‘Reward Deficiency Syndrome’? 

Have you ever heard the term ‘Reward Deficiency Syndrome’?  From what I understand, it came out of research by Dr. Kenneth Blum and others.  They were searching for a specific genetic glitch that might increase the risk of alcoholism.

They understood that something as complex as an addiction can not be caused by any single gene, but the one gene being studied did seem to increase the risk.

This initial work did lead a number of researchers to the discovery that the genetic anomaly “previously found to be associated with alcoholism is also found with increased frequency among people with other addictive, compulsive or impulsive disorders.  The list is long and remarkable – it comprises alcoholism, substance abuse, smoking, compulsive overeating and obesity, attention-deficit disorder, Tourette’s syndrome and pathological gambling.”


There’s a ton of research that shows people with ADHD are at far greater risk of substance abuse, gambling, and so on.

To explain the common thread in this, Dr. Blum came up with the term ‘Reward Deficiency Disorder’. The gene involved is in a dopamine receptor. And as you may know, most ADHD medications target dopamine.

A fresh perspective on ADHD

I first heard about this concept at a CHADD conference.  It wasn’t part of a formal presentation, just a part of a conversation among some of the speakers that Ava and I sat in on.  Someone mentioned that there was an interesting new idea that ADHD could be seen as a problem with reward deficiency.  As in, we don’t feel pleasure as intensely as other people. So we need more food, more alcohol, more drugs, more sex, more shopping… to get the same rush.  More risk and danger to feel the same thrills.

It resonated with me.  I wasn’t sure why at first.

Then it occurred to me that I had often received standing ovations when I was doing live comedy, with The Frantics.  And while most people would be thrilled, and remember it for the rest of their lives, I would head back to the dressing room thinking, “Not bad.  I think we could have done better if the lighting had been tighter to the cues.  And the stage right spotlight was too tight…”

(I cringe to think how much joy I let slip by.)

“Is something wrong?”

Fans, friends, and family would come up after a show gushing with enthusiasm.  I felt pleased, sure, but not nearly as enthused as they were. T hey often assumed my low key smile meant something was wrong, that I was upset, or perhaps we had a backstage argument.

Nope. It was just, “Done. Moving on. Who wants to go out for bagels?”

Don’t get me wrong, doing a live comedy show was great.  Being out there, playing, in that dance with the other guys was intense and exciting.  We were literally playing, dancing with the material, riffing, exploring, pushing the limits, trying new things, surprising each other and ourselves.

Numb? Insensitive? Hard to please?

The idea of being reward deficit has stuck with me.

Maybe it’s a case of seeing what I want to see, but I began to notice it more and more in myself. It was especially clear to me whenever I finished a huge project: delivering the final version of ADD & Loving It?! to the network for broadcast; the launch of ADD & Mastering It! on PBS; finishing the book ADD Stole My Car Keys.

It wasn’t high-fives, whoops, back slapping, and congratulations. I wasn’t glowing with the pride of accomplishment.

More like, “Phew. We did it. Done. Finally… What’s next?”

Then I was on to the next thing, always with a sense of urgency.

I went through this sense of, “Thank God, that’s done,” recently when we finished our biggest project ever, ADHD Medication, Straight Answers to Big Questions. I knew it was going to be ambitious. But I had no idea how all-consuming it would become.

Do you do this as well? You may not think you downplay your strengths, because you don’t believe you have any strengths. So you’re not really sure what to celebrate. So when you remember to pick up the kids, or you bring a boring party to life, or take care of an abused animal, or whatever, you don’t really appreciate what you’ve done.

How do we celebrate our accomplishments? Do we have to stop and actually pay attention to them? Perhaps take a weekend to reward ourselves? Or send a thank you to everyone who helped? Or call someone and announce, “Guess what I did!”

Maybe that’s part of the value of a coach. Someone to actually stop us from jumping onto the next thing we should be doing, and have a look at what we actually have done.

Interesting topic, isn’t it? Motivation. Procrastination. Celebration. Acknowledgment. Rewards. Achievements.

“I don’t have time to celebrate! There’s still too much to do!”

When I’m in the middle of doing those thousand little things that need doing, actually pausing to celebrate is about the last thing on my mind. Unfortunately, when I have finally finished those thousand little things, I still don’t pause.

I just rush headlong into the next thing. Or, simply collapse into, well, a state of utter exhaustion.

The danger is that life becomes a treadmill of doing. It’s monotonous, even when it’s going well. There’s no perspective, no sense of what has been done. Whether what I’ve done is to create a full-length video, or simply do my Yoga routine every morning for the whole week.

Not acknowledging the end, or even celebrating all the little steps and victories and accomplishments along the way, is kind of tragic, and it deprives all of the people who work so hard to make something happen, the pleasure and pride in surveying what we’ve done and savoring it.

“Hey, job well done!”

“Wow, look what we did!


I decided the solution is simple.

A few week back, I decided to pause at the end of every day, and look at what we have done, and how far along we are. Even if some days it feels like we took three steps backward. (And yes, some days I forgot to do it.)

Some days ended with me feeling disheartened that, “I hardly got anything done.” But taking a few minutes to talk it over what we’d done with Ava and Jimi made me aware of the fact that while there were one or two big frustrations, a whole bunch of things did get moved forward. It was amazing.

What I found is that pausing to review what had been done, even if it hadn’t worked out as hoped, had me see how much progress we were making. Instead of seeing only what still needed to be done, my focus was on how much had been accomplished.

If we are struggling with a ‘Reward Deficiency’, then we need to actually pause and be mindful of what we’ve done, big or small. And reward ourselves.



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8 Replies to “‘Reward Deficiency Syndrome’? ”

  1. Rick,

    Thanks for the link to the article. I found about every member of my family in there. My question about deliberately celebrating is, how can a person celebrate in a healthy, safe way to the degree that you get the D2-rush? I have had people comment on this my whole life:

    “Aren’t you elated that this has finally happened?”

    “I’m just glad it’s over.”

    For me, only sports, either as a participant or as a spectator, gives me that satisfaction of achievement. Winning is the only accomplishment which seems to reward me biochemically. Oh, and giving birth or trying to get in a position to give birth, but I’m told that’s an oxytocin thing.

  2. Reward Deficient – definitely. Nothing I do is ever good enough, but I’ve thought a lot about this and come to terms with it. And celebrated appropriately. Here’s the next question for me, though. Why is my life always about doing/accomplishing? Everything is about this checklist – I can’t even sit down to read a book without thinking of the other un-read, and more worthy, books looking down accusingly from my bookshelves. Where is this endless checklist coming from? And…what??… I’m going to check off every item on it and then die? There has to be something else – some way of living in the moment with depth rather than breadth.

  3. Rarely do I think that what I did was a big deal – and like many others, it’s never good enough – but I do know that I need to be appreciated for doing whatever it was. Perhaps that’s why, whenever I made it thru the week (or even the day) – whether or not it was especially stressful or just “ordinary” – I would HAVE to buy myself something. Sometimes it was a trinket, or maybe some make-up or clothes I didn’t need (my closet is beyond bursting), but mostly it was beer. I found myself trapped in buying more and more “rewards,” thinking I was doing myself a favour.

  4. Two small things I started a few years ago:
    1. If someone says something nice, say “Thank you.”
    2. If someone says “Thank you,” say “You’re welcome.”

    I had noticed that I was constantly saying:
    No problem.
    No big deal.
    It’s my job.
    It’s nothing.
    I hope it’s okay.
    Sorry it took so long.

    I was undermining myself, even when I had done something great, even when I met a totally unreasonable request. I still have to remind myself to say “Thank you,” and “You’re welcome.” Even when I don’t feel it.

  5. I am interested if this has some connection to Imposter Syndrome or Jonah complex (see the link in the same article).

    I feel this way a lot, but have always linked it to the many childhood years of hearing people in authority (often teachers) who told me I’d “never amount to anything”. As I’ve considered that possibility, recently I’ve determined that’s not the cause. I mean, I’ve been very successful at some things, but as you write, almost always feel like I could have done better, or that what I just accomplished meant nothing to anyone.

    There is an element of the Jonah complex to things I am trying to do right now. I am afraid to start drawing again because I fear I won’t ever be any good, despite evidence to the contrary. Maybe it’s this instead; I don’t know, something to consider.

  6. I really relate to this, Rick. the lack of real joy – not that I’m not happy in life, but there’s no zing. There is a sense of vast monotony, as though things will always be this way, nothing much to look forward to. If I pay more attention to successes, even small ones, perhaps some of those feelings will improve.

    Susank, you’ve given voice to my thoughts. Thank you!

  7. I have a version of Reward Deficiency Syndrome (RDS). I call it “Yeah, but….Syndrome.” Like: Yeah, I finished my dissertation and graduated, but it took me longer than it should have.” I discount, dismiss, or dissect any accomplishment I do achieve.

    I believe this relative of RDS involves hyperfocusing of errors, problems, glitches, etc. Perseverating on imperfections. Suffering from perfection paralysis, getting something completed anyway (Something imperfect, of course, because perfection is a myth.), but picking apart and shooting down the accomplishment until it feels like it shouldn’t be celebrated.

    How do we step out into the world as confident, competent beings when we have all of this “stuff” going on in our heads?

  8. I have not heard of the term ‘reward deficiency syndrome’ but it makes a great deal of sense for someone with ADHD.

    Being someone that was diagnosed late, I was conditioned not to see the value of my work. I spent too much time telling myself that it took too long, or it seemed to take a herculean effort to achieve. In my case one of my strengths is perseverance, and I have learned to embrace it and recognize that is unique whether I have ADD or not. I have been blessed with many gifts and by working hard to manage my weaknesses, I can see progress.

    I work hard to stop comparing myself to other people and embrace the wins, even if no one ever notices.

    There is a term used by Dr William Dodson called ‘Rejection Sensitivity Dysphoria’ RSD which negatively impacts our self esteem, causes depression and wears us down. I have felt beaten down more at home than I ever have at work. Would certainly suggest anyone who has not heard of RSD to do an internet search.

    What I have started to do is educate family members and surround myelf with friends who are positive. I am not expecting a pass when I forget something, hopefully a better repsonse from people in my life.

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