Magnificent Desolation: The Long Journey Home from the Moon.
Just as desire dopamine facilitates becoming addicted to
drugs—chasing the high and receiving less and less dopamine “buzz”
from it—some people have so much control dopamine that they become
addicted to achievement, but are unable to experience H&N fulfillment.
Think of people you know who work relentlessly toward their goals but
never stop to enjoy the fruits of their achievements. They don’t even
brag about them. They achieve something, then move on to the next
thing. One woman described taking a leadership position in a division
of a company that was in chaos. Years of long hours and hard struggle
allowed her to get everything running smoothly, and she immediately
became bored. For a few months she tried to enjoy the new, relaxed
environment she had created, but she couldn’t bear it, and requested a
transfer to a department that was a complete mess.
These individuals exhibit the effects of an imbalance between
future-focused dopamine and present-focused H&N neurotransmitters.
They flee the emotional and sensory experiences of the present. For
them, life is about the future, about improvement, about innovation.
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Despite the money and even fame that comes from their efforts, they
are usually unhappy. No matter how much they do, it’s never enough.
The family crest of James Bond, the resourceful, relentless, often ruth-
less secret agent, contains the motto Orbit Non Sufficit: The World Is Not
Enough.
Colonel Aldrin faced this problem in a more profound way than
perhaps any human being ever had: I have walked on the surface of the moon.
What could I possibly do to top that?
DOPAMINE EXPLAINS THE MYSTERIES OF ADHD
What about people on the other end of the spectrum, people whose
control dopamine circuits are weak? Their struggle with internal con-
trol manifests itself as impulsivity and difficulty keeping themselves
focused on complex tasks. This problem can result in a familiar condi-
tion: attention deficit hyperactivity disorder (ADHD).
2
Poor focus, con-
centration, and impulse control can severely interfere with their lives,
and it can make them difficult to be with. Sometimes they don’t pay
attention to details, or follow through on tasks. They may start paying
bills, then switch to doing the laundry, then change a light bulb, then sit
down and watch TV with everything strewn all over the place. During
conversations, they can become distracted easily, and not listen to what
people say to them. Sometimes they don’t keep track of time, making
them late, and they may lose things, such as car keys, cell phones, even
passports.
ADHD is seen most often in children, and for good reason. The
frontal lobes, where control dopamine acts, develop last, and do not
fully connect to the rest of the brain until a person finishes adoles-
cence and enters adulthood. One of the jobs of the control circuit is
to keep the desire circuit in check; hence the impulse control problem
2 This illness is commonly called
attention deficit disorder
, or
ADD
, because adults
usually don’t have the hyperactivity seen in children. Nevertheless, we’ll use the
scientific term, ADHD.
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associated with ADHD. When control dopamine is weak, people go
after things they want with little thought about the long-term con-
sequences. Kids with ADHD grab toys and cut in line. Adults with
ADHD make impulse purchases and interrupt people.
The most common treatments for ADHD are Ritalin and amphet-
amine, stimulants that boost dopamine in the brain. When these drugs
are used to treat people with ADHD, tolerance usually doesn’t develop
as it does for those who take these drugs to lose weight, get high, or
enhance their performance. Nevertheless, stimulants are addictive
drugs. The FDA puts them in the same class as opioids, such as mor-
phine and OxyContin. These are considered the highest risk in terms
of abuse, and they have the most stringent restrictions on how doctors
can prescribe them.
People who live with ADHD are at high risk of addiction, especially
adolescents, because of their poorly functioning frontal lobes. Years
ago, when the illness was less well understood, doctors and parents
were reluctant to give these vulnerable children addictive drugs such as
Ritalin and amphetamine. It sounded reasonable: don’t give addictive
substances to people at risk for addiction. But rigorous testing showed
unambiguously that adolescents who were treated with stimulant drugs
were less likely to develop addictions. In fact, those who started the
drug at the youngest age and took the highest doses were the least likely
to develop problems with illicit drugs. Here’s why: if you strengthen
the dopamine control circuit, it’s a lot easier to make wise decisions.
On the other hand, if effective treatment is withheld, the weakness of
the control circuit is not corrected. The desire circuit acts unopposed,
increasing the likelihood of high-risk, pleasure-seeking behavior.
A SURPRISING RISK AMONG ADHD PATIENTS
Drug addiction isn’t the only risk these children face. It’s hard for a
child with ADHD to extract valuable resources from his environment—
typically in the form of good grades—when he can’t focus or control
his impulses. But poor grades are only the beginning. Young people
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THE MOLECULE OF MORE
with ADHD have difficulty making friends. Who wants to be around
someone who interrupts, grabs things, and doesn’t wait their turn?
They often have to read homework assignments over and over again
before they understand the material. This happens as a result of con-
stant distractions. Spending that much time on homework doesn’t leave
much time for extracurricular activities, such as sports and clubs. With
few friends, poor grades, and cut off from healthy sources of pleasure,
children living with untreated ADHD become more willing to pursue
unhealthy sources of pleasure. In addition to drugs, they may also have
problems with early sexual activity and overeating, particularly “plea-
sure foods” that are high in salt, fat, and sugar.
A massive study involving 700,000 children and adults, including
48,000 with ADHD, found that children with ADHD were 40 percent
more likely to be obese, and adults were 70 percent more likely to be
obese. At nearly three-quarters of a million participants, with data
taken from cultures around the world, the study was not only greater
in size than most investigations of its type but also far more diverse,
allowing the scientists to compare the results from different countries
where one finds a variety of diets and eating rituals. Yet, in spite of the
differences in diets among, for instance, Qatar, Taiwan, and Finland,
the findings were the same. Country of residence did not affect the
relationship between ADHD and obesity. There was also no difference
between men and women.
Despite the strengths of this study, there are weaknesses as well. Just
because we find that people with ADHD are more likely to be obese
doesn’t necessarily mean that having ADHD causes obesity. What if it
was the other way around? What if being overweight somehow affected
the brain in a way that caused ADHD? The fancy scientific term way
of saying this is association does not imply causation. Just because two things
are found together doesn’t necessarily mean that one caused the other.
We’d have more confidence that ADHD leads to obesity if we could
show that people develop symptoms of ADHD before they become obese.
So researchers from the Universities of Chicago and Pittsburgh eval-
uated nearly 2,500 girls to find out if there was a connection between
unhealthy weight and problems with impulsivity. The lead researcher
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noted, “Children are constantly cued to eat by food commercials, vend-
ing machines, etc., so it is easy to imagine how a child who is poorly
inhibited could have difficulty resisting these cues to eat.”
The results were as expected. Girls who had problems with impul-
sivity and planning at age 10 gained more weight over the following six
years. The scientists reported that a significant amount of the weight
these girls gained came from bingeing—intense bursts of no self-control.
For a similar reason, overweight children are more likely to be hit
by cars when they’re crossing the street. It’s not because they walk more
slowly; it’s because they’re impulsive. Researchers at the University of
Iowa collected 240 children who were seven or eight years old, and
asked them to cross a busy street to measure how long they waited and
how often a child was hit by a car.
3
Although overweight people sometimes walk more slowly, in this
experiment weight had no effect on how fast the children crossed the
street. But there was a direct relationship between how overweight
the child was and how quickly he or she stepped out into traffic. Less
overweight children waited longer than more overweight children.
Overweight children also left a smaller buffer between themselves and
oncoming traffic—that is, they allowed the cars to get closer. Not sur-
prisingly, they were hit more frequently.
It’s important to remember that biology is not destiny. People whose
control-dopamine systems are at one extreme or the other can change.
People with ADHD can improve dramatically with medication, psycho-
therapy, and sometimes just time. Colonel Aldrin, who faced a different
problem, eventually found ways to harness the intensity of his creative
drive. Since returning from the moon, he has written or cowritten a
dozen books, produced a computer strategy game, and proposed a rev-
olutionary method of space travel that could make a crewed mission to
Mars more practical. He also found time to appear on numerous TV
shows, including Dancing with the Stars, The Price Is Right, Top Chef, and The
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