Why Understanding Dopamine Is Crucial to Treating Opioid Addiction

By May Wilkerson 04/27/15

Opioid substitution therapies like buprenorphine and methadone can raise dopamine to normal levels.

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Dopamine, the “feel-good” chemical in our brains, could be as crucial to our survival as food or water, evidence suggests. This has lead experts to advocate for medication-assisted therapies in treating opioid addiction.

“Without this chemical in the brain, we don’t have the capability to get out of bed,” said Corey Waller, director of Spectrum Health Medical Group-Center for Integrative Medicine, at the recent National Council for Behavioral Health 2015 conference in Orlando. “We have the inability to move forward and be the humans we want to be.”

The average brain produces about 50 nanograms per deciliter of dopamine per day, and up to 100 on a good day. This number gets a boost from substances like tobacco (450), pot (650) and heroin (975). And methamphetamine can spike dopamine up to 1,100 nanograms per deciliter, which is “instantly 10 times what the brain is supposed to be able to take,” said Waller.

Long-term abuse of these substances can lead the body to produce less dopamine over time, causing cravings similar to those by individuals on the verge of starvation or dehydration. In one study, people with no fluid intake or no food intake for five days were found to crave food or water to a lesser degree than individuals who were sober for 30 days craved their drug of choice.

“[This] really helped me understand why the behaviors we see—why these very illogical things—happen, because it’s purely survival,” said Waller. “The body is flipped over from thinking about logic and competing risks and risk adjustment.”

Opioid substitution therapies like buprenorphine and methadone both raise dopamine to normal levels of 40 to 60 nanograms per deciliter, but only 10% of patients are prescribed these medications. In addition, treatment retention rates are especially low for people with low dopamine levels—below 10%—because their brains don’t hold on to long-term memories, a condition Waller calls the “Charlie Brown effect.”

“What our hypothesis is, without the dopamine stabilizing the access in the brain that allows you to onboard memory—the therapy to change the behavior associated with the thought—it’s all wasted time,” Waller says.

Economic factors also impact recovery rates. Waller says the “haves”—those with social structures, a caring family, and a job—typically have more motivation to stop using than the “have-nots,” who lack all of the above.

The mortality rate for Medicaid patients who pursue abstinence-based recovery is 10 times higher than individuals who receive opioid substitution therapy, says Waller. He explains that addiction treatment is flawed, since it doesn’t take into account individual and environmental factors that could make abstinence-based treatment difficult, or even impossible, for some patients.

“If we don’t move toward an evidence-based model of treatment in every aspect that we do, then we are failing our patients," Waller said. "We are doing harm.”

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May Wilkerson is a writer, comic and Managing Editor @someecards. Co-host of the podcast Crazy; In Bed w/alyssalimp. She is also the top Google result for "insufferable lunatic." Follow this insufferable lunatic on Twitter.