Addicted Brains

A neuroscientist examines life on drugs.

The Pivot Point: Once More With Feeling

How does surrender turn into relief?

It's been a while since I've posted here. A US book tour took a month out of my life, and then there was a lot of catching up to come back to. But I'm going to start posting on this blog again, and the best place to begin is with a topic I left hanging several months ago. 

Back in January I did a post on the "the pivot point" -- the moment when we give in to our cravings and dive for the drugs or the booze. I concluded with the following:

-it can begin with a change in your internal dialogue, when you already know, without full consciousness, that you're going to give in and do it

-at the final moment, it feels like you are throwing off control, not just surrender but also relief, happiness, and even triumph

-there is often a feeling of abandon, or escape from suffocating self-control -- one reader called it the sense of free fall

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In a subsequent post, I talked about the pivot point in more detail, getting into the psychology of ego fatigue and the underlying brain dynamics: the weakening of the will as the anterior cingulate cortex (ACC) runs out of fuel, and the final snapping of the branch. You just can't inhibit your impulses actively for a very long time. Your brain can't take the strain.

In the present post, I want to go a step further and explore the relief that comes at the pivot point. There is still an untapped mystery here. Sure, you've been craving and craving, for hours, maybe for days, and now you finally allow yourself to get the thing you've been craving. Dopamine feels like desperate desire when the goal is out of reach. But it feels like a headlong rush when you're suddenly "allowed" to go get it. That's a part of the relief.

Yet there's a lot more to it. During periods of self-restraint, there can be an ongoing struggle that often takes the form of an internal dialogue: Don't do it. No, just stop. But it would be so nice... Stop thinking about it. But I want... Shut up! Just stop! And it can get quite a bit more nasty than that: Stop, you self-indulgent baby. But it's just one last time. That's what you always say, you hopeless cretin. So? Everyone's got their problems. You don't deserve sympathy. But I'm so depressed... No wonder you disgust people. Etc, etc. If you've ever heard a (usually unspoken) dialogue like this, going on in your head, then you've probably gotten to the point of saying "F**k it." And you know that the relief you get is not only from the drug/drink, or the anticipation of the drug/drink. It's also from silencing that vicious voice of self-rebuke.

So what's going on in the brain during this state? Picture your ACC, sitting near the top of the brain, trying to keep control, but finding it slipping, slipping, slipping away. Two floors down there's the amygdala, the organ of emotional colouring. As your ACC starts losing it, your amygdala begins to panic. Not only because of the longterm suffering you're about to contract, but also because the internal "parent-like" voice is getting more and more harsh, nasty, and punitive. (And note that it's typical for a parent to get more inflamed when the child is wandering out into traffic, or exposing herself to some other impending danger.)

With the ACC losing control and the amygdala responding with waves of anxiety, the two voices in your head, the childish self and the scolding parent, become more desperate, and more desperately at odds with each other. There is no consensus on where internal voices are generated in the brain, but we do know that anger is associated with the left prefrontal cortex (PFC) and fear with the right. The left PFC, being involved in planning, logic, and making sense, has also been associated with moral judgment. The right PFC is more "childish" -- it develops rapidly in infancy, before the left -- and it's more closely connected with raw emotion. In fact, some neuroscientists claim that an important job of the left PFC is to regulate the right. That often means inhibiting impulses. So now you're losing control, the amygdala is blaring anxiety, and the "childish" right hemisphere is being suffocated by the moral authority of the left. This is no picnic. It's a major family argument in the privacy of your own brain!

And then comes the pivot point. The ACC is finally too "fatigued" to keep controlling impulses. So here's what I think happens next:

Without the ACC to help keep the ship on course, the left-hemisphere-based punitive "voice" loses its authority. The right PFC is suddenly free to take the emotional path of least resistance. Left-hemisphere reasoning now switches over to become allied with its old friend, the ventral striatum (the engine of goal-pursuit). In fact the whole frontal brain becomes unified behind one exalted goal: LET'S GET HIGH. And the left PFC does its part by planning (its specialty) -- how to get it, how to pay for it, how to hide it. The amygdala is suddenly passing along waves of excitement rather than anxiety, and you are cruising, rudderless, in a headlong rush of pure anticipation.

So there's a (speculative) brain-based model of the relief that comes from escaping self-restraint. But I'm not recommending it. That relief is real, both psychologically and neurologically, yet it is a temporary flash of positive emotion at the start of a long dive into despair. This is part of the siren song, the fool's gold, of substance use. The rush of anticipation doesn't last long, and that's the best part of the high!


(My book, Memoirs of an Addicted Brain, was recently released in the U.S. Please see my website for reviews and purchase information, or click on the Amazon link at the bottom of the "bio" page of this blog.)




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