Dr. Anna Lembke

When people become addicted, there's either a problem with the brakes, the prefrontal cortex, or the accelerator, the nucleus accumbens and ventral tegmental area, or both, right? What we're finding is that there's actually a disconnect.

When people become addicted, there's either a problem with the brakes, the prefrontal cortex, or the accelerator, the nucleus accumbens and ventral tegmental area, or both, right? What we're finding is that there's actually a disconnect.

So there are large neuronal circuits and pathways between those deep limbic structures and the prefrontal cortex that literally get severed or disconnected when people become addicted. As we think about pleasure and pain being co-located in the same parts of the brain, working like opposite sides of the balance,

So there are large neuronal circuits and pathways between those deep limbic structures and the prefrontal cortex that literally get severed or disconnected when people become addicted. As we think about pleasure and pain being co-located in the same parts of the brain, working like opposite sides of the balance,

In order to understand what happens in the addicted brain is to appreciate that there are fundamental rules governing this balance. And one of the most important rules is that the balance wants to remain level. It does not want to be tilted very long to the side of either pleasure or pain.

In order to understand what happens in the addicted brain is to appreciate that there are fundamental rules governing this balance. And one of the most important rules is that the balance wants to remain level. It does not want to be tilted very long to the side of either pleasure or pain.

And in fact, what our brain does is first tilt an equal and opposite amount to whatever the initial stimulus is. So I'm going to try to illustrate that here. So let's say our initial stimulus is alcohol. Now, alcohol works through its own chemical pathway. It works on our endogenous opioid system, the opioids that we make. We have receptors for opioids in our brains.

And in fact, what our brain does is first tilt an equal and opposite amount to whatever the initial stimulus is. So I'm going to try to illustrate that here. So let's say our initial stimulus is alcohol. Now, alcohol works through its own chemical pathway. It works on our endogenous opioid system, the opioids that we make. We have receptors for opioids in our brains.

It works on our endogenous GABA system, which is our calming neurotransmitter. And at the end of the day, it releases dopamine in the reward pathway. So any potentially addictive substance will release dopamine in the reward pathway. The more that's released and the faster that's released in a given individual, the more likely that substance is to be addictive.

It works on our endogenous GABA system, which is our calming neurotransmitter. And at the end of the day, it releases dopamine in the reward pathway. So any potentially addictive substance will release dopamine in the reward pathway. The more that's released and the faster that's released in a given individual, the more likely that substance is to be addictive.

Now, another important concept here is what we call drug of choice, which is to say what releases a lot of dopamine in your brain may not release a lot of dopamine in my brain and vice versa, right? Which is this idea that people have predilections to different kinds of drugs. And by the way, people can get addicted to behaviors too. I should emphasize that.

Now, another important concept here is what we call drug of choice, which is to say what releases a lot of dopamine in your brain may not release a lot of dopamine in my brain and vice versa, right? Which is this idea that people have predilections to different kinds of drugs. And by the way, people can get addicted to behaviors too. I should emphasize that.

Yes. The more dopamine that's released, the faster that it's released, the more likely that drug is to be addictive for a given individual.

Yes. The more dopamine that's released, the faster that it's released, the more likely that drug is to be addictive for a given individual.

I'm holding some whiskey.

I'm holding some whiskey.

Exactly. And for many of my patients who become addicted to alcohol, they will tell you that from the first moment they had alcohol, they knew they were either in trouble or had met their best friend or some combination. It was a very potent experience for them. All right. So let's go ahead and put this on the pleasure side of the balance.

Exactly. And for many of my patients who become addicted to alcohol, they will tell you that from the first moment they had alcohol, they knew they were either in trouble or had met their best friend or some combination. It was a very potent experience for them. All right. So let's go ahead and put this on the pleasure side of the balance.

Dopamine is being released, but no sooner has that happened than my brain will work very hard to restore a level balance. And by the way, a level balance is what neuroscientists call homeostasis, okay? And one of the overarching physiologic drives for all living organisms is to return to homeostasis. Homeostasis is that parameter of...

Dopamine is being released, but no sooner has that happened than my brain will work very hard to restore a level balance. And by the way, a level balance is what neuroscientists call homeostasis, okay? And one of the overarching physiologic drives for all living organisms is to return to homeostasis. Homeostasis is that parameter of...