There are few words that pop up more in addiction research than dopamine, a neurotransmitter that drives the brain’s reward system, sometimes completely off the tracks.

In theory, dopamine levels shoot up when something feels good. They go up more if it’s been a long time. Food when you’re hungry, water when you’re thirsty, the warmth of a fire when you’re cold: these experiences trigger the release of one or more of the four “happiness hormones,” dopamine, serotonin, endorphins, and oxytocin.

Dopamine levels also increase when stress is displaced. When anxiety is alleviated by indulging in soothing substances or behaviors, dopamine levels increase as the stress is displaced. Anxiety itself is characterized by a conditioned anticipation of danger out of proportion to any real threat.

Dopamine in particular is associated with reward, reinforcement, motivation, and the mechanisms of learning and conditioning. Low levels of dopamine are associated with “feeling down,” and very low levels can impair movement and are a hallmark of Parkinson’s disease, according to Harvard Health Publishing.

An article in the journal Oxidative Medicine and Cellular Longevity on the role of dopamine (DA) and its dysfunction, found that in addition to depression and Parkinson’s disease, “Schizophrenia, autism, attention deficit hyperactivity disorders, and drug abuse are other pathological disorders that have been associated with DA dysfunction.”

The researchers found that the dopaminergic neurons fired at the anticipation of reward, and that a greater reward than expected leads to an increase in neurons firing. They explain:

The release of DA in areas such as the nucleus accumbens and the prefrontal cortex is principally due to rewarding experiences such as food, sex, drugs, and neutral stimuli that are associated with them.

The authors state that “Antipsychotic drugs act as DA antagonists” that have an inhibitory effect on DA”at the level of the receptor.” Research has also shown a relationship between anxiety disorders and dopamine levels. In a paper for Nature Neuroscience, a pair of researchers from the University of Washington say activation of dopamine neurons is critical for the prevention of generalized anxiety:

We discovered that altering the magnitude of excitatory responses by dopamine neurons in response to an aversive stimulus was associated with impaired conditioning to a cue that predicts an aversive outcome. Impaired conditioning by these mice was associated with the development of a persistent, generalized anxiety-like phenotype.

“There are evidences that dopamine plays an important role in anxiety modulation in different parts of the brain,” write a pair of Iranian researchers in the Archives of Iranian Medicine. They find that changes in the dopaminergic system “influence anxiety-like behavior,” but they’re not clear exactly how or why.

One solution to reduced dopamine levels for people suffering from Parkinson’s disease has been a transdermal patch called NEUPRO (rotigotine), a dopamine receptor agonist delivered over a 24-hour period. NEUPRO has been approved by the Food and Drug Administration (FDA) for the treatment of Parkinson’s Disease and restless leg syndrome.

The makers of the NEUPRO patch are very careful to say they don’t know how it works: “the exact way NEUPRO treats PD is unknown.” However, they do call it a “dopamine agonist” and are willing to say that, “It is believed that dopamine agonists work by stimulating dopamine receptors in the brain.” They do not say the patch reduces anxiety, but they do say stopping use can increase anxiety:

If you stop using NEUPRO, you may have withdrawal symptoms such as fever, confusion, severe muscle stiffness, feeling like you do not care about the things you usually care about (apathy), anxiety, depression, fatigue, insomnia, sweating and pain.

We are left with many questions at the end of this excursion. Could a patch that regulates dopamine delivery be used to reduce cravings and withdrawal symptoms in people who are trying to recover from addictions? Would it reduce sensitivity to cues in people with behavioral disorders or substance use disorders? Could it help people with eating addiction eat less?

We will stay on the dopamine trail, here at AddictionNews, and continue our investigations into its involvement in displacement and addiction.

Written by Steve O’Keefe. First published March 12, 2026.

Sources:

“Dopamine: The pathway to pleasure,” Harvard Health Publishing, undated.

“Activation of dopamine neurons is critical for aversive conditioning and prevention of generalized anxiety,” Nature Neuroscience, April 17, 2011.

“The Role of Dopamine and Its Dysfunction as a Consequence of Oxidative Stress,” Oxidative Medicine and Cellular Longevity, December 6, 2016.

“The Development of the Rotigotine Transdermal Patch: A Historical Perspective,” Neurologic Clinics, August 2013.

“The Modulatory Role of Dopamine in Anxiety-like Behavior,” Archives of Iranian Medicine, September 1, 2025.

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