, dopamine is left out in the synapse. Consequently, with so much dopamine out there, it takes very little more to trigger a neural connection.
The body tries to adjust to the new amount of dopamine present. As the tolerance increases, users take more cocaine to compensate. Eventually, they are taking very high levels of cocaine just to get as high as they used to.
Actually, you can never get as high as you used to (for a given dose). The first time you have a drug (or experience) is always the biggest impact it will ever have. Like your first love, first job and first car, your first hit of cocaine, heroin, or caffeine is always the largest.
Cocaine doesn’t stop there. It increases the deltaFosB levels with no tolerance ceiling. As you know (as least now), deltaFosB is a protein that changes your genetic transcription process. It elevates BDNF (brain-derived neurotrophic factor), which increases the number and complexity of dendrites (input receivers) in the brain, particularly the nucleus accumbens. This means that the brain is now more ready to receive cocaine-generated stimuli. Drugs change your brain.
Drugs increase your sensitivity to positive reinforcement. Being rewarded impacts you more than it did before. But the only reward that matters to you now is cocaine.
Remember your reward system is designed to regulate natural rewards, such as food, sex and exercise. We use this reward hierarchy to inform ourselves of what we should do. A cocaine user is no longer getting good feedback from the reward system.
In addition to increasing sensitivity to positive reinforcement, drugs decrease your sensitivity to aversion. Things that you found punishing before no longer bother you. You are less afraid of getting caught, less concerned about bad things that can happen to your or others.
On drugs, the brain also produces more compulsive reward-seeking behavior. The habit portion of the drug habit increases. Have you ever tried to stop drinking coffee, only to find yourself standing in line at Starbucks? Similarly, alcoholics find themselves drinking.
Drugs block receptors from receiving stimulation, bind them too long or prevent them from binding at all.
The also fool the transporters that recycle the neurotransmitters. Amphetamines are synthesized to imitate dopamine. They are so dopamine-like that the transporters prefer them to the real thing, and reuptake them instead.
How long does it take to get addicted? Once+. For some people, once is enough. For others, it takes repeated does to become dependent. It’s all about body chemistry. And there is no way of knowing how many doses it will take you.
Drugs are well-known for their cravings. This is another result of the reward system. Activity in the prefrontal cortex correlates with these cravings. Cravings are powerful urge to have more. Think of the cravings some women have during pregnancy and amplify them. Cravings for some drugs can last for months after disuse.
Inhalants not only impact dopamine but also deprive the brain of oxygen. The brain’s multiple components work together. When one region shuts down, it tries to find other ways of coping but isn’t always successful. If the brain is deprived of oxygen for even a relatively short period of time, it cannot always make reconnections with itself.
Many drugs are toxic in and of themselves. Alcohol is metabolized in a two-stage process. The first stage converts toxic alcohol into an even more toxic state. This phase results in headaches, rashes, vomiting and other symptoms. But the body is doing its own version of finding a common denominator.
Remember your elementary school mathematics? To add or multiply fractions, you often have to find a common denominator. Something the items have in common. With alcohol, the body is trying to find something it can easily disassemble. First, it converts alcohol into a complex substance. Second, it disassembles it into what is essentially vinegar.
Hangovers are the result of finding a common denominator.
Stimulants increase the frequency of neural firing. Opioids slow them down. Hallucinogenics can do both and also change the timing. LSD impacts the brain by changing the firing rhythm. It makes neurons fire out of sequence.
How To Fix The Reward System
When the reward system is broken, there is nothing you can do. We don’t have replacement parts. You can’t swap out a damaged thalamus and put in a new one.
Clearly, there is only one thing to do: don’t get sick. Don’t have a stroke or get any disease. Just stay healthy and you’ll be just fine.
When a reward system is hijacked by drugs, the key thing to do is nothing. No cocaine, no meth, no alcohol, no marijuana, no LSD, no opioids. Just do nothing.
Now it turns out that doing nothing is hard work. Staying clean and sober has to become your primary concern. Yes, you can work. Yes, you can have fun. No you can’t do drugs.
The brain is relatively plastic. Soft plastic. It can bend and change its shape to adapt to the environment. It can heal itself from hijack, mostly.
Remember how the reward system highlighted the drug as most important and everything else as less important? It takes a while for that to reset. And it probably never resets completely. Addicts can relapse. After years of being sober, addicts can still relapse.
If it is irrationally difficult to give up coffee, think of how much more difficult it is to discontinue cocaine or alcohol. All of those environment cues have what feels like a magnetic pull. They draw you without your consent.
Alcoholics can’t imagine why anyone would not drink all they can. They see people in restaurants leaving behind a glass of wine that’s half full. Who does that? How is that possible? Druggies don’t get it.
The point is that every time you take a drug, your free will diminishes. The first time you got high was your choice. You had your demons too but the choice was yours. But every dose you take lessens your free will.
The first time was because of you. Maybe you wanted to party. Maybe you wanted to forget life. You may have a father who didn’t show love, people who expected more from you than you had to give, or a neurotic need for love and attention.
Some of the risks factor for starting drugs include your social environment (everyone at work goes out to drink) and childhood trauma (abusive parents, sexual abuse, hostile family life). You might want to blame your addiction on these factors but they are only nudges.
Some say that it’s not the drugs. It’s the escape. Edgar Allan Poe said; “I have absolutely no pleasure in the stimulants in which I sometimes so madly indulge. It has not been in the pursuit of pleasure that I have periled life and reputation and reason. It has been the desperate attempt to escape from torturing memories, from a sense of insupportable loneliness and a dread of some strange impending doom.”
Edgar was only partially right. Drugs offer an escape but that’s not all they do. They affect your brain so that you’re not thinking right.
You started taking drugs. It was your free will choice, or free-ish at least. So feel free to blame yourself for starting.
But then, give yourself a break. Every dose lowered your free will. Has that sunk in? The drugs changed your reward system. They changed the very system that you rely on to make decisions.
Addicts don’t think when they steal money or rob someone. They are problem solving. They are compulsively trying to reach a goal: getting high. It’s the drugs.
The good news is that you don’t have an addictive personality. There is no such thing. It’s the drugs. Drugs don’t care if you are rich or poor, live in the city or country, have a great or horrible family, are popular or lonely, or are good looking or ugly. They impact everyone.
Yes, you might have a genetic predisposition. A family history of alcoholism suggests that you shouldn’t start drinking. A family member can mess you up. One famous actor got hooked on drugs because he was given marijuana by his father, at the age of 5.
But after you are hooked, it’s not the rotten role models, genetics and social pressures alone. The drugs change your brain.
You had your demons but if you want to blame yourself, limit it to the preliminaries, before you got addicted. Don’t blame yourself completely for being an addict. You must also blame the drugs.
The reward system is so powerful that there are some things addicts should expect when they decide to get clean. First, they have to stay away from triggers. Anything that will make them (think of it as forcing them) to take drugs again may well have to be removed.
There are many triggers. In drug rehab they often don’t say which drug was their drug of choice because the word itself can be a trigger for some people.
Triggers can also be people. Addicts often have to give up their old friends. Hanging around people who are currently high can be a trigger. It can be surprisingly difficult to choose between sobriety and friends.
The same is true of family members. You can’t divorce your siblings but you might have to stay away from them. Sometimes you have to find substitute family members.
You can see how important it is to have a strong support group. Usually friends and family are supportive on the person going into rehab. They say “Good. I’m glad she is finally doing something about it.”
But if an addict relapses, the support is harder to find. The more relapses, the less optimism and support the individual gets.
It may take more than one rehab to get sober. Rehab is an educational process. It requires your consent and active participation. There are no locked doors. You can leave whenever you wish. You actually do have to want to succeed for the process to work.
Rehab usually begins after detoxification, which lasts about a week. Detoxification is done in a hospital environment because getting off drugs requires special care. Each drug needs different treatment protocols. There are medications that can ease the shakes. But it can be dangerous, and in the case of alcohol deadly. Alcohol detoxification isn’t for amateurs.
Rehab focuses on the things all addicts have in common. It helps challenge the false beliefs we carry. It helps people assess triggers and take steps to avoid them.
The length of rehab varies. In general, rehab is too short. The longer the treatment, the better it is. Effective treatment seems to need a minimum 90-day but 150 or 180 days is better. Addicts need time for the environmental and internal cues to settle down. They have to let the brain recover.
Six months is enough time for the tolerance and cravings to diminish. Patients will typically feel good and ready to leave. There is sort of a let-me-put-this-behind-me attitude. Internally, the addict seems to think that they have been cured and are ready to go back to their lives.
Going back to your life can be a challenge. You will feel better before you are. You will think you are in top form but your brain is not ready for big decisions. The reward system still can’t be trusted.
Patients will feel so good and be so impatient to restart life that they make the mistake of making big changes in their lives. They might fall in love with other patients. This is a mistake.
Your brain is not ready to make good decisions for 3-5 years. During this period of time you need to rely on your friends and family for their feedback. You can’t trust the reward system, so trust them. Get the advice from others.
Best success is if seclusion in rehab is followed by two years or so of structured treatment. Group therapy is often the tool of choice. In addition to AA meetings or other support groups, patients should be followed closely by the rehabilitation center’s professionals.
Treatment for addiction takes time. Recovery is optimized with a program that provides two and a half to three years of treatment (moving from inpatient to outpatient to occasional follow-ups). It takes that long for the reward system to mostly recover and for triggers to trigger less.
Triggers are important because of those chains we talked about before. We use chains to help us learn a new song but they are at work in an addict’s life as a series of events that lead to relapse. It is difficult to stop a chain, so the focus is put on avoiding or eliminating the triggers.
Five years of nonuse is when addicts transition to advanced recovery. You have had five years of maintaining abstinence, so trigger have less impact and you have learned ways to cope with them. Most of drug dreams are gone, and you have learned to stay sober when you are happy and when you are sad. You’ve dealt with most of the demons that got you started on drugs, and you’ve formed strong ties with people who have had similar experiences and with those who haven’t
You might still have some missing pieces. The years you are on drugs don’t count for emotional maturity. If you were 16 when you started drinking and 27 when you stopped, you still have the maturity of a 16-year-old. You haven’t learned to handle the stresses and happiness of real life. You have some catching up to do. At the five-year mark, you are well on your way to recovery.
Isn’t that incredible? Five years to get your reward system back to normal or close to normal. It doesn’t mean there won’t be unexpected cravings and triggers. But by this point you know how to handle most situations, when you are being nudged, and where to go for help.
There are many approaches to recovery. If one isn’t working for you, try another. Find something that works for you.’s
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Photo by Yeh Xintong on Unsplash
