Up Close With Dr. E

The power of pleasure


Introduction: What is your pleasure? Perhaps its natural rewards, such as apple pie, playing golf, a great book, buying new clothes or cruising in a sports car. Or maybe its drug-based rewards, like an ice-cold beer, pot, cocaine, wine, or nicotine.

How does your brain transform the above rewards into the sensation of pleasure? Does your brain have a pleasure center? When you get high, does your brain have a neural library which records the pleasure cues — where, when, what — so you can re-locate and re-experience the euphoria producing event?

Are the brain mechanisms involved in substance use disorders the same as those regulating non-drug addictions, such as compulsive gambling?

Not only will today’s article answer these questions, it will also give you a deeper understanding of how your brain’s pleasure center shapes your life. Before beginning, you will need a class in neuroscience — how your brain works. A quiz format is used. After passing the quiz, your new skills will be applied to three areas: Parenting, self-healing, saving rock star Mick Jagger from a deficiency of “Satisfaction.” Ready? Let us roll!

Quiz (True or False):

1. Psychoactive drugs such as pot or alcohol alter brain functioning and produce a high, or a powerful sense of pleasure called euphoria. True

2. The brain’s anatomical pleasure center is in the limbic system, which controls our emotions. True

3. The brain chemical which allows all rewards (natural and drug-induced) to produce pleasure is dopamine. True

4. Food, gambling, internet gaming and exercise all act on the same brain mechanisms to produce pleasure. True

5. The opposite of pleasure — a state of apathy, blandness, and no satisfaction from any activity — is called Anhedonia. True

6. Chronic anhedonia is caused by several conditions: drug-withdrawal, trauma, PTSD, long-standing clinical depression, and chronic pain. True

7. Extreme stress caused by violence, fear, abuse, unrelenting hardships, can alter the brain’s reward or pleasure center. This causes one to seek out events-sex, drugs, dangerous activities – which give a bigger bang (more dopamine) for the buck. True

8. Chronic drug use causes the brain to adapt. This process, called ‘tolerance,’ can make it harder to experience the original high from the drug. To compensate, greater amounts of the drug are used. True

Multiple Choice:

15-year-old Sara has never been high. One day, her boyfriend, Nathan, takes her for a drive and introduces her to cocaine. As Nathan’s car, a ruby-red Porsche convertible, races through the countryside, music blaring, Sara experiences an overwhelming sense of pleasure. As her recreational cocaine use progresses into chronic abuse, her brain’s pleasure, or reward system begins to shape her learning. Which of the following are examples of this?

1. Her drug seeking habits begin to dominate other, more healthy habits.

2. Her brain pleasure center, which acts as a reward detector, releases dopamine when it detects any drug cues. For example, just hearing Nathan’s voice (a drug cue) fires a burst of dopamine. This creates the anticipation of getting high, which causes as much or more pleasure than the drug itself.

3. The anticipatory high distorts learning: Drugs become overvalued, while past, natural highs — sports, exercise, fishing — become undervalued.

4. Drug use overrides fear circuits which once acted as brakes, curbing dangerous behaviors. Sara no longer fears falling grades or unprotected sex.

Answer: All of the above

Congratulations! Now that you have passed the quiz, lets apply your knowledge to three areas — Parenting, self-healing and Mick Jagger.


1. Teach your children the concept of “All things in moderation.” Because binges of drug use, internet gaming or food intake trigger high dopamine release — which can alter the pleasure center and activate addiction processes — set up timed schedules for screen use, reduce food portions, and monitor your child’s electronic use.

2. Examine your own patterns of compulsive or binge behaviors. Instead of clubbing yourself with guilt or shame, ask loved ones to help you find ways of restoring balance.

3. To help Mick Jagger of the Rolling Stones who “Can’t get no satisfaction,” remember this pleasure principal: Anhedonia destroys lives. When food turns into tasteless paste, and life’s rainbow colors fade to black, you have entered the danger zone for self-harm. Seek immediate professional help.

The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.


Dr. Richard Elghammer contributes his column each week to the Journal Review.


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