Dopamine is a neurotransmitter in the brain that affects many things; most notably pleasure, which plays a role in our mental health. When the brain is functioning properly, we receive a positive reward in the form of pleasure from dopamine induced by eating, drinking, sex (normal physiological activities). This is a normal brain function that should happen automatically at regular intervals.
To say that we like these dopamine bursts is an understatement. Dopamine motivates us and makes us happy. When we find ways to increase our happiness and pleasure, we go out of our way to keep it going.
This is a very simplified explanation of dopamine and barely takes into account all of the necessary uses and functions it provides in the brain. But it’s important to highlight this role when discussing how dopamine controls the thoughts and actions of people addicted to drugs and alcohol.
Alcohol and other drugs such as cocaine, stimulants, and heroin increase dopamine output (or sensation) in one way or another. Get the picture? Not only do they increase dopamine output, or the feelings caused by it, they also alter the way it functions.
Some drugs change the flow of neurotransmitters and others bypass them and act directly on receptors in the brain altering the signals that are produced.
A full discussion of what drugs produce what changes isn’t as important as the fact that these changes occur for people who have a substance abuse problem or addiction. Short-term use produces the same reward and pleasure for almost everyone and things return to normal functioning quickly.
For addicts or abusers, the long-term effects cause changes in the brain that are more permanent. The drugs or alcohol that once “stimulated” dopamine production or sensation are now “required” to produce pleasure and happiness because the brain can’t do it on its own any more.
How does drug addiction and alcohol abuse hijack the brain’s dopamine output and require users to keep using just to feel normal?
Abusers often say they need drugs or alcohol to “feel normal” and they’re correct in saying it. This is difficult for people without an addiction to understand because they have never experienced this problem.
Exposure to drugs over time either sensitizes or desensitizes the brain depending on the drug of choice and its actions on receptors. This happens when a person builds up a tolerance to a drug. They now require more of the drug to get the same positive feelings that once occurred naturally.
Long-term overuse of drugs or alcohol actually hijacks the brain and controls emotions, motivation, and mood. Over time, these drugs replace the normal flow of dopamine and without them, the abuser loses motivation, feels sad or depressed, and is unable to function normally, both physically and mentally. They actually need a fix to get through the day and they look forward to feeling good again.
Many people look down on addicts and alcoholics because they have never been in this situation and they don’t understand how it works. To say abusers can just stop taking drugs or drinking alcohol is almost like telling non-abusers to stop being happy. If it were that easy, they would be able to stop. But their brains have been rewired in a way that they actually need something to make them feel normal because they can’t do it alone.
On a positive note, drug and alcohol treatment, psychotherapy, and medications can return most people to a state where dopamine functioning returns to normal again. Depending on the longevity and degree of usage and substance of choice, it can take time. It is always advised to work with a trained medical addictionologist instead of trying to recover alone. Safe and effective recovery is possible.
It’s important to note that very long-term, or extreme overuse of drugs and alcohol can change brain structures and behavior, which may be irreversible. However, with treatment the abuser can learn how to live with those changes of brain and behavior. Just as a person with paralysis can learn to live with his disability with proper treatment, so can a substance abuser. While many can live a quality life with treatment, they cannot be completely cured. For this reason, the sooner a person seeks treatment and overcomes their addiction, the better their chances are for a successful outcome.