High Price

wasn’t as simple as it first appeared. Although both nicotine and cocaine eventually have the effect of increasing dopamine activity in the brain, they do this via quite different mechanisms. Cocaine delays the termination of dopamine’s actions, while nicotine causes neurons to release more dopamine in the synapse. Moreover, each drug also has differential actions on a range of other neurotransmitters, all of which actions can result in very different subjective experiences. Smoking cigarettes and smoking cocaine don’t feel identical to most people, after all.
    And there were further complications. Researchers began to find that dopamine was released not just in pleasant situations; such releases also occurred during stressful or aversive experiences that were not at all enjoyable. For example, some studies show that dopamine levels rise when animals are stressed by electric shocks or cues that predict painful or negative experiences. Moreover, while animals stop self-administering drugs like cocaine if dopamine is blocked, the same isn’t true for heroin. 6 If dopamine were the only brain source of pleasure, heroin administration—indeed, administration of any pleasurable drug—should also cease.
    In addition, drugs that release dopamine, such as amphetamine (Adderall), methamphetamine (Desoxyn), and methylphenidate (Ritalin), are used therapeutically, not just on the street. These medications are often prescribed for attention deficit/hyperactivity disorder (ADHD), both in adults and in children. They’re also utilized for treating obesity and narcolepsy.
    But although there are some cases of abuse, the vast majority of therapeutic users do not become addicted. Indeed, there’s some evidence that children given these drugs to treat attention problems are actually at lower risk of addiction later in life than those whose ADHD is not treated with medication. 7 These drugs always cause increased dopamine release: if elevated dopamine-related pleasure alone produces addiction, why don’t these patients become addicts, always driven to get more?
    The problem is that when we study things like addiction, we’re focusing on pathological behavior and ignoring what occurs under the most common, normal conditions. In reality, most drug use doesn’t result in addiction. Very little research has been reported about drug users who haven’t lost control over their behavior or animals who won’t press levers for nicotine or THC. Even less is understood about the activity of the brain’s reward system when people engage in the most naturally rewarding behavior of all: sex. We don’t know much about how sexual behavior is encoded in the brain and regulated, and it’s hard to tell what’s wrong with a brain system when you don’t know what happens when it works properly.
    For me, even in my teenage years, when I was certainly as driven by sex as any adolescent male, it wasn’t something that controlled me. I wanted it, for sure, and I was certainly proud of my reputation as a player. But staying in control was paramount. That was far more important to me than any particular girl or experience of sex. In fact, I remember going to basketball practice one day, immediately after having sex with Monica, the girl with whom I’d earlier had that embarrassing first orgasm. I’d been out all night—and was definitely tired when I hit the court. My friend Jimmy Lopez, who was a guard on a rival team, was watching.
    “Damn you moving slow; that pussy must’ve gotten to you,” he said. I was horrified by the idea that he might gain confidence and think that he could dominate me on the court. So I never did that again. After that, I’d abstain before games like a boxer: I didn’t want to take the chance that sex could make me less agile. I certainly liked sex and spent a great deal of time chasing it but I always stayed in control.
    Also, like most of my friends, I wouldn’t deign to fight over a girl. We saw that as uncool; it meant that you cared too much. A player didn’t act impulsively out of jealousy. He couldn’t be seen as dependent on any one woman’s love. Of course, you’d step up if someone insulted your lady or disrespected you by flirting with her in front of you, but that was about your own status on the street, not about her. Desire, compulsion, and control had to be more complicated. It just seemed impossible that this one neurotransmitter, dopamine—one found in only about 1 percent of all