![]() Other priorities, including job, family, and hobbies that once produced pleasure have trouble competing with this cycle. The person no longer takes the substance to “get high” but instead to avoid feeling low. And like a vicious cycle, relief is purchased at the cost of a deepening disorder and increased distress when not using. ![]() As a substance use disorder deepens in intensity, substance use is the only thing that produces relief from the bad feelings associated with withdrawal. This distress, known as withdrawal, can become hard to bear, motivating users to escape it at all costs. Increasingly, people feel emotional or physical distress whenever they are not taking the substance. In substance use disorders, however, the balance between these drives shifts over time. Together, they control the spontaneous drives to seek pleasure and avoid pain and compel a person to action. If dopamine bursts in the reward circuitry in the basal ganglia are like a carrot that lures the brain toward rewards, bursts of stress neurotransmitters in the extended amygdala are like a painful stick that pushes the brain to escape unpleasant situations. The extended amygdala controls our responses to stress. As these cues become increasingly associated with the substance, the person may find it more and more difficult not to think about using, because so many things in life are reminders of the substance.Ĭhanges to two other brain areas, the extended amygdala and the prefrontal cortex, help explain why stopping use can be so difficult for someone with a severe substance use disorder. Repeated use of a substance “trains” the brain to associate the rewarding high with other cues in the person’s life, such as friends they drink or do drugs with, places where they use substances, and paraphernalia that accompany substance-taking. ![]() These same circuits control our ability to take pleasure from ordinary rewards like food, sex, and social interaction, and when they are disrupted by substance use, the rest of life can feel less and less enjoyable to the user when they are not using the substance. However, as a result, users often increase the amount of the substance they take so that they can reach the level of high they are used to. This is known as tolerance, and it reflects the way that the brain maintains balance and adjusts to a “new normal”-the frequent presence of the substance. They scale back their sensitivity to dopamine, leading to a reduction in a substance’s ability to produce euphoria or the “high” that comes from using it. ![]() As substance use increases, these circuits adapt. The most severe expression of the disorder, addiction, is associated with changes in the function of brain circuits involved in pleasure (the reward system), learning, stress, decision making, and self-control.Įvery substance has slightly different effects on the brain, but all addictive drugs, including alcohol, opioids, and cocaine, produce a pleasurable surge of the neurotransmitter dopamine in a region of the brain called the basal ganglia neurotransmitters are chemicals that transmit messages between nerve cells. This area is responsible for controlling reward and our ability to learn based on rewards. Substance use disorders result from changes in the brain that can occur with repeated use of alcohol or drugs.
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