Your Relationship with Dopamine

              Your therapist might be silently wondering if you over-indulge in happiness. That’s right! There can be such a thing as too much of a good thing. This is why addiction occurs.

Dopamine is one the neurotransmitters in the reward system in our brain that helps us feel good. There are numerous ways in which we can manipulate our brain chemistry to seek happiness highs that can lead to real problems, when overdone.

              For some this looks like overindulgence in drugs and alcohol. In others, it may be overeating. Some seek adrenaline rushes through risky or dangerous behaviors. Some gamble. Others engage in unsafe sexual behaviors or excessive pornography use. Many of us are guilty of seeking smaller but persistent dopamine hits from scrolling on our phone. In drug/alcohol counseling vernacular, we use DOC for drug of choice. Drugs and alcohol are not the only culprits for dopamine addictions, so for us DOC will represent Dopamine of Choice.

              We all should be happy and find some happiness every single day. This is one question I often ask my depressed clientele: what are you doing today that will make you happy? What are you looking forward to in the near future? If you don’t know, that’s a problem. The plight of the busy American can be to have no time for self-care. You get up early, get the kids off, go to work, come home to eat dinner and crash out. We must plan some happy every single day, otherwise, of course you will be depressed!

              But we are not meant to be happy all the time. We are also not meant to have frequent intense bouts of happiness. At some point, we all find our dopamine-of-choice. We like to drink to relax, eat to comfort ourselves, scroll on our phone to entertain us, or go shopping to enliven our spirits. All of these activities are great, when not overdone.

              The problem with chemical-induced happy highs, like with drugs and alcohol, are that they are intoxicating as the feeling is so intense and immediate. We can become physically addicted to many of these chemicals, but we absolutely become psychologically addicted. Coming down from those highs make our day-to-day content feelings seem like a low. We want back up and start chasing this feeling.

              As in most aspects of life, we need balance. A glass of wine, having sex with a partner, going on a vacation, watching a movie, and exercising are great ways to enjoy life and hit that dopamine button. As therapists, we look for those that have an unhealthy relationship with dopamine and are suffering through the highs and lows, and the inevitable repercussions of overdoing your dopamine-of-choice.

              Your therapist will tread lightly when starting the conversation around overindulging. We must not jump to conclusions and foreclose that the patient is addicted to anything. Even those that are regularly overdoing it, might not be addicted. When working at a college counseling center, I could have diagnosed many of my patients as addicts based on their behavior. The truth is, many of them partied and at some point entered the next stage of adulthood and developed a reasonable relationship with alcohol and marijuana. The one’s who didn’t were not always the ones who drank the most or the ones who drank the most often. Rather, those patients that had a strong family history of addiction and/or those that had red flags in their partying careers were the ones that ended up with a problem after college. Some can overdo it and back off and some can’t.

              There appears to be an invisible line that when crossed, there is no going back. For some that line is closer and for some it is further away. I tell my patients, anyone who drinks long enough and in a high enough quantity WILL become an alcoholic eventually. Our bodies will accommodate, want more, and then crave and have withdrawals. No one is immune. So often times therapists are wondering if their patient has crossed that line.

              In Alcoholics Anonymous they use the metaphor: Once a Pickle, Always a Pickle. Meaning if you dip a cucumber in alcohol and pull it out it will still be a cucumber. You can even let it sit in alcohol and after a while pull it out and it will still be a cucumber. But at some point, it pickles and even when you remove it from the alcohol, it is still a pickle. This is the point in which the individual can no longer have a healthy relationship with that substance or possibly any intoxicating substance.

              I take a scientific approach with my patients who are unsure or don’t believe they are addicted. I ask them to test it. Set a period of sobriety and see if you can do it. At least set a limit for yourself and see if you can stick to it (for instance, no more than 3 drinks twice weekly for three months). If they can do it without difficulty, we revert to discussing about risk taking and why they are playing with fire. If we find that they do have an unhealthy relationship with their DOC often times specific substance abuse treatment is required. It seems we have less and less humans who can go cold turkey off substances, and beware of this method. Some substances, including alcohol, can be life-threatening to stop cold turkey.

              Your therapist may teach you that dopamine, regardless of the vehicle, has a point of diminishing returns. Let’s take alcohol. When we drink one glass of wine we feel calm and uninhibited. Our brain tells us, if one is good two should be better. Our next glass of wine may intensify the calmness and invite in some euphoria. Our brain is learning that more is better! Our third glass makes us foggy, tired, and at a point in which you have very poor judgement. Fourth glass we may be blacked out, sick, and do/say something we regret. There is a point at which you are no longer gaining benefit from more dopamine and can actually get yourself in trouble. Not to mention, when your dopamine high runs out, you are often left lower than where you started. Your brain asks: how can we get that feeling again? Simple, have another glass of wine. It felt good last time! Your therapist wants you to be the master of your decision-making around dopamine. This requires your conscious mind to outpower your craving for a short-term happy high. More isn’t always better.

              I’ve used the word relationship with substances as I feel this best describes what a dopamine high attachment can be to a human. A cardinal feature of addiction is continuing the behavior despite negative consequences. If each time I went gambling, I lost money, I would soon stop and never get addicted. If one would gain noticeable weight after every binge, one would stop binge eating. The problem is, there is good and bad parts of the relationship. The individual knows how to make themselves happy in a reliable way. Taking away this fast pass to relief requires an individual to get accustomed to the mundane ups and downs of mood, not the manic ups and crashing lows that comes from extreme dopamine hits. A woman with an alcohol addiction could be compared to a woman in a physically abusive marriage. Anyone from the outside would look at the abuse and tell her to leave the man and never go back. The wife hates the abuse, as well. But there are good parts of the relationship that cause her to stay. Good parts she would miss. The intermittent good parts of the relationship can gradually get less and less until it is ten to one ratio. It has progressed to the point that most interactions are painful, but she stays for the one in ten times when things are good. The same is true for addiction. Addicts want to work on their relationship with their DOC, not get a divorce.

              Most condemn drug and alcohol addiction and can understand how problematic these vices can become. Therapists also see others who struggle have an unhealthy relationship with dopamine. The socially anxious teen who uses AI or chatrooms for companionship and connection. The binge eater who is eating her feelings and then hating herself for it. The young man who scrolls on his phone for hours and is going no where in life. The porn or sex addict who has found a high like no other. The steroid user who is addicted to external validation from others.

              We all need to learn how to make ourselves happy. Just don’t overdo it.

Feel better, y’all!