Less Than

Here’s the transcript of episode 15 of Ending Addiction called “Less Than.”

Welcome back. If there’s one idea I hope you’re holding onto after the last 14 episodes, it’s that midbrain dopamine tone at the reward center is critical to understanding addiction. We know that it’s that low midbrain dopamine tone that causes the restless, irritable, discontented base state that drives people with addiction to seek reward in the first place. And we know that low dopamine tone in that reward circuit predisposes people to a higher, very attaching spike. And that the higher the spike, the lower the crash; and it’s that lowness of the crash that gets people caught in the compulsive use cycle. So low dopamine tone leads both to seeking rewards and getting caught in compulsive use of rewards once started.

So it makes sense that we as a society ought to be really, really good at not lowering each other’s dopamine tone. Yes, I said there are genetic causes for low dopamine tone—and we’ll get to those in the future episodes. But today, what if we were lowering each other’s already normal dopamine tone? Wouldn’t we want to know how we’re doing that so we could stop?

Let me tell you the story of a very important scientific study that tells us what to look for.

So this study was done on four infant male monkeys. I’m sorry it was done on innocent animals. I wish it hadn’t been. But it was, so let’s not throw it away and forget it. Instead, let’s use it to save lives and remember it so it doesn’t have to be done again.

So this is a study of four, normal infant male monkeys. How did they know they were normal? Two ways: they put them in a positron emission [PET] scanner and measured normal levels of dopamine receptors. Also, they offered these monkeys cocaine and they didn’t want it, didn’t like it. Because normal mammals with normal dopamine tone don’t like things that make their dopamine tone too high. Then they took these normal monkeys away from their mothers and away from the rest of the troop, isolated them in cages by themselves where they couldn’t even see each other. Almost immediately, normal dopamine receptor levels fell to very low; and when offered the cocaine now, the monkeys loved it and used it all the time. They grew these monkeys up to adolescence in these isolating cages, using cocaine all the time, every day. And then they put the monkeys together in the same troop-sized cage. Of course, being four male monkeys, they fought to find out who was the alpha male. The alpha male’s dopamine receptors went back up to normal and he lost his interest in cocaine. The three subservient monkeys who felt “less than,” they had continued lowered dopamine receptor density, even though they were now socially housed with other monkeys. And they continued to use cocaine.

So what can we learn from this study? Well, we’re primates too. And if you isolate a primate, or you make a primate feel “less than,” they’re going to have almost immediately lowered dopamine receptor density, and lower dopamine tone.

Now, you’ve already experienced this. You’ve probably been spoken to in such a shaming way at one point or another in your life that the lights seemed to dim and joy seemed to fade away like a distant memory. That was the experience of having these dopamine receptors immediately inactivated and dopamine tone precipitously falling, and your midbrain saying, “This is not good. Whatever caused this, avoid at all costs and get out of the situation right now. You’re in danger.”

Do we do anything that lowers people’s dopamine tone when they have addiction? Do we ever respond to people with addiction by isolating them? Do we ever respond by making them feel “less than?” Well, yes. When you take someone with addiction and you put them in jail because they have addiction and were using a substance, we aren’t going to make them better. They aren’t going to learn a lesson. In fact, by isolating them and making them feel “less than,” we’re making it less possible that they learn, because now they have a lower dopamine tone with less ability to have long-term potentiated memory. Because they have low midbrain dopamine tone, they have less function in their decision-making frontal cortex, [they’re] less able to make the right decision next time.

What about when we’re treating addiction? Think about the places that people with addiction can go for treatment. Do you feel normal and well-treated when you have to line up in a parking lot at 5 in the morning in the dark and cold at a methadone clinic because that’s the only way you can get the medicine that’s keeping you alive? Does it make you feel normal—like any other patient—when you have to go to a “substance abuse” clinic and the walls are unpainted cinder blocks and the chairs don’t match and there’s garbage overflowing and you wait for four hours in the waiting room before you can have an intake? The way we treat people with addiction is actually making the problem worse. If we wanted to make the problem better, if we want to end addiction, if we want treatment that works, we would treat addiction with that same intent of making people feel like welcomed patients that we use when people have cancer or diabetes or any other illness.

So, the first thing we’re going to learn today about how to treat addiction is whatever system we’re going to come up with, let’s make sure it raises—not lowers—somebody’s dopamine tone. Now, inside that system, what might we want to do? We’ll pick that up next time. I hope you join me. Until then, be well.