The Molecule of More

behavioral therapy, and twelve-step facilitation therapy. Each takes a unique 
approach to using the resources found in the human brain to coun-
teract the destructive impulses of the malfunctioning desire-dopamine 
circuit.
MOTIVATIONAL ENHANCEMENT THERAPY: 
DESIRE DOPAMINE VERSUS DESIRE DOPAMINE
Addicts crave drugs. They use drugs even when drugs destroy their 
lives, but most of them know they’re harming themselves. They’re 
not completely deceived by the chemical. They’re ambivalent: part of
them wants nothing more than to use drugs, but there are other, weaker 
desires as well. Those desires can be strengthened. There may be a 
desire to be a better spouse, a better parent, or to do better at work. 
The drug addict may see their bank account drain away, and wish for 
the peace of mind that comes with financial security. Or they may wake 
up feeling sick every day, and wish they could go back to the time when 
they were strong and healthy.
None of these desires is able to provoke dopamine release the way 
drugs do, but desire not only gives us motivation to act; it also gives us 
patience to endure. In motivational enhancement therapy (MET), patients 
tolerate feeling resentful and deprived, the punishment of disappointed 

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DOMINATION
dopamine, because they know it will lead to something better. The goal 
of the therapy is to stoke the flames of desire for a better life.
MET therapists build up motivation by encouraging their patients 
to talk about their healthy desires. There’s an old saying: “We don’t 
believe what we hear, we believe what we say.” For example, if you give 
someone a lecture on the importance of honesty, then have them play 
a game in which cheating is rewarded, you’ll probably find that the lec-
ture had little effect. On the other hand, if you ask someone to give you 
a lecture on the importance of honesty, they will be less likely to cheat 
when they sit down to play the game.
MET is a little manipulative. When the patient makes a statement 
the therapist likes, referred to as a pro-change statement, such as, “Some-
times I have trouble getting to work on time after a night of heavy drink-
ing,” the therapist responds with positive reinforcement, or a request to 
“tell me more about that.” On the other hand, if the patient makes 
an anti-change statement, such as, “I work hard all day, and I deserve to 
relax in the evening with a few martinis,” the therapist doesn’t argue, 
because that would provoke more anti-change statements as the debate 
goes back and forth. Instead, she simply changes the subject. Patients 
usually don’t notice what’s going on, so the technique slips past their 
conscious defenses, and they spend the majority of the therapy hour 
making pro-change statements.
COGNITIVE BEHAVIORAL THERAPY: CONTROL 
DOPAMINE VERSUS DESIRE DOPAMINE
It’s better to be smart than strong. Instead of trying to attack an addic-
tion head on through willpower, cognitive behavioral therapy (CBT) 
uses the planning ability of control dopamine to defeat the raw power 
of desire dopamine. Addicts who struggle to stay clean are most often 
defeated when they are unable to resist craving. CBT therapists teach 
patients that craving is triggered by cues: drugs, alcohol, and things that 
remind the addict of drugs and alcohol (people, places, and things). Cues 
that suddenly and unexpectedly remind an addict of drugs produce a 

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THE MOLECULE OF MORE
reward prediction error, like the addict who felt an overwhelming desire 
for heroin when he saw a bottle of laundry bleach. Desire dopamine 
cranks up, motivating the addict to use, and threatening to shut down 
completely if it doesn’t get what it wants.
Alcoholics in CBT learn to arm themselves against cue-triggered 
craving in a number of different ways. For example, they may recruit 
a sober buddy to go with them to events where alcohol is being served. 
They also work to eliminate as many cues as possible. The patient and 
a friend are sent on a “search-and-destroy mission” in which every-
thing that reminds the patient of alcohol is removed from his home: 
cocktail glasses, shakers, hip flasks, martini olives, and so forth. Any-
thing that the drinker connects to alcohol use is a trigger, and has to go 
because otherwise it might be the agent of craving that brings an end to 
a hard-fought period of sobriety. One alcoholic patient brewed beer in 
his basement. He resisted getting rid of his beloved equipment, because 
it was his hobby, and had nothing to do with drinking, he said. Desire 
dopamine won that battle until he finally relented and threw everything 
in the garbage. Now he’s sober.
ADDICTION: 
IT’S WORSE THAN YOU THINK
Addictions are hard to treat, harder than many other psy-
chiatric illnesses. With other illnesses, such as depression, 
patients want to get better—there’s no question about it. But 
if a person is addicted to a drug, he’s not so sure. He may 
share the sentiment expressed by Saint Augustine while he 
was carrying on an affair with a young woman. He prayed,