The Willpower Instinct: How Self-Control Works, Why It Matters, and What You Can Do To Get More of It

AN ADDICT LOSES HIS CRAVINGS
Adam was not a man of self-restraint. At age thirty-three, a typical day included up to ten drinks, a hit
of crack cocaine, and sometimes a bonus round of Ecstasy. His substance abuse had a long history,
starting with alcohol at age nine and cocaine at thirteen, and by the time he was an adult, he was
hooked on marijuana, cocaine, opiates, and Ecstasy.
All that changed the day he was taken from a party to the emergency room, where he promptly
ingested all the drugs in his possession to avoid being caught with illegal substances (not a smart
move, but to be fair, he wasn’t in the clearest state of mind). The dangerous drug combination of
cocaine, Ecstasy, oxycodone, and methadone led to a near-fatal drop in blood pressure and reduced
oxygen to his brain.
Although he was resuscitated and eventually released from intensive care, the temporary oxygen
deprivation would prove to have profound consequences. Adam lost all of his cravings for drugs and
alcohol. His daily drug use dropped to complete abstinence, confirmed by drug tests over the
following six months. This miraculous change was not a spiritual revelation or some kind of wake-up
call inspired by his brush with death. According to Adam, he simply had no desire to consume the
substances.
This might sound like a positive turn of events, but the loss of desire went beyond cocaine and
alcohol. Adam lost desire, period. He could not imagine that anything would make him happy. His
physical energy and ability to concentrate disappeared, and he became increasingly isolated from
others. Without the ability to expect pleasure, he lost hope and spiraled into a severe depression.
What triggered this loss of desire? The psychiatrists at Columbia University who treated Adam
discovered the answer in scans of his brain. The oxygen deprivation during his drug overdose had left
Adam with lesions in the brain’s reward system.
Adam’s case, reported in the 
American Journal of Psychiatry
, is extraordinary because of the
dramatic change from addict to absolute loss of “I want.” But there are many other cases of people
who lose desire and the ability to expect happiness. Psychologists call it anhedonia—literally,
“without pleasure.” People with anhedonia describe life as a series of habits with no expectation of
satisfaction. They may eat, shop, socialize, and have sex, but they don’t anticipate pleasure from these
activities. Without the possibility of pleasure, they lose motivation. It’s hard to get out of bed when
you can’t imagine that anything you do will make you feel good. This complete disconnect from desire
drains hope and, for many, the will to live.
When our reward system is quiet, the result isn’t so much total contentment as it is apathy. It’s why
many Parkinson’s patients—whose brains aren’t producing enough dopamine—are depressed, not
peaceful. In fact, neuroscientists now suspect that an underactive reward system contributes to the
biological basis of depression. When scientists have watched the activity of depressed people’s
brains, they’ve seen that the reward system can’t sustain activation, even in the face of immediate
reward. There’s a little burst of activity, but not enough to create the full feeling of “I want” and “I’m
willing to work for it.” This produces the loss of desire and motivation that many people who are
depressed experience.

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