Tuesday, February 6, 2018

Addicted to Love

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Early exposure creates a sense of euphoria, a heightening of senses, a rush of pleasure. In order to recreate and further heighten the experience, more is sought, but the euphoric effect eventually starts to wear off. Craving and palpable longing intensifies in its absence, but the effect of exposure is now a calm relief rather than a euphoric high. And once cut off abruptly and completely, desperation, grief, pain and depression set in. The pull to return to it is (almost) insurmountable.

This describes the phases of substance addiction, listed by the DSM-5, the latest version of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. These phases include consumption (taking the substance), reinforcement learning (intense pleasure associated with consuming the substance), seeking more of the substance, developing a tolerance (intense pleasure is replaced with avoidance of discomfort), withdrawal (psychological and physical discomfort associated with not consuming the substance), and relapse (returning to consume the substance, even in the face of large costs of doing so).

Now re-read the first paragraph, but instead of imagining the development of a substance addiction, imagine the process of falling in love.

It sounds the same, doesn’t it? According to one theory, it sounds the same because it is the same. In essence, falling in love is the process of becoming addicted to another individual.

There are undeniable similarities between how the brain responds to substance addiction and how the brain responds to falling in love. Both substances of addiction and individuals we are attracted to cause the brain to release dopamine, a neurotransmitter, into a brain region called the nucleus accumbens. Dopamine acting in this region helps us learn to associate cues with rewarding feelings. However, dopamine acts on two different types of receptors, called D1-receptors and D2-receptors, in complex ways. Activation of D2-receptors promotes bonding with a partner; it also promotes the reward value of a substance. Activation of D1-receptors reduces bonding with a partner; it also reduces the reward value of a substance. During this time early on in a romantic relationship or early exposure to an addictive substance, dopamine is primarily acting on D2 receptors, heightening our senses and focusing our attention on the cues of our next encounter… developing our craving, our longing, our drive for the next meeting.

When we are in the early obsessive stages of love, every encounter (and especially sexual encounters) cause a pleasurable release of not just dopamine, but also natural opioids. These two brain chemicals work together in the brain to continually strengthen the association of the stimulus (the one you are falling in love with) with intense positive feelings. This will cause you to seek more and more of these interactions, craving them intensely in the times in between. These same chemicals act on the same receptors in the same way during the process of forming an addiction to a substance, causing the person to seek more and more of it.

With time, the brain adapts. Repeated encounters no longer cause the same euphoria they once did, but rather, a sense of calm contentment. The dopamine that is released before and during these encounters is now activating more of the D1-receptors, which result in less of a feeling of pleasure, and more agitation and aggression. In terms of relationships, it is thought that this transition actually helps maintain a pair bond with one individual, because in this stage you are less driven to seek a competing pair bond and you are more likely to aggressively defend the pair bond you have already established. In terms of substance abuse, this phase is called tolerance. (I know, this perspective really takes the romance out of long-term marriages, but...)

During this tolerance phase, lack of exposure to the object of your addiction (whether it is a person or a substance) results in a lack of dopamine and opioid release and an increase in stress hormone release. If we are talking about addiction to a substance, we call this withdrawal. If we are talking about a relationship, we call this separation anxiety or even heartbreak. To avoid these horrible feelings, we often relapse… right back into the arms of our addiction.

Love is not listed as a psychological disorder in the DSM-5, nor do we think of it as one. But in a true physiological sense, we may actually be addicted to the ones we love.

Want to know more? Check these out:

Burkett, J.P. and Young, L.J. (2012). The behavioral, anatomical and pharmacological parallels between social attachment, love and addiction. Psychopharmacology, 224:1-26.

Potenza, M.N. (2014). Non-substance addictive behaviors in the context of DSM-5. Addictive Behaviors, 39(1): 1-2.

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