Step One
Featuring The Crazy-Ass-Ex-Girlfriend
Dopamine is one of the chemical motivator of humans, so when I think of motivation, I think of dopamine. It is what rewards us for the essential things in life like learning, eating, and sex. It is a part of every day in our life.
I am not a doctor nor trained in medicine, but I have done extensive research and learning on the subject of addiction, and I have heard many explanations. Dr. R. Corey Waller of Health Management Associates Institute on Addiction has a presentation that explains the issue of addiction with reference to dopamine. It’s available on YouTube.
He presents this dimension at a very basic level which is easy to understand. When listening to his presentation, I could easily relate it to other knowledge I’ve gained, so I wanted to correlate his lesson to other things I’ve learned along the way. Those who have struggled with addiction and who have been part of the recovery community will see how the science of his presentation ties to the culture of the twelve-step community.
The purpose of this writing is to show how learning about dopamine and its effect on people has helped my sustained remission from alcohol use disorder. I’m going to start off with some numbers, but I won’t get deep, and there is no math. It starts with physical dependency driven by unnatural dopamine levels, and then I will tie it into psychological issues.
Dopamine effects leading to physical dependency
We have different levels of dopamine depending on the situation of our day. The baseline amount in a human body for a normal day is approximately 50 nanograms per deciliter of blood (50ng/dl). That’s what most of us have on an hour-to-hour basis.
When we are feeling really low and unmotivated, the dopamine level is around 40ng/dl. This is basically a typical level in a person on a rainy Monday morning when we don’t want to get out of bed.
The highest natural occurrence level of dopamine is 100ng/dl. Think of the greatest moments of your life where everything was perfect and that’s probably what you had for a dopamine level. It’s a girl’s wedding day, or when the guy scored the winning goal of the game. It’s when the pilot makes the perfect landing, or the artist swipes the perfect last stroke of the masterpiece.
The next near highest occurrences of high levels of dopamine are eating your favorite food and having sex. Those are around 94ng/dl and 92ng/dl. Yes – food is higher, most likely because it is more important for survival.
However, when we have high levels of dopamine, it doesn’t last long. The body has chemicals that attempt to keep normal levels called down regulators that uptake the excess dopamine out of the system. They bring levels back to normal, eventually striving for 50ng/dl of dopamine.
When we ingest drugs, we raise our numbers to abnormally high levels of dopamine, well above the natural maximum level of 100ng/dl. Nicotine can raise the levels to 400ng/dl and methamphetamine (meth) can take the levels to 1100ng/dl. Cocaine and alcohol take our dopamine to various levels between these two unnaturally high levels.
The brain takes note of this wonderful feeling that comes from these supernaturally high levels of dopamine. The learning of its effect is what will cause problems in the future when we try to distance ourselves from using these pleasure drugs. The brain will remember how good we can feel with them.
When we raise our levels of dopamine to unnaturally high levels through using pleasure drugs, the down regulators (the countermeasures) get to work to reduce our levels of dopamine to natural levels. When the levels of dopamine are abnormally high, the down regulators act accordingly with higher countermeasures to lower the levels. However, they can overshoot and take the levels abnormally low in the effort to create the balance. This is part of the withdraw from the pleasure drugs and negative effects commonly known as the hangover.
If we continue to repeat the cycle of using drugs, the body counteracts the abnormally high levels of dopamine with stronger and stronger down regulation. This is what happens when we increase our tolerance. We have to use more drugs to replicate the good feeling effect from before. With the increased use, the body increases the down regulation.
Eventually, the downregulation, when the pleasure drug effects are mitigated, can bring the levels of dopamine dangerously low. Instead of being on the rainy-day level of 40ng/dl, it can go down to levels as low as 10ng/dl.
Because dopamine deployment is part of the survival mechanism, when the body gets down to these abnormal levels, the older systems of the brain (limbic systems) goes into survival mode. It bypasses the higher levels of needs (cortex systems) to meet the basics.
If you are familiar with Maslow’s hierarchy of needs (which is normally shown as a pyramid), it shows that lower levels in the hierarchy must be met for the higher levels to function. If the lowest levels are not met, the body thinks it’s at the base levels of survival needs and will do anything to get the survival needs back to normal levels. It ignores the higher level needs because it prioritizes meeting the lowest needs first.
This can lead to doing what society calls unethical and immoral actions. The person can no longer regulate their actions to act on the higher levels of the pyramid of needs. They feel they must do whatever is necessary to put more pleasure drugs into their system to return to normal levels of dopamine and reducing their discomfort of those low levels.
This phenomena is what Twelve Step Facilitation groups refer to as Step One. Basically this assigns agency to the drug of choice and claim it supernaturally allows it to control your actions… as if it were a possessive intruder into your mind, and Step One gives the drug the ability to override one’s ability to function normally. It renders you ‘powerless.’
The reality is it is a survival mechanism when the brain no longer honors the higher moral values. The systems of the brain dictates actions as if the person will die if the levels are not raised to normal.
People will lie, cheat, and steal to ingest the drugs to bring themselves not to a euphoric level, but simply up to the normal levels of 50ng/dl. They can lose control of their conscious actions to meet the unconscious needs driven by the survival mechanisms of the brain. Step One refers to this as being powerless over the pleasurable drug, but in fact, the higher order of the brain function is powerless over the lower orders of the brain that regulate the basic needs of humans.
The reality of it is that we become powerless over ourselves.
To reduce the need for the pleasurable drugs, in more severe cases, the medical community has the ability to ween the person off the pleasurable drugs by managing the dopamine levels with pharmaceuticals so the person is at normal levels of dopamine. We refer to this as detoxification or detox. This is important in recovery because we need to be at the normal levels of dopamine as we enter recovery so we can focus on the higher levels of brain function to include comprehension of therapy, mitigation, and education.
After going through detox and removing the body’s need for additional pleasurable drugs, the person eventually becomes able to maintain a normal level of dopamine without them. This is referred to as the pink cloud. Just feeling normal is markedly better than living with the lows between the repeated drug use that bring us to normal levels. It feels like you are past the problems with addiction, but in reality, it is the transition into a different set of issues to face.
The psychological issue
The pink cloud elation of feeling, after a period of time, wears off. We get back to the hum-drum of day to day things where the monotony of a stable life turns to boredom. Even with spurts of good feelings from positive events, the levels of dopamine reward remain at natural levels.
This is where I was talking about the problems in the future previously. The brain begins to remember the abnormally high pleasure from the time of pleasurable drug use. Subconsciously, the mind has euphoric recalls and intrusive thoughts that remind the person that there are ways of feeling better through pleasurable drug use. Despite the conscious knowledge that using the pleasurable drugs will evoke problems, the subconscious desires for increased pleasure wrecks the natural levels of satisfaction of day-to-day living.
One does not have to sink to the lowest levels of addiction, commonly known as rock bottom, to experience this psychological state. The only necessity is that the brain has experienced a level of euphoric and highly pleasurable reward from consuming the pleasure drug.
My continuous challenge in remission, which some people refer to as recovery, is managing the intrusive thoughts and euphoric recalls. After three years of abstinence, the subconscious obsession of drinking again, which is commonly called craving, is the sole issue to manage.
Quite simply for me, understanding that the cravings are merely subconscious thoughts. They are not demons and they are not character flaws. Knowing the intrusions to my stability are just thoughts makes dealing with them that much easier to deal with. The reason for this is that through my life, I have had other euphoric recalls of things in my life that have popped into my head from time to time. I learned to ignore them.
Here she comes again
I often refer to my cravings as my ‘crazy-ass-ex-girlfriend’ because they reminded me of a problem I used to have. Earlier in my life, after breaking off my relationship with her, I had an ex-girlfriend that continuously re-entered my life. Sometimes it was her calling on me, but other times it was me calling her. Despite knowing that our overall relationship was bad for me, there were aspects of this that brought pleasure to my world. While knowing that being with her was not psychologically healthy, initially I could not overcome the euphoric recall of the acute moments of ecstasy in the heated throws of passion together.
In time, after identifying this and placing barriers between us, I was able to maintain my distance. I stopped communication, and I didn’t answer the door late at night. The recall and thoughts eventually subsided. It didn’t come from anything other than abstinence and time. Don’t get me wrong – it was no easy task. It was the motivation to break away from the toxic relationship that gave me the willpower to avoid her.
When we have the obsessive thoughts and euphonic recalls, it is easy to want to fight them. However, Obsessive Compulsive Disorder (OCD) therapy translates well into managing these thoughts through externalization. This is where a person assigns agency to those obsessive thoughts and cravings.
The purpose of externalization is to give the euphoric recalls and intrusive thoughts a face, or a name, as something outside of us. We can confront them, as well as see them as something to keep our distance from. We see them not as part of ourself, but something outside of us that can be kept at a distance.
Instead of resisting the intrusive thoughts, I allow them to enter my mind and acknowledge them as if they are outside agents entering my conscious. I had to do this because unlike the ex-girlfriend, I couldn’t keep them outside the front door.
As I identify the intrusive thoughts as uncontrollable, I recognize them for what they are, and I consciously choose not to engage with them. Over time, I learned that if I do not entertain their presence, the mind moves on to other things. The reason I do not entertain them is doing so gives them strength and legitimacy. It is important not to think continuously about them, fantasize about them, or think of ways to successfully integrate them into my life.
As time passes, as with the crazy-ass-ex-girlfriend, the intrusions subside and enter my mind less and less. Like with her, I do not expect the memory to every escape me completely, but as time passes, it gets easier. Soon it requires little to no effort to manage them and keep them at bay. The major benefit of not engaging them after several years is that it’s getting to the point where the intrusive thoughts and euphoric recalls of drinking rarely come around anymore.
Still, I remain vigilant. Like letting the “ex” back through the door, I know that returning to using can make me feel good, but I also recognize that there are other effects that are very costly.
Summary
The intoxicating dopamine rush of using drugs and alcohol is a very real and very potent. The high of pleasure drugs is something that cannot naturally be replaced by even the greatest of natural life experiences from a dopamine point of view – there is no equivalent. That’s why our brain obsesses about them after we stop using.
The good news is amongst other things, as I said in the beginning of the presentation, there is a healthy dopamine rush that comes from learning. It is the reward from your brain for figuring problems out. Hopefully this writing gave you a natural and healthy hit of dopamine, and this knowledge of it helps you continue to find stability and peace in your day. The true reward is that, with regard to the obsessions and cravings, life continuously becomes easier in time, and eventually you don’t have to answer when the euphoric recall and intrusive thoughts reach out to you.
By Chuck S.