A substantial part of the research undertaken in my laboratory is directed at understanding the biological causes and consequences of addictions. My team and I study what brain processes cause some to be more susceptible for addictions, and we study how drugs of abuse change the molecules and cells of the brain in a way that corrupts its functions. We believe that an understanding of these events is crucial to developing preventions and treatments. With that in mind, it’s important to note that there are no medicines today (not one) for someone suffering from cocaine or methamphetamine addiction. In other words, there is a big need for answers to the mystery of addiction.
Despite this, quite a significant number of people opposed to my research (mostly because it involves animal subjects) have said that research on addictions is worthless. After all, they say, the solution is simple! Never take drugs in the first place! Or if you are taking drugs, just quit… it’s easy enough to do.
Of course, their challenges are hollow. Here, I outline why scientific research must tackle the problem of addictions, in general.
The pleasure problem
The world is full of things that give our bodies pleasure, and our brains are wired to desire them and to seek them out. Whether it’s chocolate, sex or the thrill of jumping out of a plane, we love things that make us feel good, and we’re willing to spend our time and money to get them. The situation is no different for illicit drugs like cocaine, methamphetamine and heroin, although – at least for some people – the grip of these agents on the reward centers of the brain can be incalculably powerful. It can be so strong that the addict begins to ignore other normal rewards (the pleasure of caring for a child, of loving your partner or of maintaining one’s own health) in order to consume more drug, more often. Even as their lives suffer, their health declines and their families weep, and even as the drug itself begins to lose its ability to cause the pleasure it once did (a phenomenon called tolerance), they seek and take it more furiously. It’s a spiral that, without intervention, may well cost them their life.
“It” is a disease
Addiction (referred to, in the medical literature, as substance abuse or substance dependence) is a disease of the brain. It’s what happens when intake of a drug corrupts the brain cells that process reward and make decisions to a degree that they are unable to sustain the functions they once did. For many, their lives start out bright; they are loving, productive, intelligent and successful, but then, “it” happens. They fall victim to a drug, and all that promise and hope disappears. Sometimes, they hit rock bottom and find a way to stop the use of the drug for a time. If they are remarkably lucky and have proper medical and psychological support, they may return to a healthy life and never use again. But for most, their freedom is only temporary, and they will relapse again days, weeks, months or even years later, returning them to their suffering and to their fateful spiral. You see, drugs kill. They are powerful toxins that can stop breathing or a heart. If they are injected, they can bring infectious diseases like hepatitis and HIV along with them. And because they intoxicate the mind, they lead to reckless driving and other behaviors that risk the lives of the addict and those around them.
The story of addiction is melodramatic. It starts with a choice and ends with a disease. In between, it lays waste to human life. It MUST be stopped.
Of the approximately $31 billion that the National Institutes of Health was allocated in 2011, approximately $1 billion was budgeted to support the mission of the National Institute on Drug Abuse. Another $450 million supported alcoholism related research. That means that the NIH spent about $1.5 billion on research related to substance abuse and its consequences. That seems like a lot, but it pales in comparison to the estimated $600 billion a year in economic damage that addictions cause our society each and every year. Put differently, for each dollar we spend to deal with the health and social consequences of addictions, we spend a mere 1/4 of a penny to understand and develop treatments for these disorders. That is a staggering statistic given that a successful treatment or cure could wipe the economic damage of addiction off our budget forever.
That said, the financial cost of addictions are nothing compared with the human costs. Addiction ravages families and communities. It destroys relationships. It devastates the previously happy lives of children. It kills. We all know this. We’ve all seen it.
One of the saddest ironies of addiction is that – sometimes – no one wants an addict to quit more than the addict him/herself. They know better than anyone what the final outcome of their addiction will be because they are living it and they have seen its effects on their friends and family. Despite their intense motivation to stop, they can’t. Our job, as researchers, is to figure out ways to aid them in their transition to abstinence. Our job is to develop medicines that suppress the cravings and desires. Our job is to correct the brain dysfunction that compels them to seek and take drugs. Our job is to give them back the hope that addiction stole from them and in doing so, to restore the hope for families, our communities and our society.
We must not fail in our effort. We must not fail to make even partial or incremental advances because a treatment that is only 10% successful can already save huge numbers of lives and families.
We must use every scientific tool available to us, including arguably controversial methods – like research on rats, mice and non-human primates – to affect a positive outcome. To do otherwise is to ignore the real, palpable need of those in distress. To do otherwise is frankly unethical. To do otherwise is wrong.
Jul 3 2012 Update: National Institute on Drug Abuse Director Nora Volkow talks to MSNBC’s Andrea Mitchell about drug addiction as a disease of the brain, making many of the same points addressed here: http://video.msnbc.msn.com/mitchell-reports/48062311