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Anhedonia: A Lack of Pleasure in Early Recovery

Updated: Jan 25, 2019

Anhedonia is a brain state that occurs after chronic abuse of substances or behaviors.  The individual will enter into a state where experiences that ordinarily derive pleasure due to dopamine release no longer do so.  This makes early recovery a very difficult time for some.  How does this brain state work and how can the effects be reversed?

Excessive Dopamine Output

Anhedonia is experienced when individuals abuse drugs or behaviors.  Our bodies and brain love homeostasis, and constantly struggle to maintain this in multiple areas and systems.  This is evident in our body temperature, or how the body fights back against elevating or depressive substances to return to a state of “normal mood.”  Substances and behaviors that are addictive release such large amounts of dopamine that the brain is not entirely sure how it should proceed.  As drug or behavior abuse continues, the brain begins to learn that this is a normal level of dopamine.  As this information is incorporated, the brain elevates its expectations for dopamine to know what behaviors or substances are good, better, and best for survival.  Once this expectation is elevated, normal experiences, such as eating food, are not noticed as being good for survival.

When this happens, the brain enters into the state called anhedonia.  Everyone may not experience this, at least not as severe as others.  While it is not clear why this occurs at different severities, it does occur.  Individuals that experience this state, even moderately, are at high risk for relapse.  This is because their lives become devoid of pleasure.  When the stress system kicks in, and the brain is looking for a dopamine release to soothe itself, nothing will cut it, not food, not sex (unless this has developed into an addictive behavior), and not cigarettes.  The individual may fight it for some time, but the urge to return to substance or behavior use will be strong.

Cross Addictive Behavior and Justifiable Substances

In a desperate attempt to avoid substances and experience a modicum of relief, the individual experiencing anhedonia is likely to use cross-addictive behavior or justifiable substances.  This behavior, or these substances, may release lower amounts of dopamine in the brain, but they will still affect the individual enough that they will continue to use them at extreme levels in a desperate attempt to scratch an itch that will never be scratched in this way.  Working at an inpatient level of care for many years, we have seen individuals attempt to find this relief in many ways.  Caffeine, nicotine, sex, or relationships, are all available and abusable substances and behaviors that are easily justified by this population.  Unfortunately, abusing these substances or behaviors keeps this system compromised and will delay the healing process, perhaps to the point where the individual returns to their primary substance or behavior.

Letting the Reward System Repair

In order to achieve recovery, the reward system needs to begin to regulate itself properly once again. Unfortunately, there is no easy way to do this, and it really just takes some time. To support this process, it is beneficial to avoid as many behaviors and substances as possible.  Ideally, the individual would only eat food and drink water for an extended period of time, while participating in counseling, and the brain would heal quickly.  This is perhaps not realistic, but it is ideal.  There is plenty of evidence to support this, with some studies indicating that quitting smoking at the same time as substance or behavior use increases successful outcomes.  We highly recommend talking with a professional about other substances or behaviors that may be best to avoid while working on a primary substance or behavior of abuse.  A professional may be able to help you identify problematic substances or behaviors that you did not even consider.

Independent Recovery

We fully support your decisions to pick and choose which behaviors and substances you wish to let go of.  We may make some recommendations, but ultimately, we will not attempt to force you into a certain way of achieving recovery.  If you want to know more about this topic, or wish to have professional assistance while you let your brain heal, please reach out to us.  Head on over to our Get Started page and let us know how we can support your change process!