By Kristin Battista-Frazee
Nora Volkow, National Institute on Drug Abuse Director and neurobiologist, presented on “The Emerging Science of Addictions” at the recent National Council for Behavioral Health annual conference.
An estimated 21.5 million Americans suffer from addictions—and veterans are at greater risk—yet only 19% receive needed treatment. Clinical social workers know all too well the struggles of providing care for addiction, whose biological aspects are worth reviewing.
Volkow identified the long-term effects on the brain of untreated addiction, and addressed the importance of prevention and early treatment, especially for young people. She also spoke about how science can help people get a better understanding of substance use disorders.
Volkow shared how substance use can change brain biology and impact one’s ability to make decisions. She described addiction as a disease of the brain with functions that can be measured by technology: for example, a myocardial infarction can be measured in terms of the weakness it causes in the heart muscle—a critical factor in treatment. Similar technology is used to measure problems in the brain for addicted individuals.
Volkow stressed that the damaged and addicted brain creates a pathology in which a person loses the ability to control their behavior, an effect she compared to being unable to known when you’ve had enough to eat. She also acknowledged that addiction can be a developmental disease which is detrimental to a young person who is experimenting with drugs.
Young people are more likely to engage in risky behavior because the frontal cortex, which controls emotions and impulse control, is not fully formed until age 24. A teenager’s brain is more elastic too, and drug-abuse can impact brain-development and cause long-term problems. She further stated that early patterns created by drug use leaves young people at greater risk for addiction later in life.
Volkow also presented research showing how drug use can produce addiction. Drugs activate the reward regions in the brain which trigger neuroadaptations and leave powerful memories which drive addictive behavior. Food in certain studies produces similar effects but Volkow pointed out that drugs were more efficient in triggering dopamine.Cocaine, for example, interferes with the reception of dopamine; and the brain’s biology can adapt to strong stimulations by blocking and reducing dopamine receptors which effect a person’s ability to experience pleasure. Volkow described this as a psychological process embedded in our biology and tissues. Drug use over time can lead a person to develop a high tolerance and the need for more drugs in order to reach a pleasure state and activate dopamine.
People with a reduced number of receptors are vulnerable to addicted behaviors. These simple proteins and receptors have a profound influence on our behavior. In animal studies, addicted subjects were injected with a virus to build receptors this dramatically decreased addiction behaviors. This discovery, Volkow pointed out, can lead us to more easily believe addiction is not “a weakness” but mostly a biological structure of the brain. “If the brakes in our brains are not working, this poses challenges in asserting judgment and control,” said Volkow.
The brain can rebound in the aftermath of addiction. Studies showed that, after 14 months of being drug-free, the receptors can return to a more normal state.
This gives us hope that treatment is effective. Volkow urges clinicians to keep increasing access to addiction care, for the science is now available to show that treatment works. She also noted that addiction needs to be treated as a chronic disease requiring long-term care. “It’s like stopping the medicine for blood pressure. If the treatment stops, a relapse occurs. It’s the same for addiction.”
Volkow offered the following final thoughts about addiction treatment:
For additional statistics on substance use in the United States, review The Substance Abuse and Mental Health Services Administration (SAMHSA) annual National Survey on Drug Use and Health (NSDUH).
Images from presentation “Progress in Treating: Drug Addiction,” by Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse. Citations for individual slides are located at the bottom of images.