The neuroscience behind an alcohol use disorder (AUD) is complicated but Judith Grisel, author of Never Enough: The Neuroscience and Experience of Addiction, explains that we all have different dopamine pathways which increases or decreases our risk of AUD.
Grisel explained that if we removed the mesolimbic pathway where the brain’s reward system exists, we wouldn’t experience a rewarding effect from cocaine or alcohol or marijuana — which would eliminate the societal concern of alcohol use disorders. But if we did remove it, then we also wouldn’t experience the rewarding effect of music or chocolate or sex.
As I said, it’s complicated.
Dopamine is often referred to as the pleasure chemical but the problem is that dopamine does not actually produce pleasure. We are taught to believe that the higher your dopamine levels, the happier you will be, but this isn’t always the case. Both low levels and high levels of dopamine can be problematic and disruptive to the body. But how do you balance those levels?
When it comes to alcohol use disorder, and the recovery process, it’s important to understand how dopamine actually works and how alcohol (and/or other drugs) impact the dopamine system.
Here’s How The Dopamine System Works
Dopamine is just one of many neurotransmitters that controls communication in the brain. There is epinephrine, acetylcholine, norepinephrine, serotonin, etc. What makes dopamine so interesting is that it exists in both the right side of the brain and the left side of the brain, sending various signals throughout the body. It’s easy to assume that the higher the dopamine levels, the better, but the key is to maintain a healthy dopamine balance because dopamine influences everything from our movement and our sleep to our memory and our attention.
If your dopamine levels are low, you could experience a wide range of issues, such as loss of balance, muscle cramps, low energy, weight change, anxiety, mood swings, a low sex drive, hallucinations, or depression. However, when you have high levels of dopamine, you could experience anxiety, agitation, a high sex drive, high productivity, stress, paranoia, and yes, heightened levels of pleasure.
All of us experience dopamine differently. You and I may have equally high levels of dopamine, but our symptoms — and experiences — will be completely different. Some individuals are more sensitive to dopamine than others, which partially explains why some of us are more susceptible to alcohol or drug use disorders.
When it comes to alcohol use disorder, and the recovery process, it’s important to understand how dopamine actually works and how alcohol (and/or other drugs) impact the dopamine system.
A study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging shows that people with a family history of alcohol use disorder release more dopamine in expectation of alcohol and may be at a greater risk for alcohol use disorder. Unfortunately, doctors don’t usually test for dopamine levels so you don’t know how your brain’s going to react to a substance like alcohol or drugs until you’ve encountered it.
George Kolodner, Chief Clinical Officer and Founder of Kolmac Outpatient Recovery Centers, however, insists that genetics play a huge role in the development of an alcohol use disorder so if you know your family history, you can better prepare for this possibility. (Keep in mind that there isn’t a single addiction gene, but rather an amalgamation of many factors— biological and otherwise— that determine vulnerability.)
Dopamine, unlike other neurotransmitters, plays a crucial role in the brain’s motivation and reward system — and contributes to our survival as a human race. Dopamine creates rewarding experiences and is, essentially, the one chemical that takes in pleasure and signals to the body: This experience is worth repeating. The brain is wired with the reward system to ensure that we eat food, drink water, and have sex (which then leads to reproduction and as a result, keeps the human race alive).
The problem is that the dopamine system can make you believe that certain experiences are worth remembering — and repeating — over and over again, even if the experience is harmful to the body (hence the problem with alcohol or drugs).
Understanding Dopamine and Alcohol Use Disorder
Whenever something unexpected or memorable happens, whether it’s pleasurable or unpleasurable, you get a dopamine spike, explains Kolodner. Many people confuse this feeling for pleasure but what’s actually happening is that the brain is anticipating a reward.
For some, the first taste of alcohol is euphoric, mind-altering. The chemical is causing a very distinct reaction inside the brain that says, yes, you want to experience this again, which can lead to a continuous chase of that “high,” Kolodner explains.
We may not know everything about the science behind alcohol use disorder but we do know that drinking alcohol or consuming drugs regularly disrupts the brain’s neurotransmitter systems and this could be why you may feel depressed or desensitized when you remove the alcohol or other drugs from your life.
Dopamine, unlike other neurotransmitters, plays a crucial role in the brain’s motivation and reward system — and contributes to our survival as a human race.According to the Recovery Research Institute, it takes 14 months of complete abstinence for the dopamine transporter levels (DAT) to return to nearly normal.
Grisel, who has overcome both alcohol and drug use disorders, now studies the way drugs and alcohol affect the brain. She told NPR, “[alcohol has] been really hard to study. In fact, we still are just beginning to understand how it is that you feel drunk — what the mechanisms are for feeling drunk — because it acts kind of like a sledgehammer or just in a widespread way to disrupt all kinds of cell functioning.”
So if you’re in recovery and wondering why you’re not experiencing that “high” anymore, even from new, exciting experiences, know that your brain’s dopamine system is probably still off balance. Your brain needs to heal, says Kolodner. And with all wounds, it takes time.
What the Recovery Process Looks Like
Kolodner explained that certain medications can help normalize a recovering patient’s dopamine levels. The drug Naltrexone, for instance, is an opiate antagonist that works to remove the pleasure response. And once you remove that, you can start to eliminate the desire to drink, which can aid in the process of recovery.
The drugs, themselves, will not cure you. They will simply help you change your brain’s reward system, which correlates drinking or drug use with pleasure. For some patients, the drugs have a calming effect, Kolodner explains, but what’s really happening is that the drugs themselves are normalizing the brain’s dopamine levels. The drugs aren’t actually calming you, even if they feel like they are.
The problem is that the dopamine system can make you believe that certain experiences are worth remembering — and repeating — over and over again, even if the experience is harmful to the body (hence the problem with alcohol or drugs).
“Some patients will test themselves,” said Kolodner, “to see how much progress they’ve made.” They think, I’m recovered. I can return to my favorite bar and not drink, but will find themselves returning to that place and immediately experiencing a spike in their dopamine system, leading them to crave the “high” again. This can lead to drinking again, which is why Kolodner and his clinical staff advise patients to avoid known cues during recovery. Some cues are unpredictable, however, like airports (which, unfortunately, have more and more options for drinking these days).
At the end of the day, here is what you need to know: It takes time to rewire the brain, just as it takes time to change a habit or reach for a long-term goal. Whether it’s months or years, eventually, your dopamine system will balance itself out and you will, again, experience the pleasures of new experiences.
Just know that your brain is hard at work trying to support numerous mental and physical needs.
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