One of the major reasons why people relapse, especially in early recovery, is due to anhedonia and therefore a subsequent lack of knowledge of this issue . The best way to describe anhedonia is a state of ‘blah’. A current dissatisfaction with sobriety or somebody’s current reality. Anhedonia consists of two primary factors: The first is biochemical and the second is psychological.
First let’s focus on the biochemical. When somebody ingest drugs or alcohol they release dopamine into the brain and this continues over a period of time, for years sometimes, and every time they put a drug in their body dopamine is released in the brain. What eventually happens is the brain says, ‘that’s it I’m done, I don’t need to produce this naturally any more’. Now dopamine is responsible for a lot of things, it’s responsible for a reward that keeps us safe and alive and keeps us moving forward as individuals. If we don’t have dopamine or a natural production of dopamine, we’re gonna feel that ‘blah’ feeling.
When somebody enters a recovery center or any kind of treatment environment and they are no longer having a chemically altered amount of dopamine going off in their brain throughout the day, whenever they put the drug in their body, what will happen is as they go through everyday activities during that initial phase of sobriety they’re not going to feel very good. They’re not going to feel that reward. That’s the biochemical reason of why somebody’s going to feel anhedonia. The second thing to discuss when really understanding anhedonia is the psychological effects that somebody’s going to be experiencing while in early sobriety.
To really understand, let’s take a look at somebody while in active addiction. This is usually a pretty exciting lifestyle, now it’s negative excitement a majority of the time, but excitement nonetheless. This is somebody who might be participating in illegal activity, somebody who’s probably putting themselves in pretty dangerous situations. They may be dealing with some pretty shady people or running from the police or maybe even just the excitement provided from being dishonest to the people around them, trying to hide their stash or just get away with the substance use or anything involved in the substance use.
One thing all of these types of behaviors do is get the heart beating and it can start to produce adrenaline, all of these behaviors will create excitement. But what about that individual when they decide to go into treatment? They’re not going to be receiving that same kind of excitement and what this can do is lead to a comparison: ‘I understand those were negative behaviors but the way I interpreted it while in active addiction was, ‘that was very exciting! Now that I’m in treatment, I have a schedule, I have a routine, and I’m not receiving that same kind of adrenaline pumping excitement that I’m used to.’
This can often lead to other psychological set-up behaviors. A person may now awful-ize sobriety or even romanticize past using. So, with both the biochemical and the psychological effects, somebody can have anhedonia. Anhedonia can be consistent during somebody’s recovery process, at least the initial phase, it can also spike during different months of their process. It can get elevated during activities that maybe somebody has formerly had a relationship with.
If somebody grew up surfing and they loved surfing, every time they go out surfing they get that dopamine reward — if that same individual later on in life, decides to get sober and they go out surfing, there’s a good chance they’re not going to get the same reward they used to. That dopamine deficit can easily lead somebody to ‘awful-ize’ their sobriety or even hyper-focus on things from their past that would produce that dopamine, like substance abuse.
Here we see where a lot of people tend to relapse. You may have someone in treatment waking up at the crack of dawn, going out to the ocean and experiencing that joy, that excitement, getting the heart beating, getting the adrenaline going as they’re out there, they’re riding the waves, etc. Now they’re doing this sobriety thing and it’s a structured, controlled environment but they’re still creating a new relationship with that excitement. For a lot of people who were bad addicts and may still very much crave drugs, they then go from the beach, then they’re going to the gym, and they’re participating in intense workouts. So when they’re doing that, it’s going to kickstart that natural dopamine production.
In treatment, we have the ability to assist somebody through that initial phase in this way, without the use of any kind of medications, at least anything that’s actually gonna do more harm than good. Ultimately what’s going to happen is, we can help somebody get through that initial physical phase of anhedonia. Then on the clinical side, someone in treatment is going to come into the office or group and they’re going to get lessons from clinical staff or peers and they’re going to learn about things like anhedonia. They’re going to learn in real time how to use coping skills.
All of this works together well, but anhedonia is gonna act as a one-two punch as far as the biochemical factors and the psychological factors. We use the same kind of recipe combating it: address the physical and the psychological aspects. The problem often seen however, is people making permanent or life-threatening decisions based on temporary uncomfortability or boredom, and that’s why people will relapse from anhedonia. From this prospective, it becomes necessary for the addict to enter an environment where they’re given the opportunity to promote brain healing, along with gaining the knowledge of why they’re acting or feeling a certain way, which can set somebody up with an ability to maintain long-term, sustainable sobriety.