Addiction
The Challenge of Moderation
In struggles with any substance, moderation can be a matter of harm reduction.
Updated July 22, 2023 Reviewed by Ray Parker
Key points
- Moderation of food, alcohol, or cannabis consumption is often difficult, but it's necessary for good health.
- How we conceptualize the conflict between desire and better judgment determines how we manage it.
- Understanding the neurophysiology of this struggle permits a harm-reduction approach to moderation.
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I often touch, directly or indirectly, on the topic of moderation in many of the posts I have written. I have explained how most adults can use cannabis safely—if they pay attention to the five warning signs of using it frequently enough to be reducing the number of brain cannabinoid neuroreceptors: restlessness, anxiety, boredom, loss of appetite, and insomnia (5 Signs of Using Cannabis Too Frequently).
More recently, I wrote of how too frequent use of cannabis can occasionally cause hyperemesis (persistent nausea and vomiting) and even severe constipation and bladder dysfunction.
Moderating the Usage
What about addressing the challenge people often have to moderate their use of cannabis, as well as a wide variety of other behaviors from eating to exercise, work, and other drugs? Moderation is simply difficult, especially when we want to sustain as vibrant, active, and productive a life as possible.
Moderation is most difficult when it comes to life’s pleasures. Whether we are celebrating victory or soothing defeat, adding a little hedonic pleasure is always attractive. And, if a little is good, a little bit more often feels even better.
A Matter of Harm Reduction
I approach moderation as a matter of harm reduction, not as a moral virtue (which it may well be, but this perspective too often treats failure to moderate as a stigmatizing moral vice). I approach moderation as a practical matter necessary for achieving optimal health.
The conflict between desire and knowing what is best for our health underlies the challenge of moderation. Short-term pleasure versus long-term gain. Momentary willfulness versus future security. “I want” versus “I know.” Emotion versus intellect. Body versus mind.
This struggle is universal and how we answer the challenge is influenced by an infinite number of variables, including how tired we are, or how abandoned, mistreated, or rejected we feel.
A Useful Metaphor
A wonderfully useful metaphor was suggested by J.D. Vance in his book Hillbilly Elegy. To be healthy, Vance says the mind must treat the body like a good parent treats a child. You want to give the child as much freedom as possible, but you must be ready to set and maintain guardrails to keep the child safe.
The body, like a child, can mislead us often enough that we need to let our better judgment take over sometimes. Just as we let children overindulge in candy on Halloween and birthdays, the rest of the year we impose reasonable restrictions.
But a good parent will not shame their child for wanting candy, won’t be domineering when imposing restrictions, and won’t demand their child understand. Their body-to-mind ratio is far greater than a parent’s.
Neurophysiology and Moderation
I conceptualize Vance’s parent-child metaphor for how our minds must restrain our bodies’ unhealthy desires by looking at the neurophysiology involved in the struggle for moderation.
There lies deep within our brains a collection of nerve cell bodies called the Nucleus Accumbens, also known as the reward center. I see this structure as guiding us toward behaviors necessary for the survival of the species—eating, sexual activity, exercise, and others.
Dopamine is released in the Nucleus Accumbens by these survival-oriented behaviors, which creates the tendency to repeat them. Unfortunately, other behaviors and substances not necessary for survival also release dopamine in the reward center—computer games, sugar, and addictive drugs.
Some drugs pour out ten times the amount of dopamine released by mere behaviors. In the inverse of the phrase, “use it or lose it,” dopamine in the reward center operated according to “the more dopamine, the stronger the urge to repeat whatever releases more dopamine.”
The reward center’s thirst for dopamine motivates us to repeat whatever releases it the most. When I am tired at the end of a long workday and want to feel calm, and even soothed, my Nucleus Accumbens raises thoughts over and over of ice cream in the freezer, peanuts in the pantry, or a bit of alcohol or cannabis.
As a result, a conflict develops between the reward center and the frontal lobes, where understanding of the future and long-term consequences resides. The frontal lobes process urges sent from the reward center, label them temptations, and argue that my extra ten pounds will not be shed if I continue eating evening snacks.
I refrain from visiting the kitchen, but this does not stop the reward center from continuing to remind me that all these treats are available and would soothe me in the short term. It nags, like a child, because that is what it does. Moderation must come solely from our better judgment sometimes.
It is best not to fight the reward center, nor to chastise it since these thoughts do not work to shut it up. They lead to feeling shame and divert energy from where it needs to be placed—on the awareness of our long-term desires and goals. We need to remind ourselves that moderation is the only path toward greater health, physically and emotionally. We need to allow our better judgment, the product of our frontal lobes, to guide our behavior.
Conscience
This is often hard, and our conscience both helps and hurts our efforts. Our conscience is a meta-function of the mind, like our sense of self. It stands apart and above both the reward center and our frontal lobes, though I have no idea where in the brain such global meta-functions might be localized.
Conscience watches the struggle between body and mind, “child” and “parent”, frontal lobe and nucleus accumbens, and it gives us a grade on how we are doing in the struggle for moderation. It keeps track of our integrity. Conscience borders on spirituality’s ability to achieve an increasingly grander perspective on ourselves, on others, and on the universe as a whole. But that is another story.