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NIDA leader emphasizes chronic, neurological nature of addiction

LAS VEGAS — Viewing addiction as a chronic brain disease, both by clinicians and health care systems, may improve diagnosis, management and treatment of addiction, according to a presentation at the National Council for Behavioral Health annual conference.

“It is utterly unacceptable the way we are addressing mental illness, including substance abuse, in the very large number of individuals that are suffering,” Nora D. Volkow, MD, of the National Institute on Drug Abuse, said. “I believe that science provides us a way to change the system and also help address the issue of stigma and discrimination. But ultimately, it is the work that all of you are doing that makes this possible.”

During her presentation, Volkow explained how addiction affects regions in the brain, and as a result, the ability to appropriately process pleasure and other emotions and functions.

“You are overstimulating [by taking drugs]. So if this was pleasurable in the past, for it to now be similarly pleasurable, you must achieve a much greater amount of dopamine stimulation,” she said. “This is the price that people who take drugs are paying. In order to get a temporary high, they actually are sacrificing their ability to perceive stimulation that is rewarding in the future.”

Armed with this knowledge, mental and behavioral health clinicians can provide better management and treatment using new technologies that provide insight into the brain.

Additionally, Volkow stressed the following points to conference attendees:

• No single treatment is right for everyone;
• Remaining in treatment for an adequate period of time is critical, as addiction is a chronic disease;
• Effective treatment addresses multiple needs, including comorbid mental illness and infectious diseases;
• Medications are an important element of treatment for many patients;
• Drug use should be monitored continuously, as lapses during treatment do occur; and
• Treatment does not need to be voluntary to be effective.

“Why is that only 19% of people that are suffering from substance abuse disorders receive treatment? How can we justify that? The knowledge is out there, the evidence is out there that we can treat substance use disorders. This actually demonstrates one of the challenges we have, where again we need to revolutionize the system of care — the insurance system, the mental health care system, maybe even community programs,” Volkow said. “Addiction is a chronic disease, the changes [it makes in the brain] last very long.” – by Amanda Oldt

Reference:

Volkow N. The emerging science of addictions. Presented at: The National Council for Behavioral Health Conference; March 7-9, 2016; Las Vegas.

Disclosure: Volkow reports no relevant financial disclosures.