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Stanton Peele Stanton Peele

Why We Need to Stop Nora Volkow From Taking Over the World


The head of the National Institute on Drug Abuse uses brain scans to propagate the disease model of addiction. I say she's wrong—and the dominance of her theory causes great harm.

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nora_volkow

Nora Volkow, director of the National Institute on Drug Abuse (NIDA). Photo via

The disease theory of addiction, which has always been with us in one form or another, now boasts Nora Volkow, the director of the National Institute on Drug Abuse (NIDA), as its principal representative. Volkow holds worldwide sway with her approach, which focuses exclusively on neuroscience and the brain and which is increasingly seen as the key to eliminating addiction.

“Groundbreaking discoveries about the brain have revolutionized our understanding of drug addiction, enabling us to respond effectively to the problem,” trumpets the White House website, beneath a video of Volkow proselytizing her theory.

Yet there are no diagnoses or treatments based on neuroscientific research pegged to the brain scans so avidly pursued and enthusiastically presented by Volkow and her school. We are told to be patient because the new scientific paradigm must mature before it produces real-life applications. Until then, we have a glut of super-high-tech pictures of the living brain to distract us. They distract us above all from the major truth revealed by addiction epidemiology: Most people overcome alcoholism and drug addiction on their own. Finally, belief in the disease theory—to the extent that it persuades you of your powerlessness to control your substance use—has been shown to increase relapse and diminish the prospects for recovery.

But Volkow and her neuroscience campaign reign supreme in the US, and appear to be conquering the world, with the result that addiction will only grow worse.

Consider the following five facts.

1. Since the mid-19th century, the US has subscribed to the disease theory of addiction; it is a key American cultural meme.

In the second half of the 20th century, Alcoholics Anonymous was presented as a non-moralistic, modern disease view of addiction to replace the failed Temperance model.  But Temperance anticipated the essential elements not only of the 12 Steps but also of the new “chronic, relapsing brain disease” theory: that addiction is a progressive, irreversible disease state that must end in death or institutionalization unless you take a religious pledge (in Temperance terms), join AA or (now) undergo medical treatment. Although AA apologists argue that a belief that “a Power greater than ourselves could restore us to sanity” is not religious, the 12 Steps fall short of what most people regard as modern medicine. It was as a supposedly scientifically valid way to fill this addiction-disease niche that the neuroscience vision of addiction has become our ruling paradigm.

2. Nora Volkow has reinvented the disease theory of addiction as a function of neuroscience and positioned herself as the international go-to source on addiction. 

Appointed in 2003 by President George W. Bush to head NIDA, Volkow has been a tireless crusader for the neuroscience of addiction. She has used her bully pulpit to brilliant effect. Volkow is always available to the press. She cuts a most mediagenic figure: a neuroscientist who is stylish, quotable and on a mission. On top of this, she is Trotsky’s great granddaughter!

The New York Times presents her not only as the embodiment of addiction science but also as the spokesperson for the age-old anti-drug/anti-alcohol vision: The Times’ accolade to Volkow is titled “A General in the Drug War.” Volkow’s attention was urgently demanded, according to the Times, in the fight against the prescription painkiller “epidemic”: “Eight years into her tenure at the institute, the pace of addiction research is accelerating, propelled by a nationwide emergency that has sent her agency, with a $1.09 billion budget, into crisis mode.”

In a recent major editorial, the world’s leading scientific journal, Nature, declared that neuroscience has settled all questions about addiction: “Drug addiction is a disease. Images of the brains of addicts show alterations in regions crucial to learning and memory, judgment and decision-making, and behavioral control. Drugs imitate natural neurotransmitters, resulting in false or abnormal messages being sent around neural circuits. The brain’s central reward system is overstimulated and flooded with dopamine. The brain adapts to this flood by turning down its ability to respond to dopamine—so addicts take more and more of the drug to push dopamine levels higher.”

Lamenting that this revolution has lagged in Europe, the journal advised “Europe [to] look to the United States and to inspirational figures such as Nora Volkow…who has the scientific clarity of vision, and the relentless patience, to be able to argue for the promise of research effectively year in, year out.”

3. Neuroscience’s chronic brain disease model has produced no useful diagnostic or treatment tools for addiction, even as it expands endlessly before us.

In 1977, celebrating the discovery of the first family of neurochemicals—the endogenous opioid-like endorphins—prominent neurologist Richard Restak declared, “It’s hard to leave out the exclamation points when you are talking about a veritable philosopher’s stone—a group of substances that hold out the promise of alleviating, or even eliminating, such age-old medical bugaboos as pain, drug addiction and… schizophrenia.”

Restak was never held accountable for what have proved to be overblown, unfounded claims. Nor have the media, from the most prestigious medical journals to TimeNewsweek and Scientific American, had to issue a correction, let alone an apology, for regular depictions of the brain’s addictive structure and chemistry—even though nothing of therapeutic significance has been forthcoming. Americans seem to find these schemas rewarding in themselves, as “proof” that our faith in “better living through technology” is being fulfilled.

Ignoring this 35-year losing track record, Nature’s editorial predicts that neuroscience’s promises to alleviate addiction will come true: “It is likely that demand [for drugs] can be reduced by developing treatments for the self-destructive cravings that drive drug addiction. Given the technical tools now available for looking deep inside the brain, there is realistic hope that such treatments will emerge from research in the coming decades.”

Brain images displayed at "DrugAbuse.gov." Are they helpful?

Brain images displayed at “DrugAbuse.gov.” Are they helpful?

Nature’s projection is notably far off in the future. We lack anything like a basic biomarker to diagnose the “disease.” But the more fundamental problem is pegging the neuroscience vision of addiction to the brain’s pleasure centers or reward systems in the first place.

To begin with, the people whose brains are the material for Volkow & Co.’s research have been identified—and self-identify—as addicts. By contrast, we know very little about the brains of the people who use cocaine but don’t become addicted or who overcome their addictions, including the many who cut back their use. Instead, comparisons are made to brain scans of people who have never (or rarely) used drugs. But without seeing how the brains of casual, former or moderating users respond to cocaine, we lack the relevant control groups that science requires. Without these comparisons, it is not even theoretically possible to use a brain scan as a diagnostic tool to distinguish a person who has the “disease” of addiction from the person who does not.

Also, brain scans only reflect a moment in time. They do not have any predictive value. Maybe those whose brains spell out “I’m addicted!” (or, more accurately, “I have taken a hell of a lot of cocaine!”) in marquee light bulbs will moderate as they mature. Many will, after all, concentrate on more productive things—like taking care of children—that will cause them to restrain themselves.

Most important, these images cannot depict why people become addicted—or differentiate between those who keep using in the face of grievous consequences and those whose values cause them to desist or cut back their use. And this—the science of quitting addiction—is the crucial scientific question.

The limitations of brain scans fold into a larger theoretical limitation of the theory that people become addicted to pleasure. Don’t we all experience more or less pleasure from many different things? And doesn’t how we handle such pleasure depend on many factors?

Dopamine is not limited to drug use. Larry Young and Brian Alexander write in The Chemistry Between Us, “Dopamine is involved in reward and motivation for everything we do in life—whether we’re eating good food, drinking good wine or interacting with our kids and family.” All of us are exposed to many pleasure-causing activities, and most of us have experienced excesses in these areas. But only rarely do excesses become chronic. Why is that? The regulation of dopamine-mediated pleasure is a fundamental aspect of life, just as the experience of pleasure is. Yet, according to Volkow, anything that activates the same parts of the brain and brain chemicals that drugs do will be irresistibly addictive.

The new edition of American psychiatry’s bible, DSM-5, for the first time recognizes as addictive a non-drug-taking activity—gambling. In addition, the DSM committee is contemplating adding gaming as an addiction. But why stop there? Volkow’s brain revolution could presumably enter every serious area of our lives.

4. Natural recovery from drug addiction and alcoholism is the norm, often without abstinence, completely undercutting the “chronic, relapsing brain disease” meme.

My work in helping people recover from addiction is dedicated to the idea that there is some ineluctable element in human experience centering on values, purpose and free will driving people to recovery. This idea is supported by an abundance of evidence.

The vast majority of addicts recover, frequently be moderating use on their own. In 2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) studied 43,000 randomly sampled Americans’ lifetime history of alcohol and drug abuse. Called the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), it concluded: “Twenty years after the onset of alcohol dependence, three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence.” Only a quarter had any treatment, and only half of those who did—13% of the entire sample—attended AA or rehab.

NESARC found that the same held for drug addicts. Gene Heyman has analyzed NESARC and other major drug surveys. He summarized these results in the Times: “Since 1991 four major national surveys of psychiatric disorders and their correlates have been published. Each found that most of those ever addicted to illicit drugs were ‘ex-addicts’ by about age 30. Moreover, most of those who quit did so without professional help.”

Several studies have tracked people who developed alcoholism or drug addiction, following them for decades. In one such study, Kenneth Sher found that “people mature out of addictions at all ages.” In another, Madeline Meier reported that “relapse does not appear to be as ubiquitous as one might expect based on estimates from clinic samples (i.e., those in AA and treatment).” This leads Meier to “the view that alcoholism, at least in most cases, represents a changeable habit rather than a brain disease.”

But the neuroscience-based American Board of Addiction Medicine (ABAM)—like NIDA itselfhas declared the “chronic, relapsing brain disease” model to be its official policy. (Volkow is a central figure in both organizations). “The management of folks with addiction becomes very much like the management of other chronic diseases, such as asthma, hypertension or diabetes,” said ABAM’s Daniel Alford. “It’s hard necessarily to cure people, but you can certainly manage the problem to the point where they are able to function through a combination of pharmaceuticals and therapy.” In other words, as with AA, addicts and alcoholics never get better, but must rely on these groups, experts and medications to function.

5. The disease view is associated with higher addiction rates and longer-lasting addictions.

There is good evidence that the disease theory is not only wrong but bad for you. William Miller and his colleagues at the University of New Mexico tracked subjects following outpatient treatment for their drinking problems. They found that two primary factors predicted the likelihood of relapse: “the lack of coping skills and belief in the disease model of alcoholism.”

If you believe that you are powerless, you are at much higher risk of relapsing and of then throwing in the towel on your efforts to quit than if you feel that quitting is within your own power. In other words, the disease-cum-powerlessness view is self-fulfilling. A study of smokers trying to quit found that people who were heavily dependent and used nicotine replacement therapy were twice as likely to relapse as those who quit cold turkey. And obese subjects presented with the idea that obesity is a disease ate significantly worse diets—based on their learning that they couldn’t control themselves—than those not given this information.

Our growing reliance on the recovery-world idea of addiction, now cloaked in neuroscience, as a disease that is, at best, manageable is hurting us badly. As new brain discoveries “uncover” new addictions all the time, we congratulate ourselves on our medical progress. Yet we likely have many more addicts today than we had a century ago. Why, then, are we so confidently embracing this neuroscientific worldview?

Nora Volkow has pulled off a remarkable coup in the field of addiction. She has built an international reputation—and mission—by persuading us that we can’t do what we have been doing for centuries: resolve addictions through our values, purposes and life experiences. Studies following addicts and alcoholics over the course of their lives show this to be a regular occurrence. By denying this naturally occurring phenomenon so as to fit substance use and many other activities into an institutionalized, medical framework, Volkow and her expanding neuroscience legions are effectively reducing natural recovery while prolonging otherwise-transient addictive behavior. And they are glorying in this achievement.

Stanton Peele has been at the cutting-edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has developed the on-line Life Process Program, and has published a new book, with Ilse Thompson, Recover! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program.


16 Comments

16 comments on “Why We Need to Stop Nora Volkow From Taking Over the World

  1. Scott Kellogg
    kellos01

    Stanton – Why are you conflating the “Disease Model” of the 12 Step Fellowships with the “Brain Disease” Model of NIDA? These two visions have nothing to do with each other. The first is opposed to medication and advocates powerlessness and the second advocates for medication (ie.g., methadone) and supports treatment models based on empowerment (Relapse Prevention, Motivational Interviewing, Contingency Management). I believe that this kind of clarity is important.

    • Stanton Peele
      Stanton Peele

      Hi, Scott!

      You provide the perfect example of their conflation — neither AA nor Nora Volkow (nor you or Dole and Nyswander or Bob Newman) believes people are capable of escaping their addictive destinies — their brains are fried. Thus, you write,

      The NIDA Brain Disease model has its roots in the Dole, Nyswander, and Kreek’s Metabolic Theory which argued that heroin played a role in fundamentally altering the biology of the individual. Once altered, they were always at high risk of relapse. This is why decades of research at Lexington, Kentucky, showed that 70 to 90 percent of all heroin users would relapse back to opiate use within two years. For them, methadone was a life-long medication – an equivalent to insulin for a diabetic. Something happened in their brains and, perhaps elsewhere, and they will experience drug hunger when stressed and return to heroin use. Tragically, it seems that the brains of heroin-addicted individuals do not ever normalize – which is why methadone and its equivalents are simply the most successful way of treating opiate addiction.

      Did you happen to note in my piece the following (from Gene Heyman)? I meant it as a centerpiece of my argument: “Since 1991 four major national surveys of psychiatric disorders and their correlates have been published. Each found that most of those ever addicted to illicit drugs were ‘ex-addicts’ by about age 30. Moreover, most of those who quit did so without professional help.”

      But we don’t have to rely on NESARC et al. I jotted this down recently (but haven’t posted/published it anywhere):

      Recently, opposing my writings on the natural recovery trend for addicts of all types, a psychologist blogger cited 1960s research about the incredibly high relapse rate (90%) found among heroin addicts treated at the federal Public Health Hospital in Lexington, Kentucky.

      Which individuals would you imagine were most likely to be discovered as heroin addicts in the 1960s and sent to Lexington? That’s right, inner-city heroin users. But there were two groups treated at Lexington – along with known street addicts were physician addicts identified due to their purloining of carefully regulated pharmaceutical narcotic supplies.

      Do you think the recovery rate is better for the physicians, or for the street addicts? Would you be surprised to learn that the recovery rates were exactly reversed, with 90 percent of the physicians recovering? That was the result of the sister study to the research finding the overwhelming relapse among urban ghetto addicts, “Physician Narcotic Addicts,” in 1961, the year before Winick published “Maturing Out of Narcotic Addiction.” The latter found that, over time (Scott, you reference a two-year window), by their mid-thirties, two-thirds to three-quarters of inner-city addicts, who typically became addicted in their teens or early twenties, remit.*

      If you have a chance, read that whole section and its links. Then consider my summary point:

      Nora Volkow has pulled off a remarkable coup in the field of addiction. She has built an international reputation—and mission—by persuading us that we can’t do what we have been doing for centuries: resolve addictions through our values, purposes and life experiences. Studies following addicts and alcoholics over the course of their lives show this to be a regular occurrence. By denying this naturally occurring phenomenon so as to fit substance use and many other activities into an institutionalized, medical framework, Volkow and her expanding neuroscience legions are effectively reducing natural recovery while prolonging otherwise-transient addictive behavior. And they are glorying in this achievement.

      Scott, you, Dole, Nyswander, Newman, AA, and Vokow all fill this bill, and, frankly, given the abundant and growing research I cite about natural recovery, it’s a dehumanizing–not to mention antiscientific–disgrace, and you should be ashamed of yourself!

      Cheers!
      stanton

      * Charles Winick. “Physician Narcotic Addicts.” Social Problems 9(1961): 174-186; “Maturing Out of Narcotic Addiction.” Bulletin on Narcotics 14(1962): 1-7.

      • NSA
        NSA

        The difference between the success rates of physicians and inner city addicts fits right in with what Carl Hart has been telling us and his experiments are backing up. “Drugs Aren’t the Problem” The use of drugs, at a level that causes addiction, is an failed attempt at addressing an underlying issue that causes a person misery. The life a recovering physician returns to would likely be in stark contrast to the life a inner city addict returns to. The fact that a intercity addict returns to the same miserable living situation, that likely played a part in their addictions, while the physician may be more likely to have problems that are more addressable as their addictive roots, could be part of the huge difference in success.

        I would also think that the physicians receive higher quality treatment overall than the intercity group does.

        The brains of the physicians are also likely to have a strong advantage, in most cases, to the brains of the intercity addicts. A physician’s brain would be in a state that would make it easier to recover.

        Physicians may also have an advantage if good support from family and friends is more available than it is for intercity addicts.

      TheCleanSlateBlog

      I must be stupid, because I don’t understand the difference between 12-step programs’ description of people as being “powerless” over their “addictions”, and NIDA’s claim that “Addiction means being unable to quit”

    KenRagge

    Kellos01: I’m not sure why you see the 12-Step disease model as so different from NIDA’s brain disease. They both serve essentially the same purpose. They both are held up as proof that it is improbable that someone can and will drinking “alone.” Once one believes the power isn’t within himself to change his behavior, he is vulnerable any group that claims that God will essentially “quit for him” if he is obedient to doctrine whether that group is a Fundamentalist Christian group, Scientology, or Alcoholics Anonymous.

    What is the real difference between AA’s “allergy” (from Oxford Grouper Dr. Silkworth) and Volkow’s brain disease leaving aside the motivations of the proponents? The only important difference that I can see is that the allergy nonsense is simply too easy to discard. Anyone who has the vaguest idea of what an allergy is can see through that nonsense. Looking at “pretty high-tech science pictures” and results gotten from staring into petri dishes while ignoring what happens to people in real life “really works.” It leaves the “pigeons” impressed. The disease metaphor is much more difficult to discard.

    I don’t believe the Step groups could survive without “the disease” to cow people into obedience and acceptance of the “spiritual not religious” “Program of His Kingdom.” AAers have always had two opposing opinions on “disease,” one, “It is a disease” for when frightening someone into obedience and the other “doesn’t matter what you call it” to preserve “plausible deniability.”

    Dirkh

    Stanton doesn’t care about different interpretations of the disease model. He’s a polemicist who has been making the same tired obstructionist argument for 40 years now. Do yourself a favor and ignore him.

      KenRagge

      I’m not sure what you mean when you say, “Stanton doesn’t care about diffrent interpretations of the disease model” without any suggestion as to why someone would care about the “scientific models” of the “disease of alcoholism” without any evidence supporting it. The fact that the AMA voted alcoholism a disease, the only disease that “needed” a vote to be considered one, at the urging of 12-Step Group members is not evidence it is a real disease. There was no need to vote cancer, the flu, or tuberculosis diseases. There is no reason to believe destructive drinking is a disease except on the basis of needing to believe it in order to win converts to the 12-Step micromanaging deity.

      Relgion as a whole tends to be a very, very poor source of science, if for no other reason that it is not about science. Twelve-Step religion, which is at the far extreme of authoritarianism and anti-intellectualism, is even worse. Leaving aside for a moment whether long-term drinking to destructive excess is an actual disease, where is the methodologically-sound research which shows that _anything_ we are taught about “the disease” by “two-hatters” and other 12-Step group members is true? I’m referring to things like, “progressive and incurable,” “loss of control,” and alcoholism being a “primary disease,” none of which have a scintilla of evidence.
      Wednesday-night prayer-meeting type testimonials and the “AA Bible” (the Big Book) are _not_ evidence. If such testimonials were evidence, we’d have plenty of proof of Benny Hinn actually curing his followers. But we don’t. Only testimonials.

      And what do you mean by “obstructionist”? Personally, I think that anyone who does anything to “obstruct” the spreading of self-serving falsehoods by speaking the truth is doing good. Would you say the same about him if instead of spending the last 40 years critical of the Step groups he had instead spent his time criticizing Scientology, the Moonies, or Heaven’s Gate?

      If you are interested in the source of modern disease theory, here are a couple of sources:

      The first is D.H. Walter’s Soul Surgery. Originally published early last century, it contains “the scientific method of Soul Surgery,” which, in everyday language, is a conversion manual. It was from following the instructions here that the AA program found great success.

      The other is the chapter “Disease Theory” in More Revealed at:

      Perhaps far better than the above is “The Meaning of Addiction” by Stanton Peele. Unlike most pro-12-Step/pro-disease nonsense, this book is written with references to the scientific studies the information it holds is based on.

  2. Scott Kellogg
    kellos01

    Ken – After working for decades in the field as a Clinician and, at times, as a Researcher, it is simply astounding to me that anyone could actually think that the 12 Steps and NIDA have anything in common. For years and years, there were bitter battles between those who embraced the Moral/12 Step Paradigm and those who fought for the Humanistic/Scientific Paradigm (which includes the work of NIDA).

    Addictions are best understood as a multi-factorial phenomenon. The brain disruptions that take place are one factor – sometimes an important one, sometimes a negligible one – but just one factor. Given that, there is nothing in the Brain Disease model that says anything about powerlessness. As I said in my first comment, NIDA has championed the development of therapies that seek to empower patients – Relapse Prevention, Motivational Interviewing, Contingency Management, and Mindfulness. They are also the great leaders in medication development – something that the 12 Step Fellowships and their treatment advocates have long opposed.

    Stanton has been in the field a long time; I am just amazed that he does not seem to know these things.

    For a psychologically-informed vision of addiction treatment, you might want to see my article: http://www.tandfonline.com/doi/abs/10.1080/07347324.2012.635544#.Uz8etYVp5jc

      KenRagge

      I find the “differences” you list as, for the most part, more cosmetic than anything. You say nothing is said about “powerlessness.” However, what is being said when someone reports, “a person’s ability to exert self control can become seriously impaired. Brain imaging studies . . .” If that is not a suggestion of “powerlessness” (or “helplessness” or “incompetence”) what is it?

      I seem to be getting rather old rather quickly. I remember the days when psychologists would talk about things like “autonomy” and, when the government first started paying for treatment, about how to work for the client and avoid simply being an “agent of the state.” Nowadays, it seems most psychologists, at least the “experts on alcoholism” require the government to coerce patients to them in order to have patients.

      Funny thing, just 15 or 20 years ago, those who were critical of the Step groups all almost to a one opposed to court coersion into “treatment.” The arguments went beyond simple “right to life, liberty, and pursuit of happiness.” They included things like the fact that those who are coerced into treatment normally don’t even qualify as “alcoholic” or “addict.” But since some of those who most opposed 12-Step coercion have founded their own “fellowships” or “self-help” groups, they have changed their positions.

      How can someone be in favor of “helping” people by forcing “help” on them by government agents and not be very much like Alcoholics Anonymous? Where is the methodologically-sound research showing _any_ of the treatments forced on people successful? Why must therapy be forced on those who don’t want it?

      Comparing a form of research that uses therapy #1 which is hitting the patent up side the head with a two by four randomly vs. therapy #2 that doesn’t hit the patient up side the head with a two by four does not show that therapy #2 is “successful” even if it does, as one might predict, do better than therapy #1. Where is the control group? How do we know either is better than nothing? We simply don’t.

      How come the Vietnam vets (Robins, Addiction 1993 v88:1041-1054) who quit their heroin addictions on returning home from the war overcome their addiction since they doubtless could have made very pretty brain pictures of addicted brains prior to leaving the war zone?

      How did they survive without an addictions expert harping on them day after day on recognizing all the unimagined possibilities for failure (Relapse Prevention) and “Motivational Interviewing” to get them into treatment? I guess those soldiers just didn’t know they couldn’t quit.

  3. Scott Kellogg
    kellos01

    For those of you who have a deep interest in this topic and the patience to read this, I am pasting in a very long response to this article that I posted elsewhere:

    “Addictions are best understood as a multi-factorial phenomenon. The brain disruptions that take place are one factor – sometimes an important one, sometimes a negligible one – but just one factor. People use drugs because they: bring pleasure; help soothe psychic and emotional pain and anguish; enable the individual to cope with brain-induced cravings, withdrawal symptoms, and affect dysregulation; reduce the suffering connected to medical illnesses; facilitate membership in social groups; and are a means of coping with social oppression and disenfranchisement. When we work with patients, I believe that need to assess their use on all of these dimensions.
    Since the brain is the site of action for the effects of substances, the brain always has a role – sometimes an important one, sometimes a secondary one. To say that addiction is a brain disease only, is to be overly simplistic; to believe that the potentially-damaging impact of drugs on the brain is not a factor is substance-use disorders is to be non-scientific.

    Keeping it simple, drug use can change the way the brain functions. It is the darkness is the slides, the down-regulation of neurotransmitters, that is the problem. This imbalance plays a role in cravings, withdrawal symptoms, and drug-induced dysphoria – all of which play a role in motivating the patient to return to the use of drugs as a way of coping with this discomfort. Drug use can also disrupt the stress-response system so that addicted individuals may feel the effects of stress even more intensely – which also contributes to their returning to drugs to change the way they feel. Are drugs the only things that damage the brain in this way? No. Trauma, poverty, genetics, and disease can do this as well and when we mixed that with drug use we have a very complicated situation in the brain.

    The NIDA Brain Disease model has its roots in the Dole, Nyswander, and Kreek’s Metabolic Theory which argued that heroin played a role in fundamentally altering the biology of the individual. Once altered, they were always at high risk of relapse. This is why decades of research at Lexington, Kentucky, showed that 70 to 90 percent of all heroin users would relapse back to opiate use within two years. For them, methadone was a life-long medication – an equivalent to insulin for a diabetic. Something happened in their brains and, perhaps elsewhere, and they will experience drug hunger when stressed and return to heroin use. Tragically, it seems that the brains of heroin-addicted individuals do not ever normalize – which is why methadone and its equivalents are simply the most successful way of treating opiate addiction.

    The brain, however, is not one entity. While the Limbic System is involved in the experiences of pleasure, desire, craving, and dysphoria that the drugs provide, the Prefrontal Cortex is involved in self-regulation, delay of gratification, and future-oriented planning. In fact, all treatments are, in one way or another, seeking to change the balance between the Limbic System and the Prefrontal Cortex. This may involve reducing the intensity of the former and/or strengthening the power of the latter. Relapse Prevention, Motivational Interviewing (which can be re-interpreted as a dialogue between two parts of the brain), Contingency Management, Mindfulness, and Harm Reduction are each strategies for strengthening the Prefrontal Cortex and, in some cases, calming the Limbic System.

    It is this battle between the two parts of the brain that may, eventually, explain how people get better, go into remission suddenly, successfully moderate, and relapse after 20 years. Again, these are early days; we simply do not yet know how all of this works as we also do not understand the relationship between the brain and the mind.

    When Stanton advocates for jobs and more complex lives for people with addictive disorders, it is not that he is wrong – it is just that he is incomplete. NIDA’s growing understanding of the brain is helping us to develop better medications and it may, eventually, help us to understand how to better use our psychotherapeutic and behavioral interventions. There are no simple answers, but by placing her within a broader context, Dr. Volkow is contributing to the healing of the world.”

    Remmy Skye

    I would like to say something now from the position of a 11 year often homeless heroin lover in NYC. To save us time let me just say that it is definitely safe to assume all the stereotypes about me although I don’t have HIV/AIDS and have proven one of the lucky ones able to cure himself of Hep C, nevertheless, prison, starvation, suffering of an indescribable nature, panhandling, prostitution etc. etc. is all true. I’m not saying by any means I’m the worst case, that’s a hilarious thought in fact but I am definitely a case. I like to comment on the stop the drug war and DrugWarRant websites often under my real name of CJ. That being said, so, I can see here that there are comments from professionals with experience, the writer of the article here is clearly a man with experience (I mean in the field) and so I hope it’s okay to forego explaining some of the more basic things that the general public may not know or understand but to all of us experienced folks things we know, have seen, have dealt with etc. etc.

    So yes I’m sure we all know that in my position, everyday there is pretty much nothing I am above doing for 10 dollars (the average price of a bag of dope in Manhattan/NYC) for 20 I’d suggest for general safety locking yourself and possessions indoors or just far away from me. Regardless of that, however, I have never met nor have I ever spoken with the writer of this article. In short I’ve not been paid to comment here or vouch or anything. That being understood, I have to say I was so absolutely delighted by this piece you have no idea. I read the comments, I appreciate the comments from the fellow “Kellios” i think that was how it was spelt. I appreciate Kelios taking the time to write and share his thoughts, of course. From what I’ve read, maybe there are some things about the author and his beliefs that I would absoultely despise. I don’t know. But, as far as this article goes, as far as this woman goes, listen, the truth of the matter is methadone is absolutely a nightmare. I’ve been on it many times, it is always a last resort, especially in the winter. I am not alone. The truth is that there is what I have called “Jane Say’s Syndrome” which, if you’re familiar with the song, is this ridiculous junkie guilt wherein after copping the junkie says “I’m gonna kick tomorrow” maybe they even want to, in my experience that’s not true though. They won’t kick tomorrow and deep inside they don’t really want to. These times of coercive treatment remind me of some kind of religious intolerance, like people being brainwashed in ancient days to subscribe to one religion or another. Look, so many of us honestly don’t want to stop, we don’t want the methadone, the buprenorphine, etc. We want dope. That’s it. We love it. It’s honest. I am a more honest than normal junkie. I have had the unfortunate pleasure of telling people for a long time that the 12 step model is a junkie killer. Loved ones abandon your kids, forget your parental responsibilities. Bathe in materialism. Indeed the junkie steals 1,000′s of dollars worth of things to end that sickness and since we have to worship the dollar in a capitalist society then a loved one stealing your beloved money must be tatamount (sp) to the most intolerable betrayal, no? 12 Step, abstinance (sp) based treatment kills alot of people, just as it (usually only temporarily) helps people. Have nothing to do with your beloveds, cut them totally off, take away everything. I am one of these people and all of my friends are the same. Eventually family and friends in some cases realize how assenine (sp) that is and take people back. Others just blindly listen to that tough love dogma and they dont have any contact until a friend goes to inform the family that their son brother daughter sister husband wife is now dead in a ditch somewhere – happens all the time.

    My attitude has evolved. I realize these are all just mechanisms within prohibition society. The truth is, the best, most successful treatment is heroin assisted treatment. Not methadone. I hate suboxone worse than methadone but thats a personal opinion because most my fellow junkies prefer suboxone because they can truly use it when they are absolutely sure they wont get any money or their dealer wont reup etc. I tried that many times too but buprenorphine loves to put me in precipitated withdrawals so I can’t play that game. I understand why many do. I just left a close friend sleeping on the sidewalk this morning who loves that game. I digress. Anyhow, yes I am not at all surprised to read about the results of heroin maintenance and to read how, after ‘x’ amount of time being given the heroin people just wake up and decide to quit and generally never look back. The game is over. The need has been fulfilled. None of this 20-30-40 year back and forth BS. The sad truth is junkies love what they do, but they have the hardest time being proud and admitting it. I myself suffered from that Jane Say’s Syndrome for some time and my life changed when one day after being sick all day and finally scoring I heard that Jane Say’s mantra “oh this is the last time that’s it, tomorrow I’m done ” BLAH BLAH BLAH BLAH, but one magical day I stopped myself and said, “wait, no no no. that’s bull. why am i saying this? I don’t want to kick. not for my family, girlfriend, nobody and if they truly love me then they must accept me for me but tomorrow I’m not gonna kick. Not even gonna try. I’m gonna wake up, hopefully have a wake up shot and if not I’m gonna be sick and I’ll make my money one way or another and score again and it will be AWESOME!”

    So I applaud this writer for saying the truth about the disease model and how dangerous it is. We don’t want it. We don’t need it. Advocates ought to advocate for the best method, heroin assisted treatment (and for those who are too afraid of heroin, then replace the heroin with dilaudid or whatever opiate they love the most.) Otherwise the good doctors and researchers are no different than the junkies they try to treat, that is, we are all spinning our wheels then.

      andrew tatarsky

      Dear Remmy,
      Thank you for your honesty, courage and forthrightness. I agree that heroin assisted treatment is the most effective treatment for many people, and I have met some, and should be available. It would solve so many problems for those who love and choose to use heroin and for society at large. The criminalization of drugs contributes to creating all the ills associated with drug use…it is irrational, unworkable, inhumane and unjust.

      The state, treatment providers, family members and society at large needs to listen closely and respectfully to the feelings and perspectives of drug users like Remmy and work collaboratively with them to find just, fair and workable solutions to the problems associated with illicit drug use. Until then, the insanity on all sides will not stop. Dr. Andrew Tatarsky

    Paul Depew

    Addictions are determined by the chemical disposition of the human condition. Some are more predisposed to addiction than others. Basically a chemical imbalance. ergo: The more obsessive the persons disposition the higher the addiction probability. It is simple not complicated.
    Education is the answer to almost everything. So to be sure the information being transferred should at least pass the scientific method for any reliability at all…

      TheCleanSlateBlog

      Hi Paul,

      I wonder how you don’t see the obvious contradiction of stating in one breath that: “Addictions are determined by the chemical disposition of the human condition” and then “Education is the answer to almost everything.”

      IF, addictions are determined by our chemical makeup, THEN “education” – what one thinks or believes about addiction (including whether or not it is a disease) – shouldn’t matter an ounce. If it’s the chemicals in my body making me do things, then how would educating me be of any importance?

      -Steven

        paulhalf

        In the same way that health professionals teach people with long term conditions to better manage them? So if they have COPD they are educated in how best to manage that condition themselves?

        Chemicals in the body – or pathways in the brain, or hormone releases in the endocrinal system – don’t replace freedom of the will. They just influence it. Sometimes very, very strongly.

    doc

    I have always thought the great granddaughter of Leon Trotsky a little disingenuous since her main reason for getting into AOD research was to carry on with her brain scanning research started in Mexico. NIDA was simply a way for her to get funding and while she is passionate about brain scanning technology, she holds the same views about marijuana as does DEA Chief Leonhart: “I believe all illegal drugs are bad”.

    In addition: the mega corporation that run AOD treatment need to establish AOD as its very own disease. So they are doing a hostile take-over of the DSM’s OCD. Peele is right. AOD recovery needs to assert itself as a disease as science is taking over for religion. First they blind U with science and then they hit U with technology.

    Re-branding AOD abuse as a ‘brain disease’ will assure profits down the road. Once it becomes a disease, treatment will have monopolistic control.

    First a plant (pot)… then a pet… and then a person…

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