When Pursuing Pleasure Turns Into Avoiding Pain

Long-term effects of drug use.

Posted Feb 27, 2019

Drug addiction is not just about chasing pleasure (feeling good) but also involves relieving emotional pain (relief reward or negative reinforcement). The negative emotional state is termed as the “dark side” of addiction (Koob, 2015). The dark side includes withdrawal symptoms, such as irritability, depression or even physical pain when access to the drug is denied. The dark side of drug addiction contributes to vulnerability to cravings triggered by drug cues and stress.

There are two major sources of motivation with drug addiction (Koob, 2015). First is the pleasure that makes the person becomes hooked in the first place. But after a while, the brain system becomes so compromised that one is taking the drug to return to a normal state. In effect, an addict is not trying to get some extra pleasure, but just trying to feel normal or avoid feeling worse. In the words of Dr. Koob (2015), the same brain region responsible for making you feel good also makes you feel bad when you become addicted.

Every drug user starts out as an occasional user and then shifts to a compulsive user. At some undefined point, substance abusers are no longer in control of their substance use. Just as a pickle can never become a cucumber again, once a person crosses over this undefined line, there is an alteration in brain circuitry that cannot be reversed. The end result of such a process is that the individual begins to engage in compulsive drug use. They are no longer in control of their drug use.

For every action, there is a reaction. According to Richard Solomon (1980), the brain system contains mutually opponent processes in any emotional situation (pleasure-pain). The two processes are arbitrarily termed as the a-process and the b-process. The a-process represents a positive mood state followed by the b-process (negative emotional state) to neutralize the drug’s effects to maintain equilibrium. The difference in magnitude between the a-process and b- process determine whether the user experience pleasure or pain (distress of drug withdrawal).

The opponent process theory describes a shift from casual to compulsive drug use. The initial use is normally pleasant which motivates further use. However, with repeated use and growing tolerance, b-process (feel bad) begins to dominate the a-process (feel good). The b-process gets larger with repeated use and is opposed by progressively weaker a-process (due to tolerance). As mentioned before, the b-process is known as the “dark side” of addiction that drives the negative reinforcement of addiction.

Essentially, drugs rewire the brain little by little with each use. Chronic drug use leads to a pathological change in the emotional “set point” of addicted individuals. That is, eventually the opponent process fails to bring the user back to a normal homeostatic range. So the addict transitions from using the drug to feel good to using it to avoid feeling bad.

What happens when the addict quits cold turkey? Cold turkey is the process of suddenly stopping any use of a drug. The abrupt removal of drugs from the system unmasks the brain alteration, which is manifested by withdrawal syndrome. On termination of drug use, the b-process (suffering) dominates the a-process (feel good). And this fact makes life difficult without the drug.

The opponent processes also play a role in the domain of pain (Shurman et al., 2010). That is, repeated use (or misuse) of opioids can increase sensitivity to pain, which is a sign of opioid withdrawal. The intense pleasure of the opiate drug would be opposed by aversive withdrawal symptoms. This can explain the vulnerability to addiction in opioid-treated patients. Thus, the inappropriate use of the opioid (or treating an individual without pain) engages opponent processes.

The opponent process theory provides an explanation for the compulsive use of drugs in which one is taking the drug to avoid pain. Thus, addictions are sustained not only by positive feelings but also by the potential for strong negative feelings that build up internally. The discomfort and suffering phase of addiction (tolerance and withdrawal) often force the addict to admit his or her pathological status and possibly seek treatment.

References

Koob GF. (2105), The dark side of emotion: the addiction perspective. Eur J Pharmacol. 15;753:73-87.

Shurman J, Koob GF, Gutstein HB. Opioids, pain, the brain, and hyperkatifeia: a framework for the rational use of opioids for pain. Pain Medicine. 2010;11:1092–1098.

Solomon, R. L. (1980) The opponent-process theory of acquired motivation: The costs of pleasure and the benefits of pain. American Psychologist, Vol 35, 691-712.