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This article comes from the official account of Wechat: ID:fanpu2019, author: Chen Ruidong

In today's society, addiction is actually more common than we think. What is the physiological basis of addiction? The parts of the brain that deal with pleasure and pain are in the same area, and according to the authors of Addiction, happiness and pain are like a balance, metaphorically the tolerance of the dopamine system-when dopamine concentrations are too high for a long time, the number of dopamine receptors decreases, thus weakening the effect of dopamine per unit. In other words, we need more stimulation to increase pleasure. And the process will tilt towards pain. In the long run, the tolerance of pain also becomes less. On the other hand, technological development is also a factor contributing to addiction, and it is difficult for us to be immune from all kinds of temptations.

Write article | Chen Ruidong

Addiction means repeating something that you know is harmful to you.

Anna Lembke, author of Addiction, is director of the Stanford double Diagnostic Clinic for Addiction Medicine. She observed the frequent occurrence of addiction in modern society from the perspective of doctors, and interspersed the book with a discussion of her addiction process of reading love novels. I also reflect on my addictive behavior, one of which is buying games. I loved playing Nintendo games when I was a student. I want to play all the fun games, but because I am a student, I try to save money. In order to play the most and most fun games with the least money, I often refresh store discount pages and review sites. When I see games with high discounts and high reviews, I buy them first. Before you know it, 10% of your annual income is spent on games. In fact, I know that I will not play, but still can not resist the temptation to buy more games, which undoubtedly belongs to the category of addiction. Ironically, my research topic at the time was how the dopamine system works in sports learning, and the behavior of constantly buying discount games fits well with how the dopamine system works. Since both authors who specialize in the treatment of addiction and those who specialize in the dopamine system have addiction problems, I think addiction should be a fairly widespread phenomenon. This is also a lesson from this book: addiction is more common than we thought.

Addiction is not limited to drug abuse, with the development of science and technology and economy, the problem of addiction is becoming more and more common. Depression, anxiety and other mental diseases have become prominent in modern society, especially in developed economies. Many cases and data are cited in Addiction to illustrate this phenomenon. In North America, which has the most developed material economy in the world, the number of cases of depression increased by 50% from 1970 to 2017. 34% of Americans say they often feel physical pain, compared with 19% in China. In the first decade of the 21st century, the prescription of opioids (painkillers) in the United States increased exponentially. Under the influence of drug companies and insurance companies, doctors are prescribing more and more of these prescription drugs, resulting in rising rates of addiction and mortality. In 2016, Rumbock published Drug Dealer, MD, becoming the first person in the medical community to warn of the dangers of opioid prescription drugs. In Addiction, she gives two explanations of addiction and a series of suggestions on how to deal with addiction.

According to modern biomedical research, the root cause of addiction is the excessive activation of the dopamine system in the brain. Dopamine is a neuromodulator in the human brain and is widely released by a small group of neurons deep in the brain. Of all the substances that act on the nervous system, dopamine is the best known. From time to time, there are headlines such as "dopamine withdrawal" and "passion is dopamine, love is endorphin" in the media. Whenever I see such a title, I feel headache and tiredness. ) it may be because of its wide spread, the public misunderstanding about it is also very widespread. The most common misconception is to equate dopamine with happiness, and even to think that abstaining from dopamine can achieve happiness (dopamine is indispensable to the normal functioning of the human brain, and Parkinson's disease is the consequence of dopamine cell apoptosis). In the book, the author makes it clear that the main role of dopamine is not happiness, but as a reward signal to promote "want" and emphasize the difference between "want" and "like". My craving for oranges ("want") and the pleasure I get when eating oranges ("like") are two separate signals in my brain. Dopamine is only closely related to the former. This may explain why many addictive behaviors bring a feeling of wanting to do something and get less and less happiness from it.

In fact, the involvement of dopamine is not limited to the pursuit of reward. For example, I found that the dopamine system is involved in sports learning without external rewards, such as reporting whether a bird is out of tune when a bird sings. Naoki Uchida of Harvard University has found that certain dopamine releases can prompt animals to avoid possible risk factors in the environment. I once asked Professor Uchida what he thought of the popular science books on dopamine, and he told me an interesting experience: his high school daughter needed to answer what the function of dopamine was on a class test. The daughter naturally asked her father, who specializes in dopamine. However, this is a problem that he is still trying to study. Although there are standard answers in the high school test, he doesn't know what the correct answer is. The same is true of many front-line researchers: the data we are faced with do not allow a concise answer, and people expect such an answer. This is our disadvantage in communication science: if we give empirical answers according to scientific norms, the answers are often too complex and uncertain. Although "addiction" has a small part of the actual shortcomings of science, such as ignoring the above-mentioned dopamine-related research when discussing dangers, and mistaking the level of dopamine in the blood for the content of the brain, but it is a useful popular science to meet the needs of more people, let's jump out of the curse of knowledge.

The dopamine system is as tolerant as many neural connections in the brain. This is similar to the Le Chatelier principle in chemistry. The author uses the metaphor of the pleasure-pain balance to illustrate the tolerance mechanism of the nervous system. It happens that the areas of the brain that deal with pleasure and pain overlap, while the homeostasis mechanism of the human body keeps it balanced. Although this balance is not real, it helps to understand the ubiquitous tolerance mechanism of the nervous system. When the concentration of dopamine is too high for a long time, the number of dopamine receptors decreases, thus weakening the effect of dopamine per unit. This is also the neural basis of most addictive behaviors: repeating the same behavior can constantly produce reward signals, but because of tolerance, larger and larger doses are needed to produce the same reward signals.

The author's thoughts on pain are subject to her study of opioid painkillers. She believes that avoiding pain often leads to more pain, because the pleasure-pain balance is more skewed towards pain. In this crisis, what is more important than the dopamine system is that painkillers cause tolerance of pain-relieving neural pathways. This idea is well suited to explain the painkiller crisis that the United States is facing, but can it be extended to other scenarios? I doubt that any type of pain can be used to balance any type of happiness. In spite of this, the author's thinking about the relationship between happiness and pain is still worth reading. Especially in the seventh chapter, the author mentioned that the pursuit of pain, such as soaking in cold water, can also lead to addiction. This example shows that replacing one simple behavior with another, even if it changes from the pursuit of happiness to the pursuit of pain, can easily fall into a vicious circle of dopamine tolerance. But the authors repeat a common misconception here: soaking in cold water increases blood dopamine levels, demonstrating that pain increases the release of dopamine in the brain. This argument is invalid because dopamine cannot cross the blood-brain barrier. Dopamine in the blood regulates blood pressure rather than acting on the nervous system, and the amount of dopamine measured in blood is different from that in the brain. Neither taking nor injecting dopamine affected the amount of dopamine in the brain. About the relationship between pain and happiness, you can also refer to psychologist Paul Bloom's book, "how much pain is worth: the value of pain and how it brings us happiness" (The Sweet Spot: The Pleasures of Suffering and the Search for Meaning). People often pursue painful activities, and the psychological principles behind these phenomena are far from as simple as the balance of dopamine or several neurotransmitters.

In addition to the biological basis of addiction, the phenomenon of addiction in modern society is also related to the operational logic of capitalism. The dopamine system is a genetically determined human physiology and has not changed significantly since ancient times. But the phenomenon of addiction has changed significantly in recent decades. This is due to the development of capitalism.

The author quotes the concept of Limbic capitalism described by David Courtwight, a history professor at the University of North Florida, in his book The Age of Addiction. The limbic system in the brain includes medial and subcortical structures that undertake more "animal" functions such as emotion, reward, memory, etc. (not "limbic"). This classification is somewhat vague in neuroscience, but when the relevant concepts were introduced into history and society, Courtlett made it clear: controlling people's emotions and reward mechanisms, that is, controlling your brain's limbic system can effectively change consumer behavior. The logic of capitalism and the resulting new technologies lead businesses to produce more addictive drugs and other products, and they will continue to pursue the addiction of more people in order to achieve higher profits. The movie "Social Network" depicts how modern social networking services such as Facebook predict and model users' every move, and use reward theory to promote users' addiction to using social networks. in order to put precisely targeted advertising to make a profit. The fast food industry takes advantage of the natural addictive nature of sugar; modern cigarettes and brewing techniques can be used to distribute more alcohol and tobacco on a larger scale. In the absence of government regulation or active user resistance, this phenomenon is likely to continue to worsen. Therefore, understanding the biological basis and social background of addiction is essential for the formulation of effective policies and individual behaviors to combat addiction.

As a doctor who treats patients with a variety of addiction problems for many years, Rumbock describes in detail the eight steps to treating addiction. She abbreviated the treatment to "DOPAMINE" (dopamine, each letter is a stage). This is a summary of many years' experience of one of the world's top professional doctors in the treatment of addiction, which is of practical significance. It should be emphasized that these methods are not suitable for everyone, and if there is a serious addiction problem, professional treatment should be sought. The last two chapters of the book advocate being honest with the facts and causes of your addiction and maintaining good social relationships that can monitor bad behavior. This may be a clich é, but the author provides very convincing concrete cases to illustrate why these traditional experiences are right.

About radical honesty (Radical honesty, complete honesty, no lies), the author mentions an interesting neuroscience perspective. Because lying is instinctive in many cases, telling the truth requires higher prefrontal lobe activity to suppress lying. As a result, long-term radical honesty training can enhance self-control, including resistance to drugs or other temptations. When discussing social relationships, the author uses "adaptive" dopamine release to explain why intimate relationships are different from addictive activities, which I think is unfounded. All we know is that intimacy is rewarding and not addictive. But no one measured the release of dopamine in an intimate relationship. More importantly, the author does not need to introduce this guess to support her argument. We only need to draw the conclusion that intimate relationships are good for health based on psychological facts, regardless of the actual state of dopamine release.

The title chosen by the author for the final chapter is "the way of balance". This fits the balance metaphor throughout the book, but the last piece of advice is deeper than balance: immerse yourself in life, refuse to escape, and choose to face it. People fall into addiction because the pressure of reality makes us want to escape through a short period of pleasure, and there are many opportunities for pleasure: alcohol, nicotine, social media, online porn, video games, and so on. These escapist activities give us short-term happiness, but escape itself aggravates the original problem. The right solution is to focus on what makes sense.

Chen Ruidong

March 25, 2023

A brief introduction to the author

Anna Lembock is a professor of psychiatry and addiction medicine at Stanford University School of Medicine and director of the Stanford Addiction Medicine double Diagnostic Clinic. She has published more than 100 articles in journals such as the New England Journal of Medicine and the Journal of the American Medical Association. Rumbock was also one of the first people in the American medical community to sound the alarm about opioid abuse, publishing popular books Addiction, Drug Dealer, and MD.

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