Pleasure, tolerance and compulsion
The concept of the process of pleasure, tolerance, compulsion and anticipation was published in July 2011 by Harvard Health Publications titled “How Addiction Hijacks The Brain”, which I would highly recommend reading. Although it reveals vital information, I decided to create my own diagram to simplify this principle for people who do not read online medical journals. Above is an image I created, which I use while facilitating mindfulness/addiction workshops.
When an overeater is anticipating bingeing on chocolate the brain releases a chemical called dopamine. The release of this chemical sends a “reward” signal and many addicts report feeling a huge sense of relief once they know they are just about to indulge in active behaviour. The alcoholic feels relief when walking to the local shop to stock up on alcohol “supplies”, the cocaine addict feels slightly better when the drug dealer has promised to deliver several grams of cocaine within thirty minutes, and the pornography addict feels okay about life when he is about to log onto the internet to binge on cyber sex. The codependent gets a “hit” while considering how to “fix” others, and so on. These examples demonstrate the anticipation and pleasure phase of a cycle of addictive behaviour.
Once the addict begins indulging in addictive behaviour (acting out) the brain deliberately produces a drop in dopamine to attempt to restore balance. Therefore the anticipated high is never as fulfilling when actually realised. Further, there is a greater need to escape reality and alter ones mood. As a result, the addict must consume more of the drug of choice to get any kind of effect. Many heroin addicts report injecting greater quantities of diamorphine just to “feel normal”. Pornography addicts disclose needing to binge for five hours at a time, to create the same euphoric feeling that they hitherto had been able to create in thirty minutes before becoming addicted.
The first time I used 3,4-Methylenedioxymethamphetamine (MDMA) the anticipation was immense followed by an explosion of feeling empathetic, compassionate, warm, happy and euphoric. The following week I created an emotional high just by anticipating using MDMA again. When I used the drug the following weekend, the high was much less satisfactory than it had been the previous weekend. By the time I had developed the habit of using ecstasy every weekend, the actual anticipation was much more effective in producing a mood altering affect than the effects of the actual drug. Thus, the addictive cycle worsened leaving me struggling to find mental relief. This is the tolerance phase.
Subsequently, it takes less to trigger a craving and it requires more of the mind and mood altering substance or addictive behaviour to reach a desired state of oblivion. To compound the problem, the amygdala and hippocampus store information with respect to environments where the addictive behaviour took place.
For example, if an overeater is accustomed to bingeing at a local fast-food restaurant, his amygdala and hippocampus will unleash memories of this anytime he walks into or past the restaurant. This activates cravings and can lead to another episode of acting out. Practising alcoholics often have a hard time walking past a certain bar without being incapacitated by a craving for a drink. This is why many drug and alcohol rehabs suggest that alcoholics stop visiting places they used to drink in until they have enough physical sobriety and emotional/spiritual recovery. With respect to addiction, association is very powerful. This is the compulsion phase.
The good news is that mindfulness has been proven to slow down addictive patterns of behaviour (compulsive thoughts and random urges to “act out”). Similarly, mindfulness lessens the impact of tempestuous emotions.