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NIDA Director: Ensuring Drug Policy is Grounded in Science

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A profile of National Institute on Drug Abuse (NIDA) Director, Dr. Nora Volkow, in The New York Times, says her mission is to ensure that the nation’s drug policy, which is increasingly focused on prescription drugs, is grounded in science.

Dr. Volkow oversees a $1.09 billion budget for an agency that is dealing with skyrocketing rates of prescription drug abuse. Hospitalizations from prescription drugs have jumped fivefold in the last decade, while overdose deaths have risen fourfold, the article notes. Dr. Volkow says that prescription drugs are especially challenging because they are needed for patients in pain, yet are the cause of so many cases of substance abuse.

Dr. Volkow says she is in favor of a planned merger between NIDA and the National Institute on Alcohol Abuse and Alcoholism, according to the newspaper. She said that addictions share many triggers and much biology, and tend to move together.

An expert in the brain chemical dopamine, Dr. Volkow has conducted research that has helped explain how addiction causes changes in brain function. Don C. Des Jarlais, who directs the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center in New York, told the newspaper that Dr. Volkow “is as responsible as anyone for showing that addiction really does cause changes in brain function. Her work is a primary basis for considering it a disease, rather than poor choices or immoral behavior.”

Dr. Volkow recently wrote, “On a personal level, as a physician I have never met an addicted person who chose to be addicted or who expected that this compulsive, uncontrollable behavior would emerge when they started taking drugs. Like any other medical disorder that impairs the function of vital organs, repair and recovery of the addicted brain depends on targeted and effective treatments that must address the complexity of the disease. Research is the cornerstone in proving how this can be done.”

6 Responses to this article

  1. Gene / June 16, 2011 at 1:08 pm

    There are different reasons to call it disease, there are also different agenda. Medical professional call it disease to treat medical complications associated with acute or chronic poisoning caused by some addictive substances. 12 steps called disease to extract the personal responsibilities (behavioral component or choice) from the etiology of this medical condition.

  2. Joshua / June 15, 2011 at 11:53 am

    the fact that “this compulsive, uncontrollable behavior would emerge when they started taking drugs” is pretty much common knowledge. (if you doubt this, go ask a 5 year old what happens when you take drugs and see if you don’t get an answer very similar to this statement) choosing to take an addictive substance is the same as choosing to become addicted. the choice to take any addictive drug for the first time is always made by someone who is not addicted. call it a disease and treat it like a disease, but you can’t seperate out the element of choice from addiction without losing all credibility.

  3. Avatar of Jason
    Jason / June 14, 2011 at 3:18 pm

    If you discover the cure for addiction the societal problems from substance abuse will barely drop, if at all. If you make broad policy and environmeantal changes around alcohol societal problems from alcohol could drop substantially.

  4. DrJJMD / June 19, 2011 at 2:29 am

    That is actually NOT true. I have come across many patients who have “experimented,” with different drugs of abuse who are NOT currently addicted but rather view their experience as a phase in their lives. Furthermore, chronic diseases such as diabetes (Type II), Hypertension, and in many cases Hypercholesterolemia, Peripheral vascular disease Heart, and many others can be traced back to the behavior of the patient and thus are behavior based to a large degree and in some instances totally; in other words, the individual patient many times contributes to the development or the severity of the disease. However, we rarely hear that these diseases are illegitimate, or not really diseases because the person knew that their over-eating and/or their food choices contributed to the development of their disease. Therefore, I ask that you please really think this through before dismissing it. Dr. Volkow’s theory of addiction concedes that the nature of addiction has long been debated along Moral VS. Biological lines (Primarily because the layperson cannot peek into the brain of patient X). However, recent advances in neuroscience offer insights that helped Dr. Volkow bridge the gap between these opposing views. As a matter of fact, current evidence shows that most drugs of abuse exert their initial reinforcing effects by inducing dopamine (DA) surges in limbic regions, affecting other neurotransmitter systems and leading to characteristic plastic adaptations. Importantly, there seem to be intimate relationships between the circuits disrupted by abused drugs and those that underlie self-control. Significant changes can be detected in circuits implicated in reward, motivation and/or drive, salience attribution, inhibitory control and memory consolidation. Therefore, addiction treatments should attempt to reduce the rewarding properties of drugs while enhancing those of alternative reinforcers, inhibit conditioned memories and strengthen cognitive control. Dr. Volkow posits that the time has come to recognize that the process of addiction erodes the same neural scaffolds that enable self-control and appropriate decision making. Imaging studies have provided evidence of how the human brain changes as an individual becomes addicted. The findings from imaging studies have been integrated to show that the process of addiction is initiated in part by the fast and high increases in DA induced by drugs of abuse. Further, that this supraphysiological effect of drugs trigger a series of adaptations in neuronal circuits involved in saliency/reward, motivation/drive, memory/conditioning, and control/disinhibition, resulting in an enhanced (and long lasting) saliency value for the drug and its associated cues at the expense of decreased sensitivity for salient events of everyday life (including natural reinforcers such as food, sex, etc). Although acute drug intake increases DA neurotransmission, chronic drug consumption over time, results in a marked decrease in DA activity, associated with, among others, dysregulation of the orbitofrontal cortex (region involved with salience attribution) and cingulate gyrus (region involved with inhibitory control). The ensuing increase in motivational drive for the drug, strengthened by CONDITIONED RESPONSES together with the DECREASE in inhibitory control favors the emergence of compulsive drug taking. Though this model focuses mostly on findings from PET studies of the brains’ DA systems it is evident that other neurotransmitters are involved.

  5. Carlos / September 24, 2011 at 3:52 pm

    Thank you doc: very impressive response regarding neuroscience, but I have difficulty believing that current Drug Policy is grounded in Science. Does this mean that it is right now grounded in science or that that is her goal? Drug Policy has been around since the late 1800 early 1900, and as far as I can tell Science was the farthest thought from the law makers. Most policies where done on political and many biases sometime even racial and bigotry believes. Even today’s drug treatment approaches, were we spending over 90% of all our funds is based on the 12 Step programs and there is very little science available. In fact there is a gigantic gap between practice and science which truly alarms me, because I do not see much of an effort when significant number of mental health practitioners and I guess much less substance abuse treatment staff do not read scientifically based articles (I have to get you the study, it was in reverse only 28% of mental health parishioners read scientific articles). In fact I am venturing to say that most practitioners probably fail high school science test. That to me is very alarming. I have basic knowledge of neuroscience, I promise to spend more time this year learning a lot more. I have a hunch and a hunch only that most of what we are going base treatment,
    assessment and pharmacology is going to be based on general neuroscience. Way too
    much time has been wasted on practicing untested hypothesis and providing treatment that has no support on science.

  6. DrJJMD / January 4, 2012 at 2:17 pm

    I absolutely agree with your theory that current drug policy is archaic and that neuroscience/biology has NO place in current drug policy. As evidence I direct you to the “war on drugs,” waged by Pesident Nixon and the formation of the DEA. As a matter of fact opioid agonist therapy such as methadone, up until the Federal DATA law was passed in 2001 (or 2000?) remained the most regulated drug in the United States with overlapping Multi-agency control despite its’ CII status.

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