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

“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.”

(Image: David Hathcox)

Maternal Warmth May Be Protective for Boys Whose Mothers Are Depressed, Study Shows

The experience of warmth and affection from mothers may be a protective factor for boys exposed to maternal depression by affecting brain regions associated with how children plan for, anticipate, and enjoy rewards, a feature associated with depression. That’s the finding from a report by researchers at the University of Pittsburgh published online in the Journal of the American Academy of Child and Adolescent Psychiatry.

At 18 months and 24 months, 120 boys and their mothers participated in two semi-structured tasks that required maternal interaction. Mothers’ warmth was coded using the Early Parenting Coding System. They were assessed for lifetime depression using a structured clinical interview when the boys were 42 months old; they reported on current depressive symptoms using the Beck Depression Inventory when the boys were aged 10 and 11. At age 20 the boys underwent functional magnetic resonance imaging while playing monetary reward games.

Maternal warmth during early childhood was associated with levels of activation in two areas crucial to anticipating and experiencing loss or gain of rewards—the striatum and the medial prefrontal cortex (mPFC). And the association between maternal warmth during early childhood and early adolescence and reward function in the striatum and mPFC was stronger for boys exposed to maternal depression relative to boys who were not.

“Greater maternal warmth may prevent boys from overanalyzing their performance during disappointment,” the researchers say. “...[A]s indicated by heightened caudate activation when experiencing loss, boys who have experienced greater maternal warmth may find the pursuit of rewards pleasurable even when experiencing disappointment. These neural responses to reward and loss may promote healthy reward seeking.”

For related information, see the Psychiatric News article, "Maternal Depression May Affect Brains of Unborn Children."

(Image: Oddech/Shutterstock.com)