Background: People commonly use psychoactive substances to increase physical and
psychological pleasure. Neuroadaptations in the brain’s reward system coupled with changes in social
functioning and networking resulting from chronic substance use impede the ability to derive
pleasure from non-substance related activities.
Objective: We elucidate and validate the hypothesis that treatments for substance use disorders
would potentially have a stronger and broader impact by helping recipients to experience pleasure as
part of an expansive focus of increasing adaptive functioning, well-being, and personal fulfillment
Method: We have organized and integrated relatively sparse and disparate theory and research to describe
a multi-stage model linking pleasure and substance use. We review research on pleasure in the
context of treatment for substance use, and describe future research directions.
Results: Our model integrates several independent research programs with prominent theories and
models of substance dependence that together provide evidence that pleasure, or lack thereof, is a
risk or protective factor for initiating, escalating and maintaining substance use and substance use
disorders. Pleasure is an overlooked but potentially high-yield target of existing evidence-based
Conclusion: Research is needed to investigate the relation between pleasure and substance use, and
existing and newly developed treatments that have the potential to increase pleasure. By increasing
pleasure such treatments have the potential to help recipients to live fuller and richer lives. Integration
of pleasure into existing treatments has compelling transdiagnostic implications for individuals
at any point along a substance use severity continuum.