NIDA Director Calls for Humane Response to Addiction as a Brain Disorder

FROM Psychiatric News Alert: “If we as psychiatrists can embrace addiction as a disease of the brain that disrupts the systems that allow people to exert self-control, we can reduce the stigma that surrounds this disorder—for insurance companies and the wider public—and help to eliminate the shame and suffering that accompany the addict who experiences relapse after relapse after relapse.”

That was the message that Nora Volkow, M.D., (left) director of the National Institute on Drug Abuse, brought to APA members at the 59th Convocation of Distinguished Fellows at APA’s 2015 annual meeting in Toronto Monday evening.

Volkow opened her speech with a moving and emotional story of how she learned of her grandfather’s lifetime of chronic alcoholism and suicide; he had died when she was a girl of 6 in Mexico, but Volkow’s mother did not reveal the truth of her grandfather’s addiction and death until many years later, when her mother was dying and after Volkow had already achieved distinction as an addiction expert.

It was a dramatic illustration of the despair experienced by people who have an addiction and continue to engage in a behavior that they may know is destroying them—a phenomenon that Volkow has devoted her career to understanding. She gave a brief overview of her own research and the evolution of addiction science, describing how it was once believed that addiction was a disorder of hyperactive reward centers in the brain—that addicts sought out drugs or alcohol because they were especially sensitive to the pleasure-inducing effects of dopamine.

But Volkow explained that in recent years research has revealed just the opposite: that addicts are actually less sensitive to the effects of dopamine. They seek out drugs because of the very potency with which they can increase dopamine in the brain, often at the expense of other pleasurable natural stimulants that do not increase dopamine so dramatically. And it is the neurobiological reflection of the phenomenon of “diminishing effects” that addicts typically report clinically: they require more and more of the drug to get a similar effect.

“This was completely counterintuitive,” Volkow said.

Moreover, she emphasized that addiction to drugs disrupts multiple systems in the brain—not simply reward centers—that govern the ability to plan, anticipate, and change behavior in response to changing circumstances. Volkow said it is this phenomenon that accounts for the “craving” experienced by addicts and alcoholics in response to environmental triggers—often leading to what she characterized in the account of her grandfather’s death as that “one last moment of self-hatred.”

NIDA Summarizes Research on Negative Health Consequences of Marijuana Use

English: one high-quality "bud " nug...

English: one high-quality “bud ” nugget of marijuana (Photo credit: Wikipedia)

A recent comprehensive research review published this week in the New England Journal of Medicine reports that marijuana use is linked to several adverse effects—particularly in youth. The review was conducted by scientists at the National Institute on Drug Abuse (NIDA) who compiled data from previous studies highlighting the adverse consequences of marijuana use among teenagers. The NIDA review showed that teenage marijuana use was associated with impaired critical thinking and memory functions that last up to days after drug use, impaired driving, and lowered IQ scores into adulthood. The review also suggested that risks for adverse effects are increase when the drug is used along with alcohol.
The authors noted that because older studies are based on the effects of marijuana containing lower levels of THC—the primary psychoactive chemical in cannabis—stronger adverse health effects may occur with the use of today’s more potent marijuana. They emphasized that more research must be done on the potential health consequences of second-hand marijuana smoke, the long-term impact of prenatal cannabis exposure, and effects of marijuana legalization policies on public health.

“It is important to alert the public that using marijuana in the teen years brings health, social, and academic risk,” said lead author and NIDA Director Nora Volkow, M.D. “Physicians in particular can play a role in conveying to families that early marijuana use can interfere with crucial social and developmental milestones and can impair cognitive development.”

To read more about the use of marijuana among teens and legislation concerning marijuana use in this population, see the Psychiatric News articles, “News Is Mixed on Teenagers and Substance Use” and “Marijuana Legalization and Young Brains: Time for Serious Study.”