Roller coasters, high-speed skiing, and parachute jumping
are great sources of thrills, causing dopamine to circulate
at top speed in the nervous system. Drug addicts are looking
for this kind of sensation when they take cocaine or alcohol.
The problem is that the little pleasures in life—reading
a good book, dining with friends, listening to a Chopin
sonata—are of no interest to them. When they’re
not high, the world is monotonous. Dr Jean-Yves Roy, clinical
professor in the Department of Psychiatry at Université
de Montréal, feels that drug addicts have to try
to develop their appreciation of the little pleasures if
they want to give up their dependence. “They have
work to do on the hedonist side,” he says.
Smiling wistfully, he says that the Cormier-Lafontaine clinic
in Montreal, which receives 260 drug-addict psychiatric
out-patients, could almost be called the “Pleasure
Clinic” because this aspect of rehabilitation is so
essential. For the psychiatrist, who authored a well-known
essay on the relation between gurus and their protégés,
The Shepherd Syndrome, published by Boreal in 1998,
pleasure is a talent, like painting or music. Anyone who
does not have it should work to cultivate it.
Among schizophrenics, this “anhedony”—or
absence of hedonism—is especially obvious. But the
specialist cannot tell if it is part of the illness or a
consequence of the antidepressant drugs that are prescribed.
“Antipsychotic medication is definitely a good thing
in psychiatry,” he insists. “But I wonder if
we aren’t prescribing massive doses for too long,
thus inhibiting the very possibility of experiencing pleasure.”
Antidepressants block nerve circuits that are overloaded
with dopamine. When a crisis occurs, the physician must
try to stop the flood. But when calm returns, the doses
are not always decreased accordingly. Dr Roy has called
for better use of these psychotropics and the development
of new molecules that allow a capacity for pleasure. He
is conducting his own clinical research along these lines
with forty schizophrenic patients. One underestimated characteristic
of these patients is their strong predisposition to addiction.
Dr Roy estimates that from 75% to 85% of young psychotics
consume drugs or alcohol. However, the drugs used to treat
schizophrenia are tested mainly on abstainers.
The Cormier-Lafontaine Clinic, located in the Dollard-Cormier
Detox centre on Prince Arthur in Montreal, was created especially
to serve the most difficult cases of addiction combined
with mental health problems, a phenomenon the founder of
the clinic calls the “double pathology.” Until
the clinic was opened, this clientele was practically forced
to fend for itself, dividing its time between mental hospitals,
homeless shelters and the street.
Researcher: Jean-Yves Roy
Telephone: (514) 251-4000
Email: jean-yves.roy@umontreal.ca
Funding: Astra-Zeneca
