Sympathetic Arousal, Tolerance, and Escalation

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David Fawcett PhD, LCSW

Methamphetamine, which elicits the release of nearly 14 times more dopamine than an orgasm, acts as a super-stimulant that quickly “hijacks” the reward circuitry of the brain, resetting the required baseline of stimulation far beyond levels that are possible through “natural rewards” such as food, cooperation, and (non-compulsive) sex. Sexual acting out and pornography function in exactly the same way, quickly sensitizing the user to current behaviors and driving escalation toward activities that are more thrilling, kinkier, and even more taboo.

Treatment therefore must address the paired drug use and sexual behavior that creates this super-stimulation, including strategies to:

  • Help clients recognize their hyper-intense arousal patterns
  • Understand and manage internal emotional triggers
  • Improve affective regulation
  • Differentiate paired drug and sex behaviors

All of these tasks are essential for recovery and the restoration of healthy

Arousal, Satiation, and Fantasy

While all addictive drugs and behaviors alter mood by impacting the reward circuitry of the brain, there are several different ways this is accomplished. Amphetamines, for example, are dopaminergic (dopamine-releasing). They create a flood of good feelings as a result of excess dopamine in the synaptic cleft, the space between neurons. Opioids, on the other hand, boost levels of dopamine indirectly by reducing levels of GABA, a neurotransmitter that reduces the amount of dopamine released in the brain. With less GABA, there is less control on the release of dopamine, so dopamine levels rise.

Research[i] has proposed three addictive states that are induced by various drugs and behaviors: arousal, satiation, and fantasy. The authors of that research conceptualize these states as being represented by two overlapping continuums (like a plus sign). The first is a limbic (pleasure) system continuum ranging from arousal on one end to satiation on the other. The second is a cerebral cortex (mental content) continuum, with endpoints of fantasy and super-reality. Each of the three addictive states is associated with a different location on this conceptualized space.

The Limbic Axis

The limbic system plays a central role in rewarding the use of various drugs and behaviors through the release of dopamine. One end of the limbic axis represents arousal, which can extend from heightened risk-taking all the way to mania. Intensity-seeking is the hallmark of arousal. This intensity can be propelled by amphetamines (cocaine, meth, Adderall, MDMA, diet pills, etc.) along with gambling, competitive sports, shoplifting, sex (for power), porn, work, and even chaos in one’s life. Dopamine and adrenaline are the dominant neurotransmitters in play with limbic arousal.

The other end of the limbic axis represents satiation, a more detached, numb state, with the ultimate endpoint being anhedonia (inability to experience pleasure), apathy, and depression. Addictive drivers in this direction include alcohol, opioids, food, sedatives, television, shopping, relationship addiction, and sex (for security). Endorphins and GABA (inhibits dopamine) are the primary drivers pulling in this direction.

The Cerebral Cortex Axis

This axis represents the outer layer of the brain – the portion of the brain that controls executive function (thinking, reason, impulse control, etc.) The cerebral cortex evolved long after the limbic system (located in the midbrain) developed. The neocortex (part of the cerebral cortex) controls the mental states that interact with the limbic system. One endpoint of this axis is super-reality, characterized by intense experiences such as skydiving, rock climbing, and piloting aircraft. The heightened sense of reality elicited by such compulsive risk-taking may be linked to the left hemisphere.

The opposite end of this axis represents fantasy, which can extend all the way to schizophrenia and other thought disorders, including psychoses. Hallucinogenic drugs, marijuana, mystical experiences, sex, and infatuation are all included here. Dopamine, serotonin, and norepinephrine as well as the right hemisphere of the brain are involved in these elements of fantasy, disconnection, and other imagination-oriented activities.

Why Does This Matter?

No matter which of the three forms of addictive coping styles (arousal, satiation, fantasy) is favored by an individual, trauma and other adverse childhood experiences play a significant role, along with other forms of family dysfunction or an inability to cope with the demands of childhood. Stated simply, people do not become addicted to mood-altering drugs or behaviors. Instead, they become addicted to the arousal, satiation, fantasy that the mood-altering effects enable.

This understanding is important because there are differences among persons gravitating toward the various states.

Individuals who gravitate toward arousal or intensity-seeking search for stimulation and even confrontation, a process similar to the sympathetic arousal response of fight-or-flight. There is a belief that this coping style is meant to counter feelings of helplessness and vulnerability. Drugs utilized for arousal include amphetamines such as cocaine, methamphetamine, and Adderall, along with behaviors such as risk-taking, gambling, sexual acting out, and even crime.

Individuals who gravitate toward satiation may binge on food or television or choose depressant drugs such as alcohol or heroin. The goal of satiation is to shut down negative feelings, including aggression, by reducing stimulation from the internal or external world.

Individuals who gravitate toward fantasy favor repetitive activation of right-hemisphere thinking. In terms of drug use, these individuals may gravitate toward hallucinogens. Often, they avoided childhood problems with prolonged periods of fantasy. There may be a preoccupation with dreams, fantasies (including sexual fantasies), or mystical experiences with or without hallucinogens or other drugs to facilitate the experience. While seductive for some individuals, fantasy and hallucinogens are not considered to create the same addictive potential as the drugs and behaviors in the first two categories – though plenty of sex and porn addicts (addictions that are driven by fantasy more than anything else) might disagree.

In all cases, identifying a person’s addictive coping style provides important information that can guide elements of recovery and healing. Essentially, treatment will diverge at various points based on the addict’s tendency to seek arousal, satiation, or fantasy. This is especially apparent as the individual works to create heathier, non-addictive coping mechanisms. For the fantasy-driven addict, emphasis will be placed on grounding techniques and reality-checks. For the satiation addict, emphasis will be placed on learning to cope with life stressors. For an arousal-driven addict, emphasis will be placed on finding less intense but still enjoyable ways of living, including, first and foremost, the development of emotionally intimate relationships.

References

[i] Milkman, H., Sundeerwirth, S. (1987). Craving for Ecstasy: The consciousness and chemistry of escape. Lexington, MA: D.C. Heath and Company.