Monday evening, at the American Psychiatric Association’s 59th Convocation of Distinguished Fellows, Nora Volkow, M.D., the Director of the National Institute on Drug Abuse, began her speech with a personal and poignant story about her grandfather, who died when she was just a six-year-old girl in Mexico.
She recalled how she had always known that her grandfather had died, but she never knew what had really happened until it was revealed decades later by her own dying mother.
The reality was that her grandfather was a chronic and lifelong alcoholic who had committed suicide. In a strange twist of fate – or perhaps serendipity –Dr. Volkow was already a recognized expert on addiction disorders when she learned the truth. She called her grandfather’s suicide “one last act of self-hatred”.
In a very dramatic and emotive fashion, Dr. Volkow’s private family story starkly illustrated the dire anguish experienced daily by individuals who have an addiction that they fully understand is destroying them, yet they continue to actively engage in behaviors that feed their addiction.
This paradox has been the focus of Dr. Volkow’s career.
After relating her grandfather’s tale, Dr. Volkow gave a brief overview of how addiction science has evolved and how ideas that once prevailed now all had been proven to be the antithesis of actuality.
Once upon a time, the belief was that individuals suffering from addictions abused alcohol and drugs because they had a sensitivity to dopamine – the neurotransmitter that helps control the reward and pleasure centers of the brain.
As Dr. Volkow went on to explain, however, recent research has uncovered indications that strongly suggest the exact opposite. These indications are both startling and completely counterintuitive to what was previously believed.
Addicts are actually less sensitive to dopamine’s effects. The entire reason that they seek out drugs is so they can increase the brain’s dopamine levels.
This artificial stimulation leads to a decline in the efficacy of other natural stimulants, because they do not increase dopamine production quite so drastically. This creates the infamous cycle of “diminishing returns”, because when the other natural stimulants cease to have a positive effect, more and more of the drug is needed to achieve the same high.
Dr. Volkow went on to stress that drug addiction disrupts more than the body’s reward centers. It also can wreak havoc on the brain’s ability to organize, anticipate, or visualize future consequences, and can impair an individual’s ability to react to changing circumstances.
This echoes the findings in Dr. Volkow’s own previous work.
In her own paper, “Addiction: a Disease of Self-Control”, published in Neurosciences and the Human Person: New Perspectives on Human Activities, co-authored with Ruben Baler, Dr. Volkow concluded:
“This inability to appropriately weigh delayed rewards can be devastating to an addicted person who may be willing to sacrifice future gains or incur major losses in exchange for instant gratification. An individual in this situation may not think twice about the risk of losing his or her freedom tomorrow in order to chase the drug today. This knowledge helps explain why the prevailing social system that dangles some future threat of imprisonment over an addict’s head seldom deters immediate substance abuse-related behaviors in addicted subjects.”
Emphasizing that point during Monday’s speech, Dr. Volkow told the assembled guests:
“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.”