The Molecule of More

THE MOLECULE OF MORE

reward prediction error, like the addict who felt an overwhelming desire
for heroin when he saw a bottle of laundry bleach. Desire dopamine
cranks up, motivating the addict to use, and threatening to shut down
completely if it doesn’t get what it wants.
Alcoholics in CBT learn to arm themselves against cue-triggered
craving in  a  number of different ways. For  example, they may recruit 
a sober buddy to go with them to events where alcohol is being served.
They also work to eliminate as many cues as possible. The patient and
a friend are sent on a “search-and-destroy mission” in which every-
thing that reminds the patient of alcohol is removed from his home:
cocktail glasses, shakers, hip  flasks, martini olives, and  so  forth. Any-
thing that the drinker connects to alcohol use is a trigger, and has to go
because otherwise it might be the agent of craving that brings an end to
a hard-fought period of sobriety. One alcoholic patient brewed beer in
his basement. He resisted getting rid of his beloved equipment, because
it was his hobby, and had nothing to do with drinking, he said. Desire
dopamine won  that  battle until he  finally relented and  threw everything 
in the garbage. Now he’s sober.

ADDICTION:

IT’S WORSE THAN YOU THINK

Addictions are hard to treat, harder than many other psy-

chiatric illnesses. With other illnesses, such as depression,

patients want to get better—there’s no question about it. But

if a person is addicted to a drug, he’s not so sure. He may

share the sentiment expressed by Saint Augustine while he

was carrying on an affair with a young woman. He prayed,

Lord, give me chastity, but not yet.

Because they’re so difficult to overcome, doctors and

patients often characterize addictive substances like alco-

hol as the enemy. It’s an enemy we respect, because it’s not

only powerful, it’s clever.