A young man reported that the hardest part of giving up drugs is "the rush" that came with the search for the next fix. "Addiction is not so much about doing drug as about the thrill of the chase; going the whole nine yards in search for it. Every right step that brings one closer to where the drugs can be found has its own quota of thrill; its own mini-rush.
He sounded as if looking for drugs was a feat akin to searching for the "Holy Grail".
He then declared that "the rush" must have deep psychological pockets for even when one gives up the drug and goes into abstinence for a long time, the craving for the rush continues to haunt one in "dreams of using".
Then he talked about his dreams of using. The script is stereotypical, he declared, with some insignificant variations. The dream typically begins with "the craving" followed by calling up of the drug buddies and "the contacts", worrying over the relative dangers of different drug houses, taking the trip, dodging the dangers and finally getting the drug.
The rush strangely is not reserved for the endpoint when the drug is finally done. In fact, the dreams rarely reaches the stage of doing it. Some interruption or another always prevents that. The rush - or rather mini-rushes - occur at each step of the way. So the function of the rush has more to do with guiding one correctly through the maze of difficulties that lie on one's way to procuring the drug rather than appearing as one great burst of pleasure at the endpoint.
"His dreams," the patient continued, "always ended before he could snort the drug. Either the powder got spilled, or could not be found at the last minute even after being paid for, or the "rock" rolled out of reach, or some problems arose in assembling the paraphernalia. His description of these interruptions reminded me of the phrase "there are many a slip betwixt the cup and the lip".
Since the man had grown up in the world transformed by video games, I asked him if the rush [mini-euphoria] at each successful step was similar to how one felt shooting the enemies, overcoming the obstacles, and rising from one level to the next, in those computer games, and he said the simile had merit.
Now let us see if we can make some psychoanalytic sense as to what must be going on at the level of psyche, brain and consciousness when a person is experiencing the mini-rushes as he goes hunting for drugs whether in real life or in dreams.
"The mini- rushes" in the psychoanalytic language should be looked upon as quotas of pleasurable feelings getting generated in the consciousness from reports arriving of successful progression towards reaching the goal.
Whenever something is done successfully - success means discharge of physical and mental tensions - a report of relief from the tension is sent to neurons that generate consciousness ( Freud proposed that a separate system of neurons generate consciousness and he termed them omega neurons; see his Project for Scientific Psychology) and it is felt there as pleasure. Simultaneously, it is my conjecture, that whenever there is discharge of tensions (experience of satisfaction) there is activation of dopamine neurons and a release of dopamine from its axonal projections on those neurons that were involved in bringing the relief from tension.
Why there is release of dopamine?
Dopamine appears to be the neurochemical that makes one repeat things - dopamine causes stereotypy. And it appears that whenever a behavior brings satisfaction (brings relief from tension) perceptual and motor neurons that underlie and made that behavior possible are subjected to dopaminergic stimulation through some feedback mechanism. And the purpose of this dopamine feedback is to further prime those specific perceptual and motor neurons which were responsible in noticing the desired object and in bringing it in a position that the person could consume/ incorporate it to end the tensions/the state of craving.
For example in a hungry person, who is in a state of craving, those perceptions - of smell and sight - which locate the food and those motor neurons which bring the food - like plucking the fruit off the tree; successful chasing of the prey, cutting the vegetables and putting them in a dish and on the stove - to one's mouth will get primed once the food is consumed/incorporated (reaches the stomach and the blood stream) ending the state of craving (relief from the tension of hunger).
In a drug addict the behaviors that take the person nearer to the drug get similarly primed by dopamine by using the same feedback mechanism.
The purpose of this dopaminergic priming is for these specific neurons to be more readily activated when the state of craving arises. Already primed (cathected) neurons make the search for the desired object more expedient because one does not have to waste time on fruitless motor activities, concentrating the efforts exclusively upon those neurons that have brought success in the past. Dopamine primes only those neurons which brought success in the past and when similar situation arises more focus/attention falls upon these neurons via fresh release of dopamine - this is the mini-rush that the patient was so enthusiastically talking about - and it is done to further facilitate the sequences of behaviors which will end the state of craving and bring relief from tension.
As if anything done successfully demands that its repetition in future should take less effort. And dopamine appears to be the neurotransmitter which is used for this purpose. As if any activity that is biologically useful causes release of dopamine and strengthening of that activity while those behaviors (and the neuronal circuits underlying them) which do not bring success and thus do not get dopamine input get pruned away.
Now we also know that drug use activates dopamine release. If we claim that any successful activity causes dopamine release should we also then say that doing drugs is a biologically successful activity? We can without any ado reject such a conclusion. Doing drugs, which withdraws the person from all other interests of the world to the exclusive preoccupation with finding drugs and doing them, something that has no nutritional and questionable reproductive rewards, cannot be considered a biologically successful behavior.
So what is going on? How do we explain the paradox?
It appears that addictive drugs bring a spurious sense of success. The brain is tricked into believing that one is doing something good while searching for and doing drugs. Even if in reality/biologically one may be doing just the opposite.
And how does this happen?
Let us first try to examine what exactly is success.
Success at the most basic level means the organism reaching its aim to procure some substance/object to add to itself - or to expel some substance that has become an irritant within one's system like CO2 in blood stream, feaces in alimentary canal, a nagging spouse - to maintain its status quo/homeostasis. This is the principle of constancy/inertia - everything in the universe, including living organisms, have this most fundamental property: to resist change and conserve/preserve its current state forever.
Let us go further on this line of reasoning. What do we mean by saying that the organism procures some substance/object to add to itself to maintain status quo? Easiest example would be of hunger. Hunger can be looked upon as reports reaching the consciousness (omega neurons) of a changing status quo, due to depleting energy and body contents, through the gnawing of the stomach muscles and through the activation of receptors in the brain that are sensitive to chemical changes in blood like falling blood sugar levels. And this sensation of hunger initiates a series of actions that will result in procuring of food. Freud calls such series of actions, which end the state of craving, "specific action". Once the food is procured it replenishes one's energy and bodily contents and restores homeostasis. Now the series of motor actions that bring the organism closer to the food (specific action) produces pleasure [through decrease of tension]. Every step which brings the desired object - food in this case - closer to one's sensory vista (perceptual sphere) causes a fresh secretion of dopamine. While every wrong move which allows the satisfying object to get further away from oneself, produces unpleasure [through increase in tension]. Every move that brought the desired object closer to our sensory vista and lowered tension was rewarded with secretion of dopamine and strengthening/priming of that motor behavior.
Now what happens when the organism meets failure? Every move that results in allowing the desired object to get away from oneself because of defeat by the competition - others also seek the same object - or by meeting some disaster like falling off the cliff while chasing the object or by misjudging the direction in which that object grows is met with increase in tension and avoidance of the behavior in future through generation of pain. And through these strengthening/priming and extinguishing/pruning of behaviors through eons of biological/evolutionary/phylogenetic experiences the release of dopamine has become a method to direct focus upon those memory traces that point the way to satisfaction. And the release of neurochemicals (acetylcholine? and other neurochemicals?) that are generated with lack of success, injury and pain, act as warning to not go any further in that direction.
Pain is like a watchdog over us, it prevents wrong moves. Success/experience of pleasure strengthens the series of behavior that led one to it, while pain warns us not to go on a particular path because it will bring no good, and instead of discharging tension may raise its level further because of encounter with danger.
Now what the addicting drugs do is to knock out this protective mechanism of pain and make dangerous and harmful activities not look all that dangerous and capable of causing pain. Narcotics achieve this aim directly. They block the perception of pain, and the memories of pain which had occurred when the forbidden activity was first undertaken. Anti-anxiety agents do the same job by taking away the fear of meeting with painful consequences.
The result is that the person starts indulging in those pleasurable activities that once had brought pleasure but now, because of maturity (developmental changes), are no longer age appropriate and should cause more pain than pleasure. Each age has its own aims and own sources of pleasures, but as one goes to the next stage of development, pursuit of these earlier goals results in more pain than pleasure. For example the auto-erotic pleasure of thumb sucking and masturbation which were age appropriate during the first and fourth and fifth years of life respectively, have to be abandoned through generation of pain, when indulged in as an adult, for, as one matures more complex and challenging aims as courting a woman and having proper genital satisfaction with her becomes more age appropriate outlet. However, these more mature and difficult aims can be abandoned in favor of regressive auto-erotic satisfaction if the negative emotions - of pain and fear of pain - attached to them are blocked out with narcotics and/or anti-anxiety agents.
For example discharge of sexual tensions through oral, anal and other pregenital mechanisms is a shorter route to procuring sexual pleasures than going the whole nine yards of searching for a woman, falling in love with her, and having consensual genital sex only after proving oneself as worthy of her love. It is easier to take cocaine and indulge in sexual fantasies that were once the province of masturbation than actually woo a woman and bring all aspects of one's psyche in harmony with her to enjoy complete union with her.
Similarly a beautiful girl who at the age of 3 enjoyed exhibiting her naked body, and the behavior was perfectly successful with her parents, and other grown-ups, and brought lot of release of sexual tension and release of dopamine then, she can no longer do so once she grows up. If she wants to indulge in erotic pleasure of showing her body, she has to sublimate the original instinct of exhibitionism by developing some further skills in that direction like ballet dancing or fashion show modeling or designing clothes for others and enjoying the exhibitionism by proxy. However, such a girl can take a short cut. She can take drugs like Oxycontin or Vicodin along with anti-anxiety agents like Xanax, and by blocking the memory of the pain and fear associated with exhibiting herself blatantly meted out, or dangled as a possibility, for indulging in it during the latency period and puberty - can now go to strip joints and indulge in showing off her nude body again without much art.
The lure of drugs and other addictive behaviors appears to be motivated by a desire to indulge in one's childhood fantasies and other autoerotic shortcuts to pleasure by silencing the objecting conscience which demands that we find satisfaction in real world and with other people. The strife of the real world and the pain associated with it makes one withdraw and create a mini world where all those grand fantasies of success are acted out in a childlike manner with age inappropriate objects with the aid of drugs.
For example a patient of mine said that once he was a very successful fellow, having a restaurant in partnership with somebody else. "I was busy in it from 6 in the morning till midnight. There was so much excitement, pleasure and give and take in our little enclave. Then my wife left me for not paying her enough attention and caring more for the restaurant than her. I fell apart and started doing drugs. My partner kicked me out of the business after buying my share for a song. Now I have a new world, which is built around finding drugs. Instead of hobnobbing with my restaurant customers now I hobnob with my drug buddies. Before my partner and I would cheat each other a few bucks here and there. Now my drug buddies and I cheat each other on who owes how much drug to whom. In the past I would sometimes be magnanimous with my customers in the restaurant giving them free deserts. In the drug house we can be ten times more generous but also extremely cruel. We do not hesitate to cut someone's hand if that hand is suspected of stealing one's last fix. Everything is taken to extreme when one is on drugs. Let me tell you, living for procuring drugs is a way of life too, full of dangers and frustrations granted, but when you are in it it becomes more important than anything else, your children, your wife, even the opportunity to become the President of the United States."
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