By Katie Gibas
Could your brain be making you fat? Actually, it’s a possibility. According to panelists, there are physical, chemical and biological differences in the brains of people with addictions versus people without.
Nora Volkow, M.D., is the director of the National Institute on Drug Abuse and a pioneer in the field of addiction and treatment. She says addiction is a disease of the brain and a developmental disease that starts in adolescence and childhood. She says addiction involves multiple factors including a genetic component and an environmental component. For example, with alcoholism, if a family member has it, a person has a 70 percent chance of having it too. But socially stressful environments and situations can make a person more likely to turn to addictive behaviors as well.
“Just like hypertension, addiction is a chronic disease that requires continued care,” Volkow said. Basically, she says, “The bad news is we don’t cure addiction. We treat addiction.” There are two treatment options including behavioral modifications and medications. She says there is research on developing vaccines to treat certain addictions, like cocaine.
But her main concern is that “treatments are not being used by the people who need them.” Volkow says only 19 percent of people who need it get some sort of treatment. That’s why she says, “We need to do better to integrate drug abuse and addiction screening, prevention and treatment into the health care system.” She says these things should be integrated into primary care. Doctors should be constantly asking and screening for addictive behaviors, so patients can get the help they need.
James MacKillop, Ph.D., is the director of the Experimental and Clinical Psychopharmacology Laboratory and the associate director of the Owens Institute for Behavioral Research at the University of Georgia. He discussed the behavioral economics and neuroeconomics of addiction. He says behavioral economics is a “hybrid of psychology and microeconomics.” Neuroeconomics integrates behavioral economics with cognitive neuroscience. He says EEGs, PET scans and MRIs can all help detect addictive behaviors.
He also cited a test for relative impulsivity, which can be indicative of addictive behaviors. It’s called the marshmallow test. If offered one marshmallow now versus two later, how long will a person wait? The quicker a person takes the one marshmallow, the more impulsive they are and the more susceptible they are to addictive behaviors. MacKillop also discussed the costs of desire, a behavioral economic approach to craving. How is craving defined? The way it is defined is how much someone is willing to spend to satisfy their craving. And often, higher stress leads to more craving. All of this can play into addictive behaviors. MacKillop’s scenario illustrates both the genetic and environmental factors of addiction.
Mark Gold, M.D., is a distinguished professor and chair of psychology at the University of Florida College of Medicine. His way of explaining addiction and treatment is, “If you think of turning addiction of turning a cucumber into a pickle, it’s hard for a pickle to become a cucumber again.” He says some drug effects are irreversible. For example, he said doing meth is like hitting a hammer on your head: Your brain will never be the same.
He says he’s concerned about the rise in teens using prescription drugs because they will inherently cause changes to the brain. He discussed how availability of the drugs and the stress of one’s job will play into addictive behaviors. He said another concern of adolescent drug use because their brain responds differently to drugs than the adult brains. That’s why the effects are longer lasting in an adolescent than an adult. For example, teens who start smoking earlier, smoke more cigarettes per day. One study showed that people who start smoking after 35 only smoke one or two cigarettes per day, versus the younger a person starts, the more they will smoke per day.
Gold also studies the neurobiology of food addiction, which was only recently accepted as a form of addiction. He says more study needs to happen in this area of addiction to address the issue and get people the help they need.
As for treatment, the concern all three experts have is that a large majority of people with addictions are being ignored. Most of the addiction cases they receive are from referrals by drug courts. But integrating behavioral health into primary care is essential to combat the issues of addiction. The experts say too many people are going without help with has both quality of life and economic effects on both the individual and society as a whole.
Katie Gibas is a reporter at YNN-Syracuse, N.Y., and was a 2012 AHCJ-New York Health Journalism Fellow.
