The Myth of Reward: Why Addiction Isn’t About the High

Addiction is a complex disease. Moreover, the extra struggles associated with addiction (i.e., easy relapse, substance-induced cognitive deficits, and comorbid mental health diagnoses) require a sophisticated and long-term approach to both understanding and treating addicted clients (Alim et al., 2012). Until very recently, the common focus in addiction research has been on dopamine and so called “reward,” which has been very helpful in studying human and animal models of compulsive behavior, avoiding or escaping from withdrawal symptoms and other negative affective states, and understanding the “obsession” commonly referred to in the Twelve Step program. The problem, however, is that this reward process has given lay people and professionals alike a mistaken impression of addiction.

Addiction and the Brain

According to Nestler (2013), the use of psychoactive substances affects our memory and motivation, causing changes in brain wiring, metabolism, and homeostasis. Anderson (2016) explored the neuroscience related to the hyperfocus, or attentional bias, in our addicted brains. He explained how the brain’s ability to focus attention is now so hijacked and cue specific (thanks to chronic use) that relapse is more common just because the addicted brain is more “on the lookout” for drug-related cues. So, if we are always on the lookout, it is not hard for the “obsession” to kick in quite often in early recovery.

Neurobiological perspectives on addiction (Kuhn & Koob, 2010) focus on “reward” and salience (i.e., importance) processes associated with positive reinforcement and negative reinforcement during withdrawal states (i.e., getting rid of withdrawal-induced negative emotions/feelings). Self-control is offline (Koob & Volkow, 2016) because important parts of our frontal and self-regulating brain areas are dysregulated or disconnected when the obsession hits. Our ability to pay attention correctly is now gone. This shows that addiction promotes broad-sweeping attention, memory, and more.

Our ability to feel rewarded normally is now shot because the high, the come-down, and the obsession from drugs is about two hundred times stronger than the “high” of a hug from a lover or a tasty bite of food. So, addicts look like these impulsive, hedonistic, shady characters we simultaneously feel bad for and are baffled by every time they relapse. Maybe this “reward” pathway is not actually so rewarding.

“Seeking” Versus Reward

Panksepp and Biven (2012) postulate that the dopamine midbrain (i.e., nucleus accumbens) involved in addiction and other compulsive behaviors functions more as a “seeking” system. Modern addiction neuroscience is missing our basic needs (Alcaro, Huber, & Panksepp, 2007). According to Panksepp’s work, the idea goes like this:

We have normal needs for food, water, sex, social status, and other typical, survival-oriented, mind-body states.
We notice one of our needs is not being met.
Our reward system is supposed to fire like crazy to make us seek out the thing that satisfies the need in number one (i.e., the “obsession”).
As we start to feel “rewarded” or satisfied, our dopamine reward system starts to taper off and the other chemical systems (e.g., opiate system) intensify firing to signal “I am satisfied” if hungry or horny or “I am no longer in pain” if lonely or low on the totem pole, etc.
As we learn that our behavior satisfied our urge, our memory systems implicitly learn that this behavior works and creates a very complex expectancy state that tells us “do that thing again” because it is good for our survival
We repeat this whole process the next time we have an urge.

Drugs of abuse clearly hijack and overactivate this process, but the excessive dopamine seen in addiction, that most scientists call “reward response,” is actually a “seeking” (i.e., reward-expectancy) urge. Addicts have not taught themselves to be hedonistic. They have taken an evolutionarily necessary system, the seeking system, and taught it to treat drugs of abuse like typical evolutionary needs.

Implications for Treatment

So how does this change, if at all, what we do in treatment? We need to start seeing our clients as people struggling with a hijacked seeking system, not as hedonistic infants. We need to help clients and treatment providers understand that a craving is not just a delusional feeling, but a hijacked, “I need this or I am going to die” process that we are all programmed with. We need to stop shaming them due to their manipulative behavior, relapses, and self-destructive impulses, but still punish and have appropriate boundaries. If you thought, “I am going to die if I do not get X” and it was literally true because X is a miracle cure, people would completely understand if you broke into a store to steal X or robbed someone to have enough money to buy X. Why are we unable to see the craving and bad behavior in the same way? It is the same process in the brain, just hyperfocused on drugs with the dial turned up to eleven.

Acknowledgments: In loving memory of Jon Daily, a man dedicated to helping teens and young adults struggling with addiction.

References

Alim, T. N., Lawson, W. B., Feder, A., Lacoviello, B. M., Saxena, S., Bailey, C. R., . . . & Neumeister, A. (2012). Resilience to meet the challenge of addiction: Psychobiology and clinical considerations. Alcohol Research: Current Reviews, 34(4), 506–15.

Alcaro, A., Huber, R., & Panksepp, J. (2007). Behavioral functions of the mesolimbic dopaminergic system: An affective neuroethological perspective. Brain Research Reviews, 56(2), 283–321.

Anderson, B. A. (2016). What is abnormal about addiction-related attentional biases? Drug and Alcohol Dependence, 167, 8–14.

Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet: Psychiatry, 3(8), 760–73.

Kuhn, C. M., & Koob, G. F. (Eds.). (2010). Advances in the neuroscience of addiction (2nd ed.). Boca Raton, FL: CRC Press.

Nestler, E. J. (2013). Cellular basis of memory for addiction. Dialogues in Clinical Neuroscience, 15(4), 431-43.

Panksepp, J., & Biven, L. (2012). The archaeology of mind: Neuroevolutionary origins of human emotions. New York: WW Norton and Company.

Patrick Lockwood, PsyD

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Patrick Lockwood, PsyD, is a staff psychologist at PCI Westlake Centers and has worked for various for-profit and not-for-profit organizations for the past ten years. He is the author of The Fear Problem: How Technology and Culture Have Hijacked Our Minds and Lives (Mascot Books, 2018).