Discussions that mention dopamine

Addiction & Recovery board

Anything that is pleasurable can be addictive, or more accurately, people can become addicted to anything that causes pleasure; consider gambling, sex, food, internet. There is even a condition where patients drink so much water they thin their blood, causing some level of intoxication (hyponatremia). They are addicted to this behavior, although water is not considered addictive.

The brain has a natural reward system that helps us to learn that things that cause pleasure are good and should be repeated. This helps our species survive by reinforcing the desire for food and sex. These activities initiate a biochemical sequence and release dopamine in the brain. This feels good and is reinforced when repeated. Some substances can trick the brain and initiate the same biochemical sequence, but to a greater and unnatural degree. The brain senses this activity as the most pleasurable and hence the most necessary for survival, and creates a memory of the activity and cravings for more. The cycle reinforces itself and can lead to addiction.

Research has shown that substances that reach the brain faster have a higher potential for addiction. Also substances that provide a stronger effect cause more reinforcement. This begins a cycle of euphoria then craving then euphoria, craving and so on. Each time the cycle completes it reinforces a memory in the brain, the more frequent the cycle the more reinforcing.

The potential for addiction has to do with 3 main things, the speed of the onset, the level of reinforcement (pleasure), the duration of action. IV heroin, is fast acting, strong euphoria, short duration. This gives it a high potential of becoming addicted to it. Drugs with short intense cycles provide more potential for addiction than drugs with long “flatter” cycles.

Buprenorphine has a slow onset, mild effect, and long duration, which puts it at some risk of being addictive, more than water, but less than full agonist opioids.

In countries where only Subutex is available (buprenorphine without the naloxone safeguard added), some people have injected their buprenorphine, thus decreasing the onset time and increasing euphoria, this in turn increased the potential for addiction and thus more people became addicted to it. The risk of addiction is less when taken sublingually as directed.

Although there is the potential for addiction to buprenorphine, the risk is low. Few people develop the dangerous uncontrollable compulsion to buprenorphine that we know as addiction. Buprenorphine will maintain a level of physical dependence to opioids but that is manageable and can be resolved with a gradual taper once the patient is ready.