Happiness, Pleasure, and Addiction

As noted in my previous blog there's a difference between momentary pleasure and a more enduring sense of happiness that can come from having meaning and joy in your life. At any moment in time what they both share is a sense of peace, of being unburdened, and the lack of the need to do anything right now. 

Recent research on the emotions suggests that they are subject to cultural, environmental, circumstantial, and individual cues.  We automatically and unconsciously appraise our physical and mental states and create a conscious narrative about our feelings. For example, Milt Erickson the famous psychiatrist, was reputed to have some clients do physical exercises during therapy so that they would misattribute their anxiety symptoms as simply part of their physical movement.  In her recent book How Emotions Are Made, The Secret Life of the Brain Lisa Feldman Barrett  gives an example of a friend who reluctantly went on a date and found herself mysteriously and surprisingly attracted to her date, because of autonomic arousal symptoms she was experiencing. Later she went home and threw up and spent the next week in bed with the flu, not infatuation.

Dopamine is the substance that largely lies behind the feelings of pleasure. Anything that can activate the dopaminergic system is going to produce positive feelings, moreover feelings that will be continually sought out: sex, food, drugs, experiences, etc. When we feel that sense of being relaxed and unburdened, we want to repeat them because in busy, stressful lives, they don't often occur naturally. In fact, the research suggests that our search for dopamine highs is relative. For example, cocaine can produce a significantly greater high than food or sex, leading to addicts to downgrade normally pleasurable experiences because they are relatively weaker than the cocaine experience. This also explains why soldiers who are involved in high stress but also extremely adventurous  experiences  when in combat have a difficult time returning to a more mundane, less dopaminergic existence.

It's common, of course, for people to use alcohol and drugs to get that high and that sense of pleasure. However, how much does context,  expectation and experience determine the feeling and the appraisal of it? If you gave someone a non-alcoholic drink that they thought was their usual elixir, sat them down with their usual drinking buddies, who were having their typical drinks, in the pub or bar where they always meet for a good time, would that guy rate his pleasure as any less than normal? Would his dopamine levels be less than normal?

The possibility also exists of environmental cues triggering physiological responses. Using the concept of hyper-prepared conditioning, in which one takes advantage of cues and responses are likely to be easily associated for evolutionary reasons, for example, food and nausea, it might be possible to condition and elevate physiological effects. For example, one anecdotal report told of a child who could only tolerate a small amount of medications needed for her illness. The smell of lavender, a novel fragrance, was pared with the medication and subsequently, the presentation of the lavender produced a physiological response very similar to that of the medication, effectively increasing the medication effects without increasing the dose.

This raises the possibility of increasing pleasure not by increasing or even using substances that stimulate dopamine, but by increasing the environmental cues associated with pleasure.

I am reminded of a client of a friend of mine. She always went to the family's large Christmas parties where people came to Colorado from across the country. One year, as she had just started in sobriety, her parents who were the hosts, decided that there would be no alcohol at the family Christmas party that stretched over a long weekend. The client felt some guilt that she had ruined this family gathering and was sure that it would not be its usual fun gathering. She was completely wrong. The family gathering and joint activities produced the usual level of pleasure and joy. Moreover, because the guests weren't hungover, many of them actually enjoyed a day of skiing and other activities that they would not normally do. Everyone agreed it was one of the  best gatherings ever.

So, perhaps we need to reevaluate what gives us pleasure, even in the short term. Do we really need substances to produce it?

SohoMD Office