Addiction is a condition that revolves around pleasure. It does not revolve around suffering, as it may be portrayed or imagined. People who suffer from addiction suffer greatly, but it is not a disorder that derives from, or is based on, the mechanism of coping with suffering. On the contrary, it begins with pleasure: drugs “disrupt” the ability to regulate pleasure, or rather the desire for pleasure. The brain is better equipped to resist pain than to manage desire.
There is an efficient analgesic mechanism that, in extreme circumstances, allows a person not to feel the pain of injuries when the situation instead requires them to continue fighting or fleeing. There are even people who exploit the pain mechanism because stimulating a pain response produces a temporary state of calm through a neurochemical mechanism.
By contrast, it appears that the system responsible for the ability to detach from a pleasurable bond and contain desire is much more fragile. Perhaps this is because, in nature, human beings are creatures who want things, and who, when necessary, must not suffer in order to continue wanting. We reproduce because we want to; we feed ourselves because we want to, with hunger as an emergency mechanism but appetite—the desire to eat—as the basic driving force.
Let us see how desire “goes into a tailspin” in addiction. Certain stimuli, such as a drug, produce states that people describe as pleasurable. There is nothing unusual about this in itself. This is not what triggers addiction. In addition to being pleasurable, the stimulus does something else: it reinforces itself, increasing the likelihood that the person will seek it again. This happens because the person finds themselves “wanting” it.
This desire is not so much about the effect produced by the stimulus as it is about consuming it—the desire to have it and consume it. The same thing can happen with ordinary experiences: when something is pleasurable, we may want it again, but this kind of desire operates through the memory of the pleasure experienced.
There is also an independent pathway, one that functions beyond the pleasure actually experienced and that can grow even when the pleasure disappears, diminishes, or becomes corrupted. In addiction, the desire to repeat the stimulus may increase even when the person is trying to avoid it, and indeed wants to exclude it from their life because it has become harmful, dangerous, and problematic.
A person with an addiction therefore experiences this strange dissociation: wanting on one side and pleasure on the other, often no longer knowing where the pleasure actually is. Rather than seeking pleasure elsewhere, the person continues to look in the direction in which their desire pushes them, as though pleasure were still supposed to come from the stimulus to which they have become strongly attached, even though rationally they know very well that this is no longer the case and will not be.
Craving is the pathological version of desire: desire that no longer responds to pleasure. It no longer presupposes pleasure, no longer evokes it, and does not diminish when pleasure is absent. In technical terms, addiction occurs when “liking” (pleasure) no longer goes hand in hand with “wanting” (desire), because wanting proceeds on its own and in a single direction. Desire, in this case, has become “craving” (pathological desire). It is obvious that a desire that is no longer controlled and no longer regulated by pleasure will eventually produce suffering and emptiness.
In rehabilitation and relapse management, a person with an addiction therefore does not primarily display a deficit or deficiency, but an excess, an overabundance. The function underlying relapse is not an engine that switches off and causes the person to “fall” back into drugs; it is an engine that overheats and pushes the person toward drugs. The tragedy of relapse lies precisely in the inability to put the brakes on desire.
It is important to understand this point in order to understand how addiction treatment works. Some people believe that treating a person with an addiction means eliminating an underlying suffering, after which the person will stop being addicted. This is not the case.
Others believe that treating addiction ultimately involves reproducing a “substitute” effect with a different but similar substance, thereby diverting the person from one addiction only to redirect them toward another altered mental state. This is not the case either.
A practical example is provided by the most established treatments for opioid addiction: methadone and buprenorphine. These substances do not satisfy “liking,” meaning that they do not produce pleasure, and therefore they divert the person away from heroin. Their function is to reduce the “wanting” directed toward heroin, so that the person moves from “craving” back to a normal desire, similar to the one they had initially. In this way, they regain the freedom to choose not to use.
This process requires specific doses and a certain duration of treatment before the brain “responds.” The doses of medication do not correspond to the doses the person previously took as a drug, nor do they correspond to the doses required simply to prevent withdrawal: they are doses intended to produce a different effect.
Treatment is not aimed at why a person began using drugs, nor at confronting their relationship with the pleasure produced by the drug, which often no longer exists. Rather, it is aimed at preventing the drug from maintaining the desire for itself and at extinguishing the craving that, by that point, has become self-sustaining and continues to draw the person back toward the drug.
These treatments, therefore, are improperly described as “substitution” therapies; they are instead referred to as anti-craving treatments.
Detoxification, which is so heavily mythologized, does not affect spontaneous wanting, nor does it affect the desire that returns each time the substance is used. In fact, detoxifying a person means returning them to a state in which they feel the effects of the substance more strongly because they are no longer tolerant to it. Consequently, the “wanting” triggered by the effect is amplified.
But, as already mentioned, even if this component is removed—that is, even if we assume that the substance has become nothing more than “plain water”—the desire remains alive. People who, for example, are treated with naltrexone, a substance that simply blocks the effects of heroin, almost always respond by stopping their medication or attempting to overcome the blockade with large doses of heroin, thereby risking an overdose.
Addiction is therefore not a disorder concerning the general mental effects of drugs; rather, it concerns the effects of drugs on a specific part of the brain. The pathological element of addictive drugs does not lie in some “diabolical” mental effect, but in a property that might indeed be called “diabolical”: the ability to establish a memory that is disproportionate to the pleasure experienced.
As a result, the person invests far more in wanting to use drugs than they receive from them, and at a certain point they invest far more than could reasonably be expected in terms of pleasure.
From the discrepancy between wanting and pleasure arise the frustration, anger, and unhappiness experienced by people with addiction, as well as the loss of their ability to use the sources of pleasure available to them in a concrete and effective way.
Wanting and pleasure are functions that can be visualized in the brain using specific techniques. This has made it possible to observe the distortion of desire induced by drugs—a kind of parasitic craving that grows on the same system that normally allows us to move from one pleasurable experience to another, to become bored with what loses its appeal, and to become excited by something new without running the risk of becoming permanently attached to it.
In other words, this is what we might call “free will.” Addiction is precisely a model of the loss of free will over the desire to pursue one’s own satisfaction.
Treatment therefore involves a phase aimed at restoring free will, followed by a preventive phase during which it is important to rebuild, sometimes with guidance, relationships with new stimuli or with stimuli that had been neglected or lost, thereby strengthening the part of the brain that has been compromised by addiction.