THE MOLECULE OF MOREaddictions. You can’t beat drugs with willpower alone. It takes more
than that. There are medications that help with some addictions, but
they don’t work when they’re given alone. They have to be combined
with some form of psychotherapy.
The goal of addiction psychotherapy is to pit one part of the brain
against another. Part of the dopamine desire circuit becomes malignant
in drug addiction, pushing the addict into compulsive, uncontrollable
use. It has to be opposed by an equally potent force. We know willpower
won’t do it. What other resources can be called on to win this fight?
This question has been studied extensively, and the knowledge
gained has been formalized into a variety of different psychothera-
pies. Among the best studied are motivational enhancement therapy, cognitive
behavioral therapy, and twelve-step facilitation therapy. Each takes a unique
approach to using the resources found in the human brain to coun-
teract the destructive impulses of the malfunctioning desire-dopamine
circuit.
MOTIVATIONAL ENHANCEMENT THERAPY:
DESIRE DOPAMINE VERSUS DESIRE DOPAMINEAddicts crave drugs. They use drugs even when drugs destroy their
lives, but most of them know they’re harming themselves. They’re
not completely deceived by the chemical. They’re ambivalent: part of
them wants nothing more than to use drugs, but there are other, weaker
desires as well. Those desires can be strengthened. There may be a
desire to be a better spouse, a better parent, or to do better at work.
The drug addict may see their bank account drain away, and wish for
the peace of mind that comes with financial security. Or they may wake
up feeling sick every day, and wish they could go back to the time when
they were strong and healthy.
None of these desires is able to provoke dopamine release the way
drugs do, but desire not only gives us motivation to act; it also gives us
patience to endure. In motivational enhancement therapy (MET), patients
tolerate feeling resentful and deprived, the punishment of disappointed