Published: Oct. 19, 1998
Updated: Nov. 3, 2004
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By Duke Medicine News and Communications
DURHAM, N.C. -- You won't find a giraffe swaying to the melody of Frank Sinatra, nor will a beautiful sunset inspire a hamster to romance his cage mate. That's because scientists say the ability to derive pleasure from the world and oneself is a uniquely human characteristic -- one so ethereal that describing the pleasure at hand fails to evoke the same delight in the listener.
Just try going through life without being able to experience beauty and pleasure first-hand and you'll get a glimpse of what life can be like for many a drug addict, says Dr. Roy Mathew, director of the Duke Alcoholism and Addictions Program. Many former addicts describe themselves to Mathew as having been incomplete, lacking in a fundamental quality they knew could make them feel whole. Drugs, they say, replaced the pleasure they failed to derive from life -- if only temporarily.
It is Mathew's goal to teach addicts how to experience real pleasure in life, the kind that imparts sustained, long-term fulfillment: the giddiness of new love, the warmth of cuddling your baby, the satisfaction of a job well done.
Without that ability, he says, even the high of heroin or cocaine cannot impart the sense of spiritual fulfillment one derives from truly satisfying experiences.
"Addicts don't find long-term happiness in drugs," Mathew says. "Addiction is often the only pleasure they've known. But once you have experienced real pleasure, the lesser pleasures derived from drugs lose their appeal."
It's an approach long embraced by recovery groups like Alcoholics Anonymous, where spiritual pursuits are encouraged as a way to replace the artificial and fleeting euphoria of drugs. And while he applauds its merits, Mathew is not content to dispense spirituality without understanding the mechanisms that underlie its therapeutic effects.
Drug Research Provides Clues
Finding answers is more of a journey than a destination, he admits. But along the way, he has gained some valuable insights into how the brain works. By imaging the brain as it responds to various experiences and chemicals, Mathew has found that drugs like marijuana stimulate the very same pleasure centers in the brain that are stimulated by spiritual experiences, such as beautiful music or scenery.
Marijuana, for example, increases blood flow in a brain region called the anterior cingulate, where emotions are turned into conscious thought. It is in this region where feelings of altered consciousness and dissociaton arise – experiences common to both drug users and those who experience a spiritual epiphany. In the cerebellum, marijuana acts to alter perception of time and space. Such advances are admittedly incremental, but Mathew is hoping they'll eventually shed light on a field whose only hard data is that which the drug user describes.
"Knowing where the pleasure centers are, and how to invoke them to respond, could give us the answers we need to understand their craving for drugs," Mathew says.
It is far more complex than targeting a faulty gene or neurotransmitter, he believes. Genes are only part of the human equation, in which biochemical and behavioral elements converge to create the unique perception of self. When the self is incomplete -- as so many addicts describe -- you can't make it whole by giving quick-fix remedies, Mathew says.
For example, giving methadone to a heroin addict inhibits the user's craving for that particular drug but fails to address his inherent need for pleasure and fulfillment. With nothing to replace the addict's thirst for pleasure, the person is likely to continue seeking socially inappropriate means of pleasure, whether through drugs, gambling, sexual promiscuity or other behaviors.
Drugs Without Addiction
But what about the individual who uses drugs to enhance an already pleasurable state without succumbing to destructive behaviors associated with addiction? Such is one of the many questions that plague Mathew about the brain's response to drugs and how the brain experiences the pleasure sensation.
"Fifty percent of drug users do so because they have a mental disorder like anxiety or depression. The other 50 percent use them because they simply like to – because it feels good," Mathew says. "Does that mean their baseline personality is deficient in some way? Or does it mean that person is unusually inquisitive about other mood states? In other words, if an important part of life is feeling good, what's wrong with using a drug that enhances that feeling?"
Mathew theorizes the difference may be in the user's ability to evoke a spiritual response from within, independent of drug use. Even though a starlit sky can bring about a spiritual sense of awe and wonder, the brain should be able to experience pleasure independent of external cues, independent of the five senses and the information they bring.
Mathew points to the many cultures around the world that, for centuries, have used drugs to enhance spiritual or religious ceremonies, yet in that context, drug use is considered a spiritual aid rather than a spiritual crutch.
The dichotomy that such varying perspectives on drug use present are fueling Mathew's search to define pleasure and impart its therapeutic effects in a holistic setting.