Dr. Nora Volkow
http://thedianerehmshow.org/shows/2012-07-09/dr-nora-volkow
Brain images showing decreased dopamine2 receptors in the brain of a person addicted to cocaine versus a nondrug user. The dopamine system is important for conditioning and motivation, and alterations such as this are likely responsible, in part, for the diminished sensitivity to natural rewards that develops with addiction.
Photo courtesy National Institutes of Health
Dr. Nora Volkow is the director of the National Institute on Drug Abuse at the National Institutes of Health. She studies how drugs affect the human brain. A leading research psychiatrist and scientist, Volkow sees addiction as a disease, not a moral failing. Her research has also led her to discover parallels between substance abuse and obesity. For example, a person who overeats often experiences similar changes in brain activity and behavior as that of an addict. Volkow’s family history is as intriguing as her work: She is the great-granddaughter of Russian revolutionary Leon Trotsky and grew up in the house where he was assassinated. Dr. Volkow talks about addiction and her efforts to cure it.
Guests
Dr. Nora Volkow
director of the National Institute on Drug Abuse of NIH
Comments
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My mother tried unsuccessfully to stop smoking when she was diagnosed with lung cancer at 74.
Does Dr. Volkow consider nicotine addiction to be as seriously life-threatening as illegal drug abuse?
Coca leaf is a safe and mild stimulant used for working under harsh conditions in the Andes of South America. It is also an effective household remedy for a wide range of medical complaints. Coca also contains calcium, iron, phosphorous, vitamin A and riboflavin. It is an integral part of the lives of the Quechua and Aymara peoples of Bolivia and Peru. The effects are a feeling of energy and mental clarity, similar to a cup or two of coffee.
Does Dr. Volkow have any suggested reading for a layperson, to help us understand the brain science behind addiction?
I have a close relative addicted to crack cocaine. She went into treatment 6 years ago; at a one week inpatient treatment hospital after having a severe heart attack which required a triple by-pass. She stayed clean for a few weeks (as long as she was away from her home & friends), but went right back to her old envirornment and began using again. As a result of her continued drug use she had a second serious heart a few years ago.
I would like to move her out of her current environment to a new city & state to live with me. Will removing her to a new place remove the stimulus and help her get clean and stay clen?
Dr. Volkow, could you comment on how xenoestrogens or other endocrine disrupting synthetic chemicals might be altering the brain's reward system--specifically, how are reproductive hormones involved in the dopamine system? Thank you.
Amanda
I have been in recovery for more than 10 years. During this time, I took 12 Step meetings to a local jail, where I was continually amazed that the men, who were incarcerated for drug-related crimes, could not stop using, even when they were involved in a drug court system that spared them jail time if they stayed clean and sober. These men, fully aware that if they tested dirty they would likely go to prison for multiple years, were usually unable to stay clean for any length of time after their release -- even after being clean in the jail for 6 or more months.
I also recognize, in my own life and many of these jail residents, how addiction plays a part in how people cope with emotions and stress, especially in relation to various types of trauma or familial abuse or dysfunction.
Are kids who take stimulants for ADD/ADHD at higher risk for addiction? I've wondered if my son may be more likely to experiment with drugs since he already views meds as something that makes him feel better. Also, does it permanently change a kid's brain structure to take stimulants during adolescence? Does his brain look like an "abuser"?
Carine
I have a son who is sober and in the midst of treatment for alcohol and marijuana abuse. He is 21 and we got him in treatment at 17. From all I have read, treatment is most effective before the brain stops developing at about age 24. Is this true and if so, why is this not given more emphasis for parents struggling with this in their children?
I learned that there were specific receptors in the brain for both nicotine and THC. In my family there is a history of depression and drug and alcohol abuse. Many of us smoke and I was wondering if there is a potential for more of the nicotine and THC receptors in the brains of those with mental illness.
What about caffeine? It seems to be the most prevalent addictive substance in the country.
The doctor said alcohol and nicotine are the two big killers and why would we want a third. Please ask your guest to define what third was she referring too. I believe she was insinuating that marijuana was the third and I'd be interested in hearing her explain how this is true when marijuana has never been attributed to a single death in the medical record.
DC has the worst alcohol and drug problem in the nation, and a near-worst treatment gap. Even those who get treatment have a high relapse rate. Can Dr. Volkow offer any suggestions on how we can get more people into treatment and help them stay clean and sober when they finish?
What is the relationship between ADD and ritalin, cocaine - are ADD people less likely to be addicted?
Why are some people less compulsive and prone to addiction than others?
Is there any truth to the popular wisdom that native Americans are more addiction prone to alcohol?
Thank you -
Unlike some, I will freely admit that marijuana, as used, is a drug, and is somewhat addictive---though much less so than caffeine in my experience. However, to say of alcohol, and nicotine 'We have two killers[...]' and then to say implicitly of marijuana, '[...] do we want a third?' is to imply that in its effects marijuana is similarly dangerous. My experience, though of course anecdotal, is that it is not so---in particular, as it is used in the U.S. and Europe, at least, it tends not to lead to the aggressive and absolutely headless behaviours I associate with alcohol.
Of course, to me, the greater sin of alcohol is that I don't like its taste or the way I feel after I've drunk some of it, whereas I like a little cannabis, and I consider pleasure a good in itself. I've heard hours of people debating drugs without addressing this, but I say that many people gain enjoyment from moderate and sane drugs use, and that is good...and many hate drugs precisely because they give pleasure more than for their ill effects. They either would not have us enjoy ourselves at all, or limit ourselves to a list of pleasures they have deemed acceptable because they enjoy making other people do things, leading me to ask (and if you read one line of this aloud on the air, let it be the following):
Is the exercise of power over other people addictive?
I have a glass of red wine in the evening to relax after a hard day of work. I do not consider myself to be addicted to wine. I have friends who smoke marijuana in the evening to relax after a hard day of work. Like me, they are active, productive members of society.
Although I do not use marijuana, I strongly disagree with your characterization of cannabis as an addictive drug whose users need treatment. Alcoholics have a disease and need help. People who abuse marijuana and are unable to function in society have a disease and need help.
Please ask if she has strong opinions about the question: Was there an alternative to Stalinism? Many people believe that Trotsky did pose the alternative and feel that his most important contribution was the building of the Fourth International against Stalinism. The analysis Trotsky made of the death agony of capitalism is today showing its ugly self in stark detail throughout the world. What does she think?
Dr. Volkow mentioned that dopamine is first conditioned when babies are breastfed. Could there be negative effects for children who are not breastfed? Could it be that these babies are more prone to addition later because of they were not conditioned properly as a baby?
Is there a more positive activity- such as exercise or religion-that has some addictive properties that could replace the more destructive addictive habits?
Sue
Do individuals who have been treated throughout childhood for asthma with ongoing doses of prednisone, epinephrine develop a high tolerance for drugs and/or
alcohol or a propensity for addiction?
This Volkow sounds like another opportunistic individual that identified an area where government spends tons of money trying to control people's behaviors, and decided to get in on the money shower.
According to her, everything is a disorder that MUST be dealt with - Just the thing the government needs to justify keeping the gulags full of prisoners.
Does getting a tattoo excite the same brain centers as drug, alcohol, gambling and other addictive behaviors?
I have young friends who are tattoing, and lately getting "XXX" or "straight edge," I think they're called, tattoos. The 3 Xs symbolize no dope, no drink, no sex or something.
If the pain of getting a tattoo is addictive, doesn't that make these symbols oxymoronic?
Dr. Volkow is an inspirational person who has revolutionized the the field of addiction medicine. What a great interview! Thanks Diane. Can Dr. Volkow touch more on her personal life, specifically what led her to go into Addiction medicine?
IBOGAINE. I remembered hearing years ago about an African root extract that was supposed to completely ELIMINATE certain addictions and without withdrawal symptoms, but was illegal in the US. This releasing characteristic had been discovered accidentally when the substance was being consumed itself for its own psychoactive properties, and the partakers found themselves released from previous addictions to cocaine or other drugs, including alcohol and nicotine. A study was about to start at the University of Miami.. Googling gives this name: ibogaine
Well said Gerald.
To be expected that Dr. Volkow as director of the National Institute on Drug Abuse of the NIH toes the party line if she wants to keep her job.
The slogan with which she responded to Ms Rehm's question on the legalization of marijuana (rewarded with an unfortunate grunt of satisfaction from Ms. Rehm): "We have two killers (alcohol, and nicotine) do we want a third?" is absurd on its face.
The Social Sciences have enough trouble being taken seriously in the company of the hard sciences without this type of flagrant egregious disregard of reason and evidence in the service of slavish pandering to political correctness.
The Netherlands (where marijuana use is not prosecuted) has the most lax drug law enforcement policy in the world yet has amongst the lowest number of drug-related deaths amongst European countries. Also, the Dutch are among the lowest users of marijuana or cannabis in Europe.
What is Ms. Volkow smoking?
I am a huge believer in personal responsibility, and accountability. The slippery-slide into calling everything a "disease," is opening a Pandora's Box of "can't help anything-I have a disease."
Having been a pain patient for five years, personal testimony can be offered here. After five years of comprehensive pain treatment, my pain doctor suddenly dropped me due to a billing dispute. Now, it stands to reason that severe withdrawal would have been my fate; however, during those five years of treatment, the doctor alternated me between three different pain meds so that my brain and body would not become tolerant to any one drug; and, I did exactly as instructed. The only problem I was left with was chronic pain!
The FDA and DEA needs to totally overhaul how pain meds are prescribed. Pain meds are completely safe and effective, and demonizing of them is not. I took those meds wisely, no one shoved them down my throat. An abuser is an abuser; and pain meds must be grossly abused in order to become a hard-core addict, and those numbers ARE small, and greatly exaggerated.
What should be of concern are the psychiatric meds being prescribed in place of conventional pain treatment. Therefore, I found it quite interesting that today's (7.9,12) guest was a psychiatrist.
As a chronic pain sufferer, should a doctor offer me only one type of narcotic to be taken 24-7 for long-term, chronic pain? No way, absolutely not.
I believe the doctor did not offer an objective perspective regarding marijuana. THC, the active chemical contained in marijuana has not caused a single death due to overdose (in it's natural form, the synthetic THC pill Marinol has been the cause of 4 deaths during 1997 and 2005, according to the FDA). The danger comes from the carcinogens contained in marijuana smoke. Marijuana smoke is dangerous, not marijuana. Although, the doctor may also have been referring to the dangers posed by those driving while under the influence of marijuana. However, that is a reason to outlaw driving under the influence (of any mind-altering substance, including certain prescription medications), not a reason to outlaw the substance itself.
Dr. Volkow's remarks about cannabis is completely inaccurate. Cannabis is NOT addictive according to all of the serious studies and the experience of untold millions of people who have smoked it.
The Doctor's opinion that nicotine is not very addictive is also completely inaccurate according to all of the serious studies and the experience of untold millions of people who have smoked it.
Sorry, but I am now dismissing the entire conversation and wishing I had my 50 minutes back.
Excellent show. Especially to me because the NIH is local at Brookhaven Labs.
My attorney has never been able to accept the notion - often espoused by reformed drug abusers and especially popular among those on probation - that you can get a lot higher without drugs than with them. And neither have I, for that matter.”
― Hunter S. Thompson, Fear and Loathing in Las Vegas: A Savage Journey to the Heart of the American Dream