A question I get asked often (and used to ask myself) is, “Why is quitting alcohol so hard?”
It’s really one of the hardest things you’ll ever do.
I would rather run a marathon in high heels than try to quit drinking again.
The cravings are horrible. The stress and anxiety are often unbearable. Even when you’ve gone weeks or months without alcohol, the urge can still sneak up on you.
I’ve seen it take out people with years of sobriety.
We know a lot of the usual reasons:
- Social pressure to drink
- Self-medicating stress and mental health issues
- Physical dependence
- Psychological dependence
- Fear of change
- Major life events
But something we don’t talk about as much, but should, is dopamine.
Understanding The Role of Dopamine in Craving:
Dopamine is one of the brain’s neurotransmitters. Here’s a succinct explanation from Psychology Today on what it does exactly:
“Dopamine helps regulate movement, attention, learning, and emotional responses. It also enables us not only to see rewards but to take action to move toward them.”
It plays a critical role in addiction.
Dr. Marc Lewis explains what dopamine actually does to our brains quite well. He states:
“What dopamine does in the striatum is to narrow the field of potential actions from many down to one. The competition is quashed, and now there’s only one goal on the radar. That’s the basis of craving: a narrowing of focus and motivation to one thing and one thing only.”
I’ve known this cycle all too well with drinking and smoking. But it would appear the bug has bitten me again. This time with food.
Dr. Lewis explains the role of cues in addiction and craving.
Cues are reminders or associations of something that produce an emotional response. When exposed to a cue, the brain becomes flooded with dopamine.
Isn’t that a good thing?
A brain flooded with dopamine becomes singularly focused on one thing: satisfying the craving.
Whether it’s booze, cigarettes, or food, once those cues are activated and the dopamine unleashed, your prefrontal cortex gets overrun.
Loosely translated, you can no longer think about anything other than satisfying the urge.
Why quitting things you are addicted to feels like torture:
A lot of people experience depression in early sobriety. The same is true for people who try to quit other things they’re addicted to, like technology, sex, and gambling.
Anna Lembke is a Standford professor, psychiatrist, and author of the book “Dopamine Nation.” In her book and subsequent interviews, she explains the delicate teeter-totter we ride whenever we consume an addictive substance or experience.
Things like alcohol and fried food spike dopamine levels in our brains. It’s why we feel good after that first drink or three bites into a particularly decadent meal.
But our brains do not like imbalance, so, in response to this unnatural flood of dopamine, the body will shut down the production of dopamine, putting us into a dopamine deficit state.
In her book, Dr. Lembke asks readers to think about the delicate balance inside our brains like a balance or teeter-totter. On one side is pleasure, and on the other, we have pain.
Our brains work hard to maintain a level balance between pain and pleasure.
As pleasure tilts up, the brain sends pain signals to bring it back into balance.
That increase in pain is the craving for another drink or the desire to watch one more TikTok video. Push through it, and the pain will dissipate, the dopamine levels will return to baseline, and all will be well again.
But the thing is, the more you artificially boost dopamine levels, the more intense that pain response will become.
And this is why when you give up something that has changed your brain chemistry in profound ways, you feel bored, miserable, depressed, and agitated.
It’s also why after spending hours on your phone or drinking heavily, you start to lose the ability to experience pleasure in everyday life.
Three rules governing the dopamine balance in our brain:
To understand this process more clearly, Dr. Lembke breaks down three important rules for the way our brains maintain balance related to pleasure and pain.
1. For every pleasure, we pay an equal and opposite price.
Remember, the balance wants to remain level.
As previously mentioned, the brain achieves this by tilting an equal and opposite amount to whatever the initial stimulus was before returning to neutrality.
So if you eat something that spikes dopamine and gives pleasure, the brain goes into correction mode by tipping the scale back towards pain to create balance.
She asks us to think about them as little pain gremlins hopping on the scale to bring things into balance.
It’s why after a night of heavy drinking, you wake up feeling anxious, moody, or generally “blah.” Those pain gremlins are piling on that teeter-totter to compensate for the flood of dopamine from the previous night’s drinking.
This is called the opponent process mechanism.
2. Over time, the pleasure response gets shorter and the pain response longer.
Repeated exposure to the same (or similar) stimulus results in the initial pleasure response getting shorter and the painful response getting longer.
Eventually, we get to a point where that drink or candy bar doesn’t do as much for us, but we pay a bigger price for them emotionally.
To further the metaphor, Lembke explains that those pain gremlins get beefed up and stronger, staying longer on their side of the scale.
This is what happens in addiction. We get to a point where we change our pleasure set point so drastically that we need our drug of choice just to restore a level of balance and feel normal.
And we aren’t using it? We’re tipped way too far to the pain side and experience things like anxiety, irritability, and craving.
Lembke explains that this is why people will relapse even after years of prolonged sobriety. It takes a long time for brains to adapt. In the meantime, people are walking around in a constant dopamine deficit, which can feel unbearable after a while.
3. The balance remembers.
We have really strong memories of the exact details related to stimuli that give us pleasure and pain. This is perhaps one of the most interesting aspects of the level-balance theory from Dr. Lembke’s book.
Evolutionarily, she says this makes sense.
Our ancestors needed to remember where the delicious berries were located, and they also needed to recall where the location of the lion’s den.
What we’re not good at remembering is the negative side of our pleasure stimuli.
It’s true of pain as well.
We remember that working out is hard and painful, but are less able to focus on how good we feel for the rest of the day from exercising.
It’s why breaking bad habits that are indulgent and give us a quick dopamine boost are so hard to quit, and adding new habits with delayed gratification is so challenging to adopt.
And then it changes your dopamine set point.
So something like drinking becomes a horrible, self-reinforcing cycle. The pleasure spike from alcohol puts you in a dopamine deficit that only gets longer the more your drink, which you, in turn, attempt to remedy by drinking more.
You end up having to have a drink or zone out playing Candy Crush for an hour just to feel normal.
But the other stuff you should enjoy doing, like playing with your kid? That feels impossibly dull, and you don’t even know why you can’t enjoy just being around people anymore.
Want to learn more from Dr. Lembke? I highly recommend watching her appearance on Andrew Huberman’s podcast:
The Craving Cycle And Addiction
For those of us who abuse alcohol and/or drugs, this entire process starts to take on a life of its own. The more you scratch the itch, the stronger the cues become.
Repeatedly subjecting yourself to the crave and satiate cycle changes the structure of the striatum and prefrontal cortex.
And you don’t want that because those are the parts of the brain responsible for (among other things) decision-making and voluntary action.
It’s why when you first get sober, it can feel like your brain will explode, and you have to literally hold yourself back to keep from hoofing it to the liquor store to get your fix.
Your brain has been rewired to want and get alcohol. Denying the brain its dopamine fix is an act of war on your internal world – at least, it can feel that way.
How do we overcome the dopamine deficit in sobriety?
The biggest thing is to give your brain time to heal and return to a pre-drinking set point. Equally important is to stay away from alcohol and other dopamine-inflating substances so you can break free of major dopamine fluctuations.
From there, you can do things to raise dopamine levels naturally, like:
- Get a massage
- Nature walks
- Reading a good book
- Spending time with a pet
- Hanging out with friends and family
With consistency, commitment, and time, you can recover and experience the simple joys of life once again.