I feel like I’m touching the third rail by even attempting to tackle this topic, but I’ve always been a risk-taker so here we go. Right off, I will go out on a limb and say the general consensus seems to be that addiction never goes away. But as with everything, there are dissenters and outliers. I also want to clarify that this article is based on my own opinion and experience … along with a lot of science that makes me look smart.
The people who seem to be able to leave addiction behind
There are people who went through a stage of misusing a substance … and then sort of grew out of it. Maybe it’s akin to a child passing through the Terrible Twos. For some of these people, their substance use was spurred by a situation. For example, perhaps they were 17 and rebellious, giving the bird to their parents. Or perhaps it was just a stressful time in their 30s when they were going through a divorce or their parents were dying or their jobs were living nightmares, and they drank to take the edge off. When their life circumstances changed, they were able to put the substances away.
There’s a second group, who are people who shot heroin for a bit or used opiates and went to jail—people who had a verifiable problem—who can now drink normally because it’s been so long or booze wasn’t their drug of choice or whatever. In this same group, I include people who used to drink heavily and snort mounds of coke, who can now just smoke weed in moderation, and it’s chill and they don’t destroy their marriages, health, or careers. Lucky them.
Some heavy drinkers can take naltrexone (yes, the opioid blocker) an hour before they drink, and it will dull or block the “buzz” from booze so they can have 2 beers instead of 10. This targeted use of naltrexone is called the Sinclair Method. It works phenomenally for some people, while others have vivid nightmares or other side effects that make it a bad fit.
And then there are the rest of us. Or at least me and the people I’ve come into contact during my 30 years battling addiction.
Genetics plays a role in substance use disorder
They say 50% of addiction is genetic, but I don’t believe researchers have narrowed it down to a single, specific gene. Rather, there are multiple genes associated with a higher risk of addiction. Scientists do see substance use disorder running in families, but one could argue that’s generational trauma, not nature.
What reserachers have discovered is a genetic mutation called MTHFR, wherein people lack a specific enzyme to break down folic acid from green veggies into l-methylfolate, the building block of neurotransmitters like dopamine and serotonin. Basically, we don’t methylate properly. This means we can’t make enough dopamine and serotonin, so we’re always looking for outside sources to boost it to feel vaguely normal and un-depressed. According to Dr. Howard Wetsman, addictionologist, recovering addict/alcoholic/food addict, and previous owner of a rehab in Louisiana, 80% of his clients tested positive for this genetic mutation. I tested positive for this genetic mutation, having two copies, one from my mother (who was an alcoholic and speed addict) and one from my father (a life-long depressive). Yay me!
My extensive experience chasing dopamine
Now that you have the veritable lay of the land, I’m going to relay my own personal experience, which is far from unique. Prior to my methamphetamine addiction, I had a terrible eating disorder. Once I found meth, my eating disorder vanished. Conversely, I often see people get into recovery who then struggle with food and disordered eating. Guess what they’re looking for? Dopamine.
Similarly, how many people in recovery do you know who smoke or vape? It took me YEARS into recovery to finally put that down for good (never, say never); the way I used to smoke and vape horrified normal people. I wasn’t doing it for enjoyment. It was for the nicotine. I was addicted to the nicotine. Guess what nicotine does? It increases dopamine levels.
I’ve also struggled with my caffeine intake in recovery. In early sobriety, I would drink two huge Monsters or Rock Stars … until one day it triggered my epilepsy. I had a seizure and was reprimanded by my neurologist for my energy drink habit. Later I turned to six-shot lattes. Once my epilepsy became intractable again, I switched to yerba mate, but I still drink two back-to-back until I feel nauseous and anxious. Know what caffeine does? It increases the amount of dopamine in our brain by slowing down the rate of reabsorption. Do you see a pattern here?
And now sex. I was a sex addict for the first 2-3 years of this sobriety. It was compulsive and terrifying and eventually mortifying and dangerous. Then after a breakup, I was celibate for six years. Now I’m seeing somebody again. This man who HIMSELF is in recovery and admits to having been pretty promiscuous, calls ME a nymphomaniac. (Ironically that’s the nickname the techs gave me in my sixth rehab. Cringe.) I can see I’m in overdrive but I’m just relieved that it’s now within a relationship and not with a string of strangers from Tinder.
“So it’s okay because you’re just buying from ONE dealer?” my boyfriend asked. “Got it.”
Ooof.
I don’t think I need to tell you, but orgasms result in a huge spike in dopamine in the brain. Hi.
Have a problem with impulsive buying? When we purchase something, our brain releases endorphins and … drumroll … dopamine.
The list is literally endless, which is why I see people (and myself) grapple with other compulsive behaviors once we’ve put down our drug or drugs of choice. I’m convinced it’s the way our brains are wired and I don’t think I’m wrong.
They’ve studied the normal brain vs. the addicted brain. When a normal brain experiences something pleasurable, there is a big spike in dopamine levels but then a gradual return to a normal baseline level. For people with addiction like I have, when we experience something pleasurable, we get a HUGE spike in dopamine which lasts longer. When it passes, we don’t return to baseline, but plunge down past it to zero. No dopamine. That’s not good.
This tendency is why I have to be so careful to guard my recovery
I’ve had years in recovery and when I then started drinking or using again, it was so all-consuming that I’d land back in rehab within months. It didn’t matter what the substance was. I recently wrote a piece on taking pain pills for two root canals that ended up triggering my addiction big time. The tricky part is, that this doesn’t happen every single time, for every single person. So you don’t know until you know and then it’s sort of too late.
Note that this isn’t a reason not to get into recovery. It’s a reason to stay in recovery and guard the new, stable life you build there vigilantly.
At 11 years sober, I live knowing that my addiction is polymorphic and can take many forms. I have years of lived experience and many failed experiments. I also know that I’m not great at moderation. I’m either doing something all the time, or I trap whatever I was doing compulsively in a box, put a padlock on it, and don’t do it at all. Moderating things that give me pleasure is extremely difficult and usually unsuccessful. So it’s easier for me to just not do them.
So does addiction go away? I can’t speak for everyone. For people who don’t have the reaction to dopamine that I have, they may. Brain plasticity can allow the brain to heal and recover over time.
For me, though, and people like me, I don’t believe that addiction ever goes away. I can channel my addictive impulses into work, or making money, or exercise, or helping others. (Helping people or giving gifts boosts neurotransmitters including dopamine. It’s what’s called a “helper’s high.” I’ll shut up now.)
My only advice is to know yourself, learn coping strategies, and pick your poisons wisely.