Dr Hamaad Muin Ahmad, Junior Doctor, UK
Addictive behaviours are now well-established in society and are the root cause of a myriad of disorders. Addiction can be commonly misunderstood to mean only addiction to drugs or alcohol, otherwise known as substance addiction. However, the World Health Organization (WHO) now categorises gaming and gambling as ‘disorders’. In the International Classification of Diseases 11 (ICD-11) endorsed for release by the WHO in 2019, the WHO defined these addictions as disorders:
“Based on similarities in symptomatology, epidemiology, and neurobiology, gaming disorder and gambling disorder are categorized as disorders due to addictive behaviours in ICD-11.” (www.who.int/health-topics/addictive-behaviour#tab=tab_3)
In the modern world, addictions can range from substance addictions, including alcohol and drug abuse (such as cocaine and methamphetamine), to behavioural addictions, such as digital gaming, viewing pornography, gambling, or even extensive mobile phone use.
Dr Andrew Huberman beautifully defines addiction as “a progressive narrowing of the things that bring you pleasure.” Essentially, one becomes numb to anything else in life other than the addiction, which has become the sole source of their pleasure.
If not controlled, addictions can be detrimental to our dopamine brain circuits. In our brains, we have the mesocorticolimbic pathway, which is sometimes referred to as the reward pathway as it is a dopaminergic pathway (a path of neurons with dopamine as a neuromodulator). It is responsible for motivation, reward-related behaviour, and attention.
When we are seeking a task that, in turn, will increase our dopamine levels, our dopamine levels initially increase with the idea of pursuing this task. For example, if one is thinking of going to eat a specific cuisine they highly enjoy, their dopamine levels will go up steadily when the thought initially comes. From this rise, until the action is performed, their dopamine drops towards the baseline. This drop will make the individual want and crave that dish. Once they have eaten the dish, their dopamine levels increase in proportion to how fulfilling and pleasurable the experience was. Dopamine levels increase, causing joy and euphoria. If the dish is not as good as hoped for, the dopamine levels drop, thus causing low mood.
When an addiction initially starts, the individual gains a lot of pleasure from it. Later on, when experiencing subsequent dopamine hits, their perception of pleasure will eventually narrow to that thing to which they are addicted. Consequently, their interest and motivation in everyday tasks such as school, work, and normal hobbies diminish. If the addiction carries on long enough, they will also eventually lose the dopamine hit that they’re addicted to. The neurobiology behind this will be of great assistance in explaining this further.
This brain circuit physiology is incredibly important when talking about addictions. If a person is addicted to a substance or a behavioural act, the pursuit of that task, which results in a dopamine spike, is analysed and learned by the mesocorticolimbic pathway. The mesocorticolimbic pathway eventually memorises that pursuit for the dopamine spike and stores it. For example, if a person is addicted to a substance that causes a dramatic peak in dopamine, the steps performed to hit that dopamine peak are very short. Eventually, after performing that act many times, the brain circuit, and thus your main brain reward pathway, becomes ‘hardwired’ into thinking that the easiest way to access dopamine is via that act. The brain will now no longer be used to long, gruelling hours of writing an essay, performing physical activity, or studying long hours.
In a nutshell, it will not understand the concept of delayed gratification at all. The brain now only wants the quick dopamine spike from the easy route it has learnt.
Another incredible point that clearly displays the vicious cycle of addiction is the example of gaming. For a person who loves gaming, the act of gaming will increase dopamine roughly three to fivefold. Now, a general rule of thumb is that the steeper and faster the dopamine spike, the steeper and deeper the drop below baseline. So, after this spike, the dopamine levels plummet. The gamer then experiences melancholy, emptiness, and low motivation.
As stated before, low dopamine levels naturally trigger the brain to seek an increase in dopamine. To fulfil this easy dopamine access, the gamer then turns on the game again – the brain now naturally understands this to be an easy pursuit to attain a dopamine spike.
Neurobiology has explained that when seeking dopamine from the same act as before, dopamine does not increase as high as it did when initially performing the task for the first time. On the other hand, it actually drops even lower than before and experiences a deeper trough. Consequently, in subsequent voyages to seek those dopamine spikes, the addict will experience lower highs and even lower troughs. This vicious cycle is incredibly dangerous and is the neurobiological explanation for the vicious cycle that extreme addicts eventually enter.
It becomes clear why the WHO categorises addictive behaviours as disorders.
In a normal working week, if a person is constantly doing activities they enjoy and does not practise moderation, they’re constantly accessing those dopamine hits, and consequently, their dopamine synaptic reserve drops. Eventually, they constantly feel down because those activities do not produce those dopamine hits anymore – since there is no more dopamine reserve left as it is all being used up.
The world today is a complete depiction of this. The same old dull routine in one’s life results in a person’s brain being numb to the world, and nothing brings them delight as it used to because they’ve exhausted every worldly route to gain happiness.
In the Holy Quran, Allah the Almighty tells us that He has created us with the purpose of worshipping him. (Surah adh-Dhariyat, Ch.51: V.57) Thus, if our main life purpose is to worship Allah and develop a living relationship with him, then our perception of our life goals completely changes. Islam teaches us that our ultimate reason for living is not to acquire the pleasures of the world but to gain nearness to Allah.
The journey towards attaining the pleasure of Allah has no end at all. In contrast, the pleasures of this world do have an end, and the behavioural addictions that crop up in everyday life negatively impact our dopamine levels, thus negatively affecting our mood and motivation.
Hence, if a believer develops the mindset of working towards a relationship with God – a relationship that ultimately is eternal and infinite because God Himself is eternal – then one’s dopamine baseline will not experience those lows.
The goals, pleasure, and ultimately the dopamine acquisition of believers will now be completely different from those of a non-religious person. The dopamine spikes (which are now the product of delayed gratification) will be derived from experiencing the pleasure of gaining God’s nearness – something that is infinite and has no end.