Addiction: Decreased Reward Sensitivity and Increased Expectation Sensitivity Conspire to Overwhelm the Brain's Control Circuit

What This Research Found

Nora Volkow's landmark research presents a comprehensive neurobiological model explaining how addiction hijacks the brain's reward and control systems. Published in 2010 and cited over three thousand times, this paper synthesises decades of neuroimaging research into a unified framework with profound implications for understanding narcissistic supply-seeking behaviour.

The dual dysregulation model: Volkow's central insight is that addiction involves two simultaneous brain changes that conspire to overwhelm executive control. First, the reward system becomes less sensitive to natural rewards—ordinary pleasures no longer register, requiring increasingly intense stimulation to achieve the same effect. Second, the expectation system becomes more sensitive to cues associated with the addictive stimulus—anticipation of reward triggers intense craving even when the actual reward no longer delivers satisfaction. Together, these changes create a brain that desperately wants something that no longer truly satisfies—a neurobiological trap with devastating consequences.

Decreased reward sensitivity: Volkow's neuroimaging studies demonstrate that addiction involves measurable reduction in dopamine D2 receptors in the striatum—the brain's reward processing centre. Fewer receptors mean less response to the same dopamine signal. What once felt rewarding now feels ordinary; what once felt ordinary now feels empty. The brain requires escalating stimulation to achieve baseline satisfaction, creating the tolerance that characterises all addictions. A drug addict needs increasing doses for the same high; a narcissist needs escalating admiration for the same validation. Neither is making a choice; both are responding to a brain that has fundamentally recalibrated its reward thresholds.

Increased expectation sensitivity: Simultaneously, the brain becomes hyperresponsive to cues associated with anticipated reward. The mesolimbic dopamine system—particularly projections from the ventral tegmental area to the nucleus accumbens—shows exaggerated activation when the addicted brain encounters stimuli predicting reward. This creates intense craving that persists even when the actual reward no longer satisfies. The addict who has stopped feeling pleasure from their drug still experiences overwhelming urges when they encounter drug-related cues. The narcissist who found yesterday's admiration "mediocre" still experiences intense craving when new supply opportunities arise. The wanting persists even when the liking has diminished.

Overwhelmed executive control: The prefrontal cortex—the brain's executive control centre—normally provides top-down regulation of subcortical drives. Volkow's research demonstrates that addiction involves measurable impairment in prefrontal function, particularly in the anterior cingulate and orbitofrontal cortices responsible for decision-making, impulse control, and error monitoring. The addicted brain is not simply experiencing stronger urges; it has lost the neural capacity to resist them. The prefrontal cortex that should say "this is a bad idea" has been functionally compromised, leaving drives to run unchecked. This explains why addicts make decisions they later recognise as self-destructive, and why reasoning with someone in active addiction so often fails.

The addiction cycle: These three changes—decreased reward sensitivity, increased expectation sensitivity, and impaired executive control—create a self-reinforcing cycle. Diminished reward sensitivity drives pursuit of more intense stimulation, which further desensitises the reward system. Heightened expectation sensitivity creates persistent craving that cannot be satisfied by actual consumption. Impaired prefrontal function prevents the rational override that might break the cycle. The brain becomes trapped in a pattern it cannot escape through willpower alone—not because of insufficient motivation, but because of altered neural architecture.

How This Research Is Used in the Book

Volkow's addiction neuroscience appears throughout Narcissus and the Child, providing the neurobiological framework for understanding why narcissistic supply operates as a genuine addiction rather than a metaphor.

In Chapter 8: Behavioural Manifestations, the book applies Volkow's model to explain why nothing survivors provide is ever enough:

"Richard's brain, during the party, flooded with dopamine. Sixty people celebrating him, his favourite band playing, the speeches—his reward circuits lit up like a slot machine hitting jackpot. He felt genuinely happy. His wife saw it on his face. But Richard's reward system is not healthy, it operates like that of an addict. The dopamine surge that felt so intense at nine o'clock had already begun fading by the drive home. By morning, his brain had recalibrated: that level of admiration was now the new baseline. The party that exceeded expectations yesterday now merely met them. Within two weeks, it fell below them. 'Mediocre.'"

In Chapter 10: Building the Maze, the book uses Volkow's research to explain how the narcissistic reward system develops through early relational trauma:

"The primary mechanism is receptor downregulation—the same defensive response we saw in the stress system. When dopamine signals are chaotic and unpredictable, target neurons reduce their D2 receptors, the receptors most responsible for experiencing reward as pleasurable. Fewer receptors means less response to the same signal. The neuron is protecting itself from the whiplash of constant prediction errors. This is the cellular basis of tolerance. With fewer D2 receptors, ordinary levels of dopamine no longer register as rewarding. The child needs more—more intense validation, more dramatic confirmation of worth—to achieve the same reward system activation that another child gets from a simple hug."

In Chapter 11: The Contagion, the book applies the addiction model to explain trauma bonding:

"This is addiction—mediated by the same neural circuits and neurochemicals that drive substance dependence... The victim whose attachment system has been hijacked into addiction-like bonding is not 'choosing' to stay."

In Chapter 20: The Field Guide, the book explicitly cites Volkow's research to explain the neurobiological basis of supply-seeking:

"Supply-seeking operates through addiction neurobiology: tolerance (needing more for the same effect) and withdrawal (collapse when supply is removed)."

Why This Matters for Survivors

If you have been in relationship with a narcissist—as partner, child, employee, or in any other role—Volkow's research illuminates experiences that may have felt incomprehensible and provides crucial validation for the impossible position you were placed in.

Their insatiability was neurobiological, not your failure. Perhaps the most painful aspect of narcissistic relationships is the experience of never being enough. You planned elaborate celebrations that were dismissed as "mediocre." You provided constant reassurance that evaporated within hours. You gave everything you had, only to be told it was inadequate. Volkow's research explains why: you were trying to satisfy a brain that cannot hold satisfaction. The narcissist's reward system has been fundamentally altered—fewer dopamine receptors means less response to any level of validation. They required escalating admiration not because of anything lacking in you, but because their brain had recalibrated to require ever-more-intense stimulation. You could not have given enough because "enough" does not exist for a system in tolerance. This knowledge cannot undo your suffering, but it can release you from the false belief that you failed. You were attempting the neurobiologically impossible.

Their desperation was genuine addiction. When you watched the narcissist pursue validation with desperate intensity—sacrificing relationships, reputation, and even self-interest—you may have wondered how anyone could care so much about something so superficial as admiration. Volkow's research reveals that this was not vanity but addiction. The same brain circuits that drive heroin-seeking drove their supply-seeking. The same tolerance and withdrawal dynamics that characterise substance dependence characterised their relationship with validation. Their craving for admiration was as neurologically compelling as a drug addict's craving for their substance. This does not excuse their behaviour—addicts remain responsible for their actions—but it explains the intensity you witnessed. They were not choosing to prioritise validation over you; their brain was compelling them with forces they genuinely could not resist through willpower alone.

Their returns were withdrawal-driven, not insight-driven. If the narcissist discarded you, you may have experienced their return—the messages claiming they had finally realised what they lost, the promises to change, the apparent remorse. Volkow's research illuminates what was actually happening: withdrawal. When supply sources are severed, the narcissist experiences the same neurobiological distress as an addict deprived of their substance—diminished dopamine function creating dysphoria, anhedonia, and intense craving. Their return was not driven by genuine insight or love; it was driven by the neurochemistry of withdrawal. They were not seeking you as a person; they were seeking you as a supply source—the most familiar route to relieve their distress. This knowledge can help you recognise hoovering for what it is: the addict returning to their substance, not the lover returning to their beloved.

Your own attachment was neurologically engineered. If you found yourself inexplicably attached to someone who treated you badly—returning despite knowing you should leave, missing them despite remembering the abuse—you were not weak or foolish. The intermittent reinforcement pattern characteristic of narcissistic relationships hijacks the same dopamine circuits Volkow describes. Unpredictable reward is more neurologically compelling than consistent reward; the relief of reconciliation after conflict releases more dopamine than stable happiness would. Your brain was conditioned by the same mechanisms that make gambling addictive. The attachment you felt was neurologically engineered by the pattern of abuse, not generated by genuine relational quality. You were not bonded despite the abuse; you were bonded because of the neurochemical effects of the abuse pattern. Understanding this can help you extend compassion to yourself for attachments that felt irrational but were, in fact, neurobiologically inevitable.

Clinical Implications

For psychiatrists, psychologists, and trauma-informed clinicians, Volkow's addiction model has direct applications to both treating narcissistic patients and supporting survivors of narcissistic abuse.

Narcissistic supply-seeking should be conceptualised as genuine addiction. Volkow's research provides neurobiological justification for treating validation-seeking in narcissistic patients as a true addiction rather than merely a characterological preference. The tolerance (escalating need for admiration), withdrawal (narcissistic collapse when supply is severed), and compulsive pursuit despite negative consequences precisely parallel substance addiction. This conceptualisation has treatment implications: interventions that address addiction dynamics—such as motivational interviewing, abstinence-based approaches, and relapse prevention—may have application to narcissistic supply-seeking. Clinicians treating narcissistic patients might consider how addiction treatment principles apply, including the recognition that the patient's relationship with validation must change fundamentally, not just superficially.

The prefrontal impairment explains treatment resistance. Volkow's research on prefrontal dysfunction illuminates why narcissistic patients so often fail to follow through on therapeutic insights. They may understand intellectually that their behaviour is harmful, yet remain unable to change it—not from insufficient motivation but from compromised neural capacity for impulse control. The same prefrontal circuits that would enable a healthy person to override subcortical drives have been functionally impaired. This suggests that treatment may need to focus on rebuilding prefrontal capacity (through interventions like mindfulness training, which has been shown to increase prefrontal gray matter) before insight-oriented work can translate into behavioural change. Expecting narcissistic patients to simply "choose" better behaviour is as neurobiologically unrealistic as expecting an addict to simply "choose" sobriety.

Recovery requires sustained abstinence from supply-seeking. Volkow's research demonstrates that the brain changes underlying addiction can reverse with sustained abstinence—dopamine receptor density increases, prefrontal function improves, craving diminishes. For narcissistic patients who have achieved some treatment readiness (often through narcissistic collapse), this suggests that recovery may require a period of deliberate abstinence from supply-seeking behaviours while the brain heals. This might involve limiting exposure to validation-rich environments (social media, competitive settings, admiring audiences), developing alternative sources of self-worth, and sitting with the discomfort of reduced dopamine function until the system recalibrates. The timeline Volkow describes for addiction recovery—one to two years of sustained abstinence before significant neural recovery—may apply to narcissistic supply addiction as well.

Survivor treatment must address trauma bonding as addiction. For clinicians working with survivors of narcissistic abuse, Volkow's model illuminates why standard relationship grief processing is often insufficient. The survivor's attachment to their abuser was neurologically conditioned through intermittent reinforcement—the same mechanism that creates gambling addiction. Treatment must address this as genuine addiction, not merely unhealthy attachment. This means recognising that no-contact functions as abstinence, that cravings and urges to return are withdrawal symptoms, and that relapse (returning to the narcissist) operates through addiction rather than relationship dynamics. Survivors may benefit from interventions borrowed from addiction treatment: identifying triggers, developing coping strategies for craving, understanding the neurobiological nature of their urges, and building support systems for sustained no-contact.

Broader Implications

Volkow's addiction model illuminates patterns far beyond individual clinical work, helping us understand how narcissistic dynamics operate across families, organisations, and society.

The Intergenerational Transmission of Reward System Dysfunction

The reward system alterations Volkow describes can be transmitted across generations. Children raised by narcissistic parents experience the chaotic, unpredictable reinforcement that shapes reward circuitry during critical developmental windows. The infant whose parent responds with admiration to performances but ignores authentic emotional bids learns that only certain behaviours produce reward—their dopamine system calibrates accordingly. By the time this child reaches adulthood, they may have the same decreased reward sensitivity and increased expectation sensitivity that characterises their parent. The narcissism was transmitted not through genetics alone but through relational environments that shaped developing brains. Volkow's research suggests that breaking this cycle requires intervention during critical developmental periods when reward circuitry is still forming—or intensive adult intervention to reshape circuits that have already consolidated.

Social Media as Validation Delivery System

Volkow's model predicts that technologies providing intermittent social validation would have addictive properties—and social media has confirmed this prediction. Likes, comments, and shares function as dopamine-triggering validation hits delivered through unpredictable schedules optimised for maximal engagement. The adolescent compulsively checking their phone is experiencing the same neurobiological dynamic as the narcissist seeking supply—decreased sensitivity to ordinary rewards combined with heightened response to validation cues. This suggests that the current epidemic of mental health problems among heavy social media users may represent a form of mass addiction, with particular vulnerability for those already predisposed to validation-seeking. Understanding this neurobiological framework may inform both individual treatment and public policy approaches to social media regulation.

Organisational Dynamics and Narcissistic Leadership

Leaders whose reward systems have been hijacked by validation-seeking create organisations in their image. Volkow's model helps explain why narcissistic leaders make demonstrably self-destructive decisions—pursuing admiration-generating projects over strategically sound ones, surrounding themselves with sycophants rather than competent advisors, and doubling down on failing strategies rather than admitting error. The impaired prefrontal function Volkow describes means these leaders literally cannot override their subcortical drives toward validation-seeking. Organisations that understand this dynamic can design structures—distributed decision-making, anonymous feedback systems, external advisory boards—that limit damage from leaders whose brains cannot provide internal impulse control. They can also recognise that attempts to reason narcissistic leaders out of self-destructive decisions may fail not from stubbornness but from neurobiological incapacity.

Legal and Forensic Applications

Volkow's research has implications for legal understanding of narcissistic behaviour. The documented prefrontal impairment suggests diminished but not eliminated capacity for impulse control—similar to the diminished capacity considerations in addiction-related offences. However, unlike substance addiction where intoxication may impair judgment at specific times, the narcissist's impairment is chronic and characterological. This creates complex forensic questions: to what extent should neurobiological vulnerability mitigate responsibility? How do we balance compassion for a brain disorder with protection of those harmed by its manifestations? Courts and forensic evaluators may increasingly need to grapple with how addiction neuroscience applies to personality-disordered defendants whose validation-seeking led to criminal behaviour.

Cultural Factors in Reward System Development

Volkow's model suggests that cultures providing abundant intermittent validation during development might produce populations with higher rates of narcissistic reward system alterations. Cultures emphasising exceptional achievement over consistent attunement, celebrating dramatic success while ignoring ordinary effort, or providing validation through unpredictable parental mood states rather than reliable presence—all these would be predicted to shape reward circuitry toward narcissistic patterns. This cultural dimension of narcissism suggests that prevention efforts might focus on cultural practices that provide consistent, reliable validation to developing children rather than the intermittent, performance-contingent validation that appears to drive reward system dysfunction. Parental leave policies, childcare quality standards, and educational approaches all become relevant interventions.

Public Health Prevention Strategies

Viewing narcissistic reward system dysfunction through an addiction lens reframes prevention as a public health priority. If narcissistic supply-seeking operates through addiction mechanisms, then the same public health approaches that reduce substance addiction might reduce narcissism prevalence. These include ensuring adequate caregiver presence during critical developmental periods (when reward circuitry is forming), reducing exposure to intermittent reinforcement patterns in early relationships, and identifying high-risk children before reward system alterations consolidate. The return on investment—measured in reduced relationship damage, workplace dysfunction, and intergenerational transmission—could be substantial. Volkow's research suggests that narcissism prevention might be as amenable to public health intervention as addiction prevention—if we recognise both as neurobiological conditions with developmental origins.

Limitations and Considerations

Volkow's influential model has important limitations that warrant acknowledgment.

Generalisation from substance to behavioural addiction. Volkow's research primarily studied substance addiction. While the model has been extended to behavioural addictions including gambling and internet use, direct neuroimaging evidence for narcissistic supply-seeking as addiction remains limited. The book's application of Volkow's model to narcissistic supply is theoretically grounded and clinically useful but represents an extension of her research rather than direct confirmation. Future neuroimaging studies specifically examining reward circuitry in narcissistic personality disorder would strengthen this application.

Individual variation in neurobiological vulnerability. Volkow's research describes general mechanisms that operate differently across individuals. Some people appear more neurobiologically vulnerable to addiction than others, and the same likely applies to narcissistic supply-seeking. Genetic factors, developmental timing of adverse experiences, and individual variation in baseline dopamine function all influence whether exposure to intermittent reinforcement produces addiction-like changes. Clinicians should avoid deterministic conclusions—not everyone exposed to narcissistic parenting develops narcissistic reward system alterations, and not everyone with such alterations becomes abusive.

The agency and responsibility question. While Volkow's research illuminates neurobiological constraints on choice, it does not eliminate moral responsibility. The field of addiction medicine has grappled with this tension: addiction is a brain disease, yet addicts are still held responsible for seeking treatment and for harms caused during active addiction. The same nuanced position applies to narcissism. Understanding neurobiological constraints should increase compassion for the narcissist's genuine suffering without excusing harm caused to others. Survivors should not feel obligated to tolerate abuse because the abuser has a brain disorder.

Recovery evidence is hopeful but incomplete. While Volkow's research demonstrates that addiction-related brain changes can reverse with sustained abstinence, the timeline and completeness of recovery varies considerably across individuals and substances. Evidence for recovery from narcissistic supply addiction specifically is limited, though neuroplasticity principles suggest healing is possible. Clinicians should offer hope while remaining honest about uncertain outcomes.

Historical Context

Nora Volkow's 2010 paper appeared at a pivotal moment in addiction science. The previous two decades had seen an explosion of neuroimaging research demonstrating that addiction involved measurable brain changes—challenging the moral model that viewed addiction as simply weakness or bad choices. Volkow was instrumental in this paradigm shift, using PET imaging to visualise dopamine system alterations in addicts' brains.

Her model synthesised findings from multiple research programs into a coherent framework. Earlier work by Wolfram Schultz had demonstrated how dopamine signals predict reward rather than simply respond to it. George Koob had characterised the negative emotional states of withdrawal. Volkow's contribution was integrating these findings with the frontal cortex impairment literature to explain why addicts cannot simply override their urges—their brains have lost the neural machinery for impulse control.

The paper's impact extended beyond addiction treatment. By providing a comprehensive neurobiological model of compulsive behaviour, Volkow created a framework applicable to any behaviour characterised by tolerance, withdrawal, and continued pursuit despite negative consequences. Researchers began applying the model to gambling, internet use, and pornography. The book's application to narcissistic supply-seeking continues this extension, treating validation-seeking as operating through identical neural mechanisms.

Volkow's work helped establish the National Institute on Drug Abuse's position that addiction is a "brain disease" deserving medical treatment rather than incarceration. This has influenced policy in the United States and internationally, though the moral and social dimensions of addiction continue to be debated. The same neurobiological evidence could inform how society views narcissism—as a condition with developmental origins and neurobiological manifestations, warranting compassion alongside accountability.

Further Reading

• Volkow, N.D., & Morales, M. (2015). The brain on drugs: From reward to addiction. Cell, 162(4), 712-725.
• Koob, G.F., & Volkow, N.D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773.
• Schultz, W. (2016). Dopamine reward prediction error coding. Dialogues in Clinical Neuroscience, 18(1), 23-32.
• Leshner, A.I. (1997). Addiction is a brain disease, and it matters. Science, 278(5335), 45-47.
• Koob, G.F., & Le Moal, M. (2008). Addiction and the brain antireward system. Annual Review of Psychology, 59, 29-53.
• Chester, D.S., & DeWall, C.N. (2017). Combating the sting of rejection with the pleasure of revenge: A new look at how emotion shapes aggression. Journal of Personality and Social Psychology, 112(3), 413-430.