The Molecule of More

DOMINATION

dopamine, because they know it will lead to something better. The goal
of the  therapy is to stoke the  flames of desire for a better life.
MET therapists build up motivation by encouraging their patients
to talk about their healthy desires. There’s an old saying: “We don’t
believe what we hear, we believe what we say.” For example, if you give
someone a lecture on the importance of honesty, then have them play
a  game in  which cheating is  rewarded, you’ll probably find  that  the  lec-
ture  had  little  effect. On  the  other hand, if you  ask  someone to  give you
a lecture on the importance of honesty, they will be less likely to cheat
when they sit down to play the game.
MET is a little manipulative. When the patient makes a statement
the therapist likes, referred to as a pro-change statement, such as, “Some-
times I have trouble getting to work on time after a night of heavy drink-
ing,” the therapist responds with positive reinforcement, or a request to
“tell me more about that.” On the other hand, if the patient makes
an anti-change statement, such as, “I work hard all day, and I deserve to
relax in the evening with a few martinis,” the therapist doesn’t argue,
because that would provoke more anti-change statements as the debate
goes back and forth. Instead, she simply changes the subject. Patients
usually don’t notice what’s going on, so the technique slips past their
conscious defenses, and they spend the majority of the therapy hour
making pro-change statements.

COGNITIVE BEHAVIORAL THERAPY: CONTROL

DOPAMINE VERSUS DESIRE DOPAMINE

It’s better to be smart than strong. Instead of trying to attack an addic-

tion head on through willpower, cognitive behavioral therapy (CBT)

uses the planning ability of control dopamine to defeat the raw power

of desire dopamine. Addicts who struggle to stay clean are most often

defeated when they are unable to resist craving. CBT therapists teach

patients that craving is triggered by cues: drugs, alcohol, and things that

remind the addict of drugs and alcohol (people, places, and things). Cues

that suddenly and unexpectedly remind an addict of drugs produce a